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

The case files of 4,456 medical admissions in 1975--1976 at Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria, included 354 cardiovascular patients. The most common causes were hypertension (45.5%), cardiomyopathy (20.6%) and chronic rheumatic heart disease (14.4%). The mean age of hypertensive and cardiovascular patients was lower than in Europe. The majority of hypertensive patients suffer from essential hypertension. Congestive cardiac failure is the commonest complication of hypertension and cardiomyopathy. Rheumatic valvular disease with mitral incompetence is frequent and sometimes severe in young people. Other cardiovascular diseases included pericardial disease, bacterial endocarditis, cor pulmonale, anaemic heart failure, congenital and syphilitic heart disease. Coronary heart disease was only encountered in non-Africans. Cardiovascular mortality in hospital was high (20%).
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PMID:Cardiovascular disease in Northern Nigeria. 31 94

The aim of this study was to evaluate the usefulness of M-mode echocardiography as a non-invasive diagnostic tool when facilities for cardiac catheterization were not available. We used this technique to study 275 patients whose clinical diagnosis included hypertension, rheumatic heart disease, cardiomyopathy, peripartum cardiac failure, pericardial disease and some forms of congenital heart disease. Characteristic echocardiographic patterns made specific cardiac diagnoses possible and allowed a distinction to be made between clinically similar conditions. It is concluded that echocardiography is very useful in the African setting because it is safe and repeatable.
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PMID:M-mode echocardiography in the diagnosis of heart diseases in Africans. 55 66

In conclusion, patients on chronic maintenance dialysis have an increased incidence of death from cardiovascular disease. Hypertension plays a major role, and these patients must be carefully monitored for complete control of blood pressure. Adequacy of ultrafiltration to maintain normal extracellular volume is an essential part of the dialytic treatment. Hypertensive patients should be screened for excessive renin secretion because of its possible role in unresponsive hypertension in patients on dialysis. Nephrectomy should be used when necessary, where dialysis and antihypertensive medication have not adequately controlled blood pressure. Patients must be monitored for the presence of pericardial disease to avoid subsequent pericardial effusion and the development of constrictive pericarditis with its adverse effect on myocardial function. When constrictive pericarditis is present, it obviously should be relieved by appropriate surgery. Efforts should be made to minimize cardiac output in hemodialysis patients. Whether or not routine transfusions to maintain a higher hematocrit are indicated is a question that cannot yet be answered. However, patients with marginal cardiovascular function who are accepted on hemodialysis and must have an arteriovenous shunt should be supported in any manner to minimize an increase in cardiac output. Early and aggressive treatment of known episodes of sepsis is important in the elimination of valvular endocarditis in this patient population. Perhaps one of the finer indicators of adequacy of hemodialysis will be K rate and peak immunoreactive insulin levels. Continued abnormality of these parameters may contribute to cardiovascular disease. Clearly, further study of the effect of abnormal carbohydrate metabolism on lipid metabolism is in order. Serum triglyceride, serum cholesterol and lipid electrophoretic pattern should be followed to evaluate the beneficial effects of drug therapy and changes in dialytic technique on the development of cardiovascular disease. Careful monitoring of calcium, phosphorus, bone films and parathyroid hormone levels is indicated to assess parathyroid status. The use of aluminum binders and parathyroidectomy to prevent vascular and myocardial calcification is important in the therapy of these patients. The use of cardiac catheterization, coronary artery arteriography, and possibly cardiac vascular repair, should be considered in the chronic hemodialysis patient with coronary artery disease if he is otherwise well. Adequacy of hemodialysis perhaps can be evaluated through its effect on all of the above parameters. Whether or not changes in artificial kidney treatments can correct the final vascular disease remains to be seen.
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PMID:Cardiovascular disease in uremic patients on hemodialysis. 109 1

Computed tomography (CT) scans in 30 patients with neoplastic involvement of the heart and pericardium were retrospectively reviewed. Computed tomography was compared with echocardiography in three of four patients with large primary cardiac tumors and in three patients with metastatic pericardial disease. Computed tomography was superior to echocardiography in determining tumor extent and site of origin of a right atrial sarcoma, as well as in assessing tumor extent and presence of pulmonary arterial hypertension in a left atrial malignant fibrous histiocytoma and a left atrial myxoma. Pericardial effusions were detected by echocardiography in two out of three patients with metastatic pericardial disease, but the malignant nature of the effusion was not recognized; in all three cases CT showed nodular pericardial thickening. Of the 23 patients with evidence on CT of direct extension of anterior mediastinal masses, bronchogenic carcinoma or mesothelioma to the pericardium 21 had nodular pericardial thickening and 2 diffuse thickening; only 6 had pericardial effusion. We conclude that CT is useful in the characterization of large primary cardiac tumors that are incompletely visualized with echocardiography. Computed tomography is superior to echocardiography in assessing tumor involvement of the pericardium because pericardial effusions are often absent; CT is also superior in identifying nodular pericardial thickening.
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PMID:Computed tomography of cardiac and pericardial tumors. 220 88

