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

In 18 patients who presented in less than 2 years with heart disease characterized by arrhythmias (including atrial fibrillation, ventricular arrhythmias and heart block), atypical chest pain, pericarditis and cardiac failure, extensive investigation revealed no cause for the disease except for evidence of toxoplasmic infection. One patient had acute toxoplasmosis; the other 17 patients had chronically increased titers, higher than the expected level in the community and also higher than in a control series of patients with well defined heart disease. Toxoplasmosis is probably a fairly common cause of heart disease in this community. The source of infection appeared to be cats, uncooked meat and congenital infection. Patients received chemotherapy with either pyrimethamine and sulfadiazine or tetracycline. Serious relapse occurrred in three patients and embolic complications in two. Experimental myocarditis occurs when toxoplasmic cysts rupture within the heart; therefore clinical symptoms may occur sporadically during a chronic infection.
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PMID:Toxoplasmic infection in cardiac disease. 42 23

Treadmill stress testing is used in assessing the condition of patients with known or suspected heart disease. We did a prospective study to clarify physician ordering and integration of the test. Ordering criteria were always complied with, although most tests were ordered for evaluation of atypical chest pain and only a few for high risk patients with known cardiac dysfunction, indicating a misplaced emphasis on the diagnostic capabilities of the test. Tests in patients with atypical chest pain and stress-induced ischemic changes were always integrated, but in 30 percent of patients with atypical pain and no stress-induced electrocardiographic changes, the tests were not used in patient management. This was often due to the misconception that negative findings on a stress test excluded coronary disease. Physicians should be alerted to this misplaced emphasis and misconception.
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PMID:Graded treadmill stress testing. Patterns of physician use and abuse. 61 35

Chest pain and breathlessness are common somatic symptoms of emotional disorder in ambulatory care. Chronic chest pain has a prevalence of 12% and is associated with high utilization of health care. Of patients with chest pain and breathlessness who are referred to a cardiac clinic but subsequently shown not to have heart disease, the majority continue to report symptoms. Those patients with the worst outcome, in terms of continuing limitation of activity and use of medical resources, are those with chest pain but normal coronary arteries. A number of studies that fail to support a unitary theory of causation of noncardiac chest pain are described. A multifactorial, interactive model is proposed, with contributions from physical factors, such as palpitations and intercostal muscle pain; psychologic factors, which include enhanced awareness of and selective attention to bodily sensation; and environmental factors, such as previous exposure to cardiorespiratory disease in first-degree relatives or significant others. Although there have been few controlled intervention studies in patients with unexplained cardiorespiratory symptoms, there is evidence for the efficacy of both drug treatments and psychologic treatment. The results of intervention studies in patients with chest pain and normal coronary arteries are eagerly awaited. Atypical chest pain and breathlessness are common causes of office consultations and/or functional disability. The diagnoses should be established on the basis of positive evidence of psychiatric illness rather than by exclusion. The etiology is multifactorial, and management is aimed at treating the underlying psychosocial problems and/or psychiatric illness. Cognitive-behavioral treatments are probably as effective as drug treatments in the short-term, and the care of these patients would be improved by a more detailed explanation of noncardiac causes and a greater opportunity for patients to discuss their fears.
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PMID:Chest pain and breathlessness: relationship to psychiatric illness. 173 29

We reviewed the clinical history of 191 patients undergoing endomyocardial biopsy and correlated signs and symptoms of heart disease with the presence or absence of small vessel disease. Idiopathic congestive heart failure (78%), arrhythmia (35%), and chest pain (25%) were the most frequent indications for biopsy. Small vessel disease was noted in 61% of the biopsies (67% female, 56% male): 10% severe, 36% moderate, and 15% mild small vessel disease. Patients with hypertension were twice as likely to have small vessel disease than those without hypertension. Of the 27 females with hypertension, 85% had small vessel disease, 67% with either severe or moderate small vessel disease. Small vessel disease was almost twice as frequent in patients with chest pain compared to patients without chest pain. Chest pain was significantly more common in patients with severe small vessel disease than in those with normal small vessels. Of all patients with chest pain, 18% had severe small vessel disease; however, of 20 patients with severe small vessel disease, 45% had chest pain. This analysis suggests that small vessel disease seen in endomyocardial biopsy is more common in women and is related to hypertension. When severe, it is likely to be associated with atypical chest pain.
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PMID:Endomyocardial biopsy diagnosis of small vessel disease: a clinicopathologic study. 229 8

