Cardiac Manifestations of Noncardiac Disease

  • David W. Snyder
Part of the Developments in Cardiovascular Medicine book series (DICM, volume 135)


In the elderly population, the heart may be involved secondarily by disease elsewhere in the body or may be affected by a systemic disorder. Thus, renal disease, lung disease, and hypertension may place excessive demands on the heart that can lead to cardiac decompensation. Direct involvement in a systemic process may be seen in some endocrine abnormalities, collagen vascular diseases, or infiltrative processes such as amyloidosis. In this chapter we will review some of the more common extracardiac diseases that lead to cardiac dysfunction in the aged.


Chronic Obstructive Pulmonary Disease Atrial Fibrillation Pulmonary Hypertension Chronic Obstructive Pulmonary Disease Patient Pulmonary Vascular Resistance 
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  1. 1.
    Ferrer MI. 1979. Management of patients with cor pulmonale. Med Clin North Am 63:251–265.PubMedGoogle Scholar
  2. 2.
    Enson Y, Giuntini C, Lewis ML, et al. 1964. The influence of hydrogen ion concentration and hypoxia on the pulmonary circulation. J Clin Invest 43:1146–1162.PubMedCrossRefGoogle Scholar
  3. 3.
    Bove AA and Santamore WP. 1981. Ventricular interdependence. Prog Cardiovasc Dis 23:365–388.PubMedCrossRefGoogle Scholar
  4. 4.
    Rice KL, Leatherman JW, Duane PG, et al. 1987. Aminophylline for acute exacerbation of chronic obstructive pulmonary disease: a controlled trial. Ann Intern Med 107:305–309.PubMedGoogle Scholar
  5. 5.
    Dullinger D, Kronenberg R and Niewoehner DE. 1986. Efficacy of inhaled metaproterenol and orally-administered theophylline in patients with chronic airflow obstruction. Chest 89:171–173.PubMedCrossRefGoogle Scholar
  6. 6.
    Parker JO, Kelkar K and West RO. 1966. Hemodynamic effects of aminophylline in cor pulmonale. Circ 33:17–25.CrossRefGoogle Scholar
  7. 7.
    Matthay RA, Berger HJ, Loke J, et al. 1978. Effects of aminophylline on right and left ventricular performance in chronic obstructive pulmonary disease. Am J Med 65:903–910.PubMedCrossRefGoogle Scholar
  8. 8.
    Parker JO, Ashekian PB, DiGiorgi S, et al. 1967. Hemodynamic effects of aminophylline in chronic obstructive pulmonary disease. Circulation 35:365–372.PubMedCrossRefGoogle Scholar
  9. 9.
    Matthay RA, Berger HJ, Davies R, et al. 1982. Improvement in cardiac performance by oral long-acting theophylline in chronic obstructive pulmonary disease. Am Heart J 104:1022–1029.PubMedCrossRefGoogle Scholar
  10. 10.
    Mahler DA, Matthay RA, Snyder PE, et al. 1985. Sustained-release theophylline reduces dyspnea in nonreversible obstructive airway disease. Am Rev Respir Dis 131:22–25.PubMedGoogle Scholar
  11. 11.
    Winter RJD, Langford JA and Rudd RM. 1984. Effects of oral and inhaled salbutamol and oral pirbuterol on right and left ventricular function in chronic bronchitis. Br Med J 288:324–325.Google Scholar
  12. 12.
    Brent BN, Mahler D, Berger HJ, et al. 1982. Augmentation of right ventricular performance in chronic obstructive pulmonary disease by terbutaline. A combined radionuclide and hemodynamic study. Am J Cardiol 50:313–319.PubMedCrossRefGoogle Scholar
  13. 13.
    Tashkin DP, Ashutosh K, Blecker E, et al. 1985. Comparison of the anticholinergic bronchodilator ipratropium bromide with metaproterenol in chronic obstructive lung disease: a 90 day multicenter study. Am J Med 81 (Suppl 5A):81–89.Google Scholar
  14. 14.
