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

The efficacy of treatment with spironolactone for congestive heart failure secondary to congenital heart disease was studied in 21 infants under 1 year of age. All received digoxin and chlorothiazide. In addition, group A (n = 10) was given supplements of potassium and group B (n = 11) received spironolactone. Daily clinical observations of vital signs, weight, hepatomegaly, and vomiting were recorded. Paired t test analysis showed significant reduction in liver size and weight (P less than 0.01) and respiratory rate (P less than 0.05) in group B, and less significant decreases in group A. The incidence of vomiting was slightly lower in group B. We conclude that the addition of spironolactone hastens and enhances the response to standard treatment with digoxin and chlorothiazide in infants with congestive heart failure.
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PMID:Spironolactone therapy in infants with congestive heart failure secondary to congenital heart disease. 703 14

The prognostic significance of various clinical and biochemical factors was investigated in 179 patients who had ingested more than 2 mg digitoxin. The mortality rate in this series was 17%. Supraventricular arrythmias had no influence on prognosis, but the death risk was higher in males and in patients with AV block. It increased with age, with digitoxin and potassium serum levels and even more with persistent hyperkalemia. Two other factors--previous heart disease and vomiting--were also significant in patients without heart block. Calculated on the basis of 4 clinical factors, the mortality rate varied from 2 to 74%. The death risk in acute digitalis poisoning can therefore be easily assessed simply from clinical criteria.
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PMID:[Prognostic factors in acute digitalis poisoning]. 713 39

To define the prevalence, frequency and characteristics of premature ventricular complexes (PVCs) in adults free of recognizable heart disease, we performed 24-hour ambulatory electrocardiography on 101 subjects (51 men and 50 women, mean age 48.8 years) in whom physical examination, chest x-ray, ECG, echocardiogram, maximal exercise stress test, right- and left-heart catheterization and coronary arteriography were normal. Thirty-nine subjects had at least 1 PVC/24 hours, but only four had more than 100 PVCs/24 hours and fewer than five had more than five PVCs in any given hour. The probability of having at least 1 PVC/24 hours increased with age (chi square = 11.789, p = 0.019). The number of PVCs/24 hours was also positively associated with age (4 = 0.33, p = 0.001). These was no consistent relationship between the presence or number of PVCs/24 hours and sex, blood pressure, weight, height, body mass index, serum potassium or calcium, cholesterol and triglyceride, hemoglobin, the ingestion of coffee, tea or alcohol, and cigarette smoking. Four subjects had multiform PVCs, two of whom had early PVCs.
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PMID:Premature ventricular complexes in the absence of identifiable heart disease. 722 80

The prognostic significance of various clinical and biochemical factors was investigated in 179 patients who had absorbed more than 2 mg of digitoxin. The mortality rate in this series was 17%. Supraventricular arrythmias had no influence on prognosis, but the death risk was higher in males and in patients with A-V block. It increased with age, with digitoxin and potassium serum levels and even more with persistent hyperkalemia. Two other factors, previous heart disease and vomiting, were also significant in patients without heart block. Calculated on the basis of 4 clinical factors, the mortality rate varied from 2 to 74%. The death risk in acute digitalis poisoning can therefore be easily assessed from simple clinical criteria.
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PMID:[Prognostic factors in acute digitalis poisoning (author's transl)]. 726 27

