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

The effect of pulmonary artery hypertension on right-ventricular performance in patients with chronic obstructive pulmonary disease (COPD) is unclear. Decreased values of right-ventricular ejection fraction (RVEF) have been reported, but most patients with stable COPD are not in cardiac failure and have normal or even increased cardiac outputs. We therefore hypothesized that RVEF may be afterload dependent, and thus a poor parameter of cardiac function, and that right-ventricular contractility may be normal even in COPD patients with pulmonary hypertension. We therefore studied 24 COPD patients using a combined hemodynamic and radionuclide approach. RVEF and thermodilution stroke volume index were measured simultaneously at rest in all 24 patients and also during bicycle ergometry in 9 patients. We then calculated end-diastolic and end-systolic volume indices and derived right-ventricular systolic pressure-volume relations in all and the slopes (E) of the pressure-volume line in 9 patients. RVEF was normal in COPD patients without pulmonary hypertension, but was reduced in those with pulmonary hypertension. A strong inverse linear relation between RVEF and mean pulmonary artery pressure (r = -0.73; p less than 0.001) and pulmonary vascular resistance (r = -0.69; p less than 0.001) could be demonstrated, indicating RVEF to be highly afterload dependent. Right-ventricular end-diastolic volume index was significantly higher in patients with pulmonary hypertension, indicating increased preload as the major mechanism to maintain adequate stroke volume in the face of an increased afterload. Right-ventricular end-systolic pressure-volume relations, a good parameter to define right-ventricular contractility independent of systolic loading conditions, were not different between COPD patients with or without pulmonary hypertension, nor did the slopes of the pressure-volume lines in the 9 patients studied during exercise show any difference. From these data we conclude that (a) RVEF is a poor indicator of overall right-ventricular function; (b) right-ventricular contractility is well preserved in stable COPD patients; (c) the major mechanism of maintaining stroke volume in the face of increased right-ventricular afterload seems to be preload augmentation.
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PMID:Right-ventricular contractility in chronic obstructive pulmonary disease: a combined radionuclide and hemodynamic study. 338 85

The respective value of four non-invasive methods for the diagnosis of pulmonary arterial hypertension (PAH) was investigated in 63 COPD patients, using right heart catheterization as the reference method: 22 patients had no resting PAH (pulmonary artery mean pressure (PAP) less than or equal to 20 mmHg); 26 patients had mild PAH (PAP = 21-30 mmHg); and 15 patients had moderate to severe PAH (PAP greater than 30 mmHg). The specificity of ECG was 86% and the sensitivity 51% (only 38% in mild PAH). The specificity of radiological measurements was 63% and the sensitivity 46% (38% in mild PAH). Echocardiography (echo) had the best results with a specificity of 75% and a sensitivity of 78% (73% in mild PAH), but reliable echo measurements were available in only 52 out of 63 patients. Myocardial scintigraphy had a specificity of 68% and a sensitivity of 66% (58% in mild PAH). A stepwise regression analysis (including one echo, one ECG, one radiological and one functional variable) explained only 43% of the variance of PAP (multiple r = 0.66). These results suggest that no individual method is sufficiently reliable for predicting the presence of PAH, and particularly mild PAH, but the combination of echo + myocardial scintigraphy allows the prediction of PAH with a good probability. The precise level of PAH cannot be estimated, even when using multiple regression equations.
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PMID:Non-invasive diagnosis of pulmonary hypertension in chronic obstructive pulmonary disease. Comparison of ECG, radiological measurements, echocardiography and myocardial scintigraphy. 344 64

