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

Treatment of hypertension has succeeded in preventing the complications attributable to pressure, including heart failure and the arteriolar complications such as brain hemorrhage and renal failure. Recent understanding that antihypertensive drugs have effects on lipoproteins and flow disturbances that may be important in atherosclerosis progression, and the recent development of drugs that are more effective in treating hyperlipidemia, have given impetus to the design of studies to test whether interventions are anti-atherosclerotic. Since studies depending on clinical endpoints by necessity consume vast resources, it is desirable to develop methods for measurement of atherosclerosis, in order to make it possible to conduct intervention studies efficiently. Because angiographic methods are costly and associated with risk, and many patients are unable or unwilling to undergo followup angiography at the end of a study, we are developing an atherosclerosis severity index based on clinical and noninvasive ultrasound assessment. This scale can be used as a surrogate outcome in place of, or complementary to angiographic measurement of atherosclerosis, to avoid costly loss of subjects in intervention studies. It has the additional advantage that it is suitable for repeated assessment over time, permitting the power of analyses such as life table analysis which look at time to development of endpoints.
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PMID:Measurement of atherosclerosis: development of an atherosclerosis severity index. 267 64

Cirrhosis is associated with several circulatory abnormalities. A hyperkinetic circulation characterized by increased cardiac output and decreased arterial pressure and peripheral resistance is typical. Despite this hyperkinetic circulation, some patients with alcoholic cirrhosis have subclinical cardiomyopathy with evidence of abnormal ventricular function unmasked by physiologic or pharmacologic stress. Florid congestive alcoholic cardiomyopathy develops in a small percentage, but the concurrent presence of cirrhosis seems to retard the occurrence of overt heart failure. Even nonalcoholic cirrhosis may be associated with latent cardiomyopathy, although overt heart failure is not observed. Tense ascites is associated with some cardiac compromise, and removing or mobilizing ascitic fluid by paracentesis or peritoneovenous shunting results in short-term increases in cardiac output. Cirrhosis also appears to be associated with a decreased risk of major coronary atherosclerosis and an increased risk of bacterial endocarditis. Small hemodynamically insignificant pericardial effusions may be seen in ascitic patients. The release of atrial natriuretic peptide appears to be unimpaired in cirrhosis, although the kidney may be hyporesponsive to its natriuretic effects.
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PMID:Cardiac abnormalities in liver cirrhosis. 269 Apr 63

Since hypertension is an important risk factor for atherosclerosis, it is logical to assume that treatment to lower blood pressure will prevent atherosclerosis. However, the relationship between hypertension and atherosclerosis is indirect and complex. Drugs that lower pressure will prevent heart failure and arteriolar complications such as renal failure or strokes caused by lacunar infarction or brain haemorrhage due to rupture of microaneurysms. However, there is little evidence that atherosclerotic complications can be reduced by lowering pressure. It is important to understand the pathogenesis of atherosclerosis and its complications, which are related to lipoproteins and arterial flow disturbances, in order to develop an approach to selecting those antihypertensive drugs which may prevent atherosclerotic complications related not only to initiation and progression of atherosclerotic plaques, but to the embolisation of platelet clumps or atherosclerotic debris, or events such as intraplaque haemorrhages, that lead to myocardial or cerebral infarction. Antihypertensive drugs have different effects on lipoproteins and on arterial flow disturbances that may have important implications for prevention. Alpha-blockers and drugs with beta 2 agonist activity have beneficial effects on lipoprotein profiles, ACE inhibitors and calcium channel antagonists have some anti-atherosclerotic effects in animal models, while beta-blockers have beneficial effects on flow disturbances and are anti-atherosclerotic in animal models and man. Future studies to determine how to prevent atherosclerotic complications in hypertensive patients will require methods for noninvasive measurement of atherosclerosis.
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PMID:Pathogenesis of atherosclerosis and its complications: effects of antihypertensive drugs. 269 95

