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PubMedDate not supplied

[Specific dilated myocardiopathy. Chronic chagasic cardiopathy at the National Institute of Cardiology Ignacio Chávez].

Cardiomyopathies are a heterogenous group of heart ailments. Some of them are primary myocardial diseases and are classified as dilated, hypertrophic, restrictive and arryhithmogenic. Dilated cardiomyopathies (DCs) are the most common. Sometimes it is possible to identify an etiologic agent, in that case we talk about a specific dilated cardiomyopathy. Here in, we review one of these specific DCs, the so called Chronic Chagasic Cardiopathy (CCC) from the point of view of our personal experience at the Instituto Nacional de Cardiología "Ignacio Chávez". Chagas' disease is present in Mexico, therefore CCC is also present. We estimate that 5,000 people, suffer CCC with severe symptoms. In Mexico, Chagas' disease occurs below the Tropic of Cancer and between 2,000-2,500 m above sea level, in this area there is a real risk for vectorial infection, mainly in rural villages. Clinical diagnosis should be supported by epidemiological and seroepidemiological confirmatory data. There is not appropriate therapy yet for this condition.

Cardiomyopathy, Dilated↗
PubMed2002

Echocardiographic features of pigs with spontaneous hypertrophic cardiomyopathy.

Ultrasonography is one of the most common, noninvasive techniques used for cardiovascular diagnosis because it provides reliable information and enhances patient safety. Two-dimensional (2-D) and M-mode echocardiography is conducted to assess the severity and distribution of myocardial hypertrophy. Hypertrophic cardiomyopathy (HCM) is a primary myocardial disease that has variable manifestations because interactions between the many facets of systolic and diastolic dysfunction of the heart are complex. The objective of the study reported here was to characterized clinical HCM in pigs. A commercial Vingmed (CFM-800) 3.25 MHz transducer was used to perform 2-D and M-mode echocardiography. Experimental pigs (about 100 kg in body weight) were anesthetized and positioned in left lateral recumbency. Echocardiographic images (2-D) were acquired in parasternal short-axis and long-axis views. The 2-D images provided M-mode under direct anatomic visualization. The pigs were sacrificed for pathologic study after echocardiographic examination. In typical HCM cases (n = 8), the interventricular septum thickness increased, the left ventricular (LV) end-systolic and end-diastolic dimensions decreased, and the left atrial dimensions and the indexes of systolic function, such as ejection fraction and velocity of fiber shortening, increased. The LV outflow tract narrowed, particularly when gross upper septal hypertrophy was evident. Moreover, systolic cranial motion (SCM) of the septal leaflet of the mitral valve was observed. Doppler evidence of mitral regurgitation often was associated with SCM. The echocardiographic findings from pigs with HCM resembled those from humans. Thus, porcine HCM may serve as a spontaneous animal model for the study of HCM in humans.

Animals↗
PubMed1964

MYOCARDIAL DISEASE IN A RURAL POPULATION IN JAMAICA.

An epidemiological study of the prevalence of heart disease in a representative rural population in Jamaica was carried out in 1962. Six hundred adults aged 35-64 years were selected at random from an agricultural population of which a census had been taken previously, and this report describes the clinical and electrocardiographic findings in 548 of these subjects.It is clear from the results of this survey that symptoms and physical signs of heart disease are common in this population; electrocardiographic evidence of myocardial damage-frequently interpreted as due to myocardial ischaemia-has also an unexpectedly high prevalence for an ethnic group in which a number of careful pathological studies have shown myocardial infarction and occlusive coronary artery disease to be comparatively rare.Much of the heart disease found was wholly unexplained, and it is thought that many of these subjects may have a type of cardiomyopathy of unknown etiology. A number of reports from the tropics and subtropics have drawn attention to this problem, but this is, so far as is known, the first investigation of its epidemiology.

Adult↗
PubMed1992

[Ventricular function in hypertrophic cardiomyopathy. Systolic and diastolic ventricular function].

BASIC CONSIDERATION: Hypertrophic cardiomyopathy is defined as a primary myocardial disease associated with a hypertrophic non-dilated left ventricle with no other heart or systemic disease that might lead to hypertrophy of the left ventricle. The leading symptoms are effort-associated angina and dyspnea, rapid fatigue, dizziness and syncope. MAIN POINTS DISCUSSED: The hemodynamic situation is characterized by a hyperdynamic systole and impaired diastole and left-ventricular filling. In the obstructive form, hypertrophy of the basal septum and an anteriorly moving mitral valve during systole result in an end-systolic reduction in the cross-section of the outflow tract associated with considerable intraventricular pressure gradients. Disturbances in the myocardial calcium metabolism are presently suspected to be causally involved in the diastolic function impairment.

