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

To assess the potential effect of hypertension on the results of thallium-201 stress imaging in patients with chest pain, 272 thallium-201 stress tests performed in 133 hypertensive patients and 139 normotensive patients over a 1-year period were reviewed. Normotensive and hypertensive patients were similar in age, gender distribution, prevalence of cardiac risk factors (tobacco smoking, hyperlipidemia, and diabetes mellitus), medications, and clinical symptoms of coronary disease. Electrocardiographic criteria for left ventricular hypertrophy were present in 16 hypertensive patients. Stepwise probability analysis was used to determine the likelihood of coronary artery disease for each patient. In patients with mid to high likelihood of coronary disease (greater than 25% probability), abnormal thallium-201 stress images were present in 54 of 60 (90%) hypertensive patients compared with 51 of 64 (80%) normotensive patients. However, in 73 patients with a low likelihood of coronary disease (less than or equal to 25% probability), abnormal thallium-201 stress images were present in 21 patients (29%) of the hypertensive group compared with only 5 of 75 (7%) of the normotensive patients (p less than 0.001). These findings suggest that in patients with a mid to high likelihood of coronary artery disease, coexistent hypertension does not affect the results of thallium-201 exercise stress testing. However, in patients with a low likelihood of coronary artery disease, abnormal thallium-201 stress images are obtained more frequently in hypertensive patients than in normotensive patients.
Hypertension 1987 Jul
PMID:Thallium-201 stress imaging in hypertensive patients. 295 4

Chest pain is a common complaint among hypertensive patients. Hypertension and coronary heart disease each may present with symptoms and signs that are clinically indistinguishable. Noninvasive testing by routine exercise stress testing and stress radionuclide angiography are not reliably predictive of ischemia resulting from obstructive epicardial coronary artery disease and should be abandoned for that diagnostic purpose. Noninvasive thallium-201 myocardial perfusion imaging for this purpose may prove to be a valuable tool, avoiding the risk and expense of coronary arteriography. However, carefully performed prospective studies are not available. Because of the high prevalence of both diseases, a high priority must be given to obtaining these data and evaluating other noninvasive methods (especially positron emission tomography) if they appear promising.
Hypertension 1987 Nov
PMID:How can we diagnose coronary heart disease in hypertensive patients? 295 21

We herein report the case of a 53-year-old white acromegalic patient with an abdominal mass due to massive cardiomegaly. The patient suffered from long lasting acromegaly refractary to bromocriptine, transsphenoidal surgery and radiotherapy. He had been previously diagnosed as having systemic hypertension, ischemic chest pain and congestive heart failure with marked cardiomegaly. The present admission was due to asthenia, anorexia and weight loss that were finally attributed to adrenal insufficiency secondary to radiotherapy. Plain abdomen X-ray suggested the presence of supramesocolic mass. A large cold area in the left hepatic lobe was detected on the radionuclide liver scan. Radionuclide angiography surprisingly identified the cold area as a vascular structure corresponding to the heart. A body CT scan revealed the heart was expanding between stomach and liver. Two-dimensional echocardiography showed marked enlargement of left ventricle. Cardiomegaly was probably multifactorial (chronic hypertension, ischemic heart disease and acromegaly). To our knowledge, this is the first reported case of massive cardiomegaly behaving as an intraabdominal mass. This possibility must be considered when invasive intraabdominal diagnostic procedures are to be done, particularly in an acromegalic patient.
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PMID:Cardiomegaly and abdominal mass in an acromegalic patient. 296 77

