Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over the 3-year period from Jan. 1, 1986, through Dec. 31, 1988, we have implanted 101 automatic implantable cardioverter-defibrillators into patients with life-threatening ventricular arrhythmias. There were 82 male patients and 19 female patients. The mean age was 58 years with a range of 25 to 82 years. The indication for implantation was ventricular fibrillation in 89 patients and recurrent ventricular tachycardia in 12 patients. Seventy-seven patients had a history of prior myocardial infarction or coronary artery disease, or both. Eighteen patients had nonischemic cardiomyopathy. One patient had a prolonged QT syndrome and five patients had no evidence of preexisting structural heart disease. The mean injection fraction was 37% +/- 17%. Forty-one of the automatic implantable cardioverter-defibrillator implantations were associated with procedures necessitating cardiopulmonary bypass. The hospital mortality rate was 4% and the morbidity rate was 15%. The only statistical difference between those patients who did and did not have postoperative complications was a history of a prior myocardial infarction (90% versus 54%, p less than 0.05). Twenty percent of patients had new-onset postoperative atrial fibrillation after implantation of the device. Eleven percent of patients had sustained ventricular tachycardia postoperatively. Although there was a trend toward a higher complication/death rate in the patients whose automatic implantable cardioverter-defibrillator was inserted in association with cardiopulmonary bypass (24% versus 15%) and the occurrence of new-onset postoperative atrial fibrillation (27% versus 15%), these findings were not statistically significant. Automatic implantable cardioverter-defibrillator implantation with and without concomitant cardiopulmonary bypass is associated with a clinically important morbidity and mortality rate and development of postoperative arrhythmias.
J Thorac Cardiovasc Surg 1990 Sep
PMID:Short-term morbidity and mortality of implantation of automatic implantable cardioverter-defibrillator. 207 23

A retrospective review was made of 59 open lung biopsy specimens taken between 1984 and 1988 from children with congenital heart disease who were at risk for pulmonary vascular disease. Thirty-seven patients (ranging in age from 3.5 months to 23 years; median age, 14 months) had a primary left-to-right shunt (group A) and 22 patients (ages 1 to 15 years) had palliated cyanotic heart disease (group B). Forty-five of the lung biopsy specimens were requested as frozen sections. In both groups lung biopsy specimens were graded by the Heath-Edwards classification and correlated against preoperative hemodynamic data and outcome. In group A patients, carefully measured pulmonary vascular resistance and pulmonary/systemic vascular resistance ratio were reliable indicators of the structural state of the pulmonary vascular bed, obviating the need for routine lung biopsy. Pulmonary/systemic vascular resistance ratios greater than 0.45 accurately predicted all patients with irreversible pulmonary vascular disease, and pulmonary vascular resistance greater than 7 units.m2 accurately predicted all but one case of disease. Reversibility of pulmonary vascular changes is not synonymous with immediate postoperative survival: Fatal postoperative pulmonary hypertensive crises occurred in the presence of reversible pulmonary disease. Of those considered for the Fontan procedure, a mean pulmonary artery pressure less than 30 mm Hg and pulmonary vascular resistance less than 3 units.m2 correlated with Heath-Edwards grade I or normal lung biopsy results. In 36% of group B patients, reliable assessment of pulmonary vascular resistance could not be made, indicating a possible need for open lung biopsy procedures. When lung biopsy procedures were used as an isolated procedure, they were more dangerous (20% mortality, 13% morbidity) than previously reported. Intraoperative frozen sections are not adequate to accurately assess pulmonary vascular changes (9% error); serial paraffin sections are required.
J Thorac Cardiovasc Surg 1990 Mar
PMID:The clinical value and risks of lung biopsy in children with congenital heart disease. 210 1

The safety of encainide has been evaluated using retrospective analyses of the Bristol-Myers Supraventricular and Ventricular Arrhythmias data base and of the Post-Marketing Adverse Experience Report data and prospective analyses of the Cardiac Arrhythmia Suppression Trial (CAST), the Cardiac Arrhythmia Pilot Study (CAPS), and the Ventricular Tachycardia/Heart Disease and Boston studies. CAST, a randomized, placebo-controlled study in patients with a history of myocardial infarction with asymptomatic or minimally symptomatic ventricular arrhythmias, showed that sudden death or nonfatal cardiac arrest occurred more frequently on encainide (24/418, 5.7%) than on placebo (7/416, 1.7%). The highest sudden death/cardiac arrest rates were found in patients with a left ventricular ejection fraction of less than 0.30, those with a ventricular premature beat count of more than 50/hr and those with a myocardial infarction of more than 90 days. Similar sudden death/cardiac arrest rates were seen in the flecainide-treated group of the study but not in the moricizine-treated group. A retrospective analysis of the data collected from a similar cohort of patients in the Bristol-Myers data base showed a 1-year cumulative incidence of 10.2% in patients with a history of myocardial infarction. A retrospective analysis of mortality data in patients with supraventricular arrhythmias (301 patients) showed this to be slightly lower than in a matched sample of the general U.S. population. The sudden death mortality in the Ventricular Tachycardia/Heart Disease and Boston studies were similar to those reported with other antiarrhythmic agents. Abnormal laboratory findings caused four patients to be discontinued prematurely, but there have been no reported cases of any blood dyscrasias. Thus, there are currently no data showing that patients with symptomatic reentry supraventricular and life-threatening ventricular arrhythmias are at increased risk with encainide therapy. Encainide should be reserved for those patients who are refractory or intolerant to other antiarrhythmic agents. Encainide is not indicated in patients with symptomatic ventricular arrhythmias and structural heart disease. In patients without structural heart disease and symptomatic ventricular arrhythmias, the benefit and risks of encainide therapy should be carefully considered before it is prescribed.
Cardiovasc Drugs Ther 1990 Jun
PMID:Encainide--an updated safety profile. 212 37

