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PubMed1995

Congenital heart disease: wide-field, three-dimensional, and four-dimensional ultrasound imaging.

The next significant advance for cardiovascular ultrasound will be the introduction of clinical three-dimensional (3-D) imaging. With increasing computer power and software and hardware, 3-D ultrasound imaging will become a reality over the next few years. Of all cardiovascular abnormalities, congenital heart disease is one of the most logical entities to lend itself to wide-field and 3-D presentation. Tomographic two-dimensional (2-D) echocardiography has in great part replaced cardiac catheterization as the means of accurately visualizing congenital cardiac defects. However, two distinct limitations exist with current 2-D presentations: (1) limited field of view (ie, 90 degrees sector) and (2) tomographic slices that must be assimilated by the examiner into a 3-D or four-dimensional diagnosis. True 3-D imaging has the ultimate capability of rendering anatomy in a format comparable to looking at the actual cardiac specimen. If electronic rendering were really feasible and of suitable quality, one could envision electronically extracting the heart from a living human and examining abnormalities much as one might examine a cardiac specimen (ie, "electronic vivisection"). This article reviews the state of the art of wide-field and 3-D cardiovascular ultrasound in the assessment of congenital heart disease.

Adult↗
PubMed1996

[Adaptational disorders of the cardiovascular regulation during brief exposure to hypobaric hypoxia].

Responses of the cardiovascular system to brief exposure to hypobaric hypoxia were the focus of this investigation. Impairment of adaptive reactions of the body was found to depend on the level of physical loading. "Critical" time of exposure to a simulated altitude of 5000 m came to 7-10 minutes. The deadaptive disorders have a non-specific character, e.g. hypotonia, dysrhythmias, etc. Probability of their emergence hinges on the physical state of subject. Low tolerance of chamber tests was a distinguishing feature of subjects with cardiovascular abnormalities.

Adaptation, Physiological↗
PubMed1989

Role of endotoxemia in cardiovascular dysfunction and mortality. Escherichia coli and Staphylococcus aureus challenges in a canine model of human septic shock.

Using different types of bacteria and a canine model simulating human septic shock, we investigated the role of endotoxin in cardiovascular dysfunction and mortality. Either Escherichia coli (a microorganism with endotoxin) or Staphylococcus aureus (a microorganism without endotoxin) were placed in an intraperitoneal clot in doses of viable or formalin-killed bacteria. Cardiovascular function of conscious animals was studied using simultaneous radionuclide heart scans and thermodilution cardiac outputs. Serial plasma endotoxin levels were measured. S. aureus produced a pattern of reversible cardiovascular dysfunction over 7-10 d that was concordant (P less than 0.01) with that of E. coli. Although this cardiovascular pattern was not altered by formalin killing (S. aureus and E. coli), formalin-killed organisms produced a lower mortality and less myocardial depression (P less than 0.01). S. aureus, compared to E. coli, produced higher postmortem concentrations of microorganisms and higher mortality (P less than 0.025). E. coli produced significant endotoxemia (P less than 0.01), though viable organisms (versus nonviable) resulted in higher endotoxin blood concentrations (P less than 0.05). Significant endotoxemia did not occur with S. aureus. Thus, in the absence of endotoxemia, S. aureus induced the same cardiovascular abnormalities of septic shock as E. coli. These findings indicate that structurally and functionally distinct microorganisms, with or without endotoxin, can activate a common pathway resulting in similar cardiovascular injury and mortality.

Animals↗
PubMed2002

Hypertrophic cardiomyopathy: who plays and who sits.

Hypertrophic cardiomyopathy (HCM) is a genetically determined, primary myocardial disease associated with an increased risk for sudden cardiac death during physical exertion. In the United States, HCM is the most frequent cause of exertion-related sudden cardiac death (SCD). Current recommendations provided by the 26th Bethesda Conference entitled Recommendations for Determining Eligibility for Competition in Athletes with Cardiovascular Abnormalities restrict participation for patients with HCM to sports requiring low levels of dynamic and isometric exertion. Such recommendations are prudent given the association of the disease with disastrous cardiovascular consequences. Nevertheless, because the prognosis of HCM and its risk of sudden death is typified by great variability among patients, these recommendations may be overly restrictive for many patients with this disease, and it is possible that a subset of low-risk patients can be identified who may continue to engage in more vigorous exercise activities. This article presents our current understanding and approach to evaluating and advising athletes with HCM.

Cardiomyopathy, Hypertrophic↗
PubMed1977

Valvular heart disease in osteogenesis imperfecta.

