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Query: UMLS:C0034065 (pulmonary embolism)
 14,979 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Left heart diseases, in particular mitral stenosis, are often associated with anatomic and functional alterations of the lung. According to the pulmonary structures involved they could be named chronic secondary intersticial and vascular lung diseases. Congenital heart diseases with pre- or post-tricuspid shunts are also often associated with anatomic and functional alterations of the lung. This condition also constitutes a chronic secondary vascular lung disease (atrial septal defect) or a chronic primary vascular lung disease ( ventricular septal defect, patent ductus arteriosus). Primary lung diseases (interstitial pulmonary fibrosis, pulmonary emphysema, recurrent pulmonary embolism) are often associated with right ventricular hypertrophy with or without dilation, a condition commonly named chronic cor pulmonale. On the whole the interrelationships between heart and lung diseases are as follows: a) anatomic and functional alterations of the lung due to left heart diseases are mediated through pulmonary venous hypertension; b) anatomic and functional alterations of the lung due to congenital heart diseases are mediated through the increased pulmonary blood flow with or without transmission of the systemic blood pressure to the pulmonary vasculature, and c) anatomic and functional alterations of the right ventricle due to primary or secondary lung diseases are mediated through arterial pulmonary hypertension. In summary, the interrelationships between heart and lung diseases are mainly mediated through the pulmonary venous or pulmonary arterial hypertension.
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PMID:Cardiac and pulmonary diseases. A pathophysiologic interelationship. 113 Sep 7

This is a retrospective study of 200 patients, with long-term results operated upon from October 1965 to July 1984. 83% women, 17% men. The mean age was 42.40 +/- 11.03 years. In 87% mitral stenosis was pure and 13% systolic murmur was heard. 60% were in classes III and IV and 40% in classes I and II (NYHA). Hemodynamically mean C.W.P. was 21 +/- 6.27 mm Hg and mean P.A. pressure 30 +/- 9.5 mm Hg. Right anterior thoracotomy was done in every case with canulation of femoral artery and V.C. extracorporeal circulation consisted of a bubble oxgenation (RYGG) and a Roller Pump. In 88.5% both commissures were opened and in 11.5% only the anterolateral commissure. In 58% both papillary muscles were incised, in 15% anterolateral and in 13% posteromedial papillary muscles were incised. In 17% valves or commissures were decalcified. In 5.5% a thrombus was removed from the auricle. Postoperative mortality was 0%. 13% of patients experienced a postoperative complication: 4% hemothorax, 2.5% gaz embolism without sequela, 0.5% lower extremity embolism, 3% pulmonary embolism, 2% phlebitis and 1% gastrointestinal haemorrhage. Postoperatively in 75% of cases no murmur was heard, and in 25% a systolic murmur was found over pericardium. 167 patients were assessed at a mean interval of 129.88 months. 11 patients died at a mean interval of 98.56 +/- 48.56 months with non cardiac cause in 9 cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Mitral commissurotomy with extracorporeal circulation. Apropos of 200 cases with a median survival of 15 years]. 205 May 31

A percutaneous transfemoral, transatrial double-balloon valvuloplasty was performed on 21 patients (53 +/- 14 years) with rheumatic mitral stenosis. An open commissurotomy was performed in six patients, 20 +/- 9 years previously; in three patients an arterial embolism had occurred previously. Balloon valvuloplasty resulted in a reduction of the mean diastolic gradient from 16 +/- 7 to 8 +/- 3 mm Hg (p less than 0.001), and the mitral valve orifice area increased from 1.1 +/- 0.3 to 2.2 +/- 0.8 cm2 (p less than 0.001). Mitral insufficiency increased in three patients and was first observed after valvuloplasty in four patients. Complications were seen in three patients: a left ventricular perforation resulting in pericardial tamponade occurred in two patients, which required cardiothoracic intervention. In one patient a pulmonary embolism occurred five days after the invasive procedure. The study shows that percutaneous transfemoral balloon valvuloplasty can successfully be performed in patients with severe or even calcified mitral valve stenosis. The risk of severe complications is, however, not negligible.
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PMID:[Transfemoral, transatrial double-balloon valvuloplasty of rheumatic mitral stenosis]. 239 63

