Degenerative Heart Disease Research Articles

Competence, persistence and motivation: Relationships in structured and unstructured assessments of high social risk 13 month olos

A case of a 29 year old female patient with sinoatrial block, first degree A-V heart block and Adams-Stokes seizures since the age of 11 is reported. The mechanism of the syncopal attacks was established by continuous radioelectrocardiographic monitoring as episodes of sinoatrial heart block or arrest, or both. There was no evidence of inflammatory, degenerative or congenital heart disease, and the patient had never received drugs assocated with the production of Adams-Stokes seizures. From the etiologic standpoint exaggerated vagal effects undoubtedly played a role; the existence of a congenital abnormality of the conduction system must, however, be taken into consideration. Treatment with artificial pacemaker stimulation proved effective and prevented further Adams-Stokes attacks.

Long term effects of childbearing on health.

Information on whether a woman had ever had any children was recorded for all deaths registered to ever-married women in England and Wales between 1938 and 1960. Analysis of the relation between parity and cause of death for 1.2 million women aged 45-74 years revealed that parous women had lower mortality from breast, ovarian, and endometrial cancer than did nulliparous women but a higher mortality from diabetes mellitus, gallbladder disease, cancer of the uterine cervix, nephritis and nephrosis, hypertension, ischaemic and degenerative heart disease, cerebrovascular disease, and all causes of death. There is a parallel between the long term effects of pregnancy and of oral contraceptives on health.

Changing pattern of infective endocarditis

There has been a significant trend toward an increase in the age of patients with endocarditis, and it seems likely that the age of these patients will continue to increase as the population ages. The proportion of patients with endocarditis who have rheumatic heart disease as an underlying lesion has decreased from about 40 percent in patients studied from 1950 to 1970 to about 25 percent in more recent series, and this trend will probably continue. Prosthetic valves and degenerative heart disease will undoubtedly become increasingly important underlying heart lesions in patients with endocarditis. Another large group of patients with infective endocarditis have no diagnosable underlying heart disease and comprise an increasing proportion of patients with endocarditis. Because of the aging of the population, more Streptococcus bovis and enterococcal endocarditis should be expected. With more prosthetic valves and with the aging of the population, more staphylococcal endocarditis should be anticipated. Economic forces will probably result in earlier discharge from the hospital, with either shorter courses of therapy or completion of therapy at home and perhaps more valve replacements.

Thyrotoxicosis in Elderly Patients

To the Editor. —In the September 1984Archives, Cobler et al 1 hypothesized that hyperthyroidism would be an infrequent cause of atrial fibrillation in older persons because atherosclerotic, hypertensive, and degenerative heart disease are more frequent with aging. They reported a prevalence rate of atrial fibrillation in 316 patients of 7.9%. Their reported prevalence rate of hyperthyroidism in the presence of atrial fibrillation in women was 31% and 11% in men. Only in women was this prevalence significantly higher compared with their patients who had atrial fibrillation and normal levels of thyroxine measured by radioimmunoassay (T 4 RIA) or no history of hyperthyroidism. Their reported high prevalence rate of hyperthyroidism and atrial fibrillation in women led us to do the very same study. Our chronic care institution has 512 residents with an average age of 85 years. Since May 1981, all new admissions had T 4 (RIA) measurements. From May

Occupational mortality patterns among British Columbia farm workers.

To examine mortality risks for farm laborers proportional mortality ratios (PMRs) were calculated for 2,328 British Columbia farm workers who died at age 20 years or over during the period 1950 through 1978. Significantly fewer deaths than expected from degenerative heart disease (PMR = 91, p less than .01) and from all cancers combined (PMR = 78, p less than .001) were observed. Deaths from bronchitis and emphysema (PMR = 70, p less than .05) were also fewer than anticipated. Elevated risks of death were found for accidents (PMR = 129, p less than .001), for homicide (PMR = 242, p less than .01), and for pneumonia (PMR = 146, p less than .001).

Infective endocarditis at autopsy in northern India. A study of 120 cases.

