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)

Although triple-drug immunosuppression with cyclosporine, prednisone, and azathioprine has reduced the incidence of acute graft rejection after cardiac transplant, its effect on the development of coronary artery disease is unknown. We have followed up 74 cardiac transplant recipients with yearly coronary angiograms. The probability of acute rejection was 10.8% at 1 year. The incidence of coronary artery disease was 8% at 1 year (six of 74 patients) and 24% at 2 years (11 of 30 patients). In patients who developed posttransplant coronary artery disease, there was a slightly higher, but not statistically significant, incidence of acute graft rejection and pretransplant idiopathic cardiomyopathy. No correlation was found between the incidence of coronary artery disease and recipient age, human leukocyte antigen (HLA) type, hypertension, diabetes, cholesterol level, triglyceride levels, weight gain after transplant, and smoking. These data indicate that triple-drug immunosuppression, despite having produced a significant reduction in the episodes of acute graft rejection, has not decreased the incidence of posttransplant coronary artery disease. Common risk factors for coronary disease and HLA mismatch are probably not important in the pathogenesis of coronary atherosclerosis after cardiac transplantation, whereas the risk for coronary artery disease may be increased by acute graft rejection and pretransplant idiopathic cardiomyopathy.
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PMID:Coronary artery disease in cardiac transplant patients receiving triple-drug immunosuppressive therapy. 280 89

Fifty-four patients (group I) underwent isolated heart transplantation between July 1983 and January 1987 and were immunosuppressed with oral prednisone and cyclosporine. Twenty-three patients (group II) were transplanted between January 1987 and June 1988 and were immunosuppressed with oral prednisone, azathioprine, and cyclosporine, with lower targeted cyclosporine blood levels. The groups were similar in sex distribution of both donors and recipients. Primary cardiomyopathy was the primary recipient diagnosis in two thirds of patients in both groups. Donor age, graft ischemic time, and length of recipient hospitalization after transplant were similar. There was a trend toward transplantation of older patients in group II, and group II patients were more likely to receive hearts from local donors. Actuarial survival at 24 months was 75% in group I and 92% in group II. Patients who had triple-drug immunosuppression had statistically less early rejection but more early infections that tended to be minor. Hypertension requiring treatment occurred in 63% of group I patients and 62% of group II patients within the first 9 months after transplantation. Elevation of serum creatinine greater than 2.0 mg/dl occurred in 34% of group I patients and 15% of group II patients. A triple-drug immunosuppressive protocol is associated with less early rejection but more early minor infectious episodes. Although the incidence of hypertension is not reduced, there is a trend toward less nephrotoxicity and better survival.
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PMID:Immunosuppression after heart transplantation: prednisone and cyclosporine with and without azathioprine. 281 26

The accuracy of a newly developed nuclear magnetic resonance-computed tomography (NMR-CT) technique in diagnosing idiopathic cardiomyopathy was assessed and compared with other procedures such as echocardiography, coronary angiography, left ventriculography, myocardial biopsy, and electrocardiography. In case 1, the NMR-CT clearly revealed thickening of the lateral ventricular free wall and ventricular septum, which strongly suggested hypertrophic cardiomyopathy. Catheterization showed a pressure gradient of 54 mm Hg and this patient was diagnosed as having hypertrophic obstructive cardiomyopathy. In case 2, the NMR-CT showed dilatation of the ventricular cavity indicative of dilated cardiomyopathy. This was confirmed by echocardiography, which revealed the enlarged cavity of the ventricle and poor movement. In case 3, the patient had marked hypertension; the cardiac silhouette was enlarged, but the NMR-CT revealed that the ventricular free wall and septum were of normal thickness. This study shows that NMR-CT is of value in the differential diagnosis of idiopathic cardiomyopathy.
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PMID:Clinical application of NMR-CT for idiopathic cardiomyopathy. 391 78

