[Role of the heart in the genesis of essential arterial hypertension].
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Biomedical subjects
Publications and source records attributed to M Dallocchio.
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62 of 100 cases of acute pericarditis observed over 15 years were so-called acute benign pericarditis. 20 of these patients (30%) had multiple relapses. Relapse could not be predicted. The interval between the initial affection and first relapse was usually more than one month (18/20). Each relapse was accompanied by pain, fever, ST-T changes, slight cardiomegaly and acceleration of the ESR. Corticotherapy appeared to be responsible for relapse in 13 cases. In 6 cases the eradication of a deep septic focus prevented further relapses. In two cases the duration of anti-inflammatory therapy was thought to have been insufficient. Antibiotic therapy did not seem to be a provocative factor. Relapses may be numerous (10 to 12) and prolonged (24-36 months) especially in the corticodependant forms in which steroids should be tailed off gradually according to a strict protocol.
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Hypertensive heart disease has been studied by means of the maximal exercise test, mechanographic techniques and echocardiography. The patients have been divided into three groups according to their electrocardiogram and the size of their heart as measured radiologically: I: normal ECG, normal size; II: ECG shows left atrial hypertrophy, heart of normal size; III: ECG shows left ventricular hypertrophy, heart is dilated. The total work on exercise decreases from group I to group III. The parameters of the pumping action (PEP/TEVG, VCF, FE) were identical in all three groups and were normal. The relationship A/H on the apexogram and the left ventricular mass/volume relationship on the echocardiogram increased from group I to group III. One possible interpretation of these findings suggests an alteration in diastolic compliance of the left ventricle in the early stages of hypertensive heart disease. The response to beta-blockers as measured on the echocardiogram also argue in favour of this theory.
The clinical significance and mechanism for changes in the axis of the QRS complex during attacks of angina pectoris (excluding cases of Prinzmetal's angina) are unknown. Previous work has suggested that left anterior hemiblock under these circumstances is a sign of unstable angina indicating a lesion in the anterior descending artery. Two cases with left anterior hemiblock associated with frequent attacks of angina have been the subject of careful study. In case one, atrial stimulation tests showed that the left axis deviation was not related to tachycardia. It only occurred when atrial stimulation was carried out for long enough to induce myocardial ischaemia as witnessed by precordial pain and disorders of repolarisation. In case two, the left anterior hemiblock came on at first at the same time as the attacks of angina, and then became permanent. Bypass graft of the anterior descending artery restored the QRS axis to normal, and corrected the repolarisation disorders which were of ischaemic origin. These findings argue in favour of an ischaemic origin of this conduction defect. Unlike ischaemia of the left anterosuperior subbranch, anterior left hemiblock is indicative of extensive ischaemia of the anterior wall of the left ventricle relative to an obstruction in the anterior descending artery or in the main trunk of the left coronary artery.
Twenty-two hypertensive patients with normal coronary arteriograms underwent a complete study of left ventricular performance. The patients were classified into three groups according to the findings on X-ray and ECG investigation: group I--ECG normal, X-ray normal (6 cases); group II--ECG showed left atrial hypertrophy, X-ray normal (7 cases); group III-ECG showed left ventricular hypertrophy, X-ray showed cardiac dilatation (9 cases). The results of this study were as follows:--cardiac ouptut was lowered in groups II and III;--end-diastolic volume was lowered in group II and raised in group III;--LVEDP was raised in groups II and III;--V max and VEC max were lower in groups II and III than in group I;--left ventricular compliance was diminished in groups I and II. Myocardial rigidity of the left ventricle was similar in the three groups. Hypertensive heart disease is therefore characterised by early changes in compliance of the left ventricle. These are associated with geometrical changes in the ventricle: disturbance of the volume/mass ratio of the left ventricle. These findings have therapeutic implications for the importance of beta-blockers.
Measurement of the blood volume in cases of essential hypertension has shown a negative correlation with increase in blood pressure. We have been able to distinguish a group of moderate hypertensives who are hypervolemic, and whose systemic effect is more marked than in the moderate hypovolemic type. Such cases respond poorly to single drug therapy with beta blockers, but well to diuretics. The authors propose a general treatment scheme for essential hypertension: single therapy (beta blockers or diuretics) in mild cases of hypertension; single therapy by diuretics in the moderate types with the increased volume; single therapy by beta blockers in the moderate types with low volume, multiple treatment with the drugs together in cases of severe hypertension.
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