The tricyclic antidepressant drug imipramine may cause ventricular arrhythmias and intraventricular conduction disturbances in clinical use, particularly in patients who have ingested toxic doses or who have preexisting heart disease. Such effects have not been reported with doxepin, another tricylic antidepressant drug. In this study, the electrophysiologic effects of these two drugs on normal and depressed canine Purkinje fibers were examined. Fiber depression was achieved by elevating potassium concentration [K+] in the perfusate to 10 mM. In normal Purkinje fibers both imipramine and doxepin were tested in concentrations of 50, 250, 500 and 1,000 ng/ml. Both drugs had no effect on resting membrane potential but caused similar, dose-related reductions in action potential amplitude, maximal velocity of phage O depolarization (Vmax), action potential duration, conduction velocity and effective and functional refractory periods. Depressed fibers were exposed to only 250 ng/ml of imipramine and doxepin. Both drugs reduced conduction velocity and failed to alter the refractory periods of the depressed fiberts whereas at the same concentration in normal fibers they caused no change in conduction velocity but shortened the refractory periods. The other electrophysiologic effects of the two drugs on depressed fibers were similar to those on normal fibers. These observations indicate that depressed fibers are more sensitive than normal fibers to certain electrophysiologic effects of both imipramine and doxepin, and that the different incidence rates of arrhythmias and conduction disturbances associated with the clinical use of these drugs is probably not due to differences in their direct electrophysiologic effects on the ventricular specialized conduction system.
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PMID:Electrophysiologic effects of imipramine and doxepin on normal and depressed cardiac Purkinje fibers. 741 20

There are conflicting data regarding the impact of serum potassium and magnesium levels on susceptibility to ventricular premature complexes (VPCs) in the clinical setting. The associations of serum potassium and magnesium levels with the prevalence of complex or frequent (> 30/hour, multiform or repetitive) VPCs were examined after adjusting for age, sex, smoking, caffeinated coffee consumption, alcohol consumption, and left ventricular mass in Framingham Offspring Study subjects who were free of clinically apparent heart disease. There were 3,327 eligible subjects (mean age 44 years). Complex or frequent VPCs were present in 183 subjects (5.5%). When age-adjusted prevalences of complex or frequent VPCs were compared among quartiles of serum potassium and magnesium using a trend test, lower potassium (p = 0.002) and lower magnesium (p = 0.010) levels were associated with higher prevalence rates of arrhythmia. In logistic regression analyses that included potassium and magnesium simultaneously, potassium (p = 0.0021) and magnesium (p = 0.0311) levels were inversely associated with the occurrence of complex or frequent VPCs after adjustment for age, sex, smoking, coffee and alcohol consumption, diuretic use, and systolic blood pressure. These associations remained significant after accounting for left ventricular mass. A 1 SD decrement in potassium (0.48 mEq/liter) or magnesium (0.16 mEq/liter) level was associated with a 27% (95% confidence interval 6% to 51%) and a 20% (95% confidence interval 3% to 41%) greater odds of complex or frequent VPCs, respectively. Lower levels of serum potassium and magnesium were concurrently associated with higher prevalence rates of ventricular arrhythmias.
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PMID:The associations of levels of serum potassium and magnesium with ventricular premature complexes (the Framingham Heart Study). 751 45

Whether non-potassium-sparing diuretics (NPSD) increase the risk of sudden cardiac death in hypertensive patients has been vigorously debated. Diuretic-induced potassium or magnesium depletion leading to cardiac arrhythmias has been suggested as the underlying mechanism. A clear dose-response relationship between NPSD and the reduction in serum K+ exists. Data regarding serum Mg++ and intracellular K+ and Mg++ are too limited to allow conclusions. NPSD seem to increase the risk of ventricular arrhythmias among hypertensive patients with clinical evidence of heart disease, but the number of studies is small. The findings among patients without evidence of heart disease are less conclusive. The interpretation of the studies on electrolyte changes and arrhythmias following diuretic therapy is obscured by the fact that only a minority of studies included a randomly allocated placebo-treated control group. The large hypertension trials provide the strongest evidence that NPSD for hypertension may induce sudden death. Although blood pressure lowering may be expected to reduce the incidence of sudden cardiac death, the incidence in the NPSD group is similar to or even higher than that in the control group in 9 of 10 trials. We conclude that the beneficial effect of NPSD therapy for hypertension is partly offset by an excess risk of sudden death. Thus, alternative drugs, notably potassium-sparing diuretics or beta-blockers, could be preferred as antihypertensive drugs of first choice, although the efficacy of beta-blockers in older patients has recently been challenged.
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PMID:Do non-potassium-sparing diuretics increase the risk of sudden cardiac death in hypertensive patients? Recent evidence. 752 Aug 54

