Coarctation of the aorta in infants.
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Aortic Coarctation↗
Biomedical subjects
D Goldring
Publications and source records attributed to D Goldring.
Dilated cardiomyopathy in infants and children.
The outcome of medical treatment of dilated cardiomyopathy in infants and children was reviewed to develop a predictive index for selection of patients likely to benefit from cardiac transplantation. The clinical findings, laboratory investigations, treatment and outcome of 20 patients (Group 1) less than 2 years of age at presentation and 12 patients (Group 2) greater than 2 years of age at onset were compared. Of 20 Group 1 patients, 5 (25%) died. Available autopsies (four patients) showed endocardial fibroelastosis. Of 15 survivors, 10 showed improvement in cardiac status and 5 remained unchanged. Ninety-three percent of survivors had dilated cardiomyopathy consistent with endocardial fibroelastosis by angiocardiography. All 12 Group 2 patients died. In addition to age at presentation and poor outcome, Group 2 differed from Group 1 in having a higher incidence of other family members with cardiomyopathy, more significant rhythm disturbances at presentation and a more rapid course to death. Risk factors of poor outcome in both groups included persistent cardiomegaly and the development of significant arrhythmias by Holter electrocardiographic monitoring. Cardiac transplantation is recommended for children with dilated cardiomyopathy presenting after age 2 years who survive 1 month. Those patients less than 2 years old at presentation whose condition has not improved after 1 year and who have persistent cardiomegaly or complex ventricular arrhythmias may also benefit from transplantation.
Actuarial Analysis↗
Should blood pressure be measured routinely in children under 3 years of age?
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Age Factors↗
Sodium-lithium countertransport in erythrocytes of children and adolescents with hypertension.
We have investigated the sodium-lithium countertransport system as a screening test for hypertensive disease in children and adolescents using the method of Canessa et al. [New Engl. J. Med. 302: 772-776, 1980]. The sodium-lithium countertransport in erythrocytes was measured in patients, ages 4-18 years, having essential hypertension or secondary hypertension and compared with age-, weight-, sex- and race-matched normotensive controls. Children and adolescents with essential hypertension possessed a significantly higher erythrocyte sodium-lithium countertransport rate than the normotensive control group (0.39 +/- 0.18, n = 28, vs. 0.22 +/- 0.14 mmol Li/l red cells/h, n = 20, respectively; p less than 0.001). Children with secondary hypertension had intermediate values (0.31 +/- 0.15 mmol Li/l red cells/h; n = 17) which did not differ significantly from values of subjects with essential hypertension or normotensive controls. There was no correlation of counter-transport values with age, sex, or body weight in either hypertensive or normotensive groups. However, white normotensive children had significantly higher countertransport levels compared with black normotensives (0.32 +/- 0.14, n = 10, vs. 0.13 +/- 0.07 mmol Li/l red cells/h, n = 10, respectively; p less than 0.005). Similarly, white children and adolescents with essential hypertension had higher mean countertransport measurements than did black hypertensives (0.42 +/- 0.20, n = 21, vs. 0.27 +/- 0.05 mmol Li/l red cells/h, n = 7, respectively) although this difference did not reach statistical significance (p less than 0.1). Although children and adolescents with essential hypertension had a significant elevation of sodium-lithium countertransport when compared to normotensives, the large degree of overlap of countertransport values in these two groups, as well as the intermediate values of children with secondary hypertension, limits the usefulness of the sodium-lithium countertransport as a screening test for essential hypertension in this population. Taking into account the influence of racial differences on the countertransport assay does not sufficiently improve the discriminatory value of the test to render it clinically useful.
Adolescent↗
Effect of weight training on blood pressure and hemodynamics in hypertensive adolescents.
Six adolescents with persistent essential hypertension were examined to determine the effect of weight training on their blood pressure and hemodynamics. Five had first completed an endurance training program; one subject trained only by weight lifting. All subjects were reevaluated after 5 +/- 2 months of weight training, and 12 +/- 2 months after cessation of training. Endurance training resulted in an increase in VO2max and decreases in systolic and diastolic blood pressure. After weight training, VO2max had decreased to the level found prior to endurance training, and body weight was significantly increased. Systolic blood pressure after weight training was 17 +/- 4 mm Hg lower than when measured initially (P less than 0.01). Weight training maintained the reduction in diastolic pressure elicited by endurance exercise in those who initially had diastolic hypertension. Cessation of all forms of training resulted in no change in body weight, body fat, or VO2max from the values measured after weight training. Systolic pressure increased significantly with the cessation of training to a value not different from that measured initially. Diastolic pressure also increased after cessation of training, but was still below the initial value. The only significant hemodynamic change found was a reduction in systemic vascular resistance in response to weight training. Weight training in hypertensive adolescents appears to maintain the reductions in blood pressure achieved by endurance training, and may even elicit further reductions in blood pressure.
Adipose Tissue↗
Effect of exercise training on plasma catecholamines and haemodynamics of adolescent hypertensives during rest, submaximal exercise and orthostatic stress.
