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

Brucella endocarditis is a rare, but often fatal, complication of brucellosis. A 32 year old man acquired brucellosis while on a visit to his former home in Greece and presented six months later with malaise, fever and aortic regurgitation. Blood cultures grew Brucella melitensis biotype 1. Combined chemotherapy with streptomycin, tetracycline and rifampin sterilized his blood; however, his aortic valve was replaced owing to recurrent emboli and cardiac failure. Over the next 18 months the patient's antibody titer to Brucella fell and his blood reamined sterile. Cure was achieved by resection of the infected aortic valve and 10 weeks of bactericidal therapy for B. melitensis.
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PMID:Successful treatment of Brucella melitensis end-carditis. 64 54

We have studied a standardized exercise protocol suitable for use with a treadmill or bicycle (STEEP protocol) and compared it with a modified Bruce treadmill protocol in a group of patients with chronic cardiac failure. The STEEP protocol has been previously validated in normal subjects. Exercise time (6.79 +/- 2.42 vs 5.34 +/- 1.95 min, P < 0.05) and peak VO2 (16.66 +/- 4.09 vs 15.01 +/- 3.72 ml.min-1.kg-1, P < 0.05) were greater with the STEEP treadmill compared with the bicycle protocol, but VO2 was very similar at equal exercise stages in both modalities. Heart rate and respiratory exchange ratio tended to be greater during bicycle exercise at equal stages. Exercise time was greater with the modified Bruce protocol (9.00 +/- 3.02 min, P < 0.05) than with either STEEP protocol, but peak VO2 (17.13 +/- 4.52 ml.min-1.kg-1) was similar to that obtained with the STEEP treadmill test. We conclude that the STEEP protocol may be used to test patients with chronic cardiac failure, and that exercise times relate well in both treadmill and bicycle. The protocol should prove useful in studies involving a wide range of exercise capacities or both bicycle and treadmill exercise.
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PMID:The use of an exponential protocol for bicycle and treadmill exercise testing in patients with chronic cardiac failure. 139 9

The mechanism of exercise intolerance in chronic congestive heart failure remains unclear. We correlated resting haemodynamic variables with the peak exercise capacity and maximum oxygen consumption (VO2 max) in patients with congestive heart failure in 27 studies on treadmill exercise testing using the modified Bruce protocol. VO2 max was measured using breath by breath expiratory gas analysis. The patients were in severe congestive heart failure (NYHA class II and III, pulmonary artery wedge pressure 23 +/- 2 mmHg, cardiac index 2.4 +/- 0.21 l/min/m2). VO2 max was 23 +/- 2 ml/kg/min. Fatigue was the commonest symptom limiting the exercise. None of the hemodynamic variables correlated well with VO2 max. [right atrial pressure (r = 0.08), pulmonary artery pressure (r = 0.05), pulmonary artery wedge pressure (r = 0.08), aortic pressure (r = -0.3) & cardiac index (r = 0.29)]. Both uni- and multi-variate analysis failed to show any relation between VO2 max and resting hemodynamic variables. We conclude that unlike the acute heart failure syndromes, resting hemodynamic variables do not correlate with exercise capacity in patients with chronic congestive heart failure. The abnormal resting haemodynamics do not limit exercise in these patients. Peripheral mechanisms may thus be more important.
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PMID:Do hemodynamic indices correlate with maximum exercise capacity and oxygen consumption in chronic congestive heart failure? 139 90

The efficacy and safety of ramipril were compared with that of digoxin in a prospective, randomized, double-blind, crossover study of 35 patients with congestive heart failure (CHF), New York Heart Association (NYHA) grades II to IV, stabilized on diuretic maintenance therapy. Major assessments were conducted at baseline and at the end of each 10-week treatment period: primary efficacy variables were total exercise duration (modified Bruce, treadmill), NYHA grade, and clinical signs and symptoms (by visual analogue score) of heart failure. Twenty-seven patients completed the study. There were two deaths (one on each study drug) and six patient withdrawals (one on ramipril and five on digoxin). Although the NYHA grade was significantly better on ramipril than on digoxin, there were no other important differences in the relief of either signs or symptoms of heart failure. A significant order effect was observed with the exercise testing data and therefore only data in the first active treatment period were analyzed; no significant differences were noted. There were fewer reports of adverse effects, and no clinically significant episodes of hyperkalemia or renal impairment on ramipril. We conclude that ramipril seems to be better tolerated and marginally more effective than digoxin in the management of patients with moderate to severe chronic CHF, stabilized on maintenance diuretic therapy.
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PMID:A comparison of the efficacy and safety of ramipril and digoxin added to maintenance diuretic treatment in patients with chronic heart failure. 172 36

