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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The results of 196 isolated aortic valve replacements in patients older than 65 years were analyzed. Eighty-four percent of patients were in New York Heart Association (NYHA) functional class III or IV preoperatively. The operative mortality was 12% for all cases and 9% for elective cases. Actuarial probability of five-year survival was 55% for the entire group and 61% for discharged patients. Myocardial failure and congestive heart failure were the most common causes of early and late postoperative death, respectively. Embolic strokes occurred in 16% of discharged patients and caused substantial disability in 9%. At the termination of the study, 94% of surviving patients were in NYHA class I or II, and none were in class IV. Aortic valve replacement in elderly patients entails reasonable operative risk, and results in satisfactory postoperative rehabilitation.
JAMA 1977 Apr 11
PMID:Isolated aortic valve replacement in patients older than 65 years. 30 Apr 38

Enterococci caused eleven of 20 cases (55%) of narcotic-associated endocarditis in Cleveland over a 54-month period. Acute staphylococcal endocarditis seen concurrently in this addict population displayed tricuspid valve involvement and septic pulmonary emboli, but enterococcal endocarditis was subacute, affected only aortic or mitral valves, and was not associated with septic pulmonary emboli. In contrast to enterococcal endocarditis in a nonaddict population, patients were younger and rarely had antecedent valvular disease or genitourinary abnormality. Staphylococcal tricuspid valve endocarditis was managed with relatively little difficulty in this addict population. Enterococcal infection, however, was complicated by severe cardiac failure that often required valvular prostheses, relapses due to continued use of narcotics, Candida superinfection, and nervous system complications, including cerebral emboli and mycotic aneurysms.
JAMA 1976 Apr 26
PMID:Enterococcal endocarditis in heroin addicts. 81 76

Primary pulmonary hypertension is a clinical syndrome characterized by pulmonary hypertension in the absence of sufficient underlying cardiac, parenchymal pulmonary, or systemic disease to account for it. The population of patients with primary pulmonary hypertension is a heterogeneous one, both clinically and histologically. As the etiologic mechanisms are unknown, therapy is directed toward the consequences of the pulmonary vascular process. Oxygen supplementation, the use of digoxin and diuretics for symptomatic heart failure, and anticoagulation all may have a role in treating primary pulmonary hypertension, although vasodilator therapy has been the main area of investigation. Screening for vasodilator responsiveness, defining a favorable vasodilator effect, predicting long-term effectiveness, and deciding who to treat have all been controversial. New approaches, such as use of high-dose calcium channel-blocking agents and continuous intravenous infusion of prostacyclin (an investigational agent), have recently been proposed. When medical therapies are exhausted, heart-lung or lung transplantation has increasingly become an option for selected patients.
JAMA 1991 Feb 27
PMID:The management of primary pulmonary hypertension. 199 95

Ethanol has long been recognized as a toxic agent that has acute and chronic effects on cerebral and hepatic function. Over the past two decades important influences on the cardiovascular system have been either rediscovered or observed for the first time. The combined use of tobacco cigarettes and alcohol appears to increase the risk of many of these clinical abnormalities. While many individuals addicted to ethanol have subclinical abnormalities of the heart, somewhat less than a majority develop symptomatic cardiac problems. These include heart failure and arrhythmias. In addition to supraventricular arrhythmias that often normalize spontaneously, there is an increased incidence of sudden death that peaks at about 50 years of age in the alcoholic population. A significant degree of blood pressure elevation occurs in individuals who abuse alcohol. This appears to be transient and is normalized in most individuals during abstinence. The increased incidence of hemorrhagic and nonhemorrhagic stroke in middle age also appears to decline when alcohol abuse is interrupted. A preventive effect of mild to moderate drinking on coronary artery disease is, at present, equivocal, largely due to the question of appropriate controls.
JAMA 1990 Jul 18
PMID:Alcohol and the cardiovascular system. 219 48

To examine the impact of gender on survival after myocardial infarction, we performed a retrospective cohort study of 332 women and 790 men. Women who had a myocardial infarction were older and more often had hypertension, diabetes, previous heart failure, and impaired left ventricular function on admission. Cumulative 3-year mortality and in-hospital mortality rates were significantly higher in women than men, but mortality among hospital survivors was similar. After multivariate adjustment for baseline differences, mortality rates were not significantly different between women and men for in-hospital deaths, and mortality at 3 years among hospital survivors tended to be lower among women. We conclude that higher observed mortality rates following a myocardial infarction in women are related to differences in known risk factors for subsequent mortality and that gender should not be considered an independent risk factor for mortality after myocardial infarction.
JAMA 1990 Feb 23
PMID:Differences between women and men in survival after myocardial infarction. Biology or methodology? 229 81

This multicenter, double-blind, placebo-controlled study compares the effects of captopril treatment with those of digoxin treatment during maintenance diuretic therapy in patients with mild to moderate heart failure. Compared with placebo, captopril therapy resulted in significantly improved exercise time (mean increase, 82 s vs 35 s) and improved New York Heart Association class (41% vs 22%), but digoxin therapy did not. Digoxin treatment increased ejection fraction (4.4% increase) compared with captopril therapy (1.8% increase) and placebo (0.9% increase). The number of ventricular premature beats decreased 45% in the captopril group and increased 4% in the digoxin group in patients with more than ten ventricular premature beats per hour. Treatment failures, increased requirements for diuretic therapy, and hospitalizations were significantly more frequent in patients receiving placebo compared with those receiving either active drug. Transitory hypotension occurred more frequently with administration of captopril. Captopril treatment is significantly more effective than placebo and is an alternative to digoxin therapy in patients with mild to moderate heart failure who are receiving diuretic maintenance therapy.
JAMA
PMID:Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. The Captopril-Digoxin Multicenter Research Group. 244 97

