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

In 48 individuals (age 1 day to 13 years) with congenital heart disease, blood oxygen transport function was studied in order to evaluate adaptive changes in shunt hypoxemia and to investigate the in vivo regulation of erythrocyte 2, 3-diphosphoglycerate concentration (RBC 2, 3-DPG) in the presence of fetal hemoglobin (HbF). Arterial pO2 and oxygen content, oxygen capacity, acid base status, oxygen affinity, HbF fraction, plasma pH, red cell pH, and RBC 2, 3-DPG were determined. During the first 50 days of life values of standard P50 (stdP50) (37, pH 7.4), actual in vivo P50 (actP50), RBC 2, 3-DPG, O2 capacity, arterial plasma pH, and red cell pH were scattered around the normal range, although tending to low values for stdP50 and arterial plasma pH and to high values for O2 capacity. After the third month, stdP50 actP50, RBC 2, 3-DPG, O2 capacity, and red cell pH were found to be elevated. Plasma pH and actP50 were scattered around the normal range (Figs. 1 and 2). Intraerythrocytic pH in hypoxemic infants was increased compared with normal children when related to plasma pH (Fig. 3). A close to normal intraerythrocytic pH was therefore found in the hypoxemic infants with low plasma pH, and an increased intraerythrocytic pH in the hypoxemic children with normal plasma pH (Fig. 1). A significant negative correlation exists between erythrocyte H+ ion and 2, 3-DPG concentration (Fig. 5); regression constants derived from data at high (mean 47%) and low (mean 9%) fractions of HbF are not significantly different (Regression Equations 8 and 11 in Table 1). Thus, the known difference in 2, 3-DPG binding to fetal or adult deoxyhemoglobin does not measurably influence the erythrocyte 2, 3-DPG concentration, indicating that in vivo the 2, 3-DPG synthesis in hypoxia is virtually regulated by the erythrocyte pH, which in turn is determined by plasma pH and the oxygenation state of hemoglobin.
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PMID:Oxygen transport in congenital heart disease: influence of fetal hemoglobin, red cell pH, and 2,3-diphosphoglycerate. 0 99

The authors present two cases of unsuccessful hanging which hat lead to a very severe neurological picture and especially the very rapid appearance of acute pulmonary edema resulting in a vertiable flooding of the alveoli. The victims, aged respectively 21 and 15 years, were free from any pre-existing cardiopathy. These cases of pulmonary edema, resistant to depletive therapy (bleeding, diuretics) and cardiotonic agents (Cedilanid) should only be jugulated after a one hour session of oxygen at 3 ATA with a baro-assisted respirator. The following are discussed with reference to these two cases: 1- The mode of occurrence of this type of pulmonary edema: - implication of sub-acute anoxic cerebral damage; - high negative alveolar pressures owing to a gasp-type ventilation with a closed glottis. 2- The opportunity for the very early treatment of the oxygen deficit contracted by the brain and myocardium.
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PMID:[Pulmonary edema in hangings]. 0 73

The effects of a new beta-blocking agent (CI 778) were studied in 8 patients in whom non-invasive data suggested absence of significant organic heart disease. The left ventricular hemodynamics at rest and during bicycle exercise were measured before and after intravenous administration of 0,9 mg/kg body weight. With exercise there was a significantly smaller increment of heart rate (18%) after beta-blockade. Stroke volume index at rest was significantly lower (17%) after administration of CI 775; the difference disappeared with exercise. There was an 18% decrease of the resting cardiac output after CI 775 and a 23% decrease with exercise. Significant changes at rest and with exercise indicating a negative inotropic action of CI 775 were noted for max dP/dt and peak measured velocity of circumferential fiber shortening (Vpm). The left ventricular enddiastolic pressure with exercise increased with borderline significance by 41% after CI 775. Also left ventricular stroke work index at rest and with exercise decreased moderately (n.s.), the systemic arterial resistance changed to the same extent as cardiac output decreased. Also the arterial venous oxygen difference increased after CI 775 only according to the decrease of cardiac output. The data suggest the hemodynamic properties of CI 775 are located between propranolol and practolol within the spectrum of available beta-blockers.
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PMID:[Effects of a new beta-blocker (CI 775) on left ventricular hemodynamics at rest and during exercise (author's transl)]. 3 26

