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

The authors report 36 cases of spontaneous angina occurring in the absence (group A) or presence (group B) of a myocardial infarct (MI), either recent or old, and accompanied, during the attacks, by transient ST elevation (T ST E) and normal enzyme levels. Group A (16 cases) was characterised by : a) the severity of the prognosis with the development of rhythm disturbances during the attacks in 10 out of 16 cases, and of a MI and/or sudden death in 4 of the 6 cases treated medically; b) the presence, in 12 of the 14 cases explored of surgical stenosis of a major coronary trunck. The simple association of attacks of spontaneous angina and T ST E is in general sufficient to define severe angina, regardless of the height of the elevation, and for which a surgical indication (95 p. cent of our cases) with the same problems as those posed by Prinzmetal angina strictly defined on a series of clinical and electrocardiographic criteria. Group B (20 cases) :a) differed from group A by the incidence of cardiac failure (15 out of 20 cases), the widespread nature and degree of the anatomical lesions, not usually amenable to by-pass; b) the severe prognosis, reflected in 6 of the 17 cases treated medically by extension of the MI and/or sudden death, did not differ fundamentally from that of any subsequent relapse, regardless of its electrocardiographic signs. In these cases, the T ST E related to the presence of the MI does not have the same significance as in Prinzmetal angina, and progressive relapses of MI should no longer be classified in this group on the pretext that they are accompanied by T ST E.
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PMID:[Spontaneous angina with ST elevation. Significance and prognostic value]. 13 Jun 17

Eighty patients undergoing one or several aorto-coronary bypass graft procedures had longterm clinical and arteriographic follow-up (mean follow-up period of two years, extremes 1 and 6 years). The indication fort operation in these patients was unstable angina in 39 (49%), threatened infarction in 16 (20%), Prinzmetal's angina in 8 (10%), and stable but incapacitating angina in 17 (21%). Significant lesions involved the three coronary trunks in 49 cases, two trunks in 25 cases, and one trunk in 6 cases. The longterm clinical results were excellent in 65% of cases, and fair in 26%; the procedure failed in 9% of cases. Angina pectoris either disappeared or improved in 96% of cases. After operation, myocardial infarctions occurred in 11 cases (14%), 7 of which were early and 4 late with a delay of 1 to 4 years. The pre-operative cardiac failure disappeared or decreased in 13 cases out of 16. Finally the quality of the clinical results does not seem to be influenced by the various indications for operation with the exception of Prinzmetal's angina, where the results have been excellent in all cases (8 cases out of 8).
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PMID:[Long-term results of aortocoronary bypass. 1. Clinical aspects]. 41 76

Among the clinical manifestations of ischemic heart disease, right coronary artery (RCA) disease offers a wide variety of right and left ventricular ischemic involvement, including prevalent right ventricular dysfunction and severe cardiac failure. Whether the right ventricular impairment is dependent primarily on ischemia of the right ventricle or requires a concomitant left ventricular dysfunction remains debatable. To assess the pathophysiology and clinical relevance of RCA-related ischemia, a systematic study of patients with single RCA disease (either vasospastic angina at rest or typical stable angina) was undertaken by radionuclide ventriculography. A high incidence of ischemia-induced right ventricular dysfunction was observed (93% and 95% in angina at rest and on effort, respectively), either alone or associated with left ventricular impairment. These results were compared with those obtained in a control population with isolated left anterior descending artery disease and either primary or secondary angina pectoris. We infer that the impairment of the right ventricle was related primarily to right ventricular ischemia and that left ventricular dysfunction alone did not cause an important depression of right ventricular systolic function. In conclusion, the clinical manifestations of RCA disease can be protean; the right ventricle can be the target of ischemia, and recognition of its impairment poses diagnostic problems. Radionuclide ventriculography and two-dimensional echocardiography, together with stressors of coronary flow reserve, are reliable techniques for assessing RCA-related ischemia.
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PMID:Right coronary artery disease. Pathophysiology, clinical relevance, and methods for recognition. 202 49

