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

As a result of population ageing and improved medical care that contribute to better life expectancy, heart failure occurs more and more commonly in the elderly. In the USA approximately 80% of patients discharged from hospital with newly diagnosed heart failure are over 65 years of age, whereas 50% are over 75. The average 5-year mortality rate is about 50% in subjects with systolic dysfunction and similar in those with preserved left ventricular systolic function. Disorders of the cardiovascular system occurring in the elderly (e.g. increased left ventricular mass, myocardial rigidity, atrial fibrillation, decreased maximum oxygen uptake in cardiopulmonary exercise tests) result from the physiological ageing; they may also be caused by a concomitant cardiac failure syndrome. In the elderly, heart failure is often accompanied by concomitant conditions that often make diagnosis and treatment of chronic heart disease difficult. Non-specific clinical symptoms in the elderly as well as those associated with age (e.g. easy fatigability, exertional dyspnea) make a correct diagnosis difficult. The recognized biochemical marker of heart failure--brain natriuretic peptide, N-terminal pro-brain natriuretic peptide--has a limited diagnostic value in the elderly. Echocardiography plays a key role in the diagnosis. Owing to altered metabolism, impairment of hepatic processes to various degrees and decreased renal excretion of drugs, treatment requires attention, individual choice of drugs and doses, as well as periodic modification of both the doses and the intervals between them. Correct treatment improves quality of life and prolongs it. The aim of the present work is to present the differences in the pathophysiology, diagnostic evaluation and management of chronic heart failure in the elderly, in light of the current views and standards.
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PMID:Chronic heart failure in the elderly: a current medical problem. 1911 19

Obesity is associated with comorbidities that may lead to disability and death. During the past 20 years, the number of individuals with a body mass index >30, 40, and 50 kg/m(2), respectively, has doubled, quadrupled, and quintupled in the United States. The risk of developing comorbid conditions rises with increasing body mass index. Possible cardiac symptoms such as exertional dyspnea and lower-extremity edema occur commonly and are nonspecific in obesity. The physical examination and electrocardiogram often underestimate cardiac dysfunction in obese patients. The risk of an adverse perioperative cardiac event in obese patients is related to the nature and severity of their underlying heart disease, associated comorbidities, and the type of surgery. Severe obesity has not been associated with increased mortality in patients undergoing cardiac surgery but has been associated with an increased length of hospital stay and with a greater likelihood of renal failure and prolonged assisted ventilation. Comorbidities that influence the preoperative cardiac risk assessment of severely obese patients include the presence of atherosclerotic cardiovascular disease, heart failure, systemic hypertension, pulmonary hypertension related to sleep apnea and hypoventilation, cardiac arrhythmias (primarily atrial fibrillation), and deep vein thrombosis. When preoperatively evaluating risk for surgery, the clinician should consider age, gender, cardiorespiratory fitness, electrolyte disorders, and heart failure as independent predictors for surgical morbidity and mortality. An obesity surgery mortality score for gastric bypass has also been proposed. Given the high prevalence of severely obese patients, this scientific advisory was developed to provide cardiologists, surgeons, anesthesiologists, and other healthcare professionals with recommendations for the preoperative cardiovascular evaluation, intraoperative and perioperative management, and postoperative cardiovascular care of this increasingly prevalent patient population.
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PMID:Cardiovascular evaluation and management of severely obese patients undergoing surgery: a science advisory from the American Heart Association. 1952 35

Herein we report the diagnostic potential of cardiac computed tomography (cCT) to delineate the origin and course of an anomalous right coronary artery (RCA) originating from the midpart of the left anterior descended artery (LAD) in an adult with no other form of congenital heart disease. The patient was referred to our institution due to exertional dyspnea and suspected coronary artery disease. The patient underwent X-ray coronary angiography, and no high grade lesions were observed in the left coronary vessels. In the course of the mid-left-anterior-descending artery (LAD), an anomalous side branch coursing away from the left circumflex coronary artery (LCX) was observed, while a right coronary ostium could not be depicted. cCT confirmed the absence of a right coronary ostium, and the vessel originating from the mid LAD was identified as an anomalous RCA, which coursed anterior of the aorta and the pulmonary trunk.
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PMID:Single coronary artery with anomalous rising of the right coronary artery: a rare coronary anomaly diagnosed by 256-multidetector computed tomography. 2211 May 7

Tetralogy of Fallot (TOF) is a congenital heart disease that is usually diagnosed and treated during infancy. Only 3% of such patients reach the age of 40 without surgery. We describe a 61-year-old woman with uncorrected TOF that was successfully treated by radical surgery. The patient presented with exertional dyspnea, insomnia, and malaise. Echocardiography and cardiac catheterization indicated a dilated, severely hypertrophic right ventricle, ventricular septal defect, an overriding aorta, and infundibular stenosis in the right ventricular outflow tract. All symptoms disappeared after full surgical correction, which remains the preferred treatment for adult TOF because it confers long-term survival and an improved quality of life.
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PMID:Surgical correction of tetralogy of Fallot in a 61-year-old patient. 2241 86

