Antithrombotic therapy for coronary artery disease and valvular heart disease.
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Angioplasty, Balloon, Coronary↗
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[Management of patients with valvular heart disease and poor ventricular function. The Working Group on Valvular Heart Disease].
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Heart Valve Diseases↗
[Syndrome differentiation, gastro-intestinal function and electro-gastrography of chronic obstructive pulmonary disease and pulmonary heart disease].
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Aged↗
Primary care in children with congenital heart disease.
Congenital heart defects, abnormalities in the structural development of the heart, occur in approximately 1% of live births. With improved detection, diagnosis, medical management, and surgical techniques, the number of children surviving with congenital heart disease is increasing. These children require the same comprehensive primary care as all other children; however, there are certain aspects of primary care that will be affected by the presence of a congenital heart defect. This article attempts to clarify the special considerations regarding growth and nutrition, development, physical activity, immunizations, dental care, use of over-the-counter medications, and perioperative concerns for these children. The unique needs of the cardiac transplant patient are beyond the scope of this article.
Child↗
Setting the agenda for research and education on coronary heart disease.
Coronary heart disease (CHD) disproportionately affects the African American population with death and disability. The disparity in mortality continues to exist between the general population and African Americans despite decreases in death rates in both groups since the 1970s. The National Heart, Lung, and Blood Institute (NHLBI) is committed to developing and supporting research and activities that improve the health of African Americans through community partnership initiative. One such initiative is the CHD in Blacks Project, developed to increase awareness of the adverse effects of CHD, encourage healthy lifestyle behaviors, and, among health professionals, ensure that the latest treatment guidelines from the NHLBI in high blood pressure, high blood cholesterol, and obesity are used. The NHLBI has also established a network of health professionals from across the country to assist in developing medical education programs and community education outreach activities in conjunction with the National Medical Association, the Association of Black Cardiologists, and the National Black Nurses Association.
Black or African American↗
Temporary endoepicardial atrioventricular sequential pacing for complete heart block following complex surgery for congenital heart disease.
Complete heart block following intracardiac surgical repair for complex congenital heart disease is not uncommon. In the presence of ventricular dysfunction, ventricular pacing alone may not improve the cardiac output. We report the feasibility and efficacy of endoepicardial atrioventricular sequential pacing in a case of postoperative complete heart block.
Cardiac Pacing, Artificial↗
Real-world effectiveness of lipid-lowering therapy in male and female outpatients with coronary heart disease: relation to pre-treatment low-density lipoprotein-cholesterol, pre-treatment coronary heart disease risk, and other factors.
BACKGROUND: Determinants of the real-world effectiveness of lipid-lowering therapy have been rarely assessed in an unselected observational coronary heart disease (CHD) community cohort over time. DESIGN: Randomly drawn patients (n=605) from randomly drawn practices (n=62) were retrospectively followed for a median of 3.6 years (1998-2002) on lipid-lowering therapy (98% statins). METHODS: Coronary heart disease population-averaged estimates and variances accounting for repeated measurements within patients were obtained using generalized estimating equations. RESULTS: Post-treatment low-density lipoprotein-cholesterol (LDL-C) was 124 mg/dl in men and 141 mg/dl in women and was independently associated (all P<0.05) with pre-treatment LDL-C (+3.7 mg/dl per 10 mg/dl increment), female sex (+14.0 mg/dl), coronary bypass (-9.5 mg/dl), drug-treated diabetes mellitus (-6.8 mg/dl), and era 2002/2001 versus 1999/2000 (-6.4 mg/dl) in age-adjusted multivariate analyses. Holding pre-treatment LDL-C constant post-treatment LDL-C was associated with pre-treatment Framingham CHD risk in men (-13.9 mg/dl per doubling of risk), whereas LDL-C control in women resembled that in low-risk men. The likelihood of attaining LDL-C <100 mg/dl was 0.28 in men and 0.17 in women and was likewise associated with the above factors. CONCLUSION: Low-density lipoprotein-cholesterol control remained low despite lipid-lowering therapy across a wide range of pre-treatment LDL-C and pre-treatment CHD risk. Low-density lipoprotein-cholesterol control in women was inferior to that in men, a finding that warrants attention and clarification.
Aged↗
Enhanced expression of vascular endothelial growth factor in pulmonary plexogenic arteriopathy due to congenital heart disease.
