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

Systemic arterial compliance, a major component of aortic input impedance, was determined in 10 patients with congestive heart failure secondary to idiopathic dilated cardiomyopathy and 11 age-matched control subjects found free of detectable cardiovascular disease. Total arterial compliance was determined from high-fidelity ascending aortic pressure and velocity recordings using 1) the traditional monoexponential aortic diastolic pressure decay and 2) the direct solution of the equation, which describes the three-element windkessel model of the arterial system. Resting values for total arterial compliance (x10(-3) cm5/dyn) derived from method 1 were significantly correlated with compliance derived from method 2 (r = 0.89, P less than 0.01). However, method 1 values (control mean 1.15 +/- 0.27, heart failure mean 1.18 +/- 0.54) were consistently and significantly lower (P less than 0.001) than method 2 values (control mean 1.59 +/- 0.50, heart failure mean 1.38 +/- 0.60). Resting total arterial compliance in heart-failure patients was not significantly different from control subjects. Total arterial compliance did not significantly change with exercise in either group despite increases in arterial pressure. However, nitroprusside administration in the heart-failure group increased total arterial compliance both at rest and on exercise compared with the unmedicated state. These different methodological approaches to the estimation of total arterial compliance in humans resulted in significantly different absolute values for compliance, although both methods provided concordant results with respect to the response of arterial compliance to physiological and pharmacological interventions.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Estimation of total systemic arterial compliance in humans. 239 40

The incidence of congestive heart failure (CHF), derived from more than 30 years of follow-up, is examined by electrocardiogram (ECG) and radiography in relation to cardiac hypertrophy. Cardiac failure occurred in 485 of 5,209 subjects participating in the Framingham Study. Hypertension was the dominant predisposing factor for both cardiac hypertrophy and cardiac failure. The ECG pattern of left ventricular hypertrophy (ECG-LVH) heralded serious cardiovascular disease of all varieties, but risk ratios were two- to fivefold greater for the development of CHF in men and women (ages 35-64 years) than for any other sequelae. Risk of CHF in those with ECG-LVH exceeded that for unrecognized ECG patterns at myocardial infarction (ECG-MI). The ECG pattern of left ventricular hypertrophy, characterized by increased voltage unaccompanied by a repolarization abnormality, carried a decreased risk, chiefly reflecting the severity of coexistent hypertension. The independent contribution of ECG-LVH with accompanying repolarization changes to the risk of CHF was equal in the two sexes and persisted with advancing age. The ECG pattern of left ventricular hypertrophy was more strongly associated with occurrence of CHF than was radiographic enlargement, and contributed to the risk of CHF (taking radiographic heart size into account). Echocardiographic evidence of LVH (ECHO-LVH) was more common in subjects with CHF than was ECG-LVH, occurring in 63% of women and 77% of men with CHF, and LVH was the most frequently observed echocardiographic finding. Cardiac hypertrophy was found to be an ominous harbinger of cardiac failure, particularly when it was manifested on an ECG with repolarization abnormality.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Left ventricular hypertrophy and risk of cardiac failure: insights from the Framingham Study. 248 19

To evaluate the mechanism of sudden death in childhood and the physical activity levels at the onset of sudden death, we studied the following items: (1) the incidence and the circumstances surrounding sudden death at school in Kanagawa Prefecture, (2) high risk heart diseases detected among healthy school children by heart disease screening, (3) sudden cardiac death or near miss seen in outpatients with heart disease except congenital heart disease. Among total 15,156,346 school children, sudden death was observed in 97 subjects (M:77, F:20). Annual incidence of sudden death was 6.4 per 10(6). Of the 97 subjects, acute heart failure of unknown etiology was found in 60 (62%), cardiovascular disease in 18 (19%), cerebral vascular accidents in 14 (14%) and heat stroke in 5 (5%). Of the 78 subjects (M:64, F:14) considered as sudden cardiac death, 62 (79%) died during sports activities, and 16 (21%) died at rest. Of the 62 subjects, 29 died during track and field activities and 7 while swimming, both in physical education classes. Eighteen died during athletic club activities and 8 during extracurricular activities. Consequently, 54 subjects (87%) died in the presence of a school teacher. Of the 18 subjects with cardiovascular disease, 9 (hypertrophic cardiomyopathy in 3, myocarditis in 3, Kawasaki disease in 2 and long QT in one) were diagnosed initially by the autopsy study. Latent high risk heart diseases, detected among presumably healthy school children by the heart disease screening program, were the following: hypertrophic cardiomyopathy, long QT syndrome, Kawasaki disease and some arrhythmias (ventricular tachycardia, sick sinus syndrome, A-V block and atrial fibrillation). Follow-up observations of outpatients with heart disease revealed the same results as the heart disease screening program. In order to prevent sudden death at school, the following recommendations should be observed: 1) sports directors should learn "sports medicine in childhood", including primary cardiovascular resuscitation, 2) an accurate heart disease screening program should be operated to detect latent high risk heart diseases, advise on adequate medical treatment, and help ensure an appropriate selection of sports activities, 3) comprehensive autopsy studies should be performed.
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PMID:Sudden cardiac death in childhood. 263 28

