Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0231807 (exertional dyspnea)
 3,402 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The relationships between aortic stenosis, coronary artery disease, angina pectoris, and myocardial infarction were examined in 173 patients with isolated calcific aortic stenosis who had coronary arteriography as well as cardiac catheterization. All were over age 40 and had definite cardiac symptoms; 156 later had aortic valve replacement. Coronary lesions narrowing the lumen by 50% or more were present in 37% of patients aged 40 to 59 and 68% of those aged 60 to 82. Coronary disease was present in 64% of patients with angina pectoris and 33% of those without angina. Angina which occurred only in association with dyspnea on exertion was associated with coronary disease in 45% of instances, whereas angina which also occurred on exertion without any dyspnea or which occurred with emotional stress, after meals, during sleep, or at rest unprovoked was associated with coronary disease in 80% of instances. Patients with coronary disease without any chest pain or with atypical pain considered nonanginal were men, usually over age 60, with congestive heart failure as the predominant symptom. Electrocardiograms showing transmural inferior or anterolateral infarction nearly always indicated coronary disease, while QS patterns in Leads V1-2 occurred frequently with normal coronary arteries. Serum cholesterol was elevated in 23% of those with coronary disease and 8% of those without. A group of patients with moderate aortic stenosis could be identified, with aortic valve areas of 0.55 to 0.80 cm. per square meter, in whom coronary disease was the sole or chief cause of symptoms. The operative mortality rate with aortic valve replacement was 9.6% in those with coronary disease and 1.4% in those without significant coronary disease. Coronary disease is frequently present in patients with calcific aortic stenosis, particularly in those over 60, those with angina, and those with symptoms despite only moderate aortic stenosis. The type of anginal syndrome, the ECG evidence of transmural infarction, and the coronary risk factors provide additional clues for clinical diagnosis.
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PMID:Aortic stenosis, angina pectoris, and coronary artery disease. 30 Feb 16

A 44-year-old male was admitted to our hospital complaining of general fatigue and dyspnea on exertion with congestive heart failure (NYHA IV). Cardiac catheterization and angiogram revealed Ebstein's anomaly with severe tricuspid stenosis and functioning small right ventricle. Because of tiny right ventricular chamber, the usual surgical treatment for Ebstein's anomaly i.e. tricuspid valve replacement or valvuloplasty were deemed to be inappropriate. Tricuspid valvulectomy was performed to relieve the inflow stenosis of the right ventricle and excellent symptomatic relief was achieved. It is very rare to seen an adult case of Ebstein's anomaly with severe tricuspid stenosis and functioning small right ventricle. Tricuspid valvulectomy may be justified to use in this rare condition.
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PMID:[A successful case of tricuspid valvulectomy for Ebstein's anomaly with severe tricuspid stenosis]. 159 75

Congestive heart failure (CHF) is a major cause of mortality and morbidity, and has a prognosis similar to that of several malignancies. There are increasing trends in both prevalence and incidence rates of CHF which points towards CHF becoming a major community health problem. Early detection of CHF is dependent upon criteria to define the initial stages of a condition which progresses slowly over many years. In western countries the dominant causes of CHF are hypertension and coronary heart disease, which account for more than 75% of the cases. Other precursors are diabetes and rheumatic heart disease. Independent risk factors for CHF are hypertension, smoking, obesity, and psychological stress. Early detection of CHF through identification of early symptoms such as dyspnea on exertion, treatment of known heart diseases, and treatment of risk factors may prevent its progress. Epidemiological data indicate that primary preventive efforts should be directed against hypertension, smoking and obesity. A multiple risk factor interventional approach seems to yield the best result since these risk factors act synergistically.
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PMID:Epidemiology and prognosis of heart failure. 179 25

