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

A 34 year old patient with prolonged unstable angina pectoris who did not respond to medical treatment is presented. In the course of three days he developed acute subendocardial infarction complicated by severe ventricular arrhythmias and cardiac arrest. Previously renovascular arterial hypertension due to important stenosis of the right renal artery had been diagnosed by renal arteriography. The precordial pain did not disappear with acute myocardial infarction. He presented acute postinfarction angina which required the use of vasodilator and beta-adrenergic blocking agents which did not alleviate his symptoms completely. Coronary arteriography performed a month after acute myocardial infarction demonstrated 99% stenosis of the left main coronary artery and 70% stenosis of the left anterior descending artery. During three days before surgery intraaortic ballon pumping was employed and the patient did not present precordial pain. The patient became asymptomatic after placing two aortocoronary vein grafts to the left anterior descending and circumflex arteries, and three months later blood pressure fell to normal after placing a right aorto renal graft. The poor prognosis of critical stenosis of the main left branch, its medical treatment and better evolution after surgery is discussed. The indications for intra-aortic ballon pumping in this type of patients and its use before surgery so as to be able to suspend beta-adrenergic blocking agents without risks are specified. Finally the surgical indications for renovascular hypertension are discussed.
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PMID:[Role of the ballon of intraaortic contrapulsation in a patient with stenosis of the main left branch and renovascular hypertension]. 30 93

Six patients with the diagnosis of acute mania were treated with high doses of the beta-adrenergic blocking agent propranolol. One of these patients was treated during two manic phases. Psychopathologic change during treatment was rated daily by a psychiatrist not informed on the patients medication. The IMPS (Inpatient Multidimensional Psychiatric Scale) was used. Three cases were placebo-controlled under double blind conditions. Four times we had a second medication period, twice with propranolol and once with oxprenolol and dexpropranolol respectively. Propranolol was administered every 4 h (six times per day), starting with single doses of 20-40 mg. Doses were increased individually under control of pulse rate, blood pressure, and ECG. Augmentation of doses was continued until an effect on manic symptomatology was undoubtedly seen or until therapy had to be discontinued because of side-effects. In four patients definite improvement of manic symptomatology could be achieved during altogether five manic phases within usually two treatment periods of 5-15 days. Manic behavior disappeared completely in two of these patients. The effective dosage of propranolol varied between 280 and 2320 mg per day. All of the improved patients relapsed after discontinuation of the drug. In the only case on dexpropranolol (5 days up to 900 mg daily) the effect was questionable. No extrapyramidal side-effects were observed. In one patient treatment was discontinued because of lack of cooperation, in another because of extrasystoles. Gastrointestinal bleeding occurred in the patient who received dexpropranolol. This complication was possibly due to other medication. Other side-effects were insomnia, hypertension, precordial pain, abdominal pain as well as the expected hypotension and bradycardia. The significance of these results regarding the catecholamine hypothesis of manic-depressive illness is discussed.
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PMID:[The effect of the beta-adrenergic blocking agent propranolol in mania (author's transl)]. 99 94

The present research work about "the satisfaction of the clients of an out-patient department toward the approach of the nursing team" was carried out in a central hospital, in Lisbon, with a sample of 82 clients. The principal subjects broached on the biliography revision are: some risk factors of cardiovascular disease and the client approach. We have found at the end of this study that the precordial pain, the arrhythmias and the arterial hypertension, are the main causes that alert the clients, as well as the health professionals who send them to this department to a precocious diagnosis of cardiovascular disease. It was applied an approach guide to the clients of the experimental group and another instrument, a formulary was applied to both of the groups. The mean and the mode were used as measures of central tendency on the statistical treatment and as measures of dispersion the standard deviation and the variation amplitude. For testing our hypothesis we used the following tests: Kolmogoro-Sairnov, Qui-Square with the Coefficient of Yule and the Difference of Means Test, to a significance level of 0.05. All these tests confirmed our hypothesis, meaning that the clients to whom the new nurse-client-approach has been applied showed greater satisfaction than those who have been approached according to the usual procedure on the department and the majority of these clients suggest the continuation of this kind of approach.
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PMID:[The satisfaction of the clients of an outpatient consultation in view of the nursing team's approach]. 250 75

