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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The growth of complex diagnostic and therapeutic technologies in the clinical management of cardiovascular diseases has mandated a more comprehensive and detailed analysis of cases which reach the pathology laboratory. This report describes in detail the relatively simple techniques and protocol which we have employed for postmortem evaluation of the coronary vascular bed and myocardium. The key elements include the use of a pigmented gelatin mass containing radiopaque material (Barosperse), proper injection technique with simultaneous filling of the main coronary vessels at identical pressures, postmortem arteriography, cardiac dissection, and histologic confirmation of coronary and myocardial lesions. Three cases with sharply differing cardiac diseases are presented to illustrate the kind of information which may be obtained with this approach. Our experience in terms of frequency and distribution of occlusive coronary vascular disease and the relationship to age and sex has been summarized. Significant disease (> 75% lumenal obstruction) was identified angiographically and confirmed by dissection in 46 of 57 cases of clinically suspected disease. None of six hearts from patients without clinical evidence for cardiovascular disease demonstrated actual or angiographically false-positive occlusive coronary disease. It is suggested that a more detailed analysis of the coronary vascular bed can be accomplished in the pathology laboratory with this relatively simple approach and that important information bearing on clinical management can be reliably obtained.
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PMID:A simplified technique for postmortem evaluation of coronary arteries. 13 11

Clinical, experimental and pathologic studies strongly indicate that hypertension is a major factor in coronary heart disease, sudden death, stroke congestive heart failure and renal insufficiency. The deleterious effect of the elevated blood pressure on the cardiovascular system appears to be due mainly to the mechanical stress placed on the heart and blood vessels. Humoral factors and vasoactive hormones such as angiotensin, catecholamines and prostaglandins may play a role in the pathogenesis of hypertensive cardiovascular disease but this role has not yet been defined and is probably secondary. Hypertension and the resulting increase in tangential tension on the myocardial and arterial walls, leads to the development of hypertensive heart disease and congestive heart failure as well as hypertensive vascular disease that affects not only the kidneys but also the heart and brain. Hypertensive vascular disease involves both large and small arteries as well as arterioles and is characterized by fibromuscular thickening of the intima and media with luminal narrowing of the small arteries and arterioles. The physical stress of hypertension on the arterial wall also results in the aggravation and acceleration of atherosclerosis, particularly of the coronary and cerebral vessels. Moreover, hypertension appears to increase the susceptibility of the small and large arteries to atherosclerosis. Thus the patient with hypertension is a candidate for both hypertensive and atherosclerotic vascular disease of the coronary and cerebral vessels leading to occlusive disease of both the large and small arteries and resulting in myocardial infarction and stroke. Other major complications of hypertensive vascular disease include rupture and thrombotic occlusion of blood vessels, especially in the brain. Disease of the arterial media, which begins in childhood with the deposition of calcium in the vessels, may be an important cause of arterial hypertension. This form of hypertension may manifest itself in adults as arteriosclerotic hypertension and lead to cardiovascular complications very similar to those of essential hypertension. The relation of arteriosclerotic hypertension to nutritional factors, including dietary salt intake, deserves study.
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PMID:Role of hypertension in atherosclerosis and cardiovascular disease. 13 91

The role of hypertension in cardiovascular disease was studied in the hypertensive coarcted monkey during the feeding of an atherogenic and nonatherogenic diet. During the 15-month period of observation, half of the hypertensive coarcted monkeys developed cardiovascular disease which included heart failure, ischemic heart disease, stroke, and sudden death. There were no cardiovascular complications in the control normotensive monkeys except for one cholesterol-fed animal. The incidence of ischemic heart disease and sudden cardiac death was higher in monkeys with both hypertension and hypercholesterolemia than in those with hypertension or hypercholesterolemia alone. Postmortem studies revealed that the former monkeys had both hypertensive and atherosclerotic heart disease, whereas the monkeys with hypertension or hypercholesterolemia had either hypertensive or atherosclerotic heart disease. Hypertensive heart disease was characterized not only by hypertrophy of the left ventricle but also by focal myocardial degeneration and fibrosis and by focal thickening and narrowing of the small coronary arteries, particularly the sinus node artery and the atrioventricular node artery. The finding of transmural myocardial infarction in two monkeys with patient coronary arteries suggests a possible role of coronary artery spasm in ischemic heart disease in hypertension. The cerebral vascular complications of hypertension included hypertensive encephalopathy, transient "ischemic" attacks, and hemorrhagic stroke. The complications were associated with severe hypertension and with hypertensive vascular disease or hypertensive and atherosclerotic vascular disease of the cerebral arteries.
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PMID:Role of hypertension in ischemic heart disease and cerebral vascular disease in the cynomolgus monkey with coarctation of the aorta. 14 28

