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At least 631 records · Page 35Linked to original sources
PubMed1987

Intrathoracic interventional vascular techniques in congenital cardiovascular disease.

Interventional radiologic techniques have been applied to the management of congenital cardiovascular abnormalities. Transcatheter embolization is now the procedure of choice in the treatment of pulmonary arteriovenous malformations. Transluminal angioplasty has been successfully employed in the management of patients with congenital pulmonary and aortic valvular stenosis and may also be the treatment of choice for postoperative restenosis of coarctation of the aorta.

Angioplasty, Balloon↗
PubMed2003

Clinical consequences of cardiovascular autonomic neuropathy in diabetic patients.

A wide range of clinical consequences of cardiovascular autonomic neuropathy (CAN) can be observed in diabetic patients and contributes to the clinical picture of the diabetic heart. Resting heart rate and cardiovascular reflexes as well as circadian heart rate variability may be altered by CAN in diabetes. Moreover, blood pressure is also influenced by sympathovagal imbalance. Postural hypotension is a clinical characteristic in diabetic subjects with CAN. Painless myocardial infarction, ischaemia and left ventricular dysfunction are also observed in some cases. Impairment of cardiac parasympathetic and sympathetic innervation as well as QT-interval prolongation may play a partial role in the pathogenic mechanism of sudden unexpected death in diabetic patients. The risk of surgical intervention and that of anaesthesia are increased due to abnormal cardiovascular reactions. Clinical symptoms and signs of CAN should be assessed as severe diabetic complication and the therapy is difficult in some cases. Taken together, symptoms and signs of CAN carry a poor prognosis in diabetic patients.

Autonomic Nervous System Diseases↗
PubMedDate not supplied

Diagnosis and management of drop attacks of vestibular origin: Tumarkin's otolithic crisis.

Erroneous signals of vestibular origin can cause sudden falls without warning. Drop attacks of vestibular origin in our experience most commonly occurred in patients with late or end-stage endolymphatic hydrops (usually idiopathic, ie, Meniere's disease). Eponymically termed Tumarkin's otolithic crisis, drop attacks of vestibular origin must be distinguished from drop attacks due to cardiovascular abnormalities, seizure disorders, vertebral basilar arterial insufficiency (transitory brain stem ischemia), multiple sclerosis, and drug-induced motor control disturbances. The treatment of choice for drop attacks of vestibular origin is either surgical ablation (labyrinthectomy) in the absence of serviceable hearing or middle fossa vestibular nerve section in order to preserve serviceable hearing.

Cardiovascular Diseases↗
PubMed1984

Complications of total knee replacement.

The records and radiographs of 162 patients with 224 total knee replacements were reviewed for evidence of complications. Early complications included cardiovascular abnormalities, in particular deep vein thrombosis (3%), and limitation of motion requiring manipulation under anesthesia (7%). Late problems included patellofemoral arthritis (11%), heterotopic bone formation (10%), loosening (7%), deformity (4%), fracture (3%), and infection (2%). Patellofemoral pain and arthritis is the most common and often the most disabling complication.

Adult↗
PubMed1996

Absence of correlation between transient cranial hemorrhages and congenital malformations following neural crest ablation in chicks.

Ablation of premigratory cardiac neural crest has been used to produce and study extensively a model of abnormal cardiovascular dysmorphology. Previous and continuing research in this laboratory concerns different aspects of the involvement of cranial neural crest in the development of cranial, cervical and cardiac tissues in chick embryos. Recently, we detected the occurrence of transient cranial hemorrhages 24-48 hr after the ablation of selected segments of premigratory cranial neural crest. Since one possible mechanism of action for certain teratogens involves nonreparable damage to a primordial embryonic tissue by an antecedent hemorrhage, the objective of this study was to determine which of three different neural crest ablations is associated with hemorrhages and whether subsequent congenital abnormalities were correlated with the ablation procedure and/or hemorrhage. Premigratory neural crest was ablated from 3 different sites, designated cardiac, mesencephalic and trunk crest, respectively, of stage 8-10 chick embryos. Sham-operated embryos were controls. At 24, 30, and 48 hr after ablation, each embryo was observed for the presence of hemorrhages. On incubation day 11 all the living embryos were killed, fixed, weighed, and analyzed for selected length measurements, developmental stage, and the types and rates of congenital abnormalities. Cardiac and mesencephalic ablation group embryos exhibited significant incidences of cranial hemorrhages and changes in many of the parameters analyzed. It was concluded that the cardiac and mesencephalic, but not the trunk neural crest ablations, produced significant changes in incubation day 11 embryos. However, there was no correlation between the abnormalities and the prior occurrence of the transient cranial hemorrhages.

