Using echocardiography, we identified 21 patients with a syndrome that included severe concentric cardiac hypertrophy, a small left ventricular cavity, and supernormal indexes of systolic function without concurrent medical illness or ischemic heart disease. Thirteen of the patients presented with dyspnea or chest pain. All patients studied had a history of hypertension and were compared with normotensive controls matched for age and sex. The patients were elderly (mean age, 73.3 years), predominantly female (16 patients), and mostly black (15 patients). Their cardiac function was characterized by excessive left ventricular emptying (ejection fraction on two-dimensional echocardiography [patients vs. controls], 79 +/- 4 vs. 59 +/- 5 per cent, P less than 0.001) and abnormal diastolic function as manifested by a prolonged early diastolic filling period (279 +/- 25 vs. 160 +/- 45 msec, P less than 0.001) and reduced peak diastolic dimension increase (11 +/- 4 vs. 16 +/- 5 cm per second, P less than 0.05). In spite of the clinical presentation of heart failure, all of 9 patients receiving either beta-receptor antagonists or calcium-channel blocking agents obtained symptomatic relief, whereas 6 of 12 patients receiving vasodilator medications had severe hypotensive reactions, including one death. We conclude that this unique subset of hypertensive patients has a clinical syndrome that warrants recognition and tailored management.
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127: 4-6
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58: M56-59
[Abstract][Full Text]
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[Full Text]
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[Abstract][Full Text]
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[Abstract][Full Text]
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102: 1076-1078
[Full Text]
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21: 582-589
[Abstract]
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[Full Text]
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[Abstract][Full Text]
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[Abstract][Full Text]
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[Abstract][Full Text]
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[Abstract][Full Text]
Spooner, P. H., Perry, M. P., Brandenburg, R. O., Pennock, G. D.
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[Abstract][Full Text]
Pak, P. H., Maughan, W. L., Baughman, K. L., Kieval, R. S., Kass, D. A.
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98: 242-248
[Abstract][Full Text]
Vignon, P., Mor-Avi, V., Weinert, L., Koch, R., Spencer, K. T., Lang, R. M.
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97: 1053-1061
[Abstract][Full Text]
Aranki, S. F., Shaw, D. P., Adams, D. H., Rizzo, R. J., Couper, G. S., VanderVliet, M., Collins, J. J., Cohn, L. H., Burstin, H. R.
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94: 390-397
[Abstract][Full Text]
Clarkson, P. B.M., Wheeldon, N. M., MacFadyen, R. J., Pringle, S. D., MacDonald, T. M.
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93: 2037-2042
[Abstract][Full Text]
Bartunek, J., Sys, S. U., Rodrigues, A. C., Van Schuerbeeck, E., Mortier, L., de Bruyne, B.
(1996). Abnormal Systolic Intraventricular Flow Velocities After Valve Replacement for Aortic Stenosis : Mechanisms, Predictive Factors, and Prognostic Significance. Circulation
93: 712-719
[Abstract][Full Text]
Hussain, K.M.A., Gould, L., Sosler, B., Bharathan, T., Reddy, C.V.R.
(1996). Clinical Science Review: Current Aspects of Thrombolytic Therapy in Women with Acute Myocardial Infarction. ANGIOLOGY
47: 23-33
[Abstract]
Cannan, C. R., Reeder, G. S., Bailey, K. R., Melton, L. J. III, Gersh, B. J.
(1995). Natural History of Hypertrophic Cardiomyopathy : A Population-Based Study, 1976 Through 1990. Circulation
92: 2488-2495
[Abstract][Full Text]
Wigle, E. D., Rakowski, H., Kimball, B. P., Williams, W. G.
(1995). Hypertrophic Cardiomyopathy : Clinical Spectrum and Treatment. Circulation
92: 1680-1692
[Full Text]
Marian, A.J., Roberts, R.
(1995). Recent Advances in the Molecular Genetics of Hypertrophic Cardiomyopathy. Circulation
92: 1336-1347
[Full Text]
Vaccarino, V., Krumholz, H. M., Berkman, L. F., Horwitz, R. I.
(1995). Sex Differences in Mortality After Myocardial Infarction : Is There Evidence for an Increased Risk for Women?. Circulation
91: 1861-1871
[Abstract][Full Text]
Lund, O., Jensen, F. T.
(1989). Late Cardiac Deaths After Isolated Valve Replacement for Aortic Stenosis. Relation to Impaired Left Ventricular Diastolic Performance. ANGIOLOGY
40: 199-208
[Abstract]
Bier, A. J., Eichacker, P. Q., Sinoway, L. I., Terribile, S. M., Strom, J. A., Keefe, D. L.
(1988). Acute Cardiogenic Pulmonary Edema: Clinical and Noninvasive Evaluation. ANGIOLOGY
39: 211-218
[Abstract]
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