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

Electrophysiologic studies were performed in 47 children aged 3 to 18 years, 15 of whom had cardiac arrhythmias 1 to 15 years after repair of tetralogy of Fallot. Six exhibited sinus or atrioventricular nodal dysfunction, 8 had ventricular extrasystoles, and 1 had supraventricular tachycardia. Hemodynamic and electrophysiologic data were obtained at postoperative catheterization. Although electrophysiologic responses were abnormal in a proportion of both the children with and those without arrhythmia, hemodynamic values were similar. Three of 6 children with impaired sinus impulse generation or atrioventricular nodal conduction had a prolonged A-H interval, and in 3 Wenckebach heart block developed at low pacing rates. Ventricular ectopic rhythm was not associated with any particular abnormality of basic intracardiac conduction intervals. Thus, arrhythmias and conduction abnormalities are not consistently related to residual right ventricular hypertension. Abnormalities in electrophysiologic function are common after repair of tetralogy of Fallot in patients with sinus rhythm and may have prognostic implications for these patients.
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PMID:Hemodynamics and intracardiac conduction after operative repair of tetralogy of Fallot. 618 35

Inadequate coronary reserve is present in left ventricular hypertrophy secondary to hypertension. Since this abnormality might be due in part to vascular hypertrophy of coronary resistance vessels in response to chronic hypertension, we studied a model of ventricular hypertrophy without hypertension. Volume-overload hypertrophy was produced by creating complete heart block in mongrel dogs; 6 to 7 weeks later the dogs were studied in the awake state. The thirteen dogs with chronic heart block had a 49% increase (P less than 0.05) in left ventricular mass compared with eight control dogs. The major findings in this study were: 1) at rest, coronary blood flow (microsphere technique) per unit weight of left ventricle was not increased in dogs with hypertrophy; and 2) the minimal coronary vascular resistance per unit weight of left ventricle calculated during iv adenosine infusion at a rate that produced maximal vasodilatation was not significantly higher in dogs with left ventricular hypertrophy than in controls (16.4 +/- 1.0 vs 14.7 +/- 1.5 kPa . litre-1 . min . 100 g, respectively). Minimal coronary vascular resistance of the entire left ventricle was significantly less in dogs with hypertrophy than controls (13.0 +/- 0.8 vs 17.3 +/- 1.7 kPa . litre-1 . min, respectively). This data suggests that vascular hypertrophy of coronary resistance vessels related to chronic hypertension may be the cause of the increased minimal coronary vascular resistance seen in dogs with pressure-overload left ventricular hypertrophy.
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PMID:Effect of volume-overload hypertrophy on the coronary circulation awake dogs. 621 4

Between January 1973 and July 1981, 128 patients less than 1 year of age with failure to thrive, congestive heart failure or pulmonary artery hypertension underwent primary repair of a ventricular septal defect. The hospital mortality rate was 7.8% (10 of 128), and the late mortality rate was 2.3% (3 of 128). Mortality was highest among younger infants with preexisting respiratory problems or a hemodynamically significant residual lesion postoperatively. Complications included a large residual shunt in eight (6.2%), transient neurologic problems in five (3.9%) and persistent complete heart block in three (2.3%). Lung biopsy specimens obtained from 49 patients showed pulmonary vascular abnormalities in all. Complete right bundle branch block developed in 74 (64%) and bifascicular block appeared in 11 (9%). Recatheterization in 70 patients (55%) showed normal pulmonary artery pressures in all but 2 patients with a large residual shunt. Complete closure of the defect had been achieved in 49 (70%), and a hemodynamically insignificant shunt remained in 19 (27%). Patients without significant hemodynamic residua were asymptomatic and tended to accelerate in growth after surgery.
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PMID:Primary surgical closure of ventricular septal defect in the first year of life: results in 128 infants. 670 79

After nearly 10 years in clinical use, prazosin has been shown in numerous studies worldwide to be an effective antihypertensive agent over the entire range of hypertension (mild, moderate, and severe), when used alone or in multitherapy. In addition to its general effectiveness, prazosin is particularly useful in specific subpopulations of hypertensive patients, such as those with impaired renal function, those on hemodialysis, and those with concomitant heart block, bronchospasm, diabetes mellitus, or disturbed carbohydrate metabolism, hyperlipidemia, or hyperuricemia. The side effects of prazosin are usually mild and transient and seldom require discontinuation of the drug. Sexual dysfunction is uncommon. In clinical experience with 22,000 patients receiving an initial dose of 1 mg of prazosin, syncope was reported in 1 of every 667 patients (0.15%). Withholding diuretics for 1 day before initiating prazosin therapy, utilizing prazosin as first-line therapy, limiting the initial dose to 1 mg, and taking it at bedtime are all helpful in eliminating many of the initial adverse effects. Fluid retention, although rare and not as pronounced as that with other antihypertensive agents, may develop on long-term therapy and may necessitate the addition of a diuretic later on.
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PMID:Effectiveness of prazosin as initial antihypertensive therapy. 682 27