An analysis of 41 trials of angina of all varieties confirms that calcium antagonists are an important advance and are now established therapy for these syndromes. In effort angina, verapamil in a dose of 360-480 mg daily is better than propranolol in standard doses. Although nifedipine is highly effective against vasospastic angina, its use in threatened myocardial infarction or severe unstable angina is not supported by recent studies, unless combined with a beta-blocker. Diltiazem has recently been tested with apparent benefit in non-Q-wave myocardial infarction. Otherwise, these calcium antagonist agents all seem to have approximate equipotency in clinical ischemic syndromes including effort and vasospastic angina. Subjective side effects seem most troublesome in the case of nifedipine. All three calcium antagonists, especially nifedipine, have been successfully combined with beta-blocker therapy, yet occasional additive negative inotropic or chronotropic or dromotropic interactions may occur when verapamil or diltiazem is added to beta-blockade, and occasionally the direct negative inotropic potential of nifedipine may become evident. The choice between the calcium antagonists is determined not only by the clinical picture but also by the anticipated side effects in a given patient and by the overall cardiovascular status. In patients with supraventricular tachycardias or sinus tachycardia, verapamil or diltiazem is preferred, whereas in patients with a resting bradycardia or borderline heart failure nifedipine is likely to be chosen.
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PMID:Calcium channel antagonists. Part II: Use and comparative properties of the three prototypical calcium antagonists in ischemic heart disease, including recommendations based on an analysis of 41 trials. 315 77

The prerequisite in establishing the indication for coronary arteriography is low mortality and morbidity of the procedure. Mortality is about 1%, major complications are myocardial infarction (1.5 to 2%) and cerebral embolism (less than 1%). These low complication rates are generally achieved only in institutions which perform at least 400 procedures per year. Coronary arteriography is indicated in the following groups of patients: patients with angina pectoris aged below 45; patients over 45 with sudden worsening of angina, angina pectoris uncontrolled by medication (impaired quality of life) and cases where there is objective evidence of severe ischemia on exercise though angina is mild; recurrence of angina or positive stress ECG after myocardial infarction; following an episode of unstable angina; following resuscitation due to ventricular fibrillation; suspected Prinzmetal angina; postinfarction aneurysm with signs of heart failure; candidates for valve surgery aged over 45. Coronary arteriography is also performed to evaluate the result of bypass surgery, in patients with unclear diagnosis exposed to occupational hazards, and in acute myocardial infarction (thrombolysis, ventricular septal rupture, acute mitral regurgitation). The main indications for radioisotope studies (Tl-201 myocardial scintigraphy and radionuclide angiography during dynamic exercise) are detection and localization of ischemic zones and scars in patients with known coronary disease, and evaluation of the result of coronary artery bypass surgery. Less frequent indications are, today, atypical chest pain and uninterpretable ECG, and asymptomatic patients with abnormal stress ECG. 2-d echocardiography is the most widely used noninvasive technique for qualitative assessment of regional wall motion disorders at rest. 3800 coronary arteriographies are performed yearly in the public hospitals of Switzerland.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Indications for coronary angiography and other special studies]. 660 28

A systolic blood pressure greater than 160 mm Hg is a more significant risk factor for cardiovascular disease than a diastolic blood pressure greater than 95 mm Hg, regardless of a patient's age. Treatment of isolated systolic hypertension significantly reduces the incidence of both fatal and nonfatal cardiovascular events, even in patients who are over 80 years of age. Non-pharmacologic measures and behavior modification should be tried for three to six months in a patient with mildly elevated blood pressure (140 to 160 mm Hg/90 to 100 mm Hg). If these measures fail or the patient has target-organ disease or multiple cardiac risk factors, medication may be prescribed earlier. Half the usual recommended dose should be initially prescribed in the frail elderly. Long-acting diuretics or beta blockers are recommended first-line agents. Angiotensin-converting enzyme inhibitors, calcium channel blockers and alpha blockers have not been shown to reduce mortality in hypertensive patients who do not have comorbid disease. Angiotensin-converting enzyme inhibitors may benefit hypertensive patients with heart failure, and calcium channel blockers may help those with angina, especially vasospastic angina.
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PMID:Hypertension in the elderly. 863