Congenital heart disease (CHD) leading to increased pulmonary blood pressure and flow is an important cause of pulmonary plexogenic arteriopathy (PPA). This type of arteriopathy tends to progress to an irreversible stage, hallmarked histologically by the emergence of a number of characteristic lesions, which include concentric laminar intimal proliferation and fibrosis, and plexiform lesions. The pathogenesis of these lesions, which connote a very poor prognosis, is not well understood. Since endothelial cell proliferation has been demonstrated in these lesions, it was hypothesized that vascular endothelial growth factor (VEGF), a key mediator of angiogenesis, might play a role in their pathogenesis. Thirty-nine patients with various types of CHD, who underwent cardiac catheterization and subsequent cardiac surgery, were studied prospectively. On the basis of a detailed assessment of the type of cardiac defect, the haemodynamic abnormalities, and the histopathological features evident from open lung biopsies, taken in all instances, patients were histologically grouped into cases with moderate PPA (n=18), advanced PPA (n=7), pulmonary congestive vasculopathy (PCV, n=5), and controls lacking pulmonary hypertension or increased pulmonary blood flow (n=4). Five patients were excluded from analysis because of inadequate sample size or quality. The presence of VEGF was assessed immunohistochemically using standard procedures and was correlated with haemodynamic and histological data. Immunoreactive VEGF was detected in pulmonary arterial smooth muscle cells and endothelial cells in 13 out of 34 cases and was more frequent and more pronounced in patients with the histological lesions of advanced PPA than in those with moderate PPA (p<0.01). VEGF positivity was particularly prominent in the lesions characteristic of advanced PPA. No difference in VEGF expression was observed between controls, PVC, and moderate PPA cases. Measured haemodynamic parameters did not differ significantly between VEGF-positive and VEGF-negative cases. We conclude that VEGF may play a role in the angioproliferative changes of advanced PPA.
Child↗
Chromosome 1q21.1 contiguous gene deletion is associated with congenital heart disease.
Congenital heart disease (CHD), comprising structural or functional abnormalities present at birth, is the most common birth defect in humans. Reduced expression of connexin40 (Cx40) has been found in association with atrial fibrillation, and deletion of Cx40 in a mouse model causes various structural heart abnormalities in 18% of heterozygotes. We screened 505 unrelated CHD cases for deletions or duplications of the Cx40 gene (GJA5) by real-time quantitative PCR, in order to determine whether altered copy number of this gene may be associated with a cardiac phenotype in humans. Dosage of Cx40 flanking genes (ACPL1 and Cx50 gene, GJA8) was determined by real-time PCR for all apparent positive cases. In total, 3 cases were found to carry deletions on chromosome 1q21.1 spanning ACPL1, Cx40, and Cx50 genes. Absence of heterozygosity was observed in all 3 index cases over a 1.5- to 3-Mb region. Samples from the parents of two cases were obtained, and microsatellites across 1q21.1 were genotyped. One of the apparently unaffected parents was found to carry this deletion. All 3 index cases presented with obstruction of the aortic arch as the common structural cardiac malformation, and had no consistent dysmorphic features. Genotyping of 520 unrelated normal controls for this deletion was negative. We hypothesize that this 1q21.1 multigene deletion is associated with a range of cardiac defects, with anomalies of the aortic arch being a particular feature.
Acid Phosphatase↗
Management of dyslipidemia in the primary prevention of coronary heart disease.
Coronary heart disease is a leading cause of death in industrialized nations. Hyperlipidemia with elevated serum total cholesterol, LDL cholesterol, and triglycerides is a known major cardiovascular risk factor. HDL cholesterol is considered to be protective, so low HDL cholesterol is being recognized as an independent cardiovascular risk factor that contributes to the development of atherosclerosis and related adverse cardiovascular events. The recognition of insulin resistance and metabolic syndrome is a step further in understanding these risk factors. Attempts at reducing serum cholesterol with different strategies in the past have met with limited success until the development of statins. The advent of statins has revolutionized the management of hyperlipidemia. The post-statins era has seen major clinical trials demonstrating the benefit of cholesterol reduction in the setting of both primary and secondary prevention. In general, there appears to be a 25% to 40% relative risk reduction in major adverse cardiovascular events such as death, myocardial infarction, and stroke. The recent megatrials further suggest that aggressive management of cholesterol in patients with high cardiovascular risk may be beneficial. Though the concept of the-lower-the-better may be looming, the question of "How low is good enough?" remains controversial. The results of recent megatrials such as the Heart Protection Study go a step further than the NCEP guidelines and suggest that statin therapy may benefit patients at high risk of cardiovascular disease regardless of their baseline values. We summarize the results of the available large clinical trials in our understanding of the management of dyslipidemia in a setting of primary prevention.
