Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Cardiovascular disease, the major cause of death in the elderly, is mostly ascribable to complications of coronary atherosclerosis: angina pectoris, myocardial infarction, and sudden death. However, other degenerative diseases involving several cardiac structures exist, and should be distinguished from age-related cardiac changes. Extensive dystrophic calcification determines aortic stenosis, and may affect either a normally tricuspid or a congenitally bicuspid valve. Surgical valve replacement is now a low risk option, even in elderly persons, whereas the efficacy of balloon valvuloplasty is questionable. Aortic incompetence in adults and aged persons is mostly the consequence of aortic tunica media atrophy with anular ectasia, in the setting of nearly normal aortic leaflets. Mitral valve prolapse is the main cause of mitral incompetence; spontaneous cordal rupture is a late complication in the natural history of this disease, thus warranting prompt surgical valve repair or replacement. The entire spectrum of cardiomyopathies is observed in the elderly: dilated, hypertrophic, restrictive, arrhythmogenic. Cardiac amyloidosis is by far the most frequent secondary form and leads to congestive heart failure by impairing ventricular compliance. Idiopathic fibrosis of the specialized AV junction or dystrophic calcification of central fibrous body are the usual substrates of AV block, which requires pace-maker implantation. Nonrheumatic atrial fibrillation, due to fibro-fatty degeneration of the atrial musculature or dilated left atrium, carries a high risk of thromboembolic complications and cerebral accidents; oral anticoagulants have proven to be effective in preventing stroke. Aortic dissecting aneurysm is a spontaneous laceration, and usually a complication of longstanding systemic hypertension; exceptionally, spontaneous dissection may primarily occur in the coronary arteries. In conclusion, longevity at present is mostly threatened by cardiovascular disease, among which the role of degenerative, non-atherosclerotic disorders may be greater than thought.
 ...
PMID:Degenerative, non-atherosclerotic cardiovascular disease in the elderly: a clinico-pathological survey. 209 63

A prospective M-mode, cross-sectional and Doppler echocardiographic study was performed on 75 patients with systemic lupus erythematosus and 60 sex- and age-matched control subjects. Compared with the control group, patients with lupus had an increased prevalence of echocardiographic abnormalities. These included pericardial effusion and/or thickening (37%), left ventricular hypertrophy (12%), global left ventricular hypokinesis (5%), segmental abnormalities of left ventricular wall motion (4%), right ventricular enlargement (4%), focal verrucous valvar thickening (12%), gross valvar thickening and dysfunction (8%), mitral regurgitation (25%) and aortic regurgitation (8%). Two patients with gross mitral valvar thickening and dysfunction subsequently underwent valvar replacement. Correlation between echocardiographic abnormalities and clinical parameters showed that pericardial effusion was significantly associated with pericardial pain (P less than 0.05) and active disease (P less than 0.001), and left ventricular hypertrophy with systemic hypertension (P less than 0.05). Thus, there was a high prevalence of cardiac abnormalities, especially pericardial and valvar lesions, in patients with systemic lupus erythematosus. Echocardiography is invaluable in identifying these abnormalities and should be used routinely for cardiac evaluation of these patients.
 ...
PMID:Cardiac abnormalities in systemic lupus erythematosus: a prospective M-mode, cross-sectional and Doppler echocardiographic study. 235 96

Doppler echocardiography has become a very useful and widely employed imaging technique for evaluating valvular regurgitation, and has thus lead to the discovery of regurgitation in unexpected subjects. In this study, we examined left-sided valvular regurgitation in 31 healthy subjects, 35 patients with hypertension and 43 patients with old myocardial infarction by Doppler echocardiography. Aortic regurgitation was found in 3% of healthy subjects, 8% of hypertensive patients and 5% of patients with myocardial infarction. Mitral regurgitation was found in 35% of healthy subjects, 69% of hypertensive patients and 84% of patients with myocardial infarction. The pathogenesis of mitral regurgitation in hypertension is considered to be the impairment of the mitral leaflets, since neither anatomical nor functional abnormalities were found in the subvalvular mitral apparatus. Left ventricular dilatation and asynergy near the papillary muscles were related to the pathogenesis of mitral regurgitation in myocardial infarction. Mitral regurgitation in healthy subjects and hypertensive patients was mild and resistant to afterload stress, suggesting that it was less pathological. On the other hand, mitral regurgitation in myocardial infarction was easily worsened by afterload stress. Doppler echocardiography has thus provided us with new insights into valvular regurgitation in healthy subjects and patients without rheumatic valvular disease.
 ...
PMID:Evaluation of left-sided valvular regurgitation in healthy, hypertensive and myocardial infarction subjects by Doppler echocardiography. 236 14

