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

Since 1982, 85 patients (aged 18 to 81 years) with supraventricular arrhythmias resistant to an average of 3.8 +/- 1.2 classes of antiarrhythmic drugs, 53 of whom had underlying cardiac disease (62.3%), underwent attempted catheter ablation of the normal AV conduction pathway in 8 different French centers. The indication was atrial fibrillation and flutter in 51 cases (60%) and intranodal reentry in 16 cases (18.8%). An average of 2.5 +/- 2.3 electrical shocks of 130 to 400 joules delivered in 1 to 3 sessions successfully induced high degree AV block in 79 patients, present at the time of discharge from hospital in 43 patients (50.5%). There were 3 cases immediately complicated by non-sustained ventricular tachycardia. Late complications (1 day to 1 month) included ventricular tachycardia (2 patients) septicaemia (3 patients) and pericarditis (1 patient). Sixty nine patients were followed up for an average of 12.9 +/- 10.0 months. There was one death from septicaemia due to infection of the pacemaker and two deaths at 5 and 6 months due to cardiac failure which had been present before the procedure. Fifty six patients were asymptomatic (81.1%), 27 with high degree AV block and 29 patients with (N = 19) or without (N = 10) antiarrhythmic therapy. There were 10 failures. This study shows that closed chest interruption of the normal AV conduction pathway is an effective and relatively safe alternative method of treating supraventricular tachycardias resistant to antiarrhythmic therapy.
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PMID:[Percutaneous electric interruption of normal auriculoventricular conduction. Analysis of French cases]. 309 38

The authors report their experience of dual chamber pacing in 29 men and 21 women of mean age 71 +/- 4 years. 35 had sinus node dysfunction associated with node-His bundle conduction disorders; 31 presented with neurological symptoms and 4 with heart failure (due to pacemaker syndrome in 1 case). Sinus node dysfunction was diagnosed by surface ECG in 25 cases and after electrophysiological studied in only 10 cases. Fifteen patients had atrioventricular block without sinus node dysfunction: 2 of them were young subjects, 1 had pacemaker syndrome and 12 were actual or potential heart failure patients for whom preservation of the atrial systole was justified. Nine patients presented with neurological symptoms. 43 (86%) had cardiac or arterial disease associated with cardiac rhythm and conduction disorders. The percutaneous single subclavian vein approach was used in 36 cases (78%). 41 active and 9 passive fixation electrodes were utilized. The mean follow-up period was 25 months (12 to 70 months), with a cumulative figure of 1,253 months/patients. Two late re-operations for displacement of the atrial electrode were performed. Dual chamber pacing was abandoned, 14 months on average after implantation, in 9 patients (18%), on account of arrhythmias in 4 of them. Three cases of tachycardia from "electronic re-entry" and 6 cases of supraventricular arrhythmia transferred to the ventricle by the pacemaker were observed. Sixteen patients (32%) died 12 +/- 4 months on average after surgery: 12 (33%) had sinus node dysfunction and 4 (26%) had AV block. Death was caused by a cardiovascular disease in 12 cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical study of double-chamber stimulation. Apropos of 50 cases followed-up for 1 to 5 years]. 310

Among 128 consecutive patients operated upon between 1972 and 1984 at the Marie-Lannelongue Surgical Centre for incomplete persistent atrioventricular canal, 102 could be followed up for periods ranging from 18 months to 11 years. Of the 23 patients lost sight of, 19 were foreigners. One patient died during the first postoperative month and two died during the following five months; there was no death thereafter. One patient developed complete atrioventricular block immediately after surgery. At the end of the follow-up period, three patients had been reoperated upon for disinsertion of the patch on the ostium primum associated in one case with massive mitral regurgitation; two complete atrioventricular blocks requiring permanent pacing had occurred some time after surgery; five patients had presented with late atrial dysrhythmia, and only six patients had signs of heart failure primarily due to residual mitral regurgitation. At radiography, the cardiothoracic ratio was reduced in 74 p. 100 of the cases from 0.60 +/- 0.08 to 0.53 +/- 0.05 (p less than 0.001), and the earlier the operation had been performed, the greater the reduction in cardiothoracic ratio (p less than 0.05). A mitral regurgitation murmur was observed in 72 p. 100 of patients immediately after surgery and in 82 p. 100 of patients at the end of the follow-up period. The murmur was usually weak (79 p. 100) with a tendency to remain stable (44 p. 100) or to increase in intensity (43 p. 100, but reoperation was necessary in only one case.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Surgery for incomplete atrioventricular canal. Mid-term follow-up apropos of 128 patients]. 313 11

