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At least 433 records · Page 24Linked to original sources
PubMed2002

Morphine promotes autonomic learning.

Morphine (0.01-10 mg/kg) promoted rapid autonomic learning of discriminative, Pavlovian conditioned heart rate decelerations to tone signals in male and female rabbits, and the higher doses (1-10 mg/kg) promoted decelerative heart rate orienting reflexes to novel tones. Morphine dose dependently reduced heart rate acceleration to signaled shock but had no effect on heart rate acceleration to unsignaled shock. Morphine did not impair retention of cardiac conditioned reflexes, and its U-shaped dose effect, increasing conditioned heart rate discrimination early in training, reappeared in extinction. The authors propose that morphine promotes autonomic learning of preparatory, compensatory reflexes to signaled stressors that reduce their stressful effects. This action may mimic the normal, adaptive function of an endogenous messenger released by the Pavlovian contingency.

Analysis of Variance↗
PubMed2000

Patients with cardiac disease: considerations for the dental practitioner.

The provision of dental treatment under both local anaesthesia and sedation has an excellent safety record, although medical problems may occur. The high prevalence of cardiac disease in the population, particularly ischaemic heart disease, makes it the most common medical problem encountered in dental practice. Additionally, the increasing survival of children with congenital heart disease makes them a significant proportion of those attending for dental treatment. While most dental practitioners feel confident in performing cardio-pulmonary resuscitation, treating patients with co-existent cardio-vascular disease often causes concern over potential problems during treatment. This article aims to allay many of these fears by describing the commoner cardiac conditions and how they may affect dental treatment. It outlines prophylactic and remediable measures that may be taken to enable safe delivery of dental care.

Anesthesia, Dental↗
PubMed2000

Cirrhotic cardiomyopathy and liver transplantation.

Myocardial contractility in cirrhosis is impaired, particularly under stressful situations, in a phenomenon termed cirrhotic cardiomyopathy. Impairment of the cardiac beta-adrenergic receptor and its signaling function appears to be involved in the pathogenesis of this disorder. Additional mechanisms that may have a role include alterations in the physicochemical properties of the cardiomyocyte plasma membrane and abnormalities in circulating humoral factors, such as nitric oxide, carbon monoxide, and catecholamines. The widespread use of orthotopic liver transplantation (OLT) and its associated stresses on the cardiovascular system have highlighted this condition. Cardiac failure has emerged as an important cause of morbidity and mortality in the liver transplant recipient. Unfortunately, pre-OLT recognition of cirrhotic cardiomyopathy is suboptimal because of a lack of sensitive, noninvasive diagnostic tests. Similarly, the management of cirrhotic cardiomyopathy is largely empirical because of a paucity of existing literature. Although evidence suggests that cirrhotic cardiomyopathy may be reversible after OLT, the natural history of this condition warrants further investigation.

Animals↗
PubMed1993

[Cerebral embolism in elderly patients with atrial fibrillation].

Novalvular (nonrheumatic) atrial fibrillation (NVAF) is the most common cardiac condition associated with presumed embolic stroke, accounting for approximately half of the cardiogenic embolic infarctions. Of autopsied stroke patients in the Tokyo Metropolitan Geriatric Hospital, cerebral infarction was found in 75%, intracranial hemorrhage in 19%, and coexisting cerebral hemorrhage and cerebral infarction in 6%. Twenty-eight percent of the cerebral infarctions were embolic infarctions of cardiac origin, 56% of which were caused by NVAF. The incidence of cardiogenic brain embolism ranged from 6 to 23% of the ischemic strokes, and NVAF is the most frequent substrate for brain embolism. Atrial fibrillation increases in its incidence with increasing age. Chronic AF was observed in 10%, and paroxysmal AF in 7% of the autopsied elderly patients. Most of them were nonrheumatic AF. Twenty-two percent of the AF patients had large cerebral infarction, and 15% had medium-sized cortical infarction at the autopsy. NVAF is a very important cause of fatal massive cerebral infarction in the elderly. Of 56 patients with fatal massive cerebral infarction who died within 2 weeks after the strokes, 25 (45%) had embolic stroke associated with NVAF. Anticoagulant therapy prevents recurrent cerebral embolism of cardiac origin. The proper time to initiate anticoagulant therapy following cardiac brain embolism is controversial. Immediate initiation of anticoagulant therapy can reduce the early recurrence, but can result in secondary brain hemorrhage or hemorrhatic transformation. Patients with NVAF may have a lower risk of recurrence during the first 2 to 4 weeks following the initial embolic stroke compared with other cardioembolic sources. Cerebral embolism with NVAF can recur during a long period.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2004