Prostaglandin E2 (PGE2) has been used to maintain patency of the ductus arteriosus in four neonates with cyanotic congenital heart disease due to obstructive right heart malformations. PGE2 was infused prior to surgery, and in three patients, during surgery until a satisfactory aorto-pulmonary shunt was established. PGE2 produced consistently an immediate and persistent rise in arterial oxygen saturation, which could be ascribed to dilation of the ductus arteriosus. No major side effects occurred, except for pyrexia in two infants. All patients recovered well from surgery. We propose this treatment as preparation for surgery in any infant with congenital heart defects and ductus-dependent pulmonary blood flow. The same treatment may be useful preoperatively in patients with aortic interruption who also depend on continued patency of the ductus for blood supply to the lower half of the body.
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PMID:E-type prostaglandins: a new emergency therapy for certain cyanotic congenital heart malformations. 5 43

Prostaglandin-E (PGE) infusions have been used in an attempt to increase ductal patency in 11 infants aged one to 99 days with cyanotic heart disease. PGE1 was used in nine infants and PGE2 in two. Five patients had pulmonary atresia, four extreme pulmonary stenosis, one Ebstein's anomaly and one simple transposition of the great arteries. All but the oldest infant showed a satisfactory increase in oxygen saturation (average 36%) attributed to dilatation of the ductus. The failure in one infant may have been due largely to hypoplasia of the left pulmonary artery. The only important side effect was apnea in one infant receiving PGE2. The efficacy of this form of treatment is confirmed in infants dependent on ductal patency for survival. PGE is an important asset in saving the lives of neonates requiring an aorticopulmonary shunt operation. The recommended starting dose is 0.1 mug/kg/min of PGE1 given by constant infusion.
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PMID:Palliation of cyanotic congenital heart disease in infancy with E-type prostaglandins. 6 17

Uncontrolled hypertension increases the workload of the left ventricle causing the development of hypertrophy and an increase in myocardial oxygen consumption that may precipitate ischemia because of inadequate oxygen delivery related to accelerated coronary atherosclerosis. Control of the hypertension should prevent the further development of hypertrophy, delay the development of fibrosis and possibly also slow the rate of development of atherosclerosis. Furthermore, when myocardial function is impaired because of hypertrophy or other myocardial diseases, the level of blood pressure becomes an important determinant of left ventricular performance. Regardless of the level of arterial pressure, vasodilator drugs that lower arterial pressure may result in marked improvement in left ventricular performance and relief of symptoms of left ventricular failure. Therefore, control of blood pressure in the presence of heart disease may involve treatment of normotensive patients to bring them into a lower normotensive range as well as the more traditional treatment of hypertensives to bring them into the normotensive range. Although this scenario is consistent with conventional wisdom and clinical experience, intricacies of the relationship between hypertension, hypertrophy, myocardial oxygen delivery, atherosclerosis and intramyocardial blood flow distribution remain poorly understood. Until these aspects of the natural history of heart disease are better worked out therapy will remain largely empirical.
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PMID:Heart disease in the hypertensive patient. 14 Feb 80

Myocardial ischemia occurs when there is an imbalance between myocardial oxygen demand and supply, and it is usually entirely or predominantly subendocardial. Animal experiments have shown that relative subendocardial ischemia (a reduced inner:outer flow ratio) can be predicted quite accurately from the ratio of two pressure-time areas:DPTI, the area between diastolic aortic and left ventricular pressures, and SPTI, the area beneath the systolic left ventricular pressure curve. Although the importance of relating supply and demand is obvious, care is needed in applying the results of these animal experiments to man. Recent work has shown that the critical DPTI:SPTI ratio below which subendocardial ischemia occurs is about 0.4 to 0.5 rather than 0.7 to 0.8, as originally reported. On the other hand, the critical ratio may be raised to an unknown extent by myocardial edema or hypertrophy, or by thickened or narrowed coronary arteries. Furthermore, the critical ratio is not independent of absolute coronary diastolic pressure: It is much lower than 0.4 when coronary pressures are high, perhaps because intramyocardial diastolic pressures are much higher than once thought. Further work is required to allow an important physiologic concept to be used in making decisions about patients with heart disease.
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PMID:The myocardial supply:demand ratio--a critical review. 14 25

