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

Mitral stenosis with severe pulmonary artery hypertension constitutes a high risk subset for surgical commissurotomy or valve replacement. Balloon mitral valvotomy has been proposed as a technique for treating high risk surgical patients with mitral stenosis. The efficacy of this technique in patients with severe pulmonary artery hypertension, however, has not been fully evaluated. Percutaneous transvenous mitral commissurotomy (PTMC) was performed in 450 consecutive patients. Of these, forty-five (10%) patients had systemic or suprasystemic systolic pulmonary artery pressures (110 +/- 20, range 96 to 170 mm Hg). The baseline characteristics and immediate hemodynamic results of these 45 patients with systemic/suprasystemic systolic pulmonary artery pressures (group I) were analysed and compared with those of 405 patients with subsystemic systolic pulmonary artery pressures (group II). Patients in group I were more symptomatic (New York Heart Association functional class > or = III, 96 vs. 55%, P < 0.001) and had severe subvalvular fibrosis (mitral subvalvular distance ratio [MSDR], 0.14 +/- 0.04 vs. 0.22 +/- 0.04, P < 0.01). Before PTMC, mean transmitral gradient was higher (34 +/- 8 vs. 25 +/- 4 mm Hg, P < 0.02) and mitral valve area smaller (0.5 +/- 0.3 vs. 0.9 +/- 0.4 cm2, P < 0.02) in group I patients, who also had higher pulmonary vascular resistance (16 +/- 5 vs. 9 +/- 5 U, P < 0.005). After PTMC final mean transmitral gradients (7 +/- 3 vs. 5 +/- 3 mm Hg) and mitral valve areas (1.9 +/- 0.4 vs. 2.0 +/- 0.4 cm2) were similar in both groups (P = NS). Group I patients had a greater decrease in pulmonary artery pressures (34 +/- 4 vs. 25 +/- 2%, P < 0.05) but final systolic pulmonary artery pressures (82 +/- 20 vs. 50 +/- 14 mm Hg) and pulmonary vascular resistance (12 +/- 4 vs. 6 +/- 4 U) remained significantly higher in this group (P < 0.005). Thus, in patients with severe pulmonary artery hypertension, PTMC is a safe and effective technique providing good immediate hemodynamic results.
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PMID:Balloon mitral valvotomy in patients with systemic and suprasystemic pulmonary artery pressures. 854 26

Topical congenital pulmonary vein stenosis is a uncommon defect, both isolated or associated to other cardiac abnormalities. Only the localization of the lesions seems to affect the survival, because 60% of survival cases has unilateral stenosis; the severity of associated cardiac lesions become the prognosis poor. We describe two cases: 1st case, a 43 days old boy presented with heart failure and convulsion and had a diagnosis of pulmonary hypertension, atrial septal defect and tricuspid regurgitation, without pulmonary abnormalities. He had recurrent pulmonary infections and a cerebral ischemia in the following months, and died at 15 months of age for sepsis. Autopsy revealed stenosis and atresia in all pulmonary veins, with venous and arterial hypertension. There was also aortic hypoplasia and aortic and tricuspid valves indifferentiation; 2nd case, a 7 days old girl had a diagnosis of aortic coarctation and atrial and ventricular septal defects. Surgical corrections, at 38 and 46 days old, firstly of the aortic coarctation and after for the septal defects, disclosed and relief a supra-valvar mitral stenosis, but she remained on heavy respiratory insufficiency. At 6 months old, she returned to the hospital with dyspnea and cianosis, heart failure and hemoptisis; a sepsis developed and she died. At autopsy, there were severe pulmonary vein stenosis on the left and in the superior right veins, with pulmonary hypertension and hemorrhage.
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PMID:[Pulmonary vein stenosis. Report of 2 cases and review of the literature]. 854 96

We demonstrated selective pulmonary vasodilation in patients with congenital mitral stenosis with inhaled NO, and used NO as prolonged therapy to stabilize the postintervention course of these children. The pulmonary vasoreactivity was greater than that previously reported in adults and may be due to particular sensitivity of pulmonary veins to inhaled NO when pulmonary venous hypertension has been present since birth.
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PMID:Inhaled nitric oxide in children with pulmonary hypertension and congenital mitral stenosis. 860 19

Atrial fibrillation is a frequent arrhythmia which has a high prevalence after 65 years of age, thus the typical patient's age is about 75. There are two atrial fibrillation predictors: traditional factors of cardiovascular risk (age, male sex, high blood pressure, diabetes), and structural heart disorders (heart failure, valvular heart disease). All preventive measures to reduce atrial fibrillation incidence, must be directed towards these factors. Additionally, left atrial size, ejection fraction and ventricular hypertrophy are echocardiographic predictors. Atrial fibrillation doubles the mortality rate and is related to an annual stroke rate of 4.5%. The stroke risk factors are: age, hypertension, diabetes, previous stroke, congestive heart failure, coronary heart disease, mitral stenosis, prosthetic heart valves and thyrotoxicosis. Left atrial size and ventricular disfunction are echocardiographic stroke risk factors. Each patient's risk can be stratified on the basis of these factors. All of this information is essential to handle the arrhythmia appropriately; this arrhythmia may be more important than has been thought. Atrial flutter is not very frequent and so it is less studied; however it is an arrhythmia with a similar clinical context to atrial fibrillation, although, probably, with a smaller embolic risk.
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PMID:[Epidemiology, risk factors, and pathogeny of atrial fibrillation and atrial flutter]. 875 90

