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)

To evaluate the effects of pericardial effusion on the ECG, we compared clinical, echocardiographic and ECG findings in 459 patients. The prevalence of echocardiographic effusion ranged from 1% (1/79) among normal subjects, to 28% (32/114) among patients with valvular disease, 30% (27/90) in patients with hypertension, and 86% (18/21) in patients with pericardial disease. No relationship existed between left ventricular function and the prevalence of effusion, but a strong inverse relationship was found between LV function and effusion size (r = -0.63, p less than 0.01). Small and moderate sized effusions had a progressive damping effect on ECG voltage, displacing the regression lines between Sokolow -Lyon voltage and left ventricular mass downward by 1.2 and 4.4 mm respectively. Standard ECG criteria for low voltage (leads I, II, III each less than 0.5 mV, or V1 to V6 each less than 1.0 mV) were extremely insensitive for detection of effusions (12%), although highly specific (94%). Other ECG criteria which improved sensitivity resulted in an unacceptably high prevalence of false-positive diagnoses of pericardial effusion. Thus, echocardiographic effusions occur in only 1% of normal subjects but in more than 25% of patients with hemodynamic loading conditions, with a strong relationship between worsening left ventricular function and increasing effusion size. In contrast to the close relationship between echocardiographic pericardial effusions and clinical findings, low electrocardiographic QRS voltage is a weak predictor of the presence of pericardial effusion.
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PMID:Pericardial effusion: relation of clinical echocardiographic and electrocardiographic findings. 673 33

Echocardiographic examinations of 21 unselected patients with systemic lupus erythematosus revealed a wide variety of abnormalities. The abnormalities consisted of substantial pericardial effusion in five patients (24%) and a thickened pericardium in six patients(29%); significantly larger left atrial and left ventricular dimensions and significantly smaller ejection fraction percentages, fractional shortening of the left ventricle, and rate of early diastolic mitral valve closure compared to that in a control group of subjects; and paradoxical and hypokinetic movement of the septum in one patient (5%) each. The presence of pericardial effusion and a thickened septum and a decrease in the ejection fraction percentage, fractional shortening of the left ventricle, and mitral valve diastolic closing velocity showed no correlation with previous hypertension, the presence or absence of anemia, renal failure, serum levels of proteins, and duration of patients' illnesses. Long-term follow-up studies to determine the implications of these subclinical cardiac abnormalities using noninvasive techniques (such as echocardiography) is vitally important.
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PMID:Cardiovascular abnormalities in systemic lupus erythematosus. 678 90

Minoxidil (U-10,858) has been shown in several controlled and blind studies and numerous uncontrolled studies to be a potent peripheral vasodilator for use in the management of sustained, severe, accelerating or malignant hypertension and moderate hypertension inadequately controlled by conventional therapy. Some effect may be seen four hours after oral administration with the peak effect being seen between four and 18 hours. The drug has a plasma disappearance half-life of 4.2 hours despite a duration of action of approximately 24 hours, suggestive of extravascular accumulation. Reported dosages range from 2 mg to 80 mg daily, most patients requiring approximately 20 mg daily. Rapid loading schedules have been studied but are not yet widely used. Frequent adverse effects include sodium retention, tachycardia, EKG changes, and hypertrichosis. Pericardial effusion, altered renal function, diabetes mellitus, and changes in plasma renin, urinary norepinephrine, and aldosterone levels have been reported. Other minor problems have been reported infrequently.
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PMID:Minoxidil. 698 52

Pericardial effusion, diagnosed clinically or by echocardiography, was found in 13 of 16 regularly dialyzed patients (81%) receiving minoxidil for refractory hypertension. In a comparable group of 125 patients not receiving minoxidil, 28 patients (23%) had evidence of pericardial effusion, the difference between the groups being highly significant (p less than 0.0005). In minoxidil treated patients, the effusions resolved spontaneously in 4 (3 remaining on treatment), required pericardiocentesis (3), or pericardiectomy (1), and persisted in 4 (3 remaining on treatment). It is suggested that minoxidil treated dialysis patients be regulary examined for the development of potentially threatening pericardial effusions.
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PMID:Pericardial effusion associated with minoxidil therapy in dialyzed patients. 735 9