A large-scale, prospective, 8-week, office-based study was conducted to evaluate the effects of adding captopril to a therapeutic regimen of diuretic and digoxin or diuretic alone in the management of patients with mild to moderate congestive heart failure (CHF). A total of 2218 primary care physicians evaluated 6669 patients over the study period for efficacy parameters, which included changes in a modified New York Heart Association (NYHA) functional classification, symptomatology, and daily activity levels. Overall, 63.8% of evaluated patients improved with regard to functional ability, with 19% improving two or more modified NYHA classes. Symptoms of CHF, including dyspnea on exertion, fatigue, and orthopnea and signs, including rales and peripheral edema, were reduced in 86% of these patients: 41.5% demonstrated mild improvement; 30.0%, moderate improvement; and 14.5%, marked improvement. Three parameters, with which patients reported having difficulty at study entry, were assessed serially to evaluate changes in functional capacity; 78.5% of patients reported an increased walking distance, 72.3% had increased capacity for climbing stairs, and 60.2% had improved capacity for individual recreational activities. Adverse experiences were reported in 18.1% of all patients; 4.9% of patients withdrew from the study because of an adverse effect. Combination therapy with captopril and diuretic for CHF was shown to be safe and effective regardless of patient age (less than 70 years vs. greater than or equal to 70 years), duration of heart failure (less than 1 year vs. greater than 1 year), presence of digoxin treatment, or the dosing schedule employed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A large-scale trial of captopril for mild to moderate heart failure in the primary care setting. 191 72

A 62-year-old man who had complained of swelling of bilateral lower extremities, exertional dyspnea and jaundice for 3 months was referred to our hospital with a diagnosis of large abdominal aneurysm and congestive heart failure. His aortography and Doppler echocardiography revealed that he had the aorto-caval fistula due to rupture of abdominal aorto-iliac aneurysm. He underwent a reconstruction of abdominal aorta with woven Dacron bifurcation graft together with a closure of fistula with 3 mattress sutures. The postoperative course was uneventful and he is free from any symptoms. Problems of diagnosis, operative management and results are discussed, reviewing the previously reported cases in Japan.
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PMID:[Aorto-caval fistula due to rupture of abdominal aorto-iliac aneurysm--a case report of successful repair]. 196 Nov 90

Adults, especially high-aged patients with tetralogy of Fallot (TOF) are said to have a higher operative risk than younger ones because of fragility of their myocardium, bleeding from rich collateral circulation to lungs, and other complications such as brain abscess and endocarditis. It is often difficult to determine the surgical risk for total correction in cases of high-aged patients who have such complications. We report a successfully operated high-aged case of TOF with marked left ventricular dysfunction. A 52-year-old male was referred to our hospital because of exertional dyspnea and cyanosis. He had a history of cerebral embolism and meningitis several months prior to admission. On admission, he was NYHA class 3, and cyanosis and clubbed fingers were present. Cardiac catheterization showed a large VSD, 50% over-riding of the aorta and an infundibular pulmonary stenosis. Right to left shunt was 60% and Qp/Qs was 0.38. The left ventricular end diastolic volume index was 109 ml/m2, slightly larger than normal, and the ejection fraction was only 30%. This left ventricular dysfunction was thought to be caused by fibrosis of the myocardium due to longstanding hypoxemia and hypoxemia itself. There is no previous case report dealing with a successful total correction for a high-aged patient with TOF associated with such a severe left ventricular dysfunction. Congestive heart failure in the post-operative period was successfully treated by catecholamine for two weeks. Postoperative cardiac catheterization showed a small left-to-right shunt, and an improvement of left ventricular ejection fraction from 30% to 38%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A successfully operated case of tetralogy of Fallot with marked left ventricular dysfunction in adult]. 223 64

The heart as the primary site of lesion in malignant lymphoma is extremely rare. We experienced 2 cases of malignant lymphoma whose initial presentation was massive pericardial effusion with cardiac tamponade. The first case was a 75-year-old man who had shortness of breath for 1 week. Chest X-ray showed cardiomegaly (CTR 65%), and his condition was diagnosed as congestive heart failure at first and thereafter echocardiogram revealed pericardial effusion. The second case was a 76-year-old man who complained of exertional dyspnea which worsened over 2 weeks. His condition was diagnosed as congestive heart failure at first and echocardiogram revealed pericardial effusion. Pericardial drainage tapped bloody fluid and cytological examination revealed malignant lymphoma. After treatment, the first case lived for eleven months with no recurrence of pericardial effusion. The second case has lived for 4 years. We present these 2 cases can be defined as primary cardiac lymphoma according to McALLISTER and FENOGLIO, i.e., a lymphoma that involves only the heart and pericardium. More cases of primary cardiac lymphoma will be found in the future because of the ease with which the echocardiogram can detect pericardial effusion.
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PMID:Two cases of primary cardiac lymphoma presenting with pericardial effusion and cardiac tamponade. 226 77

