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

The one year mortality of patients from the Perth Acute Myocardial Infarction Register surviving the acute episode (first 28 days) is presented. Of 1138 patients suffering definite or possible acute myocardial infarction in one year, 705 (62%) survived 28 days. There were 89 deaths (11-5%) in the subsequent 11 months. One year mortality was related to age but not sex, previous symptoms of coronary heart disease, but not hypertension or diabetes, to tachycardia and congestive cardiac failure at first examination, but not arrhythmias in the acute episode. These observations highlight the importance of protecting the myocardium in the acute phase of myocardial infarction.
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PMID:Acute myocardial infarction: one year follow-up of 1138 cases from the Perth Community Coronary Register. 107 74

Severe congestive heart failure secondary to myocardial infarction remains a difficult management problem. Although intravenous vasodilators and mechanical assist devices have been reported to improve the depressed hemodynamic function, these interventions are limited to the intensive care unit and cannot be used for long-term management. This study evaluates the hemodynamic and symptomatic response to sublingual administration to isosorbide dinitrate (5 to 10 mg) in seven consecutive patients with severe congestive heart failure after anterior wall myocardial infarction. Serial measurements of mean right atrial and pulmonary arterial end-diastolic pressure, mean blood pressure, heart rate and cardiac output were obtained during the control period and during the 4 hours after administration of isosorbide dinitrate. The peak response occurred approximately 30 minutes after drug administration with an 83 percent reduction in mean right atrial pressure (from 6 to 1 mm Hg, P less than 0.02), a 36 percent reduction in pulmonary arterial end-diastolic pressure (from 25 to 16 mm Hg, P less than 0.0001) and a 6 percent reduction in mean blood pressure (from 94 to 88 mm Hg (P less than 0.05). There were small but statistically not significant increases in cardiac index (from 2.3 to 2.6 liters/min per m2 and stroke work index (from 26 to 32 gm/beat per m2). The total systemic vascular resistance was reduced by 5 percent from 1,605 to 1,518 dynes sec cm-5 (P less than 0.10). The baseline heart rate of 105 beats/min was not significantly changed. The reduction in pulmonary arterial end-diastolic pressure became statistically significant (P less than 0.05) between 15 and 30 minutes after administration of isosorbide dinitrate and remained significant for 3 to 4 hours. This reduction of pulmonary arterial end-diastolic pressure to less than 22 mm Hg was associated with relief of the patients' pulmonary symptoms. The response to nitroglycerin (0.4 mg) was similar in magnitude but of much shorter duration (approximately 15 minutes for nitroglycerin versus 4 hours for isosorbide dinitrate in patients with and without congestive heart failure. The slope (calculated by dividing the change in cardiac index or stroke work index by the change in pulmonary arterial end-diastolic pressure) was significantly (P less than 0.05) depressed in the patients with congestive heart failure. These data demonstrate that the symptomatic pulmonary venous hypertension can be effectively relieved by isosorbide dinitrate without further compromising left ventricular function.
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PMID:Isosorbide dinitrate for the relief of severe heart failure after myocardial infarction. 110 34

Evaluation of the results of surgery for coronary artery disease requires a knowledge of the clinical course of patients not having this mode of treatment. To obtain such information we performed a retrospective analysis of the fate of 266 patients with arteriographically documented significant stenosis following from one to ten years. For the entire group the five year survival was 73%. Subdivided into single, double or triple vessel disease categories the percent five year survival rates were respectively 92, 65 and 55. A history of angina pectoris or myocardial infarction prior to angiography did not affect survival. However, hypertension, congestive heart failure, abnormal hemodynamics or left ventricular asynergy were all associated with a diminished five year survival, the values being respectively 61%, 38%, 62% and 58%. These results should be of VALUE IN ASSESSING THE PROGNOSIS OF NONSURGICALLY TREATED PATIENTS WITH CORONARY ARTERY DISEASE.
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PMID:Prognosis in coronary artery disease. Angiographic, hemodynamic, and clinical factors. 110 13

