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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The basic disorder in sinoatrial disease is a functional and/or anatomical defect in the sinus node and the atrium respectively. The clinical feature includes palpitations, angina pectoris, heart failure, giddiness and systemic emboli. Associated diseases are coronary heart disease, hypertension, diphtheria, myocarditis or rheumatic fever. Diagnosis is primarily made by clinical symptoms and conventional or long term ECG-monitoring. However, impaired sinus node function including sinusbradycardia, sinus arrest, sinoatrial block and the bradycardia-tachycardia syndrome cannot easily be assessed, when rhythm disturbances are occurring intermittently, as the recording of electrical activity of sinus node pacemaker cells is not available in man. Therefore methods of provocative atrial stimulation (rapid atrial stimulation, premature atrial stimulation) have been developed for (indirect) estimation of sinus node recovery time and sinoatrial conduction time. Treatment depends on symptoms. In most cases implantation of an electric pacemaker is mandatory since drug treatment usually is unsatisfactory. The natural history of the sinoatrial disease is imperfectly known but probably covers 5--10 years.
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PMID:[The sick sinus syndrome. What causes it?]. 722 53

Eighty Nigerian children (mean age = 8.8 years) with rheumatic heart disease (RHD) were studied prospectively. The initial acute rheumatic fever (ARF) was recognized in 34 of them (42%) while 18 patients (23%) had recurrent ARF. 76 patients (95%) had mitral incompetence, either alone or in combination with other lesions. Symptomatic mitral stenosis was present in 21 patients (26%), occurred early in life, and appeared to be causally related to recurrent ARF and intense host reactions. Aortic and tricuspid valve diseases were uncommon and pulmonary valve disease was rare. 94% of the patients presented in heart failure, and, 4 years after, 20% of those re-examined had improved, 32% remained about the same, and 48% had deteriorated. The high cumulative mortality at 6 years (20%) was attributable to heart failure and subacute bacterial endocarditis. We suggest that in developing countries, all episodes of pharyngitis in children susceptible to ARF should be treated with penicillin, the only exception being pharyngitis associated with definite viral illnesses like measles.
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PMID:Childhood rheumatic heart disease in Nigeria. 724 45

The natural history of acute rheumatic fever (ARF) in adults has been studied from an analysis of 23 patients together with a review of a further 466 published cases. In contrast to the picture in juvenile ARF, in our patients (average age 55 yr), only arthritis (83%) and carditis (35%) were major criteria for the diagnosis. All patients had at least 3 minor criteria. To summarize, 39% of the patients, average age 56 yr were seen in their initial attack of ARF. In those patients with a previous history of rheumatic fever, the mean interval between the index attack and the first illness was 20.5 yr. Contact with young children appeared to be an important predisposing factor. None had an ESR of less than 50 mm in the first hour, even in the presence of cardiac failure. Findings in the acute illness included anemia (70%), hyperglobulinemia (70%), urinary sediment (66%), and hypercalcemia in 7 out of 12 cases. The response to treatment was good and only 1 patient of 13 followed-up developed a new valvular lesion. A survey of the literature shows that attacks of ARF may occur at any age; death in the acute episode is rare and occurs only in patients with severe preexisting valvular disease with congestive failure. The problem of diagnosing active carditis in the presence of rheumatic heart disease (RHD) is discussed. While juvenile ARF may be overdiagnosed, the diagnosis may be missed in the adult rheumatic patient whose cardiac state inexplicably deteriorates. In such patients evidence for a preceding streptococcal infection should be sought. Patients with a high risk of developing ARF include those with carditis in previous attacks, with preexistent RHD, and with several children in the family. These factors should be considered when advising on the duration of antibiotic prophylaxis.
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PMID:Acute rheumatic fever in adults over the age of 45 years: an analysis of 23 patients together with a review of the literature. 729 18

