Gene/Protein Disease Symptom Drug Enzyme Compound
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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To evaluate left ventricular function in patients (pts) with right ventricular overload, exercise echocardiographic studies using a bicycle ergometer were performed for seven pts with pulmonary hypertension (PH), two with cor pulmonale (CP) and 16 with atrial septal defects (ASD), and the results were compared with those of 10 (control I) and 27 (control II) normal persons. These subjects were categorized in two study groups; study I consisting of PH, CP and control group I with an exercise workload of 25 watts for 3 min; and study II consisting of ASD and control group II with an exercise workload of 50 watts for 3 min. The results were as follows: M-mode echocardiography revealed that: During exercise, the stroke volume (SV) was increased with a significant decrease of left ventricular end-systolic dimension (LVDs), but without a change in left ventricular end-diastolic dimension (LVDd) in control groups I and II, with a marked increase of LVDd and a slight decrease of LVDs in the ASD group. By contrast, the SV in the PH group tended to decrease during exercise with a slight decrease of LVDd, but without a significant change in LVDs. Right ventricular dimension (RVD) was significantly increased during exercise in the PH group, but was decreased in the ASD group. In control groups I and II, RVD did not change during exercise. In ASD, and control groups I and II, the peak velocity of circumferential fiber shortening (Vcf) was increased during exercise, and the peak negative Vcf was significantly decreased. However, these parameters exhibited impaired responses during exercise in the PH group. Abnormal interventricular septal (IVS) motion at rest tended to become normal during exercise in 12 of 16 pts with ASD. In all pts with PH, however, IVS motion did not change substantially during exercise. There were similar parameter responses between the PH and CP groups. Two-dimensional echocardiography showed that: The left ventricular short-axis view demonstrated a diastolic left ventricular configuration which changed from oblique to relatively circular orientation during exercise in the ASD group. In four of five pts with PH, the diastolic configuration of the left ventricle was oblique because of a loss of the normal curvature of the IVS at rest and during exercise. The diastolic left ventricular configuration improved during exercise in only one pt with PH, with slightly elevated pulmonary arterial systolic pressure as in the ASD group.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Left ventricular function in patients with right ventricular overload evaluated by exercise echocardiography: comparison of pulmonary hypertension and atrial septal defects]. 653 82

A variety of mechanisms have been implicated in the development of left ventricular dysfunction in patients with chronic cor pulmonale. A two-dimensional echocardiographic study of cystic fibrosis (CF) patients with severe cor pulmonale was undertaken to evaluate the effects of long-term pulmonary abnormalities on right and left ventricular geometry. Ten patients with severe obstructive pulmonary disease secondary to CF underwent evaluation by a mechanical sector scanner from the long axis, short axis, and four chambered views. All patients manifested right heart failure. Eight had clinical scores less than 40 and died within six months of the initial examination. All patients were receiving diuretics, and six were taking digoxin at the time of the study. The most striking echographic feature was flattening or compression of the left ventricle along its minor dimension by a massively dilated right ventricle. Compression of the left ventricle and additional abnormalities of interventricular septal motion resulted in dyskinetic contraction and relaxation that could contribute to a diminished stroke volume. Massive right ventricular enlargement appears to be a major factor producing left ventricular dysfunction in chronic cor pulmonale.
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PMID:Ventricular interdependence in severe cystic fibrosis. A two-dimensional echocardiographic study. 727 91

Hemodynamic studies at rest, at exercise and during oxygen breathing (FiO2 99.6%) were carried out in 12 patients with severe chronic obstructive lung disease and cor pulmonale without congestion (NOCA). All lived in Mexico city (2,240 meters). Our data confirm the concept of a spectrum of ventricular behaviour, from normal to the one when right ventricular pressure abnormalities exist and blood flow is restricted. The right ventricular stroke work index was considerably higher due mainly to the increase in pressure work. Grossly right ventricular performance at altitude is not different from the described at sea level. When stroke index (SI) is related to the right ventricular end diastolic pressure (RVEDP), patients with NOC at sea level show depressed right ventricular function. This relation was different for NOC-A and it could be related indirectly to higher altitude. On the basis of the relation found for SI-RVEDP at our altitude we could not conclude that NOC-A show depressed right ventricular function.
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PMID:[Right ventricular function in chronic obstructive pneumopathy with pulmonary cardiopathy. A study at the altitude of Mexico City (2240 meters)]. 732 45

