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

Complications of infective aneurysm are not rare in patients with infective endocarditis. An optimal timing of heart operation after brain surgery for hemorrhage is controversial. We reported a 19-year-old woman with ventricular septal defect (type II), mitral regurgitation and ruptured cerebral aneurysm with infective endocarditis. Cerebral aneurysm had been ruptured during infective endocarditis treatment. Resection of the aneurysm was performed next day. Vessel spasm occurred, resulting in cerebral infarction 7 days after the operation. Conservative therapy was continued for infective endocarditis until heart failure appeared. Heart operation was successfully performed 41 days after brain surgery without cerebral complication. This report indicates that heart operation might be avoided at the early postoperative stage of brain surgery for cerebral aneurysm with hemorrhage.
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PMID:[A case of heart operation in infective endocarditis after brain surgery for mycotic cerebral aneurysm]. 1071 13

Warfarin is effective in preventing thromboembolism in patients with atrial fibrillation, but aspirin is frequently used as an alternative treatment. A multicenter, retrospective study was undertaken to identify patients at risk for thromboembolism during treatment with aspirin. The study group consisted of 470 patients (318 males, 152 females, mean age 59.9 +/- 11.8 years at initial examination) with atrial fibrillation who were treated with aspirin. Thirty-seven percent of patients had paroxysmal atrial fibrillation and 65% of patients received aspirin at a daily dose of 81 mg. Thromboembolism occurred in 31 patients (6.6%) during the follow-up period, resulting in cerebral infarction in 19 patients, transient ischemic attack in 7, and embolism of peripheral arteries in 5. Patients with thromboembolism had lower prevalence of New York Heart Association (NYHA) functional class I (52% vs 72%, p < 0.02) and paroxysmal atrial fibrillation (23% vs 38%, p = 0.085) compared with patients without thromboembolism. Multivariate analysis with the Cox proportional hazard model determined age (> or = 65 years, relative risk 2.29, p = 0.032) as an independent risk factor. NYHA functional class (> or = class II) tended to indicate an increased risk of thromboembolic events (relative risk 1.90, p = 0.076). These results suggest that aspirin has limited efficacy for prevention of thromboembolism in patients with atrial fibrillation who are old (> or = 65 years) or have symptomatic heart failure.
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PMID:[Risk factors for thromboembolism in patients with atrial fibrillation during treatment with aspirin: a multicenter, cooperative retrospective study. Research Group for Antiarrhythmic Drug Therapy]. 1083 81

We presented 20 patients, who were underwent combined valve and coronary artery bypass surgery in our institute from September 1995 to December 1999. They were 13 male and 7 female, ages ranged from 54 to 79 (mean 67.5 years). Previous cardiac operation was done in 2 cases. The patients carried out a combination of CABG with aortic valve replacement (n = 9), mitral valve replacement (n = 4), mitral valve plasty (n = 6), double valve replacement (n = 1). Emergency operation was performed in 2 cases. The hospital mortality was 5%. One patient who was underwent mitral valve repair and CABG died due to severe heart failure 2 week post operatively. The perioperative complications were found in 2 patients, one was acute renal failure with HD, the other was cerebral infarction. There are no patient with perioperative myocardial infarction. The combined operation of valvular surgery and CABG for the patients with coexisting disease might be safety and reliable methods, even in older one.
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PMID:[Combined CABG and valve operation]. 1093 71

The use of extracorporeal assist devices in heart failure is associated with the risk of thromboembolic complications [1]. Prove of thromboembolic material in the ventricles and tubes of the assist devices is difficult, and the clinical relevance of thrombotic material in the tubes is not clear. Here, we report on a patient with severe heart failure caused by endstage dilated cardiomyopathy who was bridged to transplantation using a biventricular assist device (BVAD). Five weeks after implantation, transcranial Doppler sonography (TCD) revealed high intensity transient signals (HITS) in basal cerebral arteries, suggesting continued cerebral microembolism. Apart from a correlation of these Doppler sonographic findings with neurological symptoms, macroscopic evidence of fibrin thrombi in the artificial ventricle, and post mortem confirmation of cerebral infarction could be proved.
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PMID:Doppler-sonographic evidence of cerebral microembolism originating from a biventricular assist device. 1110 Jul 64

