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

Digoxin remains a very useful agent for chronic atrial fibrillation or for the ectopic beats associated with heart failure. But when rapid control of the ventricular rate is required to arrhythmias such as atrial fibrillation, atrial flutter, or paroxysmal atrial tachycardia, a slow infusion of verapamil is the agent of choice. In general, verapamil may be added to digoxin or given intravenously while a digoxin effect is awaited, unless there is digitalis toxicity. In digitalis toxicity, lignocaine remains the agent of choice for ventricular arrhythmias, and is given in the same doses as for acute myocardial infarction; phenytoin is used for digitalis-arrhythmias with A-V block. Verapamil may be infused very cautiously for digitalis-induced supraventricular tachyarrhythmias. The use of oral agents such as quinidine, disopyramide and mexilitene for chronic prophylaxis of ventricular ectopic beats is of doubtful effectiveness, unless the ectopic activity is symptomatic. Serious ventricular arrhythmias may be induced by quinidine and disopyramide. Beta-blockade is especially useful for ectopic beats associated with anxiety, or when arrhythmias are associated with angina of effort or hypertension. As always, major contraindications to the use of beta-blockade include cardiomegaly, heart failure or asthma.
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PMID:Anti-arrhythmic agents in ischemic heart disease: supraventricular arrhythmias, digitalis toxicity and chronic stable ventricular ectopic beats. 708 6

We performed an echocardiographic and hemodynamic study in 10 patients with cath proven pulmonary arterial hypertension (PAH). The results show that the echocardiographic pattern of PTH such as flat diastolic pulmonary echo, premature closing, flutter, abscense of "A" wave, in creased opening velocity and changes in the right ventricular systolic time intervals, are equivocal. The most common echo finding in our study, was the increased opening velocity. Other echo data could be absent despite the true presence of pulmonary hypertension in a particular case. This report shows similar findings to a recent one published elsewhere (12) with no correlation between echo and hemodynamic data.
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PMID:[Echocardiographic evaluation of pulmonary arterial hypertension]. 746 12

Esmolol is a unique cardioselective, intravenous, ultra-short acting, beta-adrenergic blocking agent. A 9-minute half-life with rapid clinical onset and offset of action and the ability to titrate the drug to changing circumstances makes esmolol a useful addition to our treatment armamentarium. The efficacy and safety of esmolol have been shown in specific clinical settings, i.e. in patients with unstable angina, myocardial infarction, atrial fibrillation or flutter and supraventricular tachycardia. In the emergency management of hypertension, tachycardia or arrhythmia in critical care units, emergency room and surgery, esmolol is effective by attenuating hemodynamic responses from sympathetic activation or endogenous catecholamine release. With careful titration and monitoring of the patient, esmolol is relatively safe in the management of hypertension or tachyarrhythmias associated with congestive heart failure or chronic obstructive lung disease where beta-blockers are otherwise contraindicated. Different dosage schedules have been employed as per the clinical setting and the diagnosis. Generally, esmolol is infused intravenously in doses ranging from 25-300 micrograms/kg/min, along with a loading dose or bolus. The most frequently reported adverse effect associated with esmolol infusion was hypotension. Adverse effects due to beta-blockade can be corrected by down-titrating or discontinuing the infusion with complete disappearance of clinical effects in 20-30 minutes. Therefore, as an ultra-short acting beta-blocker, esmolol is an important therapeutic option in the acute clinical setting.
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PMID:Clinical rationale for the use of an ultra-short acting beta-blocker: esmolol. 762 Jun 91

Two cases of severe aortic regurgitation due to non-traumatic rupture of the aortic valve commissures are reported. The cause of rupture was hypertension in one patient, but it could not be identified in the other, where microscopic examinations of the aortic wall and the aortic cusps showed no particular pathologic changes. M-mode echocardiography revealed enlargement of the left ventricle, diastolic flutter of the anterior mitral leaflet and diastolic separation of the closure line of the aortic cusps in both patients. Two-dimensional echocardiography showed a downward displacement of the prolapsing motion of the aortic valve cusp during diastole toward the left ventricular outflow tract in one patient, and eccentricity of the coaptation point of the aortic valve without thickening of the cusps in the other. In addition to clinical features of progressive heart failure and characteristic cardiac murmur, echocardiographic studies provided correct diagnosis of aortic valve prolapse resulting from rupture of the aortic valve commissures. Both patients underwent aortic valve replacement successfully.
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PMID:Aortic regurgitation due to non-traumatic rupture of the aortic valve commissures: report of two cases. 774 98

