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

Electrocardiographic (ECG) and echocardiographic examinations and 24-h ECG Holter monitoring were carried out in 100 patients (age < 65 years) with rheumatoid arthritis (RA) of stages II-IV according to Steinbrocker's criteria. One hundred patients with osteoarthrosis, spondyloarthrosis and painful shoulder matched for age, sex and body surface area constituted the control group. All patients with myocardial infarction, hypertension, rheumatic fever or a history of diabetes were excluded. Cardiac involvement, evaluated by echo-Doppler cardiography, 24-h ECG Holter monitoring and an ECG at rest, occurred in 52 (52%) patients with RA and in 23 (23%) control group patients (p < 0.0005). In the RA group ECG examination, 1 mm ST depression in at least two consecutive leads was observed more frequently, and occurred statistically more frequently for the highest stage of RA according to Steinbrocker's criteria, highest level of functional index and longer duration of disease. The 24-h Holter ECG monitoring did not show any differences in frequency of rhythm disorders between the RA group and the control group. However, silent myocardial ischaemia episodes appeared more often in the RA group. An ECG examination revealed more cases of valvular heart disease, especially mitral insufficiency, in RA patients than in the control group. A mitral valve prolapse was noted in 6% of patients and a pericardial effusion in 4% of patients. Patients with RA were noted to have a larger diastolic left ventricular diameter and aortic root diameter, and smaller ejection fraction, mean velocity of circumferential fibre shortening and fractional shortening. The results of the examinations show that RA is associated with cardiac involvement in a significant proportion of cases.
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PMID:Echocardiographic findings, 24-hour electrocardiographic Holter monitoring in patients with rheumatoid arthritis according to Steinbrocker's criteria, functional index, value of Waaler-Rose titre and duration of disease. 980 80

The authors report the results of a prospective study about echocardiographic parameters of 14 chronic dialyzed patients. Mean age was 44.4 +/- 12 (extremes: 16 and 63). There are 12 men (86%) and 2 women (14%). The main renal disease responsible was nephroangiosclerosis (9 cases, 64.3%). Hypertension is found in all the patients, anemia in 13 (92.8%). The heart, as shown by echocardiography, was concerned in 13 patients (92.8%). The main abnormalities found were: left ventricular hypertrophy (13 cases: 92.8%), left ventricular dysfunction (4 cases: 28.5%), abnormality in left ventricular relaxation (3 cases: 21.4%), pericardial effusion (4 cases: 28.5%).
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PMID:[Echocardiographic data from chronic dialysis patients in Dakar]. 982 13

Aortic dissection with no entry or false lumen flow was recently identified as intramural hemorrhage of the aortic wall (IMH). Analysis of the literature revealed 209 cases of in vivo diagnosed IMH reflecting 17% of all dissections, whereas in postmortem studies this condition is found in 4-13%. Transesophageal echocardiography, computed tomography, magnetic resonance imaging and aortography (to rule out dissection) have been applied for diagnosing IMH in 57, 49, 43 and 38% of the cases, respectively. However, diagnostic accuracy of each modality is not available to date. In 34%, IMH involves the ascending aorta (type A). The average age of patients with IMH ranges between 55 and 65 years; 65% are males. In 12%, IMH was associated with abdominal aortic aneurysm. With 87%, arterial hypertension is the predominant risk factor for IMH irrespective of its location. As suggested by the term "mediastinal apoplexy" IMH may--similar to cerebral apoplexy--result from hypertensive rupture of the vasa vasorum in the aortic media. With 97%, the majority of patients present with acute chest or back pain similar to classic dissection. Mediastinal widening is found in 83%; signs of hemothorax/pleural effusion are present in 38%, acute aortic regurgitation in 26%, pericardial effusion in 23%, acute neurologic deficits in 12%, and pulse deficits in 5%. In 18%, IMH progresses to dissection and in another 15% to rupture. In 25% and 28%, respectively, dissection and rupture occur in the ascending aorta and in 12% and 9%, respectively, in the descending thoracic aorta. The 30-day mortality of IMH is 24% (36% with type A and 12% with type B IMH; p < 0.05). With surgical repair, mortality of type A IMH is lowered to 18% compared to 60% with medical treatment (p < 0.01). In contrast, with 8% mortality associated with medical treatment, prognosis of type B IMH is more favorable without surgical intervention, the latter associated with a 30-day mortality of 33% (p < 0.05). Thus, IMH is a potential precursor of dissection and should be managed like dissection with undelayed surgical intervention in patients with type A IMH and with medical treatment in type B IMH.
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PMID:[Intramural hemorrhage of the thoracic aorta: diagnosis, therapy and prognosis of 209 in vivo diagnosed cases]. 985 55