The emergence of heart transplantation as the ultimate treatment for end-stage heart failure has been accompanied by new diagnostic challenges. Computed tomography (CT) has emerged as an important diagnostic tool in the evaluation of heart transplant recipients because many infectious, ischemic-hemorrhagic, and neoplastic complications are amenable to early detection with this modality. In the early postoperative period, CT is mostly indicated in the evaluation of infectious complications or cerebral symptoms. Later, CT is mostly performed for staging of infectious or neoplastic disease. Infectious complications include mediastinitis, soft-tissue inflammation, abscess formation, cerebral infarction, and aspergillosis. Complications related to ischemia or hemorrhage include allograft rejection and coronary allograft vasculopathy, the latter being the leading long-term cause of death in heart transplant recipients. CT is also indicated in malignant disease (eg, lymphoma, visceral carcinoma, skin tumors), which is the second most important long-term cause of death. Moreover, CT is helpful in identifying disease caused by immunosuppressive therapy (eg, leukoencephalopathy, osteoporosis, thoracic lipomatosis). CT has proved superior to both ultrasound and magnetic resonance imaging in the evaluation of heart transplant recipients. It has become the diagnostic modality of choice for many transplant-related complications and may help improve postoperative treatment of affected patients.
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PMID:CT of heart transplant recipients: spectrum of disease. 1111 18

Based on the results of the Cardiac Arrhythmia Suppression Trial (CAST), strategies for the treatment of tachyarrhythmias have changed rapidly. The Japanese Antiarrhythmics Long-Term (JALT) study was planned to investigate the present methods for choosing antiarrhythmic drugs, and the effects on long-term prognosis in patients with tachyarrhythmias in Japan. Following a 6-month preliminary study (JALT-1), there was a multicenter nonrandomized prospective study (JALT-2), with a 2-year follow-up, of patients with paroxysmal atrial fibrillation (PAF), sustained ventricular tachycardia (SVT) and nonsustained VT (NSVT). Four hundred fifty-five patients were registered, and 361 of them (79%) were analyzed. Cerebral infarction occurred in 10 of 193 patients (5.2%) with PAF. Transition to chronic AF was observed in 21 patients (10.9%), but in none of the patients receiving Ca antagonist therapy. Twenty-five patients died: 5 deaths were arrhythmic, 10 were because of pump failure, and 9 were noncardiac. The most significant difference in drug selection between JALT-1 and JALT-2 was the increase in the use of slow kinetic Na channel blockers for PAF and the decrease in the use of the same agents for VT in the JALT-2 study. A marked change of therapeutic strategy occurred in JALT-2 compared with JALT-1. Most patients with a poor prognosis had underlying heart diseases and heart failure, but the per annum rate of death by arrhythmia and pump failure in JALT-2 was less than that in JALT-1.
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PMID:Multicenter prospective nonrandomized study of long-term antiarrhythmic drug therapy in patients with tachyarrhythmias: Japanese Antiarrhythmics Long-Term Study-2 (JALT-2 Study). 1131 22

Intra-aortic balloon pump counterpulsation (IABP) was used to treat two patients with symptomatic vasospasm after subarachnoid hemorrhage. One could not tolerate triple H therapy (hypertensive hypervolemic hemodilution) because of poor cardiac function and another suffered acute myocardial infarction after aneurysm surgery followed by cardiac failure. IABP increased cerebral blood flow and prevented cerebral infarction in the former case but this could not reverse cerebral ischemia in the latter. IABP may be one choice for patients with vasospasm after subarachnoid hemorrhage.
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PMID:[Two patients treated with intra-aortic balloon pump counterpulsation after subarachnoid hemorrhage]. 1155 17