The natural history of the cardiovascular manifestations of systemic lupus erythematosus (SLE) have been altered by corticosteroids which exert their own cardiovascular effects. This study describes clinical and necropsy observations in 36 corticosteroid-treated patients with SLE and compares them to necropsy observations in patients with SLE reported before the use of corticosteroid therapy. The 36 patients averaged 32 years of age, and 33 were women. Systemic hypertension was present in 25 (69 per cent) and left ventricular hypertrophy in 23 (64 per cent) patients. Hypertension was twice as common in the 19 patients who received this drug for more than 12 months (average 38 months) than in the 17 patients who received this drug for less than 12 months (average 6 months), and was almost five times more common among our patients than in patients with SLE in the presteroid era. Congestive cardiac failure occurred in 15 patients (43 per cent), eight times more frequent than that reported in noncorticosteroid-treated patients with SLE. Subepicardial and myocardial fat was increased in all 36 patients. Lupus carditis was similar in frequency but differed morphologically in our patients compared to those not treated with corticosteroids. Libman-Sacks-type endocardial lesions, present in 18 (50 per cent) of our patients, were smaller, fewer in number, univalvular rather than multivalvular, and mainly left-sided. Most verrucae were either partly or completely healed, and some were calcified. Pericarditis, present in 19 (53 per cent) patients, was predominantly of the fibrous type. Myocarditis was present in three patients, each of whom also had endocarditis and pericarditis. The lumen of at least one of the three major coronary arteries was narrowed more than 50 per cent by atherosclerotic plaques in 42 per cent of the 18 patients who received corticosteroids for more than 1 year, but in none of the 17 patients who received corticosteroids for less than 1 year. Four of the eight patients with narrowed coronary arteries had myocardial infarcts. Although vital to the management of SLE, corticosteroids have an over-all deleterious effect on the heart. Systemic hypertension and left ventricular hypertrophy appear or, when present, worsen; congestive cardiac failure increases; epicardial apartment of Me
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PMID:The heart in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy. A study of 36 necropsy patients. 111 70

Periodic sleep apnea may be due to repeated episodes of upper airway obstruction in patients who have a short thick neck and/or large jowls. Apnea due to complete cessation of breathing may occur to a lesser extent. Anaylsis of the sleep electroencephalogram shows that these patients rarely achieve deep sleep and have less stage 1-REM sleep than normal subjects of comparable age. They are chronically sleep-deprived, a manifestation expressed by daytime somnolence, chronic fatigue and often by personality disturbances marked by paranoia, agitated depression and hostility. The definitive diagnosis of this syndrome may be established by monitoring during sleep, the electroencephalogram, measuring abdominal excursions through a mercury-in-Silastic-strain gauge and recording air flow at the nose by means of a thermocouple. As demonstrated by other investigators, chronic hypoventilation during sleep leads to both pulmonary and systemic arterial hypertension, which may produce generalized cardiac enlargement and congestive heart failure. The abnormalities in the periodic sleep apnea syndrome are abolished by establishing a patent airway either through tracheostomy or weight reduction.
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PMID:Periodic sleep apnea: chronic sleep deprivation related to intermittent upper airway obstruction and central nervous system disturbance. 111 91

The series reported includes 85 patients who underwent arterial embolectomy for 101 embolic events. The over-all hospital mortality rate following embolectomy was 41 percent. The etiological factors for this high mortality rate are analyzed. The group includes 58 patients who had arteriosclerotic heart disease and 27 patients with rheumatic valvular disease. The mortality rate encountered in the arteriosclerotic group of patients was 52.9 percent, whereas that in the rheumatic group of patients was 18 percent. The major cause of death was cardiorespiratory failure (51 percent). Factors which weighed heavily on the final outcome were previous myocardial infarction, hypertension, diabetes, cardiac decompensation, and rhythm disturbances. Limb salvage was accomplished in 51 patients (60 percent). Amputation was performed in 17 patients (20 percent).
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PMID:Mortality rate following lower limb arterial embolectomy: causative factors. 112 92

