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

Computed tomography and magnetic resonance imaging in the elderly have demonstrated the common occurrence of deep white-matter lesions in the aging brain. These radiologic lesions (leukoaraiosis) may represent an early marker of dementia. At autopsy, an ischemic periventricular leukoencephalopathy (Binswanger's disease) has been found in most cases. The clinical spectrum of Binswanger's disease appears to range from asymptomatic radiologic lesions to dementia with focal deficits, frontal signs, pseudobulbar palsy, gait difficulties, and urinary incontinence. The name senile dementia of the Binswanger type (SDBT) is proposed for this poorly recognized, vascular form of subcortical dementia. The SDBT probably results from cortical disconnection most likely caused by hypoperfusion. In contrast, multi-infarct dementia is correlated with multiple large and small strokes that cause a loss of over 50 to 100 mL of brain volume. The periventricular white matter is a watershed area irrigated by long, penetrating medullary arteries. Risk factors for SDBT are small-artery diseases, such as hypertension and amyloid angiopathy, impaired autoregulation of cerebral blood flow in the elderly, and periventricular hypoperfusion due to cardiac failure, arrhythmias, and hypotension. The SDBT may be a potentially preventable and treatable form of dementia.
JAMA 1987 Oct 02
PMID:Senile dementia of the Binswanger type. A vascular form of dementia in the elderly. 362 88

One hundred one infants with chronic respiratory failure (CRF) who required prolonged mechanical ventilation were cared for in the pediatric intensive care unit at The Children's Hospital of Philadelphia between January 1967 and December 1984. Chronic respiratory failure of infancy is a condition that requires mechanical ventilation for more than 28 days in the first year of life. Thirty-six children had severe bronchopulmonary dysplasia, 50 had congenital anomalies, and 15 had neuromuscular disorders. The mean duration of mechanical ventilation for the 101 patients was 12.3 months. Seventy-one children were alive, and 53 (75%) of the 71 had been weaned from mechanical ventilation as of Dec 31, 1984. Pulmonary insufficiency and cardiac failure were the predominant causes of death in 17 of 22 infants in the first two years after the onset of CRF; four of eight deaths that occurred beyond two years were caused by airway- and ventilator-related accidents. Mechanical ventilatory support was emphasized for as long as necessary to provide normal blood gas tensions, nutrition, growth, and development rather than weaning as rapidly as possible. This clinical experience demonstrates that it is feasible to save over 70% of infants with the severest forms of CRF and prolonged ventilator dependency.
JAMA 1987 Dec 18
PMID:Chronic respiratory failure in infants with prolonged ventilator dependency. 368 38

To determine their perioperative risk, we reviewed the records of 35 patients with hypertrophic cardiomyopathy diagnosed by cardiac ultrasound and/or catheterization who underwent general (52) or spinal (four) anesthesia--a total of 56 major surgical procedures. There were no operative or related perioperative deaths and no significant ventricular tachyarrhythmias. Intraoperative or postoperative complications included: myocardial infarction with heart failure in one patient who also had coronary artery disease and was one of three patients who had spinal anesthesia, arrhythmia requiring therapy in eight, and angina during supraventricular tachycardia in one. We conclude that the risk of general anesthesia and major noncardiac surgery is low in patients with hypertrophic obstructive cardiomyopathy. Spinal anesthesia, which decreases systemic vascular resistance and increases capacitance, may be relatively contraindicated. Concomitant coronary artery disease may increase the risk.
JAMA 1985 Nov 01
PMID:Perioperative anesthetic risk of noncardiac surgery in hypertrophic obstructive cardiomyopathy. 404 65

Coronary heart disease (CHD) was examined as a precursor of stroke based on 24 years of biennial examinations, during which time 344 strokes occurred. Routine ECGs, chest roentgenograms, and BP levels were obtained, CHD and cardiac failure status were evaluated at each examination, and risk of stroke was ascertained. The five major CHD risk factors jointly were actually as predictive of stroke as CHD. The dominant stroke risk factors were hypertension, clinical manifestations of CHD, cardiac failure, atrial fibrillation, and ECG and roentgenographic evidence of a compromised coronary circulation. Coronary heart disease almost tripled the risk of a stroke, and cardiac failure was associated with more than a fivefold increased risk. Angina pectoris carried half the risk of myocardial infarction. Coronary disease and cardiac failure added to the risk of stroke associated with hypertension. Coronary heart disease increased stroke risk in the absence of hypertension or cardiac failure, but risk was greatly augmented when these coexisted.
JAMA 1983 Dec 02
PMID:Manifestations of coronary disease predisposing to stroke. The Framingham study. 622 57

This article describes four years' experience with heart transplantation using conventional immunosuppression. Twenty of 32 patients are alive. The one-year survival rates were 75% (1979), 67% (1980), and 75% (1981). Actuarial survival rates for operative survivors were 70% at one year, 60% at two years, and 51% at three years. Patients in the 50- to 55-year age group have survived as well as younger recipients. Rejection resulted in six deaths, infection in three, donor heart failure in two, and multiple organ failure in one. There were 1.5 acute rejections per patient and one infection per patient in the first three posttransplant months. Postoperative hospital stay averaged 62 days and cost a total of $58,351.
JAMA
PMID:Heart transplantation. Four years' experience with conventional immunosuppression. 636 66