A comparative study of the myocyte nucleolar organizer activity (NOA) was performed on silver-stained myocardium from 6 patients who had died from the hypertension disease and 7 others patients with secondary renal hypertension non-complicated by severe coronary atherosclerosis and heart failure. In the first group, positive correlations between NOA of cardiac cells and the level of maximal diastolic pressure (r = 0.8, p less than 0.028), wall thickness of the left ventricle (r = 0.8, p less than 0.028) as well as myocardial weight (r = 1.0, p less than 0.001) were found. In the second group, on the contrary, there was a pronounced negative correlation between NOA of the myocytes and myocardial weight (r = -0.86, p less than 0.005) which may be explained partially by a primary metabolic myocardial deficiency in such patients.
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PMID:[Activity of the nucleolar organizers in cardiomyocytes of patients with arterial hypertension of varying genesis]. 280 43

From July 1984 to December 1987, intra-aortic balloon pumping (IABP) was attempted percutaneously to 22 patients at the ages of 37-78 with cardiogenic shock or medically refractory heart failure complicating acute myocardial infarction (CS/MRHF-AMI). There was only one failure because of severe bilateral iliofemoral atherosclerosis. Of the 21 patients undergoing IABP, 17 were in cardiogenic shock and 13 of them showed reversal of shock syndrome after 10 to 48 hours of IABP. Cardiac index increased from 1.91 +/- 0.43 to 2.45 +/- 0.43 L/min/M2 (P less than 0.005), spontaneous systolic arterial pressure rose from 79 +/- 10 to 114 +/- 19 mmHg (P = 0.0001), heart rate dropped from 111 +/- 26 to 85 +/- 13 beats/min (P = 0.0001), pulmonary artery wedge pressure decreased from 29 +/- 5 to 16 +/- 3 mmHg (P = 0.0001), and urine output increased from 7 +/- 10 to 79 +/- 22 ml/h (P = 0.0001). Twelve patients, including 4 shock-free, were subsequently weaned from balloon assistance. Of these patients, 8 (5 shock and 3 nonshock) were discharged from the hospital and followed-up for a mean period of 23 months (4 to 38 months). Of the surviving patients, 4 underwent surgical reperfusion and/or infarctectomy during balloon support (n = 1) or after weaning from IABP (n = 3). All of the 10 patients who underwent coronary angiogram were found a severe left anterior descending artery lesion. The main complication was leg ischemia, which was observed in 7 patients: 3 needed removal or replacement of balloon catheter and one required surgical removal of the thrombus.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical experience with percutaneous intra-aortic balloon pumping in cardiogenic shock complicating acute myocardial infarction. 280 84

Pericardial lesions are the most frequent complications of thoracic radiotherapy; they occur in 2% to 30% of the cases depending on the publications. Acute pericarditis, which is the most common form, develops early or late and usually has a favourable course. Chronic pericarditis is divided into chronic pericardial effusion, the incidence of which is underestimated as it produces few or no symptoms, and chronic constrictive pericarditis, itself divided into 2 subgroups of different prognosis depending on the presence (pure fibrous pericarditis) or absence (constrictive sero-fibrous pericarditis) of underlying myocardial lesions. The incidence of myocardial lesions ("myocarditis") varies from 4% to 13% in the literature. They have a minor clinical form characterized by arrhythmias or disorders of conduction and a major form as restrictive or congestive cardiomyopathy with or without cardiac failure. Lesions of the coronary vessels are probably underestimated in view of the results of recent necropsies. Radiation-induced vascular lesions and hyperlipidaemia seem to act synergetically in the genesis of atherosclerosis. Cardiac valve lesions are even less frequent, but here again their incidence seems to be underestimated by conventional diagnostic methods. Echocardiography, radionuclide angiography and exercise tests appear to be useful for the long-term monitoring of patients who had their chest irradiated.
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PMID:[Radiation-induced cardiopathies]. 294 May 28