[The risk of noncardiac surgery in patients with heart disease: a new way for an easy approach to a right preoperative assessment].

The aim of cardiovascular preoperative evaluation in noncardiac surgery is to assess the current cardiovascular status of patients, to find underlying unknown diseases, to advise about medical management for patients in the preoperative period and, eventually, to postpone noncardiac surgery until cardiac conditions are improved or stabilized. The basic clinical evaluation, obtained by history, physical and ECG examination, provides enough data to estimate the cardiovascular risk. Cardiovascular risk factors and specific surgery risk have a huge importance in this evaluation; the specific surgery risk can be classified into three categories: high, intermediate, and low. However, the evaluation of cardiac risk is not simple and the eventual legal consequences are important. For this reason we propose this hypothesis for an easy approach to a right preoperative assessment based on a succession of eight steps; this way would be a support for specialists and young physicians that are called to give a clinical report on surgery timing and on possible problems of patients with cardiovascular disease undergoing noncardiac surgery.

Decision Trees↗
PubMed2000

Impaired heart function and noradrenaline release after ischaemia in stroke-prone spontaneously hypertensive rats.

1. Stroke-prone spontaneously hypertensive rats (SHRSP) are a strain of rat that exhibit severely high blood pressure and stroke attacks at an early age, but their heart function in vitro has seldom been studied in detail. Although the activity of the sympathetic nervous system is known to increase after myocardial ischaemia, there is little information about the cardiac release of noradrenaline (NA) associated with heart function after ischaemia in SHRSP. The aim of the present study was to examine heart function and cardiac NA release after ischaemia in SHRSP. 2. Isolated hearts of 4- and 8-month-old SHRSP and age-matched Wistar-Kyoto (WKY) rats were perfused in a working heart preparation and were subjected to 30 min ischaemia followed by 30 min reperfusion. Heart function and coronary flow were monitored throughout the experiment. Coronary effluent was collected for determination of NA using high-performance liquid chromatography coupled with electrochemical detection. 3. Under baseline conditions, cardiac output of 4-month-old SHRSP was slightly but significantly decreased compared with that of WKY rats (P < 0.05), although coronary flow was maintained normally at this age. Eight-month-old SHRSP showed a further impairment of systolic heart function, with lower coronary flow and higher coronary vascular resistance under baseline conditions. Elevated left ventricular end-diastolic pressure was evident in SHRSP at both ages before ischaemia. Heart function was severely damaged after 30 min global ischaemia in SHRSP from both age groups. Stroke-prone spontaneously hypertensive rats also showed lower coronary flow and higher coronary vascular resistance during reperfusion. 4. Coronary NA was not detectable in WKY rats or SHRSP at 4 months of age under baseline conditions. In 8-month-old SHRSP, pre-ischaemic NA release was significantly higher than that in age-matched WKY rat controls. The concentration of NA in the coronary effluent of SHRSP during reperfusion was also significantly higher than that of WKY rats at both ages. 5. These data demonstrate that SHRSP have early impairment of both systolic and diastolic heart function compared with WKY rats. Severe damage of heart function and coronary flow after ischaemia in SHRSP was accompanied with an increased release of NA, which may play a harmful role in heart function impairment in SHRSP after ischaemia.

Animals↗
PubMed1998

Diastolic heart failure: standard Doppler approach and beyond.

