Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

An accidental rupture of the pulmonary artery in a 77 year old female patient is reported. She was admitted for total mastectomy, but her past medical history revealed an old myocardial infarct, treated arterial hypertension and asthma. She was under heparin as well for her varicose veins. Her clinical examination revealed a patient in mild chronic heart failure. It was therefore decided to carry out invasive monitoring during surgery and the recovery period. A Swan-Ganz catheter was put up. Its progression was controlled by looking at the pressure curves. Several attempts were made to obtain a wedge pressure, with no success. During these attempts, the patient developed a cough followed by massive haemoptysis. Despite adequate resuscitative measures, the patient died before a surgical procedure could be attempted. Postmortem examination showed the rupture to be 9 cm away from the origin of the pulmonary artery. This unfortunate accident confirmed that the following three factors, all present in this patient, should call for extreme care in the setting-up of Swan-Ganz catheters: age greater than 60 years, pulmonary arterial hypertension and anticoagulant therapy.
 ...
PMID:[Perforation of the pulmonary artery during the insertion of a Swan-Ganz catheter]. 320 33

Myocardial function was studied in 131 patients with infectious-allergic bronchial asthma. The chronic cor pulmonale formation was shown to be a complex process including hypertrophy not only of the right but also of the left ventricle caused by raised pressure both in the lesser and greater circulation. Functional changes prevailed at the initial stages of the development of disease, but with progression of disease, especially in a severe course, not only functional but also irreversible organic myocardial changes were revealed. Early diagnosis of pulmonary hypertension, forming cor pulmonale and subsequent heart failure in bronchial asthma promoted objective assessment of myocardial function in such patients and administration of timely and appropriate therapy.
 ...
PMID:[Features of the functional status of the myocardium of patients with the infectious-allergic form of bronchial asthma]. 360 88

The aim of the present study was to evaluate how many cirrhotics may receive propranolol after upper gastrointestinal bleeding. One hundred and twelve patients were consecutively admitted in a digestive intensive care unit during a two-year study, for bleeding of esophageal (63 p. 100) or gastric (4 p. 100) varices, or acute gastric erosions (33 p. 100). Twenty-one per cent of patients were initially class A (Child's classification). 26 p. 100 were B, and 53 p. 100 were C. Eighteen patients (16 p. 100) died within the first 10 days. Eighty patients (71 p. 100) did not receive propranolol because of: a) contraindication for this drug (asthma, heart failure, diabetes, n = 25); b) carcinoma, mainly of the liver (n = 11); c) foreseeable lack of compliance with the treatment (n = 8); d) criteria for which the efficacy of propranolol has not been demonstrated (small esophageal varices, jaundice, or ascites, n = 36). Only 14 patients (13 p. 100) received propranolol therapy: 5 stopped their treatment, 3 because of gastrointestinal rebleeding. Our experience suggests that propranolol can be used only in a few cirrhotics for prevention of recurrent gastrointestinal bleeding.
 ...
PMID:[How many cirrhotic patients may receive propranolol after digestive hemorrhage?]. 387 54

Plasma catecholamine concentrations were measured in 15 patients (six male) aged 14-63 years attending the casualty department with acute severe asthma (peak expiratory flow 27% (SEM 3%) of predicted). Nine patients were admitted and six were not. The plasma noradrenaline concentration, reflecting sympathetic nervous discharge, was two to three times normal in all patients and was significantly higher in those who required admission compared with those discharged home (mean 7.7 (SEM 0.6) v 4.7 (0.5) nmol/l (1.3 (SEM 0.1) v 0.8 (0.08) ng/ml); p less than 0.001). Plasma adrenaline concentration, however, was not increased in any patient. This surprising failure of the plasma adrenaline concentration to increase during the stress of an acute attack of asthma was unexplained and contrasts with the pronounced rise in plasma adrenaline and noradrenaline concentrations in acute myocardial infarction, heart failure, and septicaemia. The failure of plasma adrenaline concentration to increase in acute asthma is unlikely to be explained by adrenal exhaustion, but it may be another example of impaired adrenaline secretion in asthma.
 ...
PMID:Circulating catecholamines in acute asthma. 391 81

