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

We developed a new echocardiographic approach to detect the interatrial septum (IAS) by tilting a transducer leftward, cephalad and backward from the right subcostal area. This technique could allow us to visualize the IAS moving perpendicularly to the ultrasonic beam. In normal subjects the IAS showed a small posterior deflection moving toward the left atrium due to atrial contraction following the P wave of the electrocardiogram. Following the onset of ventricular ejection the IAS rapidly moved anteriorly. During diastole the IAS showed an initial rapid posterior displacement and then a more gradual slope, reflecting rapid and slow filling phases, respectively. The magnitude and configuration of IAS motion showed variations dependent on atrial conditions of cardiac diseases. In atrial fibrillation there were f waves on the IAS echogram and in mitral stenosis a septal notch was recorded at the timing of a mitral opening snap. In mitral valve prolapse there was also a midsystolic notch of the IAS echogram almost coincident in time with the onset of a late systolic murmur. On the other hand, the IAS revealed a systolic increased excursion or paradoxical motion in mitral or tricuspid regurgitation, respectively. In hypertension and myocardial infarction the atrial kick of the IAS echogram showed an exaggerated excursion. In 125 out of the consecutive 150 cases (83.3%) we could record satisfactory IAS echograms by this new approach.
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PMID:[Clinical application of a new right subcostal approach in the evaluation of interatrial septal motion]. 667 95

The results of elective mitral valve replacement between January 1978 and June 1982 in 35 patients aged over 70 are reported. The early mortality was 22,8% and late mortality 17,1%, after a mean follow-up of 25,1 months. Patient-related risk factors included chronic mitral stenosis, often after a previous closed mitral valvotomy, increased cardiothoracic ratio, pulmonary arterial hypertension, functional tricuspid incompetence and a raised left ventricular end-diastolic pressure.
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PMID:Mitral valve replacement in the elderly. 671 Feb 70

An unusual form of mitral valve endocarditis was observed on echocardiography. A 49 year old female with well tolerated mitral stenosis and mild aortic incompetence contracted staphylococcal endocarditis. Pulmonary venous hypertension developed and the diastolic murmur increased. The echocardiogramme showed voluminous vegetations obstructing the stenosed mitral orifice in diastole, simulating a left atrial myxoma. An acute ischaemic episode of the lower limb occurred under antibiotic therapy. A voluminous fibrino-cruoric infected embolus was extracted from the iliac artery and a second echocardiogramme showed the intra mitral mass to have disappeared. Concurrently, the diastolic murmur decreased and the signs of intolerance disappeared. When the infective process seemed to have been controlled, the patient died suddenly. Post-mortem examination showed fresh mitral endocardial lesions and renal and splenic infarcts. Five cases of mitral obstruction by vegetations have been previously reported, three of which had echocardiographic studies. The echocardiographic image is stereotyped and resembles a myxoma wedged in the mitral orifice but without the intra atrial mass. This type of mitral obstruction complicated moderate mitral stenosis in all cases. Regression of the echographic appearances of valvular vegetations has been reported in rare cases, but we were unable to find another case of embolism of vegetations reducing the valvular obstruction.
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PMID:[Obstructive mitral vegetations in bacterial endocarditis. Disappearance after migration as an embolism]. 677 14

The role of active and passive factors involved in the genesis of Pulmonary Arterial Hypertension (PAH) is analyzed in a group of eighty patients with several cardiopathies and pneumopathies. The group include: 20 patients with Chronic Obstructive Lung Disease (NODC), 20 with Diffuse intersticial pneumopathy (NI), 12 with Cardiorespiratory Syndrome of the grossly obese (OB), 6 with Pulmonary Embolism (TEP), 6 with Mitral Stenosis (CRI), 5 with Hypertensive Ventricular Septal Defect (CIV + HAP) and 11 patients with Pulmonary Arterial Hypertension of Unknown etiology (HAP-ED). For the analysis, the Harvey and Enson's formulas were used. The conclusions of the study are: 1) The compliance of the elastic arteries of the lung in the groups of NOC, NI and OB is normal but in the other groups seems to be modified. 2) In the groups of NI and OB the interrelationship of factors such as alveolar hypoxia and pulmonary wedge pressure (PWP) play the major role in the genesis of PAH, although the role of the PaCO2 in the OB group remains to be established. 3) In the groups of NOC, CRI and TEP the PWP is not determinant. The absence of a significant correlation between arterial oxygen unsaturation and pulmonary diastolic pressure in the NOC group suggests other factors. 4) The vascular structural damage seems to be the most important factor in the genesis of PAH in the HAP-ED and CIV + HAP groups.
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PMID:[Active and passive factors in the genesis of pulmonary arterial hypertension in various cardiopathies and pneumopathies]. 678 61

Vasomotor dynamics were studied in 52 patients undergoing direct coronary revascularization or mitral valve replacement utilizing cardiopulmonary bypass. Emphasis was placed on the study of venous tone. Operation resulted in a general vasoconstrictive response with increased arterial resistance and reduced venous capacitance. These changes were magnified in patients who underwent mitral valve replacement for mitral valve stenosis related or partially related to reduced cardiac performance before and after operation. Nine patients became hypertensive following coronary artery bypass and were treated with nitroprusside; eight patients were given nitroglycerin to reduce venous tone and prevent hypertension. A comparison of these two vasodilators, with their somewhat different actions on the vascular bed, reveals that afterload reduction and increase of cardiac output were equivalent with both. However, nitroglycerin had the effect of increasing venous capacitance, while nitroprusside had little effect on the venous circulation. In addition, nitroglycerin was especially effective in reducing venous tone and left ventricular preload following mitral valve replacement. Relative merits of pharmacologic reduction of venous tone as a part of overall relief of increased vascular resistance following cardiac operation should be considered when attempting to obtain an optimal hemodynamic state.
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PMID:Vasomotor dynamics associated with cardiac operations. I. Venous tone and the effects of vasodilators. 680 18

