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

Persistence of the fetal circulation is a recently recognized cause of severe cyanosis in newborn full term infants. Abnormally elevated pulmonary vascular resistance apparently stimulated by hypoxia, acidosis, and/or hyperviscosity results in cyanosis due to large right-to-left shunts through persistent fetal channels (patent foramen ovale and patent ductus arteriosus). Initial chest radiographs demonstrate clear lungs, decreased, normal, or mildly prominent pulmonary vascularity, and normal to moderately enlarged cardiac silhouettes. Angiocardiography, when required to rule out cyanotic congenital heart disease, demonstrates normal intracardiac anatomy, normal great vessel relationships, and right-to-left shunting across the patent foramen ovale and patent ductus arteriosus. Significant tricuspid regurgitation occurs in some of these infants, associated with variable right ventricular dilatation; the left ventricle is normal. The majority of babies with this condition ultimately survive. Treatment consists of intensive care including oxygen therapy and correction of acidosis. Vasodilators such as tolazoline may be helpful.
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PMID:Persistence of the fetal circulation: radiologic considerations. 40 2

Six unselected neonates with cyanotic congenital heart disease and life-threatening degrees of arterial oxygen desaturation have been managed by a protocol that includes administration of prostaglandin E1 (PGE1) and early Blalock-Taussig shunting. In 5 patients (seven paired observations) partial pressure of arterial oxygen (PaO2) rose from 19 mm Hg to a mean of 32.9 mm Hg within 20 minutes of initiation of PGE1 (0.1 to 0.2 microgram/kg/hr), infused intravenously or through an aortic catheter placed at ductal level or with both methods. The nonresponsive patient was older than the patients showing a positive response (1 month versus 24 to 96 hours). Following catheterization, immediate palliative operation including a Blalock-Taussig shunt was carried out. Although all had a satisfactory PaO2 (mean, 49 mm Hg) postoperatively, the PGE1-nonresponsive patient experienced serious intraoperative bradycardia, hypotension, and acidosis in contrast to the PGE1-responsive group. In this study, the use of PGE1 was not associated with any apparent serious side effects.
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PMID:The use of prostaglandin E1 and Blalock-Taussig shunts in neonates with cyanotic congenital heart disease. 45 28

The authors placed Swan-Ganz catheters in 11 preterm and 2 term infants with severe cardiopulmonary distress. The infants ranged in weight from 1100-4000 g. The procedure was performed in the neonatal ICU by jugular venous cutdown. Intracardiac pressures and oxygen saturations were measured in each chamber entered. The authors also evaluated the presence of right to left shunting through the patent ductus arteriosus and assessed the degree of pulmonary arterial hypertension. In 5 hypoxemic infants, the authors found a patent ductus arteriosus with pulmonary hypertension. Intermittent measurement of PAP served as a guide to further therapy. In 2 infants, the unexpected diagnosis of cyanotic congenital heart disease was made. The placement of flow directed pulmonary arterial catheters in critically ill infants can be performed safely at the bedside and can provide useful diagnostic and therapeutic information.
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PMID:Swan-Ganz catheterization in the critically ill newborn. 45 10

Three cases of brain abscess following an occlusion of the internal carotid artery were reported. Case 1: A 6-year-old girl with congenital heart disease was admitted with headache, disturbance of consciousness and left hemiparesis. Right carotid angiography revealed an occlusion of the right internal carotid artery. After 6 months, she was readmitted with high fever. CT scan revealed a low density area and a ring-like shadow at the same site of cerebral infarction. Case 2: A 69-year-old man was admitted in semicoma and with right hemiplegia. Left angiography revealed an occlusion of the left internal carotid artery. After 2 months, a brain abscess was noted in the infarcted area. Case 3: A 20-year-old man with congenital heart disease, was admitted due to headache, vomiting and high fever. CT scan revealed a brain abscess in the right frontal lobe. Carotid angiography showed bilateral internal carotid artery occlusion. We concluded that diminution of cerebral oxygen and encephalomalacia are predisposing factors to the evolution of brain abscess.
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PMID:[Brain abscess (Part 5)--Brain abscess following internal carotid occlusion (author's transl)]. 49 56

Dyspnea is the medical term for the patient's or subject's complaint of shortness of breath. It encompasses the respiratory discomfort experienced in many different diease states as well as the shortness of breath felt by a normal subject during or after strenuous exercise. Several parameters which have been shown to correlate with the onset or severity of dyspnea are described, including reduced vital capacity, the ratio of minute ventilation to vital capacity, reduced breathing reserve, the work of breathing, and the oxygen cost of breathing. Attempts at quantitation of dyspnea have usually consisted of measuring physiological parameters associated with the sensation, such as the "dyspneic index". The direct measurement of respiratory sensations using modern psycho-physical methods is at an early stage of development. Since the observation that the existence of dyspnea is often unrelated to any disturbance of arterial blood gas composition, it has been generally held that the mechanism of dyspnea is primarily neurophysiological. The neural pathways may conceptually be divided into those which transmit the "dyspnea message" from the respiratory apparatus to integrating centers in the brain, and those concerned with subsequently bringing the sensation to the level of consciousness. It seems likely that there is no single sensing mechanism and neural pathway which will be able to explain dyspnea in the diverse populations of patients and subjects who experience unpleasant respiratory sensations. Three theories concerning mechanisms of dyspnea are briefly described: "length-tension inappropriateness", vagal afferent activity especially from the J-receptors, and the recent concept of diaphragmatic fatigue. Some specific characteristics of the shortness of breath experienced in certain disease states are described, including chronic bronchitis and emphysema, bronchial asthma, pulmonary fibrosis and congestive heart disease.
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PMID:Dyspnea. 50 81

