Heart disease in Egypt. Part IV. Coronary heart disease.
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Angina Pectoris↗
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Advances in acquired pediatric heart disease.
Acquired heart disease in children may result in significant morbidity and mortality. Advances continue to be made in understanding Kawasaki disease, acute and chronic rheumatic heart disease, infective endocarditis, myocarditis, and dilated cardiomyopathy. The role of superantigens, particularly bacterial toxins, in the pathogenesis of Kawasaki disease continues to be defined. Intravascular ultrasound promises to improve the assessment of coronary arteries in Kawasaki disease. Current recommendations for the long-term management of Kawasaki disease are discussed. Significant changes in the epidemiology of acute rheumatic fever and endocarditis are noted. Updates on the role of echocardiography as well as current therapeutic issues in these diseases are addressed. The application of immunologic and molecular biologic techniques have implicated genetic and immune factors in the pathogenesis of myocarditis and cardiomyopathy. The relationship between viral infection and subsequent dilated cardiomyopathy, as well as the role of autoimmune mechanisms in the pathogenesis of these disorders, remains controversial.
Child↗
[Viscoelastic property alterations in patients with rheumatic heart disease and congestive heart failure].
Few papers on alteration of whole blood viscoelastic properties in patients with congestive heart failure (CHF) have been reported. In this study viscoelastic property parameters were measured in 63 consecutive patients with rheumatic heart disease and CHF. All subjects were divided into four groups according to NYHA classification of heart function. There were 14 class I, 16 class II 20 class III and 13 class IV. Contraves low-shear-30 rheometer was used for measuring the viscoelastic parameters. The results demonstrated that there was no significant difference of these parameters between class I and class II, that the apparent viscosity, AI and eta' in class III were higher than those in class I, and that eta 0.512, eta 5.96 AI, eta', eta" and G' in class III were higher than those in class II. All viscoelastic parameters but eta p in class IV were markedly higher than those in other groups. However, there were no statistically significant difference of eta p among all subjects and nor significant difference of these parameters between male and female were noted. There was a negative correlation between viscoelastic parameters and heart function parameters by pulse Doppler echocardiography (peak flow velocity, stroke volume and cardiac output). The results also showed a significant direct correlation between eta 0.512 AI, and eta" and the heart function parameters mentioned above.
Adolescent↗
Hyperthyroid heart disease.
The heart is an organ sensitive to the action of thyroid hormone, and measurable changes in cardiac performance are detected with small variations in thyroid hormone serum concentrations. Most patients with hyperthyroidism experience cardiovascular manifestations, and the most serious complications of hyperthyroidism occur as a result of cardiac involvement. Recent studies provide important insights into the molecular pathways that mediate the action of thyroid hormone on the heart and allow a better understanding of the mechanisms that underlie the hemodynamic and clinical manifestations of hyperthyroidism. Several cardiovascular conditions and drugs can interfere with thyroid hormone levels and may pose a difficulty in interpretation of laboratory data in patients with suspected thyroid heart disease. The focus of this report is a review of the current knowledge of thyroid hormone action on the heart and the clinical and hemodynamic laboratory findings as well as therapeutic management of patients with hyperthyroid heart disease.
Atrial Fibrillation↗
Clinical aspects of the Chagas' heart disease.
Chagas' heart disease, caused by protozoan Trypanosoma cruzi, is a common cause of cardiomyopathy in the Americas. Transmission of T. cruzi occurs through Reduviids, the kissing bugs. Less common ways of transmission are blood transfusion, congenital transmission, organ transplantation, laboratory accident, breastfeeding, and oral contamination. Infestation results in cardiac dysautonomia, myocardial apoptosis, and myocardial fibrosis. In acute phase, death is mostly caused by myocarditis and in chronic phase, it is mostly by irreversible cardiomyopathy. A majority of the patients with Chagas' disease remain in the latent phase of disease for 10 to 30 years or even for life. Specific anti-Chagas' therapy with trypanocide drugs is useful in acute phase but the management of chronic Chagas' heart disease is mostly empirical. The mortality during the acute phase of cardiac Chagas is around 5%. Five-year mortality of chronic Chagas' disease with cardiac dysfunction is above 50%. The clinical aspects of the Chagas' heart disease are concisely reviewed.
