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PubMed1988

Subnormal pancreatic polypeptide and epinephrine responses to insulin-induced hypoglycemia identify patients with insulin-dependent diabetes mellitus predisposed to develop overt autonomic neuropathy.

Sixteen patients with insulin-dependent diabetes mellitus with no current evidence of autonomic dysfunction underwent an insulin tolerance test during which plasma pancreatic polypeptide and epinephrine responses were determined. Compared to 11 age- and weight-matched nondiabetic volunteers, 9 diabetic subjects had subnormal plasma pancreatic polypeptide responses (n = 6) or plasma epinephrine responses (n - 8). When autonomic function was reassessed 2 to 3 years later by standard cardiovascular reflex tests and clinical examination, 8 of 9 diabetic subjects with subnormal hormonal responses to hypoglycemia developed either abnormal cardiovascular reflexes (6 of 9) or overt symptoms consistent with diabetic autonomic neuropathy (6 of 9), whereas none of the subjects with previously normal plasma pancreatic polypeptide and epinephrine responses did (P less than 0.01). Diminished pancreatic polypeptide and epinephrine responses to hypoglycemia can predict the development of overt autonomic neuropathy in patients with insulin-dependent diabetes mellitus; identification of patients with a predilection to develop autonomic neuropathy may permit earlier treatment.

Adult↗
PubMed1978

Interruption of aortic arch in two foals.

Two foals with a history of normalcy at birth developed a lack of exercise tolerance and weakness in the first few days of life. Weakness, inability to rise, and reluctance to suckle were common complaints. Physical examination of both foals revealed a cardiovascular abnormality, with a loud systolic murmur audible over both thoracic walls. Additional diagnostic techniques were blood gas analysis, radiography, cardiovascular catheterization, and necropsy. Necropsy findings were ventricular septal defect, atrial septal defect, patent ductus arteriosus, and congenital absence of the aortic arch. Additionally, 1 foal had anomalous drainage of the cranial vena cava into the left atrium.

Animals↗
PubMed1997

Cardiovascular events and correlates in the Veterans Affairs Diabetes Feasibility Trial. Veterans Affairs Cooperative Study on Glycemic Control and Complications in Type II Diabetes.

BACKGROUND: The risks and benefits of intensive therapy in non-insulin-dependent diabetes mellitus (NIDDM) need to be defined. In preparation for a long-term trial, a feasibility study of 153 men in 5 medical centers compared standard vs intensive insulin therapy. OBJECTIVE: To assess the rate of development of new cardiovascular events and their correlates. METHODS: Patients with a mean +/- SD age of 60 +/- 6 years and diagnosis of NIDDM for 7.8 +/- 4.0 years were randomly assigned to a standard (1 insulin injection every morning) or to an intensive treatment arm (stepped plan from 1 evening injection of insulin, alone or with glipizide, to multiple daily injections) designed to attain near-normal glycemia levels. A 2.07% separation of glycosylated hemoglobin (HbA1c) was sustained for a mean follow-up of 27 months (P < .001). Predefined cardiovascular events were assessed by a committee unaware of treatment assignment. RESULTS: Mild and moderate hypoglycemic events were more frequent in the intensive than in the standard treatment arm (16.5 vs 1.5 per patient per year, respectively). Mean insulin dose was 23% lower in the standard treatment arm (P < .001). There were 61 new cardiovascular events in 24 patients (32%) in the intensive treatment arm and in 16 patients (20%) in the standard treatment arm (P = .10). There was no difference in total and cardiovascular mortality (n = 5 and n = 3 in the intensive and standard treatment arms, respectively) or in new events in patients with cardiovascular history (n = 10 in each arm). In Cox regression analysis, the only significant correlate for new cardiovascular events was previous cardiovascular disease (P = .04). Entering in the analysis any baseline cardiovascular abnormality, the regression model indicated a lower HbA1c level prior to the event as the only correlate for new cardiovascular events (P = .05). CONCLUSION: A long-term prospective trial is needed to assess the risk-benefit ratio of intensive insulin therapy for NIDDM in patients who require it.

