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At least 433 records · Page 24Linked to original sources
PubMed2004

Congenital heart disease never goes away, even when it has been 'treated': the adult with congenital heart disease.

PURPOSE OF REVIEW: As the specialties of pediatrics and pediatric cardiology continue to forge ahead with better diagnoses, medical care, and surgical results, an expanding population of patients with congenital heart disease (CHD) outgrows the pediatric age group, yet does not quite graduate to routine adult cardiology or general medicine. The adult with congenital heart disease (ACHD) faces medical, surgical, and psychosocial issues that are unique to this population and must be addressed as such. This review attempts to discuss and highlight some of the important advances and controversies brought up in the past year, in the care and management of these patients. RECENT FINDINGS: The past five to 10 years have seen dynamic interest in understanding sequelae of corrected, uncorrected, or palliated congenital heart disease. The search for the ideal surgery, optimal prosthesis, and a smooth transition to adult care continues and is reflected in the vast amount of academic work and publications in this field. Of particular interest, conduit reoperations and single ventricle pathway modifications are still an art and a science in evolution. SUMMARY: While all are agreed that there is a pressing need to focus on the delivery of care to the adult with congenital heart disease, this essentially requires a clearer understanding of late sequelae of CHD. The sheer heterogeneity of anatomy, age, surgery, and institutional management protocols can make it difficult to develop clear guidelines. This review attempts to give an up-to-date perspective on some of the new findings related to the more common lesions and problems faced in this group.

Adult↗
PubMed1977

Diagnosis of valvular heart disease using transcutaneous Doppler ultrasound.

An ultrasonic Doppler instrument capable of measuring mean and maximum velocities inside a small sample volume is presented. The instrument has been used for determining velocities in normal and diseased heart valves. A method is described for identifying the different heart valves, based on their relation to one another as well as the form of the velocity curve. The pressure drop across the mitral valve can be determined from the maximum velocity and the mean velocity can be used to determine the degree of aortic insufficiency. Recordings of mean and maximum velocities can give an indication of the form of the whole spectrum, thus making complete frequency analysis unnecessary for most purposes.

Aorta, Thoracic↗
PubMed1978

[The estimated risk of coronary heart disease in four working population groups: the Rome Project of Coronary Heart Disease Prevention (author's transl)].

Within four middle-aged population groups enrolled in the Rome Project of Coronary Heart Disease Prevention, a theoretic estimation of coronary heart disease (CHD) incidence in 5 years has been made on the basis of some risk factors (age, systolic blood pressure, serum cholesterol, smoking habit, physical activity at work, body mass index), employing four different solutions of the multiple longistic function (MLF) derived from previous population studies and a simple risk score adopted by the WHO European Collaborative Group to which this study belongs. The use of different MLF solutions provides rather different levels of estimated incidence, but the ranking and the relative risk between population groups are substancially constant and little dependent on the different solutions. Moreover, an acceptable similarity has been found in terms of estimated risk between the pool of the treatment and that of the control population groups (ratio between 0.97 and 1.09). A reasonable hypothesis indicates that in the absence of preventive action the annual incidence of severe CHD (hard criteria) should be around 6 per 1,000. The estimation of the relative risk within single population groups allows to identify strata of people with different risk, which suggests, again in the absence of any preventive action, a concentration of 25-30% of all new cases of disease in a 10% of the population and about 40-45% in a 20% of the same.

Adult↗
PubMed2000

Early diagnosis of recurrence of Trypanosoma cruzi infection by polymerase chain reaction after heart transplantation of a chronic Chagas' heart disease patient.

Heart transplantation is contraindicated as an effective treatment for end-stage Chagas' heart disease because of post-operative recurrence of Trypanosoma cruzi infection and reactivation of disease after immunosupression. In a follow-up study of a heart transplanted patient with Chagas' disease, we prospectively evaluated the usefulness of the polymerase chain reaction (PCR) for early diagnosis of reactivation. We monitored post-operative recurrence of Trypanosoma cruzi infection with microscopic observation of the parasite in peripheral blood (Strout's method), endomyocardial biopsies (EMBs), skin lesions, and 2 PCR assays, based on the amplification of specific T cruzi kinetoplastid and nuclear DNA sequences. During follow-up, parasite DNA was amplified in blood samples and EMB sections 41 days before we observed patent parasitemia and cutaneous manifestations of reactivation, proving that PCR is much more sensitive than direct microscopic observation for early diagnosis of disease reactivation in heart-transplanted Chagas' disease patients.

Animals↗
PubMed1975

Arteriosclerotic and other degenerative heart diseases in Finland. I. A death certificate study of the frequency of degenerative heart diseases among males and females.

All available information recorded on the death certificates of 12973 Finnish persons who, according to the official Finnish mortality statistics, died in 1968 from arteriosclerotic and other degenerative heart diseases (ADHD, rubrics 420-422 in ICD) comprised the material of the present study. The mortality of males from ADHD analysed by age and place of residence was very high when compared with various national rates of international WHO statistics. The degree of urbanization of the domicile did not have any statistically significant effect on the mortality from ADHD. Significant differences between various provinces were found in the mortality of males from ADHD. The male population living in the eastern provinces of Finland showed a highly significantly higher mortality from degenerative heart diseases than the male population living on the west coast. A highly significant difference was found in mortality between various subgroups of the Finnish male and female populations analysed by age, place of residence, and type of community. The uniform difference between the mortality of various male and female subgroups of the Finnish population, which was obtained using the present statistical survey of death certificates, and the fairly uniform distribution of high rate of mortality of males from degenerative heart diseases in most regions of the country lend further support to the reliability of cause-of-death statistics, since certification of deaths can then be regarded to occur uniformly and with about the same accuracy in different parts of the country.