Animals↗
PubMed1994

Vasodilators: scorpion envenoming and the heart (an Indian experience).

Our aim was to assess clinically whether there was any benefit in adding a single dose of sublingual nifedipine (a slow calcium channel blocker) to prazosin in the management of the cardiovascular manifestations of envenoming by the Indian red scorpion (Mesobuthus tamulus). A total of 163 patients stung by this species was admitted to hospital at Mahad between January 1991 and October 1993. Cardiovascular abnormalities were hypertension (59), of whom 42 had bradycardia and 17 had tachycardia; pulmonary oedema (14), of whom eight had hypertension and six hypotension; supraventricular tachycardia (eight), of whom three had hypotension and one died. Of the remaining patients, 78 demonstrated severe excruciating local pain at the site of sting but had no systemic involvement. Nineteen patients with hypertension and tachycardia were given a single dose of sublingual nifedipine plus prazosin on admission, then prazosin alone repeated 6 hourly. Five patients with massive life-threatening pulmonary oedema recovered after being given intravenous sodium nitroprusside. Prazosin alone helped to alleviate cardiovascular manifestations in the remaining 52 victims. One patient was admitted in a deep coma, 12 hr after the sting, and died. Eight victims whose blood pressure had been controlled in hospital by nifedipine plus prazosin developed acute pulmonary oedema necessitating additional doses of prazosin for recovery. Fifty-two victims treated with prazosin alone did not develop pulmonary oedema and the drug appeared to hasten the recovery. In the presence of high blood pressure, tachycardia, a murmur and impending myocardial failure, nifedipine appeared to contribute to cardiopulmonary instability and to augment myocardial oxygen consumption. In this situation calcium channel blockers should probably be avoided.

Adolescent↗
PubMed2003

Injectable microbubbles as contrast agents for diagnostic ultrasound imaging: the key role of perfluorochemicals.

Ultrasonography has, until recently, lacked effective contrast-enhancing agents. Micrometer-sized gas bubbles that resonate at a diagnostic frequency are ideal reflectors for ultrasound. However, simple air bubbles, when injected into the blood stream, disappear within seconds through the combined effects of Laplace pressure, blood pressure, and exposure to ultrasound energy. Use of fluorocarbon vapor, by extending the persistence of microbubbles in vivo from seconds to minutes, propelled contrast ultrasonography into clinical practice. Imaging techniques that selectively suppress tissue, but not microbubble signal, further increase image contrast. Approved products consist of C3F8 or SF6 microbubbles, and N2 microbubbles osmotically stabilized with C6F14. These agents allow the detection and characterization of cardiovascular abnormalities and solid organ lesions, such as tumors. By providing higher quality images, they improve the accuracy and confidence of disease diagnosis, and can play a decisive role in clinical decision making. New objectives include agents that target specific cells for the molecular imaging of disease, and drug and gene delivery, including ultrasound-triggered delivery.

Cardiovascular Diseases↗
PubMed2002

Non-classical target organs in primary hyperparathyroidism.

Classical primary hyperparathyroidism (PHPT) was a multisystem disorder with clear neurologic, psychiatric, gastrointestinal, and cardiovascular consequences. The nature and extent of involvement of these target organs in the modern presentation of the disease are controversial. Although hypertension has been associated with PHPT, it is not cured after parathyroidectomy, nor is it easier to control. Despite significant data on European patients, information on the incidence of cardiovascular abnormalities in American patients with mild disease are limited. Investigation is turning to more subtle abnormalities, such as vascular reactivity and endothelial function, where data are conflicting. Many patients complain of nonspecific neuropsychiatric symptoms. This has been a difficult area to study quantitatively. Classical neuromuscular disease is rare in mild PHPT, although weakness and easy fatigability remain common complaints. These nonspecific symptoms may or may not improve with surgery. While no clear causal association exists between sporadic PHPT and peptic ulcer disease, this is not the case in patients with multiple endocrine neoplasia type 1 (MEN1). Gastrinoma is more severe in those with coexisting PHPT, and Zollinger-Ellison Syndrome improves with treatment of PHPT. Further efforts are necessary to characterize the cardiovascular and neuropsychological profiles of mild PHPT and to determine the longitudinal course of such alterations. With available data suggesting that many asymptomatic patients with PHPT can be safely followed without parathyroidectomy, this information will be of key importance in the management of such individuals.

Behavioral Symptoms↗
PubMed2004

Critical role for retinol in the generation/differentiation of angioblasts required for embryonic blood vessel formation.

