Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Coenzyme Q10 or ubiquinone normally present in many plant and animal cells is an antioxidant. Coenzyme Q10 deficiency has been observed in patients with congestive heart failure, angina pectoris, coronary artery disease, cardiomyopathy, hypertension, mitral valve prolapse and after coronary revascularization. Coenzyme Q10 is involved in the synthesis of ATP and hence is useful in preventing cellular damage during ischaemia-reperfusion injury. The clinical benefits are mainly due to its ability to improve energy production, antioxidant activity, and membrane stabilizing properties. Several studies showed that coenzyme Q could be useful in patients with congestive heart failure, angina pectoris, cardiomyopathy, coronary artery disease and in the preservation of myocardium. Coenzyme Q10 is normally present in the low density lipoprotein cholesterol fraction and inhibits its oxidation. It can also regenerate vitamin E. Coenzyme Q10 is known for producing minor gastrointestinal discomfort and elevation in SGOT and LDH when used.
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PMID:Coenzyme Q in cardiovascular disease. 1127 51

Electroconvulsive therapy (ECT) was scheduled for a 61-yr-old woman with major depression who had been taking a beta-blocker for hypertension. She underwent the first ECT under thiamylal anesthesia uneventfully. The second ECT was performed under propofol anesthesia on the next day. Immediately after ECT, the heart rate dropped from 56 to 19 beats.min-1, which was remedied by intravenous atropine. Then, the blood pressure increased to 204/108 mmHg but it was controlled by nicardipine. However, the SpO2 decreased to 84-88% under oxygen administration by mask at a rate of 3 l.min-1. The patient complained of chest discomfort and had a bloody secretion from the trachea. A chest X-ray showed a butterfly shadow. The patient was diagnosed as having neurogenic pulmonary edema and was treated in the ICU by artificial ventilation and administration of diuretics and catecholamines. These treatments proved to be successful, and the patient was discharged from the ICU 4 days later uneventfully. This case indicates that hemodynamics should be carefully monitored following ECT and that care should be taken to prevent the occurrence of complications after ECT.
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PMID:[A case of pulmonary edema after electroconvulsive therapy under propofol anesthesia]. 1142 71

Ventricular hypertrophy due to genetic mutations of sarcomeric proteins or that associated with long-standing hypertension typically yields a cavity with hyperdynamic ejection, elevated diastolic pressures, and limited filling volumes. The net result is reduced reserve capacity, dyspnea with exertional intolerance, and chest discomfort despite normal appearing coronary vessels. In addition to pharmacologic therapy by agents having negative inotropic effects, recent studies have examined the potential of ventricular pacing using right apical pre-excitation as a treatment for these disorders. This form of pacing can increase end-systolic volume and reduce cavity obliteration in both forms of the disease, yet has no demonstrable acute benefit on diastolic function. Chronic therapy trials have yielded mixed results, with more favorable responses observed in older patients particularly those with hypertensive hypertrophic disease. These data have also highlighted the importance of enhancing systolic reserve rather than diastolic function as a key therapeutic effect from pacing therapy. This review discusses the mechanisms by which pacing with ventricular pre-excitation acutely influences ventricular function, and summarizes results of recent clinical trials, putting the data into perspective regarding the relative role of systolic versus diastolic effects in these patients.
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PMID:Mechanisms and efficacy of LV pre-excitation for patients with heart failure and supra-normal systolic function. 1149 49

We describe a 72-year-old woman with hypertension who developed acute neurogenic pulmonary edema and giant negative T waves on electrocardiography (ECG) due to subarachnoid hemorrhage. The patient was alert and complained of precordial chest discomfort, dyspnea and shoulder stiffness. Echocardiography demonstrated normal left ventricle contraction with hypertrophy. Computed tomography (CT) and subsequent cerebral angiography revealed subarachnoid hemorrhage and saccular aneurysm at the anterior communicating artery. It is important to consider the possibility of subarachnoid hemorrhage when a patient shows pulmonary edema and ECG abnormalities even without typical clinical signs of subarachnoid hemorrhage.
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PMID:Neurogenic pulmonary edema and large negative T waves associated with subarachnoid hemorrhage. 1151 36

Intramural hematomas (IMH) are regarded as a hemorrhage into the aortic wall. In general a traumatic form can de differentiated from a spontaneous non-traumatic. There is a predisposition of IMH with arterial hypertension and mesoectodermal dysplastic syndromes. The diagnosis is established with the clinical presentation in combination with the findings of different imaging modalities. Acute and subacute discomfort associated with a tendency of collaps are considered as typical presenting complaints. A semicircular or concentric thickening of the aortic wall with the absence of blood flow or a dissection membrane are typical findings in transesophageal echocardiography, computed tomography and magnetic resonance tomography. From a differential diagnostic point of view a distinction from atherosclerotic wall changes, intraluminal thrombi and inflammatory aortic diseases is essential. The IMH is considered as an early presentation of aortic dissection, put into and treated according to the Stanford classification. In the course of natural history an IMH can disappear, rupture or progress into a classic aortic dissection.
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PMID:[Intramural hematomas of the aorta]. 1155 79

Chest pain or discomfort is one of the cardinal manifestations of thoracic diseases. Fast, accurate diagnosis is essential for patients with angina pectoris, acute myocardial infarction, aortic dissection, ruptured aortic aneurysms, and pulmonary embolisms, which have a high mortality if not treated immediately. In patients with ischemic heart diseases and aortic dissection, an accurate history and a chest roentgenogram can serve as helpful guides to their diagnosis, and ultrasound, computed tomography, and electrocardiography can establish the diagnosis. It is important to suspect cardiovascular emergencies based on quality, duration, and location of pain as well as the presents of hypotension or hypertension, and to start these conditions as soon as possible. Then it is necessary to assess the degree of cardiovascular disability and, if necessary, to introduce patients to cardiovascular specialists.
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PMID:[Pain characteristics in disease of heart and aorta]. 1155 43