Acute Disease↗
Report of Inter-Society Commission for Heart Disease Resources. Prevention of Cardiovascular Disease. Primary prevention of congenital heart disease.
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Child↗
Ventricular dysrhythmias in ischemic heart disease.
Ischemic heart disease remains a leading killer in industrialized nations. A significant cause of the morbidity and mortality in patients with ischemic heart disease is ventricular dysrhythmic events. There is a continued search for safe and effective treatment for patients with ventricular dysrhythmias. In this article, the author discusses current understanding of the mechanisms for dysrhythmias in the setting of acute ischemia and in the chronically infarcted ventricle. Therapy for patients with ventricular tachycardia and ventricular fibrillation is reviewed. Nurses caring for cardiac patients are continually involved in rhythm monitoring and dysrhythmia interpretation. The nurse is often the first responder present when a fatal dysrhythmia occurs. In addition, nurses can be involved at all levels of care, from prevention of heart disease to assisting the patient cope with a sudden cardiac death episode.
Electrocardiography↗
Maternal drugs and congenital heart disease.
Congenital heart disease comprises one-third of all major birth defects. Prevalence estimates depend on the definition of the disease and the postnatal period when the disease is diagnosed. The studies with the longest follow-up estimate that 0.9% of infants are afflicted. The cause of these cardiac defects is largely unknown. The effect of embryonic exposure to maternal drugs during cardiogenesis has been widely studied, and the evidence suggests that maternal use of ethanol, anticonvulsants, lithium, and exogeneous female hormones may increase the risk of congenital heart disease. An antiemetic agent containing doxylamine has been implicated in the courts. This review offers an analysis of the epidemiologic evidence of the occurrence of congenital heart disease in relation to maternal drug use during pregnancy. The evidence indicates that the vast majority of heart malformations cannot be attributed to these pharmacologic agents.
Amphetamines↗
An adjunctive preventive treatment for heart disease and a set of diagnostic tests to detect it: insulin-like growth factor-1 deficiency and cell membrane pathology are an inevitable cause of heart disease.
Coronary heart disease (CHD) is a preventable disease with high morbidity and mortality. Largely omitted from the efforts at detection and treatment are the contributions of the lungs, the skeletal muscles and the arteries to heart disease pathology. Also omitted are the effects of the age-related decline in insulin-like growth factor-1 (IGF-1) and the age-related increase in cell membrane pathology. The hypothesis on which this model is based postulates that growing older, over time, necessarily results in pathological changes in the heart, the lungs, the skeletal muscles and the arteries. Additionally, the age-related decline in (IGF-1) that occurs in the otherwise healthy aged population also causes similar pathological changes. The drug portion of the proposed treatment includes the use of the drug acetyl-l-carnitine (ALC) to increase the age-related decreased IGF-1 levels. The drug centrophenoxine (CPH) is used to reverse the age-related pathological changes that inevitably occur in the heart, the lungs, the skeletal muscles and the arteries. A testing procedure is included to improve the detection of heart disease and to monitor the results. It consists of five tests: the monitoring of plasma IGF-1 levels; the monitoring of blood pressure, and in particular elevated systolic blood pressure; the monitoring of blood pressure variability over time; a heart rate recovery time test and a heart rate reserve test. Heart rate reserve is defined as the difference between maximal heart rate and resting heart rate, after treadmill exercise. The changes in test results noted during treatment are an indicator of progress or deterioration in the prevention of heart disease, whatever the case may be.
Blood Pressure↗
Rheumatoid disease and ischaemic heart disease: insights from pathophysiology and vascular biology.