Aged↗
PubMed1993

Cardiovascular autonomic dysfunction in non-insulin-dependent diabetes mellitus and its relation to renal dysfunction.

To investigate the relationship between cardiovascular autonomic neuropathy and nephropathy in patients with non-insulin-dependent diabetes mellitus (NIDDM), 45 patients underwent noninvasive cardiovascular reflex tests, including the Valsalva ratio, the 30:15 ratio and postural changes in systolic blood pressure (delta SBP), along with measurement of creatinine clearance (CCr) and daily protein excretion (DPE). Clinical symptoms in 30 patients were also noted and correlated with the results of the autonomic function tests. Thirty-four normal subjects underwent the same cardiovascular reflex tests and served as controls. The results showed that NIDDM patients had a significantly lower 30:15 ratio than normal subjects. However, no significant difference in either the Valsalva ratio or delta SBP was found between diabetic patients and controls. A positive correlation between the 30:15 ratio and CCr, but not DPE, was noted in diabetics. Although abnormal cardiovascular reflex tests appeared in patients who had no autonomic symptoms, abnormal test results were not parallel with the severity of symptoms. These results show that NIDDM patients have poorer cardiovascular autonomic function which may precede the appearance of autonomic symptoms. The 30:15 ratio was weakly correlated with CCr and this suggests that the incidence of cardiovascular dysfunction increases as the renal functional reserve decreases.

Adult↗
PubMed1994

Autonomic neuropathy in systemic lupus erythematosus: cardiovascular autonomic function assessment.

AIM: To assess the prevalence and the nature of autonomic neuropathy (AN) in 17 patients with inactive or mild active systemic lupus erythematosus (SLE). METHODS: Patients were tested using questionnaires related to possible AN symptoms, and four non invasive cardiovascular autonomic function tests at rest, during lying to standing, and sustained handgrip. Eleven age matched normal subjects were also enrolled as a control group. RESULTS: At least one abnormal cardiovascular autonomic function test was observed in 15 of the 17 patients. The two groups did not differ in deep-breathing (parasympathetic, PS) and handgrip tests (sympathetic, S) although responses in patients with SLE tended towards abnormal values. Statistical differences were found in standing-heart rate ratio (R-R ratio) (PS) with a lower ratio in the group with SLE (p < 0.01) and in standing blood pressure with a higher decrease in systolic blood pressure (p < 0.05) in patients with SLE. No correlation was found between AN, age, disease duration and presence of Raynaud's phenomenon. CONCLUSION: In inactive or mild active SLE, AN could represent residual abnormalities of autonomic nervous system involvement and/or could be related to glucocorticoids.

Adult↗
PubMed1997

[Sphygmographic parameters in fighter and transport pilots].

To evaluate and discover hidden cardiovascular trouble in pilots, the cardiovascular function of 129 active male pilots was examined with a new sphygmographic method. 13 pilots (10.3%) were found to have abnormal cardiovascular function. The average arterial blood pressure and medium artery modulus of the fighter pilots aged from 30 to 34 years are inferior to those aged from 25 to 29 obviously, however, that is not the case in transport pilots. This indicates that frequent examination of cardiovascular function with convenient special method is necessary for the improvement of the quality of medical monitor on pilots.

Adult↗
PubMedDate not supplied

[Evaluation of cardiovascular response to stress in dental patients].

The purpose of this study was to record some clinical and psychological parameters in attempt to find out and to estimate patients with abnormal cardiovascular responses during dental therapy. On the basis of psychological questionnaires, used to value anxiety, resulted that patients who have self defined themselves anxious and therefore objectively nervous while in the dental chair, underwent cardiovascular responses significantly lower than those who were not anxious. Among the clinical parameters studied, blood pressure and the heart rate during basic conditions are not able to foresee hemodynamic responses during dental extraction. The only clinical situation able to relate to a corresponding regularity with an hemodynamic response during dental extraction, is the blood pressure determination during a provoked generic mental stress. These findings suggest that cardiovascular response during dental stress depends on the personal individual reaction of each individual.

Adolescent↗
PubMed1991

Reflex control in heart failure: a primer for physicians.

