Relation of left ventricular mass geometry to morbidity and mortality in uncomplicated essential hypertension

Article Abstract:

It is estimated that 25 percent of all adults in the United States have high blood pressure of unknown cause (essential hypertension). Many studies have shown that high blood pressure increases the risk of developing heart disease. Drugs are available for the treatment of high blood pressure. While these drugs have been effective in reducing blood pressure, they have not been as effective in reducing morbidity (illness) and mortality from heart disease. Therefore, better methods are needed to classify patients with high blood pressure and determine the risk factors associated with morbidity and mortality from heart disease. In some cases, high blood pressure causes the left side of the heart to increase in size; this is known as left ventricular hypertrophy. The increased pressure makes the heart muscle work harder, causing it to hypertrophy. (The left ventricle pumps blood from the heart to the main arterial circulation.) Echocardiography, a relatively new ultrasound technique, has been used successfully for measuring left ventricular size and mass. Using this technique, 253 patients with essential hypertension were examined and followed over a 10-year-period to determine the relation between left ventricular size and morbidity and mortality associated with heart disease. The results revealed that heart problems were more likely to occur in patients who had left ventricular hypertrophy (26 percent) than in those who did not (12 percent). Mortality from heart disease was greater in patients with increased left ventricular mass (14 percent versus 0.5 percent). Similarly, overall mortality was greater in patients with left ventricular hypertrophy (16 percent versus 2 percent). None of the patients who had hypertension only died as a result of heart disease, while those who had both hypertension and left ventricular hypertrophy had 21 percent mortality and 31 percent morbidity. Morbidity and mortality from heart disease were predicted by age and left ventricular mass, but not by blood pressure or blood cholesterol. Determining left ventricular mass is a useful method for classifying the risk of heart disease in patients with hypertension, and may be useful for prescribing appropriated treatments as well. (Consumer Summary produced by Reliance Medical Information, Inc.)

Mortality, Patient outcomes, Measurement, Complications and side effects, Risk factors, Diseases, Heart ventricle, Left, Left heart ventricle, Echocardiography, Heart enlargement, Heart hypertrophy, Essential hypertension

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Mitral valve prolapse: causes, clinical manifestations, and management

Article Abstract:

Studies of mitral valve prolapse published from 1963 to 1989 are reviewed. The mitral valve is a structure in the heart that normally directs blood flow from the left atrium to the left ventricle. Mitral valve prolapse is the reverse movement of the cusps or leaf-like structures of the mitral valve during contraction of the heart, allowing blood to leak back into the atrium. Most cases of this heart abnormality result from genetic factors. Mitral valve prolapse can be diagnosed by detecting abnormal heart sounds; by echocardiography, the use of sound waves to visualize internal structures; or by electrocardiography, measurement of the electrical activity of the heart. Mitral valve prolapse is associated with abnormalities of the thoracic or chest bone, low body weight, low blood pressure, an abnormal drop in blood pressure upon standing, syncope or transient loss of consciousness, palpitations or throbbing pulsations, and abnormal rhythms of the atrium. Complications from this condition account for 4,000 mitral valve operations, 1,100 cases of endocarditis, the inflammation of heart muscle, and an estimated 4,000 sudden deaths annually in the United States. These complications occur most often in older men and lead to valve surgery in 5 percent of men and 1.5 percent of women. Risk factors for developing complications of mitral valve prolapse include male gender, age over 45 years, and mitral regurgitation, the backflow of blood from the left ventricle to the left atrium due to impaired function of the mitral valve. Persons with risk factors should be provided with prophylaxis against endocarditis as well as follow-up medical care. Patients with severe mitral regurgitation or abnormal ventricular rhythms should be actively managed and closely monitored. (Consumer Summary produced by Reliance Medical Information, Inc.)

Care and treatment, Abnormalities, Heart, Cardiovascular abnormalities, Mitral valve prolapse, Mitral valve

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Rehabilitation of the exercise electrocardiogram

Article Abstract:

The exercise electrocardiogram may still be a useful diagnostic tool for examining patients with chest pain. This technique involves measuring the electrical activity of the heart while the patient exercises. Most often, changes in the ST-segment are measured because this often reveals reduced blood flow to the heart. However, ST-segment changes alone are not very useful in diagnosing coronary artery disease. Many have consequently recommended abandoning the exercise electrocardiogram, but a 1998 study found that incorporating other measures can increase its effectiveness.

Editorial, Analysis, Diagnosis, Electrocardiogram, Electrocardiography, Treadmill exercise tests

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