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

Considerable uncertainty exists regarding the appropriate use and dose limitations for ergotamine tartrate (ET) and dihydroergotamine (DHE) for the treatment of migraine despite more than 50 years of clinical experience. The Quality Standards Subcommittee (QSS) of the American Academy of Neurology (AAN) appointed an advisory committee from experts in the Headache and Facial Pain Section. As their initial project, the committee elected to review the clinical literature on the appropriate use of these compounds in the treatment of migraine. Subsequently, clinical practice guidelines were formulated and recently published in Neurology. The Headache and Facial Plan Section and the QSS of the AAN were able to reach consensus on the basis of a thorough literature review and formulated practice parameters that describe and define the limits of ergot use, provide information on the oral and parenteral dosing of ET and DHE, and provide physicians with guidance to avoid ET overuse by patients. Because this project was completed prior to the availability of the intranasal (IN) formulation of DHE, intranasal DHE is not included in the practice parameter. Ergotamine tartrate and DHE were found to be safe and effective for the treatment of migraine as long as recommended dosages are not exceeded and high-risk patients such as those with uncontrolled hypertension, coronary or peripheral artery disease, thyrotoxicosis, or sepsis do not receive these compounds. In addition, the committee recommended restricting the use of ET in some instances because the overuse of ET has been associated with physical and psychological dependence resulting in predictable recurrent and/or rebound headaches, and subsequent severe withdrawal symptoms, including nausea, upon discontinuance of ET. None of these symptoms have been reported for DHE. These guidelines should help physicians provide optimal antimigraine therapy with these drugs.
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PMID:Appropriate use of ergotamine tartrate and dihydroergotamine in the treatment of migraine: current perspectives. 900 73

Hyperthyroidism is well known to be associated with cardiovascular manifestations. The authors have noted that patients of well controlled Graves' Disease often pose problems due to intrapoperative cardiovascular instability. Retrospective analysis of 137 case records of patients with Graves' disease (n = 35), toxic nodular goitre (n = 42) and those with euthyroid benign goitre (n = 60) were studied. In Graves' disease cardiovascular instability was found in the form of hypertension (n = 9) associated with tachyarrhythmia (n = 8) and bradycardia (n = 3). The incidence of first 2 of the above mentioned 3 problems was significantly higher in Graves disease (n = 9/35 patients) in contrast to a comparable group of patients with toxic nodular in (3/42 patients; P value 0.05) and euthyroid goiter (2/60 patients; P value < 0.001). Certain parameters such as high T3, T4 at the time of presentation were associated with higher incidence of these complications, in spite of very well controlled thyrotoxicosis. Whether heightened receptor sensitivity to catecholamines and higher renin-angiotensin activation explain these findings in Graves' disease, remains to be ascertained.
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PMID:Intraoperative hypertension during thyroidectomy for Graves' disease. 908 63

Biondi, Fazio, and colleagues recently reported that long term T4 treatment to suppress serum TSH markedly affects cardiac function. T4-treated patients had more symptoms [12.2 +/- 3.9 (+/-SD) vs. 4.2 +/- 2.3 by quantitative questionnaire], higher mean heart rate, increased incidence of atrial extrasystoles, increased interventricular septal thickness and left ventricular mass index (LVMi), and significant diastolic dysfunction. The severity of cardiac abnormalities was highly correlated with scores of a rating scale used for assessing symptoms of thyrotoxicosis. We have duplicated their studies in 17 athyreotic patients (mean age, 45 +/- 10 yr; range, 27-63 yr) without heart disease or hypertension whose dose of T4 was titrated to suppress serum TSH to less than 0.01 microU/mL. The mean duration of T4 treatment was 9.2 +/- 5.4 yr. Controls were healthy volunteers matched for sex and age (+/-3 yr). The mean T4 dose was 2.8 +/- 0.9 micrograms/kg (0.192 +/- 0.058 mg/day). By questionnaire, patients had minimal symptoms, although their symptom score was significantly greater than the control value (4 +/- 3 vs. 2 +/- 1; P < 0.05; maximum score, 36). No differences in mean heart rate or in atrial or ventricular extrasystoles were noted. In patients, indexes of systolic and diastolic function and interventricular septal thickness were similar to control values. The mean LVMi was normal in both groups. However, the mean LVMi in patients (117 +/- 35 g/m2) was higher than that in controls (92 +/- 31; P < 0.05). In conclusion, patients were minimally affected by TSH-suppressive doses of T4. They had few symptoms and no increase in extrasystoles or basal heart rate. Based on current knowledge, the increase in LVMi observed in patients without associated significant systolic or diastolic abnormalities does not have clinical or prognostic importance. Therefore, in the absence of symptoms of thyrotoxicosis, patients treated with TSH-suppressive doses of L-T4 may be followed clinically without specific cardiac laboratory studies.
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PMID:Minimal cardiac effects in asymptomatic athyreotic patients chronically treated with thyrotropin-suppressive doses of L-thyroxine. 966 56

