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 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper summarises recommendations drawn up at a meeting of a group of Cardiologists and Aviation Medical personnel to review cardiovascular standards for Australian Civil Flying Licences. Major recommendations were in the field of ischemic heart disease which remains the commonest cause of disqualification. The panel recommended consideration of coronary risk factors and increased attention to the high risk group as a preventive measure for loss of licence. Licensing, with appropriate safeguards and continued supervision, was considered permissible in carefully selected subjects with ischemic heart disease. Guidelines were also drawn up for various licence categories for subjects with valvular heart disease, cardiac arrhythmias, implanted pacemakers, cardiomyopathy and hypertension.
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PMID:An appraisal of cardiovascular standards for Australian civilian flying licences. 266 12

Complications were surveyed prospectively in 2,029 catheterizations performed on 1,483 patients from the 13 centers participating in the VA Cooperative Study on Valvular Heart Disease. Complications were reported in 6.9% of 1,559 preoperative procedures of which 2.6% were major and 0.2% fatal. Clinical predictors of complications were hypertension and the precatheterization diagnosis of aortic stenosis. Nevertheless, patients with aortic stenosis successfully tolerated left ventriculography, which was routinely performed regardless of the magnitude of gradient. Procedural predictors of complication were brachial arteriotomy (vascular occlusion) and transseptal catheterization (tamponade). Among the 470 postoperative catheterizations performed solely for research purposes, there were six complications, of which five were bleeding events in patients taking warfarin. Transseptal catheterization was safer in postoperative patients with no cases of tamponade in 125 procedures.
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PMID:Complications of cardiac catheterization and angiography in patients with valvular heart disease. VA Cooperative Study on Valvular Heart Disease. 260 37

Early detection of heart failure requires criteria by which to define the initial stages of a syndrome which often has an insidious onset and which may progress slowly for many years. The most specific definitions of heart failure are those obtained towards the end of the disease process, but reliance upon these means that, although few cases are misclassified, only manifest cases can be detected. Since prevention is the ultimate goal, early detection of subjects at risk and a wider understanding of the pathophysiological mechanisms and risk factors are necessary. The principal causes of heart failure in the Western world are coronary artery disease and hypertension; valvular heart disease and other cardiac disorders are relatively uncommon causes. The major risk factors are obesity, tobacco smoking and diabetes mellitus, and in a prospective large-scale study we have also shown that individuals who develop manifest symptoms of heart failure often have a long history of exercise-induced dyspnoea. Clearly, identification of the early symptoms of heart failure and prompt treatment of risk factors such as hypertension and obesity are important objectives. However, a better understanding of the underlying biochemical and structural abnormalities would help to define more appropriate preventive treatments.
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PMID:Improving the detection and diagnosis of congestive heart failure. 280 86

Cardiac function was investigated in men with ankylosing spondylitis (AS) age 21-65 years who had no cardiorespiratory symptoms or known abnormalities of heart or lungs. Chest radiographs and standard electrocardiograms were normal in 73 of 74 subjects. In echocardiographs of 30 men, left atrial size and left ventricular cavity size and wall thickness were normal. Minor abnormalities in the valve roots were present in 3 older men. Early diastolic abnormalities of the left ventricle were demonstrated in 16 of 30 subjects. This finding was confirmed by repetition of the echocardiography a year later in 15 subjects and by comparison of 11 probands with their healthy brothers. Myocardial tissue obtained at necropsy from 28 AS patients without ischaemic or valvular heart disease or hypertension was studied. A mild, diffuse increase of interstitial connective tissue was seen but there was no inflammatory change or amyloid. Computerised image analysis showed 30.7% interstitial reticulin compared with 17.7% in age/sex matched controls (p less than 0.0001).
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PMID:The myocardium in ankylosing spondylitis. A clinical, echocardiographic, and histopathological study. 288 91

Left ventricular hypertrophy (LVH) has assumed an important role in clinical medicine as a result of the clinical implications of this often asymptomatic finding. Epidemiological data from the Framingham Heart Study have permitted an examination of prevalence, incidence, underlying predisposing factors and prognosis of LVH. Although LVH is an infrequent finding on the electrocardiogram, it is a forerunner of coronary disease, congestive heart failure, stroke and even peripheral arterial disease. Despite being strongly related to hypertension, LVH remains associated with excess risk for adverse cardiovascular morbid and fatal outcomes, even after adjusting for blood pressure. The risks associated with LVH are comparable with those of myocardial infarction. The recent introduction of echocardiography at the Framingham Heart Study has permitted the development of new criteria for LVH based on M-mode determined left ventricular mass. Unlike its electrocardiographic counterpart, echocardiographically determined LVH is a common finding, occurring in over 15% of the general population. Echocardiographic LVH is related to hypertension, obesity, valvular heart disease, coronary disease and advancing age. Ambulatory ECG results in subjects with echocardiographic LVH demonstrate increased risk for ventricular arrhythmias, which have been shown in other clinical settings to predict risk for sudden cardiac death. Preliminary data from Framingham and elsewhere suggest that echocardiographic LVH is associated with increased risk for cardiovascular disease morbidity and all-cause mortality.
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PMID:Left ventricular hypertrophy. Epidemiological insights from the Framingham Heart Study. 297 14