The authors studied 30 cases of aortic dissection performed from January 1978 to December 1987. Dissection was classified as type A (intimal tear beginning in the ascending aorta or arch) and type B (intimal tear beginning in the descending aorta). Type A predominated (66.7%). Type B dissection was most frequent in patients older than 60. Precordial pain was the main symptom in type A cases, whereas 62.5% of type B cases showed no precordial pain. Most frequent findings in type A patients were hypotension (45.5%), murmur of aortic regurgitation (40.0%), and dyspnea (40.0%), whereas in type B patients, most frequent findings were hypertension (28.6%), and pulse deficit (42.9%). The major differential diagnosis for type A was myocardial infarction (43.8%), and for type B, peripheral artery failure (25.0%) and acute pneumonia (25.0%). 24 patients (80.0%) had hemorrhage. Hemorrhage into the pericardial sac occurred in 68.8% of type A patients, and 50.0% of type B patients had retroperitoneal hemorrhage. Systemic hypertension, atherosclerosis, medial cystic necrosis and endocrine disorders were considered predisposing factors for both type of dissection. A case of dissection after aortic valve replacement associated with ascending aorta tubular graft replacement was observed in this series. In type A patients, average survival was 6.3 days, and in type B, 11.1 days. The major cause of death was hemorrhage (70.0%).
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PMID:[The dissecting aorta: clinical analysis and anatomo-pathologic correlations in 30 cases]. 263 76

An analysis of 1,600 consecutive treadmill exercise tests is made, with emphasis on those with an ischaemic response. An ischaemic response is defined as a horizontal or downsloping depression of the ST segment of 1 mm or more. A hypertensive response is recorded where the blood pressure exceeds 200 mm Hg systolic or 100 mm Hg diastolic during exercise. There were 150 (9%) ischaemic responses and 279 (17%) hypertensive responses. Cardiac arrhythmias were detected in 173 (11%) subjects. Among the 150 subjects with ischaemic responses, 69 (46%) of them presented with anginal symptoms while 64 (43%) of them had no precordial pain. Twenty-seven (18%) of them had definite previous myocardial infarction. Risk factors observed included hypertension in 54 (36%) subjects, diabetes mellitus in 33 (22%) subjects, hypercholesterolaemia in 41 (37%) out of 112 subjects and 44 (29%) cigarette smokers.
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PMID:Treadmill exercise testing in ischaemic heart disease. 368 10

24 cases of cardiac rupture (CR) (12%) were found in 200 necropsies of patients who died from acute myocardial infarction (AMI). Examination of the various factors that may affect the onset of this complication showed that age, sex, the site of AMI, the presence of coronary thrombosis, the association of persistent arterial hypertension, diabetes mellitus or previous angina syndrome and anticoagulant and corticosteroid treatment are insignificant. On the other hand, previous myocardial infarction would appear to reduce incidence considerably. CR was much more frequent in the first 3-4 days after onset of AMI and never occurred more than 21 days after. An important premonitory sign is persistent precordial pain in the absence of pericardial friction. Cardiokinetic therapy was used in 70% of the CR cases examined here. Over the past decade, the frequency of CR secondary to AMI has risen appreciably and it is hypothesised that this increase may have been influenced by the readiness with which cardiokinetics are employed now during AMI, often in very high doses. Particularly in the case of patients at high CR risk, it is considered that cardiokinetic therapy should only be employed in cases of clear cardiac insufficiency, in small, fragmented doses and after diuretics and vasodilators have proved ineffective. Such patients can also usefully be transferred to specialist wards for emergency surgery or preventive infarctectomy.
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PMID:[Heart rupture in acute myocardial infarct]. 721 92

Symptoms of fatigue and activity impairment, atypical precordial pain, and cardiac arrhythmia frequently precede by years the development of congestive heart failure. Of 115 patients with these symptoms, 60 were diagnosed as having hypertensive cardiovascular disease, 27 mitral valve prolapse syndrome, and 28 chronic fatigue syndrome. These symptoms are common with diastolic dysfunction, and diastolic function is energy dependent. All patients had blood pressure, clinical status, coenzyme Q10 (CoQ10) blood levels and echocardiographic measurement of diastolic function, systolic function, and myocardial thickness recorded before and after CoQ10 replacement. At control, 63 patients were functional class III and 54 class II; all showed diastolic dysfunction; the mean CoQ10 blood level was 0.855 micrograms/ml; 65%, 15%, and 7% showed significant myocardial hypertrophy, and 87%, 30%, and 11% had elevated blood pressure readings in hypertensive disease, mitral valve prolapse and chronic fatigue syndrome respectively. Except for higher blood pressure levels and more myocardial thickening in the hypertensive patients, there was little difference between the three groups. CoQ10 administration resulted in improvement in all; reduction in high blood pressure in 80%, and improvement in diastolic function in all patients with follow-up echocardiograms to date; a reduction in myocardial thickness in 53% of hypertensives and 36% of the combined prolapse and fatigue syndrome groups; and a reduced fractional shortening in those high at control and an increase in those initially low.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Isolated diastolic dysfunction of the myocardium and its response to CoQ10 treatment. 824 99