Numerous analyses are used in the differential diagnosis between primary and secondary dilated cardiomyopathy (PDC, SDC). The aim of this study was to assess the dimensions of heart cavities in patients with dilated cardiomyopathy (DC) by 1-D and 2-D echocardiography. Thirty-six consecutive patients who satisfied the PDC criteria, and 103 patients with criteria of SDC, were followed-up clinically, radiographically, electrocardiographically and by 1-D and 2-D echocardiography, in the period from December 1991 to April 1994, at the Department of Internal Medicine of the Clinical Hospital Split. The patients with PDC were significantly younger than those with SDC (44.4 +/- 10.4: 64.4 +/- 8.4 year). There were significantly more males than females in both DC subgroups. NYHA classification, sinus rhythm and atrial fibrillation did not differ considerably in both DC subcategories. The etiologic factor was ischaemic DC in 85.4% (88/103), systemic arterial hypertension in 11.6% (12/103), and thyrotoxicosis in 2.9% (3/103) of patients with SDC. Alcoholic DC in one patient, peripartal DC in two female patients and viral myocarditis in six patients with PDC were suspected. In the total of 75% (27/36) patients with PDC, a clear etiological factor in case histories was not defined. Left ventricular ejection fraction, diameter and myocardial thickness, as well as left atrium diameter, did not differ significantly in patients with PDC, at variance with SDC patients. Right ventricular enddiastolic diameter (31.55 +/- 4.8 mm: 26.62 +/- 8.6 mm, p < 0.05) and the ratio between enddiastolic diameters of the right and left ventricle were significantly larger in patients with PDC than in those with SDC (0.45 +/- 0.03: 0.37 +/- 0.05, p < 0.05). We conclude that right ventricle is significantly wider in PDC than in SDC patients. Compared with other noninvasive methods, 1-D and 2-D echocardiography is probably the method of choice (particularly in our environment) in the differentiation of primary and secondary DC.
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PMID:[Significance of right ventricular dimensions in the differential diagnosis of primary and secondary dilated cardiomyopathy]. 949 Mar 76

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, and its prevalence increases with age. Etiologies include coronary artery disease, hypertension, valvular heart disease, thyrotoxicosis, and other cardiac and noncardiac conditions. AF can lead to reversible impairment of left ventricular (LV) function, LV dilatation, clinical heart failure, angina pectoris, stroke, and increased mortality. Digoxin, beta blockers, or calcium channel blockers are used to control ventricular rate in new-onset AF with hemodynamically stable rhythm and in chronic AF where rhythm cannot be restored. These drugs can be used alone or in combination, depending on the clinical situation. The most complete relief of symptoms occurs when sinus rhythm is restored. Class IA, IC, and III antiarrhythmic agents can be used to restore and maintain sinus rhythm in selected patients.
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PMID:Atrial fibrillation: drug therapies for ventricular rate control and restoration of sinus rhythm. 963 6

Maternal thyrotoxicosis complicates approximately 0.2% of pregnancies. Simultaneous occurrence of maternal and fetal thyrotoxicosis during labor is rare, and control of maternal tachycardia and hypertension, as well as fetal manifestations of thyrotoxicosis, are cornerstones of management. An 18-year-old nulliparous female at 33 weeks gestational age presented in labor with thyrotoxicosis. Fetal tachycardia was present as well. Labetalol therapy resulted in a decrease in maternal pulse and blood pressure, and resolution of fetal tachycardia. Vaginal delivery occurred. Subsequent evaluation demonstrated neonatal thyrotoxicosis and high maternal titers of thyroid-stimulating immunoglobulin. In conclusion, labetalol was beneficial in the treatment of maternal and fetal thyrotoxicosis during labor.
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PMID:Intrapartum labetalol for the treatment of maternal and fetal thyrotoxicosis. 977 52