Whether giant negative T waves (GNT) of 1 mV or greater represent the electrocardiographic characteristics of idiopathic cardiomyopathy, particularly apical hypertrophic cardiomyopathy, is controversial. To clarify this point, a comparative study was conducted for 57 persons with GNT (GNT+ group) and 57 persons of hypertrophic cardiomyopathy with either asymmetric septal hypertrophy or diffuse hypertrophy of the ventricular wall in the absence of GNT (GNT- group). Patients with cerebral vascular accidents, myocardial infarctions, valvular heart disease, myopericarditis, and implanted pacemakers were excluded from the study because these patients' ECGs may show GNT. Left ventriculograms were investigated at end-diastole in the right anterior oblique projection. The GNT+ group showed a spade-like configuration indicating a marked reduction in the lumen of the apical cavity in 25 cases (43.9%); a kidney or banana-like configuration indicating the inferior wall bulging into the left ventricular cavity in its mid-zone in eight cases (14.0%), and an oval configuration which indicated no deformity of the left ventricular cavity in 24 (42.1%). The spade-like configuration was also seen in four cases (7.0%) of the GNT- group. A study of ventricular wall thicknesses based on left ventriculography showed that 25.5% of cases with GNT did not have concomitant apical hypertrophy. Generally, the GNT+ group cases had a significantly thicker anterior left ventricular wall and apical hypertrophy compared to the GNT- group. The hypertrophic states of the apical wall and anterior wall of the left ventricle correlated well. The GNT+ group included a significantly larger percentage of patients who were middle aged and older than did the GNT- group, and the frequency of accompanying hypertension was significantly higher in the former. The confirmed or suspected familial occurrence of cardiomyopathy (CM) was observed in 32 cases (56.1%) of the GNT- group, and in 18 cases (31.6%) of the GNT+ group, i.e., the incidence was significantly lower in the GNT+ group. In an endomyocardial biopsy study, 40 cases (70.1%) of HCM without GNT had bizarre myocardial hypertrophy with disorganization (BMHD). The incidence of BMHD in the GNT+ group was 21/57 (36.8%)-significantly lower than in the GNT- group. In the GNT- group, there was no significant difference in the incidence of BMHD between relatively young and old patients or between patients with and without accompanying hypertension; whereas, in the GNT+ group, it was significantly lower among those with accompanying hypertension and in older patients than in those without accompanying hypertension and in younger patients.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Do giant negative T waves represent apical hypertrophic cardiomyopathy? Left ventriculographic and cardiac biopsy studies]. 406 55

During a 10-year period a series of 114 patients was studied to determine if Trypanosoma cruzi and arboviruses could be the etiologic agents of idiopathic cardiomyopathy (ICM) in Cali, Colombia. In this area, ICM (together with rheumatic and artherosclerotic cardiopathy) represents the second most frequent cause (determined by necropsy) among adult patients with cardiopathies, hypertension being the first. No association was observed between ICM and any of the arboviruses assessed by hemagglutination tests. Only 10 of 114 cases (8.7%) showed positive seroparasitological tests for T. cruzi. Autopsy was performed in 4 of these 10 cases; 1 had Chagas myocarditis and the other 3 were patients with non-inflammatory ICM. In all 9 T. cruzi-negative cases the autopsies showed non-inflammatory ICM lesions. In contrast to typical Chagas cases, the most frequent EKG change in ICM is left bundle branch block rather than right. Since the EKG varies within either group, this distinction may not be valid in individual cases. Because of the similarities in clinical characteristics and variations in EKG between Chagas myocarditis and ICM, it is suggested that autopsies should be done in populations in endemic areas of T. cruzi to assess the frequency of ICM and its importance in the differential diagnosis of Chagas myocarditis.
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PMID:Trypanosoma cruzi and virological studies in idiopathic cardiomyopathy in Cali, Colombia. 421 66

Cardiac function was evaluated by echocardiography (echo) in ten paediatric patients, 2.5 to 15 years of age, maintained on chronic dialysis. All had moderate to severe hypertension despite intensive antihypertensive medication. Four of ten patients showed, on echo, asymmetric septal hypertrophy (ASH) typical of hypertrophic cardiomyopathy (HCM). Two also had signs suggestive of outflow obstruction. Primary cardiomyopathy was excluded by a family survey of first-degree relatives. The incidence of HCM in our series is impressive (40%). The pathogenesis of this cardiac lesion in uraemia is unknown; long-standing severe hypertension may play a role. Early recognition of this form of cardiomyopathy has important clinical considerations. Echo should become a routine examination in the diagnosis, follow-up, and treatment of children with end-stage renal disease.
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PMID:Hypertrophic cardiomyopathy in children with end-stage renal disease and hypertension. 719 48

From 1986 to February 1993, 40 children aged 2 months to 18 years (average age 10.4 +/- 5.8 years) underwent heart transplantation. Indications for transplantation were idiopathic cardiomyopathy (52%), congenital heart disease (35%) with and without prior repair (71% and 29%, respectively), hypertrophic cardiomyopathy (5%), valvular heart disease (3%), and doxorubicin cardiomyopathy (5%). Patients were managed with cyclosporine and azathioprine. No prophylaxis with antilymphocyte globulin was used. Steroids were given to 39% of patients for refractory rejection, but weaning was always attempted and generally successful (64%). Five patients (14%) received maintenance steroids. Four patients died in the perioperative period and one died 4 months later. There have been no deaths related to rejection or infection. Average follow-up was 36 +/- 19 months (range 1 to 65 months). Cumulative survival is 88% at 5 years. In patients less than 7 years of age, rejection was monitored noninvasively. In the first postoperative month, 89% of patients were treated for rejection. Freedom from serious infections was 83% at 1 month and 65% at 1 year. Cytomegalovirus infections were treated successfully with ganciclovir in 11 patients. No impairment of growth was observed in children who underwent transplantation compared with a control population. Twenty-one patients (60%) have undergone annual catheterizations and no sign of graft atherosclerosis has been observed. Seizures occurred in five patients (14%) and hypertension was treated in 10 patients (28%). No patient was disabled and no lymphoproliferative disorder was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pediatric heart transplantation without chronic maintenance steroids. 831 43