The sensitivity of 30 electrocardiographic criteria for left ventricular (LV) hypertrophy, isolated or combined, was examined to determine the relation to the underlying disease. Patients with coronary artery disease (CAD), systemic hypertension, valvular heart disease and cardiomyopathy were evaluated. A cardiac partition technique was used to define ventricular hypertrophy. Single electrocardiographic criteria often showed high sensitivity for 1 disease state, but not for others. Precordial voltage criteria were most sensitive for those with hypertensive and valvular disease. A QRS axis of more than -30 degrees occurred most often in patients with CAD. Both left atrial abnormality and abnormal T-wave inversion of more than 1 mm in V6 occurred with a high sensitivity in general; however, T-wave inversion of more than 1 mm in V6 had a low sensitivity in cardiomyopathy. Methods using combinations of various electrocardiographic criteria improved sensitivity. Using these methods, sensitivity of the electrocardiogram for LV hypertrophy was excellent for patients with systemic hypertension and valvular heart disease and acceptable by usual standards for patients with CAD and cardiomyopathy. Because the use of a single criterion is often ineffective, methods using multiple electrocardiographic criteria to detect LV hypertrophy are recommended when the patients under study have diverse cardiac diseases.
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PMID:Sensitivity of electrocardiographic criteria for left ventricular hypertrophy according to type of cardiac disease. 315 2

A total of 458 cases (11.5%) with valvular heart diseases in the aged (greater than or equal to 60 years) were found among 4,000 consecutive autopsies. They included 204 cases (45%) of aortic regurgitation (AR), 171 cases (37%) of mitral regurgitation (MR), followed by 45 (10%) of aortic stenosis (AS) and 27 cases (6%) of mitral stenosis (MS). As an etiology of the valvular diseases, degenerative type was found in 195 cases (43%), ischemic origin in 91 cases (20%), followed by inflammatory origin such as syphilitic in 51 and infective endocarditis in three, aortitis in two and rheumatic in 49 (11%). Congenital origin was also found in 18 cases (4%). Among various types of valvular diseases in the aged, degenerative AR was most frequently found in 140 cases, followed by MR due to papillary muscle dysfunction in 91 cases. The clinical characteristics in cases with valvular diseases were as follows: atrial fibrillation was prominent in MS; congestive heart failure was found in 60% of cases except those with degenerative AR; cardiac death was frequent in syphilitic and rheumatic AR; association of hypertension was found in 50% of cases with MR and degenerative AR. In this article the characteristics of the valvular heart disease in the aged and additionally its diagnosis and treatment were discussed.
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PMID:[Valvular heart diseases in the aged]. 327 12

Over the last two decades a change in the etiology of acquired valvular heart disease and a continuous further development of its treatment has been observed. In this article the following topics are addressed: The pathology as it presents today, newer aspects in drug treatment, optimal timing and choice of surgery, the problem of concomitant coronary artery disease and hypertension, and management after surgery. Present experience answers some of the questions whereas others still remain unsolved.
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PMID:[Acquired heart valve diseases--state of the art 1985]. 348 88

Optimal care of the patient with heart disease undergoing noncardiac surgery requires that the members of the surgical team, including anesthesiologist, internist-cardiologist, and surgeon, be familiar with the cardiovascular response to surgery, preoperative cardiac risk stratification, and the unique pathogenesis of cardiac complications that may occur in the perioperative period. Preoperative evaluation and computation of cardiac risk, anesthetic considerations, along with perioperative care of the patient with ischemic heart disease, valvular heart disease, congestive heart failure, arrhythmias and conduction disorders, and hypertension is discussed.
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PMID:Noncardiac surgery in the patient with heart disease. 355 69

To determine whether survival following permanent ventricular demand pacing differs from survival following permanent dual-chamber pacing in patients with symptomatic sinus node dysfunction (unexplained sinus bradycardia, subsidiary rhythms, sinus arrest, sinoatrial block, or the bradycardia/tachycardia syndrome), we followed 79 patients who received a VVI pacemaker (group 1) and 49 patients who received a DVI or DDD pacemaker (group 2) for 1 to 5 years. There was no significant difference in sex distribution, mean age, or the incidence of coronary heart disease, hypertension, valvular heart disease, diabetes mellitus, stroke, or renal failure between groups 1 and 2. Overall, the predicted cumulative survival rates at 1, 3, and 5 years were 89%, 82%, and 74%, respectively, for group 1 and 94%, 86%, and 78%, respectively, for group 2. In patients with preexistent congestive heart failure (CHF), predicted cumulative survival rates at 1, 3, and 5 years were 78%, 69%, and 57%, respectively, for group 1 (n = 23) and 90%, 83%, and 75%, respectively, for group 2 (n = 16). Five-year predicted cumulative survival was significantly lower in group 1 patients with CHF than in group 2 patients with CHF (p less than 0.03). There was no significant difference in 5-year cumulative survival rates between groups 1 and 2 in patients without CHF. The results suggest that permanent dual-chamber pacing enhances survival to a greater extent than permanent ventricular demand pacing in patients with chronic symptomatic sinus node dysfunction and CHF.
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PMID:Comparative survival following permanent ventricular and dual-chamber pacing for patients with chronic symptomatic sinus node dysfunction with and without congestive heart failure. 356 45


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