Aortic and mitral valve abnormalities have been reported which clearly appear to be related to the underlying connective tissue disorder in two patients, a father and daughter, with osteogenesis imperfecta. Although this appears to occur with a much lower prevalence and lesser severity than in the Marfan syndrome, the true prevalence of cardiac connective tissue involvement is not known, and the orthopedic complications of osteogenesis imperfecta may have overshadowed attention to cardiovascular abnormalities. In evaluating patients with osteogenesis imperfecta, careful attention should be paid to cardiovascular findings and if valvular lesions are noted, patients should be instructed regarding the need for antibiotic prophylaxis for dental and surgical procedures. The valvular lesions can progress, and regular follow-up cardiovascular evaluation should be planned. Finally, despite potential problems with tissue friability and healing and a possible tendency for increased bleeding, successful valve replacement can be carried out if necessitated by cardiac disability.

Adult↗
PubMed2004

Cardiovascular effects of HAART in infants and children of HIV-infected mothers.

Over the past decade, the course of human immunodeficiency virus (HIV) infection has been markedly altered by highly active antiretroviral therapy (HAART). As advances in early diagnosis and aggressive therapy, as well as better supportive care, become available to more HIV-infected patients, survival is being prolonged and more patients are experiencing cardiac abnormalities. Cardiovascular manifestations of pediatric HIV infection have especially proven to be an ongoing challenge to practicing physicians, who face cardiac abnormalities ranging from asymptomatic cardiomyopathy to severe heart failure. Antiretroviral therapy has substantially decreased vertical transmission of HIV; however, studies of adults receiving HAART have found increased peripheral and coronary artery disease. Children exposed to this therapy in utero are thus at an increased risk for toxicity and cardiac abnormalities, regardless of their HIV status. Preliminary studies have reported complications including lactic acidosis and mitochondrial toxicity, as well as cardiomyopathy. Further studies are needed to explore the long-term effects and possible toxicities of prophylactic antiretroviral therapy on infants born to HIV-infected mothers.

Anti-HIV Agents↗
PubMed1987

Severe cardiovascular changes associated with pancuronium after cardiopulmonary resuscitation and after brain injury.

Severe hypertension, tachycardia or ECG changes have been reported following i.v. administration of pancuronium to patients with pheochromocytoma or bronchial asthma. These cardiovascular changes were explained by an interaction between autonomic effects of pancuronium and elevated serum catecholamines or aminophylline. We noted similar cardiovascular changes associated with i.v. administration of pancuronium in two patients after successful cardiopulmonary resuscitation and in two with midbrain hemorrhage and epidural hematoma. In these patients, pancuronium produced no abnormal cardiovascular changes when given during elective surgery or before the occurrence of midbrain hemorrhage. Thus, ischemic brain damage may play a role in producing the severe cardiovascular changes associated with pancuronium.

Aged↗
PubMed2006

Cardiovascular response to treadmill testing in Parkinson disease.

PURPOSE: Exercise has been recommended as a way to maintain quality of life in individuals with Parkinson disease (PD). Experiments examining the cardiovascular response to exercise, however, have yielded controversial results. This study was designed to determine if there is any difference in vital signs and Rate of Perceived Exertion (RPE) between a group of individuals (50-80 years old) with PD and a comparison group of healthy individuals during exercise on a treadmill. METHODS: Twenty seven volunteers (16 with PD and 11 healthy) participated in this study. Subjects with PD were divided into 2 groups; one that reached target heart rate and one that failed to reach it. In this study, heart rate (HR), systolic blood pressure (BP), and the RPE were measured during a Modified Bruce Protocol. We hypothesized that treadmill testing would result in differences between individuals with PD and healthy subjects when HR and systolic BP were compared at submaximal exercise (defined as Stage 2 of the Modified Bruce Protocol) and at peak exercise (defined as 85% of age predicted target heart rate). RESULTS: During submaximal exercise, no significant differences were found between the PD group and the control group for HR, BP, or RPE. At peak exercise, one half of the subjects with PD exhibited blunted cardiovascular responses, despite reaching a comparable intensity of exercise during a Modified Bruce Protocol. CONCLUSIONS: Although cardiovascular responses to exercise on a treadmill appear similar between individuals with PD and controls at lower levels of exercise, half the subjects with PD in the present study displayed abnormal cardiovascular responses at higher exercise intensities. Administering an exercise stress test will illustrate the expected cardiovascular responses for each individual, therefore guiding exercise prescription.

Aged↗
PubMed2004

Circulating adiponectin levels and cardiovascular risk factors in acromegalic patients.

