29 research outputs found
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Some metabolic relationships in young patients with ischemic heart disease
The interrelationships between body weight, insulin secretion and serum lipids were studied in 40 young white patients (mean age 37 years) with established ischemic heart disease (IHD), living in Johannesburg. None was severely obese, hypertensive or overtly diabetic. In general, strong positive correlations were found between body weight and insulin concentrations and between insulin levels and fasting serum triglycerides. However, insulin levels were relatively low in 4 patients with marked hypertriglyceridemia (above 350 mg/dl). These data are consistent with the postulate that insulin promotes (hepatic) triglyceride synthesis, but when there is gross hypertriglyceridemia peripheral triglyceride clearance becomes defective. Insignificant correlations were observed between body weight and serum lipids and between cholesterol and other metabolic variables. We conclude that there is a sequential link between increasing body weight, insulin secretion and triglyceride levels in young patients with IHD, but that cholesterolemia is independent of this axis
Mechanisms and management of heart failure in active rheumatic carditis
Fulminating active rheumatic carditis has been observed for over three decades in this environment with no recent alteration in either the incidence or the pattern of presentation. Heart failure (in this context defined as 'an inadequate circulation at rest together with a raised pulmonary venous pressure, with or without an associated high systemic venous pressure in the absence of haemodynamically significant tricuspid valve disease or pericardial effusion') is prevalent but occurs only when a haemodynamically important leftsided valve lesion supervenes. Regurgitation is the predominant valve lesion and involves principally the mitral valve. Mitral annular dilatation is marked and predisposes to lengthening - or rupture - of chordae tendineae and prolapse of the anterior leaflet. The resultant cardiac workoverload apparently perpetuates or aggravates the rheumatic activity. Heart failure, as defined, whether caused by or associated with active rheumatic carditis, makes surgical management of the valve lesion mandatory as a life-saving measure. Aggressive medical therapy for heart failure, which should include vasodilator drugs and especially angiotensinconverting enzyme inhibitors, provides temporary improvement only. Contrary to ongoing doctrine, treatment with steroid drugs in this context is neither life-saving nor beneficial