The importance of cardiovascular system involvement in hyperthyroidism has been recognized for many years. In the elderly patient, often with mild but prolonged elevation of plasma thyroid hormones, symptoms and signs of heart failure and complicating atrial fibrillation (AF) may dominate the clinical picture and mask the more classic endocrine manifestations of the disease. Impaired cardiopulmonary function and exercise capacity, significantly more marked in older patients, is observed in hyperthyroidism. Thyrotoxicosis can aggravate pre-existing heart disease and can also lead to AF, congestive heart failure, or worsening of angina pectoris. Regarding the high incidence of AF in older patients with hyperthyroidism, it is also important to detect subclinical hyperthyroidism in older patients with AF, thus warranting the measurement of the serum thyrotropin (TSH) concentration for early recognition and treatment. Most cardiac abnormalities return to normal once a euthyroid state has been achieved, although AF may persist in a minority. Optimal treatment requires rapid and definitive antithyroid therapy. Furthermore, anticoagulation is recommended for thyrotoxic patients with AF older than 50 years, those who have histories of previous emboli, hypertension, or with echocardiographic evidence of left atrial enlargement and/or myxomatous valves.
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PMID:Cardiac risks of hyperthyroidism in the elderly. 992 Mar 73

Between January 1996 and September 1997 we treated 4 patients with iodine-induced thyrotoxic storm (2 females, 2 men; age 54-77 years). Iodine contamination was due to iodine-containing contrast media in 3 patients and iodine-containing disinfectant in 1 patient. Thyroid storm with tachycardia, hypertension, sweating, tremor, weight loss and coma occured 3-10 weeks after iodine contamination. These symptoms were accompanied by raised fT4- and fT3-values. All 4 patients were initially treated with antithyroid drugs for 7 days, whereas 2 patients with coronary artery disease, demonstrated by coronary angio-graphy, were treated with antithyroid drugs for 2 weeks. Because of unsuccessful antithyroid drug treatment, all 4 patients underwent subtotal thyroidectomy. There were no perioperative complications. We conclude that early thyroidectomy is the appropriate treatment for iodine-induced thyrotoxicosis even in patients with severe accompanying diseases.
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PMID:Thyroidectomy in iodine induced thyrotoxic storm. 1059

Authors report about a left ventricular thrombus as a complication of thyrotoxic heart disease, on a 45 years old woman. Clinical state featured signs of thyrotoxicosis, global cardiac failure and hypertension. The electrocardiogram showed a left axis deviation, the chest X-ray a cardiac enlargement (cardio-thoracic index = 0.55) on behalf of left movement of heart walls and severe left ventricule dysfunction (Ejection fraction about 18%). This exam also found a big thrombus at he left ventricule apex. The treatment disappearance of the thrombosis and improvement of cardiac failure signs and echographic parameters. Authors discuss circumstances leading to thrombosis in thyrotoxic heart disease, and the usefulness of anticoagulant drug therapy.
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PMID:[Cardiac thyrotoxicosis and left ventricular thrombosis, a case report]. 1079 74

Beta-adrenergic-blocking drugs (BABs) have a firm place in the therapy of cardiovascular conditions including angina and hypertension. Although all BABs are competitive inhibitors of beta-receptors, they may differ in their additional pharmacodynamics, i.e., beta1-(cardio)selectivity, partial agonistic activity (PAA), and pharmacokinetic properties. Understanding these additional properties would allow the physician to choose the more appropriate agent for some patients or for specific situations. beta1-Selective BABs may be of potential importance in patients with obstructive airway disease, peripheral vascular disease, and hyperlipidemia and in diabetic patients receiving antidiabetic drugs. These BABs may better control the increased blood pressure in response to hypoglycemia, exercise, or cigarette smoking. Nonselective BABs may be preferably used to decrease epinephrine-induced hypokalemia or to prevent myocardial infarction, and in certain circumstances (i.e., migraine, anxiety, thyrotoxicosis or essential tremor). BABs with PAA may theoretically cause a lesser degree of cardiodepression (reduction of heart rate at rest, cardiac output, and AV conduction), bronchospasm, and peripheral vasoconstriction and minor effects on plasma lipids. Withdrawal syndrome may be absent after BABs with PAA. The pharmacokinetic properties of the BABs such as absorption, bioavailability, elimination half-life, liver metabolization, interindividual variability, as well as pharmacological interactions depend on their hydrophilic/lipophilic ratio. The development of new BABs continues. It has been possible to incorporate into a drug molecule combinations of PAA, preferred beta1-blockade, and beta2-agonist activity. Even if these new agents cause less adverse effects (e.g., vasoconstriction, bronchospasm), their clinical significance remains to be established.
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PMID:Optimization of beta-blockers' pharmacology. 1152 10


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