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

Atrial fibrillation (AF) is associated with a higher morbidity and mortality because of the risk of systemic or pulmonary embolism as well as the negative impact on cardiac function. The authors investigate in the submitted paper factors influencing the vulnerability of atria during transoesophageal atrial stimulation (TESP). The group comprised 68 patients with a sinus rhythm, mean age 56.9 +/- 17.9 years. Depending on the response to rapid atrial stimulation, the patients were divided into three groups. In group I (small disposition to AF) they revealed a significantly lower age, the relative thickness of the left ventricular wall assessed by echocardiography and the dimension of the left atrium, as compared with groups with a medium increased (II) and high disposition (III) for AF. In group III hypertonic changes on the fundus were found more frequently, as well as anamnestic data on hypertension, diabetes and pathological values of the recovery period of the sinoatrial node. At the same time significantly lower values of the rate of the E wave were observed and of the ratio of amplitudes and E/A integrals from the Doppler record of the mitral valve. The weight of the left ventricle and its index by groups increased, however the changes did not attain statistical significance. Indicators of left ventricular systolic function did not differ. The authors conclude that the main independent factors which determine the response to provoked AF by the TESP method are the diastolic left ventricular function documented by the Doppler method, the diameter of the left atrium, the automation of the SA node. Less important factors are left ventricular hypertrophy and age.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Factors affecting the vulnerability of the left atrium during rapid transesophageal atrial stimulation]. 814 Jul 47

The indications for thrombolytic therapy in acute myocardial infarction, pulmonary embolism, deep venous thrombosis and ischemic stroke are reviewed on the basis of a risk-benefit analysis. There is strong evidence that thrombolysis benefits the majority of patients with acute myocardial infarction. Nevertheless, the overall proportion of patients actually receiving this therapy is disappointingly low (10-30%). Efforts are mainly required in minimizing delays in initiating thrombolysis (patient, doctor, in-hospital) and in providing thrombolytic therapy to an extended proportion of qualifying patients. This implies that many traditional but inappropriate exclusion criteria (e.g. age, presentation 6 to 12 hours after onset of symptoms, hypertension, reinfarction, brief cardiopulmonary resuscitation) are unfounded. Depending on duration of symptoms, infarct localization and age, we favor a differentiated thrombolytic regimen with rt-PA or streptokinase. In contrast to acute myocardial infarction, the risk-benefit ratio for the other thrombotic disorders discussed favours thrombolytic therapy only in a minority of carefully selected patients.
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PMID:[Possibilities and limitations of thrombolysis. Benefits and risk in acute myocardial infarct, lung embolism, pelvic and leg vein thrombosis as well as cerebrovascular accidents]. 817 7

Despite impressive gains in safety in recent decades, pregnancy remains risky business. From early in pregnancy until some weeks after its conclusion, pregnant women are at increased risk of morbidity and mortality compared with women who are not pregnant. This review summarizes recent national data from the U.S. Centers for Disease Control and Prevention, including vital statistics from the National Center for Health Statistics. Ectopic pregnancy is substantially more dangerous (38 deaths/100,000 events) than either childbirth (nine) or legal abortion (less than one). The three leading causes of maternal death today are pregnancy-induced hypertension, hemorrhage, and pulmonary embolism. Although comprehensive data on pregnancy-related morbidity are lacking, about 22% of all pregnant women are hospitalized before delivery because of complications. Women of minority races have much higher risks of death than do white women, and the same holds true for older women and those with limited education. For most women, fertility regulation by contraception, sterilization, or legal abortion is substantially safer than childbirth.
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PMID:The morbidity and mortality of pregnancy: still risky business. 817 96

Pulmonary circulation was evaluated in normal subjects and in post-embolic patients. Eight normal subjects, 3 patients with acute pulmonary embolism and 8 patients with chronic thromboembolic pulmonary hypertension underwent CT of the chest. High-resolution CT and angio-CT were performed to study pulmonary parenchyma and pulmonary arteries, respectively. CT showed thrombi in the main or interlobar pulmonary arteries in all 3 cases of acute pulmonary embolism and in 4 of 8 patients affected with chronic thromboembolic pulmonary hypertension. The diameters of the main pulmonary and right interlobar arteries correlated with systolic pulmonary artery pressure (p < 0.001), as measured by right heart catheterization. In the patients affected with chronic thromboembolic pulmonary hypertension, the ratio of the calibers of the segmental arteries to the corresponding bronchi was markedly higher, which was observed also in the patients with acute pulmonary embolism. The bronchial arteries were dilated in 4 of 8 cases of chronic thromboembolic pulmonary hypertension. Lung density was significantly high in the perihilar compartment in the patients with acute thromboembolic hypertension, but not in normal controls and in the cases of acute pulmonary embolism. In conclusion, CT can help to diagnose pathological pulmonary circulation. Particularly, the ratio of the diameters of the segmental arteries to the corresponding bronchi can be useful to evaluate blood circulation.
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PMID:[Systematic evaluation of the pulmonary circulation with computerized tomography: normal and post-embolic pathologic features]. 821 May 30

Although less frequent than that of the lower limbs, venous thrombosis of the upper limbs may cause pulmonary embolism. This embolism is usually moderate and facilitated by the delay or absence of anticoagulant treatment. We report the case of a young man who had multiple and recurrent embolism consecutive to thrombosis of the axillary and subclavian veins and who rapidly developed pulmonary arterial hypertension on previously healthy lungs. There was no venous disease of the lower limb. After a more than 2 years' period, the pulmonary arterial hypertension is still moderate, but the patient remains under long-term antivitamin K therapy, this being the only available treatment capable of preventing a deterioration that would result in post-embolic cor pulmonale and ultimately require lung transplantation.
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PMID:[Unusual complication of venous thrombosis of the upper limb: pulmonary hypertension]. 829 44

