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PubMed1979

Echocardiographic study on diastolic posterior wall movement and left ventricular filling by disease category.

The diastolic characteristics of the left ventricle with special reference to the patterns of left ventricular filling and diastolic posterior wall movement were studied echocardiographically in 95 patients with various cardiac conditions including constrictive pericarditis, idiopathic cardiomyopathy (CCM, HCM), valvular aortic stenosis (AS), mitral stenosis (MS), hypertension (HT), aortic insufficiency (AI), mitral insufficiency (MI), and in 20 normal subjects. 1. Various types and severities of LV diastolic abnormalities were revealed by analyzing the patterns of posterior wall movement and LV filling in three diastolic phases--rapid filling period, slow filling period, and atrial filling period, respectively. 2. Disturbances of posterior wall distension and LV filling during the rapid filling period with a compensatory augmentation of atrial contribution to LV filling were observed in most patients. These patients also showed a markedly decreased posterior wall velocity and LV filling rate during rapid filling period. 3. E-F slope was significantly decrease in patients with MS, AS, and HCM. E-F slope correlated well with DPWV and RFR in most patients. In MS, however, DDR decreased to a disproportionate degree with a decrease in DPWV and RFR, probably due to the structural changes and decreased mobility of the mitral valve. From this study, we conclude that the patterns of the left ventricular filling and posterior wall movement during three phases of diastole obtained by echocardiography is useful in detecting left ventricular diastolic abnormalities.

Adult↗
PubMed1979

Obstruction of the duodenal bulb caused by gallstone perforation.

Because of acute symptoms in the upper abdomen, upper gastrointestinal endoscopy was performed in a 75-year-old female patient. A large (5 cm x 10 cm) perforated gallstone was embedded in the duodenum, causing complete obstruction of the duodenal bulb. The stone was removed via pylorotomy. A fistula remained between the gallbladder and the duodenum. Cholecystectomy was not carried out because of the unfavourable cardiac condition of the patients. There was no complications.

Aged↗
PubMed1977

Temporal bone pathology in an active case of glue ear.

A child aged 3 1/2 died from a cardiac condition after many and prolonged antibiotic courses: bilateral glue ear had been treated for the previous 18 months. Histopathology showed cholesterol granulomata in the mastoid air cells, with evidence of old hemorrhage, and of former inflammation of bone. The exudate was histiocytic with some giant cells. An 'orange spot' on the tympanic membrane was hyperaemic middle-ear mucosa, heavily infiltrated by plasma cells, lymphocytes and histiocytes. There was no evidence of hypersecretion. Some of the most abnormal areas were around the stapedial niche and the round window.

Child, Preschool↗
PubMed1979

Let us not lose echocardiography.

Despite the unquestioned value of echocardiography in the diagnosis of valvular disease, pericardial effusion, cardiomyopathy and many other cardiac conditions, few residency programs in radiology are offering training in echocardiography. Echocardiograms of the last 100 consecutive patients in a small community hospital demonstrated a surprising breadth of clinical material. Echocardiography should be included in every residency program lest our role in this technique is lost altogether.

Echocardiography↗
PubMed1976

Body position, electrode level, and respiration effects on the Frank lead electrocardiogram.

Frank lead ECG/VCG changes with deep inspiration, expiration, and body position were investigated in 194 patients, 100 with an old myocardial infarction and the remaining 94 chosen as a representative sample of catheterization laboratory patients with a variety of cardiac conditions. In a subgroup of 144 of the patients, Frank lead records were made both at the fifth and the fourth intercostal space. Diagnostic interpretation was performed using the VA-Pipberger ECG Program. The results indicate that, in general, body position and electrode level influence on mean intervals and orientation angles is negligible. There was a highly significant decrease in the R and Q wave amplitudes in leads X and Z and in the maximum spatial magnitude of QRS when electrodes were shifted from the fifth to the fourth interspace. The most pronounced decrease in ECG/VCG amplitudes took place in deep inspiration while mean orientation angles changed little, with the exception of QRS elevation. However, while mean changes with body position and electrode level were rather small, substantial orientation and magnitude changes took place in many patients. Diagnostic interpretation of the records changed in 12.5% with electrode level change, in 11.9% with the transition of body position, and in 16.8% with deep inspiration. Strict standardization of electrode positions and recording procedure is suggested, particularly when serial comparison of Frank lead records is planned.

