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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 55-year-old Caucasian woman suddenly developed substernal chest pain at rest accompanied by pallor, diaphoresis, nausea, and vomiting. Physical examination was otherwise unremarkable. The resting ECG showed T-wave inversion in all anterior leads which returned to normal 24 h after the onset of the symptoms. The pain was eliminated promptly by sublingual isosorbide dinitrate. "Impending" acute myocardial infarction was diagnosed. Coronary arteriography, however, failed to reveal any change in any major coronary artery but an apical aneurysm of the left ventricle was detected. As the complement-fixation test for Chagas' disease was positive, the diagnosis of chronic Chagas' heart disease was then established. This unusual clinical manifestation of Chagas' disease is thought to be the consequence of a transient imbalance in the cardiac autonomic nervous system, which is considered to play a central role in the pathogenesis of chronic Chagas' heart disease. In addition, the present case may alert clinicians to the thus far neglected atypical chest pain, which is frequently seen in chagasic patients but whose etiology remains obscure.
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PMID:Chronic Chagas' heart disease presenting as an impending myocardial infarction: a case favoring the neurogenic pathogenesis concept. 359 60

Although aortic dissection is rare in children, it does occur, particularly in those with congenital heart disease, connective tissue disorders or severe trauma. Prompt diagnosis is essential. Aortic dissection should be considered in children and adolescents with severe abdominal pain, especially pain that migrates. The patient is often much more uncomfortable than can be explained on the basis of physical findings. Criteria have been established for choosing medical or surgical therapy.
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PMID:Aortic dissection in adolescence. 375 41

Clinical and instrumental (ECG, PCG, ultrasonic cardiography and polycardiography) examination of cardiac activity in 98 breast cancer patients treated at the Center after Cooper established the cardiotoxic effect of 5-fluorouracil, vincristine, methotrexate, cyclophosphamide and corticosteroids. 46% of them suffered pain in the region of the heart, tachycardia, extrasystole, atrial flutter and deranged conduction function. Congestive heart failure was observed in 7% only. In 24%, myocardial lesions could be detected by instrumental means only. They were identified on the basis of an increase in terminal diastole and systole volume and mass of the myocardium matched by a decrease in stroke volume, PCG amplitude, % delta S and VCF. Cardiac disorders did not persist and were hardly detectable during medication course intervals or one-two months after treatment.
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PMID:[Cardiotoxic effect of cytostatics in patients with breast cancer]. 384 Mar

A hypochondriacal personality has been shown to be a major determinant of continued pain in patients with chest pain, both in the presence and absence of significant (less than 75%) coronary stenosis. We investigated preoccupation with cardiac illness among 106 patients (63 women, 43 men) within a few days after coronary angiography, carried out for evaluation of chest pain, showed no significant stenosis. Thirteen questions were used in a structured interview to assess patients' beliefs, behaviors, and expectations pertaining to their cardiac health. Information about persistence of pain was obtained 1 year later by telephone interview. A composite variable, called Self-Label of Coronary Vulnerability, was determined by factor analysis; it accounted for 65% of the variance in the responses. In a multivariable regression analysis, a high score on Self-Label showed the strongest association (p less than 0.005) with continued, unimproved chest pain 1 year later even after adjusting for other variables. As a result, perhaps of a self-labeling process a set of beliefs about vulnerability to serious heart disease helps explain persistence of pain, despite the absence of significant coronary disease.
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PMID:Perceived vulnerability to serious heart disease and persistent pain in patients with minimal or no coronary disease. 394 13