The assessment of functional capacity in heart disease remains problematic, and it is unclear whether maximal exercise testing is physiologically reflective of the activities of daily living or the quality of life. We therefore employed a symptom-limited, self-paced walking protocol to assess the physical conditions of 41 Nigerian cardiac patients, with and without heart failure. The walking time, walking speed and distance as well as the energy expenditure (Kcal.min-1) were markedly reduced (P less than 0.001) in patients with heart failure (n = 26) compared to the cardiac patients not in failure (n = 15). The double product corrected for exercise time (an index of myocardial oxygen use) was, however, significantly higher (P less than 0.001) in the group with heart failure. Using multiple regression analysis, the parameters of self-paced walking capacity (distance, walking time, and speed) could reliably be predicted (r2 greater than 0.9) from age, body surface area, energy expenditure, and echocardiographic left ventricular dimension in the patients without heart failure. The presence of heart failure appeared to weaken the predictability of the regressions. A significant correlation was obtained between the self paced exercise time and the Bruce protocol treadmill time (r2 = 0.91, P = 0.004) in a subgroup of the patients with heart failure. Thus, the self-paced walking test is sensitive to changes in congestive heart failure and the exercise capacity can be predicted from age and biophysical parameters. The wider clinical usage of this modality, especially in frail patients, is hereby recommended.
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PMID:Symptom-limited, self-paced walking in the assessment of cardiovascular disease in patients with and without heart failure: the predictive value of clinical, anthropometric, echocardiographic and ergonometric parameters. 174 83

The exercise capability of 12 patients with heart failure was investigated by a variety of different methods before and after treatment with the vasodilator flosequinan. Two treadmill protocols were used, a modified Bruce with incremental workloads and a fixed workload protocol. On placebo, mean exercise time was greater with the Bruce protocol, 526 (64) s, than with the fixed protocol, 359 (59) s, P less than 0.005. Flosequinan increased exercise time more with the fixed protocol, so after 5 weeks' treatment exercise time was the same with both protocols; 680 (64) s with the Bruce and 673 (147) s with the fixed protocol. When the results are expressed as work, the patients achieved less with the Bruce protocol, 7.8 (1.9) kJ, than with the fixed protocol 12.5 (1.5) kJ on placebo, P less than 0.01. After flosequinan, the respective values were 14.5 (2.8) and 25.3 (5.1) kJ. Flosequinan improved corridor walk test times but there was no relationship between this and either treadmill test. Pedometer scores of customary activity were unchanged by flosequinan and were not correlated with any other exercise test. Different methods of assessing exercise capability provide different measures of patients' incapacity.
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PMID:Exercise tolerance in patients with heart failure--how should it be measured? 200 93

To compare the hemodynamic and gas exchange responses of ramp treadmill and cycle ergometer tests with standard exercise protocols used clinically, 10 patients with chronic heart failure, 10 with coronary artery disease who were asymptomatic during exercise, 11 with coronary artery disease who were limited by angina during exercise and 10 age-matched normal subjects performed maximal exercise using six different exercise protocols. Gas exchange data were collected continuously during each of the following protocols, performed on separate days in randomized order: Bruce, Balke and an individualized ramp treadmill; 25 W/stage, 50 W/stage and an individualized ramp cycle ergometer test. Maximal oxygen uptake was 16% greater on the treadmill protocols combined (21.4 +/- 8 ml/kg per min) versus the cycle ergometer protocols combined (18.1 +/- 7 ml/kg per min) (p less than 0.01), although no differences were observed in maximal heart rate (131 +/- 24 versus 126 +/- 24 beats/min for the treadmill and cycle ergometer protocols, respectively). No major differences were observed in maximal heart rate or maximal oxygen uptake among the various treadmill protocols or among the various cycle ergometer protocols. The ratio of oxygen uptake to work rate, expressed as a slope, was highest for the ramp tests (slope +/- SEE ml/kg per min = 0.80 +/- 2.5 and 0.78 +/- 1.7 for ramp treadmill and ramp cycle ergometer, respectively). The slopes were poorest for the tests with the largest increments in work (0.62 +/- 4.0 and 0.59 +/- 2.8 for the Bruce treadmill and 50 W/stage cycle ergometer, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of the ramp versus standard exercise protocols. 201 51

