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

The differential diagnosis of congenital heart disease which presents cyanosis or respiratory distress, or both, in the first two weeks of life, is difficult. Close correlation of clinical features, electrocardiogram and chest roentgenogram is most helpful. The diagnosis of congenital heart disease should lead to immediate cardiac catheterization, angiocardiography and appropriate therapy.
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PMID:Diagnosis of congenital heart disease in the first two weeks of life. 577 78

Acute embolic arterial occlusion is the most frequent emergency in vascular surgery; the patients usually have significant heart disease and additional risk factors due to high age. Since 1966 acute embolic occlusions of major vessels of the lower extremity have been operated in 1496 patients; 82% of patients were over 65 years of age--18% even over 80 years. Standardized embolectomy from a small groin incision in local anaesthesia after preoperative check of general conditions has the best prognosis concerned limb salvage. Postoperative long term anticoagulation is performed routinely to prevent recurrent embolization. Preoperative angiography is required only when there is a clinical suspect of preexisting occlusive vessel disease with acute arterial thrombosis. If possible, this group of patients should be subjected to elective reconstructive surgery (fem. pop. bypass, profundoplasty etc.) since embolectomy alone does not mean definitive help in this group. Also for acute iliofemoral venous thrombosis high age is a significant risk factor. Among 240 patients, operated since 1966, about 25% were over 70 years of age. In these patients operative thrombectomy is the only effective means since lysis is usually not performed. Thrombectomy provided a very good result (fully patent veins, normal venous pressure response curves) in 28%. In 64% pressure curves were grossly normal, though recurrent thrombosis had occurred in either femoral or lower leg veins. Only 8% revealed total iliofemoral reocclusion. Thus also in these high risk patients thrombectomy seems to be justified to accomplish early remobilization and prevent respiratory distress syndrome.
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PMID:[Vascular surgical emergency in advanced age: arterial embolism--iliofemoral venous thrombosis]. 613 56

The chest X-rays of 15 hypoglycaemic small-for-gestational-age infants showed cardiomegaly in 10 infants, 4 had heart failure. None of the infants had respiratory distress syndrome, congenital heart disease, septicaemia, anaemia or polycythaemia; infants of diabetic mothers were excluded. Cardiomegaly disappeared with the normalization of blood glucose in most of the cases. The cause of the cardiomegaly and heart failure might be related to insufficient cardiac energy substrates in small-for-gestational-age infants. This condition should also be considered in the differential diagnosis of cardiomegaly and heart failure.
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PMID:Cardiomegaly in hypoglycaemic small-for-gestational-age infants. 621 92

Pulmonary edema is an important feature of many newborn lung diseases, including respiratory distress from severe perinatal asphyxia, heart failure, hyaline membrane disease, pneumonitis from group B beta-hemolytic streptococcus, and chronic lung disease (bronchopulmonary dysplasia). Neonatal pulmonary edema often results from increased filtration pressure in the microcirculation of the lungs. This occurs during sustained hypoxia, in left ventricular failure associated with congenital heart disease or myocardial dysfunction, following excessive intravascular infusions of blood, colloid, fat, or electrolyte solution, and in conditions that increase pulmonary blood flow. Low intravascular protein osmotic pressure from hypoproteinemia may predispose infants to pulmonary edema. Hypoproteinemia is common in infants who are born prematurely. Large intravascular infusions of protein-free fluid further decrease the concentration of protein in plasma and thereby facilitate edema formation. Lymphatic obstruction by air (pulmonary interstitial emphysema) or fibrosis (long-standing lung disease) also may contribute to the development of edema. Bacteremia, endotoxemia, and prolonged oxygen breathing injure the pulmonary microvascular endothelium and cause protein-rich fluid to accumulate in the lungs. The risk of neonatal pulmonary edema can be reduced by several therapeutic measures designed to lessen filtration pressure, increase plasma protein osmotic pressure, and prevent or reduce the severity of lung injury.
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PMID:Edema formation in the lungs and its relationship to neonatal respiratory distress. 657 79