Kawasaki disease (KD) is a systemic vasculitis of unknown etiology, which is the main cause of acquired heart disease in children in developed countries. The main complications result from the development of coronary aneurysms which can lead to ischemic heart disease. We present the case of a teenage boy with a diagnosis of KD at the age of seven. He was treated with gammaglobulin and aspirin and echocardiographic evaluation in the acute phase was apparently normal. At the age of eleven, he developed chest pain and exertional dyspnea. Nuclear perfusion scans with exercise revealed hypoperfusion of the left anterior descending (LAD) and right coronary (RC) artery territories. Cardiac catheterization showed occlusion of the proximal segments of both arteries. He underwent coronary artery bypass graft surgery (internal mammary artery bypass graft to the LAD artery and saphenous vein graft to the RC artery), with a good clinical result. This case report highlights the importance of early diagnosis and treatment of KD and regular cardiological follow-up, bearing in mind the potential late complications of this pediatric disease.
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PMID:[Coronary artery bypass after Kawasaki disease]. 2259 79

Scimitar syndrome is a rare congenital disorder characterized by a partial, or rarely total, unilateral anomalous pulmonary venous return to the inferior vena cava. This anomaly has a distinctive bimodal presentation with the infantile form having a higher incidence, severity and mortality than the adult form, which is usually asymptomatic on diagnosis. We present the case of a 36-year-old-male transferred to our institution due to incidental anomalous vascular findings on contrast enhanced chest tomography while being evaluated for dyspnea on exertion. Patient underwent right and left heart catheterization with evidence of left-to-right shunt secondary to complete anomalous right pulmonary venous return. Patient was referred to a cardiovascular surgeon with expertise in congenital heart disease for definitive surgical correction.
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PMID:Total right pulmonary venous return to the inferior vena cava: a rare variant of Scimitar syndrome. 2273 30

Pulmonary hypertension is characterized by elevated pulmonary arterial pressure and secondary right ventricular failure. A thromboembolic occlusion of the proximal or distal pulmonary vasculature results in chronic thromboembolic pulmonary hypertension. We report an uncommon case that presented to our hospital with symptoms of dyspnea on exertion over 2 years. The patient had been treated for profound pulmonary thrombosis and right ventricular failure with adequate anticoagulation and sildenafil. Our echocardiography disclosed a large atrial septal defect with severe pulmonary hypertension and right ventricular failure. A diagnosis of Eisenmenger syndrome with pulmonary artery thrombosis was made. Although Eisenmenger syndrome with pulmonary thrombosis is well described in western societies, a huge pulmonary thrombosis is seldom reported in eastern countries. Profound pulmonary thrombosis may obfuscate the actual diagnosis of pulmonary artery hypertension with underlying congenital heart disease. A physical examination and echocardiography are essential in patients with pulmonary hypertension.
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PMID:Pulmonary arterial thrombosis in a patient with an atrial septal defect and eisenmenger syndrome. 2323 30

Ortner's syndrome results in hoarseness caused by compression of the left laryngeal recurrent as a result of cardiovascular pathology. A wide range of cardiovascular such as valvular heart disease, thoracic aortic aneurysm and congenital heart disease may result in Ortner's syndrome. We present a case of Ortner's syndrome caused by a large diameter (120 mm) aneurysm, previously unreported in the literature. A male patient aged 71 years was admitted to our clinic for exertional dyspnea, asthenia and hoarseness. In the indirect laryngoscopic examination, left vocal cord paralysis of the patient was observed and his chest X-ray revealed a mass with a diameter of 120 mm that filled the left upper zone. A dissected aortic aneurysm 120 mm in diameter in arcus level at thorax was seen in CT imaging. Surgical treatment was suggested; however, the patient refused treatment and died at the 4th month of the follow up period.
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PMID:[Ortner's syndrome caused by dissecting aortic aneurysm]. 2370 58

We describe the case of a 54-year-old man who presented with exertional dyspnea and fatigue that had worsened over the preceding 2 years, despite a normally functioning bioprosthetic aortic valve and stable, mild left ventricular dysfunction (left ventricular ejection fraction, 0.45). His symptoms could not be explained by physical examination, an extensive biochemical profile, or multiple cardiac and pulmonary investigations. However, abnormal cardiopulmonary exercise test results and a right heart catheterization-combined with the use of a symptom-limited, bedside bicycle ergometer-revealed that the patient's exercise-induced pulmonary artery hypertension was out of proportion to his compensated left heart disease. A trial of sildenafil therapy resulted in objective improvements in hemodynamic values and functional class.
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PMID:Exercise-induced pulmonary artery hypertension in a patient with compensated cardiac disease: hemodynamic and functional response to sildenafil therapy. 2587 99

A 32 year old male patient was admitted with exertional dyspnea for long duration with features of right sided failure. On examination, it seemed to be a congenital cyanotic heart disease with decrease pulmonary flow. Echocardiography showed a malaligned VSD with pulmonary stenosis with severe AR and the total regurgitation volume was going to the RV instead of going to both the ventricles leading to dilatation of right ventricle and failure.
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PMID:Tetralogy of Fallot presenting with Right Ventricular Failure. 2659 Nov 51


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