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

Patients with cardiovascular disease commonly present with problems requiring surgical treatment. They are more vulnerable than patients without cardiovascular disease to the cardiovascular stresses associated with general anesthesia and surgery--hypotension, hypoxemia, sepsis, and thromboembolism. Their risk of morbidity and mortality is higher. Certain clinical factors have a profound impact on the patient's likelihood of serious cardiac complications or death: Overt heart failure, recent myocardial infarction, and cardiac arrhythmias are the most worrisome. A careful clinical evaluation and formal assessment of the patient's risk dictate better perioperative monitoring and treatment. Early hospital admission provides time for control of other health problems. Prophylaxis with heparin and antimicrobial agents minimizes problems of thromboembolism and sepsis, respectively. Overaggressive treatment of hypertension is avoided, and withdrawal of propranolol or clonidine is carefully supervised. The use of digoxin is restricted to patients with atrial tachyarrhythmias or heart failure. Hemodynamic monitoring via a Swan-Ganz catheter or temporary transvenous pacing may be necessary for selected high-risk patients. Such careful evaluation, monitoring, and treatment are the clinician's methods for improving the chance for patients with heart disease to benefit from surgery.
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PMID:Perioperative care of patients with cardiac disease. 735 25

The local effects of angiotensin II (ANG II) on the heart may play an important role for the pathophysiology of cardiovascular disease. Numerous in vitro studies have demonstrated that angiotensin II has distinctive cellular effects in the cardiovascular system which are independent from its effects on blood pressure. These have led to the hypothesis that activation of the angiotensin system in the heart could be of functional relevance for the adaptive processes in several cardiovascular disorders such as cardiac hypertrophy heart failure. This concept has been further supported by clinical studies showing the beneficial effects of angiotensin-converting enzyme inhibitors in these circumstances. In order to study the gene regulation of renin-angiotensin system components in cardiac disorders we investigated the gene expression of angiotensin converting enzyme in human heart failure. Results showed that the enzyme is activated locally in this condition, supporting previous studies in animals. Taken together with recent evidence from genetic studies linking the enzyme to myocardial infarction and cardiac hypertrophy, our findings are in support of the notion that angiotensin converting enzyme plays a central role in cardiovascular physiology and pathophysiology.
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PMID:Role of the cardiac renin-angiotensin system in human heart failure. 748 29

Although substantial advances have been made in the management of cardiovascular disease, it remains the leading cause of death on the United States and many other countries, due to the impact of aging and other changes in patient demographics. Since cardiovascular complications are usually associated with stress, it is not surprising that perioperative complications (cardiac death, myocardial infarction, heart failure) occur in at least 10% of patients undergoing coronary artery bypass graft surgery, with such complications consuming an additional $2 billion annually in health care resources. In addition, the limitations of the newly mandated cost-saving methods have and will continue to have an impact upon the delivery of health care to cardiovascular patients. However, research and clinical studies in this area hold the promise of appropriate and cost-effective therapeutic approaches.
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PMID:Cardiovascular morbidity and CABG surgery--a perspective: epidemiology, costs, and potential therapeutic solutions. 757 28

Elevated blood pressure is a common and powerful predisposing factor for stroke, coronary disease, cardiac failure and peripheral artery disease imposing a 2-3 fold increased risk of one or more of these atherosclerotic sequelae. The risk ratio imposed by hypertension is greatest for cardiac failure and stroke, but in Western countries coronary disease is the most common and lethal hazard. In hypertensive men and women respectively, 35% and 45% of myocardial infarctions are silent or unrecognized necessitating routine periodic ECG examination for its detection. Comparison of the impacts of systolic and diastolic blood pressure gives no indication of a greater impact of diastolic pressure and isolated systolic hypertension is distinctly hazardous. Over-reliance on diastolic pressure to assess risk can be misleading, particularly in advanced age. Attributable risk estimates suggest that 78% of hypertension in men and 65% in women is directly attributable to adiposity, making weight control of paramount importance for primary prevention of hypertension. The likelihood of development of cardiovascular disease in the hypertensive patient is greatly enhanced by the presence of metabolically-linked risk factors and already existent cardiovascular conditions. These influence the urgency and choice of therapy. Rational and efficient assessment of the hypertensive candidate for cardiovascular disease requires use of a cardiovascular risk profile evaluating the joint effect of multiple risk factors and effective treatment improves multivariate risk.
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PMID:Framingham study insights into hypertensive risk of cardiovascular disease. 758 27

