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

The numerous metabolic abnormalities encountered in chronic purgative abusers were investigated and the new concept of autonomous pseudo-Bartter's syndrome documented. Detailed metabolic screening tests were performed in 9 women aged 17-54 years. Two patients underwent further studies, including serum renin and aldosterone, blood volume, total body potassium, urinary chloride and prostaglandin determinations, and each underwent renal biopsy on admission and after 1 year free from laxative abuse. Clinical complications included confusion, convulsions, coma, skeletal muscle weakness with or without paralysis or rhabdomyolysis, cardiac failure, urinary tract infections and bone disease (osteomalacia, secondary hyperparathyroidism and osteoporosis). Hypokalaemia, hypomagnesaemia, hypocalcaemia and hypophosphataemia were frequent findings. Serum creatine kinase correlated inversely with the product of the potassium and serum phosphate (r = -0.86; P less than 0.03), suggesting that hypokalaemia and hypophosphataemia act synergistically to produce muscle damage. After laxative withdrawal, oedema and weight gain, followed by diuresis, ensued in 7 patients. In the other 2, ongoing chloruresis, kaliuresis, hyper-reninaemia and raised urinary prostaglandin secretion persisted. Renal biopsies in these 2 patients showed the features of juxtaglomerular apparatus hyperplasia as well as medullary interstitial cell hyperplasia. In conclusion, pseudo-Bartter's syndrome was documented in 9 chronic laxative abusers. Because patients often indulged in more than one aberrant habit, e.g. laxative and/or diuretic abuse or bulimia, the clinical syndrome produced a myriad of confounding metabolic derangements, which we termed 'metabolic madness'. Laxative withdrawal was complicated by temporary pseudo-idiopathic oedema, which persisted in 2 patients. Further studies in these 2 women strongly supported the concept of 'autonomous pseudo-Bartter's syndrome'.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Chronic laxative abusers with pseudo-idiopathic oedema and autonomous pseudo-Bartter's syndrome. A spectrum of metabolic madness, or new lights on an old disease? 225 4

The case of a patient developing hypomagnesemic encephalopathy and coma secondary to intensive treatment for severe cardiac failure, is reported. Following an early improvement of symptoms and signs of cardiac failure, a rapidly developing neurologic disorder appeared. This was characterized by insomnia, agitation, mental derangement and, finally, sopor and I-II degree coma. Serum magnesium concentration was 1.0 mEq/l. Magnesium sulfate iv infusion was followed by a immediate and complete recovery from the neurological disorder. Patients with cardiac failure undergoing prolonged intensive therapy are prone to develop hypomagnesemia. This electrolyte alteration may be responsible for symptoms and signs of central nervous system involvement (metabolic encephalopathy) that need to be differentiated from those of organic origin.
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PMID:[Hypomagnesemic coma in heart failure: description of a case]. 237 57

In the acute neurosurgical setting, nonketotic hyperosmolar hyperglycemic coma (NHC) is thought to be caused by cerebral dehydration therapy and administration of steroids, glycerol, or mannitol. The mortality of this complication is reportedly very high, and is due to acute renal and/or cardiac failure. The authors evaluated the effect of low-dose dopamine (LDD; 1 to 5 micrograms/kg/min) administration in 10 patients with this syndrome. LDD was given to five patients. In these cases, hypovolemia was treated under central venous pressure monitoring with an iso-osmolar hyponatremic lactate solution given in a volume greater than the urine output. After the hypovolemia was corrected, the fluid was administered in a volume equal to the urine output until the serum osmolarity was normalized. In the five patients not given LDD, a large quantity of hypotonic solution was rapidly administered. In all patients treated with LDD, the urinary sodium increased and the urinary output stabilized. Consequently, the excess urea-nitrogen and serum sodium were quite easily washed out. The total net intake volume for the normalization of serum osmolarity was small and the duration of treatment was much shorter than that of patients not treated with LDD. The LDD regimen was not associated with complications, such as aggravation of cerebral edema, renal failure, or cardiac failure. On the other hand, three of the five patients not given LDD died of acute renal and/or cardiac failure without normalization of laboratory data. It is emphasized that this therapy, which results in beta-effect of catecholamine, sodium diuresis, and increased renal blood flow, is a practical means of managing acute neurosurgical cases complicated by NHC.
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PMID:[Low-dose dopamine treatment of patients in nonketotic hyperosmolar hyperglycemic coma]. 248 37