Heart failure, cause notwithstanding, is characterized by adaptive (but harmful) increases in sympathetic activity and hormone levels, as well as by abnormal cardiovascular reflexes. Such reflex derangements may contribute to neurohumoral excitation. Consequently, normalization of the reflexes may be an important determinant of the effectiveness of therapy.

Adaptation, Physiological↗
PubMed2002

Altered autonomic function and reduced arousability in apparent life-threatening event infants with obstructive sleep apnea.

The aim of this study was to examine cardiorespiratory control in infants presenting with an apparent life-threatening event (ALTE). We performed six to eight 45 degrees head-up tilts in 10 ALTE infants (age, 14 +/- 3 weeks) and 12 age-matched control subjects during slow wave sleep and rapid eye movement sleep (REM). All infants underwent full overnight polygraphic sleep recordings with noninvasive measurement of beat-to-beat blood pressure. All control infants had normal sleep breathing. In contrast, 5 of the 10 ALTE infants had more than two obstructive apneas per hour of sleep, with short hypoxic episodes (obstructive sleep apnea [OSA]). In slow wave sleep, in response to the tilt, the ALTE infants with OSA showed a reduced heart rate response, and three of the five showed a marked postural hypotension. The ALTE infants with OSA also had altered heart rate and blood pressure variability and an increased arousal threshold in REM (p = 0.0002). By contrast, those ALTE infants with normal sleep breathing had cardiovascular and arousal responses similar to those of the control infants. We conclude that a number of ALTE infants with OSA have abnormal cardiovascular autonomic control that, combined with their decreased arousability in REM, may provide an explanation for the ALTE episodes.

Arousal↗
PubMed1990

Thoracic cage deformities in the early diagnosis of the Marfan syndrome and cardiovascular disease.

The Marfan syndrome is frequently complicated by cardiovascular abnormalities. Of these, aortic dissection and aortic valve regurgitation are the most life-threatening. The most noticeable abnormalities of the Marfan syndrome--the skeletal abnormalities--may be subtle and limited. Presented here are five reports of cases of the Marfan syndrome. All patients had potentially lethal cardiovascular complications. Either the syndrome had not been previously diagnosed or the patient had not been adequately monitored despite the the presence of thoracic cage deformities present from youth. The purpose of this report is to heighten recognition of the association of thoracic cage deformities with the Marfan syndrome to permit early diagnosis of the associated cardiovascular complications. Surgical management of these complications can favorably alter the natural history of the Marfan syndrome.

Adult↗
PubMedDate not supplied

[Marfan syndrome and echocardiography].

We report the echocardiographic features of nine patients with Marfan syndrome. Six men and three women. Average age: twenty nine years. Sixty six per cent had aneurysmatic enlargement of the aortic root. One hundred per cent of the cases had aortic insufficiency, enlargement of the left ventricular diameter, decrease of the ejection fraction, and decrease in circunferential shortening; mitral prolapse, (in 6) and signs of high pulmonary artery pressure (in 4 cases). Hemodynamic studies performed in 46 per cent of the patients correlated well with the echocardiographic features. Autopsy performed in the patients who died, corroborated the cardiovascular abnormalities. We conclude that the use of the echocardiogram is a useful non-invasive technique for the early evaluation of the cardiovascular features in the Marfan syndrome.

Adolescent↗
PubMed1998

Kawasaki disease in the older child.

OBJECTIVES: To determine the prevalence of Kawasaki disease in older children and to evaluate its clinical presentation, time to diagnosis, and outcome in comparison with younger patients with the disease. METHODOLOGY: A retrospective analysis of all patients discharged with a diagnosis of Kawasaki disease at a pediatric tertiary care hospital over a 12-year period. RESULTS: A total of 133 patients were included in this study; 7.5% were 9 years of age or older at the time of illness. Patients were grouped by age: infants included children age 1 to 8 years of age and children 9 years of age or older. Older children had a higher frequency of abnormal cardiovascular physical examination (50%) versus children (6%) and infants (10%). The older age group and the infants had a higher prevalence of coronary artery abnormalities and poor left ventricular function than did the 1- to 8-year-olds. Eighty percent of the older children had coronary arteries that were either dilated or aneurysmal, and 30% demonstrated left ventricular dysfunction on initial echocardiography. The number of days to diagnosis after meeting the diagnostic criteria was 5.8 +/- 2.3 for infants, 5.2 +/- 1.5 for older children, and 1.9 +/- 0.3 for children. Older children had a complicated course of Kawasaki disease compared with younger patients. CONCLUSION: We found a higher prevalence of older children with Kawasaki disease at our center than has previously been reported. Older patients, as well as infants, had a higher rate of coronary artery abnormalities than did the children between 1 and 8 years of age. Older age at the time of illness or a delay in treatment may be important factors in determining cardiac involvement in Kawasaki disease.