Heart autopsies in six cases of fatal myocarditis were examined clinicopathologically. Included were 2 cases in the acute stage, 1 in the subacute stage and 3 in the chronic stage. As to microscopical dating changes, at the acute stage, numerous inflammatory cells were found in the edematous interstitium after 2 days from onset and degeneration, i.e., destruction of myocardial cells without fibrous replacement, was also noted after 11 days. At the subacute stage, irregular patchy and slightly loose fibrosis with inflammatory cells and vascularization was found after 50 days. At the chronic stage, loose fibrosis with inflammatory cells and tight fibrosis without the cells, that is, active and healed myocarditis co-existed. All cases showed heart failure of varying degrees, and also showed, respectively, complete AV block and ventricular fibrillation at the acute stage, and complete AV block and sustained ventricular tachycardia at the chronic stage. In myocarditis, which often was difficult to diagnose clinically, the pathological findings corresponded well to the clinical features retrospectively.
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PMID:Pathological substratum for clinical features of fatal myocarditis. 344 91

By means of abdominal fetal ECG and non-invasive ultrasound blood flow studies 113 cases of fetal cardiac arrhythmia were classified according to the origin of arrhythmia. Pregnancy outcome was characterized by an increased frequency of fetal distress and heart malformation, and increased fetal and neonatal mortality. The following types of arrhythmia were identified: supraventricular extrasystoles (n = 84), paroxysmal tachycardia (n = 6), sinus bradycardia (n = 3), atrial flutter (n = 1), ventricular extrasystoles (n = 14), and atrioventricular block (n = 5). In 37 cases the combined Doppler and real-time ultrasound technique was used to measure fetal aortic blood flow as a means of studying the circulatory effects of the arrhythmia. Increased peak velocity, rising slope and acceleration were found in the first post-pausal beat after a supraventricular extrasystole or a missed beat; this supports the validity of Frank-Starling law for the fetal heart and suggests that a strong relationship exists between these variables and myocardial contractility. In two cases of intra-uterine heart failure, the effect of digoxin treatment in utero on the fetal aortic flow variables was studied, results indicating a positive inotropic effect of the drug on the fetal myocardium. The estimation of fetal aortic volume blood flow in cases of fetal cardiac arrhythmia is useful for early detection of fetal cardiac failure, and for monitoring the effects of intra-uterine treatment.
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PMID:Clinical outcome and circulatory effects of fetal cardiac arrhythmia. 347

In a consecutive series of 2312 patients with acute myocardial infarction (AMI) admitted from 1973 till 1979, 188 were 80 years or older (group III). They were compared with 1167 patients younger than 65 years (group I) and 957 aged 65 to 79 years (group II). The sex ratio (males/females) fell from 5.46 in group I to 0.9 in group III. Group III patients had more frequently a history of previous heart failure and more often atypical or no chest pain before admission. Less group III patients were admitted within 4 hours after onset of symptoms, but the incidence of heart failure, pulmonary edema and cardiogenic shock on admission and during CCU stay was definitely higher than in younger patients. Atrial arrhythmias, 2nd and 3rd degree atrioventricular block, complete bundle branch block and intraventricular conduction disturbances occurred more frequently in group III. The electrocardiographic extent and location of the infarction and peak enzyme levels were similar in the three groups. Mortality in group III was 43.6% at the 28th day and 76.6% at one year after AMI. At different intervals after the onset of AMI mortality increased progressively from group I to III. Age by itself, probably on the basis of definite structural changes of the heart and of other organs occurring during aging, leads to higher early and late mortality in very elderly people.
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PMID:Acute myocardial infarction in the very elderly. A comparison with younger age groups. 349 69

