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

Severe congestive cardiac failure developed in a few weeks in a 44 year old man who had undergone porto-caval anastamosis for post-hepatitis cirrhosis one year previously and then treated for anaemia by repeated blood transfusion and chronic daily oral iron therapy. Infiltrative, congestive and restrictive cardiomyopathy was diagnosed in the presence of global cardiomegaly, electrocardiographic changes (microvoltage, diffuse ST-T wave changes), echocardiographic appearances (dilatation of the left ventricle, with hypertrophic and hypokinetic walls), and hemodynamic signs of adiastole with equalisation of filling pressures at 15 mmHg and a cardiac index of 1,88 l/min/m2. Cardiac haemochromatosis was confirmed by the laboratory (serum iron: 35 mumol/l; siderophilin saturation: 100 p. 100; serum ferritin: 1854 ng/ml; induced siderouria: 51 mg/24 hours) and histological findings (endomyocardial biopsy showing pigment overload). The absence of a family history, of homozygote A3 antigen, of diabetes, of iron overload on hepatic biopsy one year previously, excluded the diagnosis of familial idiopathic haemochromatosis. A secondary form of the disease was diagnosed on a possible genetic predisposition (heterozygote A3 antigen) and on environmental factors (blood transfusions, iron therapy, cirrhosis, alcoholism and perhaps the porto-caval anastamosis. Cardiac haemochromatosis was cured in this case by iron chelating therapy comprising daily subcutaneous infusions of 2 g of desferrioxamine for 2 months. The cure was confirmed by regression of the signs of clinical cardiac failure and of cardiomegaly, the increase in QRS voltages and the near normalisation of the hemodynamic and laboratory findings.
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PMID:[Adiastole caused by a secondary cardiac hemochromatosis. Successful treatment with an iron chelating agent]. 641 3

The risk of aggravated heart failure due to expanded blood volume and augmented left-ventricular filling pressure poses a challenge when transfusion is indicated by severe anemia complicating congestive heart failure. Intravenous (IV) nitroglycerin therapy produces a favorable redistribution of circulating blood volume and may be used to surmount these hemodynamic constraints during transfusion. In four patients with severe anemia and cardiac failure, IV nitroglycerin permitted rapid and large-volume blood transfusion without compromising cardiac function. In two of the four patients, recalcitrant unstable angina abated after the correction of anemia.
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PMID:Intravenous nitroglycerin in transfusion therapy for severe anemia. Association with congestive heart failure. 642 Dec 58

The chest X-ray films of 251 patients with cardiovascular lesions, collected in the major hospitals of Papua New Guinea, were reviewed. Cor pulmonale (18%) and rheumatic heart disease (16%) were the predominant cardiac disorders, and cor pulmonale was the most common cause of cardiac failure (58%). Cardiomegaly or cardiac failure of unknown cause, possibly due to cardiomyopathy or myocarditis, made up 9% of the group and may be more important than has been thought previously. Aortic-arch calcification typical of atheroma was present in 21% of the patients, and is thus quite common, even though ischaemic heart disease remains very rare (1%). More than half of the patients with aortic atheroma had chronic lung disease, and though this could be explained by the coincidental frequency of both conditions, the possibility of an association or link in pathogenesis between them deserves further consideration. Anaemia was a common cause of cardiac enlargement (14%), and sometimes led to cardiac failure. Only 16 patients had hypertension (essential in 10 patients and renal in six), and this may indicate a change from the previously reported predominance of renal hypertension in Papua New Guinea towards a more equal incidence of the two conditions. Aneurysms of unknown cause were encountered in three fairly young patients. They had some resemblance to the aneurysms in arteritis of obscure origin described in Africa. There were also two dissecting aneurysms and one syphilitic aneurysm of the aorta. Congenital lesions (8%), pericarditis due to various causes (including tuberculosis), bacterial endocarditis (in four patients with rheumatic heart disease), and miscellaneous conditions made up the remainder of the series.
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PMID:Cardiovascular disease in Papua New Guinea. 644 34