Evidence of normal systolic left ventricular function has been reported in up to 30-40% of patients with clinical signs of congestive heart failure, suggesting that diastolic dysfunction is an important predictor of prognosis and mortality. Doppler echocardiography as a noninvasive diagnostic procedure is able to provide immediate and relevant information on functional and structural changes underlying the clinical syndrome of heart failure. Four distinct early filling/late diastole (E/A) ratio patterns (normal, delayed relaxation, pseudonormal, restrictive) can be discerned if viewed within the context of other available clinical information. These patterns evolve from one to another in a single individual, with changes in disease evolution, treatment, and loading condition. They represent a continuum from normal to severe diastolic dysfunction, showing progressively increasing left ventricular (LV) chamber stiffness and subsequently decreasing deceleration time. The combination of Doppler restrictive filling pattern and decreased deceleration time provides important information that helps to differentiate gradations of diastolic dysfunction and has been found to be a potent predictor of prognosis and mortality in various cardiac conditions. When clinical and transthoracic data alone are not sufficient in guiding therapy of congestive heart failure, transesophageal echocardiography can be used to assess most Doppler flows, especially pulmonary venous and left atrial (LA) appendage flows. The use of the multiplane transducer in multiple intermediate scan planes further improves the possibility of optimizing the Doppler incident angle and obtaining the best Doppler recordings of the left upper or right upper pulmonary venous flow. Whereas LV diastolic dysfunction is common in patients with congestive heart failure and appears to be an important predictor of prognosis, little information is available about right ventricular (RV) diastolic dysfunction. The role of RV function in congestive heart failure has probably been underestimated and it is possible that RV diastolic dysfunction assessment is equally important in the follow-up of heart failure patients. Recently, 2 novel echocardiographic technologies for the assessment of ventricular wall dynamics have been developed--color kinesis and tissue Doppler imaging. Both techniques have recently been shown to provide global as well as regional information on LV contraction and filling. Complementary use of both techniques may allow a more complete noninvasive assessment of global and regional systo-diastolic LV function.

Cardiac Output, Low↗
PubMed2001

Surgical strategy for left ventricular free wall rupture after acute myocardial infarction.

BACKGROUND: Left ventricular free wall rupture is usually fatal without surgical intervention. However, the most appropriate surgical procedure remains controversial. METHODS: Seventeen patients (14 men, 3 women) who developed left ventricular free wall rupture after acute myocardial infarction were treated surgically. Their mean age was 65.4 years (range, 55 to 79 years). The following surgical procedures were performed: infarctectomy and patch reconstruction in 1 patient, direct closure with or without patch covering in 4 patients, simple patch covering anchored by running suture in 4 patients, and a sutureless technique in 7 patients. Endventricular patch closure was performed in 1 patient with ventricular septal perforation. RESULTS: One of 3 patients with a blow-out type rupture and 1 of 13 patients with an oozing type rupture died shortly after operation. The overall surgical mortality rate was 11.8%. CONCLUSIONS: Selection of the optimal procedure for each cardiac condition is important for obtaining good results. For patients with ongoing squirting bleeding, patch covering is the technique of choice. For oozing, the sutureless technique is preferable.

Aged↗
PubMed2004

[Cardiac rehabilitation in patients with a congenital heart disease, an implantable cardioverter defibrillator or chronic heart failure].

Cardiac rehabilitation is no longer just used to treat patients after the manifestation of a coronary artery disease such as a myocardial infarct, after a PTCA or after a coronary bypass operation. Patients with a congenital heart disease, patients who have received an implantable cardioverter defibrillator (ICD) and patients with stable chronic heart failure are also suitable candidates for a multidisciplinary cardiac rehabilitation programme. The new Dutch guidelines for cardiac rehabilitation, published in 2004, can be helpful in identifying potential candidates for a programme. Physical training is often a component of the treatment, but psycho-social counselling and education targeted at reducing anxiety and uncertainty, accepting the heart disease and learning to cope with it, can be just as important as those aspects targeted at improving the physical condition. Cardiac rehabilitation that includes physical training is safe for patients with congenital heart disease, for patients who have undergone an ICD implantation and for patients with stable chronic heart failure, as long as the pretraining exercise test is given a guiding role in selecting the appropriate physical work load. Patients with stable chronic heart failure should continue their physical training in order to maintain its beneficial physical and psychological effects.