Severe hypertension was seen in a patient with mitral stenosis when in sinus rhythm. A large fall in systolic blood pressure and in left ventricular end-diastolic pressure was caused by ventricular pacing. Contrary to the usual situation in mitral stenosis this patient paradoxically is a subject who improved haemodynamically with the loss of sinus rhythm and of atrial systole.
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PMID:Pacemaker-masked hypertension in a patient with mitral stenosis. 705 18

The authors investigated the left ventricular systolic function and diastolic characteristic in 25 patients with mitral stenosis and compared the results with findings in 25 healthy subjects. The patients with mitral stenosis differed from the control group by elevated left ventricular filling pressure, greater left ventricular end-diastolic volume, reduced ejection fraction, and decreased calculated left ventricular compliance. Pathological values of these indicators, however, were infrequent and as a rule only slightly exceeded the normal limits. The decrease in left ventricular compliance had significant correlations with the degree of pulmonary arterial hypertension, elevation of right ventricular filling pressure, the ratio of filling pressures of both ventricles, and left ventricular end-systolic eccentricity. Consequently, the authors infer that the main factor decreasing the left ventricular compliance in mitral stenosis is the aberrant geometry of the ventricle. The authors also point out the correlations between the left ventricular systolic function and diastolic characteristics in mitral stenosis, and assume that this affection represents a complex, although not too advanced, disturbance of left ventricular function.
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PMID:Left ventricle in mitral stenosis. 714 Mar 6

Subungueal splinter hemorrhage (S.U.S.H.) has been reported in various conditions and may herald a serious systemic disease. It has been related to miscellaneous conditions such as: subacute bacterial endocarditis, severe rheumatoid arthritis, uninfected mitral stenosis, trichinosis, peptic ulcer, hypertension, neoplasm, trauma, and in some cases, is considered idiopathic. Some dermatologic conditions such as psoriasis, dermatitis, and fungal infections may also produce S.U.S.H. It consists of "a homogeneous mass of blood in a layer of squamous cells, adherent to the under surface of the nail, considered to be of embolic origin." In a brief review of pertinent medical literature on thromboangiitis obliterans, we were unable to find a description of its occurrence in this disease. The earliest lesions described in this condition are "painful vesicles on the pulp of digits with intense hyperemia and hypersensitivity of the surrounding skin." It is our opinion that S.U.S.H. is an earlier and quite useful sign of arterial involvement as seen in the following cases observed in our vascular disease section.
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PMID:Subungueal-splinter hemorrhage an early sign of thromboangiitis obliterans. 723 12

The data from the right cardiac catheterization, echocardiography M-type and radiocardiography were juxtaposed in 54 patients with "pure" or predominating severe mitral stenosis (MS)(mitral valvular opening under 1 cm2)--confirmed at operation, in the determination of their functional and hemodynamic characteristics. The patients were grouped into three groups depending on the degree of pulmonary--capillary pressure increase (PC)--greater than 2.666, greater than 3.999 and 4.132 kPa(greater than 20, greater than 30 and less than 31 mmHg). The first group covering 28 per cent of the patients with a mean PC--2,399 +/- 0.257 kPa = (18 +/- 1.93 mmHg) are of particular interest. A light to moderate increase of pulmonary arterial pressure, elevated TPVR, absence of right ventricular insufficiency with reduced M. V SI resp. were established in them. It was assessed as a group with hypovolemia and proper preoperation preparation but requiring attention as regards the eventual hypotension, intra- or post operation. The third group covers 22 per cent of the patients and is characterized with increased TPVR, high hypertension in pulmonary artery, elevated telediastolic pressure in right ventricle and normal or lightly increased MO, assessed as a group with an inadequate diuretic therapy pre-operatively. The second group is with typical hemodynamic characteristics of severe MS and includes 50 per cent of the patients. The analysis forces the conclusion, that for an adequate evaluation of hemodynamics and MS severity, the PC pressure is necessary to be always discussed in connection with blood volume and flow, as well as with the other hemodynamic indices, in order to avoid the omissions as regards MS operability.
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PMID:[Intracardiac hemodynamic characteristics in high-degree mitral stenosis and an assessment of the indications for its surgical treatment]. 733 9

Ten patients with cardiac myxoma were reviewed. The ranged from 23 months to 60 years old. Echocardiography was the most helpful noninvasive diagnostic technique. The tumor was demonstrated by angiocardiography, left atrial myxomas frequently migrating to the left ventricle in diastole. Hemodynamically, left atrial myxomas were associated with moderately severe pulmonary hypertension and simulated mitral stenosis or insufficiency and right atrial myxomas, with right atrial hypertension. There were 7 myxomas in the left atrium, 2 in the right atrium, and 1 in the right ventricle. Eight patients underwent open-heart operation with removal of the myxoma, 1 had concomitant tricuspid valve replacement, and 1 had biopsy of the right ventricle only. The other patient was a Jehovah's Witness and refused operation. One patient died of cardiac arrest intraoperatively, and another died of a bilateral cerebral infarct. One patient had recurrence requiring reoperation. Postoperative hemodynamic and clinical improvement was more striking in patients with a left atrial myxoma presumably due to a normal mitral valve in contradistinction to the tricuspid valve.
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PMID:Cardiac myxoma. 737 80


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