Previous History Of Heart Disease Research Articles

Delayed dilated cardiomyopathy for major burn injuries

Purpose: The early impact on the heart of severe burns has all been well documented previously. Here, we report on the late effects of burns upon the heart, and dilated cardiomyopathy, such aspects having been little reported previously in the literature. Methods: Over the past 8 years (June 1991 to December 1998), 55 scalded or flame-burnt patients for whom the total burnt body surface area (TBSA) exceeded 50% were treated. Seventeen patients survived and were followed up. The mean age was 44 years. The mean follow-up period was 47.3 months; four patients displayed a previous history of heart disease. We used several parameters to evaluate and follow cardiac status to see the late effect of burns upon the heart. Results: Of 17 patients, 3 patients (17.7%) were found to exhibit dilated cardiomyopathies after a mean time of 6 months post-injury. A dramatic recovery from symptoms and roentgenographic findings were observed for all patients following symptomatic treatment. Conclusion: Here we report three cases of delayed dilated cardiomyopathy, a condition that has been little reported in the past. There may be many causating factors. Several recommendations are described.

Cardiac Risk Stratification of Patients With Symptomatic Spinal Stenosis

The leading cause of death in the perioperative period after noncardiac surgery is a cardiac event. As the number of lumbar surgeries performed in patients older than 65 years of age continues to increase, this patient population with neurogenic claudications is an at risk group for a cardiac event because of their age and associated cardiac risk factors. The authors attempted to document by means of cardiac chemical stress testing, the prevalence of silent ischemic cardiac disease in patients with neurogenic claudication who were candidates for elective lumbar surgery. Eleven of 140 patients (8%) had induced cardiac wall abnormalities on stress testing, indicating myocardial ischemia. The only risk factors associated with cardiac ischemia were smoking and history of heart disease. It is recommended that dobutamine stress echocardiography be performed in patients undergoing elective spinal surgery for symptomatic spinal stenosis if they have a history of previous heart disease, smoking, or both.

Prevalence of heart disease diagnosed de novo in pregnancy in a West London population.

To determine the prevalence of heart disease diagnosed de novo in pregnancy in a West London population and to re-examine the current role of routine cardiovascular examination in antenatal care in the UK. Retrospective study. Obstetric medical clinics at Queen Charlotte's and Chelsea Hospital, University College Hospital and Northwick Park Hospital. Three hundred and twenty women referred for cardiac evaluation during pregnancy. The majority of the 139 women referred specifically for evaluation of murmurs during pregnancy were found to have physiological murmurs (97%). Only four women (3%) were found to have significant cardiac lesions de novo in their pregnancy. Three of these four women were immigrants who had no previous history of heart disease. The only woman from the UK was already known to have a murmur from childhood. Our study shows that heart disease diagnosed de novo in pregnancy in a West London population is an uncommon problem with low prevalence. It also appears to be a problem seen mainly in the immigrant population. The results emphasise the importance of taking a thorough medical history in all pregnant women. However, our results if they are confirmed, would suggest that only immigrants and those with significant symptoms or a known history of heart murmur or heart disease need undergo cardiovascular examination during pregnancy. These findings need to be confirmed in a larger group in other parts of the UK before further recommendations on selective cardiovascular examination can be made. This will have significant implications for midwifery-led care.

Serial measurements of serum creatine kinase are of most use in the exclusion of acute myocardial infarction in patients with a history of heart disease.

Rapid sequential measurements of serum CK were assessed in the diagnosis and exclusion of acute myocardial infarction (MI) in 94 patients presenting to St Thomas' Hospital, London, with acute chest pain of less than 12 h duration. A blood sample was taken from patients on admission to hospital and then a second sample was taken within 12 h of admission. Serum CK activity was assayed on both samples and delta log10 (serum CK) per hour calculated to distinguish infarct from non-infarct using a discriminant value of 0.015. Ninety-six per cent of patients with acute MI were diagnosed on the basis of clinical history and electrocardiographic evidence alone, and did not require biochemical confirmation. Serial estimation of serum CK contributed positively towards the exclusion of acute MI in 77% of patients who presented with chest pain and who had a previous history of heart disease, but towards only 11% of cases in the absence of a history of heart disease.