The acute effects of an injection of contrast material (Renovist) on intraerythrocytic and extracellular pH was studied at cardiac catheterization in 72 patients with congenital heart disease. A decrease in mean extracellular (plasma) pH (7.444 plus or minus .006 to 7.419 plus or minus 0.009) and an increase in mean intraerythrocytic pH (7.204 plus or minus .005 to 7.232 plus or minus .006) were observed within minutes after injection (p smaller than .01). In 17/72 patients, simultaneous measurements of oxygen affinity for hemoglobin as characterized by P50 (oxygen tension at 50% O-2 saturation) corrected to in vivo arterial pH decreased from a mean of 26.4 to 25.2 mm Hg (p smaller than .01). It is postulated that the acute increase in intraerythrocyte pH and increased affinity of hemoglobin for oxygen are due to a decrease in intracellular hydrogen ion concentration induced by the increase in plasma osmolality with subsequent shift of hemoglobin oxygen equilibrium via the Bohr effect.
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PMID:The relationship between angiography, intraerythrocytic pH and hemoglobin oxygen equilibrium. 23 27

Differential diagnosis of cyanosis in the neonate is difficult and cardiac catheterisation may be required for a correct diagnosis. It has been suggested that the response of PaO2 to continuous positive airway pressure (CPAP) with 100% oxygen may be useful. The purpose of this study was to test further this hypothesis by studying all neonates investigated for cyanosis with a PaO2 less than or equal to 50 torr in 0-8 to 1-0 F1O2. Arterial blood samples were obtained in an F1O2 of 0-21-0-4 and 0-8-1-0, and in an F1O2 of 0-8-1-0 with 8-10 cm CPAP, and were analysed for PaO2, PaCO2, and pH, bicarbonate being calculated. The final diagnoses were congenital heart disease (CHD) 21 cases, pulmonary parenchymal disease (PD) 10 cases, and persistent fetal circulation (PFC) 3 cases. No significant difference in pH, bicarbonate, or PaCO2 was observed among the three groups or with CPAP. In the CHD and PFC infants CPAP produced no significant change in PaO2. In the PD babies PaO2 increased by an average of 33 torr (P less than 0-05). Despite thus attaining statistical significance 2 PD infants had no increase in PaO2 with CPAP. An increase of PaO2 greater than 10 torr with CPAP suggests PD, and a nonsignificant increase in PaO2 does not rule out PD. Irrespective of initial PaO2, final PaO2 in 0-8-1-0 F1O2 with CPAP greater than 50 torr suggests PD, and less than 50 torr suggests CHD. The results indicate that CPAP may be used as an adjunct in differentiating cardiac from pulmonary disease.
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PMID:Usefulness of continuous positive airway pressure in differential diagnosis of cardiac from pulmonary cyanosis in newborn infants. 35 48

In 31 patients with congenital or acquired heart disease, functional class III NYHAC, effects of Sulfentanil (R 30730)--a new analgetic--on hemodynamics, inotropic state and myocardial oxygen consumption have been investigated intraoperatively, during extracorporeal circulation and postoperatively. Results are compared to a fentanyl-group and control-group. There was almost no change in cardiac index and stroke index. In comparison to fentanyl (dose relation fentanyl: sulfentanil = 10:1) there was a more pronounced decrease in aterial pressure, left ventricular pressure, peak dp/dt and myocardial oxygen consumption (-20%) in the sulfentanil-group. In contrast to the fentanyl-group there was, however, no increase in total pulmonary resistance with sulfentanil.
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PMID:[Comparison of cardiac and vascular effects of sulfentanil (R 30730), a new analgetic, and fentanyl (author's transl)]. 36 2


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