A prospective study of congestive cardiac failure in 221 elderly Nigerians seen at Ahmadu Bello University Hospital, Zaria, and Ife University Teaching Hospitals Complex, Ile-Ife from 1974 to 1979 is reported. Hypertension, iodopathic cardiomegaly and pulmonary heart disease were major causes of cardiac failure. No case of coronary atherosclerotic heart disease was seen. Ventricular conduction defect was the commonest E.C.G. abnormality recorded. In over half of the patients, there was coexisting disease, mild to moderate anaemia being the most common.
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PMID:Congestive cardiac failure in elderly Nigerians: a prospective clinical study. 645 36

Echocardiographic assessment of cardiac function was made on 24 children with chronic renal failure of varying etiology and severity. In 20 patients without evidence of cardiac failure, parameters of left ventricular performance as represented by PEP/LVET and mean velocity of circumferential fiber shortening were within normal limits in the majority of patients. In addition, ejection fraction and shortening fraction were, in most children, within the 95% confidence limits for their age. In 4 patients who presented with congestive heart failure, marked left ventricular dilatation was noted in association with decreased shortening and ejection fractions and depressed mean velocity of circumferential fiber shortening. Also the PEP/LVET in these patients suggested the presence of a uremic cardiomyopathic condition. These studies, in addition to our own studies on children who have undergone fistula construction, hemodialysis, and transplantation, suggest that cardiac performance, in the majority of pediatric patients with end-stage renal disease, is well maintained and that the major factor involved in reducing exercise tolerance is the presence of uremic anemia. Only a minority of patients may develop severe uremic heart disease.
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PMID:Echocardiographic assessment of cardiac function in children with chronic renal failure. 658 80

Based on the findings of 50 patients with infective endocarditis, 37 affecting the aortic, six the mitral and seven both the aortic and mitral valves, in addition to analysis of predisposing factors, prominent signs and symptoms distinctive for the clinical entity were assessed (Tables 1 to 3). Preexistent conditions such as aortic valve lesions including bicuspid aortic valve as well as mitral valve lesions including mitral valve prolapse were proven in 66%. Factors which may have compromised host defense mechanisms such as cachexia and chronic alcohol or intravenous drug abuse were present in isolated cases. In 38% of the patients, a diagnostic or therapeutic manipulation, suspected to have given rise to the bacteremia, antedated the onset of endocarditis. Malaise, fatigue and chills were the most frequent symptoms (Table 4). Fever and cardiac murmurs were observed in all patients, anemia and bacteremia in 74% of the patients, respectively (Tables 4 to 6). In blood cultures, the most common microorganisms were found to be hemolytic and nonhemolytic streptococci accounting for 65% of positive findings, followed by enterococci and gram-negative bacteria each with 14% respectively (Table 6). Congestive heart failure predominated among cardiac complications with its occurrence in 84% of the patients. Valvular ring or myocardial abscess, aortic or sinus of Valsalva aneurysm, occasionally with perforation, were found in 24% of our patients. Coronary embolism was documented in 6%; infection-associated pericarditis was observed only rarely (Table 7). Extracardiac complications involved the skin, central nervous system, spleen and kidneys, respectively, in 20 to 30% of the patients. Complications afflicting the eyes, lungs, gastrointestinal tract and the musculo-skeletal system were seen with a lesser frequency of 0 to 12% (Table 8). The diagnosis of infective endocarditis, rendered highly-probable by the constellation of fever, cardiac murmur, bacteremia and anemia, necessitates, however, confirmation through cardiac examinations. In this respect, electrocardiographic and radiologic findings are of limited value, although they may be useful in the detection of cardiac complications. In 6% of the patients, positive criteria for myocardial infarction were indicative of coronary embolism and, i 30%, atrioventricular or fascicular block suggested the presence of abscess formation (Table 9). As radiologic evidence of heart failure, 74% of the patients were found to have pulmonary vascular congestion (Table 10).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Detection and evaluation of infectious endocarditis]. 664 98