Wide Complex Tachycardia

Wide complex tachycardias present diagnostic challenges for emergency physicians. The history, physical examination, and ECG provide information required to arrive at the correct diagnosis. When a previous history of heart disease exists, VT should be suspected; however, no single clinical feature is sufficiently reliable for distinguishing VT from SVT. Patients with VT may tolerate their dysrhythmias for several hours and maintain hemodynamic stability. ECG analysis is the most useful process in differentiating SVT and VT. Characteristics suggestive of VT include evidence of AV dissociation, QRS duration of longer than 0.16 seconds, and QRS axis between -90 degrees +/- 180 degrees. Predictive QRS morphologic criteria also have been established for VT. A four-step approach to ECG analysis has been reported to accurately identify patients with VT, but prospective validation in an ED setting is lacking. The initial approach to treating patients with wide QRS tachycardias depends on hemodynamic stability. Until the identify of a dysrhythmia is certain, consider all patients to be suffering from VT. Unstable patients require immediate cardioversion. Acute treatment of stable patients includes lidocaine or procainamide. Adenosine is appropriate when wide QRS SVT is the diagnosis, and it also has been used as a diagnostic aid to identify dysrhythmias. Reports of complications with the use of adenosine as a diagnostic agent have not yet appeared but may occur after sufficient numbers of cases have accumulated. Magnesium sulfate may be useful in refractory cases of VT and torsades de pointes. Chronic treatment of patients prone to VT may include complex pharmacotherapy and AICDs. Development of new class III agents and enhancement of AICD technology may result in improved patient outcomes and the availability of more choices for emergent therapy of wide QRS tachycardias.

Somatic awareness and coronary artery disease in women with chest pain

To determine if there was a relationship between level of somatic awareness and coronary artery disease (CAD) in women with chest pain. Descriptive, correlational study. Urban, university-affiliated, tertiary care hospital. Fifty-five women without a previous history of heart disease admitted to the hospital for evaluation of chest pain. Modified Somatic Perception Questionnaire (MSPQ); Patterson and Horowitz clinical criteria for classification of chest pain; Supplemented Rose Questionnaire for angina; age; and CAD risk factors. A small but significant inverse correlation was found between level of somatic awareness as measured by MSPQ scores and degree of CAD (r = 0.2932, p < 0.05). MSPQ scores significantly differed between women with CAD (lower scores) and women without CAD (higher scores) (p < 0.05). MSPQ score was the most important factor in a logistic regression model that modestly but significantly predicted presence or absence of CAD. Somatic awareness may be an important factor to consider in evaluating the awareness and response of women to symptoms of myocardial ischemia and to chest pain of both cardiac and noncardiac etiologies.

Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: Neurogenic stunned myocardium

Objective. The purpose of this study was to determine whether a relation exists between electrocardiographic (ECG) abnormalities and left ventricular wall motion in patients with subarachnoid hemorrhage.Background. Although ECG change simulating acute myocardial infarction are frequently seen in patients with subarachnoid hemorrhage, their relation to left ventricular wall motion has not been established.Methods. Twelve patients with subarachnoid hemorrhage were classified according to the presence of ST segment elevation in at least two consecutive leads on admission: seven patients with ST segment elevation (group I) and five patients without ST segment elevation (group II). No patients had a previous history of heart disease. Left ventricular regional wall motion was evaluated by the centerline method. The mean (±SEM) duration from onset of subarachnoid hemorrhage to left ventriculography was 9 ± 3 h in group I and 10 ± 1 h in group II. Coronary angiography was performed to rule out wall motion abnormalities due to coronary artery disease while the ST segment was still elevated. Two dimensional echocardiography was used to evaluate wall motion thereafter.Results. All patients in group I showed ST segment elevation in ECG leads V4to V6. Wall motion of the left ventricular apex was significantly reduced in group I compared with group II (−2.48 ±0.41 vs. −0.45 ± 0.72, p < 0.02). No patients showed organic stenosis or vasospasm, or both, of epicardial coronary arteries. Wall motion abnormalities decreased echocardiographically in all patients, but one patient in group I died in hospital at 2 or 3 weeks after the onset of subarachnoid hemorrhage, when the T wave was inverted in leads V4to V6.Conclusions. These findings suggest that patients with subarachnoid hemorrhage and ST segment elevation may demonstrate transient corresponding regional wall motion abnormalities. The mechanism of neurogenic stunned myocardium was not clearly elucidated in the present study.

