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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Over a period of 6 years, only twelve cases of dilated cardiomyopathy were clinically diagnosed in Nigerians between the ages of 11-30 years at the University College Hospital, Ibadan, Nigeria. Eleven presented with heart failure, while the twelfth patient presented with a cerebrovascular accident. Two other patients also had a cerebrovascular accident. A history of febrile illness was obtained in seven, but in only three was fever unresponsive to antimalarials, documented on admission. Antistreptolysin-O titre was normal and erythrocyte sedimentation rates elevated in each of the patients. Leucocytosis was present in six, three had a four-fold rise or fall in antibody titres against Coxsackie-B viruses and one, a four-fold rise or fall against Toxoplasma gondii. Histological evidences of myopericarditis were found in three of the six patients who died. It is concluded that dilated cardiomyopathy is rare in young adult Nigerians, and that constitutional upset is common, as in children, but prognosis is poorer. Infections by Coxsackie-B viruses, T. gondii and possibly other viruses appear to be of major aetiological factors
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PMID:Dilated cardiomyopathy in young adult Africans: a sequel to infections? 629 52

Swan-Ganz semifloating balloon-tipped catheters were introduced in 6 endurance-trained subjects, 7 untrained volunteers, 29 patients suffering from coronary heart disease, 8 patients with right heart insufficiency induced by chronic obstructive syndromes, and 8 patients with idiopathic congestive cardiomyopathy. All subjects except the patients with resting cardiac insufficiency performed graded ergometric tests during the catheter investigation. Hemodynamic values, plasma noradrenaline and adrenaline (in all subjects), and beta-adrenergic receptor density on intact polymorphonuclear leucocytes (in 6 endurance-trained subjects, 5 untrained healthy volunteers, and 6 patients with left heart insufficiency) were determined. For all subjects investigated, significant correlations were observed between resting plasma catecholamine levels and resting hemodynamic values, such as stroke volume (r = 0.47, p less than 0.001), cardiac output (r = 0.32, p less than 0.05), heart rate (r = 0.37, p less than 0.01), pulmonary vascular resistance (r = 0.52, p less than 0.001), and total vascular resistance (r = 0.40, p less than 0.01). An inverse relationship existed between the resting catecholamine levels and the performance ability. Catecholamine levels were approximately three- to fourfold higher and the beta-adrenergic receptor density approximately two- to threefold lower in patients with left heart insufficiency than in healthy untrained subjects. The plasma catecholamine levels were lower and the beta-adrenergic receptor density approximately 60% greater in trained subjects. The beta-adrenergic receptor density may be a critical dynamic parameter for the modulation of sympathetic effects.
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PMID:[Hemodynamics, plasma catecholamine behavior and beta-adrenergic receptor density in trained and untrained subjects and cardiac insufficiency patients]. 631 88

Recent reports have demonstrated substantial increases in pulmonary activity during radionuclide stress exercise studies in patients with coronary heart disease. These studies have shown that the degree of the increase reflected the severity of the underlying disease. We studied the effects of supine exercise on systolic function and pulmonary activity in ten normal control subjects and 20 patients with congestive cardiomyopathy (12 ischemic and 8 idiopathic). Ejection fraction rose in the normals (P less than 0.001), end-diastolic volume increased slightly but significantly (P less than 0.05), and pulmonary activity rose by less than 16%, (mean 10%) while cardiac output increased by 162%. On the other hand, the myopathy patients demonstrated a small increase in cardiac output, (+49%) with a more substantial increase in pulmonary activity (+25%, P less than 0.05 vs normals). In these patients, ejection fraction did not change during exercise, while end-diastolic and end-systolic volumes rose. In the myopathy patients, the cause for an increase in cardiac output was a rise in heart rate, with little change in stroke volume. We conclude that pulmonary activity rises in myopathy patients to a greater extent than in normal controls. This probably reflects the greater elevation in filling pressures these patients need to maintain forward cardiac output.
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PMID:Pulmonary blood volume: analysis during exercise in patients with left ventricular dysfunction. 636 63

Vasodilator drugs are generally classified according to their prevalent site of action: arteriolar vasodilators (e.g. phentolamine, hydralazine, nifedipine) which reduce peripheral resistance and, therefore, increase stroke volume and cardiac output; venodilators (e.g. nitrates), which decrease filling pressure, redistributing intravascular blood volume from the central to the peripheral reservoirs and therefore relieve signs and symptoms of congestion; "balanced" vasodilators (e.g. nitroprusside, prazosin, captopril) which present both effects. Vasodilator therapy is indicated in heart failure caused by impaired contractility (congestive cardiomyopathy, ischemic heart disease) and volume overload (mitral and aortic regurgitation, ventricular septal defect). Hemodynamic studies of acute pharmacological effects are necessary for a correct drug choice, even if they are not always predictive of the long-term efficacy. Non-invasive studies (in particular echocardiography) don't seem actually adequate for vasodilator therapy evaluation. Finally it is not known if vasodilator treatment influence prognosis of chronic heart failure (especially survival), but there is evidence that it can lessen symptoms and increase effort tolerance.
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PMID:Vasodilators in left ventricular failure. 651 Jun 23

