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

In the face of the recent introduction of beta-blockers and calcium inhibitors, the author examines the role of Amiodarone, Perhexiline and Molsidomine in the treatment of angina pectoris. Amiodarone, introduced in 1967, remains a very useful anti-anginal drug. The beta and alpha-sympathetic inhibition it produces, makes it effective in effort and resting angina. It is particularly useful in anginal patients with arrhythmias as it has a potent anti-arrhythmic effect at all levels. It can be used in patients with bronchial asthma, in elderly patients and in cardiac failure. However, it may give risk to hypo or hyperthyroidism and so, should not be used in patients with a history or thyroid disorders. Perhexiline has been used in France since 1973 and is a second-line drug to be used in cases of intolerance or contraindications to other anti-anginal drugs. It is effective but may cause severe, undesirable hepatic and neurological complications. These side effects are however rare at low doses. Molsidomine, a more recent molecule, has an action similar to that of the nitrate derivatives: it mainly reduces left ventricular preload. It has a slower onset of action than the classical nitrate derivatives but its duration of action seems to be longer; Molsidomine and betablockade can be a useful therapeutic association.
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PMID:[The classic anti-anginal agents and molsidomine]. 640 52

A 29-year-old man with asthma presenting as right sided congestive cardiac failure is reported. There was rapid resolution of the heart failure with standard bronchodilator therapy and corticosteroid therapy.
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PMID:Asthma presenting as cor pulmonale. 665 36

We have studied a patient with hypereosinophilic syndrome (HES) who initially presented with recurrent asthmatic attacks followed by progressive dyspnea. Chronic obstructive lung disease was suspected at first although involvement of cardiac and other organ systems and marked eosinophilia eventually led to the diagnosis. Thereafter a diffuse interstitial pattern gradually developed on the chest radiograph which persisted despite vigorous treatment for cardiac failure. This was due to infiltration and cuffing of the small pulmonary arteries by eosinophils. The bronchi showed changes consistent with asthma. Review of the literature indicates that this type of vascular change is common in HES but involves predominantly organs other than the lung. Similar pulmonary arterial changes have been produced experimentally in the calf by prolonged intravenous infusion of antibiotics, indicating that this may be a hypersensitivity reaction to a blood-borne material entering the pulmonary circulation.
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PMID:Hypereosinophilic syndrome with pulmonary vascular involvement. 671 8

Nine patients with achondroplasia who were seen over a three-year period developed significant respiratory complications. Eight had sleep-disordered breathing, including obstructive sleep apnea in five, for which two required tracheostomy. Of the seven patients with significant hypoxemia, five had clinical evidence of cor pulmonale and recurrent pulmonary infiltrates. Two patients died, one with autopsy findings of compression of the medulla at the level of the foramen magnum and one with respiratory and cardiac failure. Appropriate therapy for our patients depended on recognition of the mechanisms that led to the respiratory complications, including (1) chest deformity, (2) upper airway obstruction and sleep-disordered breathing, (3) neurologic complications, and (4) coincidental chronic pulmonary conditions such as asthma.
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PMID:Respiratory complications of achondroplasia. 683 88

Digoxin remains a very useful agent for chronic atrial fibrillation or for the ectopic beats associated with heart failure. But when rapid control of the ventricular rate is required to arrhythmias such as atrial fibrillation, atrial flutter, or paroxysmal atrial tachycardia, a slow infusion of verapamil is the agent of choice. In general, verapamil may be added to digoxin or given intravenously while a digoxin effect is awaited, unless there is digitalis toxicity. In digitalis toxicity, lignocaine remains the agent of choice for ventricular arrhythmias, and is given in the same doses as for acute myocardial infarction; phenytoin is used for digitalis-arrhythmias with A-V block. Verapamil may be infused very cautiously for digitalis-induced supraventricular tachyarrhythmias. The use of oral agents such as quinidine, disopyramide and mexilitene for chronic prophylaxis of ventricular ectopic beats is of doubtful effectiveness, unless the ectopic activity is symptomatic. Serious ventricular arrhythmias may be induced by quinidine and disopyramide. Beta-blockade is especially useful for ectopic beats associated with anxiety, or when arrhythmias are associated with angina of effort or hypertension. As always, major contraindications to the use of beta-blockade include cardiomegaly, heart failure or asthma.
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PMID:Anti-arrhythmic agents in ischemic heart disease: supraventricular arrhythmias, digitalis toxicity and chronic stable ventricular ectopic beats. 708 6