Acute myocardial infarction with normal coronary arteries in a case of polyarteritis nodosa: possible role of coronary artery spasm

A 20 year old man with no previous history of heart disease presented with acute left ventricular failure following extensive anterior wall myocardial infarction. Selective angiography revealed multiple aneurysms in the renal, mesenteric and hepatic arteries with an infarct in the lower pole of the right kidney. These findings, along with the presence of circulating hepatitis B surface antigen favoured the diagnosis of polyarteritis nodosa. In view of normal coronary angiogram and absence of myocardial vasculitis, coronary vasospasm was implicated as the cause of myocardial infarction. Such an occurrence, which could have different therapeutic and diagnostic implications, has not, to our knowledge, been previously described in polyarteritis nodosa.

Indoor air pollution of coal fumes as a risk factor of stroke, Shanghai.

A cohort of 957 male persons in Shanghai has been followed up for 12 years after they entered a screening program for coronary heart disease and stroke. During the period of study, 24 of the subjects who had no previous history of heart disease and stroke died from stroke. Risk factors for stroke were analyzed by the Cox proportional hazards model. Coal fumes were found to be an independent risk factor for stroke in addition to diastolic blood pressure, age, and cigarette smoking.

Idiopathic hypertrophic sub-aortic stenosis (IHSS)

A new diagnostic method for idiopathic hypertrophic sub-aortic stenosis (IHSS), using synchronized ECG gated 201Tl myocardial scintigraphy, is described. Twenty patients previously diagnosed as IHSS were evaluated by sequential three-view ECG gated 201Tl and 45 degrees left anterior oblique multigated (MUGA) cardiac blood pool imaging (Group A). The results were compared with two control groups: 20 patients with no previous history of heart disease (Group B), and 20 patients with coronary ischaemic heart disease (Group C). We suggest the following combination of scintigraphic signs as typical and diagnostic to obstructive IHSS: Elevated left ventricular ejection fraction (mean 83.9% +/- 6.15S.D. versus 72.5% +/- 5.35S.D. and 51.2% +/- 13.65S.D. in Groups B and C respectively); Systolic left ventricular cavity obliteration (71% of obstructive IHSS patients versus 0% in Groups B and C); A ratio of more than 1.3:1 in septal to free wall thickness (100% of patients with IHSS); Perfusion/wall-motion mismatch of septum was demonstrated in all (100%) of patients with IHSS (versus 0% in Group B and 10% in Group C). We suggest this last finding as a new specific diagnostic sign for IHSS, with the ability to differentiate between patients with ischaemic coronary heart disease and IHSS patients; whilst both groups may present chest pains, the first group was characterized by 'matching' of perfusion and motion of the affected myocardial wall while the patients with IHSS had 'mismatching' of these parameters. We suggest gated 201Tl myocardial scintigraphy as an additional sensitive tool for the early diagnosis and evaluation of IHSS patients.

Are cardiac arrhythmias important in stroke?

Ambulatory electrocardiography was performed on 21 consecutive acute stroke patients on the day of admission and 14 and 42 days later. There was no statistically significant difference in cardiac arrhythmias between stroke patients and a group of age- and sex-matched controls. There was considerable variation in the frequency of cardiac arrhythmias on each day but none of the arrhythmias was associated with a sudden deterioration in the condition of the patients and no arrhythmias produced symptoms in either the stroke or the control groups. Fourteen per cent of stroke patients had an associated acute myocardial infarction and 57% had a history of previous heart disease. While a history of previous heart disease or the occurrence of major ventricular arrhythmias were associated with an increased six-week mortality rate, routine continuous monitoring of cardiac rhythm would not appear to be of value in acute stroke.

