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PubMed2000

Clinical significance of abnormal electrocardiographic patterns in trained athletes.

BACKGROUND-The prevalence, clinical significance, and determinants of abnormal ECG patterns in trained athletes remain largely unresolved. METHODS AND RESULTS-We compared ECG patterns with cardiac morphology (as assessed by echocardiography) in 1005 consecutive athletes (aged 24+/-6 years; 75% male) who were participating in 38 sporting disciplines. ECG patterns were distinctly abnormal in 145 athletes (14%), mildly abnormal in 257 (26%), and normal or with minor alterations in 603 (60%). Structural cardiovascular abnormalities were identified in only 53 athletes (5%). Larger cardiac dimensions were associated with abnormal ECG patterns: left ventricular end-diastolic cavity dimensions were 56. 0+/-5.6, 55.4+/-5.7, and 53.7+/-5.7 mm (P<0.001) and maximum wall thicknesses were 10.1+/-1.4, 9.8+/-1.3, and 9.3+/-1.4 mm (P<0.001) in distinctly abnormal, mildly abnormal, and normal ECGs, respectively. Abnormal ECGs were also most associated with male sex, younger age (<20 years), and endurance sports (cycling, rowing/canoeing, and cross-country skiing). A subset of athletes (5% of the 1005) showed particularly abnormal or bizarre ECG patterns, but no evidence of structural cardiovascular abnormalities or an increase in cardiac dimensions. CONCLUSIONS-Most athletes (60%) in this large cohort had ECGs that were completely normal or showed only minor alterations. A variety of abnormal ECG patterns occurred in 40%; this was usually indicative of physiological cardiac remodeling. A small but important subgroup of athletes without cardiac morphological changes showed striking ECG abnormalities that suggested cardiovascular disease; however, these changes were likely an innocent consequence of long-term, intense athletic training and, therefore, another component of athlete heart syndrome. Such false-positive ECGs represent a potential limitation to routine ECG testing as part of preparticipation screening.

Adolescent↗
PubMed1983

Cardiac involvement in mucolipidosis. Importance of non-invasive studies for detection of cardiac abnormalities.

Although mucolipidosis, a fatal metabolic storage disorder, is associated with cardiovascular abnormalities, detailed, non-invasive cardiac examinations have not been well documented. We studied 4 children with type II and type III mucolipidosis, 3 of whom had unequivocal evidence of aortic regurgitation characterized by phonocardiography and M-mode echocardiography. Two-dimensional echocardiography showed an aortic valve prolapse in 3, a mitral valve prolapse in 2 and a tricuspid valve prolapse in 1. The QT interval was prolonged in 2 cases. In 1 autopsy case, we found considerably thickened and retracted aortic, mitral, and tricuspid valves, and accumulation of the foam cells in the myocardium. Echocardiography revealed similar findings in another 3 cases. We conclude that cardiac manifestations in this disorder should be examined carefully particularly by the use of echocardiography which is an excellent technique for detecting cardiovascular abnormalities in mucolipidosis.

Adolescent↗
PubMed1984

Sudden death in cancer patients receiving lithium.

Lithium carbonate may attenuate the incidence and severity of infection associated with cancer chemotherapy but does not appear to improve patient survival. Of 100 patients with small-cell lung cancer receiving an identical regimen of cyclophosphamide, doxorubicin, and vincristine, 40 were assigned to treatment with lithium concurrently. To date, 60 patients have died, including 14 who died suddenly of apparent cardiovascular causes without evident progression of neoplastic disease or concurrent illness. Thirteen of the 14 sudden deaths were among 50 patients with clinical or electrocardiographic evidence of cardiovascular abnormalities before study entry. Among patients with pretreatment cardiovascular abnormalities, lithium administration was associated with a greater risk of sudden death and shorter survival. A strong interaction for risk of death was evident between lithium treatment and the use of bronchodilators. In multivariate analysis, the major predictors of patient survival were the quality of tumor response and treatment with lithium with or without bronchodilators. Lithium treatment is a major risk factor for sudden death in cancer patients with pretreatment cardiovascular changes receiving combination chemotherapy including an anthracycline antibiotic.

