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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty nine patients with cardiomyopathy were evaluated by a hemodynamic study at rest and during isotonic exercise. These patients were divided into two groups on the basis of their left ventricular ejection fraction (LVEF): A, control group (LVEF greater than 40%, N = 19); B, severe congestive heart failure group (LVEF less than or equal to 40%, N = 20). Patients in group A showed adequate cardiovascular responses to exercise, i.e. increased cardiac index (80%) and stroke volume index (17%), decreased systemic vascular resistance (36.8%) but no significant change in pulmonary arteriolar resistance values. In contrast, patients in group B showed a slight and heart rate-dependent increase in cardiac index (38.5%), no improvement of stroke volume index (-3.4%), decreased systemic vascular resistance (21.6%) and increased pulmonary arteriolar resistance (41.2%) with exercise. This group also showed a significant increase in right atrial pressure that might reflect a decrease in right ventricular performance secondary to an abnormal pulmonary vascular response during exercise.
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PMID:Difference between the response of the pulmonary and systemic circulation during exercise in congestive heart failure. 317 81

To investigate the correlation of haemodynamic parameters with the intensity of the gallop sound (S3), use was made of right heart catheterization with a Swan-Ganz catheter to measure the pulmonary and right atrial pressures. The cardiac output was determined with the thermodilution method. A radiocardiogram was obtained after a bolus injection of technetium pertechnetate. The cardiopulmonary flow-index was obtained from the simultaneous recordings of the radiocardiogram and an electrocardiogram. With the haemodynamic parameters, heart sounds were recorded simultaneously and externally with a microphone. Eight Merino sheep were dosed with dried Pachystigma pygmaeum (Schltr) Robyns plant material through rumen fistulas until the clinical symptoms of heart failure such as gallop sounds, systolic murmurs and haemodynamic symptoms as well as increases in end diastolic pressure and decreases in stroke volume, appeared. After the appearance of the symptoms the sheep were treated symptomatically to delay the development of the cardiomyopathy. The changes in haemodynamic parameters before and after treatment were used and correlated with the intensity of the gallop sounds on a 6 point criterium scale. The results in brief show that, for gallop sound intensities between 0 and 6 on the criterium scale, most of the haemodynamic parameters correlate with the intensity of the gallop sounds, except the cardiac output, cardiopulmonary blood volume and the systemic and pulmonary vascular resistances. The haemodynamic parameters correlate better with the intensities of the gallop rhythm between 0 and 3. It is evident from this study that the model of heart failure in sheep is useful to study heart sounds and may also be valuable in the study of the genesis of the gallop sound.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Experimental gallop rhythm in sheep with Gousiekte: correlation of changes in amplitude with haemodynamic parameters. 321 94

Two patients with mitochondrial encephalomyopathy (MEP) serve to emphasize the variability of this group of diseases. Cerebral insults, mitochondrial cardiopathy, relapsing ileus, cerebral angioma, ataxia, and myoclonic seizures characterized the first case of an adult man with similar diseases in his family, interpreted as transitional form between mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) and myoclonus epilepsy associated with ragged red fibers (MERRF). The second patient, a floppy infant with cardiomyopathy and myoclonism, statomotoric and mental retardation showed combined defects in mitochondrial respiratory chain at NADH-CoQ reductase and cytochrome c oxidase and a deficiency of carnitine. In both patients neuropathologically criteria of Leigh's syndrome could be demonstrated in the cerebral cortex, in case 2 also clinically. The classificatory problems of the relationships between KSS, MELAS, MERRF, Leigh's as well as Alpers' syndromes are discussed.
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PMID:Mitochondrial myopathies with necrotizing encephalopathy of the Leigh type. 322 73

Arterial hypertension is the most important risk factor in all types of stroke. The significance of alcohol in the pathogenesis of stroke is less well defined. Chronic alcoholism leads to an elevation of blood pressure. Thus, the association between alcohol and stroke might be the blood pressure effect of alcohol. However, some studies have shown a significant influence of alcohol on the incidence of stroke--especially of intracerebral haemorrhage and subarachnoid haemorrhage--even after adjustment for blood pressure. Many possible pathomechanisms are discussed. Alcohol inhibits aggregation of thrombocytes, and chronic alcohol abuse may induce thrombocytopenia, which could lead to a haemorrhagic stroke. Alcohol withdrawal leads to rebound thrombocytosis. Acute alcohol ingestion induces a decrease in fibrinolytic activity and an increase in factor VIII activity, which enhances the thrombotic potential. Additionally, alcohol increases plasma osmolarity, erythrocyte aggregability, haematocrit and blood viscosity, and decreases deformability of erythrocytes. The effects of alcohol on cerebral blood flow are still under debate; there is a deterioration in autoregulation of cerebral blood flow anyway. In animal studies alcohol induced dose-dependent vasospasm of the cerebral blood vessels, which could be a possible pathomechanism in ischaemic, as well as in haemorrhagic stroke. Chronic alcoholism is the most common cause of secondary non-ischaemic cardiomyopathy, which can lead to cerebral embolism via rhythm disorders or intracardiac thrombus formation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Does alcohol consumption promote the manifestation of strokes? Considerations on pathophysiology]. 328 8

