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

Snoring usually is trivial and unimportant, but it can turn into a social or medical problem. Obesity, hypertension and heart disease are more frequent among snorers than among nonsnorers, and especially snorers with hypersomnia during the day are at risk. Hypersomnia in association with snoring usually signifies obstructive sleep apnea. Increased resistance in the upper airways, together with negative inspiratory pharyngeal pressure and muscular hypotonia during deep non-REM and REM sleep, lead to collapse of the pharynx, hypoxia and hypercapnia. Only after arousal from sleep does muscle tone return, pharyngeal obstruction reopen and airflow resume. Since this process can occur 300 or 400 times a night, repetitive alveolar hypoventilation leads to pulmonary-arterial hypertension and cor pulmonale, and the repetitive sympathetic activations can cause systemic hypertension or serious cardiac arrhythmias. The countless arousals deprive the sufferer of deep non-REM and REM sleep and their consequence is sleep fragmentation. The symptoms are excessive daytime sleepiness, intellectual deterioration and personality and behavioral changes. Oronasomaxillofacial, endocrine and neuromuscular anomalies and diseases predispose to sleep apnea, and alcohol or CNS-depressant drugs can favour its occurrence. Diagnosis is made by nighttime oxymetry, and if this is abnormal, by polysomnography. After polysomnography it is possible to distinguish between obstructive and nonobstructive sleep apnea, and the decisions for an adequate treatment can be made.
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PMID:[Dangerous snoring. Sleep-apnea syndrome]. 331 92

Disopyramide is an oral antiarrhythmic drug which reduces conduction velocity, prolongs duration of action potential and the effective refractory period, and exerts vagolytic properties. The drug is usually well absorbed orally. The principal use of the drug is to suppress ventricular extrasystoles with usual oral dosage of 100 to 200 mg every 6 h, until blood levels of 2 to 4 micrograms/mL are attained. The use of the drug for suicide is uncommon as it is a prescription drug. Two cases of fatal disopyramide intoxication seen at the Los Angeles County Medical Examiner's Office will be discussed followed by a review of the literature of fatal suicidal disopyramide overdose. Case 1 was a 31-year-old male pharmacist with known history of depression and no history of heart disease. His decomposed remains were found with a suicide note and with several disopyramide tablets. At autopsy the blood level for disopyramide was 146 micrograms/mL. Case 2 is a 40-year-old male with history of alcoholism and prior suicidal attempts who regularly took disopyramide to control ventricular arrhythmias. He apparently ingested 36 100-mg tablets of disopyramide before his final collapse. At autopsy his blood level of disopyramide was 63 micrograms/mL.
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PMID:Fatal disopyramide intoxication from suicidal/accidental overdose. 332 13

Out-of-hospital cardiac arrests were studied in Israel from 1984 to 1985. More than 3,500 patients in cardiac arrest received paramedic care. Eighty-three percent of cases were caused by underlying heart disease. Overall, 17% of patients with arrest caused by heart disease were admitted and 7% were discharged from the hospital. There was a wide variation in the percent discharged among the 15 paramedic service areas, ranging from 0% to 13%. Factors associated with successful resuscitation included witnessed collapse, rhythm of ventricular fibrillation, short interval from collapse to cardiopulmonary resuscitation (CPR) and delivery of advanced cardiac life support, collapse at public location, and bystander initiation of CPR. Improvements in survival are likely to result if CPR is more frequently and promptly initiated and the time to arrival of definitive paramedic care can be improved.
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PMID:Sudden cardiac arrest in Israel: factors associated with successful resuscitation. 339 Feb 46

Heart disease is a recognised complication of influenza. We report a unique case in which myopericarditis and collapse due to acute influenza A infection was associated with pericardial effusion and tamponade. In addition, the patient had myositis and pleurisy. Emergency pericardiocentesis and inotropic drugs were needed but recovery was complete.
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PMID:Acute myopericarditis in influenza A infection. 362 4