Pulmonary edema is an important cause of respiratory distress in newborn infants. It occurs with severe perinatal asphyxia, heart failure, hyaline membrane disease, persistent patency of the ductus arteriosus, pneumonitis from group B beta-hemolytic streptococcus, and chronic lung disease (bronchopulmonary dysplasia). Neonatal pulmonary edema often develops from increased pressure in the microcirculation of the lungs. This may occur in conjunction with sustained hypoxia; left ventricular failure associated with congenital heart disease or myocardial dysfunction; following excessive intravascular infusions of blood, colloid, fat, or electrolyte solution and in conditions that increase pulmonary blood flow. Low intravascular protein osmotic pressure from hypoproteinemia may predispose infants to pulmonary edema. Hypoproteinemia is common in infants who are born prematurely. Large intravascular infusions of protein-free fluid further decrease the concentration of protein in plasma and thereby facilitate edema formation. Lymphatic obstruction by air (pulmonary interstitial emphysema of fibrosis (chronic lung disease) also may contribute to the development of edema. Bacteremia, endotoxemia, and prolonged oxygen-breathing injure the pulmonary microvascular endothelium and cause protein-rich fluid to accumulate in the lungs. Epithelial protein leaks may develop when the transpulmonary pressure needed to inflate the lungs increases because of high surface tension at the air-liquid interface. Fibrin clots from in some of the air spaces, which in combination with atelectasis and edema constitute the pathologic features of hyaline membrane disease. The risk of neonatal pulmonary edema can be reduced by several therapeutic measures designed to lessen fluid filtration pressure, increase plasma protein osmotic pressure, and prevent or reduce the severity of lung injury.
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PMID:Edema formation in the newborn lung. 676 Oct 39

The authors report 3 cases of right atrial myxoma and review 88 other cases in the literature managed by surgery. The first personal case, in a 74 year old patient, illustrate the dramatic consequences of tumour engagement in the tricuspid orifice, in this instance cardiac arrest during catheterisation justifying emergency surgery. The second case exemplifies the diagnostic value of echocardiography: the correction of an erroneous diagnosis of pericarditis. The third case shows that some forms may be totally asymptomatic, the tumor being diagnosed on clinical examination and confirmed by echocardiography. In their review of the literature, the low overall incidence of primary cardiac tumours, of which myxoma is the most common, is emphasised. A right atrial localisation is found in only 25% cases. 88 surgical reports have been published since Bahnam's original attempt at surgical cure under cardiopulmonary bypass. Myxoma may occur at any age but it usually presents between the ages of 30 and 60. Some familial forms have been reported. The presenting symptoms are protean but usually point to an obstacle in the right heart chambers. They may be summarized as follows: 1. Isolated right ventricular failure without left heart disease may be observed in large tumours (reported in 50% of cases). 2. Simulating pericarditis (25% of cases) with a low grade pyrexia (25% of cases). 3. Paroxysmas of cardio respiratory distress of variable severity (a few cases). Clinical examination, chest x-ray and ECG are not diagnostic but do show non-specific changes which are of value in drawing attention to the heart and leading to echocardiography. This confirms the diagnosis by showing abnormal mobile echos in the right atrium prolapsing into the right ventricle in diastole. Angiography serves only to confirm these appearances. Surgery is the treatment of choice, and preferably with the shortest possible delay. It offers definitive cure at a minimal risk to the patient.
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PMID:[Myxomas of the right atrium. Apropos of 3 cases. Review of the literature]. 678 86