Acute and Transient ST Segment Elevation During Bacterial Shock in Seven Patients Without Apparent Heart Disease

Acute elevation of the ST segment in several ECG leads was observed in seven patients with bacterial shock during the course of therapy. Six patients had bacterial pneumonia, one had acute cholecystitis, and none had a previous history of heart disease. At the onset of the ST elevation, all patients were receiving dopamine infusion, which in four of them was inadvertently increased shortly before the ECG changes, the ST elevation was not associated with chest pain, pericardial friction rub, or acute changes in the heart rate, or arterial blood pressure. In four patients the maximum ST elevation was greater than or equal to 5 mm. In each instance the ST segment returned to the isoelectric line within 24 hours, and subsequent development of Q waves or changes in the QRS was not observed. Although the existence of an acute pericarditis or an acute myocarditis as possible causes of the ST elevation cannot be fully ruled out, the sudden onset, prominent magnitude, and brief duration of the ST elevation are perhaps more indicative of an acute ischemic event, possibly related to a transient coronary vasoconstriction induced by the dopamine infusion.

Risk Factors for Myocardial Infarction Associated With the Chicago Snowstorm of Jan 13-15, 1979

Sixty male survivors of acute myocardial infarction in the week after the Chicago blizzard of Jan 15, 1979, were matched by hospital and sex with 60 myocardial infarction survivors from a week without snowfall to determine whether a history of previous heart disease or of cardiac risk factors increased the risk of a postblizzard myocardial infarction. Cases did not differ significantly from control subjects with respect to age, percentage working full time, or percentage with a history of heart disease, hypertension, smoking, diabetes mellitus, obesity, or gout. Hypercholesterolemia was four times as common among cases as among controls.

Acute cardiac toxicity of antineoplastic agents as the first manifestation of pheochromocytoma

A 47-year-old male with histiocytic lymphoma and no previous history of heart disease developed significant fluctuations of blood pressure, electrocardiographic evidence of myocardial ischemia, and life-threatening arrhythmia after the first dose of BACOP (bleomycin, adriamycin, cyclophosphamide, Oncovin, and prednisone) chemotherapy. The presence of pheochromocytoma was suspected, and it was demonstrated by elevated urinary metanephrines, catecholamines, and vanillylmandelic acid, and finally confirmed on autopsy. The possible role of chemotherapeutic agents in stimulating excessive catecholamine release, thus causing transient cardiac injury, is suggested.

Plasma norepinephrine in congestive heart failure

Resting plasma concentrations of norepinephrine, dopamine-beta-hydroxylase enzyme activity and peripheral blood lymphocyte beta adrenergic receptor sensitivity to isoproterenol as reflected in cyclic 3′,5′-adenosine monophosphate (cAMP) generation were studied in patients with congestive heart failure due to atherosclerotic heart disease or to congestive cardiomyopathy or hypertensive cardiovascular disease. Systolic time Intervals were also measured in nonhypertensive patients and correlated with the plasma norepinephrine concentration. Control patients were hospital employees without a previous history of heart disease or hypertension, and were matched for age to eliminate the effect of increasing age on the plasma norepinephrine concentration. The results of this study clearly demonstrate that the plasma norepinephrine concentration is directly related to the degree of left ventricular dysfunction in patients with congestive heart failure. When the systolic time intervals were correlated with the plasma norepinephrine levels, a significant prolongation of the preejection period was observed with progressively increasing plasma concentrations of norepinephrine. The reverse was true for the left ventricular ejection time, which demonstrated a significant Inverse relation with the plasma norepinephrine concentration. The ratio of the preejection period to the left ventricular ejection time, which is a reflection of left ventricular function, significantly increased with increasing levels of plasma norepinephrine. In addition, plasma lymphocytes from patients with the greatest degree of left ventricular dysfunction failed to generate normal amounts of cAMP after beta adrenergic receptor stimulation with isoproterenol. It Is suggested that beta adrenergic receptors are desensitized in these patients and that this desensitization contributes to the observed alterations in myocardial contractility.

Streptococci and aerococci associated with systemic infection in man.