Left ventricular systolic torsion and diastolic recoil were quantified in 12 human cardiac transplant recipients with surgically implanted intramyocardial markers with the use of computer-aided analysis of biplane cineradiographic images. Measurements were performed between 6 and 16 weeks after surgery and related to the presence or absence of rejection as determined by cardiac biopsy. Torsional deformation, defined as twisting about the left ventricular long axis of the apical region with respect to the base, was characterized in terms of the rate and amplitude of systolic torsion and the rate of diastolic recoil by means of an internal reference system. Comparison of measurements before, during, and after recovery from 14 rejection episodes allowed assessment of the effects of acute reversible cardiomyopathy on left ventricular torsion and recoil. Compared with prerejection values, the amplitude of torsional deformation in the maximally deforming segment (theta max) decreased by 25% from 21.1 +/- 15.2 to 16.0 +/- 5.7 degrees (p less than .005) during acute rejection with myocyte necrosis; this was associated with significant (p less than .05) decreases in the peak systolic torsion rate (+d theta/dtmax), whereas the peak diastolic recoil rate (-d theta/dtmax) was unchanged. This suggests that the stiffness of elastic components of the myocardium may have increased, maintaining the rate of diastolic recoil when these elements are stretched less. With successful treatment of rejection episodes, the torsional deformation characteristics normalized. Heart rate, mean arterial pressure, left ventricular end-diastolic volume, stroke volume, ejection fraction, and peak left ventricular filling rate were unchanged with rejection episodes, whereas left ventricular end-systolic volume increased (p less than .05) during acute rejection and returned to normal with resolution of the rejection process. These data suggest that left ventricular torsional deformation amplitude and rate are sensitive to episodes of subclinical left ventricular dysfunction and that such intramyocardial marker techniques may provide new insights regarding the elastic properties of the ventricular myocardium and their impact on left ventricular mechanics.
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PMID:Effect of acute human cardiac allograft rejection on left ventricular systolic torsion and diastolic recoil measured by intramyocardial markers. 331 53

Thirty male patients with ischemic heart disease and cardiomyopathy entered a controlled study of the acute effects of alcohol on cardiac function evaluated by right heart catheterization. Twenty patients, nine with angina pectoris and 11 with congestive heart failure, were studied during alcohol intoxication, and ten patients, five with angina pectoris and five with heart failure, served as a control group. The mean serum ethanol concentration in the alcohol group was 93 mg/100 ml (S.D. 17). The systemic arterial blood pressure was reduced by 6% in the alcohol group, P less than 0.05 compared with the control group. No significant changes occurred in the central venous pressure, the pulmonary artery pressure, the pulmonary capillary wedge pressure, or in cardiac output, stroke volume and total peripheral resistance. Alcohol intake in moderate doses has no measurable effect on pulmonary blood pressures or cardiac output in patients with ischemic heart disease and cardiomyopathy. Such an effect may, however, be masked by a reduction of afterload.
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PMID:Cardiac function after alcohol ingestion in patients with ischemic heart disease and cardiomyopathy: a controlled study. 335 19

Cardiovascular alterations such as increased heart rate, high cardiac output, reduced systemic vascular resistance, and in most of the cases, increased contractility parameters have been recognized in patients with advanced liver disease. Some investigators define a cirrhotic cardiomyopathy as a hyperdynamic failure of the heart. Consequently, in patients with cirrhosis, the risk of developing further circulatory deterioration may be increased in situations which stress the cardiovascular system. After opening a portocaval shunt, it is expected that a large amount of blood will be distributed from the splanchnic to the pulmonary circulation and put a strain on the heart. This two-dimensional echocardiographic study was made in 30 patients with cirrhosis and in 20 patients who were chronically treated (range: 16 to 156 months) with portasystemic shunt for prevention of hemorrhage from esophageal variceal bleeding. Patients with portasystemic shunts revealed a change in hemodynamic pattern. There was a significant increase in the left ventricular end-diastolic volume index and also a slight increase in the left ventricular end-systolic index. Cardiac output remained high despite a significant decrease in heart rate due to an elevated left ventricular stroke volume index. The parameters of systolic ventricular performance were normal. In contrast to the acute opening of the portacaval shunt, the chronic shunt volume put no strain of clinical significance on the heart.
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PMID:Ventricular function in cirrhosis and portasystemic shunt: a two-dimensional echocardiographic study. 337 83