The known risk of embolic events in patients with recurrent or chronic atrial fibrillation makes it mandatory to recommend oral anticoagulation in patients with rheumatic mitral valve disease, specially mitral stenosis to maintain an INR between 2.0 and 3.0. If despite this treatment recurrent embolism occurs, the dose of oral anticoagulants should be increased (INR between 2.5 and 3.5) or dipyridamole (200 to 400 mg/day) or aspirin (160 to 320 mg/day) should be added to dicoumarinic drugs. In patients that must be cardioverted either electrically or pharmacologically and who have been on atrial fibrillation for more than 2 days, oral anticoagulation should be maintained for 3-4 weeks before cardioversion and for 3-4 weeks after regaining sinus rhythm. Transesophageal echocardiography may enable us to identify the group of patients with low risk for an immediate cardioversion. In patients under 60 years of age with atrial fibrillation and no evidence of associated cardiovascular abnormality (lone atrial fibrillation) the embolic risk is very low and antithrombotic therapy is probably not needed. In subjects over 60 years of age with a low risk profile (absence of previous stroke, heart failure or systemic hypertension) aspirin (300-325 mg a day) seems to offer sufficient protection against embolic events. In patients at a higher embolic risk (history of previous cerebral ischemic attacks, heart failure of left ventricular dysfunction, systemic hypertension) oral anticoagulation unless contraindicated, should be recommended (INR 2.0-3.0). The role of other antithrombotic agents such as ticlopidine or triflusal to prevent embolic events in patients with atrial fibrillation is unknown.
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PMID:[Antithrombotic therapy in atrial fibrillation]. 875 95

Direct current electric shocks have been used to terminate atrial arrhythmias (cardioversion) in humans since the 1960s. The likelihood of successful cardioversion and maintenance of sinus rhythm is increased if the left atrium is not markedly enlarged and fibrotic, if there is no marked left atrial hypertension (e.g., mitral stenosis), and if the arrhythmia is not long-standing. To minimize the risk of thromboembolic phenomena, therapeutic anticoagulation should be established for at least 3 weeks before and for 4 weeks after cardioversion; coumadin is usually used for this purpose. A more recent approach uses transesophageal echocardiography to demonstrate the absence of thrombi in the left atrium and left atrial appendage. If no thrombi are evident, 48 hours of heparin anticoagulation may be adequate prior to cardioversion. Anticoagulation is still required after cardioversion. Quinidine and digitalis, singly or in combination, are frequently used to achieve and maintain sinus rhythm in association with cardioversion. For the procedure itself, traditional hand-held paddle electrodes or self-adhesive electrode pads may be used; the apex-anterior and anterior-posterior positions are equally effective. Gel couplants and firm pressure should always be used with hand-held paddles to reduce transthoracic impedance and maximize current flow. Electrodes should be widely separated to avoid shunting of current along the chest wall between electrodes. Generally, electrodes should be large in size; small "pediatric" electrodes should only be used in infants < 1 year of age (< 10 kg). Shocks should always be synchronized to the R wave to avoid the vulnerable period and the inadvertent induction of ventricular fibrillation. Initial shocks for atrial fibrillation should begin at 100 J; atrial flutter generally requires a smaller shock (initial shocks at 50 J). Effective anesthesia, not merely sedation, is required to achieve amnesia and avoid pain. Exciting new developments in defibrillation and cardioversion have occurred. It is now understood that excessive energy and current may induce cardiac damage, and recent studies suggest such damage may be mediated in part by free radicals. New shock waveforms, such as biphasic and multiphasic waveforms from multiple encircling electrodes, may be superior to the standard damped sinusoidal waveform.
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PMID:Transthoracic cardioversion of atrial fibrillation and flutter: standard techniques and new advances. 890 72