Diffuse alveolar septal involvement is a rare form of pulmonary amyloidosis. Antemortem diagnosis is unusual, and most of the reported cases were diagnosed at autopsy. It has recently been reported that transbronchial lung biopsy via a flexible fiberoptic bronchoscope was a relatively safe method to confirm diffuse alveolar septal amyloidosis. We report a case of pulmonary diffuse alveolar septal amyloidosis confirmed by transbronchial lung biopsy. The patient's chief complaints were dyspnea on exertion and epigastric pain aggravated over a one-year period, while a chest roentgenogram showed bilateral diffuse interstitial infiltration. This case also showed nephrotic syndrome, cardiac arrhythmia, congestive heart failure, a tingling sensation in both hands and multiple nodules in the gastrointestinal tracts, suggesting involvement of the kidney, heart, peripheral nerves and gastrointestinal tracts. We propose that when diffuse interstitial lung disease is present with systemic signs such as nephrotic syndrome or cardiac arrhythmia, amyloidosis should be considered as a possible diagnosis. Also, transbronchial lung biopsy may be a useful confirmative diagnostic tool.
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PMID:Pulmonary diffuse alveolar septal amyloidosis--diagnosed by transbronchial lung biopsy. 227 13

Benazepril hydrochloride (CGS 14824A) is an orally active, nonsulfhydryl compound that is transformed in vivo to a long-acting inhibitor of angiotensin-converting enzyme (ACE). Previous studies have shown benazepril to lower blood pressure in hypertensive patients and to confer acute hemodynamic benefits in patients with congestive heart failure (CHF). In the current multicenter investigation, 16 patients with chronic CHF due to left ventricular systolic dysfunction (ejection fraction less than 0.40 at rest) whose symptoms corresponded to New York Heart Association classes II to IV were given open-label benazepril once daily in ascending doses of 2 to 20 mg and followed biweekly for 12 weeks. Evaluation of the 15 subjects who completed the trial showed a progressive increase in treadmill exercise duration (from 7.65 +/- 3.64 [SD] minutes at baseline to 9.74 +/- 3.66 minutes at 12 weeks, P less than .001); augmentation of the mean left ventricular ejection fraction (from 0.266 +/- 0.133 at baseline to 0.292 +/- 0.136 at 12 weeks, P less than .025); relief of exertional dyspnea in 7 of the 15 patients (P less than .02); and improvement in global symptomatic status in 10 of the patients (P less than .01). These responses were accompanied by a reduction in serum ACE activity of 75% (from 27.2 +/- 10.5 IU/L at baseline to 6.7 +/- 1.9 IU/L at 12 weeks, P less than .001), which was independent of dose and duration of treatment. The magnitude of ACE inhibition did not correlate with changes in the efficacy variables. Aside from two instances of symptomatic hypotension (one of which was complicated by volume depletion), the drug was well tolerated.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term therapy with benazepril in patients with congestive heart failure: effects on clinical status and exercise tolerance. 227 83

A 78-year-old woman with exertional dyspnea (Hugh-Jones Grade III) and dry cough was admitted to our hospital in April, 1983. She had marked cardiac cachexia and a loss of body weight due to long term heart failure. On physical examination a systolic ejection murmur and a diastolic rumbling murmur were heard without the opening snap sound. Chest radiography revealed pleural effusion and cardiomegaly. M-mode and two dimensional echocardiography demonstrated abnormal echoes in the left atrium, the density being 22.7 Hounsfield Unit. Radionuclide angiography and magnetic resonance imaging (MRI) provided similar findings. No other mass lesion existed in the other chambers. Based on these findings, the mass was diagnosed as a left atrial myxoma. She has been well except for periodic congestive heart failure, for about five years since her discharge. The course of her ailment is interesting because her treatment is mainly symptomatic.
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PMID:[A case of elderly (83-year-old) woman with possible left atrial myxoma]. 232 Jul 97


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