Twelve adolescents with essential hypertension were studied to determine the effect of exercise training on plasma catecholamine concentrations, blood pressure and cardiovascular haemodynamics at rest and during submaximal exercise and orthostatic stress. Maximal oxygen consumption (VO2max) increased 13% with training while body weight and body fat did not change. Resting systolic and diastolic blood pressures decreased significantly with training, while plasma norepinephrine and epinephrine levels were unchanged. The increase in systolic blood pressure in response to standing was significantly lower after training, while the plasma catecholamine response was not significantly different. At the same absolute work rate after training, the subjects' systolic and diastolic blood pressures, heart rates, and plasma norepinephrine and epinephrine levels were significantly lower than before training. At the same relative work rate after training, the blood pressure response was the same as before training despite significantly higher plasma norepinephrine levels. Thus, the training-induced changes in resting blood pressures and blood pressure responses to orthostatic and submaximal exercise stress cannot be attributed to decreases in plasma catecholamine levels.
Adaptation, Physiological↗
Management of childhood hypertension.
The pathogenesis of primary hypertension remains unknown despite extensive investigation. Recent publications provide evidence that primary hypertension may have its inception in childhood or possibly in infancy. Longitudinal studies are needed to determine whether the infant and child with primary hypertension becomes a hypertensive adult. What is also needed is a genetic marker other than elevated blood pressure that may specifically identify the primary hypertensive person. We recommend nonpharmacologic therapeutic intervention in the pediatric patient with primary hypertension. More intensive investigation of pediatric patients with primary hypertension should be encouraged and supported. The complex puzzle of primary hypertension is more likely to be solved if discovered at the inception of the disease in infancy or childhood rather than in the later irreversible stage in adulthood.
Adolescent↗
Spontaneous closure of secundum atrial septal defect in infants and young children.
The records of 264 pediatric patients with uncomplicated ostium secundum atrial septal defect (ASD) were reviewed. Eighty-seven patients were younger than age 4 years at the time of cardiac catheterization. Subnormal weight gain, frequent pneumonia, cyanosis or tachypnea were present in 26 patients (30%). Of the 36 infants at catheterization, 17 (48%) had the previously described symptoms, including 12 (33%) who had congestive heart failure. Eight of the 36 infants were found to have closed their defect at a subsequent catheterization. Six of 18 patients who underwent cardiac catheterization between 1 and 2 years of age also had spontaneously closed their ASD at subsequent study. Statistical analysis of hemodynamic data revealed no difference (except a smaller shunt size) between ASDs that closed and those that did not in patients who were less than 4 years at initial catheterization. Analysis of hemodynamic data revealed no statistical differences between groups of patients with an ASD who were younger than and those older than 4 years at time of diagnostic study. Patients with ASDs that closed were significantly different from patients with atrial level shunting thought to be secondary to a valve-incompetent foramen ovale with respect to age at initial study (11 versus 2 months, p less than 0.001), mean left atrial pressure (7.7 versus 12.3 mm Hg, p less than 0.02) and difference between mean right and left atrial pressures (1.0 versus 4.2 mm Hg, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
Angiocardiography↗
Effect of exercise training on the blood pressure and hemodynamic features of hypertensive adolescents.
Twenty-five adolescents (aged 16 +/- 1 years) whose blood pressure (BP) was persistently above the 95th percentile for their age and sex were studied before and after 6 +/- 1 months of exercise training and again 9 +/- 1 months after the cessation of training. Maximal oxygen consumption (VO2) increased significantly with training. There was no change in body weight or sum of skinfolds. Both systolic and diastolic BP decreased significantly with training; however, complete BP normalization was not achieved. When the subjects were retested 9 +/- 1 months after cessation of training, systolic BP and VO2 max had returned to pretraining levels; however, diastolic BP was still below pretraining levels in the subjects who had diastolic hypertension initially. Except in subjects who initially had an elevated cardiac output, no consistent hemodynamic changes were found with training or cessation of training to account for the reductions in BP. The subjects whose resting cardiac outputs were high initially had significantly lower cardiac outputs after training as a result of decreases in both heart rate and stroke volume; however, vascular resistance remained unchanged. Sedentary control subjects with similar BP had no significant change in any of the variables measured over a similar period. These data indicate that moderate endurance exercise training can lower BP in otherwise healthy hypertensive adolescents as an initial therapeutic intervention.
Adolescent↗
Blood pressure in a high school population. II. Clinical profile of the juvenile hypertensive.
One-hundred-fourteen hypertensive high school students were evaluated to determine whether a distinctive clinical profile could be identified; 71 normotensive students served as controls. Selected blood chemistry determinations, urinalysis, and chest roentgenograms were done to help rule out secondary causes of hypertension. Left ventricular function was assessed by echocardiography and systolic time intervals. The hemodynamic response to exercise was also evaluated. A significant number of the subjects 14 to 18 years of age with persistent systolic and/or diastolic pressure 1.65 SD above the mean for age and sex showed the following: obesity; elevated serum triglyceride concentration; basilar hypertrophy by electrocardiogram/vectorcardiogram; electromechanical systole and pre-ejection period shorter, and the ratio of the pre-ejection period over the left ventricular ejection time lower, than mean for age and sex as determined by systolic time intervals; volume indices depressed and cardiac contractile functions elevated as determined by echocardiography; higher blood pressure at start of exercise stress test and higher peak systolic and diastolic pressures during test, and a slower return of heart rate to base line level after the test. The above findings should be useful in following the course of a young individual with essential hypertension and may provide a means of evaluating therapeutic intervention.