Animals↗
A comparison of the pathological spectrum of hypertensive, diabetic, and hypertensive-diabetic heart disease.
The hearts obtained at autopsy of 67 patients with hypertension, diabetes mellitus, or both were examined microscopically and histochemically, and the amount of fibrosis was determined. Significant differences in heart weight, interstitial fibrosis, replacement fibrosis, and perivascular fibrosis were found among the groups. The mean heart weight of the hypertensive-diabetic patients was significantly greater than that of the hypertensive patients and the diabetic patients. The amount of microscopic fibrosis increased between the groups, the lowest in hypertensive hearts, midrange in diabetic hearts, and highest in hypertensive-diabetic hearts. Total fibrosis correlated with heart weight among diabetic and hypertensive-diabetic patients and was significantly greater among patients with congestive heart failure, most of whom had histories of both hypertension and diabetes. The microscopic grade of fibrosis correlated significantly (p less than 0.01) with a quantitative, histochemical determination of the amount of collagen per milligram of total noncollagenous protein in the heart tissue. Myocardial fibrosis may contribute to the diastolic dysfunction typical of hypertensive-diabetic cardiomyopathy, in which congestive heart failure is a common sequela. The importance of hypertension in the pathogenesis of severe diabetic heart disease is discussed.
Adult↗
Right heart assist by intermittent abdominal compression after surgery for congenital heart disease.
Right heart assist after open heart surgery in children can be accomplished by inflation of a balloon beneath a tight cloth wrap on the abdomen. This device can be inexpensively constructed of ordinary equipment found in the intensive care unit. This is a review of the use of intermittent abdominal compression in 14 children (mean age 19 +/- 15 months, mean weight 8 +/- 4 kg) after operation at Henrietta Egleston Hospital. Primary diagnoses were tricuspid atresia physiology in five, atrioventricular canal in four, truncus arteriosus in one, tetralogy of Fallot in one, ventricular septal defect (VSD) in one, D-transposition of the great arteries in one, and aortic-left ventricular tunnel with VSD in one. Compression was used for an average of 16.3 +/- 11.4 hr. Displacement of blood from the abdominal viscera to the central circulation by balloon inflation led to elevation of right atrial pressure by 3.6 +/- 1.8 mm Hg (p less than .001) and consequent elevation of mean arterial pressure by 9.8 +/- 5 mm Hg (p less than .001). Urine output was improved in almost every instance. In 11 surviving children, the net fluid intake and output balance in the first 12 hr after application of intermittent abdominal compression was -154 +/- 219 ml (p less than .05). This simple method of intermittent abdominal compression was effective after a variety of operations for treatment of congenital heart disease and was especially useful after the Fontan procedure.
Cardiac Output↗
Vitamin E in the prevention of ischemic heart disease.
Ischemic heart disease (IHD) has now assumed a global dimension. It still remains one of the major health problems not only in the advanced countries, but also, is becoming a serious health issue in the developing and the economically weaker countries. Apart from other factors, changing economic scenario, stress and strain in daily life as well as altered dietary habits in the populations appear responsible for the increased incidence of cardiovascular disease (CVD). The treatment modalities, invasive, non-invasive and pharmacological are economically no dearer, even to population of affluent countries. Likewise, treatment costs of serious cardiovascular diseases are becoming difficult to be borne by population of the developing nations. Prevention of IHD would be a better way to protect the population from physical and economic disaster. The current article comprehensively describes the relation between oxidative stress and cardiac disease, explains the direct effect of reactive oxygen species on cardiac function and projects how the use of vitamin E can be of benefit in the prevention of IHD with concluding remarks highlighting the need for inclusion of a fruit and vegetable rich diet and regular exercise to keep the dearer heart active and healthy.
Animals↗
Developmental and genetic aspects of congenital heart disease.
Congenital heart defects (CHDs) are the result of abnormal cardiac mesoderm or cardiac neural crest development. The molecular cause of most congenital heart disease remains unknown, although numerous cardiac regulatory factors have recently been described. dHAND and eHAND are basic helix-loop-helix transcription factors expressed differentially in the right and left ventricles, respectively, and in the cardiac neural crest. Mice lacking dHAND have a hypoplastic right ventricle and abnormal development of vessels arising from the heart and cell death of craniofacial precursors. By searching for dHAND-dependent genes, a gene likely responsible for the cardiac and craniofacial defects associated with chromosome 22q11 deletion has been identified. A systematic dissection of molecular pathways involved in cardiogenesis should allow for further identification of genes responsible for CHD.