    Callahan CM, Dittus RS and Katz BP. 1991. Oral corticosteroid therapy for patients with stable chronic obstructive pulmonary disease: a meta-analysis. Ann Intern Med 114114:216–223.Google Scholar
  15. 15.
    Tirlapur VG and Mir MA. 1982. Nocturnal hyopoxemia and associated electrocardiographic changes in patients with chronic obstructive airways disease. N Engl J Med 306:125–130.PubMedCrossRefGoogle Scholar
  16. 16.
    Anthonisen NR. 1983. Long-term oxygen therapy. Ann Intern Med 99:519–527.PubMedGoogle Scholar
  17. 17.
    Nocturnal Oxygen Therapy Trial study group. 1980. Continuous or nocturnal oxygen therapy in hypoxemic chronic obstructive pulmonary disease: a clinical trial. Ann Intern Med 93:391–398.Google Scholar
  18. 18.
    Levin DC, Neff TA, O’Donohue WJ Jr, et al. 1988. Further recommendations for prescribing and supplying long-term oxygen therapy. Am Rev Respir Dis 138:745–747.Google Scholar
  19. 19.
    Green LH and Smith TW. 1977. The use of digitalis in patients with pulmonary disease. Ann Intern Med 87:459–465.PubMedGoogle Scholar
  20. 20.
    Mathur PN, Powles P, Pugsley SO, et al. 1981. Effect of digoxin on right ventricular function in severe chronic airflow obstruction. Ann Intern Med 95:283–288.PubMedGoogle Scholar
  21. 21.
    Brown SE, Pakron FJ, Milne N, et al. 1984. Effects of digoxin on exercise capacity and right ventricular function during exercise in chronic airflow obstruction. Chest 85:187–191.PubMedCrossRefGoogle Scholar
  22. 22.
    Weisse AB, Moschos CB, Frank MJ, et al. 1975. Hemodynamic effects of staged hematocrit reduction in patients with stable cor pulmonale and severely elevated hematocrit levels. Am J Med 58:92–98.PubMedCrossRefGoogle Scholar
  23. 23.
    Gothe B, Cherniack NS, Bachand RT Jr, et al. 1988. Long-term effects of almitrine bimesylate on oxygenation during wakefulness and sleep in chronic obstructive pulmonary disease. Am J Med 84:436–444.PubMedCrossRefGoogle Scholar
  24. 24.
    Voisin C, Howard P and Ansquer JC. 1987. Vectarian International Multicenter Study. Bull Eur Pathophysiol Respir 23 (Suppl):169S–182S.Google Scholar
  25. 25.
    MacNee W, Connaughton JJ, Rhind GB, et al. 1986. A comparison of the effects of almitrine or oxygen breathing on pulmonary arterial pressure and right ventricular ejection fraction in hypoxemic chronic bronchitis and emphysema. Am Rev Respir Dis 134:559–565.PubMedGoogle Scholar
  26. 26.
    Sturani C, Bassein L, Schiavina M, et al. 1983. Oral nifedipine in chronic cor pulmonale secondary to severe chronic obstructive pulmonary disease (COPD). Chest 84:135–142.PubMedCrossRefGoogle Scholar
  27. 27.
    Kennedy TP, Michael JR and Summer W. 1985. Calcium channel blockers in hypoxic pulmonary hypertension. Am J Med 78 (Suppl 2B):18–26.PubMedCrossRefGoogle Scholar
  28. 28.
    Agostoni P, Doria E, Galli C, et al. 1989. Nifedipine reduces pulmonary pressure and vascular tone during short-but not long-term treatment of pulmonary hypertension in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 139:120–125.PubMedCrossRefGoogle Scholar
  29. 29.