Penetrating aortic ulcers (PAU) result from progressive erosion of atheromatose plaques perforating the internal elastic lamina. PAU is considered both a predisposing condition and differential diagnosis of classic aortic dissection; 93 cases of PAU are documented in the world literature, 60% of which are male over 60 years old. Systemic hypertension was prevalent in 85%, history of smoking in 72%, hyperlipoproteinemia in 35%, and diabetes mellitus in 31%. In 61%, PAU was associated with coronary artery disease, in 53% with abdominal or thoracic aortic aneurysm, in 31% with chronic renal insufficiency, in 17% with peripheral artery disease, and in 12% with a history of cerebrovascular accidents. In 73%, PAU was associated with formation of medial hematoma and in 16% with a thick, calcified intimal flap of less than 10 cm extent. Angiography, computed tomography, magnetic resonance imaging and transesophageal echocardiography were used in 66, 64, 23 and 14%, respectively, for diagnosing PAU; sensitivities for demonstrating PAU were 83, 65, 86 and 61%, respectively. Chest or back pain was found in 76% and an acute onset of symptoms in 68%. Signs of mediastinal widening were found in 59%, neurologic signs comprising hoarseness, syncope or coma in 8%, pulse differentials caused by embolism in 4%, aortic regurgitation in 7%, and mediastinal hematoma, pleural- or pericardial effusion in 42, 27 and 10%, respectively. PAU of the ascending aorta or aortic arch (type A) leads to dissection and rupture in 57%, compared to 12% and 5%, respectively, in the descending aorta (type B); 57% of medically managed type A PAU patients died within 30 d of hospital admission compared to only 14% of type B PAU with 20 cases of uncomplicated long-term outcome without surgery. Thus, similar to the Stanford classification for aortic dissection, type A PAU should primarily be considered for surgical management, whereas type B PAU without signs of instability may be managed medically.
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PMID:[Ulcer of the thoracic aorta: diagnosis, therapy and prognosis]. 1002 64

Echocardiographic examination and 24-h electrocardiographic Holter monitoring were carried out on 35 patients with nodular rheumatoid arthritis (RA) and 35 with non-nodular RA, who were matched with the nodular RA group regarding age, sex and BSA. A further 35 patients with osteoarthrosis and spondyloarthrosis matched, with both RA groups, constituted a control group. Patients with a history of myocardial infarction, hypertension, rheumatic fever and diabetes were excluded from the study. Cardiac involvement, evaluated using echo-Doppler cardiography, 24-h electrocardiographic Holter monitoring and ECG at rest, occurred in 25 (71.9%) patients with nodular RA and in 15 (42.9%) with non-nodular RA in comparison to 8 (22.9%) control group patients (P < 0.0002). Holter electrocardiographic monitoring over 24 h did not present any essential differences in frequency of rhythm disorders between the examined groups and the control group. However, it revealed more patients with 1-mm ST depression in the nodular RA group than in the non-nodular and control groups. Echocardiographic examination revealed more cases of valvular heart abnormalities, especially those of mitral insufficiency, in nodular RA patients than in non-nodular and control patients. Both a mitral valve prolapse and a pericardial effusion were noted in 8.6% of nodular RA patients. Patients with nodular RA were noted to have a bigger aortic root diameter, but smaller ejection fraction, mean velocity of circumferential fibre shortening and fractional shortening in comparison to non-nodular and to control group patients.
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PMID:Echocardiographic findings and 24-h electrocardiographic Holter monitoring in patients with nodular and non-nodular rheumatoid arthritis. 1039 90

The authors describe a case of clinical, echocardiographic and haemodynamic adiastole in a man with severe rheumatoid arthritis with a previous history of pericardial effusion. The adiastole was mixed, fibrous pericarditis, confirmed by ultra fast CT scan and at surgery; myocardial adiastole was suspected on finding thickening of the ventricular walls (in the absence of hypertension and coronary artery disease) and, unfortunately, confirmed by the persistence of adiastole despite very satisfactory pericardectomy. The authors underline the involvement of the three cardiac tunics in rheumatoid arthritis and the value of different diagnostic methods in the differentiation between constrictive pericarditis and restrictive cardiomyopathy.
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PMID:[Pericardial and myocardial adiastole in rheumatoid polyarthritis]. 1056 6

