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

Clinical, coronary arteriographic, and hemodynamic studies were performed in 55 patients with left bundle branch block (LBBB) and coronary artery disease and were compared with 110 patients consecutively matched for age and sex with ischemic heart disease but without LBBB. No significant differences were found in duration of symptoms or frequency of prior myocardial infarction, hypertension, or diabetes mellitus; however, the LBBB patients had a significantly (p less than 0.001) higher frequency of congestive heart failure (38.2% vs 11.8%) and cardiomegaly (63.6% vs 25.5%). An evaluation of severity of the coronary disease on the basis of subtotal vs total obstructive lesions, number of vessels involved, total coronary score, and individual coronary arteries involved revealed no significant differences between the groups. The LBBB patients had significantly (p less than 0.001) greater impairment of left ventricular function as reflected by the end-diastolic volume (107 +/- 43 vs 79 +/- 30 ml/m2), ejection fraction (0.35 +/- 0.19 vs 0.59 +/- 0.18), and frequency of an abnormal contractile pattern (91% vs 61%). Evaluating the LBBB patients on the basis of the QRS width and axis revealed no significant intragroup differences in clinical profile, severity of coronary disease, or left ventricular dysfunction. A prolonged PR interval (greater than or equal to 0.20 second) was associated with more severe coronary artery disease and an enlarged heart. This study indicates that coronary artery disease associated with LBBB identifies patients with severe left ventricular dysfunction.
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PMID:Left bundle branch block: a predictor of poor left ventricular function in coronary artery disease. 688 Oct 18

Intermittent left bundle branch block is uncommon. During anaesthesia,, left bundle branch block may be related to hypertension or tachycardia and its occurrence makes the diagnosis of acute myocardial ischaemia or infarction difficult. Patients with intermittent left bundle branch block often develop established left bundle branch block, which may represent an earlier state of ischaemic heart disease. Cardiological investigation of our patient after operation did not point towards an organic cause of intermittent left bundle branch block.
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PMID:Intermittent left bundle branch block revealed during anaesthesia. 802 21

Evaluation of operative risk in coronary artery disease patients before non-cardiac surgery is a frequent problem concerning 100,000 patients each year in France. Perioperative cardiac morbidity is the first cause of death associated with non-cardiac surgery, with infarction rates of the order of 1 to 2% in coronary disease patients. These infarcts are followed by the death of the patient in 25 to 50% of cases. Evaluation of anesthetic risk is based upon three points: type of surgery, clinical findings and results of investigations. The risk is markedly increased in emergency surgery, and in thoracic, intraperitoneal and above all vascular surgery, in particular when clamping of the aorta is involved. From a clinical standpoint, only a history of infarction and signs of peripheral cardiac failure are independent predictive factors of postoperative complications. Other criteria, e.g. age, uncontrolled hypertension, diabetes and above all the severity of angina are also associated with the onset of perioperative-complications. This evaluation can be refined by electrocardiogram (Q wave, ST segment anomalies, ventricular hypertrophy and left bundle branch block) and chest X-ray. The usefulness and predictive value of exercise tests, when possible in a preoperative context, are particularly precious when the result is positive at low work-load. Many publications have studied the value of myocardial isotope scan, in particular before vascular surgery. They report the excellent negative predictive value (95 to 100%) of this investigation. Furthermore, the predictive value of isotope scan is all the greater when the clinical risk factors seen in the patients and the number of areas with ischemia are taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Evaluation of the anesthetic risk in patients with coronary disease prior to non-cardiac surgery]. 812 64

The clinical course of 30 patients (27 women and 3 men) diagnosed with syndrome X (angina pectoris, positive exercise test and normal coronary arteries) was evaluated during 5-year follow up. Patients were divided at the control examination into 2 groups according to the median value of the heart rate/blood pressure product variation from rest to the first stage of a modified Bruce protocol, as follows: group 1 < or = 1,050 (n = 15) and group 2 > 1,050 mm Hg x beats/min (n = 15). All patients were followed at 6-month intervals during a mean follow-up of 60 +/- 8 months. During follow-up, chest pain was unchanged in 20 patients, decreased in severity and frequency in 9 (7 in group 1, and 2 in group 2), and disappeared in 1 in group 2; 3 patients in group 1 had prolonged episodes of anginal chest pain (> 30 minutes) that needed hospitalization. In group 2, 7 patients developed systemic hypertension, 4 had a progression of exercise-induced left bundle branch block to constant left bundle branch block, and 4 continued to develop rate-dependent block during exercise, but at a reduced heart rate. In the latter 8 patients, left ventricular ejection fraction at rest during follow-up decreased significantly from 61 +/- 6% to 51 +/- 8% (p < 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term follow-up of patients initially diagnosed with syndrome X. 844 63

Fibrinolytic therapy substantially reduces mortality from acute myocardial infarction. Patient selection is, however, important. The patient must present within 12 hours of the onset of ischaemic symptoms, have definite ECG changes of ST elevation or left bundle branch block and no contraindications. The major contraindications are those for risk of an intracerebral bleed, recent stroke, intracranial tumour or risk of a major systemic bleed. Age and hypertension are not contraindications but may modify the regimen used. Heparin is required with recombinant tissue plasminogen activator but is optional with streptokinase. The recent COBALT trial suggests that the accelerated weight related t-PA regimen given over 90 minutes is more satisfactory than double bolus t-PA. However, in patients under 75 years of age, the two regimens were equivalent. For patients suffering acute myocardial infarction, practitioners should now individualise choice of therapy, rather than give the same cocktail to all patients. The choice of regimen will depend on the cardiac risk, the stroke risk, the bleeding risk and the cost.
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PMID:The current status of thrombolytic therapy. 944 5