The effect of terbutaline sulfate on left ventricular size and performance was studied by M-mode echocardiography in pregnant women with premature labor. Patients with uterine activity initiated during either oxytocin challenge testing or induction of labor served as a comparison group. During terbutaline therapy, heart rate, ejection fraction, and cardiac output increased significantly. End-diastolic volume and systolic blood pressure (BP) were unchanged, and diastolic BP and end-systolic volume fell. No changes in echocardiographic or hemodynamic parameters were present during oxytocin-induced uterine activity. Terbutaline, as currently used to prevent premature labor, is a potent inotropic and chronotropic agent. Pulmonary edema accompanying terbutaline treatment is probably not due to cardiac failure.
JAMA 1981 Dec 11
PMID:Terbutaline and maternal cardiac function. 731 Sep 63

In a prospective study, 91 patients with penicillin-sensitive infective endocarditis (IE) were treated for two weeks with intramuscular (IM) penicillin G procaine, 1.2 million units every six hours, plus streptomycin sulfate, 500 mg IM every 12 hours. Viridans streptococci were isolated from 70 patients (77%); 21 patients (23%) had Streptococcus bovis infections. Eighteen patients (20%) had had symptoms of IE for three months or longer. Follow-up ranged from two months to 6.6 years. There were no relapses; mild vestibular toxic reactions occurred in two patients (2%). Two patients (2%) died--one of sudden-onset severe heart failure and one of cardiac arrest after aortic valve replacement. Twenty-six patients (19%) required cardiac valve replacement after completion of antimicrobial therapy. This therapy seems as efficacious as four weeks of parenteral antimicrobial therapy and is more cost-effective.
JAMA
PMID:Short-term therapy for streptococcal infective endocarditis. Combined intramuscular administration of penicillin and streptomycin. 745 62

Vasodilators are widely used in the treatment of heart failure patients even though the drugs are incompletely understood. Vasodilators oppose the excessive vasoconstriction of heart failure, but factors that control excessive vasomotor tone are poorly understood. Possible physiological benefits include more favorable distribution of blood flow and blood volume, but exact effects on blood vessels have been incompletely explored. As a result of vasodilation, preload and afterload reduction can improve cardiac performance, but the role of the blood vessels in the performance of the failing heart is not well understood. Clinical benefits include relief of dyspnea, improvement in tissue metabolism, and increase in exercise tolerance (in patients who have chronic heart failure). However, the degree of effectiveness among various causes of heart failure, different degrees of cardiovascular compensation, and different durations of failure is unknown.
JAMA 1981 Feb 20
PMID:Vasodilator therapy for heart failure. Concepts, applications, and challenges. 746 65

Data from large and small clinical trials reflect major differences in the pathophysiology, treatment, and prognosis of left ventricular (LV) systolic and diastolic dysfunction. These studies also indicate that medical therapy can benefit patients with LV dysfunction regardless of whether or not they are symptomatic. Because the descriptive term congestive heart failure does not provide for these important distinctions, a new classification of LV dysfunction has been developed in which patients with LV dysfunction are categorized on the basis of normal or abnormal systolic function. This classification is based on a simple assessment of LV function, it is applicable to patients without symptoms, and it reflects differences in treatment and prognosis. Those with clinically significant LV systolic dysfunction (ie, an LV ejection fraction < 40%) benefit from therapy whether or not they have symptoms of heart failure. Those with LV dysfunction and a normal LV ejection fraction (ie, diastolic dysfunction) also benefit from medical therapy. Annual mortality is higher in those with systolic dysfunction than in those with diastolic dysfunction, but within each of these categories mortality is higher in those with symptoms than in those without. This classification can be useful in the diagnosis and treatment of individual patients as well as in epidemiologic surveys designed to assess medical practice patterns.
JAMA 1994 Apr 27
PMID:Diagnosis and treatment of heart failure based on left ventricular systolic or diastolic dysfunction. 793 87

We systematically reviewed the literature to ascertain how well clinicians determine the probability and type of left-sided heart failure in their patients. Left-sided heart failure is characterized by decreased left ventricular ejection fraction or increased filling pressure. The type of heart failure determines optimal treatment. Systolic dysfunction exists when ejection fraction is reduced. Diastolic dysfunction is presumed to be present when filling pressure is increased with a normal ejection fraction and without another explanatory diagnosis. Many findings are associated with heart failure, and wide variation exists in clinicians' ability to detect these findings. The best findings for detecting increased filling pressure are jugular venous distention and radiographic redistribution. The best findings for detecting systolic dysfunction are abnormal apical impulse, radiographic cardiomegaly, and q waves or left bundle branch block on an electrocardiogram. Diastolic dysfunction is especially difficult to diagnose, but is associated with an elevated blood pressure during heart failure.
JAMA 1997 Jun 04
PMID:Can the clinical examination diagnose left-sided heart failure in adults? 916


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