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

A 62-year-old woman, long suspected of having heart disease, was admitted to our hospital for thorough examination. Her hemoglobin level was 17.7 g/dl and her 2.3-DPG level was 8.90 microM/ml RBC. The patient proved to have polycythemia, hemoglobin Kansas, and diabetes mellitus. To our knowledge, this is the third case of hemoglobin Kansas in the world.
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PMID:Hemoglobin Kansas found in a patient with polycythemia. 145 81

Thirty-one patients with chronic severe anemia of more than 3 months' duration (hemoglobin less than 7 gm/dl) and no underlying heart disease were studied by means of M-mode, two-dimensional, and Doppler echocardiography; an equal number of normal control subjects was also studied. There are conflicting reports regarding the influence of chronic severe anemia on systolic myocardial function, but diastolic function has not been systematically assessed. It is also uncertain whether anemia alone can cause heart failure in a structurally normal heart. We therefore performed a detailed study of echocardiographic indexes of systolic and diastolic left ventricular function in these patients. We found that patients with anemia have significantly faster heart rates and lower diastolic and mean blood pressures than normal subjects. They also have a significantly elevated cardiac output and stroke volume and larger left ventricles. Left ventricular contractility, assessed by the end-systolic stress-dimension relationship, was enhanced. There was no systematic evidence of diastolic dysfunction by Doppler assessment of mitral inflow. There was also no clinical evidence of congestive heart failure. We conclude that chronic severe anemia leads to a hyperdynamic state with systolic hyperfunction and no impairment of diastolic function. Anemia does not lead to congestive heart failure in the absence of underlying heart disease.
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PMID:Noninvasive assessment of systolic and diastolic left ventricular function in patients with chronic severe anemia: a combined M-mode, two-dimensional, and Doppler echocardiographic study. 146 8

A 13-mo-old child is brought to his pediatrician following sudden onset of left-sided hemiplegia. The pediatrician accompanies the child and family to the emergency room. The pediatrician has been following the child, who has a diagnosis of possible cyanotic congenital heart disease. The child has never been known to have had a hypercyanotic episode. Oxygen saturation determinations by pulsed oximeter had been in the range of 84% to 88%. On one occasion, when the child was very upset, a reading of 78% was observed. At his 1-year visit, his hemoglobin level was 13 g/dL. On admission to the emergency department, a computed tomographic scan of the head was ordered. It demonstrated a right-sided nonhemorrhagic cerebrovascular lesion.
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PMID:Complications of polycythemia in patients who have cyanotic congenital heart disease. 147 May 71

To date, attempted balloon dilation of stenotic standard Blalock-Taussig shunts has been largely disappointing. It has been suggested that this may be due to the use of balloons of insufficient diameter. Balloon dilation of stenotic Blalock-Taussig shunts was attempted with use of relatively large balloons in five patients (11 to 67 months old) with cyanotic heart disease who were becoming progressively cyanotic and polycythemic (hemoglobin 17.9 +/- 1.1 g/dl) because of discrete shunt stenosis at the site of pulmonary anastomosis. Balloon diameters selected were equal to or within 1 mm of the unobstructed proximal shunt diameter. Before balloon dilation the diameter at the site of the stenosis was 2.8 +/- 0.8 mm (range 1.7 to 4); after balloon dilation it was 5.7 +/- 1.1 mm (range 4.5 to 7.5). The diameter increased in all patients (range 2.0 to 3.5 mm); the mean increase was 2.8 +/- 0.2 mm (p less than 0.005). Expressed as a percent, the increase in diameter at the stenosis ranged from 80% to 182.4% (mean 108.2 +/- 16.8%). Before balloon dilation the systemic oxygen saturation was 72.8 +/- 9.2% (range 55% to 80%) and after balloon dilation it was 83.6 +/- 2.9% (range 80% to 87%). A satisfactory increase (range 6% to 25%) in blood oxygen saturation was seen in all patients; the mean increase was 10.8 +/- 3.2% (p less than 0.01). At follow-up, the oxygen saturation by pulse oximetry was 85.8 +/- 2.9% (mean 5.8 +/- 1.7 months after balloon dilation) and the hemoglobin was 15.6 +/- 1.9 g/dl (mean 6.6 +/- 1.5 months after balloon dilation).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Percutaneous transluminal balloon angioplasty of stenotic standard Blalock-Taussig shunts: effect on choice of initial palliation in cyanotic congenital heart disease. 171 40