Cardiomyopathy, Hypertrophic↗
PubMed1977

Coronary arteriography: current technique and standards of equipment.

Coronary arteriography has become one of the most important diagnostic procedures. It is considered indispensable prerequisite in all cases of coronary, valvular, and primary myocardial disease for definition of diagnosis as well as planning of cardiac surgical interventions. Indications seem well established today. Complications have been reviewed in detail and are well known for the different procedures being practiced today. Each examiner should have command of the Sones as well as the Judkins technique. High standards of experience and skill are demanded. Equally important is high performance technical equipment. Current status of generators, power supply, X-ray tubes, image-intensifiers and camera technique is reviewed. Cine-angiocardiography on 35 mm film with simultaneous video-tape recording can be considered standard today. Layout of the equipment should include either cradle-mount for patient rotation or better U-stands for rotation of tube-image intensifier system around the resting patient. Oblique and angulated views in multiple directions are mandatory. Bi-plane equipment seems desirable both for ventriculography as well as coronary arteriography. Future developments can be expected mainly in the field of television technology with improved camera tubes, high resolution systems, and possibly digital processing of video signals.

Angiography↗
PubMed1985

[Therapy and course of dilated cardiomyopathy].

Dilated cardiomyopathy is a primary myocardial disease of unknown origin. The typical findings are severe systolic pump failure and dilatation of all cardiac chambers with severe cardiomegaly. Clinical symptomatology is determined by myocardial dysfunction with congestive heart failure. Cardiomegaly and arrhythmia may precede clinical symptoms of congestive heart failure by years. Medical therapy is based on classical treatment of congestive heart failure with digitalis and diuretics; recently, afterload-reducing agents, such as converting enzyme inhibitors, have become the drug of choice for patients with severe congestive heart failure. Antiarrhythmic therapy is necessary in the presence of severe arrhythmia, and anticoagulation is indicated when a low-output state or atrial fibrillation are present. Clinical course in dilated cardiomyopathy is usually poor and 5-year survival is 38% in our group.

Anti-Arrhythmia Agents↗
PubMedDate not supplied

Expectations and limitations of endomyocardial biopsy.

Endomyocardial biopsy represents an attempt at applying tissue examination to the diagnosis of primary myocardial disease. The right ventricular septum is biopsied from either the internal jugular or femoral venous approach. Left ventricular endomyocardial biopsy has not gained widespread acceptance in North America. A complication rate of 1-4% has been reported. Clinical indications for endomyocardial biopsy include acute cardiac allograft rejection, adriamycin cardiotoxicity and the differentiation of restrictive myopathy from constrictive pericardial disease. The biopsy of patients with idiopathic dilated congestive myopathy to find a treatable form of myocarditis remains controversial and principally a research tool. Only 5-25% of patients with dilated cardiomyopathy are found to have myocarditis and immunosuppressive therapy in these patients has yet to be proven beneficial.

Biopsy↗
PubMed1977

Hepato-and cardiotoxicity of xanthoascin, a new xanthocillin analogue produced by Aspergillus candidus. II. A preliminary electron microscopic observation of the heart and lung with intranuclear myelin-like figures.

Xanthoascin (1-4(hydroxyphenyl)-4-(2,2-dimethyl-6-chromanyl)-2,3-diisocyano-1,3-butadiene), a toxic metabolite recently isolated from rice grains infested with Aspergillus candidus L., caused acute hepatic injury with jaundice in mice. Following this, if the animals survived, degeneration of the myocardium developed over several weeks. Myocardial cells of dilated ventricular walls were diffusely vacuolated in routine H.E. sections. Electron microscopically, the vacuoles were filled with osmiophilic, concentric lamellar figures of varied size. Judging from observations in the early stages, this structure seems to develop in relation to mitochondrial membrane. The nuclei of the interstitial cells of the myocardium and pulmonary alveoli contained similar myelin-like figures. Recently it has been found that most strains of A. candidus produce terphenyllin, another toxic compound, and a smaller number of them produces, in addition to terphenyllin, xanthoascin. This may indicate that xanthoascin can be a candidate as a causative agent of primary myocardial diseases of men and contamination of foods with A. candidus and xanthoascin should be eargently examined.

Animals↗
PubMed1984

[Treatment of cardiac failure with refractory edema using extracorporeal ultrafiltration].