Sudden cardiac incapacitation occurring during critically stressful circumstances in men engaged in a variety of occupations may compromise public safety. Since the primary cause of this incapacitation is usually heart disease, more effective medical screening has been advocated. We report the annual incidence of sudden cardiac incapacitation in four clinical groups--4105 healthy men (Group I), 537 men with atypical chest pain syndromes (Group II), 1374 hypertensive men (Group III), and 2373 men with clinically manifest coronary heart disease (Group IV)--who have been examined and tested by maximal exercise with the Bruce protocol in Seattle community practice. Five strategies for prospective risk assessment are presented in these groups, namely age alone, clinical diagnosis before testing, the combination of both parameters, exercise-enhanced risk assessment, and the exercise criteria proposed by a Task Force for Ischemic Heart Disease (Bethesda Conference XVIII, 1986). We conclude that the exercise-enhanced risk assessment is the most effective of these strategies.
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PMID:Strategies for risk evaluation of sudden cardiac incapacitation in men in occupations affecting public safety. 270 63

Intracoronary injection of acetylcholine has been shown to induce coronary spasm in patients with variant angina. To examine its sensitivity and specificity, incremental doses of acetylcholine (20, 50 and 100 micrograms into the left coronary artery and 20 and 50 micrograms into the right coronary artery) were injected into the coronary artery or arteries in 70 patients with variant angina (Group 1) (mean age 57 years) and 93 patients without variant angina or angina at rest (Group 2) (mean age 54 years). Forty patients of the latter group had atypical chest pain, 16 cardiomyopathy, 14 arrhythmia, 11 valvular disease, 7 stable effort angina due to advanced coronary artery disease, 3 congenital heart disease and 2 hypertension. A temporary cardiac pacemaker set at 40 to 50 beats/min was positioned in the right ventricle. Coronary spasm was defined as total occlusion or severe vasoconstriction associated with chest pain or ischemic ST changes on the electrocardiogram or both. In Group 1, acetylcholine induced spasm in 63 (90%) of the 70 patients in the artery or arteries predicted to be responsible for spontaneous attacks. In Group 2, acetylcholine induced coronary spasm only in one patient with effort angina and advanced coronary artery disease although lesser degrees of vasoconstriction (less than or equal to 75% of the luminal diameter) occurred in most patients after acetylcholine (specificity of acetylcholine thus was 99%). In conclusion, intracoronary injection of acetylcholine is sensitive and reliable for the induction of coronary spasm.
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PMID:Sensitivity and specificity of intracoronary injection of acetylcholine for the induction of coronary artery spasm. 304 96

Although patients with angiographically normal coronary arteries have low mortality, several studies have indicated that their social and work morbidity is high. Panic disorder appears to be a major contributor to the continuing chest pain in this population. There are also many chest pain patients appearing in cardiology clinics who also do not have heart disease but who are not given the opportunity to be evaluated for psychiatric disorders. Among those presenting with atypical or nonanginal chest pain, panic disorder represents a likely etiologic consideration. The fact that such patients do exist in cardiology populations is further substantiated by an open-label trial of alprazolam which demonstrated a positive effect in patients selected from those with atypical chest pain and no heart disease found to fit panic disorder criteria. These findings strongly support the increasing affiliation between cardiology and psychiatry and reinforce the belief that many problems of the heart may be problems of the mind/brain.
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PMID:Panic disorder, cardiology patients, and atypical chest pain. 304 7

Seventy-four patients with chest pain and no prior history of organic heart disease were interviewed with a structured psychiatric interview immediately after coronary arteriography. The majority of patients with both negative and positive coronary angiographies had undergone previous exercise tolerance tests, but the patients with angiographic coronary artery disease were significantly more likely to have had positive results on a treadmill test. Patients with chest pain and negative coronary arteriograms were significantly younger; more likely to be female; more apt to have a higher number of autonomic symptoms (tachycardia, dyspnea, dizziness, and paresthesias) associated with chest pain, and more likely to describe atypical chest pain. Patients with chest pain and normal coronary arteriographic results also had significantly higher psychologic scores on indices of anxiety and depression and were significantly more likely to meet criteria of the Diagnostic and Statistical Manual of Mental Disorders, third edition, for panic disorder (43 percent versus 6.5 percent), major depression (36 percent versus 4 percent), and two or more phobias (36 percent versus 15 percent) than were patients with chest pain and a coronary arteriography study demonstrating coronary artery stenosis.
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PMID:Chest pain: relationship of psychiatric illness to coronary arteriographic results. 333 15

A total of 98 patients with chest pain and no prior history of organic heart disease underwent a structured psychiatric interview at the time of cardiac diagnostic testing, either coronary arteriography or exercise treadmill. Patients with negative cardiac test results were significantly younger and more likely to be female, endorsed a greater number of autonomic symptoms with their chest pain, and were more likely to report atypical chest pain. These patients had significantly higher scores on measures of anxiety and negative life events and significantly greater prevalences of DSM-III panic disorder (47% vs. 6%), major depression (39% vs. 8%), and two or more simple phobias (43% vs. 12%) than did patients with cardiac test results demonstrating coronary artery disease. Using logistic regression, a model was developed to estimate the probability of negative cardiac test results from patient characteristics and psychiatric diagnoses.
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PMID:Chest pain with negative cardiac diagnostic studies. Relationship to psychiatric illness. 337 97

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


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