Adult↗
PubMed2002

Treatment with atorvastatin to the National Cholesterol Educational Program goal versus 'usual' care in secondary coronary heart disease prevention. The GREek Atorvastatin and Coronary-heart-disease Evaluation (GREACE) study.

BACKGROUND: Atorvastatin is very effective in reducing plasma low-density lipoprotein cholesterol (LDL-C) levels. However, there is no long-term survival study that evaluated this statin. PATIENTS-METHODS: To assess the effect of atorvastatin on morbidity and mortality (total and coronary) of patients with established coronary heart disease (CHD), 1600 consecutive patients were randomised either to atorvastatin or to 'usual' medical care. The dose of atorvastatin was titrated from 10 to 80 mg/day, in order to reach the National Cholesterol Education Program (NCEP) goal of LDL-C <100 mg/dl (2.6 mmol/l). All patients were followed up for a mean period of 3 years. MAIN OUTCOME MEASURES: Primary endpoints of the study were defined as death, non-fatal myocardial infarction, unstable angina, congestive heart failure, revascularisation (coronary morbidity) and stroke. Secondary endpoints were the safety and efficacy of the hypolipidaemic drugs as well as the cost-effectiveness of atorvastatin. RESULTS: The mean dosage of atorvastatin was 24 mg/day. This statin reduced total chlesterol by 36%, LDL-C by 46%, triglycerides by 31%, and non-high-density lipoprotein cholesterol (non-HDL-C) by 44%, while it increased HDL-C by 7%; all these changes were significant. The NCEP LDL-C and non-HDL-C treatment goals were reached by 95% (n = 759) and 97% (n = 776), respectively, of patients on atorvastatin. Only 14% of the 'usual' care patients received any hypolipidaemic drugs throughout the study and 3% of them reached the NCEP LDL-C treatment goal. The cost per quaility-adjusted life-year gained with atorvastatin was estimated at $US 8350. During this study 196 (24.5%) CHD patients on 'usual' care had a CHD recurrent event or died vs. 96 (12%) CHD patients on atorvastatin; risk ratio (RR) 0.49, confidence interval (CI) 0.27-0.73, p < 0.0001. In detail, atorvastatin reduced, in comparison to 'usual' care, total mortality (RR 0.57, CI 0.39-0.78, p = 0.0021), coronary mortality (RR 0.53, CI 0.29-0.74, p = 0.0017), coronary morbidity (RR 0.46, CI 0.25-0.71, p < 0.0001), and stroke (RR 0.53, CI 0.30-0.82, p = 0.034). All subgroups of patients (women, those with diabetes mellitus, arterial hypertension, age 60 to 75 years, congestive heart failure, recent unstable angina or prior revascularisation) benefited from treatment with atorvastatin. Withdrawal of patients because of side-effects from the atorvastatin group was low (0.75%) and similar to that of the 'usual' care group (0.4%). CONCLUSIONS: Long-term treatment of CHD patients with atorvastatin to achieve NCEP lipid targets significantly reduces total and coronary mortality, coronary morbidity and stroke, in comparison to patients receiving 'usual' medical care. Treatment with atorvastatin is well tolerated and cost-effective.

Adult↗
PubMed1987

Ventricular arrhythmias in hypertensive heart disease with and without heart failure.

Forty-two patients with hypertensive heart disease but without coronary macroangiopathy were examined for ventricular arrhythmias by means of 24-h, long-term electrocardiograms (ECG). They were divided into two groups according to specific criteria. Group 1 was composed of 30 patients with left ventricular hypertrophy but normal ventricular volumes, as determined by ventriculography. Group 2 comprised 12 patients with left ventricular hypertrophy and dilated left ventricles. By means of two 24-h, long-term ECGs, the mean absolute number of ventricular extrasystoles was ascertained and severity was determined according to the classification of Ryan et al. On average, patients in group 2 showed 7.830 +/- 6.579 extrasystoles, a significantly higher (p less than 0.001) number than in patients in group 1 who had 1.132 +/- 2.639 extrasystoles/24 h. Moreover, 67% of patients in group 2 had Ryan's class 4a ventricular arrhythmias (couplets) or 4b disorders (ventricular tachycardia). However, corresponding rhythm disorders could be found in only 7% of the patients in group 1. A comparison of hemodynamic parameters and ventricular arrhythmias showed that a decreasing left ventricular ejection fraction (EF, expressed in %), a decreasing mass/volume ratio (LVMM/EDV), and an increasing systolic wall stress of the left ventricle (Tsyst) are accompanied by a nearly linear increase in ventricular extrasystoles and in the severity of the ventricular arrhythmias. During long-term ECGs, nine of 10 patients with systolic wall stress of greater than or equal to 300 dyn x 10(3)/m2 showed Ryan's class 4a or 4b ventricular arrhythmias or ventricular tachycardia during programmed ventricular stimulation. However, 12 patients with normal systolic wall stress (less than or equal to 200 dyn x 10(3)/m2) showed no or only Ryan's class 1 ventricular arrhythmias. Our investigations have shown that cardiac ventricular rhythm disorders frequently occur during decompensated hypertensive heart disease, but to a lesser extent in left ventricular hypertrophy without dilation. Further investigations are needed to demonstrate whether regression of left ventricular hypertrophy is accompanied by a reduction in the incidence of ventricular arrhythmias.

Adult↗