A 14-year-old boy without overt heart disease underwent encircling ventriculotomy and cryoablation because of ventricular tachycardia resistant to antiarrhythmic therapy. Resection of the right ventricular wall with the origin of the ventricular tachycardia was performed on the basis of information obtained by epicardial mapping at operation, and histological examination showed unique findings of remarkable fatty infiltration and lymphocytic myocarditis.
Am J Cardiovasc Pathol 1990
PMID:A patient with ventricular tachycardia showing remarkable fatty infiltration and lymphocytic myocarditis in the right ventricular wall. 212 76

Therapeutic transcatheter closure with Gianturco-type steel coils has been applied to a variety of vascular communications in children with congenital heart disease. Vessel closure depends upon successful thrombus formation around the coil. Since systemic anticoagulation with heparin is commonly used during catheterization and cardiac surgery, we studied the effect of systemic heparinization on the efficiency of vessel occlusion by coil embolization in lambs. Catheters inserted in femoral arteries were used to arteriographically locate and size 36 systemic arteries in 9 lambs weighing 4.2 to 7.4 kg. Twenty-four vessels were embolized prior to heparinization with 400 u/kg heparin, IV. Effective anticoagulation was demonstrated by post-heparin activated clotting time (ACT) values greater than 300 sec. Seven vessels (29%) were not successfully coil-embolized because of inadequate coil position or distant embolization of the coil; 17 (71%) of these vessels were shown to be successfully occluded by arteriography 6 to 77 min later. After a period of systemic heparinization ranging from 71 to 159 min, 9/17 arteries remained occluded, 7/17 could not be examined arteriographically due to early demise of the animal, and only 1/17 showed recanalization. A second group of 12 vessels were embolized after heparinization. Eight (75%) were successfully occluded, and 4 (25%) were not successfully coil-embolized because of inadequate coil position or coil embolization to distant arteries. We conclude that systemic heparinization had no measurable effect on occlusion rates in coil-embolized systemic arteries in the lamb. These data support the use of systemic heparinization, when indicated, during or following therapeutic coil embolization in children.
Cathet Cardiovasc Diagn 1990 Aug
PMID:Systemic heparinization does not prevent clot formation in coil embolization. 214 74

Right heart failure in patients with carcinoid heart disease is a serious prognostic sign. Consideration and adequate timing of valvular operations seem essential for the postoperative outcome. Without any relation to duration or progression of the metastasizing tumor disease, right heart failure developed and increased rapidly for a period of 12 to 17 months in four patients with classic carcinoid syndrome. Invasive hemodynamic and cardiac ultrasound investigations revealed severe carcinoid heart disease, and medical decompensation treatment gradually failed. Tricuspid and pulmonic valve replacement operations resulted in dramatic improvement in three of the patients, and these patients were still free of cardiac symptoms 10, 12, and 38 months postoperatively. One patient died 5 days postoperatively probably of septicemia. The preoperative and postoperative development of the cardiac disease is evaluated clinically, by cardiac ultrasound and plasma atrial natriuretic peptide concentrations, and related to the tumor disease. Surgical anatomy and operative technique are reported, and the beneficial value of prophylactic treatment of the effects of tumor-released vasoactive substances by a somatostatin analog is emphasized.
J Thorac Cardiovasc Surg 1990 Oct
PMID:Surgical treatment of carcinoid heart disease. 214 80