The immediate post-operative results of conservative surgery were evaluated objectively in 31 children aged under 13 years referred to us for surgical correction of severe rheumatic mitral valve regurgitation. 16 patients had pure mitral regurgitation. In the others, lesions which required additional surgery were aortic regurgitation in 7 cases, tricuspid of the mitral valve and left ventricle was studied by two-dimensional TM-mode echocardiography. This examination was combined with a pulsed doppler study in search of a possible residual mitral regurgitation signal, with special attention to the depth at which it was recorded in the left atrium -- a semi-quantitative indication of the severity of residual leakage. Two mitral valve replacements were performed, and two early reoperations were needed for residual regurgitation developed between the 5th and 8th post-operative days. Three deaths occurred due to supra-systemic pulmonary arterial hypertension. The post-operative evaluation of mitral valvuloplasty results therefore involved 25 patients. In the absence of significant residual mitral regurgitation, two-dimensional echocardiography was inconclusive since the images obtained varied considerably according to the surgical procedures performed. There was a distinct reduction of end-diastolic diameters (43.5 +/- 5.9 versus 62.1 +/- 8.7 mm pre-operatively), reflecting the disappearance or marked decrease of the pre-operative ventricular volume overload consecutive to mitral regurgitation. The reduction of end-systolic diameters was also significant (31.2 +/- 6.7 mm versus 39.2 +/- 7.1 mm pre-operatively), though less pronounced than that of end-diastolic diameters, which explains the diminution observed in the percentage of fibre shortening, although the figures remained within normal limits (28.7 +/- 9.7 p. 100 versus 37.0 +/- 6.8 p. 100).(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Immediate postoperative results following conservative surgery of rheumatic mitral valve insufficiency in children]. 250 90

Type I dissecting aortic aneurysm is not only the most common type of all but an extremely lethal event. It is important to create the experimental model of type I dissection for clarifying behavior of this disease and successful treatment. The purpose of this study is: (1) production of experimental model of type I aortic dissection; (2) examination of progression manner of dissection; (3) and investigation of influence of dissection upon aortic valve and coronary artery. The experimental model of type I aortic dissection was produced in adult mongrel dogs. Bilateral thoracotomy was made and intimal tear was created in the ascending aorta by modified Blanton's procedure. Hypertension and creation of large pocket of the aortic media were necessary to produce type I aortic dissection. Extension of dissection had a tendency toward the inner layer of the aortic wall at distal site. However, at proximal site the dissection progressed in the same layer of the aortic wall. In this series, retrograde extension of dissection remained blind above annulus of aortic valve, and no incidence of aortic regurgitation or coronary ischemia was occurred. But on histologic examination, degeneration of the aortic wall by the dissection was observed. Such weakness of aortic wall showed potentiality to developed into subsequent aortic regurgitation or coronary ischemia.
 ...
PMID:[Experimental study on the dissecting aortic aneurysm]. 260 44

The authors studied 30 cases of aortic dissection performed from January 1978 to December 1987. Dissection was classified as type A (intimal tear beginning in the ascending aorta or arch) and type B (intimal tear beginning in the descending aorta). Type A predominated (66.7%). Type B dissection was most frequent in patients older than 60. Precordial pain was the main symptom in type A cases, whereas 62.5% of type B cases showed no precordial pain. Most frequent findings in type A patients were hypotension (45.5%), murmur of aortic regurgitation (40.0%), and dyspnea (40.0%), whereas in type B patients, most frequent findings were hypertension (28.6%), and pulse deficit (42.9%). The major differential diagnosis for type A was myocardial infarction (43.8%), and for type B, peripheral artery failure (25.0%) and acute pneumonia (25.0%). 24 patients (80.0%) had hemorrhage. Hemorrhage into the pericardial sac occurred in 68.8% of type A patients, and 50.0% of type B patients had retroperitoneal hemorrhage. Systemic hypertension, atherosclerosis, medial cystic necrosis and endocrine disorders were considered predisposing factors for both type of dissection. A case of dissection after aortic valve replacement associated with ascending aorta tubular graft replacement was observed in this series. In type A patients, average survival was 6.3 days, and in type B, 11.1 days. The major cause of death was hemorrhage (70.0%).
 ...
PMID:[The dissecting aorta: clinical analysis and anatomo-pathologic correlations in 30 cases]. 263 76

Calcific emboli from a calcific aortic stenosis is an uncommon event, usually following local trauma, as from cardiac surgery or left heart catheterization or as a sequel to bacterial endocarditis. We report what we believe to be the first case of a spontaneous calcareous emboli demonstrated by cranial computed tomography. In this patient, systemic hypertension and mild aortic insufficiency may have caused increasing mechanical forces acting on the aortic cusps and may have precipitated embolism.
 ...
PMID:Spontaneous calcific cerebral embolus from a calcific aortic stenosis in a middle cerebral artery infarct. 265 88