The radiographic findings of a series of infants of diabetic mothers and a review of the literature are presented to illustrate the wide spectrum of abnormalities that may be seen with this condition. Congenital anomalies of the spine and skeletal, genitourinary, and cardiovascular systems and visceral situs inversus are significantly more frequent among infants of diabetic mothers than normal. The most specific anomaly is sacral agenesis. Renal vein thrombosis and adrenal hemorrhage are also more common and may be diagnosed by sonography. Over one-half of the cases of the small left colon are associated with maternal diabetes and may be diagnosed and treated with a contrast enema. The incidence of the respiratory distress syndrome is higher in infants of diabetic mothers than other premature infants, and the disease may occur in the presence of reliable indicators of lung maturity. Other common causes of dyspnea include cardiomyopathy, congenital heart disease, wet lung syndrome, hyperviscosity syndrome, and persistence of fetal circulation. Echocardiography is the most valuable adjunct in differentiating cardiac from pulmonary problems.
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PMID:Infants of diabetic mothers: radiographic manifestations. 678 62

Two relatively large premature newborn infants with respiratory distress syndrome and ductus-dependent congenital heart disease were treated. In one, pharmacologic closure of the ductus arteriosus resulted in severe hypoxemia. The patency of the ductus as reestablished with the infusion of alprostadil (PGE1), until palliative surgery was performed. In the second case, persistent pulmonary hypertension was clinically suspected, and pharmacologic therapy was initiated without adequate cardiac evaluation. In large premature infants with respiratory distress syndrome, closure of the ductus arteriosus should not be attempted before ruling out the presence of ductus-dependent congenital heart disease. Furthermore, pharmacologic closure of ductus arteriosus can be reversed by the infusion of prostaglandin.
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PMID:Congenital heart disease and respiratory distress syndrome. Reversal of indomethacin closure of patent ductus arteriosus by prostaglandin therapy in a preterm infant. 688 10

Contrast echocardiography was used to detect atrial right-to-left shunts in 20 term infants; there were 10 cyanosed infants who had severe respiratory distress and signs of cardiac failure but no apparent congenital heart disease and 10 noncyanosed infants with no respiratory distress and no signs of cardiac failure who underwent exchange transfusion for hyperbilirubinemia. All of the venous contrast echocardiograms in the cyanosed infants showed an atrial right-to-left shunt with a dense contrast effect in the left atrium and aorta but little in the right ventricle. A sparse effect in the left atrium and a dense one in the right ventricle were recorded in infants with resolving respiratory distress and in three infants from the control group. The other seven infants in the control group showed no right-to-left shunt. Conventional M-mode echocardiograms showed no evidence of congenital heart disease in any of the 20 infants. This contrast echocardiographic technique was useful for demonstrating an atrial right-to-left shunt in cyanosed term infants with neonatal respiratory problems and signs of congestive failure but no apparent congenital heart disease.
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PMID:Atrial right-to-left shunt in infants with respiratory and cardiac distress but without congenital heart disease. Demonstration by contrast echocardiography. 706 22

Umbilical vascular catheters are often necessary in the care of critically ill neonates. Position of the catheter tip is usually determined by roentgenography. Location of the umbilical arterial or venous catheter was determined by 2-dimensional echocardio/aortography in 55 consecutive infants and was compared to localization by thoraco-abdominal roentgenography. Most of the infants (76%) had respiratory distress syndrome or congenital heart disease. Echocaortographic localization of the umbilical arterial catheter correlated very closely (N = 50, sr = .90) with roentgenographic determination. For localization of the tip of the umbilical venous catheters, echocardiography was more accurate than roentgenography (employing contrast echocardiography for confirmation of cardiac chamber position). Two-dimensional echocardio/aortographic localization of the tip of indwelling umbilical vascular catheters is as accurate as roentgenography in the arterial system and more accurate than x-ray for umbilical venous catheters. Echocardio/aortography is superior to roentgenography (in localizing the catheter tip) because it 1) avoids ionizing radiation, 2) makes positioning of the patient unnecessary, 3) allows visualization of the catheter in relation to cardiovascular structures, and 4) may allow demonstration of intraarterial thrombo-emboli.
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PMID:Umbilical vascular catheters: localization by two-dimensional echocardio/aortography. 711 Oct 58


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