Reversible causes of pulmonary hypertension, such as mitral stenosis or pulmonary embolism, should be corrected causally. The therapy of pulmonary hypertension is difficult in those diseases where the causes or mechanisms are not understood or are unknown. In chronic obstructive lung disease, the primary objective is to improve airflow and alveolar ventilation (theophylline, beta-sympathicomimetics). Long-term oxygen (more than 18 hours a day) should be used in patients with paO2 below 55 mm Hg, since a reduction in pulmonary vascular resistance and a prolonged survival has been demonstrated. The role of vasodilator therapy (hydralazine, nitrates, diazoxide, captopril, calcium-blockers and others) in chronic obstructive lung disease remains uncertain. In primary pulmonary hypertension, a pulmonary vasodilator is recommended after demonstrating (for example with an infusion of prostaglandin I2), that the increased pulmonary vascular resistance is still reversible. The initiation of therapy should be performed cautiously under hemodynamic monitoring.
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PMID:Treatment of pulmonary hypertension. 287 21

Using the method of equilibrium radionuclide ventriculography (RNV), the right ventricular ejection fraction (RVEF) at rest and at a standard workload of 250 kpm per min was determined in 25 control subjects and in 30 patients with pulmonary hypertension (8 patients with chronic obstructive bronchopulmonary disease, 12 with recurrent pulmonary embolism and 10 with pure mitral stenosis). In the same week as RNV, pulmonary artery pressure was registered in patients with pulmonary hypertension at rest and at standard workload. RVEF was significantly higher (45 +/- 5%) in normal subjects than in patients with pulmonary hypertension (33 +/- 5%) and during exercise increased, whereas in patients with pulmonary hypertension it did not markedly change or decreased. The RVEF correlated at rest (r = -0.6293, p less than 0.001) and during exercise (r = 0.6980, p less than 0.05) with the degree of pulmonary hypertension at rest and during exercise. The results show a good correlation between the RVEF and the degree of pulmonary hypertension in patients with pulmonary hypertension at rest and during exercise.
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PMID:Equilibrium radionuclide right ventriculography at rest and during exercise in patients with pulmonary hypertension. 369 5

Since 1966 the authors have encountered nine cardiac tumors: eight myxomas and one tumor initially thought to be a sarcoma but histologically a squamous carcinoma. Seven myxomas were left atrial and the other were right atrial in location. The carcinoma was predominantly located in the right ventricle. Eight of the nine patients were female; ages ranged from 32 to 85 years. Of the myxomas, five displayed fever and dyspnea, two congestive heart failure and one transient ischemic episodes. The patient with carcinoma was in right heart failure. All patients underwent cardiac catheterization as well as echocardiography when it became available. Five myxomas were correctly diagnosed preoperatively while three were thought to have mitral stenosis. The patient with carcinoma showed a large right ventricular filling defect and a picture of constriction. All myxoma patients underwent surgery--three via left thoracotomy and five via sternotomy. Seven patients survived; however, the patient with right atrial myxoma was explored via the left chest for mitral stenosis and the myxoma was not discovered. She died of a pulmonary embolism pathologically confirmed as myxoma. All survivors have been followed by yearly echocardiograms and are free of recurrence. The patient with carcinoma died before surgery could be performed. Autopsy revealed almost complete replacement of the right ventricle by tumor and constrictive pericarditis. The terminal event was pulmonary embolus of squamous carcinoma. Although cardiac tumors are a rare entity, a high incidence of suspicion plus modern diagnostic methods can yield the diagnosis and allow a curative operation.
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PMID:Cardiac tumors in 19 years of private practice. 381 15

Recurrent laryngeal nerve palsy and vocal cord paralysis due to mitral stenosis was first described in 1897 (Ortner 1897). Since then other cardiovascular causes, including hypertension, coronary heart disease, aortic aneurysm and congenital heart disease have been described. There are two recorded cases of left recurrent laryngeal nerve palsy due to pulmonary embolism (Albertini 1972; Wilmhurst et al. 1983). We describe what we believe to be the third case.
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PMID:Vocal cord paralysis in association with pulmonary emboli. 394 26