Pathologic data on 120 autopsied cases of infective endocarditis are presented. They constitute 1.8% of total 6,700 and 6.3% of 1,900 cardiac autopsies over 16 years. Ninety % of patients were below the age of 40 years, 42.5% had no pre-existing heart disease, 33.3% had previous valvular disease, mainly rheumatic, and 24.2% had congenital heart disease. Mitral and aortic valves were each the sites in one third cases, mitral slightly more than aortic, twenty-six point six % of the cases had lesions on the right side of the heart, 16.6% exclusively so. Cardiac complications were infrequent while systemic infarcts were found in over 80% cases. A route of infection was detected only in 24.1% of the cases, puerperal sepsis being the commonest. Staphylococci were the responsible bacteria in 18 out of 28 cases in which microbiologic data were available. There were only 2 cases with infective lesions on prosthetic valves, both fungal. The pattern of infective endocarditis in this and other reports from India and Africa differs from that in the West, in many respects including younger age of our patients, significant rheumatic background disease, absence of narcotic addicts and of "degenerative heart disease" and lower incidence of cardiac complications.

Diffuse Idiopathic Skeletal Hyperostosis (Dish) and Spondylosis Deformans as Predictors of Cardiovascular Diseases and Cancer

The associations between DISH (diffuse skeletal Hyperostosis) and spondylosis deformans on the one hand and cardiovascular disease and cancer on the other were studied in a follow-up investigation of 6 167 persons in Finland. Mean duration of follow-up investigation of 6 167 persons in Finland. Mean duration of follow-up was 6.3 years. Similar methods were employed in the baseline and follow-up examination. A finding of DISH or of spondylosis was based on a reading of lateral X-ray films. Age-adjusted incidence of hypertension, ECG findings suggesting coronary heart disease (CHD), CHD history, enlargement of the heart determined by interpretation of photofluorograms, digitalis medication, cerebrovascular incidents and a history of cancer were compared in persons with and without DISH/spondylosis and free of these conditions at baseline. A further analysis, in which the data were analysed separately for DISH and spondylosis present at baseline and cases which developed during follow-up, was also carried out. A slight association between DISH and spondylosis, and hypertension probably due to obesity was observed. According to several criteria degenerative heart disease (CHD, heart enlargement, digitalis use) was associated with DISH and spondylosis, particularly in men. An association with heart enlargement was observed with DISH but not with spondylosis. No associations with cerebrovascular accidents or cancer were observed, but the paucity of cases prevents definite conclusions. Thus, there were some difference between spondylosis and DISH with regard to risk of future cardiovascular disease.

Hazardous alcohol consumption and diseases of the circulatory system.

Received for publication: 16 February 1979. Revision: 15 April 1980. 2 The adjectives hazardous and heavy are used interchangeably to describe alcohol consumption i this discussion. At the Addiction Research Foundation hazardous drinking is defined as an average dafiy intake equal to or exceeding 80 g of ethanol, i.e., an amount equivalent to approximately 9 fluid oz of spirits with a 40• ethanol content, 30 oz of wine (12%) or 72 oz of beer (5•). While it is not possible to quantify precisely these or similar adjectives as used in other settings, in this discussion the use of hazardous or heavy is intended to imply the repeated consumption of alcohol in amounts associated with increased risk of physical disease. 3 Circulatory is used as a specific term referring to the grouping of diseases found in the International Classification o[ Diseases (IC•)A), 8th Revision, Section VII (Diseases of the Circulatory System) (183). Included in this grouping are ischemic heart disease (410-414) and cerebrovascular disease (430-438). In the 6th (197) and 7th (198) Revisions the rubrics 420 and 422 comprised the entity arteriosclerotic and degenerative heart disease, also called coronary heart disease and coronary artery disease. These rubrics correspond approximately to the rubrics 410-413 in the 8th Revision. In the 6th and 7th Revisions the rubrics (330-334) for cerebrovascular disease were titled vascular lesions affecting the central nervous system. Cardiovascular disease is used as a specific term referring to diseases of the heart and blood vessels. The latter rubrics comprise the disease ntity called coronary heart disease. In the tables, the ICnA rubric is given, wherever possible. Otherwise, the disease entity is specified to the fullest extent possible from the information available.

