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

Infusion of colloid solutions for intentional isovolemic hemodilution can help to save homologous blood in surgical patients. In addition, hemodilution improves blood fluidity which leads to an increased organ blood flow and better tissue oxygenation. A major limiting factor for the degree of dilutional anemia induced by hemodilution is the oxygen supply of the myocardium since unimpaired heart function is of utmost importance. The basic mechanism that compensates for the reduction of hemoglobin-concentration (fall of oxygen capacity) of the diluted blood is a rise in cardiac output and coronary blood flow which maintains or even enhances systemic and coronary oxygen transport capacity (hemoglobin-concentration x saturation x cardiac output or coronary blood flow). In normovolemic patients with unimpaired cardiac function there is no problem in this respect and clinical experience has shown that even high degrees of dilutional anemia are well tolerated. Patients with heart disease, however, may have a limited ability to increase cardiac output and coronary blood flow. Therefore, in these cases the risks of intentional hemodilution can exceed its benefits and a careful evaluation of risks is mandatory for every individual patient. In the following, we review knowledge from the literature and our own experimental and clinical data to explain the influence of dilutional anemia on the physiology and pathophysiology of myocardial oxygen supply.
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PMID:[Myocardial oxygen supply in hemodilution in patients with healthy hearts and heart surgery patients]. 219 24

We used frozen blood from one closely related donor in 24 patients (group I) who underwent open heart surgery for congenital heart disease, in order to reduce of complications from a large quantity of blood transfusion. Blood of 600-2200 ml was collected from the single donor and was kept frozen until the operation. Two conditions of the patients were instituted, (1) body weight less than or equal to 40 kg (2) the single donor is father or mother or a close relative. The group of these patients was compared with patients using frozen autologous blood (group II) and patients using banked blood (group III). In group I patients two times of decline of red blood cell counts (RBC), hematocrit (Ht), hemoglobin (Hb) and total protein (TP) were noticed. The first was the period during the cardio-pulmonary bypass. The second was the time about one week after the transfusion of frozen red cells. But degree of the decline was uneventful clinically. The increment of complications induced from the use of frozen red cells was not noticed, and there was no case of serum hepatitis in group I patients. We concluded that the open-heart surgery using frozen blood cells (single donor), if the application was appropriate, could be undergone safely and would be effective on reducing infection and reaction induced from blood transfusion.
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PMID:[Frozen blood from one closely related donor reduced complications of blood transfusion without adverse effects in the open-heart surgery]. 221 73

Arterial hemoglobin oxygen saturation was prospectively monitored in 103 consecutive patients undergoing office colonoscopy to determine the incidence of any clinical characteristics which might predict arterial desaturation to less than 90%. Baseline saturations were obtained prior to premedications and continuously during the examination using a finger mounted pulse oximeter. Intravenous premedication regimens varied from none to a maximal dose of 50 mg of meperidine and 10 mg of diazepam. All colonoscopies included cecal intubation and were performed by one investigator employing a video colonoscope. The incidence of desaturation was 41% without significant variation among the sedation groups. Age was positively correlated with desaturation (p less than 0.05). Sex, obesity, history of lung or heart disease, chronic cardiac medications, and baseline saturation percentage failed to be sensitive predictors of desaturation. No parameter could be correlated with prolongation of desaturation below 90%. No adverse outcomes or complications were noted during the periendoscopy period, suggesting that oximetry monitoring during outpatient colonoscopy may not be clinically useful.
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PMID:Arterial oxygen desaturation during ambulatory colonoscopy: predictability, incidence, and clinical insignificance. 235 Dec 56

Children with cyanotic heart disease were studied to determine the effects of chronic hypoxemia, iron stores, and age on hemoglobin. Red cell mean corpuscular volume greater than 90th percentile was found in 72% of children and hemoglobin was higher in this group than in patients with a mean corpuscular volume in the 10-90th percentile or less than 10th percentile (p less than 0.05). In children presumed iron sufficient and with oxygen saturation greater than 75%, multiple regression analysis showed that age (p less than 0.0001) and oxygen saturation (p less than 0.0001) were associated with hemoglobin. Significant correlations between hemoglobin and oxygen saturation were present for children less than 2 years (r = -0.50) and 2-11 years (-0.48), but not for patients greater than 11 years. We conclude that variables other than oxygen saturation, including age and iron stores, are important in determining hemoglobin concentration in cyanotic heart disease.
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PMID:Determinants of hemoglobin concentration in cyanotic heart disease. 239 39