Urapidil has been approved as sustained-release capsules containing 30, 60 and 90 mg, respectively, and as ampules containing 25 and 50 mg for treatment of all grades of hypertension, in several countries in Europe, South America, as well as in Japan and other Asian regions. In general, the treatment should start with 60 mg twice daily, 1 capsule in the morning and 1 in the evening. This schedule may be adapted according to the therapeutic needs. During the last few years, urapidil has been investigated extensively in comparison with several types of established antihypertensive drugs. Urapidil given orally has been tested in comparative trials against placebo, acebutolol, metoprolol, captopril, nifedipine and nitrendipine with responder rates of 40 to 70%. These responder rates are to be expected for a variety of antihypertensive drugs in monotherapy. Further studies with clonidine, prazosin and alpha-methyldopa showed similar responder rates as established for the other antihypertensive drugs studied. Adverse reactions include dizziness, headache and nausea and occasionally tiredness, orthostatic dysregulation and gastric disorders. These symptoms were transient, mostly occurring during the early phases of therapy and disappearing as treatment continued. Adverse effects are considered to be mainly due to blood pressure reduction. Intravenous comparative trials have been performed with urapidil against placebo, diazoxide and sodium nitroprusside. Adverse effects of parenterally applied urapidil are similar to those observed during oral treatment. Specific contraindications for urapidil are unknown. However, as for other vasodilating drugs, intravenous urapidil should not be administered to patients with stenosis of the aortic isthmus or with aortic valve insufficiency.
 ...
PMID:Overview of clinical trials with urapidil. 266 12

There has been increasing interest in the use of calcium antagonists as arterial vasodilator agents in the management of patients with congestive heart failure. Because congestive heart failure is mostly secondary to coronary artery disease, calcium antagonist drugs seem particularly appealing because of their anti-ischemic properties. The potent vasodilating action of calcium antagonists decreases impedance and improves ejection phase indexes of left ventricle function. However, these drugs interfere with calcium availability for myocardial contraction, and concern has been expressed about their potential depressant effect on myocardial performance. The net hemodynamic effect depends on the relative vascular versus myocardial potency of each calcium antagonist and on the indirect effects of reflex sympathetic activation. Balance between these factors is still influenced by the intrinsic status of left ventricle of the patient. Generally, the negative inotropic direct effect of the calcium antagonists is counteracted by the beneficial influence of the decrease of systemic vascular resistance. Because of its relatively more pronounced negative inotropic action, verapamil is not advisable in patients with left ventricular failure. Limited experience with diltiazem show no significant negative inotropic action. Nifedipine has been studied in its acute and long term effects. The use of sublingual nifedipine is established in the emergency management of acute pulmonary edema, specially in patients with arterial hypertension, or when acute ventricular dysfunction is associated with mitral or aortic insufficiency. Patients with chronic congestive heart failure have shown after nifedipine an increase in stroke volume and cardiac index at rest and during exercise, as well as decreases of pulmonary capillary wedge pressure during exercise.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Role of calcium antagonists in the pharmacologic treatment of heart insufficiency]. 269 18

We present a rare case of aortitis syndrome associated with dilatation of aorta and coarctation-like effect due to the intraluminal flap formation originated from dissected wall of the aorta. A 31-year-old woman was admitted to our hospital complaining of shortness of breath, palpitation and cough. On admission, her physical status showed congestive heart failure and hypertension of upper extremities and hypotension of lower extremities. Bruits were audible over the neck, the anterior chest and the back. Serological studies showed active inflammation. Chest X-ray film showed upper mediastinal widening, cardiomegaly and pulmonary edema. Aortitis syndrome was strongly suggested by these clinical findings, so that prednisolone therapy was started on 3rd hospital day. Special examinations were performed several days later when inflammatory changes showed a tendency to improve. Chest CT scan, RI angiography and MRI studies showed an aneurysmal dilatation from the ascending aorta to the mid-thoracic aorta. Aortography demonstrated a flap at the terminal portion of this aneurysmal dilatation and grade II (Sellars) aortic regurgitation. There was a pressure difference of 80 mmHg between the parts abutting cranial and caudal sides of the flap. A surgical operation was, then, performed to correct the pressure difference. The dissected wall was extruded toward the aortic lumen creating a flap (2 cm in length). This flap was resected and an artificial graft was inserted. Histologically, the flap consisted of adventitia, media and intima.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[A case of aortitis syndrome which presented coarctation of aorta due to intraluminal flap formation in the middle of the thoracic aorta]. 272 9


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>