Reflex heart block was studied in 20 dogs anesthetized with sodium pentobarbital and in 5 trained unanesthetized dogs. Three different vagal reflexes were produced: the Marey response during hypertension caused by administering methoxamine, a cardiogenic hypertensive chemoreflex activated by injection of serotonin into the left atrium and the Hering-Breuer reflex observed during normal respiration of unanesthetized dogs. In every dog during any of the three reflexes heart block was consistently observed after the normal slowing response of the sinus node had been selectively eliminated by the direct perfusion of 10 microgram of atropine into the sinus node artery. This was a uniform response despite its being variously produced by a pressor reflex, a chemoreflex or an extracardiac bronchopulmonary reflex. Transient heart block is therefore to be anticipated during reflexes with vagal efferent components if for any reason the sinus node is incapable of slowing suitably. The possible clinical relevance of these experimental observations is discussed.
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PMID:Reflex heart block. Baroreflex, chemoreflex and bronchopulmonary reflex causes. 737 16

Androctonus crassicauda venom has an i.v. LD50 in mice of 0.32 +/- 0.02 mg/kg, which makes the scorpion among the most toxic species in the world. Fifty-one non-fatal and one fatal cases of scorpion sting were presented. Pain and tenderness were very common following the sting. Generalized erythema occurred in 20-25% of all infants and children below the age of 5 years. Severe CNS manifestations including seizures, unconsciousness and marked irritability occurred mainly in infants and young children, while hypertension occurred in the majority of victims below the age of 11 years. Two pregnant victims were treated with antivenom with no bad consequences on mothers or foetuses. The fatal case described was inadequately treated with antivenom and presented a rare situation of intracranial coagulation in the basal cisterns or low in the cranial subarachnoid space. The victim developed moderate hydrocephalus of the communicating type with clear ventricular CSF and strongly xanthocromic fluid from lumbar puncture. The effects of A. crassicauda venom on isolated hearts, atria and anaesthetized rat blood pressure appeared to be mediated largely through stimulation of the autonomic nervous system with predominance of sympathetic stimulation and release of tissue catecholamines. Electrocardiograms recorded simultaneously with blood pressure changes showed evidence of ectopic foci during the hypertensive phase and ischaemia, inferior wall infarction and different degrees of heart block during the late hypotensive phase. Androctonus crassicauda venom was unique in following a three-compartment open model comprising a central compartment 'blood', a rapidly equilibrating 'shallow' tissue compartment and a slowly equilibrating 'deep' tissue compartment. The overall elimination half-life, t1/2 beta, was 24 hr, indicating that the venom has the slowest elimination among all known scorpion venoms. The long stay of the venom in the body might explain the increased risk of toxicity and the good potential for treatment with serotherapy even hours after the sting.
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PMID:Androctonus crassicauda (Olivier), a dangerous and unduly neglected scorpion--I. Pharmacological and clinical studies. 772 29

A retrospective study of the cardiovascular side-effects of 17 patients during and after receiving unpurged cryopreserved autologous bone marrow and/or peripheral blood stem cells was performed. Fourteen (82%) patients developed cardiac arrhythmia, of which 11 (65%) developed sinus bradycardia, four (24%) second degree heart block and one patient had complete heart block. The onset of sinus bradycardia occurred at 15-513 (median 56) min and the onset of heart block ranged from 30 to 680 (median 234) min after starting the stem cell infusion. Hypertension was noted in seven patients (41%) and usually occurred within 2 hours of infusion. There was no mortality or symptoms associated with these findings. Since some of these arrhythmias could be quite severe as assessed electrophysiologically, continuous cardiac monitoring should be considered during and after the infusion of cryopreserved stem cells.
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PMID:Cardiac arrhythmia after infusion of cryopreserved stem cells. 799 56