It was first reported by our group in 1975 that heart failure due to idiopathic dilated cardiomyopathy (IDC) could be improved by long term treatment with a beta-blocker, starting at a low dose and continuing with a stepwise up-titration. Since then, many studies have been performed in patients with heart failure of various aetiologies and the beneficial effects of long term beta-blockade have been confirmed. About 3000 patients have been included in randomised studies in which beta-blockade, given for more than 2 months, mostly elicited significant improvements in functional class, exercise capacity, cardiac function, quality of life and/or morbidity. When started at a very low dose (one-tenth to one-twentieth of the doses generally used in angina or hypertension), the treatment is well tolerated in most patients. In these studies, various types of beta-blockers were used, including beta1-selective blockers and nonselective blockers with additional properties (vasodilator and antioxidative) such as metoprolol, bisoprolol, bucindolol and carvedilol. Several large studies have also reported benefits on mortality and morbidity. In the Metoprolol in Dilated Cardiomyopathy (MDC) trial, metoprolol treatment in patients with IDC resulted in a 34% reduction of the primary combined endpoint, total number of deaths and need for cardiac transplantation. In the Cardiac Insufficiency Bisoprolol Study (CIBIS), in patients with idiopathic as well as ischaemic cardiomyopathy, there was a nonsignificant 20% reduction in mortality. In the US carvedilol studies (n = 1094), also in patients with ischaemic and idiopathic cardiomyopathy, carvedilol reduced mortality by 65%, which was highly significant. A nonsignificant reduction in mortality was observed in the Australia-New Zealand (ANZ) Heart Failure Study with carvedilol. In all these studies there was a reduction in hospitalisations, with all drugs being generally well tolerated. It can thus be concluded that the beneficial effects of beta-blockers on cardiac function and morbidity have been documented in a large number of studies in selected groups of patients. The treatment has been accepted in some countries by the regulatory authorities. Larger, placebo-controlled studies are needed to convincingly demonstrate a reduction in total mortality as observed in the pooling of the 4 US carvedilol studies. Such studies are in progress for various beta-blockers, which may lead to acceptance of their routine clinical use in patients with congestive heart failure.
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PMID:The role of beta-blockers in left ventricular dysfunction and heart failure. 933 58

Although, the diagnosis of idiopathic cardiomyopathy is determined by cardiac catheterization including myocardial biopsy, non-invasive diagnosis is important. The most useful method is nuclear cardiology to differentiate dilated cardiomyopathy from ischemic cardiomyopathy. Cardiac images in ischemic cardiomyopathy have wider perfusion and metabolic defects than in dilated cardiomyopathy using Tl-201, Tc-99m perfusion tracers, I-123 BMIPP, N-13 NH3 and F-18 FDG. The degree of heterogenecity of the myocardium is higher in ischemic cardiomyopathy than in dilated cardiomyopathy by these tracers. Left ventricular hypertrophy is common finding in hypertension and hypertrophic cardiomyopathy. However, in hypertensive heart disease the left ventricular wall thickness rarely exceed than 20 mm, and the septal wall thickness/posterior wall thickness is not more than 1.5, which are frequently shown in hypertrophic cardiomyopathy. Right ventricular hypertrophy near the ventricular septum is also one of the characteristic findings in hypertrophic cardiomyopathy.
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PMID:[Differential diagnosis of idiopathic cardiomyopathy from ischemic cardiomyopathy and hypertensive heart disease using non-invasive methods]. 1088 17

572 consecutive patients with heart failure referred to the National Cardiothoracic Centre, Accra, Ghana, over a 4-year period were evaluated for the aetiology of heart failure using two-dimensional Doppler echocardiography with colour flow. The mean age of the subjects with heart failure was 42.3 +/- 0.9 years. The male to female ratio was 1.2:1.0. Combined heart failure was seen in 50.5% of subjects. Peak incidence of heart failure occurred in the 5th decade. The main causes of heart failure were hypertension (21.3%; n = 122), rheumatic heart disease (20.1%; n = 115) and cardiomyopathy (16.8%; n = 96). Congenital heart disease and coronary artery disease accounted for 9.8 and 10% of cases, respectively. The commonest rheumatic valvular lesion was mitral regurgitation (78%). Dilated cardiomyopathy was the commonest form of idiopathic cardiomyopathy (67.7%; n = 65). Endomyocardial fibrosis and hypertrophic cardiomyopathy accounted for 22.9% (n = 22) and 9.4% (n = 9), respectively, of cardiomyopathies.
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PMID:Aetiology of heart failure as seen from a National Cardiac Referral Centre in Africa. 1089 1


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