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Orthostatic tolerance of normal Indians and those with suspected abnormal cardiovascular reflex status.

There were 143 healthy Indian males subjected to 70 degrees headup tilt (HUT) for 20 min on 166 occasions to evaluate their cardiovascular response. They responded with a significant rise in heart rate, diastolic pressure, and mean arterial pressure. Pulse pressure fell significantly. Heart rate and diastolic pressure during the tilt were significantly (p less than 0.05) and positively correlated to the height of the subjects. None of the subjects had syncope, which has been reported in normal individuals elsewhere. Of the 57 subjects with suspected abnormality of the cardiovascular reflex status, who were also investigated by the tilt test, 13 (22.8%) developed various degrees of orthostatic intolerance. Of these 13 subjects, 10 had had syncope in the past. In view of these observations, it is concluded that 70 degrees head-up tilt is an important clinicophysiological investigation in the assessment of subjects with a suspected abnormality of their cardiovascular reflex status.

Adult↗

[Cardiovascular abnormalities in systemic lupus erythematosus patients in echocardiographic assessment].

UNLABELLED: Cardiovascular system involvement is the third most common reason of death in patients with systemic lupus erythematosus (SLE). The aim of this study was to assess the cardiac involvement in the SLE patients with a regard to clinical, serological and environmental risk factors. MATERIAL AND METHODS: 103 patients were included into the study, 91 women and 12 men, aged 16-74 yrs, the control group included 25 subjects. Physical examination, two-dimensional guided M-mode and Doppler echocardiographic recordings were performed. The tests for the presence of ANA, ENA, antiphospholipid antibodies (aCL, LA, anti-beta2GPI and antiprothrombin antibodies), ANCA (anti-neutrophil cytoplasm antibodies), AECA (anti endothelial cell antibodies) were carried out. RESULTS: The following pathologies were significantly more common in the SLE patients: pericardial involvement (58%), organic changes of the mitral valve cusps (54%), organic changes of the aortic valve cusps (36%), widening of the aortal lumen (35%), enlargement of the left atrium (18%), hypokinesis of the left ventricle myocardial muscle (15%). Ultrasound cardiac pathologies were associated with presence of antiphospholipid antibodies, ANCA, anti-hitone antibodies and AECA. High activity of SLE increased risk of pericarditis and ascending aortic wall thickening. Cardiovascular manifestations occurred most frequently in patients with short time duration of SLE. CONCLUSION: Cardiac involvement is a frequent and early systemic complication of SLE and it is the most commonly related to pericardium and valvular apparatus. Cardiovascular manifestations in SLE patients are the most frequently related to the presence of serological risk factors, mainly antiphospholipid antibodies. It suggests their major role in the pathogenesis of the cardiovascular involvement in SLE. Pericarditis are markers of high activity of SLE.

Adolescent↗

The effects of monotherapy or combined therapy with an angiotensin converting enzyme inhibitor following initial treatment with calcium channel blockers on residual cardiovascular abnormalities.

The effects of sequential therapy with angiotensin-converting enzyme inhibitor (cilazapril) on left ventricular (LV) mass, LV diastolic function, and carotid artery distensibility were evaluated in 90 hypertensive patients whose blood pressure controlled below 140/90 mmHg with a calcium channel blocker monotherapy. The possibility of predicting the efficacy of cilazapril based on evaluation of biochemical and genetic markers of the renin-angiotensin system was examined. Before cilazapril therapy, LV diastolic function and carotid artery distensibility were significantly impaired in 32 patients with residual LV hypertrophy compared with patients without LV hypertrophy. Cilazapril improved the LV mass in these patients with LV hypertrophy and improved LV diastolic function in a subset of 20 patients with elevated plasma renin activity. Patients with residual LV hypertrophy accompanied by cardiovascular functional abnormalities. Subsequent treatment with cilazapril significantly improved LV morphology and function in those with residual LV hypertrophy or elevated plasma renin activity.

Aged↗

Three-dimensional computed tomographic imaging of complex congenital cardiovascular abnormalities.

Primary evaluation of congenital cardiac abnormalities traditionally relies upon echocardiography and conventional angiography, both of which have potential limitations. Echocardiography is an operator dependant study, limited by a small window and patient movement. Conventional angiography is an invasive procedure with an inherent risk of catheter complication such as vessel damage, bleeding, stroke and infection. During angiography, overlapping of the pulmonary and systemic circulation often provides a confusing picture given complex anatomy. Another limiting factor of particular significance in young children is radiation dose and contrast administration during catherization procedures. Three-dimensional MDCT provides an alternative to alleviate these pitfalls of traditional cardiac diagnostic studies. Development of multi-detector computed tomography (MDCT) and 3D software provides new methods for non-invasive visualization and evaluation of congenital cardiac abnormalities. The multiplanar, volumetric functions allow faster and more complete computed tomography diagnosis and better understanding of clinical relevance of complex cardiac anatomy. In addition, 3D imaging is particularly useful for preoperative planning and postoperative outcomes. This essay provides case studies to illustrate the usefulness of MDCT/3D CT for evaluation of complex congenital heart disease.

Adolescent↗

Effects of bone marrow transplantation on the cardiovascular abnormalities in canine mucopolysaccharidosis VII.