The effect of recombinant human growth hormone on children with Down syndrome who had growth retardation and microcephaly was examined. Thirteen children with trisomy 21 without congenital heart disease who were short for age (-1.19 to -3.5 standard deviation score) and microcephalic (-1.58 to -6.60 standard deviation score) were given recombinant human growth hormone, 0.1 mg/kg subcutaneously, 3 days a week for 1 year. Before treatment, peak serum growth hormone concentrations were less than 10 micrograms/L after levodopa and clonidine stimulation tests in five patients, after clonidine in three patients, and after levodopa in three patients. Three patients had nocturnal integrated growth hormone concentrations of 0.5, 1.5 and 0.65 micrograms/L, respectively. The mean growth rate before treatment was 5.4 +/- 1.6 cm/yr and increased to 12.2 +/- 3.2 cm/yr (p less than 0.001) after 12 months of recombinant human growth hormone treatment. The mean head circumference standard deviation score before treatment was -3.1 +/- 1.3 and increased to -2.3 +/- 1.2 (p less than 0.001) at 12 months. Bone age before and 1 year after treatment increased in correspondence with chronologic age. Plasma hemoglobin A1c concentration was normal during treatment with recombinant human growth hormone. The mean plasma concentrations of insulin-like growth factor I at baseline and at 12 months were 0.54 +/- 0.19 U/ml and 1.25 +/- 0.97 U/ml, respectively (p less than 0.02). We conclude that recombinant human growth hormone therapy can result in a significant increase in annual growth rate and head circumference in children with Down syndrome, without significant side effects.
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PMID:Treatment of children with Down syndrome and growth retardation with recombinant human growth hormone. 153 64

In right-to-left (RL) intracardiac shunting, the venous blood that is added to the oxygenated blood in the left heart is both poor in oxygen and rich in carbon dioxide. Thus, any given degree of arterial desaturation is associated with an obligatory arterial to end-tidal carbon dioxide tension difference (PaCO2--PETCO2). This paper presents a theoretical analysis of the relationship between PaCO2-PETCO2 and arterial hemoglobin saturation (SaO2) in cyanotic heart disease. Using the shunt equation as a starting point, a curvilinear, negative correlation between PaCO2-PETCO2 and SaO2 can be demonstrated. The slope of the regression of PaCO2--PETCO2 against SaO2 is shown to be positively correlated to Hb concentration, PaCO2, and the respiratory quotient R. The slope of the regression is also slightly increased at relatively high SaO2s and at high inspired oxygen fractions, although these latter factors are of lesser significance. However, in addition to the above primary effects of RL shunting, secondary effects may occur if pulmonary perfusion is reduced sufficiently to cause "alveolar hypoperfusion," which also creates an alveolar dead space. Primary and secondary effects are additive. This theoretical analysis is illustrated with a study of 27 children with congenital heart disease. Their lungs were ventilated with a Servoventilator 900 C, and carbon dioxide single-breath tests were obtained on-line with the use of a computerized system based on the Siemens-Elema carbon dioxide analyzer 930. Blood was sampled for PaCO2 measurement and arterial Hb saturation was measured by pulse oximetry (SpO2).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The relationship between the arterial to end-tidal PCO2 difference and hemoglobin saturation in patients with congenital heart disease. 190 12

Hemochromatosis was recognized as an iron-storage disease for 50 years before it was proposed to treat it by removing hemoglobin. Davis and Arrowsmith are credited with the first report that demonstrated its value. Larger series have provided statistically valid evidence of improved quality of life and increased longevity. The earlier the disease is discovered, the less risk of morbidity and mortality. Screening tests (serum iron, total iron-binding capacity, serum ferritin) are recommended for all blood relatives of index cases of this hereditary disease and for all clinics where complications of hemochromatosis may be treated: liver disorder however mild, diabetes mellitus, heart disease, arthropathies, sterility, impotence, premature menopause, and abnormal pigmentation of the skin.
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PMID:A history of phlebotomy therapy for hemochromatosis. 199 28