Ten patients with severe heart failure, symptomatic despite treatment with diuretics and captopril, completed a study of the effect of adding enoximone to their normal treatment. Enoximone or matching placebo was given for 4 weeks in randomized double-blind order following a single-blind placebo run-in period. Exercise capability was measured with two different treadmill protocols, a corridor walk test and by step-counting with body-worn pedometers. Cardiac output and limb blood flow were assessed non-invasively by measuring respiratory gases and by venous occlusion plethysmography. Measurements were made at rest and in response to treadmill exercise. The mean exercise tolerance measured using the modified Bruce treadmill protocol was increased from the placebo value (498 +/- 91 seconds) after both 2 weeks (573 +/- 94 seconds, P = 0.051) and 4 weeks of enoximone (572 +/- 100 seconds, P = 0.057). Enoximone increased exercise duration in fixed workload tests from the placebo value (252 +/- 75 seconds) after 2 weeks' treatment (431 +/- 98 seconds, P = 0.011) and after 4 weeks (381 +/- 85 seconds, (P = 0.01). The percentage improvement with the fixed workload test was greater than with the modified Bruce protocol at week 2 (P = 0.03) and at week 4 (P = 0.051). Enoximone increased the speed of walking 100 m at self-selected slow, normal and fast paces. It had little effect on customary activity of the patients. Enoximone increased cardiac output measured at rest and during submaximal exercise (P = 0.001). It also improved blood flow to the calf muscle at rest and after exercise (P = 0.01). Enoximone has a beneficial effect in chronic heart failure symptomatic despite treatment with diuretics and captopril. The magnitude of its effect, however, depends upon the technique used to assess it.
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PMID:Effects of enoximone in patients with heart failure uncontrolled by captopril and diuretics. 214 38

Brucella endocarditis, although a rare complication of brucellosis, is the main cause of death related to this disease. This report describes a case of aortic endocarditis due to Brucella abortus in an elderly farmer with known aortic stenosis. Urgent valve replacement was performed because of progressive heart failure despite appropriate antimicrobial treatment. The infection was cured with trimethoprim-sulfamethoxazole and rifampin given for 3 months after surgery. A review of the literature reports on the 38 other cases of cured brucella endocarditis made clear the need for combined antimicrobial treatment and surgical valve replacement.
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PMID:Brucella endocarditis: the role of combined medical and surgical treatment. 223 11

A submaximal treadmill exercise test performed before hospital discharge after an uncomplicated myocardial infarction is often utilized to estimate prognosis and guide management, but there is little experience with a maximal exercise test performed 6 months after infarction to identify prognosis later in the convalescent period. The performance characteristics during an exercise test 6 months after myocardial infarction were related to the development of death, recurrent nonfatal myocardial infarction and coronary artery bypass surgery in the subsequent 12 months (that is, 6 to 18 months after infarction) in 473 patients. Mortality was significantly greater in patients who exhibited any of the following: inability to perform the exercise test because of cardiac limitations, the development of ST segment elevation of 1 mm or greater during the exercise test, an inadequate blood pressure response during exercise, the development of any ventricular premature depolarizations during exercise or the recovery period and inability to exercise beyond stage I of the modified Bruce protocol. By utilizing a combination of four high risk prognostic features from the exercise test, it was possible to stratify patients in terms of risk of mortality, from 1% if none of these features were present to 17% if three or four were present. Recurrent nonfatal myocardial infarction was predicted by an inability to perform the exercise test because of cardiac limitations, but not by any characteristics of exercise test performance. Coronary artery bypass surgery was associated with the development of ST segment depression of 1 mm or greater during the exercise test. Although clinical evidence of angina and heart failure 6 months after infarction was predictive of subsequent mortality among all survivors, among the low risk group without severely limiting cardiac disease, the exercise test provided unique prognostic information not available from clinical assessment alone. Therefore, a maximal exercise test performed 6 months after myocardial infarction is a valuable, noninvasive tool to evaluate prognosis. It provides information that is independent of and additive to clinical evaluation performed at the same time.
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PMID:Prognostic significance of the treadmill exercise test performance 6 months after myocardial infarction. 287 18


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