Ketamine has been used in patients with congenital heart disease and pulmonary hypertension with hypothetical controversy. Its direct effect on pulmonary arteries has not yet been clearly characterized. This in vitro study was performed to determine the direct vasoactive effects of ketamine on isolated rabbit pulmonary arteries. Responses of pulmonary artery rings from New Zealand white rabbits were assessed in the presence and absence of intact endothelium and with or without precontraction by norepinephrine (NE, 3 x 10(-6)M) or potassium chloride (KCl, 3 x 10(-2)M). Using a preparatory tissue bath, cumulative concentration response curves of ketamine were obtained at different concentrations (0.03, 0.1, 0.3, 1, 3 mM) after a period of stabilization. Ketamine caused a dose-related vasodilation on KCl-precontracted pulmonary arteries. It elicited almost 100% relaxation at a concentration of 3 mM. Ketamine also induced a dose-related vasodilation on NE-precontracted pulmonary arteries at a lesser degree. All of the effects were endothelium independent. In conclusion, ketamine has strong endothelium-independent, direct vasodilatory effects on isolated rabbit pulmonary arteries. Ketamine may act through Ca++ channel-blocking effect as well as inhibition of Ca++ release from sarcoplasmic reticulum.
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PMID:Vasoactive effects of ketamine on isolated rabbit pulmonary arteries. 770 29

Atrial fibrillation is one of the most common arrhythmias, leading at least in a subset of patients to severe symptoms (palpitations, weakness, syncope), and to hemodynamic impairment especially in the clinical setting of left ventricular dysfunction. Thus, in many cases restauration of sinus rhythm is indicated because of the negative effects of reduced cardiac output. Quinidine has been the first line drug for many years and has been proven to be highly effective especially when combined with Verapamil. But there is growing concern about using quinidine and other class I-anti-arrhythmic agents because of some hints in clinical trials for increased longterm mortality on these drugs. This study was undertaken to test the efficacy of Sotalol, a beta-blocker with additional strong class-III antiarrhythmic action, compared to a fixed combination of Quinidine and Verapamil for conversion of chronic atrial fibrillation and maintenance of sinus rhythm after medical or electrical cardioversion. To avoid early proarrhythmic effects, potassium values in the range of "high"-normal values (> 4.3 mval/L) were tried to be obtained. 82 patients were randomly assigned to receive either Sotalol or Quinidine/Verapamil. There was no difference between the groups as far as the underlying heart disease, duration of atrial fibrillation (mean 219 days) and other clinical features including echocardiographic parameters were concerned. The dose of the drug was weight-related individually adjusted, and the drug was continued thereafter. If sinus rhythm could not be established at that time, electric cardioversion was performed and the drug was continued in lower dosage thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Sotalol and quinidine/verapamil (Cordichin) in chronic atrial fibrillation--conversion and 12-month follow-up--a randomized comparison]. 784 39

Approximately 50 million Americans are at risk for cardiovascular and cerebrovascular disease as a result of hypertension (HTN). Education and treatment programs aimed at reducing HTN have been successful in decreasing morbidity and mortality from heart disease and strokes in recent years. In addition to pharmacologic means, prevention of HTN by lifestyle modifications has become a focus of public health education. One such modification, electrolyte therapy, has been associated with HTN control and is readily available through both dietary sources and supplementary tablets. This article presents an overview of electrolyte therapy as treatment for HTN, and reviews studies of the effects of sodium, potassium, and magnesium, and their combinations as treatment to reduce blood pressure. Strategies for nurses in educating the public on the effects of electrolytes and blood pressure are also discussed.
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PMID:Hypertension and electrolyte therapy. 797 36


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