Electrocardiogram gated cardiac computed tomography (CT) was performed to evaluate the usefulness in the measurement of left ventricular volume and left ventricular wall thickness in 25 patients; five with angina pectoris, five with old myocardial infarction, eight with hypertrophic cardiomyopathy, four with dilated cardiomyopathy, and three healthy men. The left ventricular volume was calculated as the sum of the volume of each slice, which was area times thickness of the slice. The left ventricular wall thickness was measured in reconstructed short-axis view at the level of the mitral valve and papillary muscle. The left ventricular volume and left ventricular wall thickness determined by CT were compared with that by left ventriculography (LVG), and that by two-dimensional echocardiography (2 DE), respectively. The following results were obtained. There were good relationships between left ventricular volume, end-diastolic volume, end-systolic volume, ejection fraction by CT and those by LVG, but left ventricular volume by CT was smaller by about 20% than that by LVG. In the measurement of stroke volume, no relationship was recognized between CT and LVG. Concerning the measurement of left ventricular wall thickness, more available figures were obtained by CT than by 2 DE, particularly at the apical region, lateral wall, and posterior wall. In the other segments of the left ventricle, CT was also more suitable for the measurement of the wall thickness. Interventricular septal thickness was correlated between reconstructed short-axis view of CT (Y) and transverse view of CT (X), and the equations Y = 0.66X + 2.13 (r = 0.79) at the mitral valve level, and Y = 0.56X + 3.00 (r = 0.81) at the papillary muscle level were obtained. Therefore, reconstructed short-axis view should be used for the measurement of the left ventricular wall thickness not to overestimate the thickness.
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PMID:[Usefulness of ECG gated cardiac computed tomography in measurement of left ventricular volume and wall thickness]. 654 27

Vasodilator therapy in congestive heart failure has proven an effective adjunct to conventional treatment with digitalis and diuretics. In this study dipyridamole was used in combination with isosorbide dinitrate to treat twelve patients (mean age 55 years) with idiopathic congestive cardiomyopathy. All patients were in N.Y.H.A. class III or IV and were already treated with digitalis and diuretics. This conventional therapy was not discontinued for the study. Acute studies were performed during diagnostic right and left heart catheterization. Hemodynamics were obtained at rest, after intravenous administration of 40 mg dipyridamole and after 5 mg isosorbide dinitrate sublingually. An increase in cardiac index and stroke volume index was noted, while left ventricular enddiastolic pressure and systemic vascular resistance decreased significantly. The twelve patients were then treated with 4 X 150 mg dipyridamole and 4 X 40 mg isosorbide dinitrate per day while also continuing the digitalis and diuretic treatment. They were followed up clinically for a period of 8 to 24 months. Three patients died but the other nine showed a clinical improvement (mean of 1.45 N.Y.H.A. classes). It was possible to perform a second right and left heart catheterization in four patients. Cardiac index, stroke volume index and maximum and minimum DP/dt were significantly higher, and left ventricular enddiastolic pressure was significantly lower, than before vasodilator therapy. These results suggest a sustained effect of dipyridamole and isosorbide dinitrate. The postextrasystolic modification of maximum DP/dt could be of prognostic value in congestive cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Congestive cardiomyopathy: value of short and long-term vasodilator treatment and prognosis]. 654 59

To analyze the determinants of left ventricular (LV) reserve non-invasively, LV echocardiograms were taken during ergometer exercise in 52 LV disease patients (19 with hypertension [HT], 22 with aortic regurgitation [AR] and 11 with dilated cardiomyopathy [DCM] with various severities. In mild cases [HT], at exercise, fractional shortening (FS) increased, and at higher-grade exercise, an increase of LV enddiastolic diameter (Dd) was added to more increase of FS, to increase stroke volume (SV). In moderately severe cases [HT, AR or DCM], FS did not change or decreased at exercise. In severe cases [AR or DCM], FS was low at rest, and at exercise decreased further with an increase of LV systolic stress and no significant increase of Dd, resulting in a decrease of SV. The responses of LV parameters in volume-overload (AR) or dilated myocardial (DCM) hearts were poorer than in pressure-overload (HT) hearts, in moderately severe cases. In conclusion, exercise echocardiography can show non-invasively that the interrelationship among the determinants of LV reserve is different by the severities and the types of LV diseases, and this method is useful, especially in discriminating mild cases objectively.
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PMID:Evaluation of left ventricular reserve in left ventricular diseases: non-invasive analysis of its determinants by dynamic exercise echocardiography. 660 83