Fourteen patients were treated with anticoagulants during 15 pregnancies. Eleven had venous thrombosis, three with pulmonary embolism; three had prosthetic heart valves; and one had mitral stenosis with pulmonary hypertension. All 15 were treated with heparin and 10 with warfarin. The mean duration of heparin therapy was 4.5 weeks and of warfarin 14 weeks. There were two minor episodes of recurrent thromboembolism and three minor haemorrhagic episodes during anticoagulant therapy. No fetal or neonatal complications occurred.There appears to be no ideal anticoagulant regimen for treating thromboembolic disease in pregnancy. A compromise approach based on experimental and clinical findings is suggested, which is considered to offer reasonable protection to the mother without undue risk to the fetus. This is heparin when an anticoagulant is indicated in the first trimester, after 37 weeks' gestation, and for the treatment of the initial thromboembolic episodes. Oral anticoagulants are used at other times when long-term anticoagulant therapy is indicated.
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PMID:Clinical experience with anticoagulant therapy during pregnancy. 541 15

Echocardiographic analysis of right ventricular ejection time (RVET), pre-ejection time (RVPEP), RVPEP/ET and isovolumic relaxation time (RVIRT) was performed in patients with acute or chronic right ventricular pressure overloading. Fifty-five patients undergoing right ventricular cardiac catheterization, were categorized into seven groups; 11 patients with atrial septal defect (ASD) without pulmonary hypertension (PH) (group 1), 12 with ASD with PH (group 2), six with mitral stenosis (MS) without PH (group 3), nine with MS with PH (group 4), seven with primary pulmonary hypertension (PPH) (group 5), seven with acute pulmonary embolism (PE) (group 6), and three patients with convalescence of PE (group 7). Corrected RVIRT (RVIRTc) and RVET (RVETc) were calculated by regression analysis correlating with heart rate in normal subjects. RVIRTc, RVETc, RVPEP and RVPEP/ET in seven groups were significantly correlated with systolic pulmonary artery pressure (SPAP) (r = 0.62, p less than 0.001; r = -0.41, p less than 0.01; r = 0.61, p less than 0.001; r = 0.65, p less than 0.001, respectively), but RVDd did not correlate with SPAP (r = 0.370, p less than 0.05). Comparing acute right ventricular pressure overloading group (group 6) with each of chronic right ventricular pressure overloading groups (groups 2, 4, 5, and 7), RVIRTc and RVDd were significantly increased in the former than the latter, but RVETc, RVPEP and RVPEP/ET were not significantly different in both groups. There was a significant correlation between RVIRTc and RVPEP/ET in chronic pressure overloading, but not in acute pressure overloading. We concluded that early diastolic RV relaxation and systolic performance were both impaired by increased afterload in chronic pressure overloading. In acute pressure overloading, however, early diastolic RV relaxation was more significantly impaired possibly because of acute changes of muscle architectures due to acute right ventricular expansion and anoxia.
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PMID:[Echocardiographic study of right ventricular performance by acute and chronic pressure overloadings]. 653

Forty cases of new-onset atrial fibrillation (AF) were reviewed to establish the frequency of various causes. Alcohol intoxication caused or contributed to 14 cases (35%). Coronary artery disease (22.5%) and pulmonary disease (22.5%) were also common causes of acute AF. Among patients less than 65 years old, alcohol caused or contributed to approximately two thirds (63%) of the cases of AF. Thyrotoxicosis was uncommon (one case in 40); no patient had a diagnosis of mitral stenosis, pulmonary embolism, or pericarditis. There were no complications of AF in alcoholic patients; the majority (88.9%) converted spontaneously to a normal sinus rhythm within 24 hours. Alcohol intoxication should be considered early in the differential diagnosis of new-onset AF in young patients. Many patients may not require admission to an intensive care unit or a costly battery of diagnostic tests.
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PMID:The role of alcohol in new-onset atrial fibrillation. 662 72


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