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

Cold potassium cardioplegia was used in 78 consecutive patients undergoing correction of complex congenital heart disease between 1977 and 1982. Ages ranged from 4 weeks to 21 years (mean 6.7 years). The anatomical diagnoses were: tetralogy of Fallot (33), common AV canal (12), pulmonary atresia with ventricular septal defect (VSD) with previous shunts (5), transposition of great arteries (5), total anomalous pulmonary venous return (3), complex VSD (4), and complex anomalies (16). There were 3 deaths (4%). Electron microscopy was performed on biopsy specimens taken from the hypertrophied or volume-loaded cardiac chamber (1) before perfusion, (2) after cardioplegia, and (3) 30 minutes after cardioplegia. It showed near normal myocardial ultrastructure after cardioplegic arrest, however there was minimal mitochondrial and intracellular edema after reperfusion. Post-operatively, 80% of the patients had spontaneous defibrillation and only 10% required brief inotropic support. The operative exposure was excellent. No patient developed heart block during repair.
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PMID:Consecutive repair of complex congenital heart disease using hypothermic cardioplegic arrest--its results and ultrastructural study of the myocardium. 619 69

The value of red blood cell (RBC) sodium/potassium ratio in diagnosing digitalis toxicity was studied in 60 adult patients. The normal ratio was established in 34 healthy volunteers and in 10 patients with heart disease not receiving digoxin (group I). During chronic digoxin therapy, RBC sodium/potassium (Na/K) ratio and plasma digoxin were measured in 50 nontoxic patients (group II), in 10 toxic patients (group III), and in 9 of these 10 toxic patients after resolution of digoxin toxicity. Red cell sodium and RBC Na/K ratio in nontoxic patients were significantly greater than in the control group. Red cell sodium and the RBC Na/K ratio in toxic patients were significantly greater than in nontoxic patients. Despite significant group differences in these variables, however, there was considerable overlap among the subjects studied. After resolution of toxicity, red cell sodium and the RBC Na/K ratio fell to values indistinguishable from those in the nontoxic group. Although there was a statistically significant positive correlation between RBC Na/K ratio and plasma digoxin level, the RBC Na/K ratio had weak predictive value (33%) in determining digoxin toxicity. Plasma digoxin was a better predictor of digoxin toxicity (60%). The combination of plasma digoxin concentration and of RBC Na/K ratio had a higher calculated predictive value (75%), and may be more useful as an indicator of digoxin intoxication.
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PMID:Changes in red blood cell electrolyte concentrations in digitalis intoxication. 630 32

One hundred and eighty-one patients (101 men and 80 women) underwent 61 congenital and 120 acquired heart operations using cold blood potassium cardioplegia as the method of myocardial protection at Kagoshima University from August, 1978 to August, 1981. Hospital deaths occurred in 18 patients (9.8%), and 4 cases were late death (2.2%). Multivariate analysis revealed no significant relationship between type of heart disease and operative mortality or the occurrence of post-operative low output syndrome. To evaluate the superiority of cold blood cardioplegia for myocardial protection, we carried out 20 orthotopic heart transplants in dog; 16 transplanted grafts could maintain the circulation of recipient without cardiopulmonary bypass. Cardiac contractility following 90-minute ischemic time showed 97 to 100% of the control values without any inotropic drugs. These clinical and experimental findings suggest that cold blood potassium cardioplegia provides excellent myocardial protection during the ischemia of the heart.
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PMID:[Myocardial protection with cold blood potassium cardioplegia: experimental and clinical studies]. 637 82

Twenty patients aged 33 to 69 years with uncomplicated hypertension, no heart disease, and normal stress test results underwent ambulatory ECG monitoring a month after receiving placebo and two and four weeks after hydrochlorothiazide therapy. Serum potassium level (+/- SEM) averaged 4.4 +/- 0.09 mEq/L after the placebo trial and 3.4 +/- 0.07 and 3.0 +/- 0.06 mEq/L after two and four weeks of therapy, respectively. Sixteen patients had no arrhythmias. Four patients had 329 +/- 140 premature ventricular beats (PVBs) while receiving placebo and 341 +/- 203 and 315 +/- 158 PVBs per 24 hours after two and four weeks of therapy, respectively. Thus, patients with uncomplicated hypertension and no arrhythmias before diuretic therapy did not experience arrhythmias as a result of diuretic-induced hypokalemia of one month's duration. Patients with low-grade ventricular ectopy (VE) before therapy did not progress to higher grades of VE after diuretic treatment for four weeks.
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PMID:Nonarrhythmogenicity of diuretic-induced hypokalemia. Its evidence in patients with uncomplicated hypertension. 649 18

The purpose of this investigation was to evaluate the benefits and the potential risks of a very low calorie protein-diet in obese patients with metabolic abnormalities and at increased cardiovascular risk. To this end, the 420 kcal diet (with 50% of energy as protein) was administered for 10 days to 10 grossly obese subjects with glucose intolerance, hyperlipemia, arterial hypertension, ischemic cardiopathy and thrombotic risk related to high levels of fibrinogen factor VIII and reduced fibrinolytic activity. Weights loss averaged 360 g/day with a mean protein loss of 17 g/day occurring essentially during the very early phase of the diet. There was a rapid normalisation of blood pressure, plasma lipids and glycaemia. With the exception of a slightly negative potassium balance other ion remained in balance. There was no change in electrocardiogram, in parameters of blood coagulation or in hepatic and renal function. There was only a moderate increase in ketonaemia and plasma urate. It appears therefore, that an 8 to 10 day very low calorie protein-diet is well tolerated even in obese patients with increased cardiovascular risk, and that it corrects of several metabolic abnormalities without alteration in cardiac, hepatic or renal function.
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PMID:[Evaluation of tolerance of a modified protein diet in obese subjects]. 665 61