Analysis of Variance↗
PubMed1998

Relationship between severity of spinal cord injury and abnormalities in neurogenic cardiovascular control in conscious rats.

Abnormal sympathetic tone after spinal cord injury (SCI) initially results in hypotension and is subsequently associated with autonomic dysreflexia characterized by paroxysmal hypertension and bradycardia in response to noxious or visceral stimuli. To evaluate the effect of a clinically relevant compression model of SCI on cardiovascular control in the early postinjury period, we monitored arterial pressure (AP) and heart rate under control resting conditions and after visceral stimulation (colon distension) in conscious rats for 1 week after clip compression injury of the cord at T5. Rats were randomly allocated into 4 groups (n = 8 each): sham-operated, 20, 35, and 50 g injuries. Only the 50 g injury was associated with significant hypotension (73 +/- 4 mmHg) at 1 day post-SCI when compared to sham-injured rats (91 +/- 3 mmHg). In control rats, colon distention caused a transient pressor response of 16 +/- 3 mmHg and tachycardia. In rats with 20 g 35 g, and 50 g injuries, colon distension 1 day after SCI increased AP by 8 +/- 2, 15 +/- 3, and 21 +/- 1 mmHg, respectively. The hypertensive response correlated with injury severity (r = 0.75; p < 0.0001) and was associated with bradycardia. By 7 days after SCI, only rats with 50 g cord injuries experienced hypertension with reflex bradycardia with visceral stimulation. These data show that dysfunctional cardiovascular control after SCI is correlated with the severity of injury. Mild and moderate compressive SCI result in transient cardiovascular abnormalities which normalize by 1 week. In contrast, more severe injuries are associated with neurogenic hypotension and autonomic dysreflexia.

Animals↗
PubMed2006

Prevalence of glucose metabolism abnormalities and cardiovascular co-morbidity in the US elderly adult population.

PURPOSE: To estimate the prevalence of glucose metabolism abnormalities, including diabetes, and its associated cardiovascular risk factors and co-morbidity in the US elderly population. METHODS: Cross-sectional analysis of data from the Third National Health and Nutrition Examination Survey (NHANES III, 1988-1994) in adults aged 65 years and more. The 1997 American Diabetes Association (ADA) and the 1998 World Health Organization (WHO) criteria were used to classify the subject's glucose metabolism status. The 2-hour oral glucose tolerance test (OGTT) was performed only among those participants aged 40 to 74 years. RESULTS: The age-adjusted prevalence of diagnosed diabetes was 12.5% (95% CI: 11.4%-13.6%) among US adults aged 65 years or more. According to the ADA definition 40% of men and 28% of women were affected by some degree of glucose metabolism impairment. According to the WHO definition, 55% of men and 50% of women aged 65 to 74 years were affected by glucose metabolism abnormalities. Mexican-Americans were the most affected under both definitions (51% and 77%, respectively). Overall, 72% of elderly diagnosed diabetics had hypertension, 28% had coronary heart disease (CHD), 47% suffered from cardiovascular disease and 80% of them presented known CHD or multiple coronary risk factors, other than age, level of LDL-cholesterol and diabetes. Under both definitions, a trend towards a worsening coronary risk profile with increased glucose metabolism impairment was observed. CONCLUSION: A notable proportion of elderly people is affected by some degree of glucose metabolism impairment which in turn is associated with cardiovascular co-morbidity.

Aged↗
PubMed2000

Valvular abnormalities and cardiovascular status following exposure to dexfenfluramine or phentermine/fenfluramine.