In the study of cardiac abnormalities responsible for the development of cerebral embolism two-dimensional echocardiography was performed on 350 patients with ischemic cerebrovascular disease. The results were compared with those obtained from 350 controls without any history of stroke. Atrial fibrillation was detected on ECG in 115 cases (33%) of the patients and in 35 cases (10%) of the controls (p less than 0.001). The structural cardiac diseases observed in stroke patients were: rheumatic heart disease (RHD) in 37, congestive cardiomyopathy (CCM) in 7, hypertrophic cardiomyopathy (HCM) in 19, mitral annulus calcification (MAC) in 29, mitral valve prolapse (MVP) in 9, and myocardial infarction (MyI) in 10 patients. Controls were found to have these lesions in 11, 2, 3, 12, 4 and 9 patients respectively. RHD (p less than 0.001), HCM (p less than 0.01) and MAC (p less than 0.01) were significantly more frequent in patients with ischemic cerebrovascular disease, but not MyI, CCM or MVP. Intracardiac thrombi were diagnosed in 29 cases of patients and in 4 cases of controls (p less than 0.001). Our data suggested that nonrheumatic heart diseases such as MAC and HCM could also be considered as causes of embolic stroke. The reasons for the variable frequencies of cardiac abnormalities reported in the literature for stroke patients are discussed.
Stroke
PMID:Cardiac abnormalities in ischemic cerebrovascular disease studied by two-dimensional echocardiography. 665 29

In 11 patients with congestive cardiomyopathy (NYHA class III and IV, mean cardiothoracic ratio 0.59) the effect of a new positive inotropic agent, 2[(2-methoxy-4-methylsulfinyl)phenyl ))-1H-imidazo[4,5-b]pyridine (AR-L 115 BS, sulmazol, Vardax), on haemodynamics was studied. Simultaneously plasma levels of the drug were measured. All patients were pretreated with digitalis and diuretics. The following results were obtained: Heart rate increased only slightly, by 8% (n.s.), maximal left ventricular pressure rise by 37% (p less than 0.01), left ventricular enddiastolic pressure decreased by 42% (p less than 0.01), mean pulmonary artery pressure by 23% (p less than 0.01) and pulmonary vascular resistance by 22% (p less than 0.05). Left ventricular enddiastolic volume was reduced by 20% and left ventricular systolic volume by 31% (p less than 0.01). Ejection fraction increased by 36% (p less than 0.05), cardiac index, stroke index, stroke work index and systolic aortic pressure as well as systemic vascular resistance remained unchanged. In conclusion, sulmazol is an effective inotropic agent with vasodilating properties (especially on the venous capacity system). The lacking increase of cardiac output despite the augmentation of ejection fraction must be due to the prominent reduction of preload, decrease of left ventricular volume and heart size. Sulmazol therefore should not increase oxygen consumption of the heart and should be especially advantageous in patients with predominant backward failure.
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PMID:[Effect of sulmazol on left ventricular function in congestive cardiomyopathy]. 668 55

The influence of heart rate on left ventricular (LV) volumes and ejection fraction (EF) using 2-dimensional (2-D) echocardiography during atrial pacing was analyzed. The study was performed in 13 normal control subjects, 23 patients with coronary heart disease and 8 patients with dilated cardiomyopathy. An electronic sector scanner (2.25 MHz, 84 degrees) was used. Under constant scanning of the left ventricle, heart rate was increased, in steps of 20 beats/min, from 80 to 140 beats/min. The 2-D echocardiograms were stored on videotape and analyzed off-line. The end-diastolic and end-systolic volumes (EDV and ESV) were determined using a disc method. Stroke volume (SV) and EF were calculated. Constant LV scanning was possible during atrial stimulation, as shown by the analysis of simultaneously recorded 2-D echocardiograms and cineventriculograms at different heart rates, revealing a constant position of the echocardiographic transducer. Simultaneous recordings of cineventriculography and 2-D echocardiography at 80 and 120 beats/min showed that despite differences in absolute values, percent changes of LV volumes and EF determined with both methods were similar. Thus, changes of LV function can be analyzed by 2-D echocardiography. In normal control subjects, an increase in heart rate of 10 beats/min reduced EDV by 4 ml, ESV by 2 ml, SV by 2 ml and EF by 1%, corresponding to percent reductions of 4, 2, 5 and -2%, respectively. In contrast, the absolute decreases in the patients were 6 ml, 1 ml, 5 ml and 2% and the percent changes 2%, 1%, 8% and 5%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of heart rate changes on left ventricular volume and ejection fraction: a 2-dimensional echocardiographic study. 669 89


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