Survival after closed-chest ablation of His bundle with DC shock for supraventricular arrhythmias was analyzed for a 10-year period (May 1982-December 1992) with 317 consecutive patients (167 males, 150 females; mean age 66 years; range 33-93 years). Of these, 54 patients died (17.3%) and 5 were lost to follow-up. The mean age at ablation was 70.3 +/- 8.3 years with a range of 49-93 years. Of those who died, the mean survival was 30.5 +/- 28.6 months with a range of 36 hours to 120 months; the diagnosis of heart disease was: hypertension (n = 14), cardiomyopathy (n = 8), ischemic (n = 7), valvular (n = 6), cor pulmonale (n = 3), valvular and ischemic (n = 2), hypertension and ischemic (n = 1), miscellaneous (n = 3), and none (n = 10). Of the patients who died after ablation, the arrhythmias at the time of the ablation were atrial fibrillation (AF; n = 33), sick sinus syndrome (n = 5), atrial flutter (AFL; n = 4), paroxysmal AV junctional tachycardia (PAVJT; n = 4), AF + AFL (n = 4), atrial tachycardia (n = 2), PAVJT + AFL (n = 1), and AF +AFL + atrial tachycardia (n = 1). Death was sudden in 13 patients (25%), due to heart failure in 10 (19.2%), myocardial infarction in 4 (7.7%), stroke in 4 (7.7%), aortic vascular accident in 3 (5.8%), miscellaneous in 18 (34.6%), and undetermined in 2.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term survival after closed-chest His-bundle ablation with DC shock for supraventricular arrhythmias: a 10-year experience with 317 consecutive patients. 784 34

To assess the prognostic significance of supraventricular tachyarrhythmias (SVTA) during acute myocardial infarction (AMI), we studied 388 patients with first AMI, without ventricular preexcitation or chronic atrial fibrillation. The prevalence of SVTA was 14% (56/388), including atrial fibrillation (57%), atrial flutter (22%), polyfocal atrial tachycardia (14%), monofocal atrial tachycardia (7%). The arrhythmia appeared within 72 hours from the onset of chest pain in 61% of patients (early SVTA < 72 hours), while in 39% appeared later (late SVTA > 72 hours). Patients with SVTA (Group I n = 56) and without SVTA (Group II n = 232) were similar regarding prevalence of hypertension, dyslipidemia, diabetes, site of infarction and fibrinolysis, but SVTA was associated with a significant increase in death (Group I 18% versus Group II 9%; p < 0.05) and complications as pulmonary oedema and cardiogenic shock (Group I 25% versus Group II 14%; p < 0.05). Left atrial dimensions (LAD), end-diastolic left ventricular volume (EDLVV), end-systolic left ventricular volume (ESLVV) and echo-score, evaluated at admission, were not different between Group I and II (LAD 41.3 +/- 6 mm versus 40.1 +/- 5 mm, NS; EDLVV 181 +/- 34 ml versus 173 +/- 30 ml, NS; ESLVV 80 +/- 21 ml versus 75 +/- 18 ml, NS; echo-score 6.7 +/- 3.1 versus 6 +/- 2.7, NS) while pre-discharge echo-grams in Group I showed a trend towards the increase in volumes and echo-score (EDLVV from 181 +/- 34 ml to 194 +/- 36 ml, p = 0.052; ESLVV from 80 +/- 23 ml to 88 +/- 23 ml, p = 0.051; echo-score from 6.7 +/- 3.1 to 7.8 +/- 3.3, p = 0.070).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Supraventricular hyperkinetic arrhythmias in acute myocardial infarct: their prognostic assessment and correlation with the echocardiographic evolution]. 785 30