Numerous studies demonstrate that vitamin A (retinol) deficiency causes abnormal cardiovascular morphogenesis. We evaluated the impact of retinol deficiency on the regulation of the numbers of endothelial cells and angioblasts (endothelial progenitors) produced during embryonic quail development. At the one-somite stage, there were no discernible differences in the mean number of endothelial cells or angioblasts in normal and retinol-deficient embryos. However, retinol-deficient embryos at the three-somite stage had an increase in the mean number of endothelial cells but no difference in the mean number of angioblasts. By contrast, retinol-deficient embryos at the five-somite stage have 61% of the normal number of endothelial cells and 12% of the normal number of angioblasts. Similarly, retinol-deficient embryos at the 10-somite stage had 71% and 60% of normal numbers of endothelial cells in capillary-like networks and the sinuses venosus, respectively. Furthermore, we show that retinol deficiency did not elicit a global reduction in mesodermal cell numbers but was specific to cells of the endothelial lineage. Taken together, our findings suggest that vascular abnormalities observed under conditions of retinol deficiency are due to reduction in the number of angioblasts and consequently an insufficiency in the number of endothelial cells required to build complex vascular networks.

Animals↗
PubMed1977

Physiologic profiles in circulatory support and management of the critically ill.

An automated system has been developed for measuring hemodynamic, oxygen transport and tissue utilization functions. Rapid measurement and data analysis of physiologic profiles by paramedical personnel allow prompt evaluation of altered cardiovascular function. Evaluation of physiologic function allows therapeutic interventions to be instituted on a timely basis, appropriately directed toward improvement of the measured cardiovascular abnormalities. Physiologic profile studies were performed on 1016 occasions in 580 patients during a three-year period and form the basis of this report. Although utilized on hospitalized patients, there are implications for use in evaluating and treating all critically ill patients.

Biological Transport, Active↗
PubMed1984

Sequential hemodynamic and oxygen transport abnormalities in patients with acute pancreatitis.

Physiologic abnormalities were evaluated by sequential hemodynamic and oxygen transport measurements in 33 patients with acute pancreatitis. The hypotensive crisis, which was defined as the lowest mean arterial pressure (MAP), was used as the common temporal reference point to align the data in a coherent fashion. The data of the 48-hour periods before and after the hypotensive crisis then were evaluated. The patients were divided into normotensive and hypotensive groups and the latter were divided into survivors and nonsurvivors to evaluate the severity of the disorder and to identify the patterns representative of survival and death. The physiologic abnormalities of the hypotensive patients include decreased systemic vascular resistance index (SVRI) and compromised cardiac function. The latter was demonstrated during the hypotensive episode by significantly reduced left ventricular stroke work index (LSWI), despite increases in heart rate (HR), central venous pressure (CVP), pulmonary capillary wedge pressure (WP), and cardiac index (CI). The normotensive group had increased oxygen consumption (Vo2), oxygen delivery (Do2), pulmonary shunt (Qsp/Qt), LSWI, normal SVRI, and high CI. The hypotensive nonsurvivors had lower MAP, LSWI, SVRI, Do, and hematocrit as well as higher pulmonary vascular resistance index (PVRI) and Qsp/Qt than did the survivors. These findings do not support myocardial depression as the primary cardiovascular abnormality in acute pancreatitis, but rather suggest the decreased vascular tone from flow maldistribution in the peripheral microcirculation limits tissue oxygenation in the face of increased metabolic requirements of the hypercatabolic state.

Acute Disease↗
PubMed1976

Cardiac valvular anomalies in Fabry disease. Clinical, morphologic, and biochemical studies.

The cardiovascular abnormalities were investigated in two unrelated hemizygous males with Fabry disease who had clinical mitral insufficiency. Postmortem examination of their hearts revelaed anatomic, ultrastructural and biochemical abnormalities resulting from defective activity of the lysosomal enzyme, alpha-galactosidase A. The ultrastructural and biochemical studies demonstrated the marked accumulation of the major glycosphingolipd substrate, trihexosyl ceramide, in the lyosomes of all the cardiac tissues examined; the greatest concentrations were found in the mitral valve and elft ventricular myocardium. Intriguingly, digalactosyl ceramide, a glycosphingolipid substrate not detectable in normal lung, vessel or cardiac tissues, was found increased only in the lung and right heart tissues. Morphologic and chemical examination of cardiac and systemic vessels demonstrated accumulation of trihexosyl ceramide in lysosomes of the vascular endothelium. These studies demonstrate that the progressive accumulation of trihexosyl ceramide in the lysosomes of the cardiac structures and vascular system leads to the multiple cardiovascular manfiestation of Fabry disease.