A 36-yr-old pregnant woman with a history of hypertension presented at term for elective Caesarean section because of breech position. At preoperative examination, a diastolic murmur was found and transoesophageal echocardiography (TOE) revealed a large, 8.1-cm diameter ascending aortic aneurysm with severe aortic regurgitation and moderate pericardial effusion. Surgical repair was not considered to be urgently required. The patient was delivered electively by Caesarean section under epidural anaesthesia using invasive arterial pressure monitoring. TOE performed 6 h post-partum showed progressing pericardial effusion, for which emergency replacement of the aortic valve and ascending aorta were indicated. The epidural catheter was removed 4 h before starting the cardiopulmonary bypass procedure. Arterial pressure was controlled by a titrated infusion of esmolol and clonidine. To improve uterine tone, the patient received an i.v. infusion of oxytocin throughout surgery. After implantation of an aortic composite graft and weaning from cardiopulmonary bypass, the patient was transferred to the intensive care unit. Awake and receptive to neurological evaluation, her trachea was extubated 4 h after surgery. Mother and baby made an uneventful recovery.
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PMID:Emergency repair of incidentally diagnosed ascending aortic aneurysm immediately after caesarean section. 1082 16

Two girls with mixed connective tissue disease (MCTD) were treated in our hospital in the past 5 years. Patient 1, a 10-year-old girl presenting with migratory arthralgia, had an initial diagnosis of juvenile rheumatoid arthritis. Muscle weakness with elevated levels of creatine kinase and liver enzymes, sclerodactyly, Raynaud's phenomenon and heliotrope sign developed subsequently in the following 3 years. Patient 2, a 13-year-old girl, had been treated for suspected systemic lupus erythematosus since 9 years of age. She presented with lymphadenopathy, arthralgia, pericardial effusion, and paralytic ileus. The symptoms waxed and waned. Sclerodactyly, Raynaud's phenomenon, proteinuria, and hypertension were also noted. Both patients had high serum titers of antinuclear antibody (speckled pattern, 1:5120) and were seropositive for antiribonuclear protein antibody. Intravenous immunoglobulin, prednisolone, cyclosporine A, and nonsteroidal anti-inflammatory drugs (NSAIDs) were given to patient 1. Patient 2 received cyclosporine A, prednisolone, and methylprednisolone pulse therapy. The disease has been well controlled for 2 years by low-dose immunosuppressants and NSAIDs. MCTD is a rare juvenile rheumatic disease: early identification and appropriate treatment can improve the disease outcome.
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PMID:Childhood mixed connective tissue disease. 1077 31

The clinical presentation of cardiac symptoms related to hypothyroidism is only rarely observed nowadays due to early diagnosis of hypothyroidism by easily available thyroid-stimulating hormone assays. A measurable abnormality of the left ventricle is the lengthened duration of contraction and relaxation, normalizing after restoration of euthyroidism. The ejection fraction and cardiac reserve are only slightly diminished in hypothyroidism. There is reversible diastolic disfunction. Pericardial effusion is a rare phenomenon. Diastolic hypertension due to hypothyroidism is the most frequent cause of endocrine hypertension. The relation between accelerated atherosclerosis and hypothyroidism is not definitively proven. Patients below age 65 and without cardiac risk factors can probably be treated with a full replacement dose of levothyroxin from the beginning. There is no increased risk of percutaneous transluminal coronary angioplasty or coronary artery bypass graft procedure in hypothyroid patients, either during or after the intervention.
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PMID:[Cardiovascular effects of hypothyroidism]. 1077 18

Dissection of aorta is a serious condition; the main factors are hypertension and diseases of the connective tissue or of collagen. Aortitis syndrome in combination with hypertension and atherosclerosis in association with ascending aortic dissection is rarely seen. We present the case of a 53-year-old hypertensive patient whose ascending aortic dissection was associated with pericardial effusion without rupture of the aorta and with pleural effusion. Several unusual aspects of transesophageal echocardiography are described. The intraoperative biopsy revealed inflammatory aortitis with mural hematoma, without giant cells. The literature concerning aortic dissection and aortitis is reviewed.
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PMID:Stanford type A aortic dissection in a hypertensive patient with atherosclerosis of aorta and aortitis. 1097 79


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