A collection of 820 isolates of streptococci and aerococci from human blood or internal organs was classified by means of a set of cultural and biochemical tests. Of these, 719 (712 streptococci and 7 aerococci) were from patients believed to be suffering from a systemic infection: endocarditis 317; a purulent lesion in an internal organ ("purulent disease") 152; bacteriaemia 250. The endocarditis streptococci included members of all recognisable taxa, but only certain of these were common: Streptococcus sanguis, 16-4%; dextran-positive and usually mannitol-fermenting strains of S. bovis (S. bovis I), 15-1%; S. mutans, 14-2%; S. mitior, 13-2%. Streptococci of the "alpha-haemolytic" taxa (S. sanguis, S. mitior and related strains) formed only 44-8% of the total. When the percentage frequency of streptococcal taxa among the endocarditis and "non-endocarditis" isolates was compared, the dextran-forming taxa (S. mutans, S. bovis I, S. sanguis, and dextran-positive streptococci otherwise resembling S. mitior) all had higher "endocarditis : non-endocarditis" ratios than did any of the non-dextran-producing taxa. Endocarditis increased in frequency with age, and showed an excess of males over females up to the age of 65 years. In young patients (less than 35 years), "alpha-haemolytic" streptococci predominated; with increasing age, the proportion of other streptococci increased progressively but the absolute numbers of isolations of "alpha-haemolytic" streptococci did not fall. Infections with S. mutans were prominent in the age-group 35-54 years and with S. bovis I at ages greater than or equal to 55 years. A history of previous heart disease was more often obtained in endocarditis due to "alpha-haemolytic" streptococci than in other streptococcal endocarditis. The streptococcus most often isolated from purulent lesions in internal organs was S. milleri (29-3%). It was associated with brain abscess, meningitis, pleural empyema and a variety of intra-abdominal abscesses. The only common predisposing factor in endocarditis was previous heart damage. In other systemic streptococcal diseases, other general or local predisposing causes could be observed, mainly in infections with the "pyogenic" groupable streptococci, the enterococci and S. milleri.

Letter: Procainamide and acute arthritis.

Letters1 November 1973Procainamide and Acute ArthritisMARSHALL TAD MORGAN, M.D.MARSHALL TAD MORGAN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-79-5-750 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptTo the editor: Long-term procainamide therapy commonly produces a lupus-like syndrome (1). In reported cases this complication has occurred after a minimum of 1 month's duration of therapy (1, 2), and prolonged exposure to the drug is thought to be necessary for its production (3, 4). I wish to report a case in which, on two occasions, arthritis developed within hours of procainamide administration.A 38-year-old black man entered the hospital on 18 February 1973, with an acute, extensive anterolateral myocardial infarction. He had no previous history of heart disease or arthritis and was taking no medications. He did well,...

Infection due to Actinobacillus actinomycetemcomitans.

Actinobacillus actinomycetemcomitans , an unusual Gram-negative coccobacillus, was isolated from the blood cultures of two patients. One patient with multiple myeloma and pneumonia was successfully treated with ampicillin. The other, with bacterial endocarditis, but without a previous history of heart disease, responded to kanamycin therapy. Endocarditis caused by this organism is frequently complicated by cerebral embolization. This bacterium may be overlooked in blood cultures because of its slow growth and requirement for 5% CO2 when subcultured on solid agar media.

Renal Vascular Abnormalities in Acute Pancreatitis

ACUTE renal failure is an unusual manifestation of acute pancreatitis.^1-3When renal failure does occur, it is almost invariably due to acute tubular necrosis or renal cortical necrosis. This report presents a patient with acute pancreatitis and acute renal failure due to bilateral renal artery thrombosis. In addition, three patients are presented with unilateral abnormalities demonstrated by intravenous pyelogram (IVP) during acute pancreatitis and the significance of this association is discussed. <h3>Report of Cases</h3><h3>Case 1 (WHVAH No. A7937).</h3> —A 40-year-old white male alcoholic was admitted because of ankle edema of one month's duration. During this time he had dyspnea on moderate exertion but no orthopnea or paroxysmal nocturnal dyspnea. There was no chest pain or a previous history of heart disease. He denied recent sore throat, fever or chills, or previous kidney disease. Of note was the presence of intermittent cramping pain in the lower abdomen over the

Successful treatment of quinidine and procaine amide intoxication; report of three cases.

EARLIER observations from this laboratory demonstrated in the laboratory animal the efficacy of molar sodium lactate in reversing toxic electrocardiographic and blood-pressure changes resulting from quinidine and procaine amide.1 2 3 The purpose of this paper is to report the successful clinical application of these findings.Case ReportsCase 1. N.D., a 66-year-old man, was admitted to the Veterans Administration Hospital, Coral Gables, Florida, on January 18, 1958, because of chest pain. On the evening before admission, substernal chest pain and palpitation, without other cardiovascular symptoms, developed. There was no previous history of heart disease. On admission, the rhythm was regular, with . . .