Plasma concentrations of atrial natriuretic peptide (ANP) were measured in 25 patients with organic heart disease during physical exercise (baseline and maximum workload) in order to investigate if the responsiveness of stimulated release of ANP is still preserved in patients with heart failure and chronically elevated cardiac filling pressures. Since plasma concentrations of ANP are known to be positively correlated with mean right atrial pressures (RAP), the patients were divided into two groups according to their resting RAP; group I; those with normal RAP (less than or equal to 5 mmHg; n = 11); group II; those with elevated RAP (greater than 5 mmHg; n = 14). Under baseline conditions RAP (3.2 +/- 0.4 mmHg vs. 8.8 +/- 0.7 mmHg; p less than 0.01), pulmonary artery diastolic pressure (PADP; 9.5 +/- 0.9 mmHg vs. 17.9 +/- 1.8 pg/ml; p less than 0.01), and plasma ANP levels (128 +/- 19 pg/ml vs. 204 +/- 60 pg/ml; p less than 0.06) were significantly lower in group I than in group II. Both at rest and during maximum workload, plasma ANP concentrations were closely related to RAP, PADP, and mean pulmonary artery pressures in both groups. During exercise in all patients, RAP and PADP significantly increased, as well as plasma ANP concentrations. Similar increments in plasma ANP concentrations were accompanied by greater changes in RAP in group II than in group I. However, identical changes in PADP lead to identical increments in plasma ANP concentrations in both groups. In conclusion, the increments of plasma ANP concentrations during physical exercise were independent of the resting values of PADP, RAP, and plasma ANP concentrations.(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiovasc Drugs Ther 1990 Feb
PMID:Plasma concentrations of atrial natriuretic peptide during physical exercise in patients with congestive heart failure. 214 11

Men and women have similar mortality and long-term survival after coronary artery bypass surgery. When compared with men, however, women have less favorable outcomes in graft patency, perioperative infarction, relief of symptoms, and physical activity levels. Finally, little information is available about women's employment and psychosocial outcomes, making comparisons between genders speculative at best. We suggest that prospective studies of bypass surgery in women include a thorough assessment of key variables such as symptoms, activity, and return to employment, housework, or both, before and after surgery. It is essential to examine the immediate postoperative activity level of female bypass surgery patients for information on resumption of household activities. This information is critical for successful rehabilitation. Whether the term "return to work" includes household activities must be addressed. This will allow researchers to use the same outcome when discussing "gainfully employed or active." For comparisons between the sexes, women of all age groups must be studied, since age clearly affects outcome. The effect of repeated surgeries must also be examined. As more women survive the first bypass, how they fare in subsequent operations will require study. The need to examine benefits of surgical versus medical treatment is critical. A primary issue is whether women are referred for surgical intervention later than men, and if so, is this a reason for their relatively poor outcome after this procedure? Furthermore, we predict that the multiple roles now assumed by women will influence incidence of heart disease and how women fare after surgical intervention.(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiovasc Nurs
PMID:Women undergoing coronary artery bypass surgery: physiological and psychosocial perspectives. 218 93

Many advances have now been made in understanding the early natural history of coronary artery disease and essential hypertension, an understanding that these diseases begin in childhood and that CVD relates to clinical cardiovascular risk factors. Methods have now been established to determine risk factors in the pediatric age and, with a family history, to begin to identify children at potential risk for premature heart disease. Advances have also been made in developing models for intervention and beginning prevention through both high-risk and population strategies directed at schoolchildren. Obviously, both approaches are needed and complement each other. An impressive future is ahead for effective preventive cardiology beginning with children by incorporation of cardiovascular health education and health promotion in elementary schools. Applying behavioral concepts to intervention programs can strengthen their chances of success. The overall good of having children adopt healthy life-styles with an understanding of their necessity is now attainable. It will be the responsibility of physicians to guide the direction of programs being promoted for children.
Cardiovasc Clin 1990
PMID:Prevention of adult heart disease beginning in the pediatric age. 218 63

Atrial septal defects may have clinical consequences regardless of their size. We evaluated the incidence of clinically unsuspected atrial septal defects in 4,411 consecutive adult patients referred for cardiac catheterization by the previously validated method of inspired hydrogen appearance time. Oximetry was performed only when an abnormally short inspired hydrogen appearance time was measured. Seventy-five patients (1.7%) were discovered to have a left-to-right shunt by this method. The shunting was at the atrial level in 65 patients. Thirty-five of these patients (0.8% of all catheterizations) were not suspected of having any form of congenital heart disease by history, physical examination, chest X-ray, EKG, or echocardiogram. In 19 cases there was no significant oxygen step-up and the diagnosis would have been missed by oximetry. The atrial septum was explored during open heart surgery in 7 patients. Atrial septal defects were detected and closed in all. Four patients had the finding confirmed by echocardiography after the catheterization. Small atrial septal defects are frequently not detected by clinical evaluation, noninvasive testing, or oximetry and are easily detected by the rapid, safe, and accurate method of inspired hydrogen appearance time.
Cathet Cardiovasc Diagn 1990 Jun
PMID:Diagnosis of unexpected atrial septal defect by inspired hydrogen appearance time in adult patients referred for cardiac catheterization. 222 36


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