Beta-blockers are valuable agents in the treatment of hypertension, being useful at all stages of hypertension except when heart failure is present. They are usually the first choice of therapy in younger patients with mild to moderate hypertension. In elderly or Black patients, added diuretic therapy is essential. Otherwise diuretic therapy is only added if beta-blockade alone is unsuccessful, as it will be in 30-50% of patients. Requirements for an ideal beta-blocker are stated. Costs of currently available beta-blockers are given. The prices of some compare well with those of vasodilators, but thiazide diuretics are much cheaper. Centrally acting agents tend to fall into an intermediate price range. Beta-blockers cannot be prescribed without prior enquiry into a history of asthma (an absolute contraindication) or bronchospasm (an indication for a cardioselective agent), nor without examination of the heart and lungs of the patient.
 ...
PMID:Hypertension in general practice. Part II. Pharmacology and rational use of beta-blockade in hypertension. 610 17

Beta blockade is the cornerstone of the therapy for ischemic heart disease and is increasingly used as first-line therapy for hypertension. Three chief properties that distinguish among different beta blockers are cardioselectivity, intrinsic sympathomimetic activity (ISA) and pharmacokinetic differences. Cardioselectivity appears to confer some advantages, although there is a potential and serious danger in giving any beta blocker to patients with asthma, heart failure or active peripheral disease. The degree of ISA in different beta blockers may vary. This property may diminish the degree of cardiac depression caused by beta blockade, influencing the response to exercise, but on the other hand, it may make the beta blocker less beneficial in minimizing the effects of myocardial ischemia. Beta blockers also differ in duration of action, vasodilating capacity and effect on renal blood flow. Several mechanisms may be involved in the antihypertensive effects of beta antagonists. In elderly hypertensive patients, beta blockade should be given cautiously, especially if combined with a diuretic, and pharmacokinetic differences in this age group must be considered.
 ...
PMID:Basis for cardiovascular therapy with beta-blocking agents. 613 10

Both beta- and alpha-adrenergic mechanisms are important in the control of blood pressure; alpha-mediated vasoconstriction is responsible for the regulation of vascular tone, and beta-mediated responses stimulate the heart directly and indirectly by liberating renin and affecting vascular smooth muscle tone. beta-Adrenergic blocking drugs have long been established in the treatment of hypertension. The development of drugs which combine this action with an alpha-blocking effect represents an additional mode of action to lower the blood pressure. Numerous studies have demonstrated that labetalol intravenously or orally gives a rapid fall of blood pressure in essential and renal hypertension. It has also been used intravenously in phaeochromocytoma, tetanus, clonidine withdrawal, and as an adjunct to halothane to produce hypotensive anaesthesia. Intravenously, labetalol is probably best given as a graded infusion or as repeated small bolus injections to assure a smooth fall of blood pressure. Many long term studies have shown it to be effective orally in prolonged treatment of hypertension with studies of over 5 years, showing that tolerance does not develop. Labetalol can be used in combination with diuretics and other drugs when necessary. It can be employed to control the blood pressure in all grades of hypertension. A dosage of 100mg twice daily will often be adequate to control mild hypertension and the use of even lower doses has been reported. However, the dosage can be markedly increased in severe hypertension and while such doses are relatively exceptional, several trials have employed over 2 g per day for the more resistant cases. Studies have demonstrated that blood pressure control with labetalol is equivalent to that with beta-adrenoceptor blocking drugs plus vasodilators, or methyldopa. Labetalol has been used in patients with severe renal impairment and a number of studies suggest that it may now be the drug of choice in raised blood pressure of pregnancy. Side effects can be divided into those related to beta-blockade, those related to alpha-blockade and those not clearly related to either effect. It has been suggested that the side effects attributable to the beta-blocking component are less obtrusive than those seen with pure beta-blocking drugs without alpha-activity because the alpha-blockade modifies the consequences of beta-blockade. Heart failure has been reported, but for haemodynamic reasons would be expected to be less common; careful patient selection should avoid any risk. Similarly labetalol may worsen asthma even if the risks are probably less than with non-selective beta-blockade alone.(ABSTRACT TRUNCATED AT 400 WORDS)
 ...
PMID:Combined alpha- and beta-receptor inhibition in the treatment of hypertension. 615 91

Treatment of angina pectoris should follow the clinical course: Stable angina is most often responding to nitropreparations, betablockers or calciumantagonists; differentialtherapy should consider the basic state of the patient: age, heart-rate, hypo- or hypertension, cardiac failure or asthma bronchiale etc. Unstable angina needs more attention and should be transferred to a coronary care unit. Analgetics, sedatives, oxygen and nitrates should be applied under hemodynamic monitoring. Only in rare cases with cardiac failure or with rapid atrial fibrillation glycosides will be necessary. In extreme bradiacardias a pacemaker can be helpful. Captopril might be a new substance in nonresponders.
 ...
PMID:[Therapy of angina pectoris]. 615 89