Improvement of perinatal mortality rate in Japan is remarkable for the last two decades, but maternal mortality rate is still relatively high in comparison with the improvement of the perinatal mortality rate. Maternal mortality rate 1991 in Japan was 8.5. Maternal deaths occurred mostly in perinatal period. The causes of death include pre- and postpartum hemorrhage, pulmonary embolism, and hypertension. This means an intensive, vigorous therapy including anesthesia management is necessary during peripartum period. Questionnaires were mailed to 63 maternity clinics in Gifu area. Some of the questions requested as many answers as applicable. We received 51 replies to questionnaires. Average Cesarean rate in Gifu was 7.3%. Spinal anesthesia was used in 74.5% of maternity clinics. Dibucaine was the most widely used local anesthetic for spinal anesthesia. Antacid medications were rare in our study group. After induction of general anesthesia, airway was maintained by masks (36.0%) or endotracheal tube (64.0%). Obstetric analgesia by local anesthetics was not used widely.
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PMID:[Obstetric anesthesia in Gifu]. 832 Aug 20

Correlates of the size of infarcts, the time from stroke to death, and the mechanisms of death were studied in 77 consecutive patients who died from infarction in the middle cerebral artery territory. The area of infarcts was assessed by planimetry on schemas of representative brain levels and the results were expressed as a ratio of infarcted area on the whole MCA territory. No clear relationship was found between the size of infarcts in the MCA territory, and any of the characteristics of the patients, but extensive infarcts were more frequent when the internal carotid artery was occluded. No evidence was found of an adverse effect of age, diabetes or initial hyperglycemia on the size of infarcts. The mechanisms of death were not linked to sex, age, high blood pressure, diabetes, blood glucose level at admission, presence and location of an arterial occlusion, or etiology of the infarct. On the contrary, they varied as a function of interval from stroke to death. Transtentorial herniation, the main cerebral cause of death, occurred mainly in the first week and was related to the large size of infarcts. Rare recurrences of stroke and frequent extracerebral mechanisms of death (mainly pneumonia, pulmonary embolism and cardiopathy) occurred later on.
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PMID:Infarcts in the middle cerebral artery territory. Pathological study of the mechanisms of death. 833 39

Recurrent subacute pulmonary embolism leading to pulmonary arterial hypertension is an uncommon presentation of malignancy. We describe one such patient who presented to us with features of pre-capillary pulmonary arterial hypertension. A novel yet simple technique, involving pulmonary wedge aspiration cytology, provided the tissue diagnosis of trophoblastic malignancy, thus enabling prompt institution of chemotherapy and consequent impressive clinical improvement. This technique appears to be a hitherto unreported indication for intravascular catheterisation in the diagnostic work up of pulmonary arterial hypertension.
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PMID:Pulmonary wedge aspiration cytology in the diagnosis of recurrent tumour embolism causing pulmonary arterial hypertension. 839 86

A 72-year-old female, who had received medication for hypertension and angina pectoris was hospitalized with complaining of an abrupt dyspnea. Roentgenogram of the chest revealed no abnormal findings except cardiac enlargement. An electrocardiogram showed overloading of the right ventricle. Arterial blood gas analysis of room air showed 55.4 mmHg of PaO2, 25.5 mmHg of PaCO2 and 7.30 of PH, respectively. Acute and massive pulmonary embolism was diagnosed by an emergent pulmonary arteriography. Despite intensive treatment such as infusion of urokinase and heparin for four days, thrombus was still detected in the left main pulmonary artery by a transesophageal echocardiography. By the result of ineffective conservative therapy, embolectomy was performed under cardiopulmonary bypass. However mechanical respiratory support was required for a long time due to the right heart failure, she is doing well for a year after the operation.
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PMID:[Acute massive pulmonary embolism--report of a case]. 845 37

The past and present clinical history of 13 patients with hemodynamic and angiographic diagnosis of chronic thromboembolic pulmonary hypertension (CTPH) was reviewed in order to investigate the reasons for failure of resolution of acute pulmonary embolism (PE) and findings useful for diagnosis of CTPH. All patients had chest radiograph, ECG, arterial blood gas analysis and pulmonary perfusion scintigraphy performed. Clinical assessment demonstrated that no patient had diagnosis and treatment of the several retrospectively identified episodes of PE (from 1 to 8); the lack of diagnosis was due to underestimation of symptoms and signs such as dyspnea (85%), pleuritic chest pain (31%) or phlebitis (46%) that were present months or years earlier. Alternative diagnoses erroneously made were dyspnea of unknown origin (5 cases), left heart failure (4 instances) and pneumonia (2 cases). Once CTPH has developed, chronic dyspnea (92%) and substernal chest pain (100%) are almost always present: chest radiograph and ECG show signs of chronic hypertension such as enlargement of hila (100%), right heart sections (77%), azygos vein (46%) and P pulmonale (67%), T inversion on right precordial leads (75%), S-T segment depression (75%), respectively. Perfusion scintigraphy shows severe perfusion impairment (55.7% of the total vascular bed) paralleled by severe hypoxia (standard PaO2 = 49 +/- 14.1 mm Hg). In conclusion, patients with PE who develop CTPH are not diagnosed and thus untreated because clinical symptoms and signs of acute PE have not been recognized. If CTPH develops, clinical assessment (including simple and noninvasive techniques such as chest radiograph, ECG and blood gas analysis) may show a quite characteristic pattern useful for diagnosis.
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PMID:From not detected pulmonary embolism to diagnosis of chronic thromboembolic pulmonary hypertension: a retrospective study. 846 23


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