Infective Endocarditis, 1970–1979A STUDY OF CULTURE-POSITIVE CASES IN ST. THOMAS' HOSPITAL

Ninety-three episodes of culture-positive endocarditis occurred in 88 patients in the years 1970 to 1979. Streptococci caused two-thirds of the cases, with Streptococcus mitior and Streptococcus sanguis most common. Among the Group D streptococci, Streptococcus bovis was much more common than Streptococcus faecalis. Staphylococci accounted for a quarter of the episodes. Streptococcal endocarditis was commonest in the elderly, whereas staphylococcal endocarditis occurred at all ages. Degenerative heart disease was the underlying cardiac factor in nearly half the streptococcal cases, but staphylococci most often affected normal heart valves. When prosthetic valves were infected endocarditis of early onset was staphylococcal but that of late onset was streptococcal. Narcotic abuse was a common cause of staphylococcal endocarditis, second only to surgical wound infection following valve replacement. Streptococci affected the mitral and aortic valves equally but the staphylococci more usually involved mitral or tricuspid valves. The overall mortality was 36 per cent but was much higher for staphylococcal than streptococcal endocarditis.

Electrocardiographical, biochemical and morphological effects of chronic low level cadmium feeding on the rat heart.

Cadmium is known to dissociate myocardial excitation-contraction coupling and to depress the excitability of the cardiac conduction system in vitro (1-7). Short-term feeding experiments concluding that cadmium increases conduction time through the atrioventricular node-His-Purkinje system have partially extended these in vitro observations to in vivo systems (8, 9). Although the cadmium content of the heart increases with age and exposure (10-14), the effects of cadmium have not been systematically analyzed for possible significance as a contributing factor to degenerative heart disease. This preliminary study was undertaken to investigate electrocardiographical, biochemical, and morphological changes in mammalian hearts associated with long-term, low-level cadmium feeding. Methods. Eighteen weanling female rats of the Long-Evans strain were obtained and housed as described (15). They received a special rye-based, low-cadmium diet and deionized water fortified with Mn, Co, Cu, Zn, and Mo, as described by Schroeder and Vinton (16), for a total of 24 months when all were sacrificed. For half of them, cadmium acetate was added to the water to provide a final concentration of five parts per million (ppm) cadmium; for the half which served as controls, no cadmium was added; however, they were otherwise treated identically (16). For 16 rats (8 cadmium-fed and 8 control), indirect systolic pressures were determined 12, 18, and 21 months after weaning. Eight of the rats (4 cadmium-fed and 4 control) were studied electrocardiographically and their blood pressures determined directly after which they were sacrificed so that the various parts of the heart could be assayed for cadmium and zinc. The phosphate spectrum of hearts from the eight remaining rats (4 cadmium-fed and 4 control) were analyzed by phosphorus nuclear magnetic resonance spectroscopy (31P NMR). In addition hearts from a pair of rats not otherwise studied (1 cadmium-fed and 1 control) were examined by electron microscopy.

Death rates among the Italian railroad employees, with special reference to coronary heart disease and physical activity at work

All the male employees of the Italian railroad system at work on April 1, 1963, were classified by age, occupation, level of physical activity, and other relevant social and working characteristics. This group cohort, for a total of 172,459 subjects, was followed for 5 years, and all deaths occurring in that period of time were recorded and analyzed in relation to some of the entry characteristics. The analysis, mainly focused on the question of physical activity at work, showed that the overall corrected death rates are somewhat higher in men with heavy work, as compared with moderate and sedentary workers. The same applies to several other causes of death, individually considered, like “other degenerative heart disease” (excluding true coronary), “chronic bronchitis,” and “violence.” No substantial differences were found between occupations for death rates due to “cancer” and “strokes.” The only cause of death which definitely prevails in sedentary and moderate workers, as compared to the heavy ones, is coronary heart disease, defined by “myocardial infarction and sudden death of probable coronary origin,” differences being statistically highly significant.