Rheumatoid disease (RD) is a multisystem inflammatory disorder, which is associated with an increased cardiovascular mortality, thought to be due to ischaemic heart disease (IHD). The precise mechanisms causing increased IHD in RD are unclear. However, there is increasing recognition that atherosclerosis is another chronic inflammatory condition, which shares several pathophysiological features with RD. For example, endothelial damage/dysfunction, platelet activation, hypercoagulability and angiogenesis are well-recognised in both disease processes. Furthermore, RD may influence traditional risk factors such as dyslipidaemia. Although the exact reasons for the increased ischaemic burden are unclear, physicians should place a high priority upon reducing cardiovascular risk in sufferers of RD. This review summarises factors that might contribute to the pathogenesis of IHD in RD. Discussion will focus upon features shared by atherosclerotic and rheumatoid processes, as well as possible interactions between RD and conventional IHD risk factors.
Cell Adhesion Molecules↗
[An evaluation of coronary artery lesions of Kawasaki disease and congenital heart disease using rotary three dimensional digital cardiovascular angiography].
Congenital heart disease and the coronary artery lesions of children suffering from Kawasaki disease were evaluated by cardiovascular angiography using a newly developed rotary three-dimensional digital angiography method, and the usefulness of the device was examined. This method enable the observation of lesions from 144 directions within a 180 degree range depicting an image from optimal directions. In addition, the radiation exposure during one angiography was about one fifth of that of conventional cineangiography. With regard to the lesions of the coronary artery, identification of the localization of the stenotic lesions were made possible, especially at bifurcations, or the stenotic lesions overlapping with other bifurcations or coronary artery aneurysms as well as the structure at the ostium of the left and right coronary arteries, which were difficult to identify using conventional coronary artery angiography. For the case of patient ductus arteriosus or major aortopulmonary collateral artery (MAPCA), separation and imaging of the overlap with other blood vessels through the three-dimensional observation became possible. This method is effective for the evaluation of the site, direction and morphology of these arteries. With regard to stenosis of the right ventricular outflow tract, the morphology and the degree of stenosis could be evaluated more accurately than by conventional cineangiography. In addition, the images matched well with the operative findings. This method was also effective for the diagnosis and evaluation of the stenosis at the main pulmonary artery and stenosis of the bifurcation of the right and left pulmonary arteries overlapping with the main trunk of the pulmonary artery.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Screening for congenital heart disease.
Congenital heart disease has the characteristics of a disease that is suited to screening, and the four-chamber view is an effective screening tool with a sensitivity of 40% to 50%. The use of multiple cardiac views can increase the pre-natal detection to 60% to 80%. Given that most infants with congenital heart disease are born to low-risk women, routine screening is warranted. Early pre-natal diagnosis provides an opportunity to exclude associated extracardiac and chromosomal abnormalities, discuss pregnancy options, adjust obstetric management, prepare parents for delivery of an affected baby, and plan delivery in a tertiary care center. Despite the widespread use of ultrasonography, only 15% to 30% of infants with congenital heart disease are identified prenatally. There is a need to do better.
Female↗
Can anti-oxidants prevent ischaemic heart disease?
Ischaemic heart disease remains a major cause of mortality in developed countries. A number of important risk factors for the development of coronary atherosclerosis have been identified including hypertension, hypercholesterolaemia, insulin resistance and smoking. However, these factors can only partly explain variations in the incidence of ischaemic heart disease either between populations or within populations over time. In addition, population interventions based upon these factors have had little impact in the primary prevention of heart disease. Recent evidence suggests that one of the important mechanisms predisposing to the development of atherosclerosis is oxidation of the cholesterol-rich low-density lipoprotein particle. This modification accelerates its uptake into macrophages, thereby leading to the formation of the cholesterol-laden 'foam cell'. In vitro, low-density lipoprotein oxidation can be prevented by naturally occurring anti-oxidants such as vitamin C, vitamin E and beta-carotene. This article explores the evidence that these dietary anti-oxidants may influence the rate of progression of coronary atherosclerosis in vivo and discusses the need for formal clinical trials of anti-oxidant therapy.