    Adnot S, Anrivet P, Piquet J, et al. 1988. The effects of urapadil therapy on hemodynamics and gas exchange in exercising patients with chronic obstructive pulmonary disease and pulmonary hypertension. Am Rev Respir Dis 137:1068–1074.PubMedGoogle Scholar
  30. 30.
    Adnot S, DeFouilloy C, Brun-Buisson C, et al. 1987. Hemodynamic effects of urapadil in patients with pulmonary hypertension: a comparative study with hydralazine. Am Rev Respir Dis 135:288–293.PubMedGoogle Scholar
  31. 31.
    Holford FD and Mithoefer JC. 1973. Cardiac arrhythmias in hospitalized patients with chronic obstructive pulmonary disease. Am Rev Respir Dis 108:879–885.PubMedGoogle Scholar
  32. 32.
    Kleiger RE and Senior RM. 1974. Long-term electrocardiographic monitoring of ambulatory patients with chronic airway obstruction. Chest 65:483–488.PubMedCrossRefGoogle Scholar
  33. 33.
    Hudson LD, Kurt TL, Petty TL, et al. 1973. Arrhythmias associated with acute respiratory failure in patients with chronic airway obstruction. Chest 63:661–665.PubMedCrossRefGoogle Scholar
  34. 34.
    Goldberg LM, Bristow JD, Parker BM, et al. 1960. Paroxysmal atrial tachycardia with atrioventricular block. Circulation 21:499–504.CrossRefGoogle Scholar
  35. 35.
    Arsura E, Lefkin AS, Scher DL, et al. 1988. A randomized, double-blind, placebo-controlled study of verapamil and metoprolol in the treatment of multifocal atrial tachycardia. Am J Med 85:519–524.PubMedCrossRefGoogle Scholar
  36. 36.
    Nordstrom LA, MacDonald F and Gobel F. 1975. Effect of propranolol on respiratory function and exercise tolerance in patients with chronic obstructive lung disease. Chest 67:287–292.PubMedCrossRefGoogle Scholar
  37. 37.
    Esmolol Multicenter Research Group. 1985. Efficacy and safety of esmolol vs propranolol in the treatment of supraventricular tachyarrhythmias: a multicenter double-blind clinical trial. Am Heart J 110:913–920.CrossRefGoogle Scholar
  38. 38.
    Levine JM, Michael JR and Guarnieri T. 1985. Treatment of multifocal atrial tachycardia with verapamil. N Engl J Med 312:21–25.PubMedCrossRefGoogle Scholar
  39. 39.
    Iseri LT, Fairshter RD, Hardemann JL, et al. 1985. Magnesium and potassium therapy in multifocal atrial tachycardia. Am Heart J 110:789–794.PubMedCrossRefGoogle Scholar
  40. 40.
    Zipes DP, Prystowsky EN and Heger JJ. 1984. Amiodarone: electrophysiologic actions, pharmacokinetics, and clinical effects. J Am Coll Cardiol 3:1059–1071.PubMedCrossRefGoogle Scholar
  41. 41.
    Lindner A, Charra B, Sherrard DJ, et al. 1974. Accelerated atherosclerosis in prolonged maintenance hemodialysis. N Engl J Med 290:697–701.PubMedCrossRefGoogle Scholar
  42. 42.
    Capelli JP and Kasparian H. 1977. Cardiac work demands and left ventricular function in end-stage renal disease. Ann Intern Med 86:261–265.PubMedGoogle Scholar
  43. 43.
    Neff MS, Kim KE, Persoff M, et al. 1971. Hemodynamics of uremic anemia. Circulation 43:876–883.PubMedCrossRefGoogle Scholar
  44. 44.
    Menno AD, Zizzi J, Hodson J, et al. 1967. An evaluation of the radial arteriovenous fistula as a substitute for the Quinton shunt in chronic hemodialysis. Trans Am Soc Artif Intern Organs 8:62–67.Google Scholar
  45. 45.