In a statistics including 954 patients with hyperthyroidism [correction of Huprotoncoses] treated between 1966-1989, the authors found 522 cases (54) with various associated cardiac disorders. Of these cases, 199 presented rhythm disturbances: extrasystolic arrhythmia, auricular fibrillation and flutter to which 34 postoperative arrhythmias are added. Cardiac insufficiency present in 46 cases was the main complication and end point of the various myocardial conditions. Ischemic cardiopathy (181 cases), arterial hypertension (98 cases) and rheumatic valvulopathies (9 cases), either isolated or dominating the clinical picture, complete the nosological spectrum of these disturbances. The frequency of associated conditions and the absence of some specific morphologic lesions suggest that thyrotoxicosis is rather an aggravating factor although in many cases the presence of a previous cardiac disease is excluded. The two objectives in the management of thyrocardiac diseases are the amelioration of cardiac condition and an endocrine balance. In the conditions of a careful selection and preoperative preparation, surgery gave good results consisting, in this series, in over 70% cures and ameliorations.
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PMID:[The cardiac manifestations in hyperthyroidism. The surgical implications]. 815 62

The authors describe two hypertensive patients with paroxysmal auricular flutter or fibrillation. The arterial hypertension was suspected because of a hypertensive response in a treadmill stress test, confirmed by a 24-hour blood pressure ambulatory monitoring and there was no damage in target organs. They focus that auricular flutter/fibrillation may be related to "occult hypertension".
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PMID:[Paroxysmal atrial fibrillation and flutter and "occult" arterial hypertension. The importance of the ambulatory monitoring of the blood pressure. Apropos 2 cases]. 828 35

Diltiazem is a benzothiazepine derivative calcium antagonist available in several formulations, some of which enable once daily administration. The drug as monotherapy has demonstrated similar efficacy to diuretics in older patients with hypertension. Data comparing diltiazem with beta-blockers and angiotensin converting enzyme inhibitors are more limited, but available studies suggest at least comparable antihypertensive efficacy. Diltiazem as monotherapy or in combination with a beta-adrenoceptor-antagonist, isosorbide dinitrate, or another calcium antagonist, has demonstrated efficacy in patients with effort angina. The drug has also been used intravenously to terminate supraventricular tachycardias and to control the ventricular response to atrial fibrillation or flutter; it also appears to reduce the rate of early reinfarction in patients with non-Q-wave myocardial infarction. The most common adverse events during diltiazem therapy include headache, flushing, peripheral oedema and hypotension. Atrioventricular block although rare, is the most frequent serious adverse event related to diltiazem therapy and may be exacerbated by coadministration of beta-adrenoceptor antagonists, especially in the elderly. Thus, diltiazem appears to be an effective and well tolerated treatment for hypertension and angina in older patients and has shown promise as therapy for supraventricular tachycardias and as prophylaxis against early reinfarction in patients with non-Q-wave myocardial infarction.
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PMID:Diltiazem. A review of its pharmacology and therapeutic use in older patients. 836 96

Continuous ambulatory ECG (CAECG) monitoring has been advocated as an effective low-cost preoperative method for detecting silent myocardial ischemia in patients undergoing peripheral vascular surgery. In addition, silent ischemic events are associated with an increased incidence of postoperative myocardial infarctions. Ninety-six patients (mean age 73 years) admitted for elective aortic (24) or infrainguinal (72) operations over a 2-year period underwent 24-hour two- or three-lead CAECG monitoring. Results were reviewed by a single cardiologist blinded to the study. The criterion for ischemia was ST segment depressions of 1 mm or greater for 40 seconds or more 60 msec after the J point. Postoperative myocardial infarction was determined by ECG changes and/or elevated serum creatinine phosphokinase with positive MB isoenzymes. Risk factors included hypertension (71%), history of coronary artery disease (66%), smoking (61%), and diabetes mellitus (47%). Nine out of 96 patients (9.4%) had a positive CAECG test for silent myocardial ischemia. Only one patient (11.1%) developed postoperative myocardial infarction and there were no deaths in this group. The incidence of postoperative myocardial infarction in the nonischemic group was 16.1% (14/87). However, the mortality in this group was 6.9% (6/87). New and malignant arrhythmias requiring preoperative medical intervention were observed in seven patients (7.4%): two cases of ventricular tachycardia and five cases of atrial flutter/fibrillation. Contrary to previous reports, CAECG monitoring for silent ischemia was not a significant predictor of postoperative myocardial infarction or mortality in our patient population. However, we continue to recommend the preoperative use of CAECG monitoring as a diagnostic tool for unsuspected malignant arrhythmias.
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PMID:Silent myocardial ischemia is not predictive of myocardial infarction in peripheral vascular surgery patients. 851 16


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