The potent systemic and coronary vasodilatory properties of nisoldipine have been demonstrated in several studies in patients with cardiovascular disease. The increase in cardiac output results from enhancements of both stroke volume and heart rate, while coronary blood supply increases in excess of demand. There is evidence that nisoldipine favourably affects several indicators of myocardial ischemia during exercise such as time to onset of anginal complaints and ST segment changes. Furthermore, in patients with elevated left ventricular filling pressures and reduced cardiac pump function the drug tends to normalize these parameters, thus opening new avenues for the treatment of patients with heart failure. The effect of nisoldipine on the incidence of ventricular arrhythmias has not yet been studied in patients, but experimental evidence shows an antifibrillatory activity at doses which may, however, not be clinically applicable. Finally, in healthy men, nisoldipine partially inhibits platelet aggregation. This, together with a potential antiatherosclerotic effect, could be of additional benefit to patients with coronary artery disease.
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PMID:Actions of nisoldipine in cardiovascular disease. 266 29

There are now numerous angiotensin converting enzyme (ACE) inhibitors under development, clinical trial or in clinical use for cardiovascular disease, a situation analagous to the beta blockers. They currently vary in their chemical and physical structure, whether they contain a sulphydril group or are pro-drugs, and in their pharmacokinetics. Whether these differences will convey any special or particular clinical advantages to individual ACE inhibitors has yet to be established. Further research is necessary to determine whether tissue ACEs are merely isoenzymes or whether they differ in their functional properties. Different bioavailability in tissues of the individual ACE inhibitors could confer differing pharmacodynamic properties. ACE inhibitors have been a major advance in the treatment of hypertension and heart failure. In heart failure they have been shown to improve the haemodynamics, to improve symptoms, and most recently, to prolong survival. In hypertension, ACE inhibitors have some physiological advantages over current antihypertensive agents. They have several favourable cardiovascular effects without metabolic disadvantages which provide a theoretical basis for cardio-protection in hypertensive patients.
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PMID:Angiotensin converting enzyme inhibitors: differences and advantages for first line therapy in hypertension. 267 52

Diseases of the cardiovascular system are a major health-care problem. Nearly 50% of all deaths are due to cardiovascular disease. A number of cardiovascular patients experience heart failure, mostly of the left ventricle, and require some form of mechanical support. Cardiac-assist devices are used widely in the treatment of patients with damaged heart muscle. Cardiac-assist devices have been introduced recently to maintain circulation in heart failure patients, until a suitable heart transplant donor is found. Earlier types of left ventricular assist devices were the copulsation and the counterpulsation pumps, which increased the efficiency of the vascular system and decreased the workload on the failed heart. In this study, the authors investigated the performance of a valveless cardiac assist device that can be operated in copulsation, counterpulsation, or any intermediate mode with the left ventricle. The device has only one connection to the ascending aorta, no valves, and a common inlet/outlet. The authors measured the hemodynamic parameters in all modes and have suggested an optimal mode of operation in a left ventricular heart failure mode.
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PMID:In-vitro evaluation of a valveless cardiac-assist pump. 280 61

Heart failure is a common cardiovascular disorder that increases in prevalence with age. Older patients may respond differently than younger patients to the various classes of drugs used in the treatment of congestive heart failure (CHF). The responses of older patients (at least 65 years of age) were evaluated as part of a large multicenter trial utilizing angiotensin-converting enzyme (ACE) inhibitors in the treatment of CHF. A prospectively planned subgroup analysis of older CHF patients' therapeutic response to the long-acting (approximately 24-hour) ACE inhibitor lisinopril was compared with their response to captopril, a short-acting (less than eight-hour) ACE inhibitor. Symptomatic improvement occurred in both the lisinopril and captopril groups. Exercise duration also improved for patients treated with both agents. However, there was a tendency for lisinopril to be more effective than captopril (p = 0.08). Thus, the low level of renin activity often found in the plasma of older patients did not decrease the ability of the ACE inhibitors to improve effort tolerance. Left ventricular ejection fraction increased in patients treated with lisinopril but not in those treated with captopril. The improvement in left ventricular ejection fraction with lisinopril may be indicative of a more favorable prognosis in patients with CHF, since another long-acting ACE inhibitor, enalapril, reduces the rate of mortality associated with CHF. ACE inhibitors were generally well-tolerated by the older patients in the study. Therefore, ACE inhibitors appear to offer a useful therapeutic approach to the management of CHF in the older age group.
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PMID:Lisinopril and captopril in the treatment of heart failure in older patients. Comparison of a long- and short-acting angiotensin-converting enzyme inhibitor. 284 87