In the period between January 1979 and January 1989, 72 patients (46 women and 26 men, average age 46 years) out of 697 patients undergoing a tricuspid valve procedure, underwent prosthetic valve replacement for organic tricuspid valve disease. Sixteen patients had pure tricuspid regurgitation (Group I). The causal pathology was essentially traumatic (6 cases) and infections (endocarditis) (5 cases). Fifty-six patients (Group II) had organic tricuspid valve disease associated with a left-heart valvular lesion. The causal pathology was rheumatic fever in 52 cases and endocarditis in 4 cases. In 40 patients (71.5%) the procedure was a reoperation of a mitral and/or aortic and/or tricuspid valve prosthesis. In 21 cases, the initial operation had involved the tricuspid valve. All patients in Group I underwent valvular replacement with a bioprosthesis. In Group II, 40 patients were implanted with a bioprosthesis and 16 with a mechanical valve prosthesis. The follow-up was complete for an average period of 7 years (range 2 to 12 years) for a total of 295 patient-year. The hospital mortality was nil in patients with isolated tricuspid valve disease. Reoperation for deterioration of a porcine bioprosthesis was required after 4 years in 1 case. Terminal cardiac failure was responsible for one late death 7 years after surgery. The hospital mortality was 26.7% (15 patients) in Group II. The actuarial rate of patients free of reoperation at 7 years was 80 +/- 8%. The actual rate of patients free of any prosthetic valve related complication was 78 +/- 2%. The 7 year survival rate excluding operative mortality was 65 +/- 8%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Tricuspid valve replacements in adults. Long-term results]. 812 49

The availability of basic and reliable data on cardiovascular problems in Africans is limited and this hinders the presentation of a comprehensive review of the subject. Nevertheless, there is a strong suggestion that the spectrum and pattern of cardiovascular disorders in Africa is rapidly becoming indistinguishable from that observed in developed countries. The classic risk factors appear to be on the rise and smoking may attain levels equal to or exceeding those in many developed countries. Infectious and inflammatory cardiovascular conditions may still be the most common, although limitations in the technology available for accurate diagnosis make this difficult to verify. Rheumatic fever and rheumatic heart disease remain common, and the potential for educational and other preventive strategies is being realized in many countries. Hypertension at frequencies exceeding 5-10% in most rural areas and 12% in most urban areas, together with complications such as stroke, heart failure and renal failure, are leading causes of morbidity and mortality. Hypertension is the major public health problem in most African countries. The cardiomyopathies are a common problem, and the limited availability of specific diagnostic procedures is matched by limited therapeutic options for most Africans. The prevalence of atherosclerosis and coronary artery disease and its complications, such as myocardial infarction and other degenerative disorders, remains low, but the situation is rapidly changing, especially in urban areas where appropriate diagnostic capabilities exist. It is thought that changes or modifications in lifestyle, risk-prone behaviour, diet, cultural attitudes and certain other consequences of rapid urbanization and demographic tendencies largely explain the observed trends.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cardiovascular disorders in Africa. 830 7

Heart transplantation as a treatment for end-stage heart failure has spawned numerous important challenges in patient care. A heart transplant patient with clinically unsuspected acute rheumatic carditis had an ultimately fatal course marked by refractory rejection and early death after transplantation. The patient had several immune abnormalities. Peripheral blood T lymphocytes (CD2+) were significantly elevated (p < 0.05) by flow cytometry in active rheumatic carditis versus 76 healthy individuals. The CD4+:CD8+ T-cell ratio was 5.5:1 in rheumatic disease and only 2.7:1 in healthy individuals. Numbers of peripheral blood B lymphocytes (CD19+), macrophages (CD14+), and interleukin-2 receptor-positive cells (CD25+) were also elevated in rheumatic disease. Natural killer cells (CD16+) were slightly reduced in number and appeared functionally deficient, and antibody-dependent cellular cytotoxicity was also reduced. Immunohistochemically, infiltrating cells in Aschoff lesions of the rheumatic native heart were mainly T cells, with putative TH/I cells predominating. The striking immune accompaniments of acute rheumatic fever may have heralded profound immune-mediated allograft intolerance leading to the patient's demise. Considering the recrudescence of rheumatic heart disease in this country and its remaining worldwide importance, such patients as the one discussed offer daunting clinical challenges when transplantation is an obvious management choice for severe, end-stage dilated cardiomyopathy.
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PMID:Acute rheumatic carditis: diagnostic and therapeutic challenges in the era of heart transplantation. 832 6

The clinical diagnosis of acute rheumatic fever (ARF) may be challenging; however, a constellation of signs including new valvular insufficiency, cardiomegaly, and heart failure should readily prompt consideration of the diagnosis of rheumatic carditis. In addition, pulmonary findings are compatible with ARF, as associated pulmonary involvement may represent rheumatic pneumonia. We report the case of a young man with ARF and rheumatic pneumonia, a previously described but rare complication of ARF.
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PMID:Rheumatic pneumonia: reappearance of a previously recognized complication of acute rheumatic fever. 864 92