CONTEXT: Fenfluramine and dexfenfluramine were voluntarily withdrawn from the market in September 1997 because of reports of an association with heart valve abnormalities. Studies have been limited by lack of comparison with untreated controls. OBJECTIVE: To evaluate cardiovascular status and the prevalence of valvular abnormalities, as assessed by clinical cardiovascular parameters and echocardiography, in patients treated for obesity with dexfenfluramine or phentermine/fenfluramine. DESIGN: Reader-blinded controlled study completed in February 1998. SETTING AND PARTICIPANTS: Twenty-five clinical centers in the United States. Of 1640 enrolled subjects, 1473 were eligible (479 and 455 had taken dexfenfluramine and phentermine/fenfluramine, respectively, continuously for 30 days or more in the previous 14 months, and 539 were untreated matched controls) and provided clinical and echocardiographic data. Mean (SD) age was 47.4 (11.4) years, mean body mass index was 35.0 (7.4) kg/m2, and 74% were women. Mean (SD) duration of therapy was 6.0 (3.3) months (range, 1-18.4 months) in the dexfenfluramine group, and 11.9 (10.4) months (range, 1.4-63 months) in the phentermine/fenfluramine group, while the untreated group had no anorexigen use during the previous 5 years. MAIN OUTCOME MEASURES: Cardiovascular signs and symptoms; echocardiographic evidence of aortic (AR) or mitral (MR) regurgitation according to US Food and Drug Administration (FDA) criteria (AR > or = mild or MR > or = moderate) and by grade; tricuspid and pulmonic valve regurgitation; and aortic, mitral, and tricuspid valve leaflet mobility and thickness, for treated vs untreated subjects. RESULTS: Cardiovascular signs and symptoms were similar among anorexigen-treated and untreated subjects. Prevalence rates and relative risk (RR) of AR were significantly increased in anorexigen-treated patients and were 8.9% in the dexfenfluramine group (RR, 2.18; 95% confidence interval [CI], 1.32-3.59), 13.7% in the phentermine/fenfluramine group (RR, 3.34; 95% CI, 2.09-5.35), and 4.1% in the untreated group (P<.001). No statistically significant differences in prevalence were observed for MR, thickening or decreased mobility of any valve leaflet, calculated pulmonary artery systolic pressure, or left ventricular ejection fraction. Serious cardiac events (including myocardial infarction, congestive heart failure, or ventricular arrhythmia) occurring at any time were not statistically different in treated and untreated subjects (dexfenfluramine, 9.0%; phentermine/fenfluramine, 4.0%; and untreated, 8.4%); and following anorexigen treatment were uncommon (dexfenfluramine, 2.3%; phentermine/fenfluramine, 2.4%, and untreated, 3.3%, when adjusted for the median start date of anorexigen use). CONCLUSIONS: Our data indicate that use of dexfenfluramine and phentermine/fenfluramine is associated with an increase in the prevalence of AR using FDA echocardiographic criteria, but was not associated with an increase in the prevalence of MR using FDA criteria or with serious cardiac events.

Aortic Valve Insufficiency↗
PubMed2002

Abnormal postexercise cardiovascular recovery and its determinants in patients after right ventricular outflow tract reconstruction.

BACKGROUND: Abnormal responses of heart rate (HR) and oxygen uptake (VO2) during exercise characterize patients after right ventricular outflow tract reconstruction (RVOTR) for congenital heart defects. However, little is known about the postexercise dynamics. METHODS AND RESULTS: We evaluated postexercise cardiovascular dynamics in 52 patients after closure of an atrioventricular septal defect (group A), 79 patients after RVOTR (group B), and 44 control subjects. HR variability, arterial baroreflex sensitivity (BRS), plasma norepinephrine, and hemodynamics were measured. Although there was no difference between group A and control subjects, declines in HR and VO2 after light and peak exercise and in systolic blood pressure (SBP) after peak exercise were delayed in group B. Age, low-frequency component of HR variability, and plasma norepinephrine were independent determinants of early HR decline. Peak SBP and VO2 had a great impact on the corresponding recoveries. When the peak values were excluded, body weight, BRS, and right ventricular ejection fraction were independent determinants of early SBP decline. BRS and the pulmonary artery resistance were independent determinants of VO2 decline throughout recovery, and age and right systolic ventricular pressure also determined the early VO2 decline. BRS and low-frequency component of HR variability were determined independently by the number of surgical procedures. CONCLUSIONS: In RVOTR patients, in addition to metabolic and autonomic maturation, surgery-related abnormal cardiac autonomic nervous activity and impaired hemodynamics have a great impact on delayed postexercise cardiovascular recovery.

