Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

SLE affects most aspects of cardiac function, and recent studies have reported increasing cardiovascular morbidity and mortality. Pathologically, SLE is characterized by a pancarditis involving pericardium, myocardium, endocardium, and coronary arteries. In autopsy series, pericarditis has been found in 43% to 100% (mean 62%, Table I), and myocarditis was found in 8% to 78% (mean 40%, Table II), but both have been underdiagnosed clinically. Libman-Sacks lesions have been noted in 25% to 100% (mean 43%) and infective endocarditis in 1.1% to 4.9% of clinical and autopsy studies (Table III). Coronary disease may be due to arteritis, which should be treated with high-dose steroids, or it may be due to atherosclerosis, which is amenable to medical or surgical therapy. Valvular disease has been treated surgically, but with a combined surgical mortality as high as 25%. Aortic insufficiency and mitral regurgitation are the most common valvular problems, although aortic and mitral stenosis have also been reported. Hypertension has been noted in 14% to 69%, and heart failure in 5% to 44%. Evidence for a lupus cardiomyopathy, which may be subclinical, is reviewed. While steroids may ameliorate SLE pancarditis, they have also been associated with hypertension, LV hypertrophy, purulent and constrictive pericarditis, mitral regurgitation, and perhaps accelerated atherosclerosis. It remains to be seen if improved diagnosis and treatment of the cardiovascular manifestations of SLE can enhance survival.
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PMID:Cardiovascular manifestations of systemic lupus erythematosus. 390 17

Recurrent laryngeal nerve palsy and vocal cord paralysis due to mitral stenosis was first described in 1897 (Ortner 1897). Since then other cardiovascular causes, including hypertension, coronary heart disease, aortic aneurysm and congenital heart disease have been described. There are two recorded cases of left recurrent laryngeal nerve palsy due to pulmonary embolism (Albertini 1972; Wilmhurst et al. 1983). We describe what we believe to be the third case.
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PMID:Vocal cord paralysis in association with pulmonary emboli. 394 26

Despite recent renewed interest in the detection of tricuspid valve regurgitation by echocardiographic and Doppler techniques, little morphologic information is available on dysfunctioning tricuspid valves. This report describes 45 necropsy patients with clinical and morphologic evidence of pure (no element of stenosis) tricuspid regurgitation and provides morphometric observations (anular circumference, leaflet area) of the tricuspid valve useful in determining the etiology of pure tricuspid regurgitation. Of 45 patients, 24 (53%) had pure tricuspid regurgitation resulting from an anatomically abnormal valve (prolapse in 7, papillary muscle dysfunction in 6, rheumatic disease in 5, Ebstein's anomaly in 3, infective endocarditis in 2, carcinoid tumor in 1), and 21 (47%) had an anatomically normal valve with systolic pulmonary artery hypertension (cor pulmonale in 12, mitral stenosis in 9). Anular circumference was dilated (greater than 12 cm) in patients with various causes of pulmonary hypertension, floppy valve and Ebstein's tricuspid anomaly. Leaflet area was increased in floppy valve and Ebstein's anomaly. Of the 45 patients, 24 had pulmonary systolic artery pressure measurements available for correlation with tricuspid valve morphology. Pulmonary artery pressures accurately predicted morphologically normal from abnormal valves in 16 patients (89%). Morphologic overlap occurred in six patients with pulmonary pressures of 41 to 54 mm Hg. Of these six, the additional knowledge of normal or dilated anular circumference correctly separated valves with normal and abnormal leaflets.
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PMID:Etiology of pure tricuspid regurgitation based on anular circumference and leaflet area: analysis of 45 necropsy patients with clinical and morphologic evidence of pure tricuspid regurgitation. 395 62

Investigations performed in 172 patients have shown that the state of the myocardium (such parameters as the heart volume, degree of lung hypertension, end-diastolic pressure in the right and left ventricles) is of great importance in pathogenesis of the development of acute heart failure in the early postoperative period in patients with mitral stenosis of the IIIrd and IVth stage of the blood circulation insufficiency.
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PMID:[Role of hemodynamic factors and heart volume in the prognosis of acute cardiac insufficiency during the early postoperative period in patients with mitral valve stenosis]. 622 42

Two distinct myosin heavy chain isoforms, referred to as alpha and beta, were identified in the human heart with specific antimyosin antibodies. By indirect immunofluorescence, myosin heavy chain alpha was found to be a major component of atrial myosin and a minor component of ventricular myosin, while heavy chain beta was found to be a major component of ventricular myosin and a minor component of atrial myosin. In the normal heart, there was marked individual variability in the proportion of ventricular myocytes reactive for heavy chain alpha. Atrial myocytes staining for heavy chain beta were rare in the left atrium and more numerous in the right atrium, especially in the crista terminalis and in the interatrial septum. Surgical and autoptic specimens from hypertrophied left ventricles of patients with mitral regurgitation showed a myosin immunoreactivity pattern similar to that of normal specimens. Very rare muscle cells reactive for heavy chain alpha were seen in the hypertrophied left ventricles of subjects with hypertension and in the hypertrophied right ventricles of subjects with tetralogy of Fallot. A dramatic transformation of myosin heavy chain composition was observed in hypertrophied left atria of patients with mitral stenosis, with a shift to heavy chain beta in a large proportion of atrial myocytes. The findings indicate that chronic exposure to hemodynamic overload can induce marked changes in the myosin heavy chain composition of human atria, whereas it affects only slightly that of the ventricles.
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PMID:Myosin types in the human heart. An immunofluorescence study of normal and hypertrophied atrial and ventricular myocardium. 623 8