The continuous measurement of respiratory gas exchange under linearly increasing work load allows a relatively exact and reproducible localization of the point of rise of the ventilatory equivalent for oxygen (ASV). On the basis of the values of oxygen consumption (V(O2)(ASV)), oxygen pulse (O2-pulse(asv)) and relative ventilatory equivalent (Vetn. Equivalent(asv)/V(O2(ASV)), measured at the point ASV, it is possible to divide patients with different severity of heart disease into 4 groups of cardiac response to exercise: group I = normal, group II = diminished, group III = definitely limited and group IV = severely limited cardiocirculatory capacity. Simultaneous cardiac output measurements (thermodilution method) as well as the comparison with hemodynamic and angiographic data acquired during separate heart catheterization reveal good correlations between V(O2(ASV) and O2-pulse(asv) on the one hand and exercise values of cardiac output and stroke volume on the other (r = 0.82). Consequently, definite relations exist between the absolute ASV values as well as the group classification (I--IV) based on these and further heart catheterization data such as left bentricular (LV) enddiastolic pressure, LV ejection fraction, contraction pattern of the left ventricle and coronary angiogram respectively. The described method of measuring respiratory gas exchange under submaximal unsteady state bicycle exercise represents a reliable and rapid non-invasive stress test of cardiac pump function without putting too much strain on the heart patient as is frequently the case with the more familiar steady state (maximal) tests.
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PMID:[Non-invasive determination of cardiac pump function by respiratory gas exchange measurement during submaximal exercise -- comparison with hemodynamic (heart catheterisation) data (author's transl)]. 59 72

The relation between mixed venous oxygen saturation and cardiac index was determined in 11 children who underwent surgical treatment for congenital heart disease. The correlation between these two variables was found to be reliable (r = 0.78, P = 0.001). The simple determination of mixed venous oxygen saturation performance, particularly when sophisticated equipment for measuring cardiac output is not available.
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PMID:Importance of mixed venous oxygen saturation in the care of critically ill patients. 64 13

Two noninvasive methods of estimating arterial oxygenation were compared in a group of 48 infants ranging in birth weight from 870 to 4,000 gm, with diagnoses including apnea of prematurity, hyaline membrane disease, meconium aspiration, and congenital heart disease. Both transcutaneous oxygen measurements and ear oximetry gave reasonably accurate estimations of arterial oxygen levels within commonly used clinical ranges (PO2 50 to 70 mm Hg, arterial saturation 90 to 98%). Infants with shock demonstrated a wide range of values for transcutaneous oxygen levels, suggesting that this method has limited usefulness in this situation. Ear oximetry had limited ability to distinguish high, but safe, levels of arterial oxygen from excessively elevated levels. While neither method can be recommended for replacement of arterial oxygen sampling, both methods may be useful in a clinical setting if care is exercised in interpretation of the results and if the values obtained are checked against those from arterial blood.
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PMID:Noninvasive estimation of arterial oxygenation in newborn infants. 67 Nov 69

Patients with sick sinus syndrome have abnormalities of the sinoatrial node. We have measured the heart rate response to exercise in 7 patients with sick sinus syndrome without significant associated heart disease (group A) mean age 53.4 years, and compared this with 7 'normal' patients who were age-matched to within 5 years (group B), and 7 younger, well-trained subjects (group C). All underwent maximal treadmill exercise. Although maximum oxygen consumption (VO2max), 1/min per kg, in group A was not significantly different from group B (23.8 +/- 4.7 vs 19.9 +/- 0.8, mean +/- SE) maximum heart rate, beats/min, in group A was significantly lower than in group B (124 +/- 8.9 vs 163 +/- 3.7, P less than 0.001). At the end of 3 minutes of Bruce Stage I exercise, group A patients had a heart rate less than 130/minute (95% confidence level), whereas group B patients had heart rates greater than 134/minute. VO2 was plotted against heart rate (HR). Patients in group A had a significantly lower slope (deltaHR 5.20 +/- 0.33/delta1 ml VO2/kg per min, P less than 0.001). There was no significant difference in the slopes between groups A and C. On exercise patients with sick sinus syndrome have a normal VO2, but a reduced heart rate response as compared with age-matched normal patients. This abnormal heart rate response to the physiological stimulus of exercise may be of help in the evaluation of patients with sick sinus syndrome who do not have significant underlying heart disease.
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PMID:Characterisation of heart rate response to exercise in the sick sinus syndrome. 68 93

The effects of thoracic epidural analgesia (TEA) on the circulation at rest, during, and after physical exercise were investigated in 10 volunteers. At rest, TEA did not affect oxygen consumption (VO2) or cardiac output (Q), but heart rate (HR) was, increased by 7 beats/min, and stroke volume decreased correspondingly by 13 ml. Systolic arterial blood pressure was slightly reduced, but no other changes in systemic or pulmonary circulatory parameters were produced. TEA did not change VO2 during exercise, a 2.11/min reduction of Q being accompanied by a 4.2% increase of oxygen utilization coefficient. HR showed a relative reduction of about 10%. At moderate work loads during TEA, systemic arterial blood pressures were significantly lower than during control exercise. The resulting rate pressure product (RPP) was markedly reduced, while total peripheral resistance (TPR) remained unchanged. During recovery after the termination of exercise during TEA, VO2, Q, HR, RPP and TPR fell more rapidly towards values obtained at rest. From a clinical point of view the results support the safeness of TEA and also support its use in surgical patients with heart disease.
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PMID:The influence of thoracic epidural analgesia on the circulation at rest and during physical exercise in man. 69 17


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