OBJECTIVE: To describe an unusual case with clinical features of the antiphospholipid syndrome. DESCRIPTION: White child, two years and six months old, with renal failure, renal arterial thrombosis, and diagnosis of antiphospholipid syndrome was hospitalized with a history of abdominal pain, pallor, lethargy, and anuria for 36 hours. On physical examination, the patient showed malnutrition, high blood pressure, moderate edema, and hypochondrial pain. Laboratory findings included: urea=112mg/dl, serum creatinine= 4.5 mg/dl, blood pH= 7.47, blood bicarbonate= 12.8 mmol/L, K=7.2 mEq/L. Peritoneal dialysis was started and maintained for 11 days. After 7 weeks, the patient still needed anti-hypertensive drugs and the renal function was still abnormal. Renal biopsy was performed and revealed renal infarction. The result of Doppler ultrasonography revealed absent renal blood flow on the right side. Renal arteriography showed total occlusion of the right renal artery. Results for collagen diseases were negative. A right nephrectomy was performed and the blood pressure was controlled. The child was hospitalized again at 5 years and 8 months old with episodes of absence seizures and abdominal and precordial pain. Anticardiolipin antibody test was positive. The child is now 7 years old, asymptomatic, with negative anticardiolipin antibody, and has been under regular follow-up. COMMENTS: Children with arterial thrombosis should be investigated for a possible association with the antiphospholipid antibody syndrome even in the absence of collagen disease.
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PMID:[Renal arterial thrombosis and the antiphospholipid antibody syndrome: a case report] 1464 33

In recent years cardiology has opened new chapters in the treatment of acute coronary syndrome (ACS). The acute therapeutic procedures include antianginal, anticoagulant and revascularization therapy. Optimal therapeutic procedure in ACS has two objectives: 1) quick removal of the factors causing ischemia, and 2) prevention of death or myocardial infarction, i.e. reinfarction. Nitrates have been present in pharmacotherapy for more than 150 years. They are used exclusively to efficiently suppress the symptoms, but there is no proof of their positive effect on the disease prognosis. The effect of nitrates is manifested as vasodilatation in the arterial, and particularly in the venous vascular basin (central and peripheral effects) thus increasing the capacity of venous blood. Besides the peripheral effect, nitrates have an important central effect, i.e. they dilate epicardial coronary arteries, both the healthy ones and those damaged by atherosclerosis, in this way increasing the collateral blood circulation. Organic nitrates, although the oldest antianginal drug, play one of the leading roels in the treatment of ACS even today. Beta-adrenergic blocking agents have been used since 1960 in the treatment of arterial hypertension, coronary disease and cardiac arrhythmias, and later their efficacy in the prevention of secondary myocardial infarction was noted. Beta blockers (BB) reduce heart rate, systemic blood pressure and myocardial oxygen requirements, reduce myocardial contractility, thus alleviating precordial pain in ACS, decreasing the rate of threatening infarction, and reducing ventricular arrhythmias. Numerous clinical studies have shown that BB in ACS improve the disease prognosis and play an important role in long-term secondary prevention after myocardial infarction. Antagonists of calcium channel blockers are a group of therapeutic agents successfully used in numerous cardiac and noncardiac indications. Potential benefits of calcium antagonists in ACS are the result of various combinations, such as dilation of coronary arteries and arterioles, reduction of heart rate and myocardial oxygen requirements, and beneficial effect on left ventricular function and elasticity. The use of calcium channel blockers in ACS reduces or prevents the symptoms and accompanying ischemia, but there is no evidence that these agents prolong survival in patients with heart failure. In recent years the treatment of an ACS has significantly changed owing to better understanding of the pathogenesis of the disease as well as progress in medicinal and interventional treatment. Antianginal therapy, which includes nitrates analgesics, calcium channel blockers and antiadrenergic therapy using beta-blockers in treatment of ACS, takes a significant place.
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PMID:[Antianginal and antiadrenergic therapy in acute coronary syndrome]. 1520 97

This is the report on a 45-year-old female, with a history of systemic arterial hypertension and cigarette smoking, submitted to dobutamine-atropine stress echocardiography for the investigation of coronary artery disease. At stress peak, the patient reported sudden, highly intense precordial pain. The 12-lead electrocardiogram showed ST segment elevation in DII, DIII, aVF, V5 and V6, and depression in DI, aVL, V2 and V3. Echocardiographic imaging monitoring showed dyskinesia of inferior septum and akinesia of inferior wall. The test was interrupted immediately. The patient was medicated and improved her precordial pain condition as well as wall motion abnormalities. Coronary angiography showed irregular coronary lesions with <50% luminal diameter obstruction. It is a case of coronary spasm induced by alpha-adrenergic stimulation during dobutamine-atropine stress echocardiography.
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PMID:Coronary spasm induced by dobutamine-atropine stress echocardiography. 1726 96


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