Seven cases of postoperative constrictive pericarditis (PCP) were discovered in a retrospective study of patients given heart surgery in a hospital receiving patients from all over Italy in 1970-85. Five of those patients had received surgery for chronic rheumatic heart disease, 2 for congenital heart defects. Four had received a second heart operation before the pericardial condition was recognised. All were females and all presented systemic venous hypertension (one of them only after acute doses of physiological solution) with thickening of the pericardial layers revealed by sonography. In six cases the electrocardiographic ventricular complexes were normal or increased in amplitude and the heart/chest ratio was greater than 0.55. Pericardial knock was masked by natural or artificial atrioventricular valve opening noises in 6 cases. In one case only there were pericardial calcifications or signs of an earlier postpericardiotomy syndrome. The haemodynamic investigation revealed signs of ventricular diastolic constriction in 6 patients. Three patients died from complications of cardiac cirrhosis: 2 of them had previously received partial pericardiectomy. Another two, given the same operation, preserved a reasonable functional capacity 5 and 10 years after the pericardiectomy. One patient in NYHA functional class III has so far refused haemodynamic assessment (and surgical treatment) of the pericardial disease. Finally, the last patient complains only of attacks of heart palpitation caused by atrial flutter and controlled by antiarrhythmic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Postoperative constrictive pericarditis]. 277 2

Twelve patients with extracardiac malignant neoplasms and signs of severe systemic venous hypertension were admitted during the last three years to our service. It was the initial manifestation of malignant disease in six patients. Echocardiograms revealed large pericardial effusion in the 12 patients and six patients met the clinical criteria of cardiac tamponade. Pericardiocentesis was a safe procedure to give temporary relief to their problem. Cytologic examination of the pericardial fluid disclosed malignant neoplasms in 11 cases (91.6%), enabling us to make histological diagnosis in five. The most frequent site of origin was the lung (eight cases), adenocarcinoma being the predominant histologic feature. We conclude that metastatic pericardial disease must be considered as a frequent cause when a patient is initially seen with a massive pericardial effusion and/or cardiac tamponade that worsens with prognosis.
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PMID:Massive pericardial effusion produced by extracardiac malignant neoplasms. 661 8

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

Heart failure, a major contributor to cardiovascular disease morbidity and mortality, is newly diagnosed in approximately 400,000 patients each year, and is particularly prevalent in individuals over age 65 years. Average mortality rates 5 years after diagnosis are 45-60%, and may be as high as 50% after 1 year for those with New York Heart Association class IV heart disease. Heart failure occurs when myocardial muscle dysfunction prevents the heart from pumping enough blood at normal cardiac pressures to meet the metabolic needs of the body, especially during exercise, and compensatory hemodynamic and neurohormonal mechanisms are overwhelmed or maladaptive. Pathologic classifications are broadly based on the presence of systolic (dilated cardiomyopathy) or diastolic (hypertrophic or restrictive cardiomyopathies) dysfunction. The etiologies of heart failure may include inadequate coronary blood flow, pressure or volume overload, cardiomyopathy, or pericardial disease. Coronary artery disease, idiopathic dilated cardiomyopathy, and hypertension are the most frequent causes, and certain drugs may also worsen myocardial function. When contractility is reduced, stroke volume and cardiac output are decreased, and alterations in the kidneys may induce fluid retention to compensate for the perceived low output and reduced circulating blood volume. Fluid retention in turn causes preload or filling pressure to increase and symptoms of pulmonary congestion to emerge. Depressed contractility also results in a reduction in blood pressure, leading to compensatory neurohormonal activation and vasoconstriction, which significantly elevate afterload and further reduce stroke volume. The overall approach to heart failure includes defining the etiology, identifying precipitant factors, and assessing the severity of myocardial dysfunction and clinical symptoms.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathophysiology of heart failure. 823 96

Echocardiographic study of sixty patients on maintenance haemodialysis (MHD) was undertaken to determine the prevalence and factors associated with left ventricular (LV) hypertrophy (LVH), LV diastolic dysfunction and pericardial disease. The mean age was 34.4 (standard deviation 13.0), range 14-66 years with 31 (51.7%) men. LVH was found in 41 (68%) patients. Of the factors analysed, serum calcium and calcium-phosphate product were significantly associated with LVH (t = 2.01, df = 58, p = 0.046; t = 2.18, df = 58, p = 0.032 respectively). Hypertension in this study was not significantly associated with LVH (p = 0.169). LV diastolic dysfunction was found in 23/41 (56%) patients with LVH, and in 9/19 (47%) patients without LVH (difference is not statistically significant, X2 = 0.12, df = 1, p = 0.725). Small pericardial effusions were detected in 4/60 (7%) patients and two patients had pericardial thickening. We conclude that in our MHD patients LVH, is very common and that diastolic dysfunction is observed equally in patients with and without LVH. However, haemodynamically significant pericardial effusions are rare in patients who have been on dialysis for at least six months.
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PMID:Echocardiographic assessment of left ventricular hypertrophy diastolic dysfunction and pericardial disease in patients on maintenance haemodialysis. 889 63

An elevated arterial pressure in cardiac tamponade, although not unusual might postpone the diagnosis of pericardial disease. We reported a case of cardiac tamponade, due to neoplastic infiltration of the pericardium, in which the diagnosis was first suspected by the presence of pulsus paradoxus. The patient presented cardiac tamponade and arterial hypertension simultaneously.
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PMID:[Arterial hypertension in a patient with cardiac tamponade]. 911 68


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