The genetic mucopolysaccharidoses (MPS) are a family of lysosomal storage diseases resulting from defective catabolism of glycosaminoglycans (GAGs). Echocardiographic abnormalities in dogs with MPS type VII (Sly syndrome, beta-glucuronidase deficiency) included mitral valve thickening and insufficiency, large aortic dimensions in both the long and short axes, and thickened aortic valves. Grossly, at post mortem examination, there was nodular thickening of the mitral valve, a prominent ductus diverticulum, and a dilated aorta with thickened walls. Histologically, cytoplasmic vacuolation was seen in cells of the mitral valves, coronary arteries, and aorta. By electron microscopy, the cells of the mitral valve were packed with electron-lucent cytoplasmic vacuoles. The mean residual activity of beta-glucuronidase in the aorta and myocardium was <1% of normal, the mean hexosaminidase A activity >2. 5 times normal, and the mean GAG concentrations more than twice normal. In three MPS VII dogs that received heterologous BMT at 6 weeks of age, the echocardiographic abnormalities were improved, and the histopathologic and ultrastructural pathology was reduced. In the aorta and myocardium, the mean beta-glucuronidase activity of the BMT group was 4.5% and 11% of normal, respectively, and the hexosaminidase A activity and GAG concentrations were normalized. Bone Marrow Transplantation (2000) 25, 1289-1297.

Animals↗

Cardiovascular abnormalities in progeria. Case report and review of the literature.

The cardiovascular findings in cases of progeria are similar in many respects to the changes associated with aging. These changes include prominent atherosclerosis and calcification of the aortic and mitral valves, coronary arteries, and aorta. The coronary artery disease leads to ischemic changes in the myocardium, including well-defined infarcts. In addition, the present case demonstrates narrowing of the small intramural arteries, which may have contributed to myocardial fibrosis.

Adolescent↗

Cholesterolemia and cardiovascular abnormalities in rats caused by copper deficiency.

The association of copper with cardiovascular disease and a possible involvement of copper in the metabolism of cholesterol prompted the study on hypercholesterolemia mediated by copper deficiency. Copper deficient rats were found to exhibit a highly significant cholesterolemia (P less than 0.001), and plasma cholesterol showed a significant correlation with hepatic copper concentration (P less than 0.03). Two copper deficient rats died with hemothorax. The hearts of copper deficient rats were hypertrophied with large areas of hemorrhage, inflammation and focal necrosis. Prominent subendocardial fibroplasia was evident in copper deficient animals. The myocardial arteries of copper deficient rats were normal, however, aortas showed large areas of distorted and depleted elastic fibers. The results are discussed in terms of a possible role for copper in cholesterol metabolism, and in the pathogenesis of atherosclerosis.

Animals↗

Cardiovascular abnormalities associated with human and rodent obesity.

Obesity is a major risk factor for cardiovascular disease. However, a direct link between these two states is difficult to establish, since obesity frequently occurs with other disease states such as diabetes, hypertension and atherosclerosis. Clinical studies have clearly shown that uncorrected obesity is associated with cardiac hypertrophy and compromised ventricular function. A number of rodent models of obesity have been studied in terms of cardiovascular adaptations. Cardiac function of the obese Zucker rat appears to be normal at a younger age. Only after several months is depression in cardiac function discernable. These animals are mildly hypertensive, but do not exhibit the characteristic increase in cardiac output associated with human obesity. A unique characteristic of JCR:LA-cp rat is that they develop atherosclerotic and myocardial lesions. Hearts from these animals will maintain normal function when perfused with physiological levels of calcium. At higher calcium concentrations, however, mechanical function becomes impaired. Dietary-induced obese rats exhibit many of the hemodynamic alterations associated with human obesity, but there is no evidence to-date that these animals will develop severe cardiac depression. Short-term weight reduction apparently has beneficial cardiovascular effects, but weight cycling may be harmful. Given the widespread occurrence of obesity, further studies are warranted to characterize the cardiac manifestations of this condition.

Animals↗

[Williams syndrome without cardiovascular abnormalities].

In a patient with facial dysmorphic traits, growth deficiency, mental retardation but without cardiovascular anomalies, detection of hemizygosity at the elastin locus by FISH analysis confirmed diagnosis of Williams Syndrome (WS). To date, cardiovascular pathology in WS is thought to be the result of a localized response of inelastic vessels to haemodynamic stress in fetal life. Patients with deletion at the elastin locus and no cardiovascular defects suggest that genetic aspects other than hemizygosity must be investigated, such as transcriptional regulation of the elastin gene expression. Moreover, a complete characterization of the region commonly deleted in 7q11.23 is needed before excluding other genes as responsible for the cardiovascular defects. Clinical investigations are requested for selecting patients with partial phenotype, various degrees of tissue damage and different evolution at follow-up.

Cardiovascular Diseases↗

[Cardiovascular abnormalities of the antiphospholipid antibody syndrome].

The antiphospholipid antibody syndrome (APS) may present with serious cardiovascular complications which should be recognised by the cardiologist. The authors report a series of 6 cases of APS diagnosed after thrombotic events and the finding of antiphospholipid antibodies. The APS was primary in 5 cases and associated with tuberculous lymphadenitis in 1 case. There was cardiac involvement in 5 patients with pericardial effusion in 3 cases, complicated by tamponade as the presenting sign of primary APS in the other 2, valvular disease in one case (moderate mitral stenosis with aortic valve disease) and pulmonary embolism in one case. Five patients developed recurrent deep vein thrombosis of the legs. One patient had a transient ischaemic cerebral attack.

Adult↗