Assessment of the Patient With Suspected Endocarditis

IN CONSIDERING the patient with possible infective endocarditis, the medical history and physical examination are of paramount importance, for it is the clinical presentation that usually provides the initial clues to the diagnosis. The majority of cases of infective endocarditis still occur in the setting of underlying rheumatic or congenital heart disease, although the 40% to 60% of cases currently falling into this category are much less than the 80% to 90% of cases seen in earlier years. 1,2 A number of other lesions including calcific aortic stenosis and other forms of degenerative heart disease, idiopathic hypertrophic subaortic stenosis (asymmetrical septal hypertrophy), and mitral valve prolapse (click-murmur syndrome) may serve as the substrate for infective endocarditis. In recent years, increasing numbers of cases are found superimposed on prosthetic heart valves. Even normal heart valves can become infected, as in acute bacterial endocarditis due to Staphylococcus aureus . Fever is present in

Assessment of the patient with suspected endocarditis

IN CONSIDERING the patient with possible infective endocarditis, the medical history and physical examination are of paramount importance, for it is the clinical presentation that usually provides the initial clues to the diagnosis. The majority of cases of infective endocarditis still occur in the setting of underlying rheumatic or congenital heart disease, although the 40% to 60% of cases currently falling into this category are much less than the 80% to 90% of cases seen in earlier years.^1,2A number of other lesions including calcific aortic stenosis and other forms of degenerative heart disease, idiopathic hypertrophic subaortic stenosis (asymmetrical septal hypertrophy), and mitral valve prolapse ("click-murmur" syndrome) may serve as the substrate for infective endocarditis. In recent years, increasing numbers of cases are found superimposed on prosthetic heart valves. Even normal heart valves can become infected, as in acute bacterial endocarditis due to<i>Staphylococcus aureus</i>. Fever is present in

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.

Arteriosclerotic and other degenerative heart diseases in Finland. II. A death certificate study of the examination of the cause of death from degenerative heart diseases.

A statistical survey of death certificates was made to analyse the ante-mortem and post-mortem medical and medico-legal examinations used in the determination of the cause of death of 12973 decedents who were recorded officially to have died of arteriosclerotic and other degenerative heart diseases in Finland in 1968. The relationship between the regional autopsy rate and the rate of mortality from degenerative heart diseases was studied in particular. The survey indicated that there was no systematic relationship between the type of ante-mortem and post-mortem cause-of-death examinations, including medical and medico-legal autopsies, and the rate of mortality from arteriosclerotic and other degenerative heart diseases in various groups of the Finnish population analysed by age, sex and domicile. This was concluded to be an indication of the reliability of Finnish cause-of-death statistics of degenerative heart diseases which show a generally high rate of mortality and prominent regional differences in the rate of deaths from those diseases among the Finnish male population.

Cardiovascular Mortality in 4 Scandinavian Countries

Studies on cardiovascular mortality in Japan, U. S. A. and England & Wales for the years around 1950, 1955 and 1960 were previously presented. Presently, similar analytical studies of the vital records were done for the 4 Scandinavian countries, Sweden, Denmark, Finland and Norway, for the years 1951, 1955, and 1960. Four selected causes of death for the study are “vascular lesions affecting the central nervous system, ” “chronic rheumatic heart disease, ” “arteriosclerotic and degenerative heart disease” and “ other diseases of heart”. (Seventh Revision of the International List of Diseases and Causes of Death) 1. Among those countries Finland tends to have the highest death rates in all forms studied except “chronic rheumatic heart disease.” 2. Norway tends to have the lowest mortality rate in most forms of the cardiovascular diseases studied, yet the death rates for “ chronic rheumatic heart disease” is the highest for this population. The mortality trends in the 10 years course for lesions affecting the central nervous system tends to show increasing tendency in this country alone. 3. Denmark also appears to have lower death rates, although the death rates for “other diseases of heart ” is relatively high. 4. In the 10 years course, tendency for decrease in deaths due to cardiac causes in younger age groups under 30-40 years of age and for “ vascular lesions affecting the central nervous system” for the age groups over 30-40 years of age are observed in general according to age-specific death rates. Death rates for the selected cardiovascular diseases among the four countries were comparable with the age-sex-adjusted death rates, and also with that of Japanese population by index forms.