Animals↗
[Local myocardial contractility in patients with coronary heart disease and chronic heart failure].
The aim of the study was to evaluate the peculiarities of local left and right ventricular myocardial contractility in patients with coronary heart disease (CHD) and various degrees of chronic heart failure (CHF) using biventricular radioventriculography (RVG). Local left and right ventricular myocardial contractility was evaluated in 127 patients with CHD and CHF using RVG with a standard procedure of segmentary and phase histogram analysis. The patients were divided into two groups according to left ventricular ejection fraction (LVEF). Group I consisted of 89 CHD patients with NYHA II-III CHF and LVEF of > 40%; group II included 38 CHD patients with NYHA III-IV CHF and LVEF of < 40%. The significant decrease of LVEF in group II was caused by the prevalence of hypo- and akinetic segments in the structure of local contractility. In both groups total LVEF was maintained by lateral wall segments. Right ventricular contractility in patients with CHD and CHF was maintained by anteroseptal segments.
Aged↗
Profile and risk factors for congenital heart disease.
Congenital heart disease is an important cause of infant mortality and disability. The frequency, spectrum and contributory risk factors for significant cardiovascular malformations among live-births was retrospectively evaluated at the Aga Khan University Hospital. Of a total of 8331 live births between July, 1987 and December, 1992 34 babies were diagnosed to have congenital heart disease in the neonatal period giving a prevalence of 4 per 1000 live births. Ventricular septal defects was the most common (n = 10, 29%) abnormality. Eight cases had associated chromosomal abnormality, the most common being Trisomy 21. Maternal abortions, still-births, consanguinity and diabetes mellitus were not found to be significant risk factors for congenital heart disease in this survey.
Case-Control Studies↗
Brucellosis and heart disease. I. The shaky foundations of rheumatic heart disease.
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Brucellosis↗
[Congenital heart disease in adults. Part I. Non-cyanotic heart diseases].
Over the last decades major advances have been made in the diagnosis and treatment of congenital heart disease. Therefore, many children with simple and complex congenital heart defects can now survive to adulthood and represent an expanding population. Most of them are not "cured" and need specialized follow-up. This two-part review presents the more common acyanotic and cyanotic congenital heart diseases that adult cardiologists are likely to face in their daily practice and discusses recent treatment advances.
Adult↗
Electrocardiographic abnormalities predict deaths from cardiovascular disease and ischemic heart disease in Pima Indians with type 2 diabetes.
BACKGROUND: The association between electrocardiographic (ECG) abnormalities and deaths from cardiovascular diseases (CVD) and ischemic heart disease (IHD) has been reported in the general population, but there is little information regarding persons with type 2 diabetes. METHODS: Minor and major ECG abnormalities were identified and classified according to the Minnesota Code in a longitudinal study of 1605 Pima Indians aged > or =35 years with type 2 diabetes. Underlying causes of death were determined by review of all available clinical records, autopsy reports, medical examiners' findings, and death certificates. RESULTS: During a median follow-up of 14.1 years (range 0.1 to 33.8 years), there were 190 CVD deaths, 135 (71.1%) of which were attributable to IHD. The age-adjusted CVD death rates in men with none, minor, and major ischemic ECG abnormalities were 7.3, 12.2 and 27.8, and in women, 4.3, 4.8 and 12.5 per 1000 person-years, respectively. After adjustment for other co-variables in a multiple proportional hazards model, subjects with minor and major ischemic abnormalities on ECG had 1.22 (95% CI, 0.76-1.97) and 1.83 (95% CI, 1.21-2.76) times the CVD death rate, and 1.32 (95% CI, 0.70-2.50) and 2.12 (95% CI, 1.26-3.57) times the IHD death rate of those with no ischemic ECG abnormalities, respectively. CONCLUSIONS: The CVD and IHD death rates were higher in men and in subjects with major ischemic ECG abnormalities. Major ischemic abnormalities on ECG predicted death after accounting for other cardiovascular risk factors, including proteinuria.
Adult↗