Thirty-three patients with chest pain despite angiographically normal coronary arteries underwent both coronary flow studies during pacing and resting and exercise gated blood pool scintigraphy. During atrial pacing after administration of ergonovine, those patients developing their typical chest pain demonstrated significantly lower great cardiac vein flow (97 +/- 31 vs 150 +/- 33 ml/min, p less than .001), higher coronary resistance (1.27 +/- 0.43 vs 0.77 +/- 0.18 mm Hg/ml/min, p less than .005), and less lactate consumption (30.5 +/- 22.0 vs 69.7 +/- 41.1 mM . ml/min, p less than .005) and a higher left ventricular end-diastolic pressure after pacing (20 +/- 4 vs 12 +/- 1, p less than .001) compared with those without pain and in the absence of significant luminal narrowing of the epicardial coronary arteries. The 26 patients with abnormal vasodilator reserve demonstrated reduced left ventricular ejection fraction during exercise (58 +/- 8%) compared with the seven patients with appropriate vasodilator reserve (66 +/- 4%, p less than .05) and with a group of 52 control patients of similar age and sex distribution and free of known heart disease (66 +/- 10%, p less than .001). In addition, 12 of the 26 patients with abnormal vasodilator reserve demonstrated exercise-induced regional wall motion abnormalities. Many of these patients also manifested impaired left ventricular diastolic filling at rest compared with the control subjects (peak filling rate 2.6 +/- 0.7 vs 3.2 +/- 0.7 end-diastolic volume/sec, p less than .005). Thus, patients with chest pain resulting from abnormal vasodilator reserve demonstrate abnormalities of left ventricular systolic and diastolic function suggestive of myocardial ischemia.
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PMID:Left ventricular dysfunction in patients with angina pectoris, normal epicardial coronary arteries, and abnormal vasodilator reserve. 396 67

A long-term epidemiological study of heart disease in a representative rural community in Jamaica was started in 1962-63 and the first follow-up survey was carried out in 1967-68. This report describes the prevalence of several cardiovascular characteristics at each survey, and their associations with other measurements. The nature of the electrocardiographic abnormalities and their relationship with symptoms of effort pain and prolonged chest pain suggests that much of the disease seen in this population is ultimately ischaemic in origin despite evidence that classical myocardial infarction and severe coronary atheroma are relatively infrequent. Nevertheless both the symptoms and the electrocardiographic abnormalities had features that were not completely typical of occlusive disease of extramural coronary arteries. These findings are discussed in terms of the four conditions-hypertension, conventional coronary heart disease, small artery disease, and cardiomyopathy-that are believed to account for most cases of heart disease in this community, and it is concluded that the overall pattern of disease cannot be explained by any single disorder of overriding importance. The evidence suggests that all may be important contributors.
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PMID:Longitudinal study of heart disease in a Jamaican rural population. I. Prevalence, with special reference to ECG findings. 453 87

The relationship between cardiovascular characteristics and mortality was investigated in an epidemiological study of heart disease in a representative adult rural community in Jamaica. Of 449 men and 469 women followed up for 5 years, 36 men and 28 women died and the data concerning their status as regards arterial pressure, electrocardiographic abnormalities, and histories of effort pain at the intial survey have been analysed. Cardiovascular disease, and heart disease in particular, was the major cause of death in this population. Blood pressure levels exceeding 160/95 mm Hg had been recorded in about one third of the men and half the women who died and a clear trend was found between overall mortality and arterial pressure. Symptoms of effort pain and ECG abnormalities compatible with myocardial ischaemia, both of which were unexpectedly common, appeared to have independent prognostic significance. The prognosis of each was worse when associated with hypertension; hypertension unaccompanied by either effort pain or ECG "ischaemic" abnormality, on the other hand, caused no excess mortality in either sex within the period of follow-up. Although classical myocardial infarction was confirmed to be relatively infrequent, myocardial disorders with many of the features of ischaemic heart disease are an important cause of death in rural Jamaicans.
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PMID:Longitudinal study of heart disease in a Jamaican rural population. 2. Factors influencing mortality. 453 30