Echocardiography (UCG) was performed prior to and during hemodialysis therapy to detect and evaluate volumetrically the grade of pericardial effusion in 150 patients with chronic renal failure. The actual incidence of uremic pericardial effusion during the observation period was 62% and was higher during the first 3 months of therapy than at later stages. Pericardial effusion was classified from grade 0 (no effusion) to grade 5 (massive effusion). We compared the grade of effusion with laboratory test results, blood pressure, cardiothoratic ratio, left atrial and ventricular dimensions, and thickness of the intraventricular septum and left ventricular posterior wall. Significant differences between the patients with and without effusion were detected in the degree of systolic hypertension, dilatation of the left atrial chamber, anemia and hypoproteinemia. There was no correlation between the grade of effusion and creatinine, uric acid and calcium levels and changes of body weight. Our results confirm that insufficient dialysis as indexed by the degree of hypoproteinemia, anemia, hypertension and central overhydration, may play a role in the etiology of uremic pericardial effusion.
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PMID:Uremic pericardial effusion: detection and evaluation of uremic pericardial effusion by echocardiography. 740 44

Twenty consecutive female patients (mean age 30.1 years) with Primary Antiphospholipid Syndrome (PAPS) were studied cardiologically through noninvasive methods and compared with 20 age-and sex-matched healthy subjects. On physical examination 13/20 patients (65%) with PAPS had a valvular abnormality. In 12/20 (60%) patients with PAPS the ECG was abnormal, mainly due to sinus tachycardia in 5 (25%) and acute myocardial infarction in 3 (15%). In 7/20 patients with PAPS (35%) abnormal pulmonary findings were detected by X-ray and in 6 (30%) they were related to dilated pulmonary arch and pulmonary hypertension. In 14/20 cases (70%) with PAPS, abnormal echocardiographic findings were present; 13/20 patients (65%) had valvular complications attributable to PAPS: mitral insufficiency in six cases; mitral valve prolapse in three and aortic insufficiency in three. Two had pulmonary artery hypertension and two, tricuspid regurgitation (one attributable to PAPS). All valve diseases were regurgitant with mild to moderate hemodynamic repercussion. No stenotic lesions were detected. The mean mitral thickness in patients with mitral valve involvement was 7.0 +/- 1.6 mm, compared to 2.8 +/- 0.7 mm in patients with normal valves and 3.1 +/- 0.9 mm in the control group (p < 0.001). The mean aortic valve thickness in patients with aortic valve involvement was 3.6 +/- 0.5 mm compared to 1.5 +/- 0.3 mm in patients with normal valves and 1.4 +/- 0.4 in the control group (p < 0.001). None of the patients from the control group had valve disease (p < 0.0001). Three cases (15%) had pericardial effusion diagnosed by echo. Two patients with PAPS died during the 4.7 +/- 1.2 years of cardiological follow up, due to acute myocardial infarction and embolic cerebrovascular accident, respectively. In conclusion, cardiologic complications are common in PAPS, including left side regurgitant lesions that might be hemodynamically significant, acute myocardial infarction, pericardial effusion and pulmonary hypertension.
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PMID:The heart in the primary antiphospholipid syndrome. 762 Feb 75

The purpose of this study was to compare thoracic aortic pathologies of 30 patients with Marfan's syndrome and a group of 78 patients with arterial hypertension. With a mean age of 35 +/- 12 years, patients with Marfan's syndrome were younger than hypertensives (59 +/- 11) (p < 0.01) and Marfan's syndrome, women (52%) were more frequently affected than in hypertensive patients (21%; p < 0.05). While aortic dissection and intramural hemorrhage in patients with Marfan's syndrome were usually confined to the ascending thoracic aorta (62%), in the hypertensive patients aortic disease frequently extended to distal segments of the thoracic or abdominal aorta (p < 0.05). Aortic pathology was complicated by aortic regurgitation in 95% of the patients with Marfan's syndrome and in 56% of the hypertensive patients (p < 0.01). Signs of renal, mesenteric or coronary malperfusion, cardiac effusion and severe hypotension (p < 0.05) were more frequently seen in the hypertensive group. While there was no early death in the Marfan group, only 67% of the patients having aortic dissection or intramural hematoma survived the first 30 days in the hypertensive group (p < 0.01). Aortic dissection, intramural hematoma and aortic aneurysms were as often found in the Marfan's syndrome patients with 60%, 10%, and 30%, as in patients with arterial hypertension with 55%, 6%, and 38% (n.s.). One-year survival rates were high in patients with Marfan's syndrome (93%) as well as in patients with arterial hypertension (73%) (n.s.). The diagnosis of aortic dissection, intramural hematoma, and aneurysms could in all cases be established by the use of noninvasive imaging techniques, such as TEE, XCT, and MRI. Moreover, noninvasive imaging modalities were both highly sensitive and specific for the diagnosis of aortic regurgitation, pericardial effusion, or mediastinal hematoma complicating acute aortic disease.
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PMID:[Acute and chronic aortic diseases in Marfan syndrome and arterial hypertension--a comparison of anatomy, clinical aspects and prognosis]. 767 24