Studies on the pathogenic potential of the human cardiotropic enterovirus, coxsackievirus B5, show that this agent localizes and replicates in the aorta of mice. Nutritionally-induced hypercholesterolemia leads to an increased replication and persistence of virus in tissues, specifically the aorta. Coxsackievirus B cardiopathy is markedly augmented in the hypercholesterolemic host, resulting in a persistent cardiomyolysis which is not evident in virus-infected animals with normal cholesterol levels. Pathological changes in the aorta become evident only months after the acute infection, and only in hypercholesterolemic animals previously infected with coxsackievirus B5. Our findings of coxsackievirus B-induced angiopathy and cardiopathy in the hypercholesterolemic host extend the known pathogenic range of these human viruses, and further emphasizes their potential as etiological agents of cardiovascular disease.
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PMID:Coxsackievirus B cardiopathy and angiopathy in the hypercholesterolemic host. 21 92

To assess the role of serum factors in the genesis of accelerated vascular disease in chronic renal failure, human arterial smooth muscle cells (SMC) and dermal fibroblasts were grown in culture and the effects of serum from chronic dialysis patients on cell proliferation was studied. Exposure to serum from these renal failure patients was associated with significantly greater growth of both SMC and fibroblasts than that observed with control serum. A portion of this mitogenic effect appears to be related to the presence of a factor(s) which is heat stable, dialysable, and is contained in the lipoprotein deficient fraction of plasma of density greater than 1.25 g/dl. These findings suggest that circulating substances which stimulate the proliferation of SMC may contribute to accelerated cardiovascular disease in patients undergoing chronic dialysis treatment.
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PMID:Chronic renal failure and atherogenesis--Serum factors stimulate the proliferation of human arterial smooth muscle cells. 51 37

Estrogen treatment of postmenopausal women is effective in relieving the symptoms of vasomotor instability and urogenital atrophy; estrogen treatment is effective in preventing accelerated bone loss and osteoporosis in young women following castration, but in postmenopausal women aging is a more important determinant of accelerated bone loss than is decreased estrogen secretion. Low-dose estrogen treatment of postmenopausal women neither prevents nor increases the risk of arteriosclerotic cardiovascular disease or cerebral vascular disease. It cannot be definitively established that estrogen treatment of postmenopausal women causes an increased incidence of breast tumors, but it is clear that such treatment does not prevent these tumors. It is established that estrogen treatment of postmenopausal women increases the risk ratio of endometrial carcinoma.
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PMID:Estrogen treatment of postmenopausal women. Benefits and risks. 57 21

This study examines the cause-specific mortality of men employed as masons in the steel industry. Their mortality experience is compared with the mortality predicted by the age--and race--specific death rates for a control group consisting of those steelworkers whose first job in 1953 was not in the mason department. The relative risks of dying from selected causes were highly dependent on race. The most important observations are: (1) The nonwhites have an overall excess risk when compared to the nonmason group. This excess is not confined to any particular category and appears to be due to the cumulative effect of an excess in many different categories. (2) The white masons have an excess risk for nonmalignant respiratory disease. Furthermore, this risk increases with length of exposure. (3) The whites have an excess risk for respiratory cancer when compared to the nonmason group. This excess is not present in the later years of the follow-up period. (4) The interpretation of the findings for cardiovascular disease remain unclear. Results for cerebral vascular disease and hypertensive disease in nonwhites are suggestive, but need further investigation before any strong statements can be made.
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PMID:Long-term mortality study of steelworkers. 95 38