Angina pectoris is a clinical syndrome of discomfort in the chest, jaw, arm, or other sites which is associated with myocardial ischaemia. The nature of angina has many individual variations, and it is easier first to consider the typical syndrome. It is hard to better the descriptions of William Heberden: There is a disorder of the breast, marked with strong and peculiar symptoms, considerable for the danger belonging to it.... Those who are afflicted with it are seized, while they are walking, and more particularly when they walk soon after eating, with a painful and most disagreeable sensation in the breast.... the moment they stand still all this uneasiness vanishes. After it has continued some months, it will not cease so instantaneous upon standing still ... (most) whom I have seen, who are at least twenty, were men, and almost all above 50 years old, and most of them with a short neck, and inclining to be fat.... But the natural tendency of this illness be to kill the patients suddenly.... The os sterni is usually pointed to as the seat of this malady ... and sometimes there is with it a pain about the middle of the left arm. The usual cause of myocardial ischaemia is coronary atherosclerosis. Other diseases of the coronary arteries (emboli, spasm, vasculitis, Kawasaki disease, congenital anomalies), other cardiac diseases (hypertrophic cardiomyopathy, severe hypertension, severe aortic valve disease), and high output states (severe anaemia, thyrotoxicosis) are all uncommon or rare causes of angina. However, while angina is usually associated with atherosclerotic coronary artery disease, the converse is not always true. The condition of coronary atherosclerosis is very common (fatty streaks and more advanced plaques are almost universal in adults in industrialised countries) but it does not always cause myocardial ischaemia. Furthermore, myocardial ischaemia may present other than with angina - for each presentation there is a wide differential diagnosis.
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PMID:Clinical presentation and diagnosis of coronary artery disease: stable angina. 1175 1

Anxiety, agitation, delirium, and pain are common findings in the ICU. These unhealthy states may lead to increased irritability, discomfort, hypertension, tachycardia, cardiac ischemia, harmful motor activity, and psychologic disquiet for the patient. The appropriate treatment of these conditions may lead to decreased morbidity and mortality in the critically ill patient. Unfortunately, the management of anxiety, agitation, delirium, and pain in the intensive care unit is not ideal. Many patients interviewed after an ICU stay rate their pain control as poor and their memories of their stay as unpleasant. Furthermore, many caregivers lack sufficient understanding of the appropriate or indicated uses of drugs to allay patients' fears and pain. The use of suitable protocols for the proper titration of sedation of mechanically ventilated patients and monitoring of the level of sedation in ventilated patients may decrease the amount of time that patients are ventilated and may alleviate some of the emotional stresses of recall of painful procedures or uncomfortable mechanical ventilation. Future research into protocols for the care of the critically ill patient can enhance the overall well-being of these patients.
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PMID:Anxiety, delirium, and pain in the intensive care unit. 1176 63

This is a case series analysis undertaken to evaluate the importance of acute myocardial infarction (AMI) as a cause of admission at the Tikur Anbassa medical intensive care unit (MICU) and the trend of that importance over a decade (1988-1997). Clinical presentations and the frequencies of major coronary risk factors in the individual patient were also assessed for the later half of the decade (1993-1997). In the decade under study 2313 patients were admitted to MICU according to its register. Overall AMI was the third commonest cause of admission and accounted for 8.8% (N = 203) of all MICU cases. AMI annual admissions increased consistently over the years. Of the 122 AMI admissions during the second half of the decade, 92 charts were available for detailed analysis. 86% (79/92) fulfilled the stated criteria for the diagnosis. The mean age of these patients was 55.1 +/- 13.0 years. Males constituted 82% of all AMI cases. Eighty seven percent (69/79) of the cases were first admissions with the diagnosis of AMI. Ninety-four percent (74/79) of them were brought to the emergency room due to chest discomfort and 20% were in frank pulmonary oedema. Nineteen percent died in hospital. 81% and 34% of the patients had one or more and two or more major coronary risk factors excluding age and gender respectively. Raised total cholesterol and hypertension were commonest risk factors being reported in 69% and 47% of AMI patients respectively. In conclusion, this study has demonstrated that AMI is indeed on the rise at least at Tikur Anbassa Teaching Hospital, and possibly at other health institutions. The conventional coronary risk factors seem to operate in the Ethiopian series as well. The study highlights the need for coronary risk factors surveys at least in the susceptible population group to assess the gravity of the problem.
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PMID:Trends of acute myocardial infarction admissions over a decade, Tikur Anbessa Hospital. 1192 50

Acute heart failure is a life-threatening medical emergency, most commonly occurring as an immediate or delayed complication of acute myocardial infarction (AMI), or resulting from severe hypertension or valvular defects (stenosis or incompetence). Occasionally it is caused by patients' non-compliance with medication orders. In this case the patient had a history of three previous AMIs, controlled hypertension, and controlled congestive heart failure (CHF) for which he took two 40 mg frusemide tablets (a very potent oral diuretic) each morning. Because he had experienced bladder discomfort during the latter stages of previous appointments he decided to delay taking the diuretic until after his appointment and acute heart failure ensued.
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PMID:A case report of acute heart failure caused by a patient delaying taking his diuretic medication. 1203 61


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