The authors present three cases of pregnant women with symptomatic severe mitral stenosis with a mean age of 28.6 +/- 2.3 years, and during 27.6 +/- 1.52 weeks of pregnancy. Two patients were in class III and one in class IV of the New York Heart Association (NYHA). All patients had a mitral valvular area equal or less than 1 cm2, with a Wilkins score of 7 to 9 and mitral insufficiency grade I in two cases; two, had severe pulmonary arterial hypertension (mean > 50 mm Hg). After Percutaneous Mitral Valvuloplasty (PMV) the mitral valve measured by 2D echocardiography increased form 0.83 +/- 0.2 cm2 to 1.8 +/- 0.15 cm2; the mean transmitral gradient diminished from 13 +/- 3.4 mm Hg to 3.6 +/- 1.15 mm Hg; the degree of mitral insufficiency was no modified in neither case. Hemodynamic results revealed increasing of the mitral valve from 0.83 +/- 0.18 cm2 to 2.23 +/- 0.3 cm2; the mean mitral gradient decreased from 21.6 +/- 9 to 4.3 +/- 0.5 mm Hg; the mean left atrial pressure from 30 +/- 12 to 12.3 +/- 4 mm Hg; the mean pressure of the pulmonary artery diminished suddenly from 44.3 +/- 16 to 25.6 +/- 11 mm Hg. The average fluoroscopic time was 15.3 +/- 3 minutes. There were no complications. The patients were discharged 48 hours after the procedure and continued their pregnancies in class I NYHA, which resolved in a non complicated vaginal delivery with normal products. We conclude that PMV is a safe and useful therapy in pregnant patient with severe mitral stenosis refractory to medical treatment.
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PMID:[Percutaneous mitral commissurotomy using Inoue's balloon during pregnancy]. 898 57

In the decade beginning 1 January 1985, 916 individuals (including five females) were medically examined with a view to joining the full-time service of Strathclyde Fire Brigade (SFB). One hundred and nine (11.9%), including two females, were rejected. The five main causes of failure were: ocular (n = 46, 42.2%); lack of stamina (n = 21, 19.2%); 'others' (n = 12, 11.0%); cardiovascular (n = 9, 8.3%) and orthopaedic (n = 6, 5.5%). Thirty-two had chest X-rays. One abnormality was found -an azygous lobe-but it played no part in the decision to decline the applicant. There was little life- or health-threatening pathology found. The most serious cases were murmurs consistent with mitral stenosis and regurgitation (one each), one case of ocular melanoma, four cases of hypertension and two cases of haematuria/ proteinuria (++). This study shows that potentially serious findings can occasionally be detected in a population of 18-30 year olds who might be expected to be of better than average fitness, and that routine chest X-rays are not helpful in the selection process.
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PMID:Reasons for rejection: why people fail to qualify as firefighters. 898 75

Patients with primary hyperparathyroidism (PHPT) show a high incidence of left ventricular hypertrophy, cardiac calcific deposits in the myocardium, and/or aortic and mitral valve calcification and thus may carry an increased risk of death from circulatory diseases. This prospective study was designed to assess an effect of parathyroidectomy on cardiac abnormalities of patients with PHPT. Echocardiography was used to evaluate the mechanical performance of the heart muscle, the thickness of the left ventricular wall, myocardial calcific deposits, and valvular calcifications within 12 and 41 months after parathyroidectomy. In a blinded fashion, aortic and mitral value calcifications were determined in 46% and 39% of patients with PHPT. Calcific deposits in the myocardium were found in 74% of patients. Follow-up studies after parathyroidectomy disclosed no evidence of progression of these calcifications. Before operation left ventricular hypertrophy was detected in 82%. After parathyroidectomy and 41 months of normocalcemia and normal PTH concentrations, a regression of hypertrophy of the interventricular septum and the posterior wall by -6% and -19% (P < 0.05) was observed. Subgroup analysis disclosed the most impressive long-term reduction of left ventricular hypertrophy in patients without a history of hypertension (-11% and -21%; P < 0.05 and P < 0.005); no changes were determined in 9 patients who developed secondary hyperparathyroidism after operation. The present data show a high incidence of left ventricular hypertrophy and aortic and/or mitral valve calcifications in patients with PHPT. Follow-up at 1 year and at 41 months after successful parathyroidectomy disclose regression of hypertrophy. Our results give evidence that parathyroid hormone per se plays an important role in the maintainance of myocardial hypertrophy. Post-surgical restoration of normocalcemia and normalization of parathyroid hormone valvular sclerosis persists without evidence of progression. We further conclude that patients with PHPT and parathyroidectomy are at low risk for the development of severe aortic and mitral valve stenosis within this period of time.
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PMID:Cardiac abnormalities in patients with primary hyperparathyroidism: implications for follow-up. 898 42

Clinical records of 136 cardiac patients with atrial fibrillation (AF) followed in the cardiac clinic of the Black Lion Hospital were analysed. The mean age of the patients was 41 +/- 13 years, with a male to female ratio of 1.0:1.6. Rheumatic heart disease (RHD) was found in 66.3%, hypertension in 10.3%, cardiomyopathy in 8.8% and ischaemic heart disease in 6.6%. Embolic episodes occurred in 26 (19.1%) cases with five deaths. Twenty-one patients had cerebrovascular accident while five had femoral artery occlusion. The major cause of embolisation was rheumatic valvular heart diseases (65.5%), especially mitral stenosis. In order to reduce the high risk of systemic emboli, it is recommended that patients with AF and associated recent onset of congestive heart failure, previous history of thromboembolism and hypertension should be anticoagulated if there are no contraindications.
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PMID:Atrial fibrillation and embolic complications. 914 66


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