Atrial Natriuretic Factor↗
PubMed2002

Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes.

OBJECTIVES: The aim of this study was to clarify the clinical relevance of ventricular tachyarrhythmias assessed by 24-h ambulatory electrocardiograms (ECG) in a large, unique, and prospectively evaluated athletic population. BACKGROUND: For athletes with ventricular tachyarrhythmias, the risk of sudden cardiac death associated with participation in competitive sports is unresolved. METHODS; We assessed 355 competitive athletes with ventricular arrhythmias (VAs) on a 24-h ambulatory (Holter) ECG that was obtained because of either palpitations, the presence of > or = 3 premature ventricular depolarizations (PVDs) on resting 12-lead ECG, or both. RESULTS: Athletes were segregated into three groups: Group A with > or = 2,000 PVDs/24 h (n = 71); Group B with > or = 100 <2,000 PVDs/24 h (n = 153); and Group C with only <100 PVDs/24 h (n = 131). Cardiac abnormalities were detected in 26 of the 355 study subjects (7%) and were significantly more common in Group A (21/71, 30%) than in Group B (5/153, 3%) or Group C athletes (0/131, 0% p < 0.001). Only the 71 athletes in Group A were excluded from competition. During follow-up (mean, 8 years), 70 of 71 athletes in Group A and each of the 284 athletes in Groups B and C have survived without cardiovascular events. The remaining Group A athlete died suddenly of arrhythmogenic right ventricular cardiomyopathy while participating in a field hockey game against medical advice. Frequent and complex ventricular tachyarrhythmias are common in trained athletes and are usually unassociated with underlying cardiovascular abnormalities. Such VAs (when unassociated with cardiovascular abnormalities) do not convey adverse clinical significance, appear to be an expression of "athlete's heart syndrome," and probably do not per se justify a disqualification from competitive sports.

Adolescent↗
PubMed1970

Genetics and congenital heart disease.

In isolated congenital heart disease genetic factors have been shown from family studies, individual pedigree analyses, the frequency of consanguinity, examination of data from twins, and possibly from cytogenetics. In defects of the atrial septum, where data are most complete, genetic factors appear to be important, particularly in secundum atrial septal defect. In the syndromes with abnormal chromosomes in which congenital heart disease is common, the cardiovascular abnormality is probably directly associated with the abnormal genetic material present. In hereditary disorders with normal chromosomes in which congenital heart disease features, the pattern of inheritance suggests transmission by a single gene or group of genes. The cardiovascular abnormality is genetically determined, though it may not become apparent until many years after birth.

Adult↗
PubMed1982

Cardiac function in end-stage renal disease.

To assess cardiac status in end-stage renal disease, we compared clinical, ECG, and echocardiographic data from 37 patients on maintenance hemodialysis with data from 42 patients with functioning renal transplants. Cardiovascular symptoms and abnormal cardiovascular findings were more common in dialysis-maintained patients than in those with transplants. Follow-up studies indicated that despite a high prevalence of cardiac symptoms, abnormal physical signs, and dilated left ventricles among patients with end-stage renal disease, systolic left ventricular function was generally well preserved irrespective of renal failure therapy. Compared with maintenance hemodialysis, however, successful renal transplantation is associated with an overall enhancement of cardiac status, the majority of which is probably secondary to transplant-associated improvement in hemoglobin level and control of intravascular volume.

Adolescent↗
PubMed1991

[Sports and congenital cardiopathies].