Timolol has become so populat with ophthalmologists that it is prescribed 44% of the time when an anti-glaucoma drop is needed. This popularity is due to its newness and the publicity it has received, its effectiveness in most types of glaucoma, and the apparent scarcity of side effects. This paper looks at the first 489 patients treated with timolol at Wills Eye Hospital and the side effects encountered. These include blurring of vision, burning and pain, bradycardia and heart failure, hallucinations, dilated pupils, headaches, dizziness, hypotony, allergy, asthma, impotence, drowsiness, anxiety, emotional lability, and nausea.
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PMID:The place of timolol in the practice of ophthalmology. 740 91

Seven patients with late sequelae of allergic bronchopulmonary aspergillosis (ABPA) are described. All seven had significant chronic symptoms from asthma. At the time of diagnosis of ABPA all patients had marked irreversible pulmonary function abnormalities; symptoms of chronic bronchitis were present in all. Pulmonary fibrosis was present in six of seven patients. Three patients have died from irreversible lung disease with terminal cardiac failure. Despite the difficulty in establishing an early diagnosis of ABPA, its importance must be emphasized in order to attempt to prevent progression of the disease to severe irreversible and potentially fatal end-stage lung disease.
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PMID:Late sequelae of allergic bronchopulmonary aspergillosis. 741 34

During the history taking and physical examination, several important diseases should be searched for before diagnosing essential hypertension. A critical investigation is repetitive abdominal auscultation for a bruit. In young patients with significant hypertension, coarctation of the aorta must be excluded by clinical examination. Investigations will especially be aimed at uncovering renal artery disease (relatively common) or a phaechromocytoma (relatively rare). The initial assessment must also diagnose associated diseases which will influence the type of therapy chose. Thus asthma and heart failure contraindicate beta-blockers, liver disease contraindicates methyldopa, severe depression contraindicates reserpine, methyldopa and beta-blockade, while diabetes or gout may be precipitated or aggravated by thiazide diuretics.
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PMID:Hypertension in general practice. Part I. Examination and investigation of a patient with hypertension. 744 97

Churg-Strauss syndrome is a systemic vasculitis. Its most frequent complications are heart diseases and asthma. Usually, cardiological manifestations are pericarditis, cardiac failure and myocardial infarction. Endobronchial granulomas identified by bronchoscopy are unusual. We present the case of a man with congestive cardiomyopathy and endobronchial granulomas macroscopically visible at bronchoscopy. After a review of medical literature, we found one case of congestive cardiomyopathy and no cases of endobronchial granulomas observed by bronchoscopy associated with Churg-Strauss syndrome.
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PMID:Congestive cardiomyopathy and endobronchial granulomas as manifestations of Churg-Strauss syndrome. 764

The Cardiovascular Health Study provided the opportunity to determine the association of subclinical and clinical cardiovascular disease with pulmonary function in a population sample of elderly adults. Included were 2,955 women and 2,246 men over age 64 years who were recruited for this observational study from four communities and completed extensive examinations that included spirometry, echocardiograms, and blood pressure. Current smokers, past smokers with >20 pack-years of smoking, and persons with a history of asthma, chronic bronchitis, or emphysema were excluded from this analysis, leaving 2,784 (55%) of the cohort. Systolic hypertension or coronary artery disease was associated with 40- to 100-mL decrements in FEV1, and 50- to 150-mL decrements in FVC, while a history of congestive heart failure was associated with 200 to 300 mL lower FEV1 and FVC values (p < 0.0001), after correcting for age, height, and waist size. Higher left ventricular (LV) mass was also significantly associated with a decrease in FEV1 and FVC in multivariate models. This relationship was strongest with the end-diastolic LV posterior wall thickness component of LV mass. In summary, FEV1 and FVC are reduced in elderly persons with hypertension, ischemic heart disease, higher disease, higher LV mass, and congestive heart failure, though the magnitude of these associations is relatively small unless heart failure supervenes. Substantial decrements in percent predicted FEV1 and FVC should not be attributed to the presence of uncomplicated ischemic heart disease or hypertension alone.
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PMID:Reduced vital capacity in elderly persons with hypertension, coronary heart disease, or left ventricular hypertrophy. The Cardiovascular Health Study. 781 13


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