Adolescent↗
PubMed2025

What Should a Clinical Cardiologist Know About Cardiogenetics?

Inherited cardiovascular diseases are becoming increasingly prominent in clinical practice, significantly impacting diagnosis, risk assessment, and family screening strategies. Progress in genetic testing has broadened access to cardiogenetic evaluations, while also presenting new challenges in interpreting variants and incorporating findings into clinical care. This narrative review explores 20 essential questions that clinical cardiologists may face when dealing with suspected or confirmed inherited cardiac conditions. Organized as a practical, question-driven guide, it outlines when to consider a genetic cause, how to choose and interpret genetic tests, and how to manage patients regardless of their genetic test results. The review emphasizes variant classification based on American College of Medical Genetics and Genomics criteria, the importance of clinical context in interpreting uncertain results, and the principles behind family cascade screening. Particular attention is given to the management of relatives who carry a genetic variant but show no symptoms, and to the current limitations of genetic testing technologies (eg, performance). Ethical considerations, including the appropriate timing of testing in children minors, are also discussed. By connecting genetic insights with clinical cardiology, this review aims to support practical, informed decision making and promote effective collaboration with cardiogenetic specialists.

Humans↗
PubMed1975

An unusual case of urticaria -- cause and therapy.

A case is reported of a female patient who took 140 tablets of the antihistamine, mebhydrolin ('Fabahistin'), in one day for urticaria and experienced virtually no side effects. The urticaria cleared completely when her husband, who had a cardiac condition, died suddenly.

Adult↗
PubMed1976

Thallium 201 chloride uptake in tumours, a possible complication in heart scintigraphy.

An abnormal uptake pattern of 201Tl thallous chloride observed during myocardial scintigraphy of a patient with known thoracic tumour localization suggested the possibility that thallous chloride may also accumulate in tumours. This was confirmed by observing 201thallous chloride accumulation in rhabdomyosarcoma implants in rats. Thallium 201 accumulation in tumour cells should be borne in mind as a possible complicating factor when using this reagent for the evaluation of cardiac conditions in oncological patients.

Animals↗
PubMed1975

The spectrum of degenerative changes in hypertrophied human cardiac muscle cells: an ultrastructural study.

Light and electron microscopic observations were made on cardiac tissues removed at operation from 91 patients with ventricular hypertrophy, including left ventricular myocardium from 16 patients with aortic valvular disease and from 16 patients with asymmetric septal hypertrophy, and crista supraventricularis muscle from 59 patients with congenital heart diseases associated with right ventricular outflow tract obstruction. In all patients the majority of cardiac muscle cells were hypertrophied, had intact myofibrils, and were surrounded by small amounts of fibrous tissue. In 18 (20%) of the 91 patients cardiac muscle cells with a wide spectrum of degenerative changes were present in addition to hyperthrophied, nondegenerated cells. Early degenerative changes consisted of focal myofibrillar lysis, with preferential loss of thick myofilaments, and focal proliferation of tubules of sarcoplasmic reticulum. Cardiac muscle cells with advanced degeneration had extensive myofibrillar damage and a marked decrease in numbers of myofibrils and T-tubules. The most severely degenerated cells showed selective proliferation of organelles, including sarcoplasmic reticulum, mitochondria, and glycogen, which replaced the contractile elements in the cytoplasm. These findings suggest that degenerated cardiac muscle cells have poor contractile function and may be responsible for impaired cardiac performance in some patients with ventricular hypertrophy. These morphological features appear to represent a final common pathway for degeneration of cardiac muscle cells in a variety of cardiac conditions.