beta-Blocking drugs are widely used throughout the world and serious adverse reactions are relatively uncommon. Most of those which do occur are pharmacologically predictable and may be avoided by ensuring that patients who are to be given beta-blockers do not have a predisposition to the development of bronchospasm, cardiac failure or peripheral ischaemia. In some situations, the use of a beta 1-selective blocking drug may reduce the risk of a severe adverse reaction, but there is little evidence that other ancillary properties such as partial agonist activity are of relevance in this context. Long term experience with many of the beta-blockers in current use suggests that unpredictable major adverse reactions such as the practolol oculomucocutaneous syndrome are unlikely to be repeated, although some of these drugs may be associated with immunological disturbances and some have been implicated in the development of retroperitoneal fibrosis. beta-Blocking drugs appear to be associated with a number of subjective side effects including muscle fatigue, peripheral coldness and some neurological symptoms. These side effects are highly subjective and are therefore difficult to quantify and it is not known whether they are of major importance in terms of their effect upon patients' overall well-being. It cannot be assumed that simply because such side effects can be elicited that they do, in fact, matter. However, because beta-blockers are often prescribed for patients who have no symptoms and for whom the benefits of therapy are generally small, such side effects would be of considerable importance if they had an overall effect upon quality of life. There are theoretical reasons to suppose that the incidence and severity of such side effects may be related to the ancillary properties of the individual drugs, but there is little evidence that parameters such as beta 1-selectivity, or partial agonist activity are clinically important determinants of the severity of these side effects. Lipophilicity, however, may be associated with an increased incidence of neurological symptoms. beta-Blocking drugs may cause a variety of metabolic disturbances including an increase in serum VLDL-cholesterol concentrations. However, long term studies have not shown that such disturbances are associated with an increased risk of cardiovascular disease, indicating that such metabolic changes may not be of major importance in practice. beta-Blocking drugs may be involved in a number of interactions with other drugs, but few of these have been shown to be of clinical significance.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Adverse reactions and interactions with beta-adrenoceptor blocking drugs. 287 46

Congestive heart failure is the most important predisposing factor to the occurrence of sudden death in patients with cardiovascular disease. As left ventricular dysfunction deteriorates and symptoms of heart failure become evident, ambulatory ventricular arrhythmias become increasingly frequent and complex, and sudden cardiac death becomes an increasingly common occurrence. When the left ventricular ejection fraction has declined to less than 30 percent and symptoms of heart failure become refractory to treatment with digitalis and diuretics, 35 to 50 percent of patients will die of a lethal cardiac arrhythmia within three years. A number of factors interact to determine the occurrence of malignant ventricular arrhythmias in patients with congestive heart failure. Myocardial fibrosis and enhanced left ventricular wall stress may alter the electrophysiologic properties of the myocardium, but these factors may not be sufficient to explain the development of lethal rhythm disturbances. Neurohormonal activation may exacerbate the frequency and complexity of ambulatory arrhythmias in these patients, but such activation can persist for long periods without fatal electrophysiologic sequelae. Recent investigations suggest that electrolyte depletion may provide an important immediate precipitating cause for the occurrence of fatal ventricular tachyarrhythmias in the patient with severe left ventricular dysfunction whose susceptibility is markedly heightened by preexisting structural, hemodynamic, or neurohormonal factors. Further work is needed to determine if prophylactic therapy directed at preventing electrolyte depletion can favorably modify the long-term outcome of these severely ill patients.
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PMID:Immediate and long-term pathophysiologic mechanisms underlying the genesis of sudden cardiac death in patients with congestive heart failure. 288 74

Recombinant human erythropoietin is a major advance in the management of patients with chronic renal failure. The sustained dose-dependent rise in haematocrit which it produces effectively abolishes symptoms of anaemia, but at the cost of an increase in blood viscosity. This in turn predisposes to increased vascular resistance and the development of hypertension. Over half of all deaths of patients with end-stage renal failure are from cardiovascular disease, notably myocardial infarction, heart failure, and stroke, for which hypertension is a known risk factor. Erythropoietin-related increases in blood pressure are therefore of particular concern, and seem to be most severe in previously hypertensive patients. There is now a need to establish the optimum rate and extent of rise of haematocrit required to alleviate symptoms without incurring undue risk.
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PMID:Hypertension, blood viscosity, and cardiovascular morbidity in renal failure: implications of erythropoietin therapy. 289 90


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