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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Right ventricular contractility increases in response to catecholamine stimulation and greater ventricular preload, factors that increase with exercise workload. Thus, the maximum systolic dP/dt may be a potentially useful sensor to control the pacing rate of a permanent pacing system. The present study was designed to test the long-term performance of a permanent pacemaker that modulates pacing rate based on right ventricular dP/dt and to quantitatively analyze the chronotropic response characteristics of this sensor in a group of patients with widely varying structural heart diseases and degrees of hemodynamic impairment. A permanent pacing system incorporating a high fidelity pressure sensor in the lead for measurement of right ventricular dP/dt was implanted in 13 patients with atrial arrhythmias and AV block, including individuals with coronary artery disease, hypertension, severe obstructive pulmonary disease with prior pneumonectomy, atrial septal defect, dilated cardiomyopathy, restrictive cardiomyopathy, and mitral stenosis. Patients underwent paired treadmill exercise testing in the VVI and VVIR pacing modes with measurement of expired gas exchange and quantitative analysis of chronotropic response using the concept of metabolic reserve. The peak right ventricular dP/dt ranged from 238-891 mmHg/sec with a pulse pressure that ranged from 19-41 mmHg. There was a positive correlation between the right ventricular dP/dt and pulse pressure (r = 0.70, P = 0.012). The maximum pacing rate and VO2max were 72 +/- 6 beats/min and 12.61 +/- 4.0 cc O2/kg per minute during VVI pacing and increased to 124 +/- 18 beats/min and 15.89 +/- 5.9 cc O2/kg per minute in the VVIR pacing mode (P < 0.0003 and P < 0.002, respectively). The integrated area under the normalized rate response curve was 96.7 +/- 45.7% of expected during exercise and 100.1 +/- 43.4% of expected during recovery. One patient demonstrated an anomalous increase in pacing rate in response to a change in posture to the left lateral decubitus position. Thus, the peak positive right ventricular dP/dt is an effective rate control parameter for permanent pacing systems. The chronotropic response was proportional to metabolic workload during treadmill exercise in this study population with widely varying forms of structural heart disease.
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PMID:Rate modulated pacing based on right ventricular dP/dt: quantitative analysis of chronotropic response. 797 96

To elucidate the incidence and clinical significance of ventricular late potentials (LP) and reduced heart rate variability (HRV) in primary and secondary heart muscle disease, 157 patients with dilated cardiomyopathy (DCM, n = 19), chronic myocarditis (MC, n = 50), hypertrophic cardiomyopathy (HCM, n = 27) and systemic hypertension (HT, n = 61) were studied. LP measured by the signal averaging technique were found in 24% of the total study group--47% of the patients with DCM, 28% with MC, 29% with HCM and 10% with HT. Complex ventricular arrhythmias were detected during Holter monitoring in 56% of patients with DCM, in 41% with MC, in 21% with HT and in 16% with HCM. An electrophysiological study was performed in a total of 75 patients. Non-sustained or sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) were inducible during programmed ventricular stimulation in 32% of patients with MC, in 30% with HT, in 20% with DCM and in 17% with HCM. The total duration of the signal-averaged, filtered QRS complex was the only independent predictive factor for severe arrhythmic events and sudden cardiac death. HRV measured in 39 patients were most reduced in patients with DCM (RR interval standard deviation (HRV-SD) 39 +/- 23 ms), followed by 44 +/- 16 ms in patients with HCM, 45 +/- 28 ms in patients with HCM and 67 +/- 51 ms in patients with HT. A significant reduction in the HRV-SD below 30 ms was recorded in 24% of patients measured.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Late potentials and heart rate variability in heart muscle disease. 799 67

This article reports a case of profuse hemoptysis in pulmonary embolism and reviews the literature. A 74-year-old patient with hypertension and dilated cardiomyopathy was admitted to the hospital for exacerbation of congestive heart failure and hemoptysis. During hospitalization, the patient had hemoptysis of 270 cc during a 24-hour period. Chest radiograph showed bilateral lower lobe infiltration. Fiberoptic bronchoscopy was performed and revealed active bleeding from both lower lobes of the lungs. An endobronchial lesion was not seen, and the patient had an open lung biopsy. Histological examination of the lung tissue revealed an organized thrombus.
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PMID:Hemoptysis in a patient with congestive heart failure and pulmonary emboli. 804 68