Different implantable systems for electrical treatment of ventricular arrhythmias are available. Information about mode of termination of ventricular tachycardia (VT) helps to select the most appropriate electrical treatment for drug-resistant VT. During 158 electrophysiologic studies, the mode of termination of 215 episodes of VT was analyzed in 2 groups of patients. Group 1 consisted of 54 patients with documented monomorphic VT and group 2 of 46 patients with other documented or suspected ventricular arrhythmias. Eighty-two patients had coronary heart disease, 8 had other structural heart disease and 10 had idiopathic VT. Termination of VT was attempted using extrastimuli and overdrive pacing; direct-current (DC) shocks were given in case of syncopal VT. During 33 of 96 studies (34%) in group 1, DC shock was required to interrupt VT, compared with 45 of 62 studies (73%) in group 2 (p less than 0.001). This difference was a result of less frequent induction of immediately syncopal VT in group 1 (14 of 129 VTs, vs 40 of 86 in group 2, p less than 0.001). Non-syncopal VT could reliably and safely be terminated by pacing in 61%, irrespective of the clinical arrhythmia. Pacing-induced acceleration of VT occurred in 6% (single extrastimuli) to 36% (over-drive pacing) (mean 26%) of attempts. Subsequent DC shock was required in half of these cases. Immediate collapse after induction of VT was not related to the presence of heart disease, but was related to a combination of VT cycle length (shorter than 260 ms) and left ventricular ejection fraction (less than 40%). Antiarrhythmic drugs reduced the need for DC shock.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Importance of modes of electrical termination of ventricular tachycardia for the selection of implantable antitachycardia devices. 394 60

Records on 1,297 people with witnessed out-of-hospital cardiac arrest, caused by heart disease and treated by both emergency medical technicians (EMTs) and paramedics, were examined to determine whether or not early cardiopulmonary resuscitation (CPR) initiated by bystanders independently improved survival. Bystanders initiated CPR for 579 patients (bystander CPR); for the remaining 718 patients, CPR was delayed until the arrival of EMTs (delayed CPR). Survival was significantly better (P less than 0.05) in the bystander-CPR group (32%) than in the delayed-CPR group (22%). Multivariate analysis revealed that the superior survival in the bystander-CPR group was due almost entirely to the much earlier initiation of CPR (1.9 minutes for the Bystander-CPR group and 5.7 minutes for the delayed-CPR group; P less than 0.001). There were significantly more people with ventricular fibrillation (VF) in the bystander-CPR group (80%) than in the delayed-CPR group (68%); and, for people in VF, the survival rate was significantly better if they had received bystander-CPR (37% versus 29%). The authors conclude that early initiation of CPR by bystanders significantly improves survival from out-of-hospital cardiac arrest, and they suggest that it may do so by prolonging the duration of VF after collapse and by increasing cardiac susceptibility to defibrillation. The benefit of this early CPR, however, appears to exist within a rather narrow window of effectiveness. It must be started within 4-6 minutes from the time of collapse and must be followed within 10-12 minutes of the collapse by advanced life support in order to be effective.
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PMID:Survival of out-of-hospital cardiac arrest with early initiation of cardiopulmonary resuscitation. 397 Jul 66

During an epidemic of respiratory syncytial (R.S.) virus in Newcastle upon Tyne 13 children developed R.S. virus infections while in hospital with other conditions. R.S. virus infection was also noted in four members of the staff. In two of the hospital wards outbreaks developed. All children infected with R.S. virus developed symptoms. The symptoms varied with age; two children aged 2 months or less developed colds, as did five children over 1 year of age. One child of 15 months with Werdnig-Hoffman disease, though suffering from a cold, later developed pulmonary collapse. All five children aged 3 to 8 months developed bronchiolitis. The effectiveness of special nursing in cubicles was probably diminished because adults with mild colds were excreting virus. The dangers of R.S. virus infection to other children in the ward, especially those with congenital heart disease, is emphasized.
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PMID:Respiratory syncytial virus in hospital cross-infection. 556 49