Ceramides↗
PubMed2003

[Public health control of hyperhomocysteinemia and its consequences].

The etiological role of hyperhomocysteinemia in the origin of neural-tube defects was proved, therefore a mandatory flour folic acid fortification program was introduced in the USA since January 1, 1998. In Hungary one kind of breads was fortified with folic acid, vitamin B12 and vitamin B6. The Hungarian randomised controlled trials of periconceptional folic acid containing micronutrient-combination supplementation also indicated a reduction in the occurrence of congenital cardiovascular malformations, urinary tract's defects and congenital limb deficiencies and these findings were confirmed by US teams. Recent studies showed a positive association between cardiovascular diseases and hyperhomocysteinemia as well, thus it is considered as an independent etiological factor in the pathogenesis of ischemic heart diseases, stroke, deep vein thrombosis, in addition of vascular diseases in the placenta during pregnancy. Other studies showed that hyperhomocysteinemia is more prevalent in demented patients and in persons with impaired cognitive performance. Some association was also found between hyperhomocysteinemia and cancers (e.g. colon). There is strong evidence that four vitamins B, such as vitamin B11 (folate-folic acid), vitamin B12, B2 and B6 can reduce the level of serum homocysteine and subsequently neural-tube defects. In addition the results of intervention studies indicated a protective effect of folic acid and other vitamins B for some other congenital abnormalities, cardiovascular diseases, senile dementia and cancers. The flour fortification with these water-soluble vitamins B is appropriate for an effective public health program for the primary prevention of these hyperhomocysteinemia-related disorders. There is no real risk for side effects on the basis of available US, Canadian and Hungarian experiences. In conclusion an urgent task is to introduce a mandatory flour fortification program in Hungary.

Alzheimer Disease↗
PubMed2001

Detection of cardiac hypertrophy in the fetus by approximation of the current dipole using magnetocardiography.

To determine the developmental changes in the myocardial current during fetal life, and to evaluate the clinical usefulness of magnetocardiography for prenatal diagnosis of cardiac hypertrophy or enlargement, we approximated the magnitude of the one-current dipole of the fetal heart using fetal magnetocardiography (fMCG). A total of 95 fetuses with gestational age of 20-40 wk were included in this study. fMCG was recorded with a nine-channel superconducting quantum interference device system in a magnetically shielded room. The magnitude of the dipole (Q) was calculated using an equation based on the fMCG amplitude obtained on the maternal abdomen and the distance between the maternal surface and fetal heart measured ultrasonographically. In uncomplicated pregnancies, the Q value correlated significantly with gestational age, reflecting an increase in the amount of myocardial current, i.e. myocardial mass. Moreover, the Q values in fetuses with cardiomegaly caused by various cardiovascular abnormalities tended to be higher than the normal values. Although there are some limitations of the methodology based on the half-space model, and fetal orientation may influence the magnitude of the dipole, making it smaller, fMCG recorded with a multichannel superconducting quantum interference device system is a clinically useful tool for noninvasive, prenatal, and electrical evaluation of fetal cardiac hypertrophy.

Cardiomegaly↗
PubMed2006

Cardiovascular responses and postexercise hypotension after arm cycling exercise in subjects with spinal cord injury.

OBJECTIVE: To examine postexercise hypotension and contributing factors in subjects with spinal cord injury (SCI). DESIGN: Prospective clinical research study. SETTING: Rehabilitation center. PARTICIPANTS: Subjects with chronic cervical-level (n=19) and thoracic-level (n=8) SCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects underwent graded arm-cycling with electrocardiogram and oxygen uptake monitoring to exhaustion. Heart rates and blood pressures were measured before and after exercising. Injury to motor and sensory pathways was determined by American Spinal Injury Association grade, and to autonomic pathways by sympathetic skin responses (SSRs) (n=16). RESULTS: Resting blood pressures and heart rates were lower in cervical than thoracic SCI (mean arterial pressure [MAP]: cervical, 76.6+/-2 mmHg; thoracic, 93.5+/-3 mmHg; P<.001). Following exercise, heart rate responses were greater in thoracic than cervical SCI; MAP increased in thoracic SCI (8.4+/-5 mmHg) and markedly decreased in cervical SCI (-9.3+/-2 mmHg) (P<.001). No subject had significant electrocardiographic abnormalities at rest or during exercise. There were correlations between SSR and heart rate and blood pressure responses to exercise; the correlation between the SSR and blood pressure response was due to an interaction between the heart rate and blood pressure responses. CONCLUSIONS: Abnormal cardiovascular responses to exercise and transient postexercise hypotension were common in cervical, but not thoracic SCI. This may be partly related to loss of descending sympathetic nervous control of the heart and vasculature following high SCI.