To investigate some of the problems associated with pregnancy and delivery in lupus nephritis, 13 pregnancies in 7 patients with inactive lupus nephritis and 5 pregnancies in one patient with primary antiphospholipid syndrome (PAPS) were compared with 36 pregnancies in 22 patients with primary nephrotic syndrome (NS). Furthermore, a follow-up survey during 0-8 years was made with 12 babies born to mothers with lupus nephritis. Some pregnancies during lupus nephritis were accompanied by disease exacerbation and worsening of renal function. There was a higher incidence of babies born with a low birth weight, and the incidences of fetal loss or premature birth and toxemia were higher in lupus nephritis than in NS. The number of babies with a low birth weight was significantly higher in patients with pregnancy-induced hypertension or skin lesion due to lupus erythematosus. The presence of antibodies against SSA/RO in the mother was associated with the occurrence of congenital heart block. Birth weight of babies born to mothers with lupus nephritis was low, but there were no statistical differences in the growth of babies after 6 months of age compared with babies born to normal women.
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PMID:[Pregnancy and delivery in patients with lupus nephritis]. 807 22

Most, but not all, studies in Western countries have indicated that women have a higher mortality than men after an acute myocardial infarction, but this has not been well documented in the developing world. The authors studied 601 male and 294 female myocardial infarction patients, aged 26-94 years, admitted to a city hospital in Beijing, China, between 1974 and 1986. A total of 745 (98.8%) of the cohort of 754 who survived past their initial hospitalization were followed up in 1988. Compared with their male counterparts, female myocardial infarction patients were older (63.4 vs. 58.1 years) and had a higher prevalence of tachycardia (heart rate, > or = 110 beats/minute), rales, New York Heart Association class III or IV, and heart block, but a lower prevalence of smoking and white collar occupation (all p < 0.01). The mortality within 28 days of their myocardial infarction was higher in women than in men, mainly in the group whose age was less than 60 years (20.4% vs. 7.1%, p < 0.001). The greater risk of short-term mortality in women persisted even after adjustment for age, history of stroke and hypertension, tachycardia on admission, anterior infarction, Killip class III or IV, and arrhythmia (relative odds = 1.74, 95% confidence interval 1.17-2.60). The 10-year total cumulative mortality in persons who survived the first 28 days following their myocardial infarction was 51.1% for women and 35.9% for men (log rank p = 0.002). After adjustment for age, this difference was not statistically significant (p = 0.3). Our results suggest that, in Beijing, women have a higher short-term mortality after myocardial infarction compared with men.
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PMID:Short- and long-term prognosis after acute myocardial infarction in Chinese men and women. 816 30

Sleep apnea is associated with many adverse cardiovascular sequelae, including hypertension, nocturnal angina, decreased cardiac output, and bradyarrhythmias. The purpose of this study was to determine if patients referred for pacemaker therapy with asymptomatic bradyarrhythmias have underlying sleep apnea as the etiology of their bradyarrhythmias. This study included eight patients (7 males, 1 female) referred to a cardiac electrophysiology practice for pacemaker therapy. Patients included had asymptomatic bradyarrhythmias that consisted of severe sinus bradycardia, second-degree atrioventricular block, and complete heart block. In 7 of 8 patients, the bradyarrhythmias occurred at night or during the day while asleep. No patients were conditioned athletes. Symptoms often associated with bradyarrhythmias, such as lightheadedness and syncope, were not present. However, seven patients had at least one symptom suggestive of sleep apnea, such as excessive daytime fatigue, snoring, cessation of breathing during sleep (apnea), or frequent night-time awakenings. Overnight polysomnography studies were obtained on patients who had one or more symptoms suggestive of sleep apnea. In this study 7 of 8 patients (88%) referred for pacemaker therapy with asymptomatic bradyarrhythmias were documented by polysomnography to have sleep apnea. When treated with either sleep position modification, nasal continuous positive airway pressure (nasal CPAP), or tracheostomy, all seven patients had improvement in sleep apnea symptoms and remained asymptomatic from their bradyarrhythmias without pacemaker therapy over an average follow-up period of 22 months. One patient without symptoms suggestive of sleep apnea declined pacemaker therapy and remained asymptomatic. From these results, we concluded that asymptomatic transient bradyarrhythmias may suggest a diagnosis of sleep apnea. The evaluation of a patient referred for pacemaker therapy with asymptomatic bradyarrhythmias should include questions related to sleep apnea symptoms. Establishing the diagnosis of sleep apnea may reduce the need for pacemaker therapy and permit appropriate treatment of the underlying cause of these bradyarrhythmias.
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PMID:Asymptomatic bradyarrhythmias as a marker for sleep apnea: appropriate recognition and treatment may reduce the need for pacemaker therapy. 877 19


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