Survival after out-of-hospital cardiac arrest was studied in a suburban community (population 304000) before and after addition of paramedic services. During period 1 emergency medical technicians provided basic emergency care (cardiopulmonary resuscitation at the scene of collapse and during the journey to hospital). In period 2 additional care was given at the scene of collapse by paramedics capable of advanced emergency care (defibrillation, endotracheal intubation, drugs). During the 3-yr study 585 patients with cardiac arrest caused by heart disease received prehospital emergency resuscitation. Paramedic services improved the rate of live admission to the coronary-care or intensive-care unit from 19% to 34% (p less than 0.001) and the rate of discharge from 7% to 17% (p less than 0.01). The mean time from collapse to delivery of advanced emergency care was 27.5 min during period 1 with technician services, and 7.7 min during period 2 with paramedic services. Ventricular fibrillation caused cardiac arrest in nearly all patients who survived; it occurred in 91 of the 160 (57%) patients during period 1 whose rhythms were determined and in 192 of the 343 (56%) patients during period 2. The decreased time from collapse to delivery of advanced emergency care accounted for the improved survival with paramedic services.
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PMID:Out-of-hospital cardiac arrest: improved survival with paramedic services. 610 90

We have compared the effectiveness of two different mobile coronary care systems with regard to mortality from cardiac arrest (CA) outside hospital in Gothenburg, Sweden. In period 1, the mobile coronary care unit (MCCU) was part of a randomized study of the effect of an MCCU versus standard ambulances on early mortality from ischaemic heart disease. The MCCU was single, hospital based and manned by two CCU nurses and two ambulance drivers. The organization ran on workdays 08.00 a.m. to 17.00 p.m. from October, 1973 to May, 1978, corresponding to twelve months of effective time. One-year data for the MCCU have been calculated by extrapolating to a 100% allocation to the MCCU. In period 2, from November, 1980, through December, 1981, also corresponding to twelve months of effective time, the system was reorganized to a mobile intensive care unit (MICU) manned by paramedics 24 h all days of the week, and part of the time by CCU nurses. The MICU was dispatched to all suspected emergencies and the treatment capacity was defibrillation, endotracheal intubation and, part of the time, drugs. Simultaneously with the MICU, the nearest standard ambulance was dispatched and the first crew to arrive started cardiopulmonary resuscitation (CPR). Comparing the extrapolated data from period 1 with the exact data from period 2, there was an increase in period 2 of dispatches to subjects in CA due to heart disease from 59 to 181. The retrieval of subjects in ventricular fibrillation (VF) increased from 20 to 87 as a result of reduced delay times from the collapse to alarm, start of CPR and defibrillation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Resuscitation of patients in cardiac arrest outside hospital. Comparison of two different organizations of mobile coronary care in one community. 670 2

The scientific literature from January 1970 to June 1979 was reviewed for articles reporting outcomes from out-of-hospital cardiac arrest treated by paramedic programs. Only articles appearing in refereed professional journals and reporting 25 or more attempted resuscitations were included. A total of 21 articles from 15 U.S. locations were found. Four separate case definitions were distinguished. Methods and reporting formats varied considerably. Few studies used an experimental or quasi-experimental design, or control or comparison groups. The range of attempted resuscitations varied from 26 to 1.106 patients. Patients admitted to hospital varied between 22 per cent and 65 per cent (mean 38 per cent, S.D. +/- 12.4 per cent). Patients discharged alive varied from 3.5 per cent to 31 per cent (mean 17.2 per cent, S.D. +/- 7.1 per cent). Post discharge survival was either not reported or reported in different formats. A simplified reporting format is proposed using factors known to be associated with successful resuscitation: 1) underlying heart disease etiology; 2) witnessed arrest; 3) cardiac rhythm of ventricular fibrillation/ventricular tachycardia; 4) hospital admission and discharge and, when possible, by time from collapse to initiation of CPR and definitive care. Uniform reporting of outcomes will improve comparability and accurate measurement of the impact of emergency programs on out-of-hospital cardiac arrest.
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PMID:Out-of-hospital cardiac arrest: a review of major studies and a proposed uniform reporting system. 698


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