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

In this work we describe a case of Conn's syndrome caused by a suprarenal adenoma in a sixty-one year female. The patient had come to our observation because of severe hypertension and hypokalemia. Primary aldosteronism resulting from the secretion of excessive amounts of aldosterone caused by autonomous hyperfunction of the adrenal cortex usually by a solitary adenoma. In most series of unselected patients, it is found in fewer than 0.5% of hypertensives. In our study we demonstrated the circadian changes of arterial blood pressure but we failed to demonstrate the presence of hypertrophic cardiomyopathy as recently emphasized in the literature. Regardless of its rarity, primary aldosteronism is a fascinating disease, protean in its manifestations, logical in its pathophysiology.
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PMID:[Arterial hypertension secondary to Conn's disease: an infrequent pathology in nephrology. Report of a clinical case]. 130 Apr 65

Six patients with cardiac amyloidosis (four males, two females; age 27-60 years) were evaluated by us. Four patients presented with congestive heart failure, while one patient each presented with effort angina and giddiness. Extracardiac clues to the diagnosis in the form of involvement of other systems were present in only two patients. The electrocardiogram was abnormal in four patients while three exhibited roentgenographic evidence of cardiomegaly or pulmonary venous hypertension. Echocardiography suggested the diagnosis of amyloidosis in only two patients, restrictive cardiomyopathy in two other patients and dilated and hypertrophic cardiomyopathy in one patient each. Cardiac catheterisation and angiography suggested restrictive heart disease in four patients and hypertrophic cardiomyopathy in one. One patient, whose initial haemodynamic study was normal, had features of dilated cardiomyopathy at repeat study after 11 months. Endomyocardial biopsies showed amyloid deposits in all patients. We emphasise the varied clinical manifestation of cardiac amyloidosis and the need for a high index of suspicion. The diagnosis can be safely and reliably confirmed by endomyocardial biopsy.
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PMID:Cardiac amyloidosis: hemodynamic, echocardiographic and endomyocardial biopsy studies. 130 87

The frequency correlation electrocardiogram (FCECG) was recorded in 27 patients with arterial hypertension (AH) and left ventricular hypertrophy (LVH), 8 patients with hypertrophic cardiomyopathy, 22 patients with coronary heart disease (CHD) and in 10 practically healthy volunteers. V4, V5 and V6 ECG leads were used as channel X, whereas lead II was used as channel Y. Application of V6 lead as channel X turned out most informative. The patients with AH and CHD had pathological indices in channel coherence. The patients with LVH manifested deviations in the spectrum of the amplitudes of lead II. The patients with associated LVH and relative coronary insufficiency demonstrated the unchanged FCECG like the practically healthy persons. In the given case, however, the unchanged FCECG in the above patients reflected the impairment of stimulation spreading in the left ventricular myocardium rather than the lack of its hypertrophy.
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PMID:[The use of frequency-correlation electrocardiography on patients with left ventricular hypertrophy]. 144 Feb 99

To determine whether patients with hypertrophic cardiomyopathy (HC) have an altered mode of contraction of the left ventricular (LV) wall related to underlying myocardial abnormalities, geometric changes in the LV wall were analyzed at 2 points of the cardiac cycle (end-diastole and end-systole) using 2-dimensional echocardiography. The relations between meridional and circumferential shortening of the LV midwall, mean wall thickening, and the changes in the short-axis cross-sectional area of the LV wall at the level of chordae tendineae were determined in 18 patients with nonobstructive HC, and were compared with those in 31 normal subjects and 19 patients with essential systemic hypertension. In normal subjects, no significant difference was observed between meridional (16.3 +/- 2.4%) and circumferential (17.1 +/- 4.0%) shortening, whereas cross-sectional LV wall area increased significantly at end-systole (p < 0.001). In patients with hypertension, all measured indexes were not different from those in normal subjects. In contrast, patients with HC had significantly reduced meridional shortening (p < 0.001) and mean wall thickening (p < 0.01). Consequently, a striking difference was observed between meridional (8.9 +/- 2.4%) and circumferential (16.9 +/- 3.2%) shortening (p < 0.001). Furthermore, no increase in cross-sectional LV wall area was observed at end-systole. Thus, echocardiographic detection of direction-dependent contraction can be a useful index for distinguishing HC from systemic hypertension.
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PMID:Differences in direction-dependent shortening of the left ventricular wall in hypertrophic cardiomyopathy and in systemic hypertension. 144 86