The cardiovascular physical examination is used commonly as a basis for diagnosis and therapy in chronic heart failure, although the relationship between physical signs, increased ventricular filling pressure, and decreased cardiac output has not been established for this population. We prospectively compared physical signs with hemodynamic measurements in 50 patients with known chronic heart failure (ejection fraction, .18 +/- .06). Rales, edema, and elevated mean jugular venous pressure were absent in 18 of 43 patients with pulmonary capillary wedge pressures greater than or equal to 22 mm Hg, for which the combination of these signs had 58% sensitivity and 100% specificity. Proportional pulse pressure correlated well with cardiac index (r = .82), and when less than 25% pulse pressure had 91% sensitivity and 83% specificity for a cardiac index less than 2.2 L/min/m2. In chronic heart failure, reliance on physical signs for elevated ventricular filling pressure might result in inadequate therapy. Conversely, the adequacy of cardiac output is assessed reliably by pulse pressure. Our results facilitate decisions regarding treatment in chronic heart failure.
JAMA 1989 Feb 10
PMID:The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. 291 85

The impact of diabetes on recurrent myocardial infarction (MI) and fatal coronary heart disease was examined in survivors of an initial MI using 34-year follow-up data in the Framingham Study. Among nondiabetic patients, the risk of fatal coronary heart disease was significantly lower in women compared with men (relative risk, 0.6). In the presence of diabetes, however, the risk of recurrent MI in women was twice the risk in men. In addition, the effect of diabetes doubled the risk of recurrent MI in women (relative risk, 2.1) but had an insignificant effect in men. Increased susceptibility to cardiac failure among diabetic women was an important factor in determining survivorship. Women with diabetes developed cardiac failure four times more often (16%) than women without diabetes (3.8%). Furthermore, when cardiac failure developed, 25% of diabetic women experienced a recurrent MI or fatal coronary event, more than doubling the rate when diabetes was absent. We conclude that in the diabetic patient who survives an MI, cardiac failure is a common occurrence, warranting early detection and vigorous management in periods of convalescence and follow-up. In addition, when cardiac failure appears, control of diabetes assumes added importance, particularly in women, where its effect on survivorship is considerable.
JAMA 1988 Dec 16
PMID:The impact of diabetes on survival following myocardial infarction in men vs women. The Framingham Study. 272 81

We examined existing evidence concerning the relative efficacy of various vasodilator agents in chronic congestive heart failure. Only randomized placebo-controlled trials with clinical end points and treatment durations of four weeks or more were selected from an exhaustive search of the English-language medical literature. Twenty-eight trials involving 1976 patients were found. Treatment durations of the trials varied from one month to two years. Patients with symptomatic heart failure despite digitalis and diuretic therapy were studied; most were middle-aged men and approximately half had coronary artery disease. Results of the trials were appraised by three independent observers, and mortality and functional status outcomes were pooled in a meta-analysis. All vasodilator agents except hydralazine hydrochloride were associated with improvements in functional status. Angiotensin converting-enzyme inhibitors were the only agents associated with both decreased mortality (odds ratio, 0.51; 95% confidence interval, 0.34 to 0.75) and improved functional status (odds ratio, 4.53; 95% confidence interval, 3.46 to 5.92). The optimal timing for initiation of these agents was not established.
JAMA 1988 Jun 17
PMID:Relative efficacy of vasodilator therapy in chronic congestive heart failure. Implications of randomized trials. 328 14

On Nov 1, 1984, an orthotopic cardiac transplantation was performed in an 8-month-old female infant with subendocardial fibroelastosis. Because of the advanced state of cardiac failure, the operation was done despite a positive tissue crossmatch for antitoxic donor-specific antibodies. Immunosuppression consisted of high doses of cyclosporine (up to 550 mg/m2 or 30 mg/kg) and steroids. Hypertension and tremor of the extremities, which were attributed to cyclosporine, occurred during the first week but resolved after seven days. No signs of nephrotoxic effects have been noted; however, a severe episode of allograft rejection was detected by endomyocardial biopsy on the seventh postoperative day, and a moderate rejection episode was noted on the 22nd postoperative day. Histologic improvement was seen after treatment with conventional steroid pulses. The patient was discharged on Nov 29, 1984. Complications consisted of four episodes of otitis media caused by Staphylococcus aureus and one rejection episode that was treated on an outpatient basis with an intravenous methylprednisolone sodium succinate pulse. Our experience emphasizes both the feasibility and importance of performing endomyocardial biopsies in infant recipients. Through biopsy, episodes of rejection can be discovered when clinical signs are not yet apparent. Eighteen months after transplantation, the child was developing and growing normally.
JAMA 1986 Sep 12
PMID:Cardiac transplantation in an 8-month-old female infant with subendocardial fibroelastosis. 352 37


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