OBJECTIVE: Adiponectin (ApN) is an adipocytokine expressed in human adipose cells with anti-atherogenic and anti-inflammatory properties that plays a role in the pathophysiology of insulin resistance, metabolic syndrome and coronary artery disease. The aim of the study was to evaluate ApN secretion in patients with acromegaly, a chronic disease associated with insulin resistance and increased cardiovascular mortality, and to correlate ApN levels with hormonal, metabolic and cardiovascular parameters. DESIGN AND METHODS: The study included 32 patients with active acromegaly (11 male and 21 female, aged 48+/-11 years, duration of disease: 8+/-6 years, GH: 9.2+/-9.8 microg/l, IGF-I: 80+/-33 nmol/l (means+/-s.d.)) and 38 control subjects sex- and body mass index (BMI)-matched. In all subjects, serum ApN, leptin and ghrelin levels, BMI, waist circumference, insulin resistance (assessed by homeostasis model assessment and the quantitative insulin check index), lipid profile and blood pressure values were evaluated. RESULTS: Acromegalic patients and control subjects had similar ApN levels (9.4+/-3.5 vs 9.5+/-4.0 mg/l, NS), while when considering obese subjects acromegalic patients had ApN levels significantly higher than controls (10.2+/-4 vs 7.5+/-3 mg/l, P<0.05). No significant correlation between ApN and GH/IGF-I levels or duration of disease was found. ApN concentrations negatively correlated with BMI, waist circumference, glucose and diastolic blood pressure and positively with high-density lipoprotein cholesterol and ghrelin in controls, while all these correlations were lost in acromegalic patients. CONCLUSIONS: We provide evidence that, although metabolic and cardiovascular abnormalities are present in most acromegalic patients, in these subjects ApN levels are not reduced and, contrary to what is found in BMI-matched controls, do not correlate with cardiovascular risk factors. These data support the view that atherosclerosis is not the main determinant of cardiovascular mortality in acromegaly and suggest a permissive action of GH and/or IGF-I excess on ApN secretion.

Acromegaly↗
PubMed2002

[Ocular defects associated with a duplication of the distal part of the long arm of chromosome 1: a case report].

The authors report a case of de novo duplication 1q32-qter present in a patient with dysmorphic syndrome and developmental delay. This article describes the eighth case of partial trisomy 1q32-qter "pure", without chromosomal abnormalities. In the literature, a dysmorphic "syndrome" is described for trisomy 1q32-qter: hypertelorism, low set and malformed ears, prominent forehead, long philtrum, antimongoloid slanting, foot and digital malformations, cardiovascular abnormalities, urogenital abnormalities, and mental retardation. The ocular defects described in previously reported cases include: cataract, strabismus, hypoplasia of the optic disk, microphthalmia, epicanthal folds, ptosis, persistent tunica vasculosa lentis, and hyaloid vessels, but this seems to be nonspecific of this chromosomal abnormality.

Abnormalities, Multiple↗
PubMed1980

Multicystic kidney. A clinical and histological study of 13 patients.

Multicystic kidney (MK) was diagnosed in 13 patients at the University Central Hospital of Oulu during the 9 year period 1970--78. In the district of the hospital the evaluated incidence of MK was 0.3 per 1000 live-born children. 12 of the patients were infants aged under one year. Two of these died soon after birth; one had severe extraurinary anomalies and the other had bilateral MK. The removal of MK was performed in ten cases. In ten operated and two autopsied patients the cystic dysplasia involved the kidney entirely. There was no discernible normal renal parenchyma and the ipsilateral ureter was always abnormal. On the opposite side one patient had a severe ureteric stenosis with hydronephrosis, and 4 patients had vesicoureteral reflux. Extraurinary anomalies were also common. Three patients had a significant cardiovascular abnormality. The accurate diagnosis could usually be obtained preoperatively. It was found that typical findings of physical examination, plain films, intravenous urography and B-mode ultrasound give sufficient information for accurate diagnosis to be made in most cases. Mictiocystography and endoscopy were required for associated urinary anomalies. Following the diagnosis, the removal of MK should be performed at the correct time, and also if asymptomatic, because these can become symptomatic later in life.

Adolescent↗
PubMed2002

The essentials of calcium, magnesium and phosphate metabolism: part II. Disorders.