123I-metaiodobenzylguanidine (MIBG), a tracer for sympathetic neuron integrity and function, was applied to 155 patients with various types of cardiac disease. The methods for quantification of MIBG and washout were studied as well as normal ranges. Heart-to-mediastinum average count ratio (H/M) correlated well with total heart count divided by injected activity (r = 0.60, P < 0.0001 and r = 0.72, P < 0.0001 for early and delayed images, respectively). Although as a whole left ventricular ejection fraction (LVEF) positively correlated with H/M ratio, decreased H/M ratio could be associated with normal LVEF, which may indicate that the MIBG activity was an independent variable compared with cardiac contractility. High washout rate was seen in various cardiac diseases, such as dilated cardiomyopathy, hypertrophic cardiomyopathy, ischaemic heart disease, hypertension, hypothyroidism and arrhythmia. The increased washout seems to be nonspecific to disease type, but is a common feature of damaged or failing myocardium.
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PMID:Decreased 123I-MIBG uptake and increased clearance in various cardiac diseases. 804 17

Cardiac arrhythmias detected during 24-hr electrocardiographic Holter monitoring were correlated with some echocardiographic indices in 20 patients chronic renal failure (c.r.f.) on conservative treatment (10 women and 10 men, aged 43.6 +/- 9.8 years). Comparative groups consisted of 10 patients with chronic primary glomerulonephritis without arterial hypertension and renal failure (2 women and 8 men, aged 34.2 +/- 10.5 years), and 10 patients with primary arterial hypertension without clinical symptoms of renal disease (1 woman and 9 men, aged 36.6 +/- 9.5 years). In c.r.f. patients echocardiographic investigations disclosed that the left atrial diastolic dimension was within a normal range. The right ventricular diastolic dimension (RVDD) was, left ventricular systolic (LVDS) and diastolic (LVDD) dimensions and left ventricular end-diastolic volume (LVEDV) were slightly increased. The left ventricular ejection fraction (EF) was significantly lowered. In c.r.f. patients the left ventricular mass (LVM) was increased to approximately 300 g. In c.r.f. patients a significant positive correlation was found between number of ventricular extrasystoles registered within 24 hrs and RVDD. The investigation disclosed that: 1) in c.r.f. patients with arterial hypertension showed ultrasonographic signs of hypertrophic-dilated cardiomyopathy with impaired left ventricular ejection fraction; 2) in c.r.f. patients incidence and nature of cardiac arrhythmias were independent of LVM, LVDD and LVDS; 3) numbers of ventricular extrasystoles registered within 24 hrs can increase with the increase in RVDD and the decrease in EF.
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PMID:[Clinical analysis of cardiac arrhythmias in patients with chronic renal failure treated conservatively. II. Evaluation of the relationship between cardiac arrhythmias and some echocardiographic indices--preliminary investigations]. 814 49

Myocardial diseases consist of cardiomyopathy of unknown origin and specific myocardial diseases of known origin. The former consists mainly of dilated cardiomyopathy (DCM) and hypertrophic cardiomyopathy (HCM). In the latter, cardiac amyloidosis may be most frequently seen in the elderly. One hundred and twenty patients with cardiomyopathy were studied concerning their clinical courses. They were divided into 2 groups; i) young-middle-aged (Y) and ii) elderly (0). Group 1 was divided into 2 subgroups: 1a) followed up to an age less than 60 years old, and 1b) followed up to beyond age 60. In DCM, left ventricular posterior wall thickness and left atrial diameter increased significantly in the elderly. In HCM, young patients had obstructive type disease more frequently than the elderly. A history of mild hypertension was found more frequently in the middle-aged or elderly than in the young. Left ventricular end-diastolic diameter increased and left ventricular wall thickness decreased significantly in the elderly. Many patients with DCM usually die of congestive heart failure with ventricular arrhythmia, and those with HCM, both young or middle-aged, often die suddenly during sports activity. If there is an adaptive system, such as increased wall thickness in DCM or decreased wall thickness and increased diameter in HCM, which may contribute to the normalization of left ventricular wall stress, the patients might be able to survive to old age.
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PMID:[Characteristics of myocardial diseases in the elderly]. 820 70

Heart failure, a major contributor to cardiovascular disease morbidity and mortality, is newly diagnosed in approximately 400,000 patients each year, and is particularly prevalent in individuals over age 65 years. Average mortality rates 5 years after diagnosis are 45-60%, and may be as high as 50% after 1 year for those with New York Heart Association class IV heart disease. Heart failure occurs when myocardial muscle dysfunction prevents the heart from pumping enough blood at normal cardiac pressures to meet the metabolic needs of the body, especially during exercise, and compensatory hemodynamic and neurohormonal mechanisms are overwhelmed or maladaptive. Pathologic classifications are broadly based on the presence of systolic (dilated cardiomyopathy) or diastolic (hypertrophic or restrictive cardiomyopathies) dysfunction. The etiologies of heart failure may include inadequate coronary blood flow, pressure or volume overload, cardiomyopathy, or pericardial disease. Coronary artery disease, idiopathic dilated cardiomyopathy, and hypertension are the most frequent causes, and certain drugs may also worsen myocardial function. When contractility is reduced, stroke volume and cardiac output are decreased, and alterations in the kidneys may induce fluid retention to compensate for the perceived low output and reduced circulating blood volume. Fluid retention in turn causes preload or filling pressure to increase and symptoms of pulmonary congestion to emerge. Depressed contractility also results in a reduction in blood pressure, leading to compensatory neurohormonal activation and vasoconstriction, which significantly elevate afterload and further reduce stroke volume. The overall approach to heart failure includes defining the etiology, identifying precipitant factors, and assessing the severity of myocardial dysfunction and clinical symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathophysiology of heart failure. 823 96