In a 16-year mortality followup of some 293,000 insured U.S. veterans, specific causes of death were studied in relation to smoking status. The main results confirmed earlier findings.Mortality ratios for cigarette smokers as compared with nonsmokers were 1.73 for all causes of death, 1.58 for all cardiovascular diseases, 2.12 for all cancers, and 4.31 for all respiratory diseases. The highest ratios (those greater than 5.0) were observed for cor pulmonale, aortic aneurysm, emphysema and bronchitis, cancer of the pharynx, cancer of the esophagus, cancer of the larynx, and cancer of the lung and bronchus. The greatest excess in deaths in terms of observed numbers minus expected was found for the cardiovascular diseases, in particular for coronary heart disease.Mortality ratios for ex-cigarette smokers who had stopped smoking for reasons other than physicians' orders were much lower compared with nonsmokers than the mortality ratios for current cigarette smokers: 1.21 for all causes, 1.15 for all cardiovascular diseases, 1.39 for all cancers, and 2.08 for all respiratory diseases. For most causes of death, the mortality ratios for ex-cigarette smokers who had stopped smoking for reasons other than physicians' orders varied inversely with the number of years of cessation. For some diseases, the mortality risk for the ex-cigarette smoker returned to normal almost immediately after the cessation of smoking, whereas for others, the return to normal was more gradual. The first group included stroke and the combined category of influenza and pneumonia; the second group included cardiovascular diseases as a whole and coronary heart disease. For still other diseases, although the mortality ratio declined with the length of time smoking was discontinued, substantial excess risks remained even after 20 years of cessation. In this third group were aortic aneurysm, bronchitis and emphysema, and lung cancer-diseases with very high mortality ratios for current cigarette smokers. Parkinson's disease remained the one disease that clearly exhibited a negative association with cigarette smoking.
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PMID:Smoking and causes of death among U.S. veterans: 16 years of observation. 738 6

Differing opinions about the use of digitalis in patients with cor pulmonale have led the authors to study haemodynamic effect of strophantin, a cardiotonic glycoside used as therapy of choice of decompensated cor pulmonale. Five patients with severe airways obstruction recovering from heart failure were studied. Ouabain at a dose of 0.01 mg/kg was infused into the pulmonary artery. Pulmonary artery pressure and flow were measured before, at the end of the infusion, 15 and 30 min after it. There was no change in the heart rate or mean pulmonary artery pressure and a slight increase in the pulmonary wedge pressure was observed after ouabain. The most important change concerned the pulmonary blood flow. The cardiac index rose from the initial 2.48 +/- 0.44 l/min/m2 to 3.67 +/- 1.3 l/min/m2 15 min after ouabain. The increase in cardiac output was entirely due to the increase in the stroke volume. Pulmonary vascular resistance fell from 502 +/- 208 dyn. s. cm-5 to 315 +/- 216 dyn. s. cm-5 15 min after ouabain. The findings support clinical preference for strophantin in patients with decompensated cor pulmonale.
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PMID:Effects of ouabain on pulmonary haemodynamics in patients with hypoxic pulmonary hypertension. 744 98

Survival after closed-chest ablation of His bundle with DC shock for supraventricular arrhythmias was analyzed for a 10-year period (May 1982-December 1992) with 317 consecutive patients (167 males, 150 females; mean age 66 years; range 33-93 years). Of these, 54 patients died (17.3%) and 5 were lost to follow-up. The mean age at ablation was 70.3 +/- 8.3 years with a range of 49-93 years. Of those who died, the mean survival was 30.5 +/- 28.6 months with a range of 36 hours to 120 months; the diagnosis of heart disease was: hypertension (n = 14), cardiomyopathy (n = 8), ischemic (n = 7), valvular (n = 6), cor pulmonale (n = 3), valvular and ischemic (n = 2), hypertension and ischemic (n = 1), miscellaneous (n = 3), and none (n = 10). Of the patients who died after ablation, the arrhythmias at the time of the ablation were atrial fibrillation (AF; n = 33), sick sinus syndrome (n = 5), atrial flutter (AFL; n = 4), paroxysmal AV junctional tachycardia (PAVJT; n = 4), AF + AFL (n = 4), atrial tachycardia (n = 2), PAVJT + AFL (n = 1), and AF +AFL + atrial tachycardia (n = 1). Death was sudden in 13 patients (25%), due to heart failure in 10 (19.2%), myocardial infarction in 4 (7.7%), stroke in 4 (7.7%), aortic vascular accident in 3 (5.8%), miscellaneous in 18 (34.6%), and undetermined in 2.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term survival after closed-chest His-bundle ablation with DC shock for supraventricular arrhythmias: a 10-year experience with 317 consecutive patients. 784 34

The authors undertook a retrospective study of 41 patients in whom an atrial septal aneurysm (ASA) had been diagnosed at transoesophageal echocardiography performed for ischaemic cerebrovascular events in 26 cases. No significant differences in this size, thickness or mobility of the ASA or the associated cardiac abnormalities were demonstrated in this context. However, patients presenting with cerebrovascular accidents were older, had several cardiovascular risk factors and more cardiac arrhythmias. These arrhythmias were usually related to other cardiac pathology such as ventricular hypertrophy or chronic cor pulmonale. Moreover, the probability of the cerebrovascular accident being related to the ASA was only acknowledged in 11 cases. These results mean a certain degree of discretion in diagnostic investigation and therapeutic management of these cases.
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PMID:[Aneurysm of the interatrial septum. Apropos of a retrospective study of 41 cases]. 784 33