OBJECTIVE: To review the components of calcium, phosphate and magnesium metabolism that are relevant to the critically ill patient, in a two-part presentation. DATA SOURCES: A review of articles reported on calcium, phosphate and magnesium disorders in the critically ill patient. SUMMARY OF REVIEW: Abnormal calcium metabolism in the critically ill patient often presents with an alteration in plasma ionised calcium. The characteristic clinical features of an acute reduction in ionised plasma calcium include tetany, laryngospasm, paraesthesia, confusion, hallucinations, seizures and, rarely, hypotension all of which resolve with intravenous calcium administration. The clinical features of an acute increase in plasma ionised calcium include anorexia, nausea, vomiting, constipation, polyuria, weakness, lethargy, hypotonia and ectopic calcification and, depending on the aetiology, may require intravenous saline, frusemide, diphosphonate, glucocorticoid or calcitonin. Acute hypophosphataemia may present with paraesthasia, confusion, seizures, weakness, hypotension and heart failure and in the critically ill requires intravenous sodium or potassium phosphate. Hyperphosphataemia is often associated with renal failure and if severe usually presents with the clinical features of the associated hypocalcaemia. The clinical features of hypomagnesaemia include confusion, delerium, seizures, weakness, cramps, tetany and tachyarrhythmias, all of which resolve with intravenous magnesium sulphate. Hypermagnesaemia is usually associated with excess magnesium administration in a patient with renal failure and if severe can cause areflexia, hypotonia, respiratory and cardiac arrest. Intravenous calcium chloride will rapidly reverse the cardiovascular abnormalities. CONCLUSIONS: Calcium, phosphate and magnesium functions are closely linked with abnormal plasma levels of these compounds often causing similar cardiovascular and neurological features.

Journal Article↗
PubMed1994

Hantavirus pulmonary syndrome: recognition and emergency department management.

Hantavirus infection with respiratory involvement is a new clinical entity. The respiratory and cardiovascular abnormalities associated with hantavirus infection define the hantavirus pulmonary syndrome (HPS). We present two cases of HPS and discuss the presentation, epidemiology, emergency department management, and differential diagnosis. Treatment of HPS involves intensive care monitoring, airway management, and cardiovascular support. Because human hantavirus infection with respiratory involvement has been recognized recently in all geographic regions of the United States, it is important for emergency physicians to recognize this syndrome's characteristic symptoms and laboratory abnormalities. The fulminant clinical course of HPS and its 65% mortality rate underscore the importance of early recognition if potentially life-saving interventions are to be initiated.

Acute Disease↗
PubMed1997

Effects of exposure to carbon disulfide (CS2) on electrocardiographic features of ischemic heart disease among viscose rayon factory workers.

The objective of the study was to evaluate viscose plant workers for electrocardiographic manifestations resulting from exposure to carbon disulfide (CS2). A total of 162 workers (118 in an exposure group and 44 in a reference group) were evaluated using a health questionnaire, physical check-up, biochemical analysis of blood samples and electrocardiograms (ECG). The exposure group consisted of workers in the following areas: viscose manufacturing, cellophane processing, ripening, and filament spinning. Reference group workers were from the administrative office, rolling area, pulp processing, and testing office. Only slight differences were found in the biochemical analyses of the two groups, with the exception of sodium (Na) levels. Personal and area sampling results were found to have a high variation due to different locations within the plant and a wide range of manufacturing processes. Highest CS2 concentrations were found in the ripening area (54.60 ppm) and the filament spinning area (19.60 ppm). Using a multiple logistic regression model to control variables (age, gender, body mass index, duration of employment, cholesterol, smoking, and alcohol), we found a relative risk for ECG abnormalities 4.18 times significantly higher for the exposure group. The authors feel that the installation of an adequate ventilation system could greatly reduce the risk of workers developing CS2-induced cardiovascular abnormalities.

Adult↗
PubMed1987

Fetal echocardiography. VII. Doppler color flow mapping: a new technique for the diagnosis of congenital heart disease.

One of the difficulties for the fetal sonographer is the complete elucidation of structural defects of the cardiovascular system that are associated with intracardiac or great vessel flow disturbances. With the recent introduction of Doppler color flow mapping, in which blood flow is displayed in color superimposed on a real-time image, it has been impossible to identify flow disturbances in the pediatric and adult patient. This study was undertaken to determine whether Doppler color flow mapping could be used in the fetus to identify normal and abnormal cardiovascular anatomy. Thirty-five normal and high-risk fetuses were examined between 16 and 40 weeks of gestation. Doppler color flow mapping identified normal and abnormal anatomy (ventricular septal defect, atrial septal defect, endocardial fibroelastosis, dysplastic pulmonary valve, and tricuspid regurgitation). It appears that Doppler color flow mapping will add a new dimension to fetal cardiovascular imaging.

Adult↗
PubMed2003

Diabetic autonomic neuropathy.