A 76-year-old female had been followed in our hospital for dissecting aneurysm, cardiac failure, and cerebral infarction. Inguinal lymphadenopathy, anorexia, and weight loss were noted in June 1998. The histopathologic diagnosis of the biopsied lymph node was diffuse pleomorphic type non-Hodgkin's lymphoma with T-cellular phenotype, and the patient was referred to our department. She had human T-lymphotropic virus type I seropositivity, and PCR of the pX lesion disclosed a monoclonal band. She was ultimately diagnosed as having adult T-cell leukemia/lymphoma (ATL/L, stage IV). Since she had many severe complications, she was given low-dose etoposide (LD-ETP, 50 mg/day). Atypical cells disappeared from the blood, and lymphadenopathy regressed. No major adverse reaction was observed after LD-ETP. She continued to receive intermittent LD-ETP, but she developed pneumonia in June 2000, and died in August 2000. Autopsy disclosed no residual lymphomatous lesions. These findings suggest that LD-ETP is a well tolerable and effective treatment in patients with ATL/L even if there are severe complications.
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PMID:[Low-dose etoposide in a patient with adult T-cell leukemia/lymphoma who had severe complications]. 1157 38

In this study, 339 patients (154 men, 185 women) with a median age of 74 years (range 23-97) admitted to the Stroke Unit, Department of Neurology in 1986, have been followed up for 14 years. The diagnoses were intracerebral hemorrhage (ICH; 30, 8.8%), cardioembolic cerebral infarction (CE, 71, 20.9%), lacunar infarction (LI; 47, 13.9%) and atherosclerotic cerebral infarction (ACI; 191, 56.3%). The cumulative probabilities of recurrent stroke rates at 1-, 5- and 10-year follow-ups were 13.5% (95% confidence interval, CI, 9.6-17.4), 38.7% (95% CI 32.6-44.8) and 53.9% (95% CI 46.7-61.1). According to Cox proportional hazard regression analysis, age, severity of stroke, previous stroke and systolic blood pressure are each of importance in predicting recurrent stroke. During the observation period, 290 patients (85.5%) died. The mortality rate of 24.5% during the first year was 4.5 times higher compared to the normal population of the same age and gender. Patients with LI had lower mortality rates compared to ICH by the log rank test (p = 0.0275); to CE (p = 0.000) and to ACI (p = 0.049). Thirty-nine percent of all vascular deaths after the first year were caused by recurrent strokes. Fatal index/recurrent stroke occurred statistically more frequently in the CE group versus the non-CE one (p = 0.005). Cox proportional hazard regression analysis indicated that age, severity of stroke, previous stroke, heart failure and fasting blood glucose exceeding 6 mmol/l or history of diabetes were each predictors of mortality. In conclusion, this study has shown the worse outcomes for all subtypes of stroke compared to the normal population and also clearly pointed out independent predictors of recurrent stroke or death at the time of diagnosis.
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PMID:Survival and recurrent strokes in patients with different subtypes of stroke: a fourteen-year follow-up study. 1164 80

Insulin resistance and hyperinsulinemia have been observed in over 70% of the nonobese, nondiabetic subjects with essential hypertension (HT). Alpha-1 blockers, ACE-antagonists, long-acting Ca blockers including nifedipine CR, some form of beta-blockers, tilisolor, which is reported to increase blood flow, improve insulin sensitivity when blood pressure is better controlled. Decrease of serum potassium during insulin sensitivity test and intraplatelet free Ca2+ concentration is positively and negatively correlated with insulin sensitivity, respectively. Blood pressure is correlated with insulin resistance, which is also observed in secondary HT. The resistance is correlated with salt sensitivity as well as impaired nocturnal fall of blood pressure. These suggest the possible association of insulin resistance with altered intracellular cation metabolism. Insulin resistance and associated hyperinsulinemia have been observed in effort as well as vasospastic angina pectoris (VSAP), atherothrombotic cerebral infarction, and in ASO without obesity, HT, or diabetes, suggesting the resistance resulting from endothelial dysfunction. Insulin resistance has been observed in heart failure and is correlated with angiotensin II. Resistance is also observed in hypertrophic cardiomyopathy and is partially correlated with TNF-alpha. These results indicate that insulin resistance seem to be multifactorial. An effort to normalize insulin sensitivity is crucial to eliminate multiple risk factors as well as to prevent the progression of atherosclerotic vascular lesions.
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PMID:Multifactorial insulin resistance and clinical impact in hypertension and cardiovascular diseases. 1187 61


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