Traditionally when considering the pharmacologic basis of therapy in angina pectoris, attention is focussed on alterations of coronary blood flow. Yet the diseased coronary arteries in these patients often do not appear to be capable of responding to vasodilatory drugs. Since the pain of myocardial ischemia is relieved by a number of interventions without an increase in coronary blood flow, the concept herein considered is that angina pector is best viewed as an unfavorable relation between myocardial oxygen requirements and availability. Thus, the clinical value of the major antianginal agents is thought to be based importantly upon their actions to reduce myocardial oxygen consumption rather than to increase coronary blood flow. Sublingual nitroglycerin possesses a powerful dilator effect on veins which reduces venous return and thereby the size of the heart and intra-myocardial tension; thus myocardial oxygen requirements are diminished. The beta-adrenergic receptor blocking drug, propranolol (Inderal(R)), inhibits sympathetic stimulation of the heart at rest and during exercise. Thus, myocardial oxygen requirements are diminished by the reduction in heart rate and diminished contractility. As a result of this latter action, cardiac output is reduced and thereby arterial pressure and intramyocardial tension is lowered. In patients with advanced heart disease and borderline cardiac compensation, propranolol is hazardous because it removes the availability of one of the important reserve mechanisms for maintaining cardiac compensation-the sympathetic support of the failing heart. The introduction of electrical stimulation of the carotid sinus nerves as a means of therapy in patients with angina pectoris has provided a powerful tool for the treatment of patients with refractory ischemic pain.
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PMID:New trends in the treatment of angina pectoris. 498 Aug 81

The apexcardiogram (acg), when recorded serially in patients with acute myocardial infarction (ami), preinfarction angina (pia) and stable ischemic heart disease (ihd), appeared to reflect the abnormal patterns of contraction of the left ventricle in these conditions. Thus, paradoxical bulging (dyskinesis) of the systolic wave or increased "a" wave amplitude with gradual recovery over several weeks was found in all 60 patients with documented ami and in 18 of 20 patients with pia. Electrocardiogram changes were noted, however, in only eight of the pia patients. Changes in the acg frequently antedated ischemia in the ecg. Paradoxical bulging of the systolic wave of the acg was additionally noted in patients during the pain of angina pectoris but this promptly disappeared after the administration of nitroglycerine. Patients with classic angina often had normal resting ecg's but abnormal resting acg's. In contrast to the relatively transient abnormalities noted above, the acg remained unchanged in most patients with stable ihd during follow-up of three months to two years. Patients undergoing coronary bypass operations, however, showed immediate improvement in the acg in the postoperative period. These results suggest the acg reflects the contractile pattern of the left ventricle, and may be an indirectly recorded ventriculogram. Its enhanced sensitivity and the earlier development of changes in comparison to the ecg make this a valuable tool in the study of patients with heart disease.
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PMID:The apexcardiogram in ischemic heart disease. 500 98

Between 1973 and 1981, bilateral total replacement of hip and knee joints was performed in 22 patients with rheumatoid arthritis. During follow-up, 2 patients died of diseases not directly related to the operation. Besides these patients, there were 2 patients who could not be followed up. The remaining 18 patients constituted the subjects for study. We studied the postoperative results, emphasing improvement in the ability to perform everyday activities. Walking ability was improved in 16 patients. There was an increase in the number of patients able to rise from a chair, go up and down stairs, and get in and out of a car, bus or train. Of the 14 married patients (not including 2 patients who were unable to walk and 5 patients over 60 years of age) 7 were able to perform sexual intercourse as well as they had been able to when healthy. The patients who underwent bilateral total replacement of hip and knee joints often presented various problems, for example with regard to indications, the operative technique to use, as well as complications such as heart disease, pulmonary disease, and secondary amyloidosis. We have found, however, that bilateral total replacement of hip and knee joints can accomplish the operative objectives of eliminating pain and improving the quality of daily life in severely handicapped rheumatoid patients.
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PMID:Bilateral joint replacement of hip and knee joints in patients with rheumatoid arthritis. 646 58


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