Diabetic autonomic neuropathy (DAN) is a serious and common complication of diabetes. Despite its relationship to an increased risk of cardiovascular mortality and its association with multiple symptoms and impairments, the significance of DAN has not been fully appreciated. The reported prevalence of DAN varies widely depending on the cohort studied and the methods of assessment. In randomly selected cohorts of asymptomatic individuals with diabetes, approximately 20% had abnormal cardiovascular autonomic function. DAN frequently coexists with other peripheral neuropathies and other diabetic complications, but DAN may be isolated, frequently preceding the detection of other complications. Major clinical manifestations of DAN include resting tachycardia, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, sudomotor dysfunction, impaired neurovascular function, "brittle diabetes," and hypoglycemic autonomic failure. DAN may affect many organ systems throughout the body (e.g., gastrointestinal [GI], genitourinary, and cardiovascular). GI disturbances (e.g., esophageal enteropathy, gastroparesis, constipation, diarrhea, and fecal incontinence) are common, and any section of the GI tract may be affected. Gastroparesis should be suspected in individuals with erratic glucose control. Upper-GI symptoms should lead to consideration of all possible causes, including autonomic dysfunction. Whereas a radiographic gastric emptying study can definitively establish the diagnosis of gastroparesis, a reasonable approach is to exclude autonomic dysfunction and other known causes of these upper-GI symptoms. Constipation is the most common lower-GI symptom but can alternate with episodes of diarrhea. Diagnostic approaches should rule out autonomic dysfunction and the well-known causes such as neoplasia. Occasionally, anorectal manometry and other specialized tests typically performed by the gastroenterologist may be helpful. DAN is also associated with genitourinary tract disturbances including bladder and/or sexual dysfunction. Evaluation of bladder dysfunction should be performed for individuals with diabetes who have recurrent urinary tract infections, pyelonephritis, incontinence, or a palpable bladder. Specialized assessment of bladder dysfunction will typically be performed by a urologist. In men, DAN may cause loss of penile erection and/or retrograde ejaculation. A complete workup for erectile dysfunction in men should include history (medical and sexual); psychological evaluation; hormone levels; measurement of nocturnal penile tumescence; tests to assess penile, pelvic, and spinal nerve function; cardiovascular autonomic function tests; and measurement of penile and brachial blood pressure. Neurovascular dysfunction resulting from DAN contributes to a wide spectrum of clinical disorders including erectile dysfunction, loss of skin integrity, and abnormal vascular reflexes. Disruption of microvascular skin blood flow and sudomotor function may be among the earliest manifestations of DAN and lead to dry skin, loss of sweating, and the development of fissures and cracks that allow microorganisms to enter. These changes ultimately contribute to the development of ulcers, gangrene, and limb loss. Various aspects of neurovascular function can be evaluated with specialized tests, but generally these have not been well standardized and have limited clinical utility. Cardiovascular autonomic neuropathy (CAN) is the most studied and clinically important form of DAN. Meta-analyses of published data demonstrate that reduced cardiovascular autonomic function as measured by heart rate variability (HRV) is strongly (i.e., relative risk is doubled) associated with an increased risk of silent myocardial ischemia and mortality. The determination of the presence of CAN is usually based on a battery of autonomic function tests rather than just on one test. Proceedings from a consensus conference in 1992 recommended that three tests (R-R variation, Valsalva maneuver, and postural blood pressure testing)or longitudinal testing of the cardiovascular autonomic system. Other forms of autonomic neuropathy can be evaluated with specialized tests, but these are less standardized and less available than commonly used tests of cardiovascular autonomic function, which quantify loss of HRV. Interpretability of serial HRV testing requires accurate, precise, and reproducible procedures that use established physiological maneuvers. The battery of three recommended tests for assessing CAN is readily performed in the average clinic, hospital, or diagnostic center with the use of available technology. Measurement of HRV at the time of diagnosis of type 2 diabetes and within 5 years after diagnosis of type 1 diabetes (unless an individual has symptoms suggestive of autonomic dysfunction earlier) serves to establish a baseline, with which 1-year interval tests can be compared. Regular HRV testing provides early detection and thereby promotes timely diagnostic and therapeutic interventions. HRV testing may also facilitate differential diagnosis and the attribution of symptoms (e.g., erectile dysfunction, dyspepsia, and dizziness) to autonomic dysfunction. Finally, knowledge of early autonomic dysfunction can encourage patient and physician to improve metabolic control and to use therapies such as ACE inhibitors and beta-blockers, proven to be effective for patients with CAN.

Autonomic Nervous System Diseases↗