A traumatic left bundle branch block (LBBB) is uncommon in a patient with intact atrioventricular conduction. Three of our patients developed LBBB during a left-sided catheterization. Two patients suffered from angina pectoris and the other had an abdominal aneurysm. Two of them had a history of hypertension. None of the patients had ever shown any conduction abnormalities before the catheterization. The electrocardiogram just before the examination was normal in all 3 patients. LBBB was observed when a catheter was introduced into the left ventricle, and lasted 2--4 min without significant change in heart rates. Examination revealed no significant stenosis proximal to the first septal perforator and normal left ventricular contraction in all patients. One patient developed permanent LBBB 14 months later. Catheter-induced LBBB may occur easily with certain anatomical characteristics of the left bundle branch or the distal His bundle, with or without some concealed damage to the conduction system. It is important to keep this complication in mind and to pay adequate attention to patients' electrocardiograms as well as their angiographical findings, especially in those with pre-existing right bundle branch block.
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PMID:Transient left bundle branch block induced by left-sided cardiac catheterization in patients without pre-existing conduction abnormalities. 955 37

A twenty year follow up of a selected, community population with complete right and left bundle branch block is reviewed by comparative mortality analysis. In this population, where cases and controls were free of hypertension and heart disease at entry, the presence of complete right bundle branch block does not have excess mortality. Complete left bundle branch block exhibits excess total and cardiac mortality.
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PMID:Mortality analysis of complete right and left bundle branch block in a selected community population. 1016 36

It has been reported that electrocardiographic abnormalities may be associated with acute pancreatitis. However, the data are lacking or sketchy. The aim of this study was to assess the frequency and type of electrocardiographic abnormalities present in patients with acute pancreatitis. Fifty-six consecutive patients with acute pancreatitis and without previous history of heart disease were studied. Eleven patients had arterial hypertension. Forty-one patients had mild pancreatitis and 15 had the severe form of the disease. On admission, all patients underwent a standard 12-leads electrocardiogram and a serum electrolyte determination. Nineteen healthy subjects were also studied as controls. Twenty-seven patients (48.2%) (10 with severe pancreatitis and 17 with mild pancreatitis) had a normal electrocardiogram. In the remaining 29 patients (51.8%), one patient with severe pancreatitis had atrial extrasystoles and eight had bradycardia (less than 60 beats/minute) (two with severe pancreatitis and six with mild pancreatitis); 14 patients had changes of the T-wave and/or the ST-segment (two with severe pancreatitis and 12 with mild pancreatitis); seven patients showed disturbances of the intraventricular conduction (one with severe pancreatitis and six with mild pancreatitis): four had left anterior hemiblock, two had complete left bundle branch block and one had left anterior hemiblock and incomplete right bundle branch block; one patient with mild pancreatitis had atrioventricular block (first degree). No differences in heart rate, RR interval, PR interval and QT interval were found when patients with acute pancreatitis were compared with healthy subjects, nor when patients with severe pancreatitis were compared with those having the mild form of the disease. Seventeen of the 29 patients with electrocardiographic abnormalities (52.6%) also had serum electrolyte alterations. More than 50% of the patients with acute pancreatitis had electrocardiographic abnormalities and electrolyte alterations were also present in about one-half of these.
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PMID:Electrocardiographic abnormalities in acute pancreatitis. 1034 Jul 31

Chronic severe subclinical systemic hypertension was diagnosed in a 28-yr-old male western lowland gorilla (Gorilla gorilla gorilla). Thoracic radiography, electrocardiography, and echocardiography revealed an enlarged heart with a hypertrophied left ventricle, mitral regurgitation, and a persistent left bundle branch block. Enalapril, later combined with nifedipine, was of some value in reducing the hypertension, with partial reversal of cardiac enlargement and resolution of the bundle branch block. Two years after initiation of treatment, the gorilla developed lethargy and dyspnea. The diagnosis of heart failure was confirmed under anesthesia; the gorilla did not recover and was euthanized. Postmortem examination confirmed congestive heart failure with chronic, fibrosing cardiomyopathy similar to that in other gorillas.
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PMID:Chronic hypertension with subsequent congestive heart failure in a western lowland gorilla (Gorilla gorilla gorilla). 1048 43

The management of congestive heart failure remains a therapeutic challenge despite recent advances in drug therapy, including ACE inhibitors, beta blockade and spironolacton treatment. Patients affected with the disease still have a restricted quality of life and a poor prognosis in the long run. Epidemiologically, the incidence and prevalence are increasing due to improved survival from both coronary artery disease and arterial hypertension. A subgroup of patients presents with marked prolongation of the QRS-complex in the surface ECG, mostly with a left bundle branch block pattern. This acts as a marker for interventricular conduction abnormality and specifically indicates a reduced left ventricular systolic function. Biventricular pacing tries to resynchronize the abnormal activation pattern by actively influencing diastolic filling and systolic function. The mechanisms involved are supposed to be restoration of left ventricular septal mechanical synchrony, reduction in presystolic mitral regurgitation and optimization of diastolic function with the maximization of diastolic filling time. In this article the current role and future directions of biventricular pacing are discussed.
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PMID:[Pacemaker in therapy of heart failure--biventricular stimulation]. 1113 37


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