Patients undergoing elective coronary bypass surgery can benefit from Preoperative Autologous Blood Donation (PAB), despite some opinions to the contrary, as a complement of intra-operative blood salvage techniques. We report herein 106 patients eligible for coronary bypass surgery included in our PAB program. We observed a very good tolerance owing to strict exclusion criteria, a close monitoring of vital signs, and as far as we are concerned, to the infusion of a macromolecular solution (Plasmion) in a 1:1 ratio, to maintain intra-vascular volume. We chose a volume replacement because the physiological adaptation to hypovolemia is altered by the beta-blocking and/or vasodilating agents which cannot be discontinued in patients with coronary heart disease. The changes in the hematological parameters are not different from those observed in other patients eligible for PAB. The postoperative hemoglobin level is satisfactory and compatible with a normal myocardial function inasmuch as the cardiopathy has been corrected. The efficiency of PAB is good since overall, 74% of the patients did not require homologous blood, this proportion rises to 84% for patients donating 3 or more units. Preoperative Autologous Blood Donation for patients with coronary heart disease implies a perfect coordination between the Blood Bank physicians and their colleagues from the Cardiology Department. Aside from its well known advantages, PAB allows a stimulation of erythropoiesis, a progressive normovolemic hemodilution perhaps beneficial to patients with coronary heart disease, and finally, a better psychological preparation to surgery.
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PMID:[Programmed autologous transfusion in coronary surgery: experience with 106 patients]. 201 36

Pulse oximetry is noninvasive, fast, and simple, making it a very popular way of assessing oxygenation in pediatric patients. However, there are few studies that establish the accuracy of this technology over a wide range of oxygen saturations in children. This study, done in 47 children aged from 1 day to 16 years with congenital heart disease and undergoing cardiac catheterization, compared the direct measurement of arterial oxygen saturation to values from pulse oximetry. Oxygen saturation was measured by an IL-282 Co-oximeter, which also measured carboxyhemoglobin and methemoglobin, and was compared to values obtained from both a Biox III and Nellcor N100. Both pusle oximeters gave values that closely correlated with the actual saturation (r = 0.91 and 0.93, respectively) with standard errors of the estimate of 4.1 and 3.2%, respectively. For both devices, the error increased with decreasing saturations, being progressively larger below a saturation of 80%. The difference between the actual saturation and that measured by pulse oximetry bore no relationship to the presence of carboxyhemoglobin, methemoglobin, fetal hemoglobin, bilirubin, cardiac index, or age of the patient. In conclusion, pulse oximetry, while a very useful technology in pediatrics, must be interpreted with some caution in children with severe cyanosis.
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PMID:Pulse oximetry versus measured arterial oxygen saturation: a comparison of the Nellcor N100 and the Biox III. 203 Sep 22

The effect of a standardized intramuscular premedication (morphine, 0.1 mg/kg, scopolamine, 13 micrograms/kg, and secobarbital, 2.5 mg/kg) on the arterial oxygen saturation of hemoglobin was evaluated in 33 patients with congenital heart disease by use of the Nellcor pulse oximeter. Sixteen patients had noncyanotic congenital heart disease and 17 patients had cyanotic congenital heart disease. In the noncyanotic congenital heart disease group, pulse oximeter saturations decreased from 98.1% +/- 1.5% (mean +/- SD), before premedication, to 96.5% +/- 1.5% following premedication. Although this decrease was statistically significant (P less than 0.05), it was determined to not be clinically meaningful. In the patients with cyanotic congenital heart disease, oxygen saturation increased from 73.5% +/- 11.8 to 74.7% +/- 10.2 following premedication, but this change was not statistically significant. The effect of premedication on SaO2 was highly variable in patients with cyanotic heart disease; although the group mean appeared to increase, 6 of the 17 patients had decreases in saturation and the decrease exceeded 10% in saturation in 3 of them. Therefore, oxygen saturation should be monitored following premedication in patients with cyanotic heart disease and oxygen administered as needed.
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PMID:Effect of premedication on arterial oxygen saturation in children with congenital heart disease. 213 36


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