    Huug J, Harris PJ, Uren RF, et al. 1980. Uremic cardiomyopathy—effect of hemodialysis on left ventricular function in end-stage renal failure. N Engl J Med 302:547–551.CrossRefGoogle Scholar
  46. 46.
    Parfrey PS, Harnett TD, Griffiths SM, et al. 1980. Congestive heart failure in dialysis patients. Arch Intern Med 148:1519–1525.CrossRefGoogle Scholar
  47. 47.
    Ikram H, Lynn KL, Bailey RR, et al. 1983. Cardiovascular changes in chronic dialysis patients. Kidney Int 24:371–376.PubMedCrossRefGoogle Scholar
  48. 48.
    Bailey GL, Hampers CL, Hager EB, et al. 1968. Uremic pericarditis: clinical features and management. Circulation 38:582–591.PubMedCrossRefGoogle Scholar
  49. 49.
    Drueke T, LePailleur C, Zingraff J, et al. 1980. Uremic cardiomyopathy and pericarditis. Adv Nephrol 9:33–70.Google Scholar
  50. 50.
    Becker RC. 1988. Cardiovascular disease in patients with chronic renal failure. Cleve Clin J Med 55:521–530.PubMedGoogle Scholar
  51. 51.
    Comty CM, Cohen SL and Shapiro FL. 1971. Pericarditis in chronic uremia and its sequela. Ann Intern Med 75:173–183.PubMedGoogle Scholar
  52. 52.
    Jelliffe RW. 1971. Factors to consider in planning digoxin therapy. J Chronic Dis 24:407–416.PubMedCrossRefGoogle Scholar
  53. 53.
    Silverberg S, Oreopoulos DG, Wise DJ, et al. 1977. Pericarditis in patients undergoing long-term hemodialysis and peritoneal dialysis. Am J Med 63:874–880.PubMedCrossRefGoogle Scholar
  54. 54.
    Tibaldi JM, Barzel US, Albin J and Surks M. 1986. Thyrotoxicosis in the very old. Am J Med 81:619–622.PubMedCrossRefGoogle Scholar
  55. 55.
    Forfar JC and Caldwell GC. 1985. Hyperthyroid heart disease. Clin Endocrinol Metab 14:491–508.PubMedCrossRefGoogle Scholar
  56. 56.
    Symons C. 1979. Thyroid heart disease. Br Heart J 41:257–262.PubMedCrossRefGoogle Scholar
  57. 57.
    Rohmer V, Hocq F, Galland F, et al. 1984. Occult thyrotoxicosis revealed by atrial arrhythmia. Presse Med 13:145–148.PubMedGoogle Scholar
  58. 58.
    Sulimani RA. 1989. Diagnostic algorithm for atrial fibrillation caused by occult hyperthyroidism. Geriatrics 44:61–69.PubMedGoogle Scholar
  59. 59.
    Fagerberg B, Lindstedt G, Stromblad SO, et al. 1990. Thyrotoxic atrial fibrillation: an underdiagnosed or overdiagnosed condition? Clin Chem 36:620–627.PubMedGoogle Scholar
  60. 60.
    Forfar JC, Miller HC and Toft AD. 1979 Occult thyrotoxicosis: a correctable cause of “idiopathic” atrial fibrillation. Am J Cardiol 44:9–12.PubMedCrossRefGoogle Scholar
  61. 61.
    Nakazawa AK, Sakurai K, Hamada N, et al. 1982. Management of atrial fibrillation in the post-thyrotoxic state. Am J Med 72:903–906.PubMedCrossRefGoogle Scholar
  62. 62.
    Bar-sela S, Ehrenfeld M and Eliakim M, 1981. Arterial embolism in thyrotoxicosis with atrial fibrillation. Arch Intern Med 141:1191–1192.PubMedCrossRefGoogle Scholar
  63. 63.