Balloon pulmonary valvotomy was attempted in eight children with cyanotic congenital heart disease and pulmonic stenosis who were scheduled for a palliative procedure (shunt). In seven patients the balloon could be positioned across the pulmonary anulus, and valvotomy was performed. Five of the patients had tetralogy of Fallot with multiple levels of pulmonary outflow obstruction. For all patients in whom the balloon could be properly positioned the valvotomy was successful, as judged by arterial hemoglobin saturation, which increased from 72% +/- 5% to 83% +/- 5% (p less than .005). Valvotomy was followed by an immediate rise in mean pulmonary artery pressure (12.6 +/- 2.8 to 18.3 +/- 4.8 mm Hg, p less than 0.05) and a decline in hematocrit level at 2 months (54% +/- 5% to 47% +/- 4%, p less than 0.05). There was no mortality or complication from the valvotomy, and the need for a systemic to pulmonary artery shunt was eliminated in six of eight patients. Follow-up has ranged from 0.5 to 2.8 years. This trial indicates that balloon pulmonary valvotomy can be safely performed and is effective palliation in selected patients with cyanotic heart disease that is not suitable for primary repair. The increased pulmonary flow may improve oxygenation and growth of the pulmonary arteries without the need of a systemic to pulmonary artery shunt.
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PMID:Balloon pulmonary valvotomy: palliation for cyanotic heart disease. 244 61

Cigarette smoking has been causally linked to atherosclerotic heart disease. The mechanism by which cigarette smoking causes heart disease has not, however, been determined. Nicotine has been shown to lead to increases in plasma epinephrine and norepinephrine following smoking. Catecholamines have been shown to lead to increases in blood glucose. This paper demonstrates that cigarette smoking is associated with increases in average blood glucose as measured by glycosylated hemoglobin levels in smokers compared with nonsmokers. Fifteen nondiabetic smokers had an average glycosylated hemoglobin of 6.82% (SD = 1.06%), which is higher than the 5.63% (SD = .49%, t = 3.98, P less than .001) found for 23 nonsmokers. The average glycosylated hemoglobin level of the smokers is in the range found for patients with well-controlled diabetes. These data suggest that elevated blood glucose may contribute to atherogenesis in cigarette smokers.
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PMID:The effects of cigarette smoking on glycosylated hemoglobin in nondiabetic individuals. 276 87

The rate of birth abnormalities is 4-10 times higher in diabetic mothers than in the normal population. Mice embryos exposed to hyperglycemia increased developmental abnormalities (mostly before the 7th week of pregnancy) in linear fashion, while insulin treatment lowered them. The high level of glycosylated hemoglobin (HbAlC) during this period is associated with frequent abnormalities. In 116 diabetic women abnormal embryos were found in 22% of cases when HbAlC was 8.5%, while only 3% of the embryos were abnormal when HbAlC was 8.5%. Pregnant women whose diabetes was balanced from the 8th week of pregnancy had a 5.5% rate of abnormality compared to only .8% in those treated 3 months before pregnancy, and they also had fewer complications during pregnancy. The diabetic woman planning a pregnancy should have it earlier in life, get examined for nephropathy, retinopathy (treated by photocoagulation), hypertension, and ischemic heart disease. If these diseases are severe pregnancy is not advised. Before and during pregnancy sugar level must be checked 6-7 times a day and imbalance treated by insulin injections, or subdermal insulin pump in severe cases. Pregnancy is recommended only if the daily sugar balance is satisfactory, and the HbAlC value is less than 8%.
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PMID:[Pregnancy counseling in diabetic women]. 306 26