Thirteen patients with chronic congestive cardiac failure and refractory oedema were treated by haemodialysis. All patients had severe cardiac failure (Class IV NYHA) due to primary myocardial disease (5 cases), ischaemic heart disease (4 cases) or valvular heart disease (4 cases). Haemodialysis was performed via a Shaldon Y-shaped catheter in the internal jugular vein, with input and output through the same catheter using an alternating clamp. Filtration was carried out through a highly permeable membrane by a simple hydrostatic pressure gradient without a dialysis bath. The sessions were monitored haemodynamically by measuring the pulmonary artery pressures. The mean weight loss was 4.9 +/- 0.4 kg obtained after 3 three hour dialysis sessions with 24 hour intervals between each session (mean filtration flow = 12 ml/min). Hypotension was observed in one patient with low initial pulmonary artery pressures; two patients with severe valvular stenosis (1 mitral stenosis; 1 aortic stenosis) failed to lose weight. In the 10 remaining cases, there was a clearcut symptomatic improvement (5 patients Class III; 5 patients Class II NYHA) with total regression of oedema. There was a significant fall in pulmonary artery (mean PAP 40.5 +/- 6.5 mmHg to 34.6 +/- 6.5 mmHg; p less than 0.001) and pulmonary capillary pressure (27.6 +/- 6.9 mmHg to 22.5 +/- 5.8 mmHg; p less than 0.05) in these 10 cases. Cardiac output did not change significantly (cardiac index 2.2 +/- 0.5 l/m2/min compared to 2.3 +/- 0.4 l/m2/min after dialysis).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1982

Electrocardiographic findings in 45 cats with hyperthyroidism.

Electrocardiographic (ECG) abnormalities were recorded in 36 (80%) of 45 cats with untreated hyperthyroidism caused by hyperfunctioning thyroid adenomas (adenomatous hyperplasia). Tachycardia (greater than or equal to 240/min) and increased R-wave amplitude in lead II (greater than or equal to 0.9 mV) were the most frequent abnormalities recorded (62% and 49%, respectively). Other abnormalities included atrial and ventricular arrhythmias (20%), prolonged QRS duration (16%), shortened Q-T interval (11%), intraventricular conduction disturbances (3%), and ventricular pre-excitation (1%). In 17 cats, repeat ECG were recorded 6 months after hemi- or total thyroidectomy; resolution of tachycardia, increased R-wave amplitudes, shortened Q-T intervals, and atrial and ventricular arrhythmias had occurred in all cats. It was concluded that many of the ECG changes associated with feline hyperthyroidism are similar to those associated with primary myocardial disease in cats; however, the ECG abnormalities and associated cardiovascular signs of hyperthyroidism generally resolve after successful treatment of the hyperthyroid state.

Adenoma↗
PubMed1979

Ebstein's anomaly: late results of surgical correction.

Between 1969 and 1976, 10 severely disabled patients with Ebstein's anomaly were operated on at the National Heart Hospital using replacement of the tricuspid valve with mounted aortic homografts [9] or dura mater valve [1], plication of the atrialized right ventricle [10], and closure of an associated interatrail communication. 7 survivors have been followed up from 2 to 9 yr. 5 are asymptomatic. Symptomatic tricuspid regurgitation developed in 2 patients; from a paravalvar leak of the tricuspid homograft in one, and in the other calcification with stenosis in an irradiated homograft, 2.5 and 7.5 yr later. Permanent pacemakers were needed in 2 patients, 3 wk and 18 mth after surgery for symptomatic heart block. Despite corrective surgery for the structural abnormalities in Ebstein, late results remain influenced by disorders of rhythm and conduction disturbances, degenerative changes in the valves used for replacement and the intrinsic primary myocardial disease. Such "corrective" procedures in patients with Ebstein's anomaly can result in maintained symptomatic improvement but must be regarded as palliative surgery.

Adolescent↗
PubMed1995

A case of right ventricular dilated cardiomyopathy.

This paper presents a sudden death case of 16-year-old girl. She is assumed to have died of ventricular arrhythmia clinically. On autopsy, the right cardiac ventricle was markedly dilated due to extensive infiltration of fibroadipose tissue and resultant depletion of the myocytes, but there was no full thickness disappearance of the contractile element in any part. Considerable parts of remaining myocytes showed degenerative changes similar to those of dilated cardiomyopathy. The left ventricle was moderately dilated. It showed similar significant degenerative changes to the right ventricle, but the degree was less extensive than the right. These findings do not fill the diagnostic requirements of neither Uhl's anomaly nor parchment heart, which reveal almost total depletion of the right ventricular myocytes. However, the findings were consistent with arrhythmogenic right ventricular dysplasia, in case the concept of the entity is extended, we concluded that it would be better to adopt a term--cardiomyopathy--to this case rather than dysplasia. Because, there were considerable histological evidence of myocardial degeneration suggesting primary myocardial disease rather than congenital defect in nature. We diagnosed, therefore, this case as right ventricular dilated cardiomyopathy, comprising a type of dilated cardiomyopathy whose myocardial lesions predominate in the right compared to the left ventricle.