First-pass radiocardiography and biplane angiocardiography were performed on 13 patients with left-sided regurgitant valvular disease (R+) and 7 patients without regurgitation but with coronary artery disease and/or cardiomyopathy (R-). Right and left ventricular volumes and ejection fractions were calculated and compared. In the R- group, corresponding right and left ventricular volumes and ejection fractions correlated highly with each other (r = 0.86-0.89, p approximately equal to 0.01). Ejection fractions in the R+ group correlated (r = 0.64, p less than 0.05) only because stroke volume correlation was very high (r = 0.93), with end-diastolic and end-systolic volumes showing no significant correlation. Right ventricular ejection fraction (RVEF) decreased significantly with increasing mean pulmonary artery pressure (PAP) in both R- and R+ groups. The correlation of RVEF and LVEF in the R- group appears to be multifactorial in origin, consisting of effects of increased PAP, the mechanical interference of an enlarged left ventricle on the right ventricle, and direct biventricular ischemic effects. In the R+ group, the correlation appears to be due to only increased PAP and its sequelae.
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PMID:Correlation of right and left ventricular ejection fraction and volume measurements. 337 19

Improvements in mechanical support for profound circulatory collapse have resulted in increasing survival of these critically ill patients. Since 1980, 27 patients aged 3 days to 69 years (mean 34.9 years) who required mechanical circulatory assistance have been followed up after discharge from the hospital. The refractory cardiogenic shock necessitating mechanical support occurred postoperatively in 22 patients (coronary artery bypass in nine, valve replacement in four, correction of congenital heart defects in nine) and with end-stage cardiomyopathy in five. Fourteen patients were supported with a Pierce-Donachy ventricular assist device (left ventricular assist in seven, right ventricular assist in three, both in four); nine were supported with extracorporeal membrane oxygenation, two with a Medtronic centrifugal left ventricular assist pump, one with biventricular Biomedicus pumps, and one with a Novacor left ventricular assist system. The duration of support ranged from 8 hours to 91 days with a mean of 3.5 days in patients supported for postoperative shock. Major complications occurred in 18 patients (67%), including bleeding that necessitated operative exploration in 14, serious infection in five, renal failure in two, and stroke in two. The five patients with cardiomyopathy underwent cardiac transplantation. The remaining 22 patients who had postoperative cardiogenic shock were weaned from support. There have been four late deaths: two cardiac related at 6 months and two of cancer at 46 and 53 months (one patient was in New York Heart Association class I and the other in class II before death). The remaining 23 survivors have been followed up for 3 to 79 months (mean 29 months) and at last examination 17 (74%) were in class I, two (9%) were in class II, three (13%) were in class III, and one (4%) was in class IV. Eight patients are employed full time, three are retired, four attend school, three are in preschool, one is a housewife, and one is unemployed but free of symptoms. Only four patients have significant cardiac disability, and one of these still works. In conclusion, mechanical circulatory assistance allows adequate support to permit satisfactory long-term survival in patients with refractory cardiogenic shock.
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PMID:Follow-up of survivors of mechanical circulatory support. 338 94

Basing on the example of two cases, the clinical and morphological variability of mitochondrial encephalomyopathies is demonstrated. Both patients were of short build, and the clinical signs and symptoms were dementia, ataxia, epilepsy and hardness of hearing, whereas signs of myopathy were very mild or absent. Computed tomography showed infratentorial pronounced atrophy of the brain and basal ganglia calcifications, in one case additionally ischemic infarctions, as can be seen in "mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes syndrome" (MELAS). A CT follow-up over 8 years with a progression of the abnormalities parallel to the progressive clinical course is demonstrated. Besides typical "ragged red fibres-myopathy" different abnormalities of mitochondria were seen by the electron microscope. One of the patients died; he had exceptional pathological-anatomical findings with mitochondrial cardiomyopathy, angioma and necrotising encephalopathy of Leigh's type. The two case reports show that in patients with such multisystemic neurological signs and CT-findings mitochondrial encephalomyopathy should be considered and a muscle biopsy should be performed.
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PMID:[Mitochondrial encephalomyopathy: clinical aspects, CT morphology and neuropathology]. 339 29


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