Defibrillators, Implantable↗
PubMed1992

[DDD dual chamber pacemakers. Initial experience].

Our preliminary experience with dual-chamber DDD pacemakers is reported. Technological innovations of the device, atrio-ventricular electrode stability and sequential stimulation have contributed to improve the conditions of patients previously submitted to VVI pacemaker implantation. Primary indications for DDD pacemaker implantation in our series included 7 patients with complete atrio-ventricular (A-V) block, 3 with Mobitz type II second-degree A-V block and 2 with sick sinus syndrome. In six of the 12 patients (50%) additional indications included: ventricular tachycardia in 4 patients, atrial fibrillation in one and pacemaker syndrome in one. Other cardiac conditions were diagnosed: dilated cardiomyopathy in 3 patients, ischemic heart disease in 2 patients, valvular heart disease in 2 patients, congenital heart disease in 1 patient and hypertrophic cardiomyopathy in one patient. The implanted pacemakers were: 5 Genesis, 4 Ultra CPI and 3 Versatrax. J-shaped atrial electrodes were used in 8 patients and in 4 instances a screw-in electrode was employed. Improvement of hemodynamic function was achieved by frequent follow up and reprogramming of DDD pacemaker in every patient. While 4 patients died with progressive deterioration of cardiac function, eight patients survived with adequate sequential stimulation. We conclude that DDD pacemakers are reliable and afford symptomatic relief in a broad spectrum of patients.

Adult↗
PubMed1986

Physical conditioning effects on cardiac dimensions: a review of echocardiographic studies.

Echocardiographic studies related to chronic exercise effects on cardiac dimensions were reviewed. Sources of error in M-mode echocardiography include its resolving power, changes in transmission velocity in a nonhomogeneous medium, subjective analysis of records, and assumptions to predict ventricular volume and mass from one-dimensional data. Existing studies document larger values for left ventricular internal diastolic dimension (LVIDd) in endurance athletes, and for septal and posterior wall thicknesses (ST, PWT) in endurance, strength-type and anaerobic-type athletes compared to nonathletes. Values for the athletes were lower than in cardiac disease states. Short-term conditioning studies generally reported unimpressive changes in ventricular dimensions. Existing literature also does not clearly support a relationship between training intensity and the degree of cardiac enlargement, or changes in the heart's trainability with age. Hereditary and/or familial factors appear to influence heart size to some degree and a correlation with anthropometric variables may exist. Further study concerning hereditary and long-term conditioning effects is recommended.

Adolescent↗
PubMed1978

Supraventricular tachyarrhythmias in hospitalized adults after surgery. Clinical correlates in patients over 40 years of age after major noncardiac surgery.

To assess the clinical correlates and therapeutic outcome of new postoperative supraventricular tachyarrhythmias, 916 patients who were in sinus rhythm throughout the course of surgery were prospectively followed after major noncardiac surgery. The 35 patients (4 percent) who developed new postoperative supraventricular tachyarrhythmias frequently had concurrent medical problems, such as the following: other acute cardiac conditions, 16 patients (46 percent); major infections, 11 patients (31 percent); preexisting hypotension, ten patients (29 percent); anemia, nine patients (26 percent); metabolic derangements, eight patients (23 percent); parenteral therapy with new medications, eight patients (23 percent); and hypoxia, seven patients (20 percent). The arrhythmias of all treated patients reverted to sinus rhythm; 40 percent (14 patients) required no new therapy with cardiac medications, and only two patients required electrical cardioversion. No deaths were related to the supraventricular tachyarrhythmias, but 49 percent (17) of the patients died from their concurrent medical problems. The onset of a new postoperative supraventricular tachyarrhythmia should prompt a search for remediable medical problems. Direct antiarrhythmic therapy is often unnecessary and is usually secondary in importance to correction of the causes of the arrhythmia.

Adult↗
PubMed1990

Cutaneous manifestations of cardiac diseases.