Adaptor Proteins, Vesicular Transport↗
Insulin resistance, haemostatic and inflammatory markers and coronary heart disease risk factors in Type 2 diabetic men with and without coronary heart disease.
AIMS/HYPOTHESIS: We have examined markers of haemostasis and inflammation in men with diabetes, coronary heart disease (CHD) or both, and assessed their associations with insulin resistance in men with Type 2 diabetes. METHODS: The study was carried out in 4066 British men aged 60 to 79 years who were not on warfarin or insulin, of whom there were 426 men with prevalent Type 2 diabetes and 842 with prevalent CHD. RESULTS: Men with Type 2 diabetes were more likely to have multiple risk factors and higher levels of haemostatic and inflammatory markers than men without, irrespective of CHD status. Compared with men with CHD only, men with diabetes only showed increased levels of tissue plasminogen activator antigen, increased plasma and blood viscosity, and increased levels of coagulation factors VII, VIII and IX. They also had dyslipidaemia. In men with diabetes, increased insulin resistance (homeostasis model assessment, HOMA) was associated with increased levels of haemostatic markers and dyslipidaemia. The prevalence of CHD increased significantly with increasing tertiles of HOMA (adjusted odds ratio 1.32 [95% CI: 0.72-2.42] in the second, and 1.70 [95% CI: 0.92-3.44] in the third tertile; p=0.04 for trend). CONCLUSIONS/INTERPRETATION: Increased insulin resistance among men with Type 2 diabetes is associated with increased prevalence of CHD and of activated haemostasis and dyslipidaemia. Reducing insulin resistance in men with diabetes may reduce their tendency to develop thrombosis and hence CHD risk.
Adult↗
The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart disease.
An extensive psychosocial questionnaire was administered to 1674 coronary free individuals participating in the Framingham Heart Study between 1965 and 1967. The respondents were followed for the development of coronary heart disease (CHD) over an eight-year period. Women (aged 45-64 years) who developed CHD scored significantly higher on the Framingham Type A behavior, suppressed hostility (not showing or discussing anger), tension, and anxiety symptoms scales than women remaining free of CHD. Type A women developed twice as much CHD and three times as much angina as Type B women. In a multivariate analysis, Framingham Type A behavior and not discussing anger were independent predictors of CHD incidence when controlled for the standard coronary risk factors and other psychosocial scales. Men exhibiting Framingham Type A behavior, work overload, suppressed hostility (not showing anger), and frequent job promotions were at increased risk of developing CHD (especially in the age group 55-64 years). Among men aged 45-64 years, Type A behavior was associated with a twofold risk of angina, myocardial infarction, and CHD in general, as compared to Type B behavior. The association was found only among white-collar workers and was also independent of the standard coronary risk factors and other psychosocial scales. This prospective study suggests that Type A behavior and suppressed hostility may be involved in the pathogenesis of CHD in both men and women.
Aged↗
Nutritional issues in infants and children with congenital heart disease.
Congenital heart disease is often associated with a clinical picture of failure to thrive from unique nutritional issues. Poor weight gain, less than expected linear growth, and variances in normal development are commonly seen both in infancy and throughout childhood when defects are unrepaired. Major factors associated with disturbances in growth and development as well as a review of current therapeutic interventions are explored in this article.
Child↗
Genetic analysis of chromosome 22q11.2 markers in congenital heart disease.
Congenital heart disease (CHD) is a common cardiac defect found in infants and children. Despite advances in diagnosis and treatment, our understanding of the causative mechanism and etiology of CHD is limited. To determine the genetic etiology of CHD, we selected 11 consecutive short tandem-repeat polymorphic (STRP) markers located in the interval of the 22q11.2 region to perform genotype analysis on a large number of CHD patients (>120) and their normal relatives (>220). The results show that as regards the distribution of allelic size and frequency of these STRP markers, there were no significant differences between the CHD patients and the normal volunteers. This indicates that there is no linkage disequilibrium with these markers in CHD. In the level of heterozygosity for each marker in nonsyndromic CHD and conotruncal heart defect (CTD), there were no significant differences between the two populations. In syndromic CHD, the level of heterozygosity for D22S1648 was significantly lower than that observed in the unaffected population (chi(2) = 11.25; P = 0.001). This suggests that there may be a deletion at the D22S1648 locus, and the low heterozygosity of D22S1648 indicates that this marker can be used as a genetic marker for detecting microdeletions in 22q11.2. With the use of fluorescence in situ hybridization (FISH) and real-time quantitative polymerase chain reaction (PCR) performed on syndromic patients, we confirmed the molecular results.
Chromosome Mapping↗