Juxtarenal infrarenal abdominal aortic aneurysms are defined as those aneurysms that involve the infrarenal abdominal aorta adjacent to or including the lower margin of renal artery origins. The misinterpretation of findings at exploratory operation or special studies may suggest renal artery involvement and result in abandonment of operation and/or referral to distant centers, thus delaying treatment. This report is concerned with 101 patients with a median age of 68 who had such aneurysms, all referred with a diagnosis of renal or visceral arterial involvement either after exploratory operation (32), because of aneurysmal size (12), or due to misinterpretation of special studies (57). Computed tomographic (CT) scans, ultrasounds, and aortograms in the anterio-posterior projection frequently suggested renal artery involvement due to the fact that the upper end of aneurysm frequently lay over the renal artery origins due to infrarenal aortic elongation and buckling of the aorta at the renal artery level. The true nature of the lesion was best demonstrated by aortography performed in the lateral position. The operation producing the best results was one performed through a midline abdominal incision. The aorta is cross-clamped at the diaphragm and the proximal anastomosis is performed from inside the aneurysm at the renal artery level. The graft then is clamped and the other clamp removed to restore flow in the visceral vessels while the distal anastomosis is completed. Early survival occurred in 93% of patients employing the operation, despite the fact that other conditions frequently were present: renal insufficiency in 19, rupture in seven, renal artery occlusive disease in 20, chronic obstructive pulmonary disease in 34, and hypertension in 77.
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PMID:Juxtarenal infrarenal abdominal aortic aneurysm. Special diagnostic and therapeutic considerations. 352 11

Sooner or later, chronic obstructive lung disease becomes complicated with pulmonary arterial hypertension, largely responsible for chronic cor pulmonale. Its principal cause is an increase in pulmonary resistance due to chronic hypoxia. There is no non-invasive method that can be used to measure pulmonary arterial pressure (PAP) with accuracy. In the course of chronic obstructive lung disease PAP increases slowly, by about 0.5 to 0.6 mmHg per year. As mortality factor, it is the second major variable after FEV1. The usefulness of specific vasodilators has not yet been demonstrated.
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PMID:[Pulmonary arterial hypertension and chronic obstructive bronchopneumopathy]. 352 29

Radionuclide imaging, quite apart from its role in the diagnosis of pulmonary embolism, offers information about the distribution of ventilatory and perfusion abnormalities within the lung. The extent of ventilatory abnormality seen can be related to the severity of airways obstruction as assessed spirometrically, whilst abnormalities in the matching of perfusion to ventilation can be related to the severity of hypoxaemia in patients with chronic airflow limitation. Clearance of mucus from the lungs of patients with chronic mucus hypersecretion may be assessed by following the clearance rate of insoluble radioaerosol particles; by such means the relative contributions of mucociliary transport and of cough to the overall clearance can be observed. Clearance is often severely impaired in patients with airways obstruction; the radioaerosol technique can be used to determine the effects of drug or physiotherapy treatment. Chronic airflow limitation leading to hypoxaemia can be associated with pulmonary artery hypertension and right ventricular hypertrophy--this may be investigated noninvasively by a radionuclide test of right ventricular ejection fraction.
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PMID:Current status of nuclear medicine in chronic airflow limitation. 360 64

Lungs from 19 Thoroughbred racehorses with a history of exercise-induced pulmonary haemorrhage (EIPH) were studied using several forms of microscopy. Light microscopy of paraffin sections revealed three lesions in the caudodorsal region of the lungs from each horse. These correspond with the location of blue to brown stains seen at necropsy. These lesions include sequelae of bronchiolitis, hemosiderophages and increased connective tissue. Much of each of the lungs appeared normal, especially the more cranial or ventral portions. Foci of eosinophil infiltration were found in seven of the 19 lungs examined. With two exceptions, these eosinophilic foci had a different distribution to the three lesions. In areas of severe bronchiolar changes and fibrosis, vascular lesions typical of hypertension were found occasionally. Transmission electron microscopy was used to confirm cell types seen by light microscopy and to examine arterioles for changes characteristic of neovascularisation. Areas of enlarged airspaces from the vascular injected right lungs were examined by scanning electron microscopy. The balance of fibrosis and destruction varied in these areas, but none were as extensive as those seen in chronic obstructive pulmonary disease. The authors hypothesise that bronchiolitis and related neovascularisation are essential components of the aetiology of EIPH.
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PMID:Exercise-induced pulmonary haemorrhage in the horse: results of a detailed clinical, post mortem and imaging study. V. Microscopic observations. 367 83