Adipose Tissue↗
PubMed1976

The retrograde His bundle deflection: its recognition and value in the analysis of tachyarrhythmias induced by stimulation on the T wave.

Interpretation of deflections presumably retrograde His bundle in origin has to be performed in context considering the coexisting changes in simultaneously recorded intracardiac and surface leads. His bundle electrocardiography thus conceived is helpful in the analysis of the runs of ectopic beats elicited by premature ventricular stimulation during the antecedent T wave in patients without coronary artery or primary myocardial disease. Identification of AV nodal echoes within the paroxysms as well as the subsequent runs of reciprocating tachycardias, was possible in patients with and without preexcitation, although a thorough study of these cases also requires recording of coronary sinus and low lateral right atrial electrograms. The behavior of the retrograde H deflection in respect to the first extra beat following the premature QRS complex helped in excluding bundle branch reentry. The latter is improbable in patients with 'complete' bundle branch block pattern, if extra beats show a contralateral bundle branch morphology. However, in absence of bundle branch block, retrograde H deflections were not helpful in elucidating the mechanisms of pacemaker-induced intraventricular (bundle branch, fasicular or vulnerability-related) reentry.

Atrioventricular Node↗
PubMed2006

Prognostic impact of a chronic occlusion in a noninfarct vessel in patients with acute myocardial infarction and multivessel disease undergoing primary percutaneous coronary intervention.

BACKGROUND: Among patients with acute myocardial infarction (AMI) referred for primary percutaneous coronary intervention (PCI), those with multivessel disease have worse clinical outcomes. This study sought to elucidate the impact of a chronic occlusion in a noninfarct vessel among patients with multivessel disease undergoing PCI for AMI. METHODS AND RESULTS: We studied 630 patients with AMI treated with PCI within 12 hours of symptom onset. Three groups of patients were defined: Group 1 (single-vessel disease; n = 345); Group 2 (multivessel disease with no chronic coronary occlusion in another vessel; n = 201); and Group 3 (chronic coronary occlusion in another vessel; n = 84). The probability of being free from events was lower in patients with multivessel disease than in Group 1 (84 +/- 2% vs. 92 +/- 1% at 30 days; 71 +/- 3% vs. 81 +/- 3% at 2 years; Log-Rank: p = 0.001; Breslow: p < 0.001 ), and in Group 3 than in Group 2 (76 +/- 5% vs. 87 +/- 2% at 30 days; 63 +/- 6% vs.75 +/- 4% at 2 years; Log-Rank: p = 0.014; Breslow: p = 0.008 ). Freedom from cardiac death was lower in patients with multivessel disease than in Group 1 (88 +/- 2% vs. 94 +/- 1% at 30 days; 84 +/- 2% vs. 91 +/- 2% at 2 years; Log-Rank: p = 0.003; Breslow: p = 0.002), and in Group 3 than in Group 2 (82 +/- 4% vs. 90 +/- 2% at 30 days; 77 +/- 5% vs. 88 +/- 3% at 2 years; Log-Rank and Breslow: p = 0.020). Among patients with multivessel disease, the presence of cardiogenic shock, left main disease and anterior location, but not the presence of a chronic occlusion in another vessel, were independent predictors of mortality. CONCLUSION: Among patients with AMI and multivessel disease, those with a chronic occlusion in a noninfarct-related vessel constitute a subgroup with very poor clinical outcomes.

Aged↗
PubMed1982

[Predictive value of the exercise test for multivessel disease after initial myocardial infarction].

The extent of coronary artery disease after primary myocardial infarction is an important prognostic factor. The predictive value of exercise electrocardiography for multivessel disease was assessed by comparison with coronary angiography in a series of 100 patients. In the group of patients with primary anterior infarction (n = 48), 37.5% had positive exercise ECGs. Coronary angiography showed 62.5% single vessel disease. In multivessel disease, the sensitivity of exercise ECG was 78% and specificity 86%. The predictive value of a positive test was 78% and, for a negative test, 86%. In primary inferior infarction (n = 52), positive exercise ECGs were recorded in 48% of cases. Coronary angiography showed 48% multivessel disease. In multivessel disease, sensitivity of exercise ECG was 92% ans specificity 93%. The predictive value of a positive test was 92% and of a negative test, 93%. Therefore, exercise ECG gives a more precise prediction of the extent of coronary artery disease after primary inferior infarction than after primary anterior infarction. However, it is not an ideal guide for the choice of patient for coronary angiography because of its poor predictive value in cases of anterior infarction, and because of the high incidence of multivessel disease in patients with primary inferior infarcts. Nevertheless, it is of great prognostic value with regards to the eventual course of the coronary disease.

Adult↗