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

We had a rare patient for adrenalectomy who had aldosteronism complicated with hypertrophic cardiomyopathy (HCM). It has been suggested that aldosteronism could be the cause of HCM. The association is not clear in this case, but there is a possibility that myocardial hypertrophy was deteriorated with hypertension caused by aldosteronism. Two important points of the anesthetic management of a patient with HCM are (1) to prevent direct or reflex increases in contractility, and (2) to maintain adequate preload and afterload. In a case complicated with aldosteronism, there is a risk that a significant increase in peripheral vascular resistance following the manipulation of the adrenal gland would aggravate left ventricular pressure load, resulting in a marked decrease in cardiac output. Therefore, in such a case, vasodilators which are said to be poorly tolerated in a patient with HCM might be considered to facilitate the anesthetic management, provided that the vascular system is kept appropriately full. In this case, we employed enflurane-oxygen-nitrous oxide with fentanyl to keep deep levels of general anesthesia. Nitroglycerin (NTG) was used when arterial pressure increased suddenly with the manipulation of the adrenal gland. The effect of NTG is not definitely convincing since blood pressure returned to normal after adrenal excision. But the fact that pulmonary capillary wedge pressure decreased with infusion of NTG suggests improvement of hemodynamic function.
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PMID:[Anesthetic management of adrenalectomy in a patient with aldosteronism complicated with hypertrophic cardiomyopathy]. 238 99

The clinical course and hemodynamic results in patients undergoing operation for obstructive hypertrophic cardiomyopathy with preoperative pulmonary arterial hypertension were unknown. The hypothesis tested in this retrospective study was that operative relief of left ventricular outflow tract obstruction resulted in a substantial reduction in pulmonary artery pressures and mitral regurgitation without necessitating mitral valve replacement. Patients were included if their preoperative pulmonary systolic pressure was greater than 35 mm Hg and if they were without concomitant cardiac disease, with the exception of mitral regurgitation. Since 1962, 49 patients who fit our criteria underwent left ventricular myotomy and myectomy with 98% follow-up. Mean follow-up was 7.9 +/- 0.7 (mean +/- standard error of the mean) years with a range of 0.8 to 18.4 years. Early hospital mortality rate was 12% (n = 6); two deaths from low cardiac output and four from arrhythmia. There were 43 (88%) hospital survivors and 18 late deaths. Actuarial survival rate after operation was 87% +/- 5% (n = 31) at 5 years and 55% +/- 8% (n = 9) at 10 years. Thirty-nine of 43 survivors (91%) returned 9 +/- 1 months postoperatively for follow-up evaluation including cardiac catheterization. The majority (83%) were in New York Heart Association functional class I or II postoperatively. Cardiac catheterizations indicated a fall in pulmonary arterial systolic pressure from 62 +/- 3 (range = 36 to 105) to 38 +/- 2 (range = 21 to 65) mm Hg (p = 0.0001) with no difference in right atrial pressure or cardiac output. Pulmonary arterial wedge mean pressure decreased from 24 +/- 1 to 16 +/- 5 mm Hg (p = 0.0002) and preoperative mitral regurgitation improved or was abolished in 85% of patients studied (n = 13). Rest and maximal provocable left ventricular outflow tract gradients decreased from 81 +/- 7 and 103 +/- 5 to 14 +/- 3 and 45 +/- 8 mm Hg, respectively (p = 0.0001). Comparison of the above-mentioned patients, operated on since 1982, with a preoperatively matched group who underwent mitral valve replacement in the same interval showed no statistically significant difference in mortality, morbidity, hemodynamic outcome, or functional outcome with a mean follow-up of 2 years. We conclude that a consistent, significant reduction (mean = 40%) in preoperative pulmonary arterial systolic pressure, clinical symptoms, and mitral regurgitation occurs with relief of outflow tract obstruction by left ventricular myotomy and myectomy and that pulmonary hypertension and mitral regurgitation are not indications for mitral valve replacement in these patients.
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PMID:The results of operation in patients with hypertrophic cardiomyopathy and pulmonary hypertension. 239 71

CCB are a diverse group of drugs that bind to specific glycoprotein receptors associated with the cell membrane that are most likely identical to the voltage-sensitive calcium channel. By inhibiting the influx of calcium into myocardial, pacemaker, and conducting tissues and vascular smooth muscle, these agents modify excitation-contraction coupling in muscle and electrical impulse transmission in the heart. The vasodilating and electrophysiologic actions of these drugs have been harnessed for the treatment of coronary vasospasm, angina pectoris, and supraventricular arrhythmias. They also have great potential for the treatment of hypertension, cerebrovascular disorders, and Raynaud's phenomenon. Their utility in hypertrophic cardiomyopathy, congestive heart failure, myocardial preservation, and primary pulmonary hypertension has not been convincingly established. Future second-generation CCB may offer greater selectivity, improved side effect profiles, and an even wider range of actions.
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PMID:Calcium channel blocking drugs. Part II: Clinical applications. 241 54