Aortic Valve Insufficiency↗
PubMed1978

[Behavior of hypertension and cardiovascular findings in hypertension within an observation period of 10 years (the Wurzen study 1961-1971)].

In concert with literary data during a mass X-ray examination in 1961 we established in 5,517 men of the district Wurzen a frequency of hypertension of 13.6% and in 1971 in the same group of test persons a frequency of hypertension of 19.4%. The percentage of the pathological cardiovascular X-ray findings was in normotonus 10.4% in 1961 and 11.2% in 1971, in hypertension 22.3% in 1961 and 27.5% in 1971. The dependence on the age of the test persons, on the degree of severity of hypertension, and particularly on the duration of the hypertension is clear. For prevention of a hypertensive heart disease the early recognition of a hypertension and an early therapy are necessary. On the basis of our studies the making of cardiovascular X-ray findings from photofluorograms is not suitable as screening test for the hypertension. The value of blood pressure controls in mass X-ray examinations must be emphasized. Important is the collection of cardiovascular X-ray findings from photofluorograms of the thorax for the establishment of a hypertensive heart disease, of not recognized vitia and age-conditioned cardiac and vascular changes. It implies an optimum use of the material collected in the mass X-ray examination.

Adult↗
PubMed1976

[Association of progressive external ophthalmoplegia and myocardiopathy with complete atrioventricular block. Apropos of a new case].

The authors report the case of a 31 year old man with an occulomotor palsy, who was admitted to hospital with complete atrio-ventricular block and syncopal attacks. The possible pathogenic significance of this association has given rise to differing hypotheses. A review of the literature shows that the occulomotor palsy has been interpreted either as an ophtalmoplegia (of neurogenic origin) because of the associated neurological findings and the histological changes in the occulomotor nuclei, or as an occular myopathy because of the associated muscular disorders and the changes on electromyography and on histology. The relationships between the occulomotor palsy and the cardiac condition are also discussed.

Adult↗
PubMed1977

Atrial fibrillation in children.

Atrial fibrillation is rare in children. Previous reports associated it with severe rheumatic heart disease and a poor prognosis. This review is of the unique experience of 35 cases of atrial fibrillation in children in the past 22 years; 23 patients were boys. The age of onset ranged from 1 day to 19 years (average, 8 years). Associated cardiac conditions were severe rheumatic mitral regurgitation (3 cases), cardiomyopathy (5), atrial tumors (2), infective endocarditis (1), paroxysmal atrial tachycardia of infants (4), idiopathic paroxysmal atrial fibrillation (1), Marfan's syndrome with mitral regurgitation (1), endocardial fibroelastosis (1), and structural congenital heart malformations (17). Surgical correction of congenital heart lesions was directly related to the development of atrial fibrillation in 14. Varying arrhythmias of the sick-sinus syndrome were observed in five children. The atrial fibrillation was paroxysmal or transient in 21 patients and persistent in 14. Treatment depended on the underlying condition. Digoxin was used in all cases and cardioversion attempted in ten; no patient was given anticoagulants. Three children had cerebral emboli, with residual defects. Eighteen patients are known to be alive, 13 are dead, and 4 are lost to follow-up. Atrial fibrillation in childhood is an indication for complete investigation of the patient and for the institution of treatment appropriate to the underlying disease.

Adolescent↗
PubMed1977

[Evaluation of the clinical effect of treatment with cardiac glycosides under conditions of ambulatory observation].