Many general signs familiar to physicians can be found on the skin in cardiac patients. These include (a) cyanosis, central and peripheral, (b) erythremia, flushing and erythema, (c) digital clubbing and (d) alteration in texture. Specific cardiac conditions often have useful diagnostic cutaneous clues. Of these the association of coronary heart disease, hyperlipidemia and xanthomas is the most important. Rare syndromes such as the "leopard syndrome" often have distinctive skin signs. Multisystemic disorders may affect the heart and skin simultaneously or in sequence. They include collagen vascular diseases, amyloidosis, sarcoidosis and relapsing polychondritis. Finally iatrogenic disease arising from treatment of cardiac or cutaneous disease may induce changes in one or the other organ. The heart and the skin have much in common. These manifestations help elucidate the cause, evaluate the diagnosis, and follow the treatment and progress of these diseases.

Heart Diseases↗
PubMed2002

Effects of aging and subsequent exercise training on gene expression of endothelin-1 in rat heart.

Endothelin-1 (ET-1) is produced by endothelial cells and cardiac myocytes. ET-1 has potent positive inotropic and chronotropic effects on heart and induces myocardial cell hypertrophy. We investigated whether gene expression of ET-1 in rat hearts is altered by aging and subsequent exercise training. We also investigated whether gene expression of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), which participate in some pathological cardiac conditions, in the rat hearts is altered by aging and subsequent exercise training. We studied mRNA expression of ET-1, ANP and BNP in hearts of sedentary young rats (Sedentary young; 4 months old), sedentary aged rats (Sedentary aged; 23 months old), and swim-trained aged rats (Trained aged; 23 months old, swimming training for 8 weeks). The left ventricle weight mass index for body weight and left ventricular end-diastolic dimension were significantly higher in the Trained aged group compared with the Sedentary aged group. These results showed that Trained aged rats developed cardiac hypertrophy with improvement of cardiac function. The mRNA expression of ET-1 in the heart was significantly higher in Sedentary aged group compared with Sedentary young group, and was significantly higher in the Trained aged group compared with the Sedentary aged group. The mRNA expression of ANP and BNP in the heart was significantly higher in Sedentary aged group compared with Sedentary young group, and was significantly higher in the Trained aged group compared with the Sedentary aged group. The present results show that mRNA expression of ET-1 in the heart is increased by aging, and that the mRNA expression is further increased by exercise-induced cardiac hypertrophy, suggesting that ET-1 in the heart may participate in these physiological cardiac adaptations.

Aging↗
PubMed1996

Cardiac complications after hepatic resection.

During a period of 94 months between 1985 and 1993, 474 hepatic resections were performed in 451 patients, of whom 23 (5 per cent) had cardiac problems: ischaemic heart disease in 16 (previous myocardial infarction in five and angina pectoris in 11), arrhythmic disorders in three, valvular disease in three (previous mitral valve replacement in two) and hypertrophic cardiomyopathy in one. The cardiac patients had a higher incidence of cardiac complications (24 versus 0 per cent, P < 0.0001) including two myocardial infarctions, and of non-cardiac complications consisting of postoperative liver failure (16 versus 4 per cent, P < 0.01) and bile leak (16 versus 5 per cent, P = 0.02), as well as hospital death (16 versus 3 per cent, P < 0.001). However, long-term survival was similar in the two groups. Patients with preoperative cardiac conditions appear to be at increased risk for early postoperative morbidity and mortality after hepatic resection.

Adolescent↗
PubMed2002

Influence of patient gender on admission to intensive care.

STUDY OBJECTIVES: To compare the case mix and outcomes of male and female patients admitted to intensive care units for a wide range of conditions. DESIGN: Cross sectional study of prospectively collected data. SETTING: The Intensive Care National Audit and Research Centre, (ICNARC) Case Mix Programme. PARTICIPANTS: 46 587 admissions to 91 units across England, Wales, and Northern Ireland. MAIN RESULTS: No gender differences were found in case mix on admission or in mortality for five conditions (cardiac arrhythmia, chronic obstructive airways disease, asthma, self poisoning, and seizures). There was some evidence of horizontal and vertical inequity for female patients with myocardial infarction and with neurological bleeding. Vertical equity was not achieved for male pneumonia and ventricular failure patients and for women with primary brain injury. CONCLUSIONS: This study demonstrated, for the first time, possible inequitable use of intensive care for patients with certain conditions. This may be secondary to gender bias and can result in either over-treatment in the favoured group, or under-treatment in the neglected group. It would therefore be pertinent to re-examine these findings using other databases, and to further investigate the causative factors, including gender bias.