As public health measures decrease the number of deaths due to infectious diseases, life expectancy will increase and chronic and degenerative diseases will claim a greater part of the public health resources. Moreover, many of these diseases are directly related to certain preventable risk factors, which it would be advantageous to identify and eliminate before they become major problems in developing countries. First, demographic analyses, using multiple decrement life tables, were performed to show 1) the survival experience of persons in the population who would die of a disease, given the current cause-specific mortality rates, 2) the life expectancy at any age in the table for a given cause of death, and 3) the gain in life expectancy among persons expected to die of the disease. Second, models were constructed for assessing the effects of risk factors and their change over time. The 1st part of this analysis used hazard functions to relate the risk of disease or death to the values of the risk factor; the 2nd part used linear regression equations to project future values of the risk factors as a function of their past values. Data for the life tables were drawn from World Health Organization cause-specific mortality profiles for cancer, diabetes, cirrhosis, stroke, and heart disease in highly developed, moderately developed, and less developed nations. Data for assessing the effects of various risk factor interventions were drawn from the Framingham Study of cardiovascular disease. Risk factors used were serum cholesterol, blood pressure, smoking, Quetelet index, blood sugar, hemoglobin, vital capacity and age. Demographic analysis showed that the effects of major noncommunicable diseases on life expectancy was not significantly different in developed and developing countries; there were differences in the proportions of deaths from the 5 diseases analyzed but not in the distribution of age at death. Moreover, numerically there are currently more chronic disease deaths in developing than in developed countries, and as life expectancy increases and fertility declines, the impact of noncommunicable diseases will rapidly increase in those countries. Analysis of risk-factor reduction by intervention, such as nonsmoking campaigns and low cholesterol diets, showed that such interventions would be cost-effective, but less so at some ages than at others. Nevertheless, such interventions would be worthwhile if they prevented unhealthful life styles from gaining a foothold in these countries.
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PMID:The global impact of noncommunicable diseases: estimates and projections. 323 13

To test the hypothesis that tissue oxygen delivery would be affected by diminished oxygen stores in cyanotic congenital heart disease, serum ferritin, transferrin saturation, hemoglobin, red cell mean corpuscular volume (MCV), red cell 2,3-diphosphoglycerate (DPG), P50, blood gases, oxygen saturations and systemic oxygen transport were measured in 29 hypoxemic infants and children. For the group, aortic saturation was 81 +/- 9%, PaO2 was 50 +/- 12 mm Hg, hemoglobin 16.2 +/- 2.1 gm/dl and systemic oxygen transport 620 +/- 145 ml/min/m2. P50 was increased above normal values (28.8 +/- 2.3 vs 26.6 +/- 1.1 mm Hg, p less than 0.01), and DPG was 2.35 +/- 0.54 mumol/ml, at the upper limits of normal for this assay. Iron deficiency was present in 8. When patients with P50 greater than or equal to 30 mm Hg and P50 less than 30 mm Hg were compared, iron stores were diminished in the high P50 group: [serum ferritin (19 +/- 8 vs 53 +/- 48 ng/ml, p = 0.0006), transferrin saturation (11 +/- 6 vs 23 +/- 11%, p = 0.003) and MCV (79 +/- 8 vs 86 +/- 4 fl, p = 0.05)]. Hemoglobin, aortic oxygen saturation, PaO2 and systemic oxygen transport were similar in both groups. In children with iron sufficiency, 15 of 21 had MCV greater than 90th percentile for age and sex (p less than 0.001 versus expected distribution). Also, MCV greater than 90th percentile for age and sex had a positive predictive value of 0.88 for iron sufficiency. This study demonstrates that diminished iron stores in cyanotic congenital heart disease are associated with a more right-shifted oxyhemoglobin dissociation curve (increased P50).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of iron deficiency on tissue oxygen delivery in cyanotic congenital heart disease. 334 85

We hypothesized that children with cyanotic congenital heart disease and moderate hypoxemia, as a result of erythrocytosis, and adequate iron stores would have low serum erythropoietin titers, low tissue oxygen delivery, and normal red cell 2,3-diphosphoglycerate (DPG) concentrations. We assessed hemoglobin levels, aortic oxygen saturation, iron stores, red cell 2,3-DPG, oxygen consumption, and systemic O2 transport in 19 hypoxemic patients, aged 3 months to 8 years. Low erythropoietin titers (less than 30 mU/dl) were found in 14 patients. Patients with high erythropoietin titers had lower Pao2 (36 +/- 7 vs 49 +/- 7 mm Hg, p less than 0.01), lower aortic saturation (68 +/- 12 vs 81 +/- 9%, p less than 0.01), and higher red cell 2,3-DPG (2.47 +/- 0.34 vs 3.23 +/- 0.73 mumol/ml, p less than 0.01). Aortic oxygen saturation higher than 80% was associated with a low erythropoietin titer and a hemoglobin level below that associated with hyperviscosity. The relationship between aortic oxygen saturation and hemoglobin concentration was strong (r = 0.77). These data suggest that for children less than 8 years of age, adequate compensation for moderate hypoxemia can occur with moderate increases in hemoglobin levels.
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PMID:Erythropoietin in cyanotic heart disease. 339 15


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