Coffee, Tobacco, and Cardiovascular Disease: The Self-Selection Problem

To the Editor.— Disparate findings have been reported regarding the question of possible harm to health resulting from coffee drinking. 1-6 The association of coffee and tobacco use 1-4 was suggested as a confounding factor. 1 In a prospective study, Thomas 7 showed significant positive association between coffee drinking and cigarette smoking. A similar finding was also reported by Hrubec. 8 Palotas, 5 using international data, reported significant positive correlation between "apparent per capita coffee consumption and deaths per 100,000 from arteriosclerotic and degenerative heart disease" for 16 countries. For six European countries, grossly similar in diet and climate, a highly significant positive correlation was found. Since significant associations evidently exist between coffee drinking and cigarette smoking on the one hand, and between coffee drinking and risk of certain cardiovascular diseases 9,10 on the other, the suggestion 1 that the "discrepancies" might be related to cigarette smoking needs clarification. Usage

Recent trends in mortality in Australia.

Before World War II, mortality in Australia had decreased progressively since 1860, the first year for which statistics are available. The present study shows that this decline in mortality, although interrupted by the war, continued again during the 1950s but appears to have halted around 1960. In some age groups, death rates have even increased during the 1960s.The alteration in the trend of mortality has occurred mainly in the middle age group, 35–64, while death rates for persons aged over 64 have tended to remain constant and those for persons aged 15 and under have continued to decline. Death rates for males aged 15–34 declined throughout the period, tending to level off towards the end, whereas the rates for females aged 15–34 have increased during recent years.The retardation of mortality decline appears to have resulted from a slight increase in death rates from arteriosclerotic and degenerative heart disease, together with rapid increases in death rates from lung cancer for males and motor vehicle accidents for females.

Fatal arteriosclerotic heart disease, water hardness at home, and socioeconomic characteristics.

Comstock, G. W. (Training Center for Public Health Research, Johns Hopkins School of Hygiene and Public Health, Box 2067, Hagerstown, Md. 21740). Fatal arteriosclerotic heart disease, water hardness at home, and socioeconomic character-istics. Amer J Epidem 94: 1–10, 1971.—Several reports have indicated an inverse correlation between the hardness of community water supplies and deaths from arteriosclerotic and degenerative heart disease. An unusual opportunity to look at this association in more detail arose in Washington County, Maryland. Drinking water sources there vary markedly in hardness, and a private census in 1963 made it possible to match cases and controls from the same defined population and to study a number of socioeconomic characteristics. During the next three years, there were 189 deaths attributed to arteriosclerotic and degenerative heart disease among white males aged 45 to 64 who could be identified in the census. For each case, 2 controls were randomly selected from the census lists and matched for race, sex and year of birth. Water samples were collected from the residences of cases and controls and examined for total hardness. No significant association of arteriosclerotic and degenerative heart disease deaths could be found with water hardness. Deaths from these causes were more common among persons of lower socioeconomic status, among cigarette smokers, and among persons who attended church infrequently. Although water hardness is not likely to be a real risk factor for cardiovascular disease, the role of trace elements in home drinking water supplies should be investigated.

Differential mortality from cardiovascular disease in migrants from England and Wales, Scotland and Italy, and native-born Australians

Death rates from cardiovascular disease, and in particular arteriosclerotic and degenerative heart disease in the locally-born and principal migrant groups in Australia have been calculated for both sexes in 10 yr age groups. Migrants from England and Wales and Italy upon arrival have much lower rates than those prevailing in Australia. The longer their period of residence in Australia, however, the greater their death rate from cardiovascular disease becomes, until it significantly exceeds that existing in their countries of origin.