Hypertrophic cardiomyopathy is characterized by a hypertrophic and non-dilated left ventricle with disproportionate involvement of the intraventricular septum compared to the free walls, and by varying degrees of outflow obstruction during systole. Its symptoms and clinical course, pathogenesis and treatment are briefly discussed. It is speculated whether hypertrophic cardiomyopathy and hypertension are both caused by systemic disorders of calcium channels and calcium uptake and binding by cardiac and smooth muscle membranes, respectively.
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PMID:Hypertrophic cardiomyopathy. 242 66

The correlation between the plasma atrial natriuretic peptide (ANP) levels and echocardiographically measured atrial and ventricular dimensions was studied in various cardiovascular diseases. A total of 107 patients (valvular heart disease 27, cardiomyopathy 11, ischemic heart disease 17, hypertension 42, congenital heart disease 2, and normal 8) were studied. None of the patients had overt signs of heart failure, though 22 of them had atrial fibrillation. Left ventricular end-diastolic and end-systolic diameters, ejection rate and end-diastolic posterior wall thickness were measured by M-mode echocardiography. Maximal left and right atrial diameters and right ventricular end-diastolic diameter were measured by the apical four-chamber view. Following echocardiographic evaluation and blood pressure measurement, blood sampling was performed via the antecubital vein into a tube containing aprotinin and the samples were analyzed by radioimmunoassay. There was no significant correlation between ANP level and heart rate, systemic blood pressure, left ventricular end-diastolic and end-systolic diameters, ejection fraction, posterior wall thickness or right ventricular end-diastolic diameter. The most probable reason for the insignificant relationships was that the correlation varied according to the underlying cardiovascular diseases; e.g., correlation between ANP level and left ventricular diameter was significantly positive in mitral regurgitation, while it was significantly negative in hypertrophic cardiomyopathy. There was a significant correlation between ANP level and the maximal right (r = 0.40, p less than 0.001) or left atrial diameter (r = 0.57, p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Relations of intracardiac dimensions as measured by echocardiography and plasma atrial natriuretic peptide levels in various cardiovascular diseases]. 253 Mar 34

In order to develop the tentative criteria of the differential diagnosis, 18 patients with obstructive hypertrophic cardiomyopathy (OHCMP), 3 with nonobstructive hypertrophic cardiomyopathy (NOHCMP), 8 with essential hypertension (EH) with inadequate left ventricular hypertrophy (LVH) and 10 normal persons were subjected to clinical examination and to ultracardiosonography. The patients with OHCMP mainly complained of dizziness and syncopes. Since childhood they had systolic murmur and ECG abnormalities. Ultracardiosonography showed asymmetrical LVH, a considerable decrease of the ventricular cavity as well as abnormalities of the localization and function of the papillary muscles. NOHCMP was marked by the combination of the good well-being of the patients with gross abnormalities on the ECG. Ultracardiosonography demonstrated moderately pronounced and asymmetrical LVH. The group suffering from EH with inadequate LVH was characterized by the early development of severe circulatory failure with arterial hypertension of moderate intensity. The changes in the architectonics of the left ventricle and its subvalvular structures turned out to be similar to those in OHCMP but were less remarkable.
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PMID:[The differential diagnosis of various forms of hypertrophic cardiomyopathy and hypertension with inadequate left ventricular hypertrophy]. 253 35

In order to understand the mechanism of development of asymmetric septal hypertrophy (ASH) in hypertension, 290 patients with essential hypertension (HT) were examined echocardiographically. Out of them 84 cases of advanced left ventricular hypertrophy (LVH) [37 cases of symmetric hypertrophy (HT-SH group) and 47 cases of ASH (HT-ASH group)] were compared in their clinical and echocardiographic findings with hypertrophic cardiomyopathy (HCM). In the 290 HT cases, the highest systolic pressure in each patient's history was found to correlate with left ventricular (LV) posterior wall thickness (PWT), but not with the septal wall thickness (IVST). There were no differences in LV thickness (IVST + PWT) among patients in the HT-ASH, HT-SH and HCM groups. While the HCM group patients showed no significant differences in IVST and PWT from those in the HT-ASH group, they did have greater IVST and smaller PWT than HT-SH group patients. The rapid filling rate (RFR) was also not much different in the HCM and HT-ASH groups, but was significantly lower in the HCM group than in the HT-SH group. Furthermore, HT-ASH group patients has a milder degree of hypertension and a higher incidence of familial occurrence of HCM than did those in the HT-SH group. After treatment for HT, the HT-SH group showed a significant decrease in wall thickness during long-term observation, while the HT-ASH and HCM groups, failed to exhibit such changes. Moreover, the degree of myocardial disarrangement in the HT-ASH group did not differ significantly from that in the HCM group. These results suggested that LVH in HT is related not only to pressure load but also to genetic factors similar to that in HCM.
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PMID:Mechanism of development of asymmetric septal hypertrophy in patients with essential systemic hypertension. 253 75