In patients with varying degrees of chronic obstructive pulmonary disease (COPD), simultaneous measurements of central hemodynamics and left ventricular radionuclide ventriculograms at rest and during exercise were made. In 21 of these patients, satisfactory echocardiograms could be performed. In seven of the patients, arterial blood pressure at rest was increased. Decreased compliance of the left ventricle was thought to be present in patients with COPD and additional arterial hypertension. The left ventricular ejection fraction (LVEF) at rest was in the high normal range in all patients. During exercise, no further increase was observed. This pattern of LVEF response seems to be typical in patients with COPD. Because the highest values were observed in the more severe COPD and right ventricular hypertrophy, it is unlikely that an impairment of left ventricular function is caused by COPD. In five of 27 patients, an abnormal decrease of LVEF and regional hypokinesis occurred during exercise, thus suggesting additional coronary heart disease. The fact that at least 30% of the patients with COPD suffered from arterial hypertension and 20% of the patients exhibited unexpected ischemia detected by regional hypokinesis in RNV during exercise, but not in the ECG, may be of practical relevance. Coronary angiography was not indicated because most of these patients were over 65 and the factor limiting the working capacity was ventilatory impairment and not angina pectoris, in all patients. For this reason, a diagnostic uncertainty remains with regard to additional coronary heart disease in the older patients with advanced chronic obstructive pulmonary disease.
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PMID:Left heart function in chronic obstructive lung disease. 371 12

The study of 216 hospitalised patients with essential arterial hypertension (108 males and 108 females) revealed a high percentage of essential arterial hypertension associated with other diseases, in particular chronic obstructive lung disease in males. The behaviour of bronchial hyperreactivity was studied in 10 patients by means of inhalation tests with carbachol in order to assess the extent of the condition and its response to antihypertensive treatment with alpha-methyldopa. The result showed that the drug had no effect on bronchial reactivity and is therefore to be recommended even in cases where chronic aspecific lung disease is associated with arterial hypertension.
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PMID:[Aspecific bronchial reactivity during pharmacologic treatment of arterial hypertension]. 382 25

The case of a 73-year-old man who developed acute thrombosis of the left subclavian artery during CPR is presented. The patient was known to have severe chronic obstructive lung disease, hypertension, coronary artery disease, and severe peripheral vascular disease. He was admitted with ventricular fibrillation. CPR was successful, and the ECG revealed acute extensive anterior and recurrent inferior wall myocardial infarctions. Soon after, acute occlusion of the left subclavian artery was diagnosed. Thrombectomy was performed and circulation was restored to the left upper limb. The patient died 12 hours later from severe bradycardia and asystole.
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PMID:Acute thrombosis of subclavian artery during CPR. 382 17

Among 509 patients referred to our Institute for Holter monitoring, between 1st September, 1982-30th October, 1983, 28 patients aged 65-90 (mean 76) were referred for dizziness and syncope. There were 17 men and 11 women. Seven patients had a M.I. in their past, 4 angina pectoris, 5 hypertension, 4 aortic stenosis or aortic insufficiency or both, hemodynamically significant, one had mitral valve prolapse (MVP) and one transient ischemic attacks (TIA). In our series 16 out of 28 patients received digoxin and antiarrhythmic drugs (quinidine, propranolol, procainamide, Neo-gilurythmal, amiodarone), 2 of them digoxin and quinidine in full doses and one digoxin and amiodarone. Other drugs administered to our patients included Aldomin, Isordil, Lasix, aminophylin, cromoglycate etc. In 10 patients (35.7%) we found complex ventricular arrhythmias (7 with M.I., 3 patients of 4 with significant aortic valve lesion, 2 patients of 2 with left anterior hemiblock (LAH), 1 patient with MVP, 1 patient with TIA). In another 5 patients (17.8%) we found atrial fibrillation, fast rhythm (2 with chronic obstructive lung disease, 2 with hypertension and 1 in post M.I.) which explained their symptomatology. From our data we conclude that the pluripathology found in old age as well as the multimedication administered, cause a plurietiology of syncope, arrhythmias playing an important role in its determination, in this particular age group.
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PMID:Holter monitoring for dizziness and syncope in old age. 387 98


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