Five cases of hemangiomas of the cecum and gastrointestinal bleeding are presented. All were demonstrated by colonscopy after more conventional diagnostic methods failed. The hemangiomas were bright red, flat lesions clearly seen through the colonscope. They were successfully treated by electrocoagulation. All patients in this series had some type of associated cardiac or vascular disease. These patients may represent a syndrome of gastrointestinal blood loss of obscure cause, hemangiomas of the cecum, and cardiovascular disease.
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PMID:Hemangiomas of the cecum. Colonoscopic diagnosis and therapy. 108 11

In conclusion, patients on chronic maintenance dialysis have an increased incidence of death from cardiovascular disease. Hypertension plays a major role, and these patients must be carefully monitored for complete control of blood pressure. Adequacy of ultrafiltration to maintain normal extracellular volume is an essential part of the dialytic treatment. Hypertensive patients should be screened for excessive renin secretion because of its possible role in unresponsive hypertension in patients on dialysis. Nephrectomy should be used when necessary, where dialysis and antihypertensive medication have not adequately controlled blood pressure. Patients must be monitored for the presence of pericardial disease to avoid subsequent pericardial effusion and the development of constrictive pericarditis with its adverse effect on myocardial function. When constrictive pericarditis is present, it obviously should be relieved by appropriate surgery. Efforts should be made to minimize cardiac output in hemodialysis patients. Whether or not routine transfusions to maintain a higher hematocrit are indicated is a question that cannot yet be answered. However, patients with marginal cardiovascular function who are accepted on hemodialysis and must have an arteriovenous shunt should be supported in any manner to minimize an increase in cardiac output. Early and aggressive treatment of known episodes of sepsis is important in the elimination of valvular endocarditis in this patient population. Perhaps one of the finer indicators of adequacy of hemodialysis will be K rate and peak immunoreactive insulin levels. Continued abnormality of these parameters may contribute to cardiovascular disease. Clearly, further study of the effect of abnormal carbohydrate metabolism on lipid metabolism is in order. Serum triglyceride, serum cholesterol and lipid electrophoretic pattern should be followed to evaluate the beneficial effects of drug therapy and changes in dialytic technique on the development of cardiovascular disease. Careful monitoring of calcium, phosphorus, bone films and parathyroid hormone levels is indicated to assess parathyroid status. The use of aluminum binders and parathyroidectomy to prevent vascular and myocardial calcification is important in the therapy of these patients. The use of cardiac catheterization, coronary artery arteriography, and possibly cardiac vascular repair, should be considered in the chronic hemodialysis patient with coronary artery disease if he is otherwise well. Adequacy of hemodialysis perhaps can be evaluated through its effect on all of the above parameters. Whether or not changes in artificial kidney treatments can correct the final vascular disease remains to be seen.
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PMID:Cardiovascular disease in uremic patients on hemodialysis. 109 1

2 case histories of retinal damage in users of oral contraceptives (OCs) are discussed. The 1st, a 27-year-old woman who had used Eugynon for a year, had no history of cardiovascular disease of hemicrnaia. Ophthalmic examination showed vision in the right eye as less than 6/120, in the left 6/6, with indications of central serous chorio-retinpathy, with edematous center surrounded by small hemorrhages. After discontinuation of OCs, vision returned to 6/6 and paracentral scatoma disappeared. In the 2nd case a 37-year-old woman who had taken Eugynon and Ovulen for 1 year and Neolyndiol for 2 years complained of the appearance of a wedge-shaped shadow in her right eye. The patient had a history of metrorrhagia and hemicrania on the right side. Vision in both eyes was 6/6, but a paracentral scotoma in the right eye was present, a probable symptom of the patient's hypertensive spastic angiopathy. OCs were discontinued and propanol was administered, then discontinued due to symptoms of a scotoma in the left eye. The angiopathy disappeared but the ocular lesions remained. Ocular complications occur in about .07% of OC users. The damage results from arterial hypertension and changes in the macula lutea. Careful observation of blood pressure and ocular disturbances is the best preventative for ocular damage in OC users.
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PMID:[Retinal damage and oral contraceptives]. 125 82


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