The authors give recommendations regarding the eligibility to sport practice of children with cardiovascular abnormalities. Exercise testing is important to determine the consequences of the cardiovascular abnormality on the child's physical ability. Echocardiography with Doppler ultrasound is essential in order to assess the repercussion of valvulopathies, particularly on the function of the left ventricle. Holter electrocardiographic recording is useful in the case of a history of malaises or syncopes. These investigations allow those children who are at risk of cardiac accidents during sport practice to be recognised, and to choose the sport which is the most appropriate to their individual condition. There are few complete contra indications to all types of sports, essentially obstructive myocardiopathy, primary pulmonary hypertension, severe aortic stenosis, and coronary abnormality.

Child↗
PubMed1983

Cardiac abnormalities in mixed connective tissue disease.

Sixteen patients with mixed connective tissue disease (MCTD) were studied using noninvasive cardiovascular techniques. Cardiovascular abnormalities including pericarditis, asymmetric septal hypertrophy, and LV dilatation were found in 38 percent of the study group. Borderline ECG and echocardiographic abnormalities were present in 31 percent of the study group, and the remaining 31 percent were normal by all study techniques. MCTD patients have a high prevalence of cardiovascular abnormalities when studied noninvasively. The most common clinical abnormality is a steroid-responsive pericarditis, present in 25 percent of our series.

Adolescent↗
PubMed1994

Cardiovascular causes of loss of consciousness in patients with presumed epilepsy: a cause of the increased sudden death rate in people with epilepsy?

UNLABELLED: BACKGROUND, METHODS, AND RESULTS: Syncope and seizures are often indistinguishable clinically. We present a series of 12 patients diagnosed as having epilepsy. Despite normal or nonspecific electroencephalographic findings, 11 of 12 patients were treated or offered treatment with long-term anticonvulsant agents. Subsequently, diagnoses of arrhythmic or neurally mediated syncope were made in all patients using Holter monitoring, long-term ambulatory loop electrocardiographic recording, or tilt-table studies. Arrhythmias included torsades de pointes (four patients), atrioventricular nodal reentrant supraventricular tachycardia (one patient), and sinus arrest (two patients). The remaining five patients had neurally mediated syncope with hypotension and bradycardia, including asystole in two patients. Treatment for the documented cardiovascular abnormalities resulted in the alleviation of syncopal symptoms. CONCLUSIONS: Because the observed cardiovascular abnormalities are potentially fatal, this series suggests that undiagnosed cardiac syncope may contribute to the documented increased sudden death rate in patients with presumed epilepsy. Cardiac causes of loss of consciousness should be considered in patients with presumed epilepsy, atypical premonitory symptoms (such as nausea, lightheadedness, or palpitations), nondiagnostic electroencephalograms, and failure to respond to anticonvulsant therapy.

Adolescent↗
PubMedDate not supplied

Left ventricular changes in isolated office hypertension: a blood pressure-matched comparison with normotension and sustained hypertension.

BACKGROUND: Isolated office (IO) hypertension is a benign condition according to some researchers, whereas others believe it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this study is to compare morphofunctional characteristics of the left ventricle (LV) in IO hypertensive subjects, normotensive subjects (hereafter, hypertensives and normotensives), and never-treated sustained hypertensives. The 3 groups were matched not only by age, sex, and body mass index but also by clinic blood pressure (BP) (IO hypertensives and sustained hypertensives) and daytime BP (IO hypertensives and normotensives). METHODS: We enrolled 42 IO hypertensives (clinic BP > 140 and/or 90 mm Hg and daytime BP < or = 130/80 mm Hg), 42 sustained hypertensives (clinic BP > 140 and/or 90 mm Hg and daytime BP > or = 140 and/or 90 mm Hg) and 42 normotensives (clinic BP < 135 and/or 85 mm Hg and daytime BP < or = 130/80 mm Hg). Left ventricular morphologic features and function were assessed using digitized M-mode echocardiography. RESULTS: Compared with normotensives, IO hypertensives had significantly thicker LV walls, increased LV mass, reduced diastolic function, increased prevalence of LV hypertrophy, and preclinical diastolic dysfunction. Sustained hypertensives, compared with IO hypertensives, had significantly thicker LV wall, higher LV mass, and lower diastolic function, whereas the prevalence of LV hypertrophy and preclinical diastolic dysfunction was greater than in IO hypertensives, but the difference did not reach statistical significance (P = .29). CONCLUSIONS: Comparing matched BP groups, IO hypertensives have LV morphofunctional characteristics considerably different from normotensives and qualitatively similar to sustained hypertensives. Therefore, our results support the hypothesis that IO hypertension should not be considered as simply a benign condition.