Intracoronary injection of acetylcholine has been shown to induce coronary spasm in patients with variant angina. To examine its sensitivity and specificity, incremental doses of acetylcholine (20, 50 and 100 micrograms into the left coronary artery and 20 and 50 micrograms into the right coronary artery) were injected into the coronary artery or arteries in 70 patients with variant angina (Group 1) (mean age 57 years) and 93 patients without variant angina or angina at rest (Group 2) (mean age 54 years). Forty patients of the latter group had atypical chest pain, 16 cardiomyopathy, 14 arrhythmia, 11 valvular disease, 7 stable effort angina due to advanced coronary artery disease, 3 congenital heart disease and 2 hypertension. A temporary cardiac pacemaker set at 40 to 50 beats/min was positioned in the right ventricle. Coronary spasm was defined as total occlusion or severe vasoconstriction associated with chest pain or ischemic ST changes on the electrocardiogram or both. In Group 1, acetylcholine induced spasm in 63 (90%) of the 70 patients in the artery or arteries predicted to be responsible for spontaneous attacks. In Group 2, acetylcholine induced coronary spasm only in one patient with effort angina and advanced coronary artery disease although lesser degrees of vasoconstriction (less than or equal to 75% of the luminal diameter) occurred in most patients after acetylcholine (specificity of acetylcholine thus was 99%). In conclusion, intracoronary injection of acetylcholine is sensitive and reliable for the induction of coronary spasm.
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PMID:Sensitivity and specificity of intracoronary injection of acetylcholine for the induction of coronary artery spasm. 304 96

The exercise-electrocardiography test shows limited feasibility and diagnostic accuracy for the noninvasive detection of coronary artery disease in hypertensive patients. Recently, the dipyridamole-echocardiography test (two-dimensional echocardiographic monitoring with dipyridamole infusion, up to 0.84 mg/kg over 10 minutes) has been proposed as an exercise-independent method for the diagnosis of coronary artery disease. The diagnostic usefulness of the exercise-electrocardiography test and the dipyridamole-echocardiography test was evaluated in 63 consecutive inpatients with history of chest pain, essential hypertension, and no previous myocardial infarction. The criterion of positivity for the exercise-electrocardiography test was a horizontal or downsloping ST segment shift exceeding 0.1 mV and for the dipyridamole-echocardiography test, a transient dyssynergy of contraction. Fifteen patients could not perform a diagnostic exercise-electrocardiography test because of an inability to exercise adequately (two patients), severe hypertension in spite of full antihypertensive therapy (six patients), or excessive blood pressure rise at the first step of the exercise-electrocardiography test (seven patients). Five patients could not perform the dipyridamole-echocardiography test because of a poor acoustic window. The overall feasibility was 76% for the exercise-electrocardiography test and 92% for the dipyridamole-echocardiography test (p less than 0.05). All 43 patients who performed both tests underwent coronary angiography; 30 had significant coronary artery disease (greater than 70% lumen reduction of at least 1 major coronary vessel). Sensitivity was 67% for both the exercise-electrocardiography test and the dipyridamole-echocardiography test (p = NS); specificity was 46% for the exercise-electrocardiography test and 92% for the dipyridamole-echocardiography test (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
Hypertension 1988 Sep
PMID:Dipyridamole echocardiography in essential hypertensive patients with chest pain. 316 39

The purpose of this study was to define the clinical features of acute myocardial infarction in a group of elderly Chinese. The presenting symptoms, complications and mortality of acute myocardial infarction were compared in 631 patients (430 men and 201 women) aged 60 and over and 389 patients (333 men and 56 women) whose ages were under 60 years. The incidence of painless myocardial infarction was 17.6% in the elderly versus 5.9% in the younger group. Typical chest pain was present in 63.1% of the elderly and 84.3% of the younger Chinese. However, the incidence of other nonspecific presenting symptoms was higher in the elderly group. Likewise, the major complications in the elderly group were more severe than those in the younger group. For example, the incidences of cardiogenic shock, heart failure, arrhythmia, pulmonary infection and cardiac rupture in the older group were 19.8, 24.2, 77.2, 22.0 and 4.4%, versus 15.1, 19.5, 48.1, 9.5 and 1.1% in the younger group, respectively. The immediate (4 week) mortality rate of the older group was 21.9% (over 80 years 51.5%), but was only 11.0% in the younger group. Although the incidences of hypertension and pulmonary disease were significantly greater in the elderly group, these diseases alone did not account for the higher mortality rate in the elderly.
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PMID:Acute myocardial infarction in elderly Chinese. A clinical analysis of 631 cases and comparison with 389 younger cases. 317 74