We used hemofiltration to treat a patient with digoxin overdose complicated by refractory hyperkalemia, congestive heart failure, chronic renal failure, and complete atrioventricular heart block. Hemofiltration was associated with a progressive fall in plasma digoxin level and potassium level. This was accompanied by resolution of the heart failure and complete heart block. Hemofiltration appears to provide a therapeutic alternative in digoxin overdose.
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PMID:Hemofiltration in digoxin overdose. 371 10

In 113 cases of fetal cardiac arrhythmia, i.e. 94 with supraventricular arrhythmia, 5 with atrioventricular block and 14 with ventricular arrhythmia, the clinical outcome was studied and compared with the general pregnant population. The arrhythmia group was afflicted with a significantly increased frequency of congenital malformations, 6.2% vs. 2.0%; fetal distress in labor, 20.4% vs. 13.5%; perinatal mortality, 3.5% vs. 0.7%; and neonatal mortality, 1.8% vs. 0.1%. In 4 cases, pharmacological cardiac treatment was needed in utero due to fetal heart failure. Fetuses with cardiac arrhythmia thus constitute an obstetric and pediatric high-risk group that should be subjected to an intensified supervision to detect fetal heart failure or fetal distress. When indicated, these complications can be treated in utero.
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PMID:Fetal cardiac arrhythmia. Clinical outcome in 113 cases. 373 33

The effect of an acute change in blood pressure (BP) on ventricular ectopic activity and the influence of antiarrhythmic agents on this effect were examined in 24 patients. In 11 patients with premature ventricular complexes (PVCs), the BP was temporarily reduced by a sodium nitroprusside drip. In all of them the incidence of PVCs was reduced (or annihilated) by the induced hypotension. In 13 patients without ventricular ectopic activity, a metaraminol drip was given until either a PVC appeared or the systolic BP reached 200 mmHg, or symptoms appeared. In 12 cases at least one PVC appeared and in 8 of them the total number of PVCs was 13 or more, usually in the form of bigeminy. The repetition of the test following quinidine administration (serum quinidine level 1.7 +/- 0.5 ng ml-1) in 6 cases did not change this pattern, with one exception. It prevented the appearance of idioventricular accelerated rhythm in one case in whom this rhythm had been induced by the hypertension provocative test before the quinidine administration. All cases, in whom the test failed to induce more than 3 PVCs, had no cardiac problem at all. Six of the 8 cases in whom the test induced 13 or more PVCs had organic cardiac disease or palpitation. Other arrhythmias observed on BP elevation, were supraventricular extra beats, nodal escape rhythms and atrioventricular block. In one case with cardiomyopathy, the BP elevation was associated with early signs of heart failure that subsided quickly. In conclusion, acute elevation on BP may be associated with the generation of PVCs and its reduction with their reduction or disappearance.
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PMID:Acute changes in blood pressure as a cause of cardiac arrhythmias. 381 38

Between June 1979 and June 1984 the authors observed 40 fetal arrhythmias in 11,122 births (0.36%). Initially there were problems of differential diagnosis with cardiotokography and fetal abdominal ECGs. However, these problems were surmounted with real-time sonography, supplemented with split-image echocardiography (M-mode technique) with video recording. In three-quarters of the cases supraventricular and ventricular extrasystoles were found. These forms of arrhythmias were clinically harmless. Follow-up examinations of the children confirmed the favorable long-term prognosis. One-quarter of the arrhythmias were high-risk cases. Supraventricular tachycardias, total AV block, sinus tachycardia and bradycardia, and congenital atrial fibrillation were found. There were five cardiac abnormalities in this group. Heart failure occurred in six fetuses and neonates. Four of ten infants died. Three infants remained in pediatric cardiologic care. In the light of the authors' experience, it is still too early to invest great hope in intrauterine treatment of the fetus. Intrauterine diagnosis at the earliest possible time and intensive cardiologic care, starting immediately after birth, can improve the prognosis in cases with high-risk arrhythmias.
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PMID:[Fetal arrhythmias. Differential diagnosis, clinical significance and prognosis]. 389 45


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