The effects of hypertension on the heart include the development of left ventricular hypertrophy, impairment of left ventricular function leading to heart failure and accelerated coronary atherosclerosis leading to ischemic heart disease. The precise role of hypertension in precipitating these cardiac events is poorly understood, and the effect of antihypertensive drugs in preventing or reversing these abnormalities is surprisingly unclear. Current understanding of the pathophysiology and therapeutic responses of these cardiac manifestations of hypertension will be examined.
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PMID:Role of drugs for systemic hypertension and their effect on the heart. 296 Feb 28

Cardiac transplantation for the treatment of end-stage congestive heart failure has been shown to be of benefit regardless of the etiology. With few exceptions, the evaluation of patients with end-stage heart failure is the same, regardless of the etiology. In those with cardiomyopathy not as a result of CAD, special attention must be given to exclude secondary causes of cardiomyopathy such as amyloidosis, hemochromatosis, and sarcoidosis, as well as generalized systemic illnesses that may also involve the heart, either secondary or hereditary, because special consideration must be given to these patients on a case-by-case basis to determine that there is no general systemic involvement of the illness that would preclude satisfactory rehabilitation after transplantation. Before cardiac transplantation becomes widely available, there must be a greater number of donor hearts, the lack of which now severely limits the number of transplants performed in comparison with the estimated need.66 Additionally, more effective and specific immunosuppressive agents must be identified in order to reduce the incidence of rejection, infection, and accelerated atherosclerosis that now limits the longevity of transplant recipients. Furthermore, the ideal immunosuppressive agent should be associated with fewer side effects than those currently available. The emotional and economic burdens placed on the patient, the family, and society must be balanced against the benefits generated by the procedure. Despite these limitations, cardiac transplantation continues to offer hope for the terminally ill patient, which must be tempered by an understanding of the real limitations of transplantation.
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PMID:Patient selection and results of cardiac transplantation in patients with cardiomyopathy. 304 84

Cardiac transplantation has evolved from an experiment to an accepted therapy for severe heart failure. Increasing competition for donor organs mandates a greater emphasis on selection and timing for transplantation and paradoxically forces more reliance on aggressive medical therapy for all patients after evaluation. The growth of recipient and donor pools may enhance the opportunity for assessing histocompatibility, for which distinguishing between autoantibodies and human leukocyte antigen-determined reactivity is important, and some general nonresponders may be detected. Therapy with cyclosporine has improved the outcome after transplantation, but further refinement is needed, perhaps with pharmacologic synergy, to minimize nephrotoxicity and maximize specific immunosuppression. Survival is more than 80% at 1 year, after which the incidence of acute rejection and infection declines and accelerated atherosclerosis becomes prominent. Although resuming employment is not always possible, the overall quality of life is excellent after cardiac transplantation.
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PMID:Cardiac transplantation. Selection, immunosuppression, and survival. 307 57

The combined transplantation of heart and lungs, first done successfully by the Stanford Team (USA) in 1982, at present seems to be superseding lung transplantation alone, and has broadened the indications of heart transplantation to include terminal heart failure with fixed pulmonary arterial hypertension. After reviewing the causes for failure in lung transplants, the authors stress the superiority of heart-lung transplants compared to isolated lung transplantations: healing of the tracheal anastomosis, ease of detection of rejects by endomyocardial biopsy and the lack of inhomogeneity of the ventilation/perfusion ratios. This operation still poses problems of surgical technique as the mediastinal nerves need to be preserved and the risk of haemorrhage linked to the mediastinal dissection or to the eventual pulmonary separation under cardiopulmonary bypass is important. Donor subjects for cardiopulmonary transplantation are rare as they ought to have a thoracic cage of matching size to the recipient and to be free of pulmonary infection and trauma. The post-operative complications are essentially those of immediate haemorrhage, graft rejection, pulmonary oedema and infection. The late complications are coronary atherosclerosis and bronchiolitis obliterans. The indications of such a transplant are currently reserved for primary or secondary pulmonary hypertension and to respiratory failure with a normal thoracic cage and ventilatory mechanics.
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PMID:[Heart-lung transplantation]. 310 71


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