This prospective study compares the outcome of patients with acute myocardial infarction managed by mobile intensive care (paramedic phase) with that of similar patients managed by basic emergency medical care (control phase) in the same community before the introduction of paramedics. All paramedic-transported patients were managed according to a standard chest pain protocol with use of prophylactic lidocaine and, as needed, treatment for sinus bradycardia, hypotension and life-threatening ventricular arrhythmia. There were no specific interventions for supraventricular tachyarrhythmia or hypertension. All patients were treated under similar in-hospital protocols. Percent mortality in patients with hypotension, the highest risk subgroup in the control phase, was significantly lowered with paramedic-level care (69 versus 10%, p = 0.01). Patients with hypertension, a relatively low risk subgroup during the control phase (16% mortality), were also at lower risk during the paramedic phase (10% mortality). In fact, there was no mortality in either study phase for patients with an initial systolic blood pressure greater than 180 mm Hg. During the combined study phases, patients with normotension and tachycardia demonstrated a tendency toward higher percent mortality (33%) than either patients with normotension without tachycardia (10%) or those with hypertension and tachycardia (6%). Although the overall percent mortality was reduced by 24% (from 21 to 16%), this decrease was largely due to the improvement of patients with hypotension. Investigation into the feasibility of prehospital interventions for the high risk patient with acute myocardial infarction normotension and tachycardia appears warranted.
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PMID:A comparison of paramedic versus basic emergency medical care of patients at high and low risk during acute myocardial infarction. 319 53

Hypertension and ischaemic heart disease often co-exist. Recent studies, using ambulatory ST-segment and haemodynamic monitoring, have shown that myocardial ischaemia may not necessarily be accompanied by angina pectoris. Unless transient myocardial ischaemia is actively sought it may, therefore, be missed and this may have important prognostic and therapeutic implications. Studies investigating the use of beta-blockers, calcium antagonists and nitrates in angina pectoris have shown that these agents have an equal effect on painless as opposed to painful myocardial ischaemia. While there are no currently completed studies demonstrating the prognostic implication of silent ischaemia in stable angina, it is well known that approximately one-quarter of all myocardial infarctions occur without chest pain. Recent investigation in unstable angina showed that silent ischaemia was an important predictor of future coronary events.
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PMID:Hypertension and the ischaemic myocardium. 331 24

The term "penetrating aortic ulcer" refers to an ulceration of an atheromatous plaque that extends deeply through the intima and into the aortic media. It may precipitate an intramedial dissection (usually localized) or may rupture into the adventitia to form a pseudoaneurysm. The typical patient with penetrating atheromatous aortic ulcer is elderly and has hypertension, atherosclerosis, and back or chest pain, but pulse deficit, stroke, aortic insufficiency, and compromise of a visceral vessel are not present. Classic aortic dissection and symptomatic thoracic aortic aneurysms are among possibilities in the differential diagnosis. Aortography demonstrates the presence of an aortic ulcer similar in appearance to gastric ulcers seen on barium examination; in addition, an intramural aortic hematoma may be present. Our experience with penetrating aortic ulcers in symptomatic patients indicates that conservative medical therapy leads to recurrence of symptoms and a need for surgical intervention. We present a case that illustrates the salient features of this distinct clinical entity.
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PMID:The penetrating aortic ulcer: pathologic manifestations, diagnosis, and management. 338 11

We assessed beliefs about the symptoms, causes, and prevention of cardiovascular disease in population-based surveys of black and white Twin Cities adults in 1985-86. Whites had a generally higher awareness of heart attack symptoms than did blacks; 72% of blacks and 85% of whites mentioned chest pain as a likely symptom. Sixty-five percent of blacks and 76% of whites correctly offered at least one of the three major, modifiable risk factors (smoking, hypertension, and high cholesterol in blood or diet) as likely causes of cardiovascular disease. However, less than 5% of respondents mentioned all three major risk factors. The most frequent response offered as a cause was stress/worry (54% of blacks, 51% of whites). Individuals with higher educational levels generally responded more correctly than those with less education. After accounting for differences in educational level, blacks demonstrated a higher awareness of hypertension as a risk factor, whereas whites were more knowledgeable about smoking and cholesterol. In light of the high percentage of adults still lacking awareness about cardiovascular risk, public education about prevention should continue. Such efforts are broadly desirable but may be most effectively targeted toward minorities and groups with less education, in whom awareness is low and risk of disease is high.
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PMID:Beliefs among black and white adults about causes and prevention of cardiovascular disease: the Minnesota Heart Survey. 339 97


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