Arterial hypertension can badly affect coronary circulation through several mechanisms that are not mutually exclusive, namely, coronary artery disease, left ventricular hypertrophy, and microvascular disease. Theoretical and experimental data suggest that coronary microvascular disease may exist in hypertensives, in whom it can cause both a reduction of coronary flow reserve and a shift to the right of the coronary flow autoregulation curve. To address this issue, we used dipyridamole- echocardiography test, which causes ischemic-like ST segment depression with no detectable changes in left ventricular function in different subsets of patients with microvascular disease (Syndrome X; Hypertrophic cardiomyopathy; acute heart rejection). We found that dipyridamole infusion can cause a similar pattern of response (i.e., echocardiographically silent ST segment depression) in mild-moderate essential hypertensives with normal epicardial coronary arteries, without left ventricular hypertrophy, with increased forearm minimal vascular resistances and with a reduced coronary reserve. This pattern of response identifies hypertensives with higher risk of ventricular arrhythmias, is amplified by acute reduction of diastolic blood pressure and can be reversed, together with the reduction of forearm vascular resistances by chronic antihypertensive treatment. Taken together these findings suggest that microvascular coronary disease can exist in hypertensives with two adverse consequences, consistent with the experimental background: the reduction of coronary flow reserve as well as a shift to the right of the coronary flow autoregulation curve.
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PMID:Coronary microvascular disease in hypertensives. 154 Oct 47

Abnormalities of left ventricular (LV) systolic performance develop during exercise in patients with coronary artery disease (CAD) as a result of ischemia-induced regional wall motion abnormalities. Like patients with hypertension and those with hypertrophic cardiomyopathy, patients with CAD display abnormalities of LV diastolic performance under basal conditions in the absence of ischemia. The purpose of these studies was to compare the effects of bepridil versus those of propranolol or diltiazem in patients with exertional angina pectoris. LV systolic and diastolic performance were assessed at rest and during peak upright bicycle exercise by first-pass radionuclide ventriculography. Compared with propranolol, bepridil increased exercise capacity, cardiac output, and stroke volume and decreased systemic vascular resistance. Compared with diltiazem, bepridil increased exercise capacity, peak filling rate, and early diastolic filling fraction and decreased systemic vascular resistance, heart rate, time to peak filling rate, and atrial filling volume. Bepridil therapy is associated with improved exercise capacity and decreased anginal frequency and nitroglycerin consumption. In addition, its use is accompanied by favorable changes in LV systolic and diastolic function at rest and during exercise. These changes are consistent with benefits resulting from resolution of myocardial ischemia as well as from positive lusitropic effects of bepridil on the ventricular myocardium.
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PMID:Effects of antianginal therapy on left ventricular systolic and diastolic performance: comparison of the response to bepridil, propranolol, and diltiazem. 155 88

A 61-year-old female was admitted to our hospital, presenting hypertension and giant negative T-wave (GNT) on an electrocardiogram (ECG). The ECG taken one year prior to the admission showed left ventricular hypertrophy (LVH) without GNT. Hypertension had been poorly treated during the year previous to her admission. These had been almost no administration of antihypertensive drugs. Echocardiograms, left ventriculograms and magnetic resonance imaging revealed concentric and diffuse LVH. Endomyocardial biopsy of bilateral ventricles disclosed a degeneration of myocytes and their bizarre hypertrophy with disorganization. This pathologic finding was compatible with that of hypertrophic cardiomyopathy (HCM). Although GNT has frequently been noted in apical type of HCM, the alteration from normal T-wave to GNT within a year has rarely been reported. The present case exhibited GNT on an ECG which showed no apical hypertrophy. Since GNT had developed within a year while hypertension was poorly treated, the rapid development of GNT might have been precipitated by hypertension, which possibly altered the hypertrophic pattern of the left ventricle.
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PMID:[Hypertrophic cardiomyopathy with rapid development of giant negative T-wave within a year: a case report]. 162 Sep 98