Adult↗
PubMed2005

Medical considerations in dental treatment of children with Williams syndrome.

Williams syndrome is a rare disorder that was first described in 1961. It is thought to be caused by a microdeletion in the long arm of chromosome 7 at 7q11.23 and is a multisystem, congenital, and panethnic disorder characterized by a number of developmental and physical abnormalities, including congenital cardiovascular abnormalities, mental retardation and neurological features, growth deficiency, genitourinary manifestation, gastrointestinal and musculoskeletal problems, behavioral characteristics, craniofacial features, ophthalmologic features, and dental problems. We describe cases of children with Williams syndrome treated in the department of Pediatric Dentistry of the Hadassah School of Dental Medicine, Jerusalem, Israel. The different treatments rendered to these children are discussed followed by general remarks drawn from those treatments and from a literature review. We conclude that sedation can be helpful in the younger age group to reduce anxiety and uncooperative behavior during minimal dental treatments. Treatment under general anesthesia seems more appropriate for older children and adolescents. Special attention should be given to initial evaluation of these patients, especially because with age aortic stenosis tends to intensify, which together with the progressive renal impairment can escalate blood pressure elevation.

Adolescent↗
PubMed2006

Isolated office hypertension: association with target organ damage and cardiovascular risk indices.

BACKGROUND: Isolated office hypertension (IOH) has been accepted as a benign condition by some researchers, whereas others believe that it is associated with cardiovascular abnormalities and increased cardiovascular risk. The aim of this present study was to evaluate the effects of IOH on target organ damage and cardiovascular risk indices. METHODS: Arterial blood pressure (BP) measured in the office and by 24-hour ambulatory blood pressure measurement (ABMP), carotid intima-media thickness (CIMT), left ventricular mass index (LVMI), cardiothoracic index (CTI), duration of QTc, 24-hour microalbuminuria, fibrinogen, C-reactive protein (CRP), total cholesterol, low-density-lipoprotein (LDL) cholesterol, high-density-lipoprotein (HDL) cholesterol and triglyceride levels were evaluated. Thirty-three subjects with IOH (office BP > or = 140/90 mmHg and daytime ambulatory BP <135/85 mmHg), 17 patients with sustained hypertension (office BP > or = 140/90 mmHg and daytime ambulatory BP > or = 135/85 mmHg), and 17 normotensive control subjects were recruited in the study. The three groups were matched for age, sex and body mass index. RESULTS: CIMT was greater in patients with IOH than in normotensive subjects, and it was significantly lower than that of sustained hypertension patients. Significantly higher LVMI was determined in subjects with IOH compared to normotensive subjects. CTI, QTc, microalbuminuria, fibrinogen, CRP, total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride levels did not differ significantly among the three groups. CONCLUSIONS: IOH causes significant target organ damage and should not be regarded as a benign condition.

Blood Pressure↗
PubMed1983

[Clinico-morphological characteristics of status thymicolymphaticus in adolescents and adults].

Analysis of 18 autopsy observations of status thymicolymphaticus (STL) in patients aged from 14 to 44 years is presented. The clinical diagnosis of STL in adults was shown to be unsatisfactory because physicians are not properly acquainted with its clinical manifestations. The latter are in some cases conditioned by predominant involvement of the endocrine system, in others by incompetence of immunogenesis. Fatal complications developing in some cases of STL are associated with congenital abnormalities in the cardiovascular system. Morphological signs of STL include hyperplasia of the thymus and lymphoid tissue in combination with adrenal hypoplasia and, in most cases, with cardiovascular abnormalities. This analysis suggests that STL is a congenital syndrome of immunoendocrine insufficiency combined in the great majority of cases with other malformations.

Adolescent↗