Age Distribution↗
PubMed2000

Hypothermia, coagulopathy, and acidosis.

The management of patients requiring a damage control approach taxes the abilities of the best equipped trauma center. These patients present with severe metabolic abnormalities, most notably characterized by a deadly triad of hypothermia, coagulopathy, and acidosis. Using volumetric, oxymetric pulmonary artery catheters, hypothermia and any ongoing cardiovascular abnormalities can be identified quickly and treatment can be monitored. External, forced air rewarming is a valuable technique in treating the patient with hypothermia, as are more invasive modalities, including body cavity lavage. Although there is no shotgun approach to blood component transfusion therapy, the coagulopathy shown by these patients has a time course that is more rapid than stat laboratories can presently keep up with. Given the fulminant nature of this coagulopathy, the authors feel justified in empirically initiating platelet and plasma or cryoprecipitate transfusion on identification of visible coagulopathy. The willingness of trauma surgeons to push the envelope in treating these most severely afflicted patients has allowed patients who once would have certainly died to lead meaningful lives.

Acidosis↗
PubMed1996

Management of non-immune hydrops: 8 years' experience.

During a period of 8 years (1985-92), 100 fetuses were diagnosed to have non-immune hydrops on the basis of ultrasonographic findings and absence of rhesus isoimmunization. Both the mother and the fetus were thoroughly evaluated by a set protocol that included a detailed fetal abnormality scan with echocardiography and fetal blood sampling. A cause for non-immune hydrops could be identified in 81% of the fetuses. Cardiovascular abnormalities (23%) and alpha(1)-thalassemia (22%) were almost equally common etiological factors in the South-East Asian population under investigation. A chromosomal abnormality was detected in 10% of the fetuses with non-immune hydrops. Twenty-six fetuses were found to be suitable for in utero therapy. In utero therapy included one or more of the following: (1) fetal intravascular blood transfusion; (2) direct fetal drug therapy; and (3) fetal pleuroamniotic shunting. Eighteen of the 26 babies (69.2%) were alive and well at 1 month after delivery. It is concluded that in well-selected cases appropriate in utero fetal therapy can lead to significant improvement in fetal salvage.

Evaluation Studies as Topic↗
PubMed1990

Teratogenic effects of sodium valproate in the Jcl: ICR mouse fetus.

Sodium valproate was administered to Jcl:ICR mice in order to evaluate its teratogenicity. A single dose of 600 mg/kg of sodium valproate was injected intraperitoneally on gestational day 6, 7, 8 or 9. On day 18 of gestation, dams were laparotomized, and live fetuses were inspected for the presence of external and internal abnormalities. Exencephaly and urogenital abnormalities showed the highest frequency in the group treated on day 8, being recognized in about 60% and 10% of live fetuses, respectively. Cardiovascular abnormalities were found in the highest frequency in the group treated on day 7 (in about 30% of live fetuses). Incidence of tail abnormality was found to increase with delay in day of drug administration. Other abnormalities observed were cleft palate and digital malformation. Our study showed that a constellation of major abnormalities similar to the congenital valproate syndrome suspected in humans could be produced in the Jcl:ICR mouse fetus.

Abnormalities, Drug-Induced↗
PubMed2004

The heart: an end-organ of GH action.