The epidemiological approach to investigation of cardiovascular disease was innovated in 1948 by Ancel Keys' Seven Countries Study and T.R. Dawber's Framingham Heart Study. Conducted in representative samples of the general population, these investigations provided an undistorted perception of the clinical spectrum of cardiovascular disease, its incidence and prognosis, the lifestyles and personal attributes that predispose to cardiovascular disease, and clues to pathogenesis. The many insights gained corrected numerous widely held misconceptions derived from clinical studies. It was learned, for example, that the adverse consequences of hypertension do not derive chiefly from the diastolic pressure, left ventricular hypertrophy was not an incidental compensatory phenomenon, and small amounts of proteinuria were more than orthostatic trivia. Exercise was considered dangerous for cardiovascular disease candidates; smoking, cholesterol, and a fatty diet were regarded as questionable promoters of atherosclerosis. The entities of sudden death and unrecognized myocardial infarction were not widely appreciated as prominent features of coronary disease, and the disabling and lethal nature of cardiac failure and atrial fibrillation was underestimated. It took epidemiological research to coin the term "risk factor" and dispel the notion that cardiovascular disease must have a single origin. Epidemiological investigation provided health professionals with multifactorial risk profiles to more efficiently target candidates for cardiovascular disease for preventive measures. Clinicians now look to epidemiological research to provide definitive information about possible predisposing factors for cardiovascular disease and preventive measures that are justified. As a result, clinicians are less inclined to regard usual or average values as acceptable and are more inclined to regard optimal values as "normal." Cardiovascular events are coming to be regarded as a medical failure rather than the first indication of treatment.
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PMID:Clinical misconceptions dispelled by epidemiological research. 758 24

Heart failure is a prevalent problem with increasingly high rates of mortality and morbidity. Frequent exacerbation of heart failure leads to multiple rehospitalizations and interferes with patients' quality of life. In addition, it induces excessive consumption of health care resources. This leads to detrimental repercussions for these patients. Studies that have looked at causes of heart failure exacerbation determine an implicit need for more nursing influence. This nursing influence requires the expertise of Master's-prepared advanced practice nurses (APNs) who have exceptional knowledge of cardiovascular disease. APNs can enhance quality and efficiency through coordination and provision of care in the hospital and outpatient settings. Future research is needed to support the role of the APN in the delivery of health care.
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PMID:Advanced practice nurses can refine the management of heart failure. 760 Apr 86

A systolic blood pressure greater than 160 mm Hg is a more significant risk factor for cardiovascular disease than a diastolic blood pressure greater than 95 mm Hg, regardless of a patient's age. Treatment of isolated systolic hypertension significantly reduces the incidence of both fatal and nonfatal cardiovascular events, even in patients who are over 80 years of age. Non-pharmacologic measures and behavior modification should be tried for three to six months in a patient with mildly elevated blood pressure (140 to 160 mm Hg/90 to 100 mm Hg). If these measures fail or the patient has target-organ disease or multiple cardiac risk factors, medication may be prescribed earlier. Half the usual recommended dose should be initially prescribed in the frail elderly. Long-acting diuretics or beta blockers are recommended first-line agents. Angiotensin-converting enzyme inhibitors, calcium channel blockers and alpha blockers have not been shown to reduce mortality in hypertensive patients who do not have comorbid disease. Angiotensin-converting enzyme inhibitors may benefit hypertensive patients with heart failure, and calcium channel blockers may help those with angina, especially vasospastic angina.
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PMID:Hypertension in the elderly. 863

Hypertension is a major contributor to cardiovascular disease, which imparts a threefold increased risk over that of normotensive persons the same age. It accelerates atherogenesis-promoting premature coronary disease, now its most common sequela. The effect of elevated blood pressure on cardiovascular disease morbidity and mortality in general and on coronary disease incidence in particular is independent of the influence of other predisposing atherogenic cofactors but is greatly affected by them. Elevated blood pressure is more often than usual associated with hyperlipidemia, hyperglycemia, hyperuricemia, excessive weight, elevated fibrinogen, and electrocardiogram (ECG) abnormalities, which enhance its impact. Hypertensive coronary candidates usually have an increased low-density lipoprotein/high-density lipoprotein (LDL/HDL) cholesterol ratio, impaired glucose tolerance. ECG abnormalities, or a cigarette smoking habit. These coexisting risk factors exert a greater influence than the character of the blood pressure elevation. Those at risk for hypertensive stroke have left ventricular hypertrophy (LVH), atrial fibrillation, cardiac failure, coronary disease, diabetes, or a cigarette habit. Cardiovascular risk ratios for hypertension diminish with advancing age, but this is offset by a higher absolute risk, making hypertension an important precursor of cardiovascular disease in the elderly.
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PMID:Hypertension as a risk factor for cardiac events--epidemiologic results of long-term studies. 769 48

