Prolonged bed rest in the treatment of idiopathic cardiomegaly
01 Jan 1968-Transactions of The Royal Society of Tropical Medicine and Hygiene (Oxford University Press)-Vol. 62, Iss: 3, pp 362-370
TL;DR: The relationship of improvement to mode of onset and clinical findings on admission is discussed, and the value of prolonged complete bed rest coupled with a high protein diet, vitamin supplements and standard measures of treatment of heart failure is tested.
Abstract: 18 subjects in heart failure due to idiopathic cardiomegaly were admitted to a trial to test the value of prolonged complete bed rest, coupled with a high protein diet, vitamin supplements and standard measures of treatment of heart failure. 10 completed 6 months or more in bed and 5 showed a reduction in heart size. 4 demanded discharge before 6 months in hospital had been completed, and of these 1 showed a reduction in heart size. 5 died in hospital. The relationship of improvement to mode of onset and clinical findings on admission is discussed.
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TL;DR: Plasma tryptophan was found to be low in adults at risk and intermediate in Africans receiving a higher protein intake, as compared with Europeans whose protein intake might include more than 40 % as animal products.
Abstract: 1. An examination has been made of the plasma amino acids of adult Uganda Africans at risk to endomyocardial fibrosis compared with people from areas where the disorder is rare. The amino acid profile, both free and in the protein of the main staples, has also been examined.2. Plasma tryptophan was found to be low in adults at risk and intermediate in Africans receiving a higher protein intake, as compared with Europeans whose protein intake might include more than 40 % as animal products.3. Leucine and valine were also low in the plasma of adult Africans at risk.4. The non-essential amino acids alanine and glycine were increased in the adult Africans at risk.5. The similarity of these changes with the changes seen in kwashiorkor by other workers suggests that adherence to limited vegetable diets may introduce a chronic stress with regard to certain essential amino acids.6. Studies on the vegetable staples used by Africans established that they are particularly poor in tryptophan and such Africans are probably dependent on other sources for their trypto-phan. None of the staples was a rich source of leucine. Plantain contained relatively large amounts of histidine, and cassava of arginine.7. A comparative study of muscle protein suggests that the composition is similar regardless of diet and species. Leucine is quantitatively one of the most important amino acids in the muscle profile.8.The above findings are discussed in the context of the requirements for heart muscle and the high incidence of cardiomyopathies within such African communities.
11 citations
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TL;DR: Thirty-six patients with persistent cardiomegaly of indeterminable origin were studied to observe the effects of prolonged bed rest on heart size, and all patients showed marked clinical improvement.
Abstract: Thirty-six patients with persistent cardiomegaly of indeterminable origin were studied to observe the effects of prolonged bed rest on heart size. All patients previously had exhibited little or no response to conventional treatment. Treatment consisted in the institution of prolonged bed rest and continuation of previous therapy, including digitalis and diuretics. The over-all response was good. Eleven of 21 patients who completed the prescribed course of bed rest showed return of heart size to normal, four showed definite decrease in heart size, and six experienced no change. Four deserters and an additional 11 patients currently on prolonged bed rest experienced the same level of response during incomplete observation periods. All patients showed marked clinical improvement.
49 citations
TL;DR: The importance of cardiac disease as a cause of admission to the Mulago Hospital has not changed over 5 years but the pattern of disease shows a decrease in syphilitic heart disease and an increase in cor pulmonale.
Abstract: 449 patients with heart disease were admitted to the Mulago Hospital, Kampala, each patient for the first time, during the 12 months from 1 October 1962. In order of importance the common disorders were rheumatic heart disease, hypertension or acute nephritis with heart failure, idiopathic cardiomegaly, endomyocardial fibrosis, and syphilitic heart disease. Less common were cor pulmonale, anaemia with heart failure, congenital heart disease and pericardial disease. Patients with endomyocardial fibrosis were mainly immigrants from Rwanda and Burundi or from the adjoining tribes. No other disease showed a particular tribal incidence. The importance of cardiac disease as a cause of admission to the Mulago Hospital has not changed over 5 years but the pattern of disease shows a decrease in syphilitic heart disease and an increase in cor pulmonale. Heart disease is of equal importance as a hospital problem in Uganda, Kenya, Nigeria and Rhodesia, but the incidence of the separate diseases differs in these areas.
24 citations
01 Jan 1960
22 citations
"Prolonged bed rest in the treatment..." refers background in this paper
...In tropical countries the plasma albumin level is 1 g. per 100 ml. or more lower than that found in Britain or North America (TRoWELL, 1960)....
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TL;DR: The therapeutic value of prolonged, strict bed rest in cases of severe myocardial degeneration was studied in five patients and cardiomegaly had been present in each case before the rest program was instituted, and reduction of cardiac size was an essential criterion of improvement.
Abstract: The therapeutic value of prolonged, strict bed rest in cases of severe myocardial degeneration was studied in five patients. In each case, signs of congestive heart failure had persisted despite conventional management. The bed rest and hospital care, specifically designed to minimize the work requirements of the patient's heart, were then added to the regimen. Two patients returned to their normal activities after 10 to 13 months of care in the hospital. At the time of writing three patients were still in the hospital, but their prognosis had been changed from poor to fair. Cardiomegaly had been present in each case before the rest program was instituted, and reduction of cardiac size was an essential criterion of improvement.
16 citations