    Staffurth JS, Gibberd MC and Ng Tang Fui S. 1977. Arterial embolism in thyrotoxicosis with atrial fibrillation. Br Med J 2:688–690.PubMedCrossRefGoogle Scholar
  64. 64.
    Buccino RA, Spann JF Jr, Pool PE, et al. 1967. Influence of the thyroid state on the intrinsic contractile properties and energy stores of the myocardium. J Clin Invest 46:1669–1682.PubMedCrossRefGoogle Scholar
  65. 65.
    Crowley WF Jr, Ridgway EC, Bough EW, et al. 1977. Noninvasive evaluation of cardiac function in hyperthyroidism. N Engl J Med 296:1–6.PubMedCrossRefGoogle Scholar
  66. 66.
    Santos AD, Miller RP, Mathew PK, et al. 1980. Echocardigraphic characterization of the reversible cardiomyopathy of hypothyroidism. Am J Med 68:675–682.PubMedCrossRefGoogle Scholar
  67. 67.
    Steinberg AD. 1968. Myxedema and coronary artery disease—a comparative autopsy study. Ann Intern Med 68:338–344.PubMedGoogle Scholar
  68. 68.
    Basterne PA, Bonnyns M and Vanhaelst L. 1985. Natural history of primary myxedema. Am J Med 79:91–100.Google Scholar
  69. 69.
    Rosenbaum RL and Barzei US. 1982. Levothyroxine replacement dose for primary hypothyroidism decreases with age. Ann Intern Med 96:53–55.PubMedGoogle Scholar
  70. 70.
    Keating FR, Parkin TW, Selby JB, et al. 1960. Treatment of heart disease associated with myxedema. Prog Cardiovasc Dis 3:364–386.Google Scholar
  71. 71.
    Hay ID, Duick DS, Vlietstra RE, et al. 1981. Thyroxine therapy in hypothyroid patients undergoing coronary revascularization: a retrospective analysis. Ann Intern Med 95:456–457.PubMedGoogle Scholar
  72. 72.
    Goodman BW. 1979. Temporal arteritis. Am J Med 67:839–852.PubMedCrossRefGoogle Scholar
  73. 73.
    Klein RG, Hunder GG, Stanson AW, et al. 1975. Large artery involvement in giant cell (temporal) arteritis. Ann Intem Med 83:806–812.Google Scholar
  74. 74.
    Kyle V and Hazelman BL. 1989. Treatment of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA). II. The relationship between steroid dose and steroid-associated side effects. Ann Rheum Dis 48:662–666.PubMedCrossRefGoogle Scholar
  75. 75.
    Bacon PA and Gibson DG. 1974. Cardiac involvement in rheumatoid arthritis. An echocardiographic study. Ann Rheum Dis 33:20–24.PubMedCrossRefGoogle Scholar
  76. 76.
    Kirk J and Cosh J. 1969. The pericarditis of rheumatoid arthritis. Q J Med 38:397–423.PubMedGoogle Scholar
  77. 77.
    Hara KS, Ballard DJ, Ilstrup DM, et al. 1990. Rheumatoid pericarditis: clinical features and survival. Medicine 69:81–91.PubMedGoogle Scholar
  78. 78.
    Kelly CA, Bourke JP, Malcolm A, et al. 1990. Chronic pericardial disease in patients with rheumatoid arthritis: a longitudinal study. Q J Med 75:461–470.PubMedGoogle Scholar
  79. 79.
    Mutru O, Laakso M, Isomaki H, et al. 1989. Cardiovascular mortality in patients with rheumatoid arthritis. Cardiology 76:71–77.PubMedCrossRefGoogle Scholar
  80. 80.
    Lee E, Desu M. 1972. A computer program for comparing k samples with right-censored data. Comput Programs Biomed 2:315–321.PubMedCrossRefGoogle Scholar

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© Springer Science+Business Media Dordrecht 1993

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  • David W. Snyder

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