We retrospectively analyzed the records of 63 consecutive patients with spontaneous intracerebral hemorrhage (ICH) who had been treated in our neurological intensive care unit from 1981 to 1985 (aged 17 to 84 years). In this sample, the prognostic value of initial clinical and laboratory findings was studied. The following factors were significantly correlated with mortality: concomitant cardiac failure, general atherosclerosis, and chronic obstructive pulmonary disease; coma or deranged brainstem reflexes on admission; concomitant intraventricular or subarachnoid hemorrhage, hydrocephalus and midline shift on CT scan. ICH location did not significantly correlate with outcome. Among lobar ICH occipital hematomas carried the best prognosis. No prognostic importance was detected for age and gender, initial blood pressure, time interval between ICH and admission, ECG or angiographic findings, or laboratory values.
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PMID:[Prognostic significance of initial clinical and instrumental parameters in spontaneous intracerebral hemorrhages]. 339 30

Decisions about when to perform cardiopulmonary resuscitation (CPR) are frequently made without knowing the wishes of the patient. To evaluate the feasibility of outpatient discussions about CPR, the authors surveyed 22 male and 53 female, mentally competent, ambulatory patients 65 years of age and older. Only 7% of those interviewed had an accurate understanding of what CPR meant before hearing a standardized description. Eighty-seven per cent thought discussions about CPR should take place routinely, but only 3% had previously discussed this issue with their physicians. Seventy per cent felt such discussions should take place during periods of health, and 84% felt their views should be part of the medical record. When asked about three terminal illnesses, a minority of patients wanted CPR: 25% felt CPR was indicated in the presence of irreversible coma, 28% for terminal cancer, and 41% for irreversible heart failure. More patients felt they would request CPR if they had irreversible heart failure than if in a coma (p less than 0.002) or for terminal cancer (p = 0.002). The majority of elderly outpatients have clearly defined opinions about the application of CPR and wish to discuss them with their physicians.
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PMID:Discussing cardiopulmonary resuscitation: a study of elderly outpatients. 340 92

Blood gas and haemodynamic changes caused by chronic respiratory insufficiency affect the right ventricle and produce chronic cor pulmonale. Equally important but less well known modifications affect the left ventricle and the general circulation and are the subject of the present report. Hypoxemia, hypercapnia and acidosis caused by severe hypoxia create functional disturbances in both ventricles that are manifested in a volume overload that added to other major malfunctions provoke congestive heart failure. The coronary circulation is affected by metabolic factors, perfusion alterations, right ventricular hypertrophy and concomitant coronary lesions. Advanced respiratory insufficiency caused by poorly compensated respiratory acidosis and metabolic acidosis reduces cardiac output and frequency so that tissue perfusion is compromised. Furthermore alterations in transmembrane electrolytic concentrations produce repeated multifocal ventricular arrhythmias that expose the patient to the risk of sudden death. Cardiac failure is reflected in other organs like the kidney and the central nervous system and also contributes to tissue and cerebral hypoxia. The later depresses the respiratory centres and develops into often irreversible coma. A better knowledge of these elements may contribute to the development of appropriate treatment.
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PMID:[General cardiocirculatory effects in chronic respiratory insufficiency]. 354 42

A case of intoxication with 5 g of elemental iron (25 g of ferrous sulfate) in a 30-year old woman at 36 weeks gestation is reported. Deferoxamine treatment was given with a delay of 26 hours after ingestion. A healthy infant was delivered by cesarean section 31 hours following ingestion. Subsequently, the patient developed hepatic necrosis, coma and hemostatic dysfunction and expired in cardiac failure after two weeks. The fatal outcome supports the view that the potential lethal dose of iron is lower for adults than for children. This case also demonstrates that major hepatic dysfunction can be a prominent feature of adult cases of iron intoxication. It is not unequivocal that early institution of deferoxamine treatment would have had a significant influence on the outcome. However, taking into account the well-documented efficacy of the drug in children and that no major adverse fetal effects have been associated with deferoxamine treatment in pregnancy, we suggest such antidote therapy to be considered for prompt institution in similar cases.
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PMID:Fatal iron intoxication in late pregnancy. 366 20