Most diagnoses of cardiovascular disease are made in the office or at the bedside. For example, in pulsus alternans of the radial pulse, observed when first greeting a patient, alteration of intensity of the second sound and systolic murmur and a ventricular (S3) gallop are clinical pearls--often subtle--that diagnose cardiac decompensation. A faint gallop, ventricular (S3) or atrial (S4), might be overlooked in a patient who has an emphysematous chest and an increase in anteroposterior diameter if one listens over the usual areas of the precordium. However, the gallop might be detected easily by listening over the xiphoid or epigastric area. How do you tell the difference between an S4, a split first sound, and an ejection sound? The S4 is eliminated with pressure on the stethoscope, but pressure does not eliminate the ejection sound or the splitting of S1. The atrial sound (S4) is most frequently found in patients who have coronary heart disease, and it is a constant finding in patients who have hypertension. It does not denote heart failure, as does the S3 (ventricular) gallop. In some patients, both atrial (S4) and ventricular (S3) diastolic gallops may be present. This occurrence is common in patients with cardiac decompensation associated with coronary heart disease, hypertensive heart disease, and dilated cardiomyopathy. When these diastolic filling sounds occur in close proximity, a short rumbling murmur may be heard, which causes confusion of this sound with that of a valvular or congenital lesion. When both sounds occur exactly simultaneously, a single sound results. Often, this sound is louder than either the first or second sound and can be misinterpreted as either a valvular or congenital lesion. This, however, is a summation gallop, which is rare. For the most accurate timing of heart sounds and murmurs, the simple technique called "inching" is the best. Keeping the second sound in mind as a reference, the physician moves (inches) the stethoscope from the aortic area to the apex. An extra sound may be noted to occur in systole before the second sound, thereby diagnosing a systolic click. If the sound occurs after the second sound, however, it is an S3 or ventricular diastolic gallop. If a murmur appears before S2, it is a systolic murmur; if it appears after S2, it is a diastolic murmur. When the Austin-Flint murmur is heard, significant aortic regurgitation exists.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Cardiac pearls. 830 47

There are very few contemporary studies on the frequency and cause of congestive heart failure (CHF) in a general population. In western Sweden, inhabited by 1.64 million people, a retrospective survey was performed. All hospital records of patients with CHF, ages 16 through 65 years, were examined in all hospitals in the region. During the study period 2711 patients fulfilled the criteria for CHF or cardiomyopathy. Patients were monitored for 37 +/- 28 months. The most common cause of heart failure was coronary artery disease (IHD) (40%). Other common causes were hypertension (17%), valvular disease (13%), alcohol (11%), diabetes mellitus (10%), and systemic diseases (10%). There were positive correlations between the male sex and IHD, alcohol, and dilated cardiomyopathy; the female sex was associated with systemic diseases, valvular heart disease, and diabetes. The incidence of CHF requiring hospitalization per 100,000 in the population was 1.2 to 263 men and 1.1 to 129 women, in the youngest (age 16 to 30 years) and oldest (61 to 65 years) age groups, respectively. The 5-year survival rate was 50%. Analysis of causes performed with Cox's proportional hazards model for survival showed that age, IHD, alcohol, and diabetes were independent and powerful predictors of mortality (p < 0.001). The mode of death was progressive heart failure in 54% and sudden death in 26%. We concluded that the prognosis in patients with CHF was still very poor, even among this young population. The most common cause of CHF was IHD, and the second was hypertension.
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PMID:Spectrum and outcome of congestive heart failure in a hospitalized population. 836 19

A 74-year-old woman, with hypertension and dilated cardiomyopathy, presented with sudden onset of diplopia without vertigo and other neurological symptom. Examination revealed left inferior rectus muscle paresis. Other neurological findings were normal. She had no cerebellar ataxia and sensori-motor dysfunction. Magnetic resonance imaging showed increased signal intensity on T2-weighted and proton density-weighted images in the right ventral midbrain, compatible with infarction involving the fascicular oculomotor fibers. Complete resolution of the diplopia and normal ocular motility were noted 3 months after the onset of the diplopia. Focal ischemic midbrain lesions should be considered in cases of isolated partial oculomotor nerve paresis.
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PMID:[Isolated inferior rectus muscle paresis from midbrain infarction]. 837 Feb 6


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