Our objective was to produce reductions in the luminal volume of Henle's loop and increases in linear flow velocity through the loop. We did this in a recollection micropuncture study by collecting fluid with and without suction from early distal tubules. With suction, transit time of fast green dye through the loop decreased by 34%, calculated loop volume decreased by 28%, and fractional water reabsorption fell from 73.6 to 70.3% (p smaller than 0.025) in water diuretic rats. Absolute water reabsorption did not decrease significantly. In urea-saline dieuretic rats transit time decreased 25%, calculated loop volume decreased 22%, fractional reabsorption fell from 59.0 to 51.7% (smaller than 0.001), and absolute reabsorption decreased by 2.3 nl/min (p smaller than 0.025). Single nephron glomerular filtration rate, distal tubular sodium concentration, and osmolality were unaffected. The less pronounced effect of collection with suction in water diuretic rats may be related to the lower medullary fluid osmolality, which was 338 plus or minus 9 (S.E.) mOsmol/kg as compared to 497 plus or minus 35 in urea saline diuretic rats. Collecting fluid with suction from late proximal tubules did not alter glomerular filtration rate or fractional water reabsorption. Stumpe et al. ((1970) J. Clin. Invest. 49, 1200-1212) noted an inverse correlation between fluid reabsorption from Henle's loop and flow velocity in rats with hypertension or congestive heart failure. One can reproduce this correlation by artificially altering the transmural pressure gradient in the loop.
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PMID:Physical factors influencing fluid reabsorption from Henle's loop. 113 20

Isovolumic relaxation time (IVRT) and rapid filling time (RFT) were used to evaluate elasticity and compliance in 11 control subjects (Group 1), in nine patients with angina (Group 2), in 11 with hypertensive heasrt disease (Group 3), and in ten patients with healed myocardial infarction (Group 4). Pre-ejection period (PEP), pre-ejection period index (PEPI), left ventricular ejection time (LVET), left ventricular ejection time index(LVETI) and PEP/LVET ratio were all derived from simultaneous recordings of phonocardiograms, ECGs, apexcardiograms, and external carotid arterial pulses. No patients were in congestive heart failure and none were receiving medication. LVET and LVETI were the same in control patient groups; PEP was slightly increased in patients with healed myocardial infarctions (p smaller than 0.05); and PEPI was prolonged in the patients with angina (p = 0.001). THE PEP/LVET ratio too was different from the control group in patients with angina and hypertension (Groups 2 and 3-p smaller than 0.02 and smaller than 0.05 respectively). The diastolic time intervals were significantly altered in that the IVRT was prolonged in angina patients (113.4 equals or minus 28.3 msec), compared to control patients (85.7) equal or minus 18.4 msec). It was found that in 6 out of 9 patients with angina, this interval exceeded the highest normal value (108 msec), but that in only one out 11 patients with HCVD and in three out of ten with healed infarctions, was the interval prolonged. RFT was increased in HCVD (113.8 equals or minus 18.8 msec) and in healed myocardial infarction (123.8 equals or minus 30.0 msec) patients, compared to the control group (94.5 equals or minus 12.8 msec). Diastolic time intervals reflecting disorders in elasticity and compliance may occur in conjunction with alterations in systolic time intervals.
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PMID:Diastolic time intervals in ischemic and hypertensive heart disease: A comparison of isovolumic relaxation time and rapid filling time with systolic time intervals. 114 31

Certain common but seldom recognized clinical features of renovascular hypertension peculiar to infancy are emphasized in this communication from the observations made in a 9-month-old infant. Failure to thrive, extreme irritability, hypotonia, anorexia, vomiting, diarrhea, respiratory distress, and congestive heart failure are common clinical findings. Unless the physician is aware of this symptomatology or blood pressure is routinely obtained in all infants, the condition is likely to be missed. Renovascular hypertension is malignant and carries a high mortality but if diagnosed early may be cured by surgical intervention.
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PMID:Clinical features of renovascular hypertension in infancy: report of a 9-month-old infant. 115 42

Two patients are described who presented with congestive heart failure and were found to have an atrial septal defect with a pulmonary blood flow approximately twice the systemic blood flow. Most of the usual clinical signs of atrial septal defect were absent, and the diagnosis was established by right heart catheterization and radioisotopic angiography. Both patients had hypertension and coronary artery disease. Atrial septal defect in the adult patient may not be recognized because of associated cardiac disease, including coronary artery disease and hypertension, or pulmonary disease which may obscure the usual clinical signs of a septal defect. Radioisotopic angiography and right heart catheterization should be considered in any patients with heart disease or congestive failure of obscure cause even if the usual diagnostic signs of atrial septal defect are absent.
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PMID:Occult atrial septal defect in adults. 115 34


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