The administration of digitalis glycosides causes a variety of extracardiac effects. In both normal human subjects and in other species, digitalis increases smooth muscle tone of resistance and capacitance vessels. The vasoconstriction is mediated, in part, by a direct action of these glycosides on smooth muscle and, in part, by an increase in alpha-adrenergic tone. Constriction of coronary and splanchnic vessels may lead to myocardial or mesenteric ischemia. In contrast to normal subjects, patients with congestive heart failure demonstrate arteriolar and venodilation in response to these glycosides, possibly because the myocardial effect, to increase cardiac output and peripheral blood flow, overcomes the vasoconstrictor properties of these drugs. Other important actions of digitalis glycosides occur in the central and peripheral nervous systems. Their effects on the area postrema of the medulla oblongata are largely responsible for the alpha-adrenergic-mediated peripheral vasoconstriction, as well as the nausea and vomiting that frequently accompany digitalis intoxication. Actions of glycosides on the cerebral cortex are responsible for the wide range of neurotoxic effects that range from visual disturbances and headaches to seizures and coma. Finally, peripheral neurologic effects of digitalis glycosides on baroreceptor and cardiac afferent fibers may: improve the depressed function of these receptors in the situation of heart failure, and reflexly lower peripheral vascular resistance, thereby partially preventing the vascular constrictor action of these glycosides.
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PMID:Extracardiac and coronary vascular effects of digitalis. 388 56

Hemodynamic effects of amrinone were studied in 2 groups of patients after open heart surgery. Group I consisted of 10 patients with moderate heart failure. In the absence of inotropic agents, their mean cardiac index (CI) was 2.02 +/- 0.41 liters/min/m2 and mean pulmonary capillary wedge pressure (PCWP) 19 +/- 3 mm Hg. Amrinone was administered 24 hours postoperatively by bolus injection (2 mg/kg) and by 12-hour infusions (20 micrograms/kg/min). Hemodynamic data and plasma concentrations were obtained 10 and 20 minutes after the bolus injection and at 1, 4, 8 and 12 hours during infusion. Significant beneficial changes were noted in CI, PCWP, right atrial pressure, systemic vascular resistance and pulmonary vascular resistance. Group II consisted of 5 patients in severe cardiogenic shock (mean CI 1.97 +/- 0.3 liters/min/m2, mean PCWP 28 +/- 8 mm Hg) despite adrenergic agonists in all patients and intraaortic counterpulsation in 2. After these measures, amrinone was given intravenously for 36 to 72 hours as additional inotropic support. Significant improvement was observed in CI, PCWP, right atrial pressure, systemic vascular resistance and pulmonary vascular resistance. Four patients in this group were discharged; 1 patient died after 5 days in acute renal failure and coma grade IV. No serious adverse effects of amrinone were observed in any group II patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Amrinone in the management of low cardiac output after open heart surgery. 402 58

Althesin was used in 65 patients with heart diseases undergoing orthopedic surgery, alone or in association with neuroleptanalgesic drugs. Patients were classified according to four types of heart diseases: atrial fibrillation in older patients (41.53%), disorders of cardiac rhythm (23.07%), valvular diseases (9.23%), ischemic heart disease (26.15%) and according to the degree of risk (ASA 3 and 4). All patients were carefully studied before the operation, and adequately treated with cardiac drugs in order to reduce heart rate, to reduce blood pressure and to reduce heart failure, whenever necessary. Anesthesia was induced with Althesin in all patients, and maintained with Althesin/N2O/O2 in 24.61% of the cases, and Althesin/N2O/O2/NLA in 75.39% of the cases. No significant changes in heart rate or in blood pressure were observed either during surgery or in the first 24 hours after the operation. There were five deaths in the days after the operation, one of which was due to surgery. One patient was discharged while still in a coma. All the other patients were discharged from the hospital within approximately four weeks from the day of the operation in good general condition. It was concluded that Althesin is a very reliable anesthetic agent for patients with heart diseases.
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PMID:Althesin in high risk patients with heart disease in orthopedic surgery. 403 Jan 59


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