Adult↗
PubMed2005

Increased expression of iNOS is associated with endothelial dysfunction and impaired pressor responsiveness in streptozotocin-induced diabetes.

Studies in streptozotocin (STZ)-induced diabetic rats have demonstrated cardiovascular abnormalities such as depressed mean arterial blood pressure (MABP) and heart rate (HR), endothelial dysfunction, and attenuated pressor responses to vasoactive agents. We investigated whether these abnormalities are due to diabetes-associated activation of inducible nitric oxide synthase (iNOS). In addition, the effect of the duration of diabetes on these abnormalities was also evaluated. Diabetes was induced by administration of 60 mg/kg STZ via the tail vein. One, 3, 9, or 12 wk after STZ injection, MABP, HR, and endothelial function were measured in conscious unrestrained rats. Pressor response curves to bolus doses of methoxamine (MTX) and angiotensin II (ANG II) were constructed in the presence of N-[3(aminomethyl)benzyl]-acetamidine, dihydrochloride (1400W), a specific inhibitor of iNOS. Depressed MABP and HR and impairment of endothelial function were observed as early as 3 wk after induction of diabetes. Acute inhibition of iNOS with 1400W (3 mg/kg i.v.) restored the attenuated pressor responses to both MTX and ANG II without affecting the basal MABP and HR. Immunohistochemical and Western analysis blot studies in cardiovascular tissues revealed decreased expression of endothelial nitric oxide synthase (eNOS) concomitant with increased expression of iNOS and nitrotyrosine with the progression of diabetes. Our findings suggest that induction of iNOS in cardiovascular tissues is dependent on the duration of diabetes and contributes significantly to the depressed pressor responses to vasoactive agents and potentially to endothelial dysfunction.

Amidines↗
PubMed1988

Cardiovascular pathology in osteogenesis imperfecta type IIA with a review of the literature.

Lethal perinatal osteogenesis imperfecta (OI Type II) is a biochemically diverse collagen disorder characterized by short, crumpled long bones, beaded ribs, blue sclerae and thin, fragile skin. Cardiovascular abnormalities are rarely described. Using morphometry and light and electron (SEM and TEM) microscopy, we analyzed the hearts and great vessels from 2 fetuses with OI Type IIA and compared the findings with age-matched controls. The heart weights and atrioventricular valve (AVV) circumferences were reduced in OI. The chordae tendineae were short and fragile; both the AVVs and the chordae tendineae were hypercellular. TEM showed relatively little organized collagen in the chordae tendineae of OI fetuses. Furthermore, quantitative evaluation of collagen fibril size revealed a decrease in the cross-sectional diameter. There was also a marked decrease in the adventitial and intramural collagen of the intramyocardial arteries and great vessels in OI. Our study reports, for the first time, specific lesions in the cardiovascular systems of patients with OI Type II and reviews the cardiovascular pathology in other forms of OI.

Cardiovascular System↗
PubMedDate not supplied

Cirrhotic cardiomyopathy.

Liver cirrhosis is associated with a wide range of cardiovascular abnormalities. These abnormalities include hyperdynamic circulation characterized by an increase in cardiac output and a decrease in peripheral vascular resistance. Despite the increased cardiac output, impaired ventricular contractility in response to both physiological and pharmacological stimuli has been described. Other cardiac abnormalities include structural changes including enlargement or hypertrophy of different cardiac chambers and electrophysiological changes such as QT prolongation. This constellation of cardiac abnormalities is termed cirrhotic cardiomyopathy. The pathogenic mechanisms of cirrhotic cardiomyopathy are multifactorial and include cardiomyocyte plasma membrane physico-chemical changes, attenuated stimulatory pathways, and enhanced activity of inhibitory systems. Accumulating evidence suggests that cirrhotic cardiomyopathy plays a major role in the pathogenesis of cardiac dysfunction following liver transplantation or transjugular intrahepatic portosystemic shunt placement. Recent research also strongly suggests that cirrhotic cardiomyopathy contributes to the pathogenesis of hepatorenal syndrome, especially following infections such as spontaneous bacterial peritonitis. Treatment of this syndrome remains largely empirical. Successful liver transplantation is thought to improve all the organ-related hemodynamic dysfunctions, including hepatopulmonary syndrome, cerebral hypoperfusion, hepatorenal syndrome, and cirrhotic cardiomyopathy. The prolonged QT interval normalizes following liver transplantation. Thus, liver transplantation appears to be the ultimate treatment for the cardiovascular complications of cirrhosis.

Biomarkers↗