Observation by using Swan-Ganz catheter on hemodynamic and oxygen dynamic changes before and after assisted volume controlled mechanical ventilation (MV) was carried out in 11 cases of chronic cor pulmonale complicated with pulmonary encephalopathy. Pulmonary vascular resistance and pulmonary artery pressure were significantly decreased by the relief of hypoxia pulmonary vasoconstriction after MV. Because of the relax of sympathetic tension, the heart rate, arterial blood pressure, pulmonary capillary wedge pressure and central venous pressure reduced simultaneously. Left and right ventricular stroke work decreased after MV, without significant change in cardiac output. Venous admixture (Qs/Qt) was markedly reduced by MV and oxygen supply-demand ratio raised. It is thus shown that marked improvement of hemodynamic and oxygen dynamic status can be induced by mechanical ventilation at an opportune moment.
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PMID:[The hemodynamic and oxygen dynamic effects of mechanical ventilation in chronic cor pulmonale]. 786 30

The high prevalence of obstructive sleep apnea (OSA) has only recently been appreciated, in part because the symptoms and signs of chronic sleep disruption are often overlooked in spite of their debilitating consequences. They typically develop insidiously during a period of years. We now know that the lives of millions of people each year are significantly impaired by the sequelae of OSA. Many of these patients go unrecognized, with tremendous medical and economic consequences for individual patients and for society. Evidence indicates that chronic, heavy snoring may be associated with increased long-term cardiovascular and neurophysiologic morbidity. Therefore considerable interest lies in the study of the epidemiology and the natural history of these related disorders. The fundamental problem in OSA is the periodic collapse of the pharyngeal airway during sleep. The pathophysiology of this phenomenon is reviewed in some detail. During apneas caused by obstruction, airflow is impeded by the collapsed pharynx in spite of continued effort to breathe. This causes progressive asphyxia, which increasingly stimulates breathing efforts against the collapsed airway, typically until the person is awakened. Hypopneas predominate in some patients and are caused by partial pharyngeal collapse. The clinical sequelae of OSA relate to the cumulative effects of exposure to periodic asphyxia and to sleep fragmentation caused by apneas and hypopneas. Some patients with frequent, brief apneas and hypopneas and normal underlying cardiopulmonary function may have considerable sleep disruption without much exposure to nocturnal hypoxia. Patients with sleep apnea often have excessive daytime sleepiness. As the disorder progresses, sleepiness becomes increasingly irresistible and dangerous, and patients develop cognitive dysfunction, inability to concentrate, memory and judgment impairment, irritability, and depression. These problems may lead to family and social problems and job loss. Cardiac and vascular morbidity in OSA may include systemic hypertension, cardiac arrhythmias, pulmonary hypertension, cor pulmonale, left ventricular dysfunction, stroke, and sudden death. The challenge for the clinician is to routinely consider the diagnosis and to incorporate several basic questions in the historical review of systems regarding daytime or inappropriate sleepiness. The diagnosis of OSA is made with polysomnography, and the decision to treat is based on an overall assessment of the severity of sleep-disordered breathing, sleep fragmentation, and associated clinical sequelae. The therapeutic options for the management of OSA are reviewed. Recognition and appropriate treatment of OSA and related disorders will often significantly enhance the patient's quality of life, overall health, productivity, and safety on the highways.
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PMID:Obstructive sleep apnea. 814 53

Spiroergometry might be applicable to detect alterations of cardiopulmonary functions related to hyperthyroidism. Thus, cardiac and respiratory changes as well as work capacity in hyperthroid female patients were to be assessed with the help of the Cardiopulmonal Exercise Test System. Twelve female hyperthyroid patients with Graves' disease of whom all were controlled in euthyroidism, were examined. Eighteen euthyroid female patients in whom intracardiac catheter examination ruled out cardiopulmonary disease served as controls. The anaerobic threshold was determined by means of the V-slope method. An echocardiography was performed in all patients. Ergometry was performed in a semisupine position using a continuous ramp protocol of 20 watt/min. A markedly reduced work capacity, and a high heart rate in rest and exercise were found. In the ratio heart rate/oxygen uptake a lower rise (p = 0.001) due to a decreased growth in the heart rate was noticed. Regarding the pulmonary system a decreased tidal volume in hyperthyroidism (p = 0.021), and a higher breathing frequency (p = 0.003) were recognized, as well as an impaired oxygen consumption, in comparison with the euthyroid state. Also, echocardiographically an increased cardiac index (p = 0.008) and a markedly reduced stroke volume (p = 0.005) in comparison to the control group were observed. Heart rate, work capacity, oxygen uptake, and the ratio heart rate to oxygen uptake were normalized in euthyroidism. With the help of the CPX-System noninvasive measure of marked cardiopulmonary changes in hyperthyroidism are possible, especially the lower growth of the heart rate in exercise, which might be the limiting factor of work capacity.
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PMID:[Cardiopulmonary stress in hyperthyroidism]. 814 68


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