An improvement can be obtained in the surgical prognosis of the cardiopathic by working on the main risk factors. Congestive decompensation must usually be treated with diuretics; digitalis in only indicated in certain cases. In patients with ischaemic cardiopathy, angina therapy should be continued during the perioperative period, replacing the oral route; in the postoperative period. ECG monitoring is advisable up to Day III-V. Valve defects should be assessed carefully, including haemodynamically (especially severe aortic stenosis) because correction of the defect may become a priority. In hypertrophic cardiomyopathy hypovolaemia and loss of sinus rhythm should be avoided. Valve prostheses involve particular problems represented by antibacterial prophylaxis and perioperative anti-coagulation. Congenital cyanogenic cardiopathies often require a lowering of the haematocrit and careful control of hypotension. Postoperative arrhythmias generally have medical causes and require control of the latter before possible antiarrhythmic therapy. The implantation of a temporary prophylactic pacemaker is rarely needed; for patients with definitive pacemakers, some precautions are needed for the use of the thermocautery. It is very important to deal with poor general medical conditions that might affect prognosis. Control of hypertension is less important than control of hypotension.
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PMID:[Surgical cardiac risk in patients with heart diseases. II. Perioperative treatment]. 260 76

The examination indicated that abnormal Q and QS waves recorded along the azes Z and Y in the adjusted lead system far clearly reflected a predominant site of suspected focal and scarring lestoh in hypertrophic cardiomyopathy (HCM) as in coronary heart disease (CHD) (the anterior site in the Z lead and inferior one, in the Y lead), however, the difference in their quantitative characteristics do not fulfil the goals of the electrocardiographic differentiation between HCM and CHD. To differentiate HCM and CHD in the presence of Q and QS waves, a characteristic complex of signs was identified: elevated waves Rx (greater than or equal to 17.5 mm), Sy (greater than or equal to 7.3 mm) of the total value, sigma Rxyz + sigma Sxyz (greater than or equal to 48.3 mm) at the anterior site of "scarring" myocardial lesion and increased waves Sz (greater than or equal to 20.4 mm), sigma Sxyz (greater than or equal to 21.4 mm) at the inferior site. Only "indirect" signs remained on VECG in the presence of scarring myocardial lesion concurrent with arterial hypertension in CHD patients.
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PMID:[Vector electrocardiographic features in patients with hypertrophic cardiomyopathy]. 261 73

From 1982 to 1986, 1230 sudden death cases were autopsied in Osaka Medical Examiner's Office. Among them, 810 cases were sudden cardiac deaths (SCD) including coronary heart disease (77%), cardiomyopathy (7%), valvular disease (3%). All SCD cases were dead within 24 hours of the appearance of the fatal symptoms, and most of them (72%) were considered instantaneous death. Many of the fatal symptoms began in bed (31%), at bath (17%), at toilet (8%), or at work (8%). Thirty-four percent of them were thought by themselves or by their families to be healthy before the death. Hypertension (38%), coronary heart disease (13%) and diabetes mellitus (11%) were the major past history recorded. Microscopic observation of the hearts of 200 cases autopsied in 1986 showed various cardiac lesions: hypertrophy, atrophy, degenerations of myocytes, cellular and fatty infiltrations of the interstitium. According to their cardiac lesions and degrees of severity of coronary sclerosis, patients who died suddenly were divided into 8 groups as follows: 1. myocardial infarction (41) 2. myocarditis (6) 3. hypertrophic cardiomyopathy (19) 4. chronic ischemia with severe coronary sclerosis (65) 5. chronic ischemia with moderate coronary sclerosis (27) 6. small vessel disease (18) 7. amyloidosis (1) 8. unknown (23). These results suggest that coronary heart disease and hypertension play an important role in SCD.
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PMID:An epidemiologic and histopathological study of sudden cardiac death in Osaka Medical Examiner's Office. 263 29


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