Accurate assessment of ventricular muscle contractile function in patients with heart disease is impaired by alterations in afterload, preload and wall thickness which often accompany the disease. The relationship between pressure and volume at end systole is considered to provide a contractile index which is independent of preload and which accounts for afterload. Use of the index prerequisites determinations of the left ventricular end systolic pressure, wall thickness as well as the dimensions or volumes, respectively, which may be assessed with either invasive or noninvasive methods. In patients with aortic stenosis and congestive heart failure, there was a significantly reduced slope (0.9 +/- 0.5) of the end systolic stress-volume relationship as compared with healthy subjects (5.8 +/- 1.3) or patients with aortic stenosis without congestive heart failure (3.9 +/- 1.3), while the ejection fraction showed no significant differences. In patients with mitral regurgitation with no or only minimal symptoms postoperatively, preoperatively the end systolic index (ESS/ESVI) was higher (3.3 +/- 0.4) than in patients with marked symptoms postoperatively or those who died perioperatively (2.2 +/- 0.2) and the values of both patient groups were lower than those of normals. In contrast, the values for ejection fraction among the normals and both groups of patients showed substantial overlap. In patients with aortic insufficiency and congestive heart failure, as opposed to patients with aortic insufficiency and only slight symptoms, there was a significantly compromised ejection fraction as well as diminished end systolic index (ESS/ESVI). Patients with hypertension accompanied by congestive heart failure had a significantly diminished slope of the relationship between end systolic left ventricular stress and volume while the values for hypertensive patients without congestive heart failure were within normal limits; in both groups of patients, the ejection fraction was normal. In patients with mitral stenosis, the end systolic index at 5.28 +/- 0.53 did not differ significantly from that of healthy subjects at 4.87 +/- 0.53, while the velocity of circumferential fiber shortening was diminished. Patients with large atrial septal defects and symptoms of congestive heart failure did not differ with respect to end systolic index or ejection fraction as compared with atrial septum defect patients without symptoms. In children with aortic stenosis and high pressure gradients, there was an increased ejection fraction together with a normal end systolic index.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Assessment of systolic ventricular muscle function in man: the end systolic index. 623 85

Two antigenically distinct types of myosin heavy chain, referred to as alpha and beta, have been identified in autoptic and bioptic specimens of human heart using specific antimyosin antibodies. By immunofluorescence heavy chain alpha was present in all atrial myocytes and in a variable number of ventricular myocytes. Heavy chain beta was present in all ventricular myocytes and in a number of atrial myocytes. Ventricular hypertrophy in patients with aortic stenosis, systemic hypertension or tetralogy of Fallot was characterized by an almost complete absence of fibres reactive with anti-alpha. A striking decrease in alpha chain reactivity and a parallel increase in beta chain reactivity was apparent in the hypertrophied left atria of patients with mitral stenosis. To quantify these myosin changes a novel procedure was developed whereby myosin was extracted from single cryosections serial to those processed for immunofluorescence and the relative amount of alpha and beta heavy chain was determined by enzyme immunoassay. Heavy chain alpha was less than 5% in most normal ventricular specimens and disappeared completely under the effect of pressure overload. On the other hand heavy chain beta was generally undetectable in the left atrial myocardium but increased up to 90% in biopsies of hypertrophied atria.
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PMID:Myosin changes in hypertrophied human atrial and ventricular myocardium. A correlated immunofluorescence and quantitative immunochemical study on serial cryosections. 624 7

To evaluate the relationship between extravascular lung water, pulmonary capillary wedge pressure, and chest radiographic findings, extravascular lung water (EVLW) was assessed using double indicator-dilution techniques in 34 adult patients with mitral stenosis. Seven patients were studied 6 to 12 months after successful mitral valve replacement. In the 27 preoperative patients, septal lines were found to be indicative of elevated EVLW only in the presence of intravascular congestion. An excellent correlation between EVLW and pulmonary capillary wedge pressure was observed in these patients (r = .81, p less than .001), whereas only a rough correlation between scored radiographic findings and EVLW was observed. Postoperatively, septal lines were invariably associated with normal filling pressures and EVLW. Thus in both preoperative and postoperative mitral stenosis patients, interstitial Kerley B lines are insensitive markers of elevated extravascular lung water in the absence of pulmonary vascular engorgement. This emphasizes the importance of interpreting radiographic findings of extravascular fluid in conjunction with evaluation of the vascular bed in patients with chronic postcapillary hypertension.
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PMID:Extravascular lung water in patients with mitral stenosis: relationship to pulmonary capillary wedge pressure and Kerley B lines. 333 Jun 19

A 55-year-old man is convalescing from mitral valve replacement five days earlier. He had severe calcific mitral stenosis and moderately severe hypertension, with repeated attacks of acute pulmonary edema. He had always been in normal sinus rhythm, except for a single episode of atrial fibrillation associated with one of his episodes of acute pulmonary edema. He had been taking digoxin (0.25 mg daily) but this was stopped the day before the operation. The cardiac rhythm has been mostly regular since the operation, but occasional irregularities have been noted. An ECG on the fifth postoperative day is shown.
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PMID:Changing P waves after mitral valve replacement. 641 62

This study evaluates the usefulness of chest x-ray in the diagnosis of pulmonary arterial hypertension. Twelve patients with severe interstitial fibrosis were studied by respiratory functional tests and right heart catheterization. A quantitative radiologic diagnosis of pulmonary arterial hypertension in pulmonary fibrosis results more difficult than in chronic obstructive airway disease, mitral stenosis or pulmonary thromboembolism. Nevertheless in case of severe interstitial fibrosis pulmonary hypertension was regularly present even if specific radiologic findings were not available. We have found some interesting correlations, i.e. a trend to a relationship between mean pulmonary pressure and right descending pulmonary artery diameter.
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PMID:[Radiological diagnosis of pulmonary arterial hypertension in idiopathic pulmonary fibrosis]. 653 84


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