Calcium channel blockers are used extensively in the treatment of the three major anginal syndromes. In the treatment of Prinzmetal's angina, their antivasospastic properties account for their therapeutic effectiveness. Calcium channel blockers are drugs of first choice in this syndrome. In chronic stable angina, calcium channel blockers may be used as monotherapy or in combination with beta-blockers and/or nitrates. In patients with unstable angina, reduction in the incidence of ischemic episodes produced by calcium channel blockers is well documented. Recent data suggest that calcium channel blockers should generally be used in combination with beta-blockers, nitrates and antithrombotic agents. Patients with ischemic heart disease often exhibit reduced ventricular function. All of the first generation calcium channel blockers exacerbate symptoms in patients with established heart failure and may precipitate heart failure, particularly when combined with beta-blockers. Second generation vascular-selective dihydropyridines have been introduced recently. Vascular selectivity determines the drug's degree of negative inotropic effect. Felodipine is one of the most vascular selective of the available dihydropyridines and has no negative inotropic effects at clinically administered doses. In a long term study, felodipine, 20 mg/day, abolished symptoms and chronic ischemic episodes in 81% of treated subjects with Prinzmetal's angina. In patients with stable angina, felodipine has been found to be effective either as monotherapy or in combination with beta-blockers. In patients with known or suspected ventricular dysfunction, vascular-selective dihydropyridines such as felodipine offer advantages over the nonselective calcium channel blockers, particularly in patients receiving beta-blockers.
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PMID:The evolving role of calcium channel blockers in the treatment of angina pectoris: focus on felodipine. 772 49

Calcium antagonists have multiple mechanisms whereby they are able to protect against myocardial ischaemia. Recently questions have been posed about the long-term safety of this group of agents. This article is a selective rather than a complete review of the problems. Fears have largely centred around rapidly acting nifedipine when inappropriately used. This agent remains useful in Prinzmetal's angina, a condition in which there are no long-term comparative outcome studies. Current evidence is that verapamil is as safe and as effective as the beta-blocker in effort angina and that non-dihydropyridines (verapamil and diltiazem) are efficacious in the follow up of non-Q wave infarct. Verapamil post-infarct is safe and reduces reinfarction, provided that clinical heart failure is first excluded.
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PMID:Mechanisms whereby calcium channel antagonists may protect patients with coronary artery disease. 904 44

Recently, there has been some controversy concerning calcium antagonists, suggesting the need for further debate on this heterogeneous class of drugs. Three chemical families, dihydropyridines (DHP), phenylalkylamines (verapamil) and benzothiazepines (diltiazem) bind to the type L receptors of the calcium channels with different binding, modulation and tissue selectivity characteristics. DHP are selective for type L receptors and block the extracellular portion of the channel leading to vigorous vasodilatation and little or no cardiodepressive effect. Diltiazem and verapamil also interfere with type T channel receptors. These drugs have a cardiodepressive and a bradycardia effect. Verapamil blocks the intracellular portion of the calcium channel at the site where part of the catecholamine effect occurs, leading to less reflex sympathetic activation than with other calcium antagonists (namely DHP). Deleterious sympathetic stimulation is proportional to the intensity and degree of rapid onset of arterial vasodilatation and is attenuated with slow-release formulations. Calcium antagonists in general have an anti-angina effect but high-dose short-acting DHP can cause excessive vasodilatator leading to subsequent ischemia. In chronic stable angina, slow-release verapamil has been shown to have a preventive clinical effect comparable to that of beta blockers. Slow-release nifedipine is effective and safe but must be associated with betablockers. In unstable angina, only those calcium antagonists with a bradycardia effect appear to have an effect similar to beta blockers. Beta blockers are nevertheless to be preferred in these patients (excepting Prinzmetal angina) until results of convincing clinical studies are available. After the initial phase of myocardial infarction, again only calcium antagonists with a bradycardia effect have been shown to have a beneficial effect, in patients without cardiac failure: diltiazem in infarction without Q-wave and verapamil in all infarctions, in case of residual ischemia to reduce the risk of recurrence.
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PMID:[Calcium antagonists in ischemic heart disease]. 941 Oct 6

Calcium antagonists are useful for treating hypertension, stable exertional and vasospastic angina, and supraventricular arrhythmias. Recent studies have proven their ability to decrease the rate of nonfatal strokes. Short-acting calcium antagonists should be avoided with hypertensive emergencies and urgencies, unstable angina, and acute myocardial infarction. The use of calcium antagonists in systolic heart failure should not be as the primary therapy. Care must be taken in using non-dihydropyridines because of multiple drug-drug interactions. Prospective trials are in progress through the next decade that will compare traditional drugs such as diuretics and beta-blockers to calcium antagonists, converting enzyme inhibitors, and angiotensin II receptor blockers.
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PMID:Calcium antagonists--clinical considerations. 959 57


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