Since 1944, the Jones criteria for the diagnosis of acute rheumatic fever have been regularly revised to integrate technical and diagnostic innovations. Echographic and Doppler criteria, however, remain unrecognised due to valvular insufficiency in healthy subjects. The aim of this study was to determine the cardiac lesions occurring in acute rheumatic fever and the diagnostic value of Doppler echocardiography. One hundred patients with an average age of 10 years were admitted to hospital because of a first attack of acute rheumatic fever between January 1991 and September 1992. Eighty-six had articular signs, 5 had chorea, but none had cutaneous lesions. Forty-seven murmurs of mitral insufficiency (MI) and eight of aortic insufficiency (AI) were detected; 10 children had signs of cardiac failure. Conduction defects were recorded in 12 cases. Echocardiography showed 7 pericardial effusions; often, the left heart chambers were dilated without alteration of the fractional shortening. The commonest lesions of the mitral valve were thickening of the two leaflets, the reduced mobility of the posterior leaflet, the rigidity of the anterior leaflet and 2 cases of ruptured chordae tendinae. The Doppler mode showed 73 cases of MI, 26 of which were at least moderately severe. These cases of MI were commonly excentric jets behind the posterior leaflet. There were 47 cases of AI, 10 of which were at least moderately severe. If all cases of moderately severe or mild AI and MI are considered as pathological when associated with suggestive morphological valve changes, the number of cases of carditis increased from 50 without the Doppler mode to over 80 with this mode. Doppler echocardiography validated the Jones criteria in 16 children. The authors propose Doppler echocardiography criteria for the validation of carditis.
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PMID:[Contribution of doppler echocardiography to the diagnosis of the first attack of acute rheumatic fever]. 872 63

Bernardo O'Higgins was a very apprehensive individual regarding his health and ailments. This fact is clearly reflected in his letters, that provide valuable anamnestic data. During his youth, while living is Spain, he suffered of yellow fever and later in Chile, he probably had an acute phase of a rheumatic fever. Since his adolescence, he was affected by a chronic hlepharo-conjunctivitis. During the Chilean independence revolution, he suffered several battle wounds. The most severe was a shot that affected both his right arm and elbow (1818). While living in Peru (1823-1842) he suffered of dysentery and malaria. The latter was an endemic disease in the valleys of Peru. Being previously asymptomatic, he started experiencing extensional dyspnea, angor pectoris and syncopal episodes in 1840. At that time, physicians diagnosed a hypertrophic cardiomyopathy. Analyzing his symptoms and taking into account their short term evolution, the author concludes that they were a consequence of either an aortic stenosis or coronary insufficiency. These led him to a heart failure that was his immediate cause of death in 1842.
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PMID:[A medical history of Bernardo O'Higgins (1778-1842)]. 1066 97

The clinical disappearance of the murmur of rheumatic mitral regurgitation after period of time has been documented by many researchers. However no studies have related the disappearance of the murmur with the functional or anatomical state of the mitral valve. This study was done to elucidate the mitral valve status using doppler and color coded echocardiography among those children who have lost their apical pansystolic murmur on auscultation following a documented attack of rheumatic fever. The study sample consisted of 51 patients including 31 patients in whom the murmur has disappeared (group I), and 20 patients with persistent isolated mitral regurgitation (group II). Patients of group I had significantly lower grades of murmur intensity, lower incidence of cardiomegaly, and had no heart failure in the initial attack. They were more compliant with prophylaxis and had less recurrences than patients of group II. The murmur disappeared in patients of group I from 1/2 to 14 years after the initial attack. Echocardiography revealed that such patients had a normal mitral valve apparatus, and a normal heart size and function. Only 5 patients of this group had a significant regurgitant jet demonstrated by colour doppler. We concluded that recovery of the mitral valve and return of cardiac functions to normal is possible in patients who had mitral regurgitation following rheumatic fever. Some of them may still have an inaudible mild regurgitation. Patients who have lost their murmur may be allowed to exercise freely, yet penicillin prophylaxis should not be discontinued.
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PMID:Reversibility of mitral regurgitation following rheumatic fever: clinical profile and echocardiographic evaluation. 1082 50


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