Patients on dialysis have an age-adjusted death rate 3.5 times that of the general population. The most common cause of death in patients on dialysis is cardiovascular disease. We prospectively followed a cohort of 433 patients in three centers for a mean of 41 months. Mean hemoglobin level at the beginning of dialysis was 8.39 (+/- 1.7) g/dL, and the mean hemoglobin level during follow-up was 8.84 (+/- 1.5) g/dL. Using Cox's regression model, we found that anemia predicted mortality independently of age, diabetes mellitus, cardiac failure, hypoalbuminemia, serum creatinine, mean arterial pressure, or echocardiographic heart disease. The independent relative risk (RR) of mortality was 1.18 per 1.0 g/dL decrease in hemoglobin level. Anemia also independently predicted the de novo occurrence of congestive heart failure when the same covariates were controlled for (RR, 1.49 per 1.0 g/dL decrease). Anemia was also independently predictive of heart failure at the start of dialysis (RR, 1.14 per 1.0 g/dL decrease) and heart failure recurrence (RR, 1.25 per 1.0 g/dL decrease). Left ventricular hypertrophy is present in 75% of patients on dialysis at the start of therapy for end-stage renal disease. It independently predicts mortality. Our prospective cohort study identified increasing age, hypertension, and anemia as risk factors for its development. One controlled study and several uncontrolled studies demonstrated improvement (but not complete regression) of elevated left ventricular mass in patients on dialysis treated with recombinant human erythropoietin (epoetin).
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PMID:Cardiac function and hematocrit level. 770 71

Endothelins (ET) are a family of peptides with potent biological properties. Endothelial cells produce exclusively ET-1 while other tissues produce ET-2 and ET-3. The production of ET requires an increase in intracellular Ca2+. This increase can be induced by physical chemicals (i.e. hypoxia) or receptor-operated stimuli (i.e. thrombin, angiotensin II, arginine vasopressin, transforming growth factor beta 1, interleukin-1). Most of ET is released abluminally towards vascular smooth muscle and less luminally. The main vascular effect of ET are vasodilation (transient), profound and sustained vasoconstriction as well as proliferation of vascular smooth muscle. These biological effects are mediated by distinct receptors. Three ET receptors have been cloned, i.e. ETA-, ETB- and ETC-receptors. In vascular tissue ETA-receptors are expressed on vascular smooth muscle and responsible for vasoconstriction. ETB-receptors are expressed on endothelium and linked to nitric oxide and/or prostacyclin release. Activation of these receptors explains the transient vasodilation with intraluminal application of ET. Vascular smooth muscle cells can express ETB-receptors which contribute to ET-induced vasoconstriction particularly at lower concentrations. The role of the recently cloned ETC-receptor in the vasculature is still uncertain. ET production is increased (as judged from circulating plasma levels) in vascular disease and atherosclerosis in particular, in myocardial infarction and heart failure, pulmonary hypertension and renal disease. ET production is increased in arterial hypertension remains controversial. Non-peptidic ET antagonists have been developed which either block ETA- receptors or ETA- and ETB-receptors simultaneously. The advantage of ETA-receptors is that they leave the endothelium-dependent vasodilation to ET (via ETB-receptor) intact. However, ETB-mediated contraction remains unaffected by these antagonists. In contrast ETA-/ETB-antagonists fully prevent ET-induced vasoconstriction, however, they also inhibit the endothelial effects of the peptide. ET antagonists interfere with the effects of ET in isolated vascular tissue (including that obtained from humans) as well as in vivo. In humans, ETA as well as ETA-/ETB-antagonists inhibit endothelin-induced vasoconstriction. Hence in summary ET are a family of potent peptides with profound effects in the vasculature. Several studies suggest a role of ET in cardiovascular disease. The newly developed ET-antagonists are potent and selective tools to delineate the (patho-)physiological roles of ET and may become a new class of cardiovascular drugs.
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PMID:Endothelin and endothelin antagonists: pharmacology and clinical implications. 771 86


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