Cross-Sectional Studies↗
PubMed2002

Noninvasive evaluation of pulmonary capillary wedge pressure by BP response to the Valsalva maneuver.

STUDY OBJECTIVES: To determine the BP response to the Valsalva maneuver (VM) at baseline and after changes in therapy and to compare this response to the invasively measured pulmonary capillary wedge pressure (PCWP). DESIGN: Comparison of the BP response to the VM with invasively measured PCWP. In a subset of patients, direct PCWP and pulse amplitude ratio (PAR) measurements were repeated (mean +/- SD) 3.2 +/- 4.5 months later after adjusting the therapy. SETTING: Tertiary-care center. PATIENTS: Forty-two stable patients (8 women; mean age, 58 +/- 13 years) undergoing right heart catheterization who were in sinus rhythm. MEASUREMENTS: PAR calculated between the end and the beginning of the VM using the last two beats and the first three beats of the straining phase and simultaneous measurement of PCWP. RESULTS: There was a highly significant correlation between the invasively measured PCWP (range, 2 to 32 mm Hg) and the PAR (range, 0.28 to 1.15; R(2) = 0.75; p < 0.001). In addition, changes of PCWP during follow-up (-16 to 13 mm Hg) were well-correlated (R(2) = 0.93; p < 0.001; n = 11) with changes in PAR (-0.44 to 0.47). The administration of medication (eg, beta-blockers, amiodarone, angiotensin-converting enzyme inhibitor, and digoxin) did not influence the results. CONCLUSIONS: PCWP and changes during therapy can be estimated noninvasively by measuring the PAR during the VM with acceptable accuracy in stable patients with cardiac conditions. Thus, this method may be a useful tool in detecting an elevated PCWP and hemodynamic response to therapy.

Adult↗
PubMedDate not supplied

Echocardiography in the University of Port Harcourt Teaching Hospital: April 2000 to March 2003.

BACKGROUND: Echocardiography is a cheap and non-invasive technique for the investigation of cardiac diseases with reliable levels of accuracy. Echocardiography services commenced in the Cardiac unit of the University of Port Harcourt Teaching Hospital (UPTH) in April 2000. There is a need to establish an accurate pattern of cardiac diseases seen in the centre based on echocardiography assessment. The aim of the study was to review the pattern of cardiac diseases diagnosed by echocardiography in the cardiology unit of the University of Port Harcourt Teaching hospital. METHOD: A prospective descriptive study of patients referred to the cardiology unit of UPTH for echocardiography for a variety of cardiac complain was done. Subjects had two dimensional and M-mode echocardiography assessment using a Siemens Sonoline SL 1 machine with a 3.5 MHz sector probe. RESULTS: One hundred and forty one subjects aged between 16-84 years with a mean age of 44.2 +/- 11.5 years had echocardiography assessment over the three year period. Eighty two (58.2%) of the subjects were males while 59 (41.8%) were females. Fourty eight (34.0%) of subjects had hypertensive heart disease, 28 (19.9%) had Cardiomyopathies, 13 (9.2%) had rheumatic heart disease. Pericardial disease, congenital heart disease and cor pulmonale was found in 6 (4.3%), 2 (1.4%) and 1 (0.7%) respectively. Fourty three (30.5%) of subjects had normal findings on echocardiography. CONCLUSION: Hypertensive heart disease was found to be the most prevalent cardiac condition followed by the cardiomyopathies and rheumatic heart disease in that order. This trend is very similar to what obtains in sub Saharan Africa as documented by similar studies.

Adolescent↗