Labetalol is a combined alpha- and beta-adrenoceptor blocking agent for oral and intravenous use in the treatment of hypertension. It is a nonselective antagonist at beta-adrenoceptors and a competitive antagonist of postsynaptic alpha 1-adrenoceptors. Labetalol is more potent at beta that at alpha 1 adrenoceptors in man; the ratio of beta-alpha antagonism is 3:1 after oral and 6.9:1 after intravenous administration. Labetalol is readily absorbed in man after oral administration, but the drug, which is lipid soluble, undergoes considerable hepatic first-pass metabolism and has an absolute bioavailability of approximately 25%. There are no active metabolites, and the elimination half-life of the drug is approximately 6 hours. Unlike conventional beta-adrenoceptor blocking drugs without intrinsic sympathomimetic activity, labetalol, when given acutely, produces a decrease in peripheral vascular resistance and blood pressure with little alteration in heart rate or cardiac output. However, like conventional beta-blockers, labetalol may influence the renin-angiotensin-aldosterone system and respiratory function. Clinical studies have shown that the antihypertensive efficacy of labetalol is superior to placebo and to diuretic therapy and is at least comparable to that of conventional beta-blockers, methyldopa, clonidine and various adrenergic neuronal blockers. Labetalol administered alone or with a diuretic is often effective when other antihypertensive regimens have failed. Studies have shown that labetalol is effective in the treatment of essential hypertension, renal hypertension, pheochromocytoma, pregnancy hypertension and hypertensive emergencies. In addition, preliminary studies indicate that labetalol may be of value in the management of ischemic heart disease. The most troublesome side effect of labetalol therapy is posture-related dizziness. Other reported side effects of the drug include gastrointestinal disturbances, tiredness, headache, scalp tingling, skin rashes, urinary retention and impotence. Side effects related to the beta-adrenoceptor blocking effect of labetalol, including asthma, heart failure and Raynaud's phenomenon, have been reported in rare instances.
 ...
PMID:Labetalol: a review of its pharmacology, pharmacokinetics, clinical uses and adverse effects. 631 May 29

Bronchodilating drugs can be divided into three main groups: beta-adrenergic stimulants including specific beta-2 receptor agonists (salbutamol, terbutaline, fenoterol) which are the agents of this group used in everyday practice, theophylline and its derivatives, and atropine-like drugs (ipratropium bromide). Bronchodilators act chiefly upon the spasm observed at the bronchial level in reversible obstructive phenomena (mainly asthma), their effect upon inflammation and hypersecretion being slight or controversial. Beta-stimulants have a relatively specific mode of action at the bronchial level in the setting of use in pneumology; they exhibit cardiac effects only at high doses and when used by oral or parenteral routes. Relative to isoprenaline, they also have the advantage of being active orally and over a longer period of time. They are given in maintenance treatment of asthma, by parenteral or oral routes or as aerosols. Main side effects of adrenergic beta-stimulants are tremor with oral administration, and tachycardia with very high doses by parenteral or oral routes; when given as aerosols these agents may fail to control severe attacks. The bronchodilating properties of theophylline have been known for a long time; late advances concerning this drug result from better knowledge of its pharmacokinetics. Recent studies have discriminated between serum levels correlated with therapeutic effectiveness and those accompanied with mild or severe side effects; in addition, it has been clearly shown that the half life of this alkaloid varies from one person to another and with various physiopathologic (age, dietary habits, liver failure, heart failure...) or pharmacologic (drug interactions with enzyme inductors or inhibitors...) factors; these recent advances have led to improved individual adjustment of theophylline dosage using serum concentration assays if needed. Theophylline is used in acute attacks and in maintenance therapy of asthma. Main side effects are digestive intolerance and, with toxic doses, neurologic disorders. Atropine-like drugs inhibit the effects of the parasympathetic reflex which results from stimulation of receptors by irritation of the respiratory tract, through the action of mediators. In this group, ipratropium is the only drug given in aerosols; this, together with its pharmacologic specificity, contributes to its tolerance. In some instances, the bronchodilating effect of ipratropium bromide is comparable to that of sympathomimetics.
 ...
PMID:[Bronchodilators]. 632 Apr 43


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>