Several experimental and clinical studies have indicate that the heart is an end-organ of GH action. Patients with either childhood- or adulthood-onset GH deficiency (GHD) have abnormalities of cardiac structure and function, such as reduced cardiac mass, impaired diastolic filling and reduced left ventricular response at peak exercise. These cardiovascular abnormalities can be reversed, at least partially, after GH replacement therapy. On the other hand, the chronic overproduction of GH and IGF-I in acromegaly leads to the development of a specific cardiomyopathy. Concentric cardiac hypertrophy occurs in more than two-thirds of patients at diagnosis and is commonly associated with diastolic dysfunction. In later stages, impaired systolic function ending in heart failure can occur if GH/IGF-I excess is not controlled. Additionally, acromegalic cardiomyopathy is complicated by abnormalities of cardiac rhythm and cardiac valves. Successful control of acromegaly is accompanied by a decrease of the left ventricular mass and improvement of cardiac function. These beneficial effects appear earlier in young patients with short disease duration than in elderly patients. In conclusion, GH and IGF-I play a main role in the regulation of cardiac development and performance.

Acromegaly↗
PubMed2006

Cardiovascular responses to vibrostimulation for sperm retrieval in men with spinal cord injury.

BACKGROUND/OBJECTIVE: Cardiovascular abnormalities and arrhythmias are common in individuals with spinal cord injury (SCI) who are undergoing vibrostimulation for sperm retrieval. The study aimed to examine cardiovascular control in men with SCI undergoing this procedure. METHODS: Individuals with chronic cervical (n=8; age: 33.1 +/- 1.9 years) and upper thoracic SCI (n=5; age: 35.2 +/- 2.9 years) volunteered for vibrostimulation, with continuous blood pressure (Finometer) and electrocardiographic monitoring. Patients were characterized further by sympathetic skin responses (SSR) to assess descending autonomic spinal pathways and American Spinal Injury Association (ASIA) scores to assess motor and sensory pathways. RESULTS: All but one subject with cervical SCI were ASIA A or B and were negative for SSR in the hands and feet. All subjects with upper thoracic SCI were ASIA A or B and were positive for SSR in the hands. Systolic blood pressure was lower in men with cervical injury at rest. Vibrostimulation induced an increase in systolic blood pressure >20 mmHg in all patients with cervical SCI (range = 125/65 - 280/152; median = 167/143 mmHg) and in 2 thoracic subjects (151/104 and 170/121 mmHg). During ejaculation, 6 cervical and 3 thoracic subjects developed arrhythmias (5 with bradycardia, 6 with premature atrial contractions, 4 with ventricular excitation, 1 with junctional rhythm, and 1 with heart block). CONCLUSION: The vibrostimulation procedure induced electrocardiographic abnormalities and autonomic dysreflexia in subjects with either cervical or high thoracic SCI.

Adult↗
PubMed1993

Subclinical autonomic dysfunction in patients with Hodgkin's disease and non-Hodgkin's lymphoma.

A prospective study was carried out to determine the prevalence of autonomic dysfunction in patients with lymphoma, and to assess the effect on this of chemotherapy. Twenty consecutive patients presenting with Hodgkin's disease, high-grade non-Hodgkin's lymphoma, or low-grade non-Hodgkin's lymphoma were studied. All had advanced disease, requiring combination chemotherapy which included the use of vinca alkaloids. Clinical assessment and standard cardiovascular autonomic function tests were carried out prior to and following completion of chemotherapy. Although no patients had clinical evidence of autonomic neuropathy at presentation, 16 (80%) had abnormal cardiovascular autonomic function tests. There was no correlation with the presence or absence of mediastinal disease. There was significant improvement in autonomic scores with treatment despite the use of drugs of known neurological toxicity. Some patients showed residual abnormalities of autonomic function despite disease resolution. We suggest that subclinical autonomic dysfunction is common in patients with lymphoma, and probably represents a paraneoplastic syndrome--the pathogenesis and prevalence of which deserve further study. This phenomenon may predispose patients with lymphoma to develop gastrointestinal and genitourinary dysfunction, or postural hypotension, and should be considered during the evaluation of the neurotoxicity of chemotherapy regimens.

Antineoplastic Combined Chemotherapy Protocols↗