Thirty-four patients with rheumatic heart disease and 22 with atherosclerotic and post-infarction cardiosclerosis, signs of stage I-IIB circulatory insufficiency, and disorders of cardiac rhythm (auricular fibrillation) were kept under out-patient care for periods of 6 to 42 months. They all received cardiac glycosides per os in a maintenance dose determined in the clinic after intravenous digitalization. Clinical and echocardiographic examination of the patients was conducted every 4 to 6 months. Depending on the effect of long-term digitalization, all patients were divided into clinical groups in which the causes of the disturbed compensation were determined. The importance of regular doctor's control over proper intake of the maintenance dose of glycosides and its correction depending on each concrete clinical situation is stressed.

Adult↗
PubMed1976

Cardiac actomyosin ATPase activity after prolonged physical conditioning and deconditioning.

Cardiac actomyosin ATPase was increased by making rats swim 150 min/day, 5 days/wk for 8 wk. Changes in Ca2+ -stimulated ATPase activity were then studied in these conditioned rats and in similarly conditioned animals in which swimming was subsequently discontinued (group A), reduced to 45 min/day (group B), or continued at the original level for an additional 8 wk (group C). After the 8-wk initial program actomyosin ATPase activity averaged 22% higher in hearts of conditioned rats than in hearts of sedentary controls (P is less than 0.001). In group A, actomyosin ATPase activity declined rapidly and reached the level found in sedentary controls by the 13th day. In group B, actomyosin ATPase activity declined to the control level by the 30th day. At the end of 16 wk the percent increase in actomyosin ATPase activity in group C over that in hearts of sedentary animals was approximately the same as after 8 wk. These results demonstrate that elevation in cardiac actomyosin ATPase caused by moderate physical training in rats is not maintained if the training program is decreased or discontinued. The training program must be continued at or near the initial level if the increases in cardiac actomyosin ATPase are to be sustained.

Actomyosin↗
PubMed1978

[Course of experimental cardiac insufficiency under conditions of high altitude depending on the periods of adaptation].

The data characterizing the compensatory hyperfunction of the circulation and respiration with dosaged insufficiency of the mitral valve in animals, depending on the periods of adaptation to high-altitude are presented. Unadapted animals with insufficiency of the mitral valve had more serious disorders of hemodynamic and gaseous exchange accompanied by stasis in the lesser and greater circulation. 52.9% of the animals died during the first days after the formation of the mitral defect. In animals adapted to the high altitude hypoxia the process coursed with less pronounced disturbances of circulation and respiration; 28.6% of the animals died.

Adaptation, Physiological↗
PubMed1975

[Diagnostic characteristics of cardiac insufficiency under mountain conditions].

In patients with mitral lesions and prevalence of stenosis and insufficient circulation of the I, II A and B stages clinical and functional indicators of the cardiac work were studied at three different altitudes, viz. with a low-mountain relief (760 m), middle-mountain relief (1650-2020 m) and in highland (3600-4200 m). In highland decompensated mitral incompetence was found to be characterized by a much higher incidence of such manifestations of the disease as vertigo, syncopal attacks, fits of distressed respiration, epigastral pulsation, positive venous pulse, a significant expansion of the heart to the right, accentuation and splitting of the II tone on the pulmonary artery, overloading of the right ventricle and atrium (according to ECG findings), the absence of peripheral edematization and fibrillation arrythmia, the presence of arterial and venous hypotension, highly intensive hyperventilation, a drop of PAO2 and PACO2. In patients-residents of low- and middle-mountain regions the severity of clinical and hemodynamic disorders depended on the stage of cardiac insufficiency, whereby in residents of the second region the disclosed deviations on the level of circulation proved more marked. It is shown that the correlation links between individual physiological variables become greatly disrupted parallel with progressively increasing severity of cardiac incompetence. In conditions prevailing in the middle and, especially, high altitude areas there are evident links between individual functional indicators which are absent in low-mountain areas. The above data bear evidence not only to the fact that with progressive severity of cardiac insufficiency the disrupted regulation of the circulation system becomes still more aggravated, but also to the presence of other compensatory mechanisms that are operative in mountain areas.

Adolescent↗