Incidence, type and clinical significance of cardiac involvement in advanced HIV infection was determined in 32 patients (30 men, two women; mean age 34.2 [21-52] years; mean CD4-cell number 52.2 [0-192]/microliters) over a period of 31 months. Any cardiac involvement was assessed diagnostically by one- and two-dimensional and Doppler echocardiography, complemented by other examinations and results of treatment. 14 patients (43.8%) had abnormal cardiac findings, presumably AIDS-associated. This included left ventricular pump dysfunction of various degrees of severity (n = 11), left ventricular dilatation (n = 2), pericardial effusion (n = 11), as well as cor pulmonale in primary pulmonary arterial hypertension (n = 2). In one patient the first manifestation of AIDS was tubercular pericarditis; in two patients there was a likely connection to disseminated pneumocystis infection and toxoplasmosis, respectively. In 11 patients no specific cause was found for the cardiac involvement. Nine of the 14 patients (64%) had symptoms due to the cardiac involvement. These findings indicate that the incidence and clinical significance of cardiac involvement must be taken into account in any treatment concept for AIDS.
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PMID:[Cardiac manifestations in advanced HIV infection]. 818 20

The clinical picture of aortic dissection is dominated by severe pain. In differential diagnosis the far more frequent acute myocardial infarction should chiefly be considered. Further evaluation is therefore only indicated when, in addition to pain, there are no signs of infarction in the ECG, additional aortic incompetence, pericardial effusion or history of hypertension. In recent years, in addition to contrast angiography, three non-invasive methods for this diagnosis have been developed: computer tomography, biplane esophageal echocardiography and magnetic resonance imaging. The sensitivity, specificity, advantages and disadvantages of these four methods are compared. In the individual center, according to the availability and expertise of the investigators, one method should be used as the first diagnostic tool. Only in a minority of patients should a second method be necessary until the diagnosis is confirmed or excluded, as is shown in our own series. A limitation to one, and in difficult situations possibly two, methods is not only important from the economic point of view but also to save time, since in aortic type A dissection surgery should be performed without delay.
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PMID:[Clinical assessment of the patient with suspected dissecting aneurysm]. 827 79

We report a rare case of spontaneous rupture of the ascending aorta without any evidence of aneurysm formation or aortic dissection. A woman aged 64 was admitted to our cardiac care unit as an emergency patient with severe chest pain. Her face was pale and systolic blood pressure was 70 mmHg in spite of intravenous administration of dopamine (10 micrograms/kg/min). She had a history of hypertension for two years under good medical control. No trace of the chest trauma was noted before her admission. Physical examination revealed neck vein engorgement and distant heart sounds. Chest X-ray film showed enlargement of the cardiac silhouette. ECG showed no evidence of acute coronary syndrome. Pericardial effusion with a floating hematoma-like mass was detected by 2-dimensional echocardiogram. Pericardiocentesis revealed bloody pericardial fluid (Ht: 26%). Aortagraphy was performed resulting in a clinical diagnosis of acute aortic dissection, but there were no signs of a false lumen, aneurysm formation or extravasation of the contrast medium. Although continuous pericardial drainage was performed, she suddenly lost consciousness, collapsed and died. A longitudinal intimal laceration 5 cm long was observed in the ascending aorta. Pathological examination revealed cystic medial necrosis and irregularity of the elastic fibers in the media. No atheromatous plaque was noted in the intima. Spontaneous rupture of the aorta is a life-threatening condition that requires urgent surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case of spontaneous rupture of the ascending aorta]. 833 38


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