We studied 17 hypertensive men to determine the relationship of diuretic-induced hypokalemia to ventricular ectopic activity ( VEA ). Blood values and 24-hour ambulatory ECG monitoring were done at baseline, after diuretic and after serum potassium normalization. Two subgroups of patients were identified: group A patients were older (63.0 vs. 53.8 years) and had clinical evidence of organic heart disease compared to group B. Group A had increased frequency and complexity of VEA with diuretic which reverted to baseline after potassium normalization. Group B had no changes. Serum and intra-red blood cell potassium decrements were equal in both groups. We conclude that clinical in addition to laboratory observation should be used to identify those hypertensive patients most susceptible to diuretic-induced VEA and their serum potassium level should be normalized in order to minimize this complication.
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PMID:Potassium and diuretic-induced ventricular arrhythmias in ambulatory hypertensive patients. 672 1

1 The hypothesis that magnesium deficiency, linked to the magnesium content of drinking water, induces major tone increases in coronary arteries and enhances their responses to vasoactive agents to an extent sufficient to explain sudden death associated with ischaemic heart disease was examined in an in vitro preparation. 2 The spontaneous tone of cattle coronary arteries was not increased during a 30 min exposure to Mg2+-deficient Krebs until the mineral was omitted entirely from the bathing medium, and even then the observed increase was small. Only in strips maintained under extremely deficient conditions for a prolonged period, namely Mg2+ concentration of 0.2 mM and 0.0 mM for 3 h, was tone substantially greater than in controls in standard (1.2 mM) Mg2+-Krebs. 3 Responses to acetylcholine and to noradrenaline were not increased in Mg2+-free Krebs but those to potassium and to 5-hydroxytryptamine were enlarged over the lower parts of their concentration-response curves. Responses to potassium and to 5-hydroxytryptamine were also examined in Krebs containing very low concentration of Mg2+ (0.4 and 0.2 mM) and only modest increases in contraction size were detected. Increases in the Mg2+ concentration of the Krebs (to 4.8 mM) depressed responses to potassium and 5-hydroxytryptamine. 4 It is concluded that Mg2+ deficiency must be nearly complete (0.4-0.0 mM) to induce even moderate tone increases in coronary vessels, or to sensitize them to agonist responses, and that there is no reason to link marginally subnormal Mg2+ levels, occasionally reported in humans with heart disease, to marked changes in coronary dynamics.
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PMID:The effect of magnesium deficiency and excess on bovine coronary artery tone and responses to agonists. 685 Jan 65

Long-term thiazide diuretic therapy for hypertension is associated with disturbances in carbohydrate, lipid, and potassium metabolism that theoretically may have serious adverse effects. It appears that diuretic-induced hypokalemia interferes with production of insulin, producing mild elevations of blood glucose in nondiabetic patients. The insulinopenia worsens glucose metabolism in prediabetic and type II diabetic patients. Increases in low-density lipoprotein cholesterol, triglycerides, and the low-density lipoprotein/high-density lipoprotein cholesterol ratio are frequently seen following thiazide treatment of hypertension. These changes are more pronounced in younger patients. Decrements of serum potassium of 0.6 mEq/L are commonly observed with diuretic therapy. Usually, patients remain asymptomatic and no potassium replacement is necessary. In patients with underlying heart disease, however, alterations in potassium metabolism may produce increased frequency and complexity of ventricular ectopic activity. All these metabolic disturbances appear to be, in part, dose related, and there is currently no evidence that they have clinical significance.
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PMID:Thiazide-induced disturbances in carbohydrate, lipid, and potassium metabolism. 686 6

The purpose of this study was to investigate the changes in serum and urine potassium before, during, and after the administration of potassium cardioplegia using a solution containing 28 mEq/L of potassium chloride in 20 consecutive patients with acquired heart disease. The data obtained suggest that the concentration of potassium administered does not result in inordinately elevated serum potassium levels (peak, 4.6 +/- 0.18 mEq/L at 2 hours of multidose hypothermic potassium cardioplegia) during or after infusion. Additionally, the urinary excretion of potassium increased during infusion and eventually exceeded the amount of potassium infused. While hypothermic potassium cardioplegia appears to be a safe and efficient method of myocardial protection, continued surveillance of postoperative potassium levels remains necessary to detect obligatory urinary potassium excretion following cardiopulmonary bypass and operation.
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PMID:Systemic effects of multidose hypothermic potassium cardioplegia. 697 Oct 77

The results of measurements of body sodium, chloride and potassium by isotope dilution or whole body counting in patients with heart disease are reviewed. In patients with cardiac oedema exchangeable sodium and chloride are increased while body potassium tends to be decreased or normal. The findings in normonatraemic hypochloraemia, hypokalaemia and metabolic alkalosis, in diuretic hyponatraemia and in dilutional hyponatraemia are reviewed and their possible consequences in terms of changes in electrolyte gradients are discussed. The limitations and usefulness of measurements of exchangeable electrolytes in heart disease are mentioned.
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PMID:Exchangeable electrolytes in heart disease. 702 Mar 48


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