Adolescent↗
Blood pressure in black and in white children.
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Adolescent↗
Blood pressure in a high school population. I. Standards for blood pressure and the relation of age, sex, weight, height, and race to blood pressure in children 14 to 18 years of age.
This is a report on the initial from an ongoing study of blood pressure in ninth to twelfth grade students in the St. Louis metropolitan area. The purpose was to establish standards, to determine the incidence of hypertension, and to examine the relationship of blood pressure to age, weight, height, sex, and race. Subjects with persistent hypertension were to be investigated and checked annually as long as they were in high school. Students in the ninth grade at the beginning of the project were to be screened each year for four years.
Adolescent↗
Childhood blood pressure and hypertension in office practice.
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Adolescent↗
High blood pressure in children: problems and guidelines for evaluation and treatment.
Evidence is presented from studies of the authors and of other investigators that primary hypertension is more common in children than was previously thought. Ninety-five percent of 131 asymptomatic children with incidental hypertension were considered to have primary hypertension after investigation for possible causes. The definition of hypertension was based on normal ranges of blood pressure for each age and sex. However, the definition of juvenile hypertension is still unsettled as is the question of treatment. Investigation of the effect of prolonged antihypertensive therapy on growth and development is needed. Primary hypertension in the young makes possible the study of the disease at its inception.
Blood Pressure Determination↗
The effects of long-term administration of 3H-digoxin to the pregnant ewe upon the cardiovascular hemodynamics of the fetal lamb.
Placental transfer of tritiated digoxin in the ewe and its effect upon the left ventricular output (LVO) of the exteriorized fetal lamb were studied. Seven ewes were given 6 mug per kilogram of body weight of tritiated digoxin daily (20 per cent of total digitalizing dose 0.03 mug per kilogram of body weight) during their entire pregnancies. The fetuses were exteriorized between 130 and 140 days of gestation, and the LVO was determined serially by the dye-dilution technique for one hour. The mean tissue concentrations in millimicrograms per gram for the ewes were: heart, 5.7 plus or minus 1.76; liver, 3.38 plus or minus 1.38, kidney, 01.9 plus or minus 12.3. Corresponding values for the fetuses were: 1.55 plus or minus 1.01, 0.78 plus or minus 0.35, and 2.48 plus or minus 1.18. The mean serum level for the ewe at the end of one hour was 1.65 ng. per milliliter plus or minus 0.48, and that for the fetus was 1.22 plus or minus 0.20. The amniotic fluid contained 1.45 ng. per milliliter plus or minus 0.27. At the end of one hour, the mean LVO of the fetus had decreased by 39 plus or minus 15 per cent of its control value. Although the fetal serum level of tritiated digoxin was similar to that found in the mother and the amniotic fluid contained a significant amount of tritiated digoxin, the fetal tissue concentration of tritiated digoxin was not sufficient to produce any demonstrable inotropic effect.
Amniotic Fluid↗
Constrictive pericarditis in children.
We observed five cases of constrictive pericarditis (CP) during a 12-year period, and studied the clinical findings, usual causes, and hemodynamic findings. There are two variants of CP: a chronic form, which is usually of unknown cause, and a rapidly developing form, which follows an attack of effusive pericarditis. A high index of suspicion is necessary to establish the diagnosis of CP both in children with a prolonged course of ascites and failure to thrive and in children with effusive, usually purulent, pericarditis. Although CP is rare in childhood, it should be easily recognized and curative surgical therapy should be rapidly initiated.
Adolescent↗
Idiopathic paroxysmal ventricular tachycardia in infants and children.
Seven children with idiopathic PVT ranging in age from one day to 18 yr, have been observed during the past three years. The presenting complaints and frequency of paroxysms varied greatly. Three patients presented with syncope; four were asymptomatic. Lidocaine was effective in terminating acute symptomatic attacks; procaine amide and propranolol were effective in long-term control of the arrhythmia. Monitoring of the dynamic ECG was invaluable in establishing the diagnosis, characterizing the arrhythmia, and evaluating the effects of activity and therapy.
Adolescent↗
Blood pressure and puberty.
The purpose of this investigation was to study the relation of blood pressure to sexual maturation in 229 boys and 189 girls, 10 to 14 years of age. The results showed that there was no significant correlation between the systolic and diastolic pressure with the level of serum follicle-stimulating hormone and luteinizing hormone in either sex. Nor was there a significant correlation with the stage of pubic hair development in the boys nor with the stage of breast development, menarche, and duration since menarche in the girls. Therefore the presence of hypertension during 10 to 14 years of age should not be regarded as a physiologic response to pubertal development, but rather as a suspicious finding which deserves careful follow-up examinations.
Adolescent↗