Serious defects in the living conditions of the vast majority of people in the tropics, rather than racial factors, are the underlying reasons why anaemia is common, why malaria is rampant and why the complications of sickle cell disease are so serious. Mass illiteracy, poor environmental hygiene and widespread poverty with all their implications explain why malaria eradication programmes have so far failed in tropical Africa and why basic health-care schemes have been difficult to establish. Pregnant women are very vulnerable to the effects of anaemia, malaria and sickle cell disease. However, appropriate use of folic acid and iron supplements as well as malarial chemosuppression succeeds in maintaining haemoglobin concentrations at reasonable levels during pregnancy. If, for whatever reason, the haemoglobin level falls to under 4.4 g/dl or the haematocrit value is 0.14 or less, anaemia becomes an obstetric emergency. Both maternal and fetal mortality rise sharply, maternal death being due to anaemic heart failure, fulminating bacterial infection and shock from even small loss at delivery or abortion. With the haemoglobin concentration as low as 4.4 g/dl, blood transfusion greatly improves maternal but not necessarily fetal prognosis. Additional cause of morbidity in sickle cell disease is painful crises, the control of which remains largely unsatisfactory. Now that sickle cell disease can be diagnosed early in intrauterine life the idea of aborting the affected fetuses as a means of controlling or reducing sickle cell disease is well within the means of developed countries, but it is a line of approach which developing countries cannot afford at present.
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PMID:Anaemia, malaria and sickle cell disease. 675 46

A newborn infant with massive fetomaternal hemorrhage is reported. The fetal blood loss led to severe late decelerations in the antepartal CTG. The newborn showed a marked anemia (Hb 4.9 g%!) and a rapidly progressive heart failure. Despite blood transfusions and digoxin therapy the infant developed the symptoms of a "persistent fetal circulation". This mechanism may have been responsible for the lethal outcome in other reported cases. A successful therapeutic approach adaptable to the different stages of severity of this dangerous perinatal condition is outlined.
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PMID:[Severe neonatal anemia associated with fetomaternal transfusion and persistent fetal circulation]. 687 86

A prospective randomized study of 204 consecutive upper gastrointestinal endoscopies performed with a flexible esophago gastroduodenoscope was made to determine the efficacy of diazepam as compared to the lack of sedation as pre-medication. The mental attitude of the ambulatory patients was assessed prior to the endoscopy. It was found that calm patients were satisfactorily endoscoped with or without sedation. The anxious patient had an unsatisfactory endoscopy more frequently when no sedative was used. Those patients with complication conditions (hypovolemia, liver failure, anemia, cardiac failure, etc.) were adequately studied with or without sedation. Age or sex of patients did not affect results in either group. Results show that a majority of patients can be satisfactorily endoscoped without sedation.
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PMID:[Is it necessary to administer tranquilizers as pre-endoscopic medication?]. 700 47

A review of nutritional anaemia in Africa is presented above. It has been noted that nutritional anaemia, including iron-deficiency anaemia, megaloblastic anaemia due to folate deficiency or vitamin B12 deficiency, or both, and protein deficiency-anaemia, is widespread throughout Africa. It is particularly common in growing children, women of child-bearing age, pregnant women and lactating mothers. The anaemia is also especially common during the second half of the dry season and the first half of the wet season, when food supplies are limited. In all cases the anaemia is caused either by limited dietary intake, excessive loss of nutrients or excessive utilization. The anaemia is associated with a number of sequelae including both structural changes, like mitochondrial swelling and mucosal atrophy, and functional abnormalities, such as cardiac failure, decreased work output, increased pregnancy risks and increased susceptibility to infections. The evidence in favour of increased susceptibility to infections in megaloblastic anaemia and protein-deficiency anaemia is overwhelming, but in iron-deficiency anaemia the available information argues in favour of reduced susceptibility to infections, except after initiation of iron therapy. The treatment of nutritional anaemia includes replacement of the deficient nutrients (and blood transfusion in severe cases), prevention of further nutrient losses and treatment of associated complications.
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PMID:Nutritional anaemias. Part 1: Tropical Africa. 703 May 54


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