One hundred and seventy-two patients (110 were greater than or equal to 65 years and 62 were less than 65 years) with congestive heart failure (CHF) were prospectively evaluated to determine various pathophysiologic mechanisms of CHF. The incidence of CHF with normal left ventricular (LV) systolic function was higher in elderly (30% vs 12%, p less than 0.05). Of the 110 elderly patients, LV systolic function was impaired in 77. Fifty-five patients had LV dilatation without increased wall thickness, and the clinical diagnosis was "dilated cardiomyopathy in the elderly". Twenty-two patients had hypertrophied LV and a high incidence of hypertension, and they were diagnosed as "hypertensive heart failure" due to contractile dysfunction. On the contrary, the remaining 33 patients did not have impaired LV contractile function. Thirteen patients lacking LV hypertrophy had enlarged atria. CHF was induced by reduced chamber compliance called "the stiff heart syndrome". Twenty patients had hypertrophied LV and a high incidence of hypertension. They were diagnosed as having "hypertensive hypertrophic cardiomyopathy of the elderly" and abnormalities of diastolic function accounted for the CHF. Since echocardiography can easily and accurately diagnose the pathophysiologic mechanism of CHF, an increased awareness of its occurrence in the elderly and use of echocardiography would reduce diagnostic and therapeutic errors.
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PMID:Congestive heart failure in the elderly--echocardiographic insights. 162 55

Doppler echocardiography was performed in 21 patients with hypertrophic cardiomyopathy (HC), in nine patients with no evidence of left ventricular (LV) hypertrophy by two-dimensional echocardiography, and in five patients with systemic hypertension and concentric LV hypertrophy. The LV outflow tract (LVOT) peak velocity was recorded by continuous wave Doppler technique at rest and after amyl nitrite inhalation. The LVOT pressure gradient was calculated by the modified Bernoulli equation. A significant increase in heart rate and a drop in systolic blood pressure were observed in all patients after amyl nitrite inhalation; no adverse effects were encountered. The peak LVOT velocity and pressure gradient increased significantly after provocation in all patients, but the increase was much more pronounced in patients with HC (peak LVOT velocity increased from 2.2 +/- 0.8 to 4.3 +/- 1.0 m/sec and peak gradient increased from 22 +/- 17 to 78 +/- 36 mm Hg). The Doppler spectral signal in patients with HC demonstrated a characteristic contour, with peak velocity occurring in late systole. However, the observed increase in LVOT peak velocity was not statistically different between treated (with beta-blockers and calcium blockers) and untreated patients with HC. We conclude that LVOT peak velocity and pressure gradients in patients with HC can be readily assessed by Doppler echocardiography both at rest and after amyl nitrite inhalation. The dynamic changes in LVOT velocity induced by this provocation have certain characteristic features in obstructive HC but appear to be independent of the medical regimen used, at least in the dosages tested in our study.
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PMID:Dynamic changes in left ventricular outflow tract flow velocities after amyl nitrite inhalation in hypertrophic cardiomyopathy. 167 73

This report presents 72 cases with mitral annulus calcification. The diagnosis was made by echocardiogram. There were 21 males and 51 females, aged from 38 to 93 (mean 71). The associated clinical findings in these 72 patients included: hypertension, 28 cases; valvular aortic stenosis, 3 cases; hypertrophic cardiomyopathy, 7 cases; chronic renal failure, 14 cases; congestive heart failure, 29 cases, calcified aortic valve, 27 cases; mitral regurgitation, 46 cases; cerebral infarct, 19 cases; peripheral arterial embolism, 2 cases. Their electrocardiographic findings included: atrial fibrillation, 25 cases; conduction defects, 21 cases; sick sinus syndrome, 3 cases (one case required permanent pacemaker implantation). We conclude that mitral annulus calcification is not a senile change only, and that it also results in some complications such as: mitral regurgitation, cerebral embolism, peripheral arterial embolism, atrial fibrillation and conduction defects. Echocardiography is a useful diagnostic tool in the evaluation of patients with mitral annulus calcification.
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PMID:[Mitral annulus calcification: clinical observation on 72 patients]. 167 8


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