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

From 1974 through 1977 when our hospital mortality for aortic valve replacement and myocardial revascularization was 3.5% and 1.1%, respectively, hospital mortality for mitral valve replacement (MVR) was 8.3% (13/156)--as high as 14.9% in 1976. Transverse midventricular disruption (TMD) was present in 7 of 10 patients on whom an autopsy was done and was clinically diagnosed in 3 others without postmortem examination. Transverse midventricular disruption presented as refractory myocardial failure immediately on termination of bypass or later (1 to 5 days) after an initial period of good hemodynamics. It appeared to result when volume loading or afterload pressure was returned to the untethered ventricle after MVR performed with potassium-induced, cold cardioplegia and ischemic arrest. Operative techniques were modified to preserve a portion of the mitral suspensory mechanism, to extend the reperfusion interval following cardioplegia and ischemic arrest, and to control strictly ventricular volume and pressure loading following bypass. By utilizing these methods, TMD was avoided from 1978 through 1982, and hospital mortality for MVR was 3.7% (9/241). The improved hospital mortality and avoidance of TMD did not result from patient selection. Allowing adequate time for recovery of the myocardium after cardioplegia plus ischemic arrest prior to ventricular loading, preservation of mitral suspensory function, and strict control of preload and afterload pressures have been effective in lowering hospital mortality for MVR and have eliminated TMD in a 5-year period.
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PMID:Avoidance of transverse midventricular disruption following mitral valve replacement. 402 47

Ventilation and oxygen consumption were measured in awake, unrestrained and unintubated guinea pigs during chronic and acute exposure to cold or hypoxia. Specific VE and VO2 in acute and chronic exposure to cold were more than twice that of animals in normal environmental temperatures. Increased ventilation was mainly due to a 70% greater VT in cold. Cold-acclimated guinea pigs returned acutely to normal temperatures, maintained higher VE and VO2 than that of control animals. Acclimation to cold did not result in respiratory advantages over that of control animals acutely exposed to cold. In hypoxia-acclimated guinea pigs, specific VE was 30% higher than that of control animals due to an elevation in VT; however, VO2 was similar in both groups of animals. In contrast, acute hypoxia did not increase VE in control animals. This lack of ventilatory response to acute hypoxia apparently causes the marked erythropoiesis and the severe increase in hematocrit observed throughout chronic exposure to hypoxia. The high blood viscosity resulting from the increased hematocrit contributes to the right ventricular hypertrophy and cardiac failure in guinea pigs chronically exposed to hypoxia.
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PMID:Effects of cold and hypoxia on ventilation and oxygen consumption in awake guinea pigs. 405 93

The incidence of lymphopenia and eosinopenia in 10 patients admitted to hospital in heart failure was compared with that in 11 ;cold' admissions and 10 with acute diseases admitted via the Casualty Department. Plasma cortisol determinations were made simultaneously. A significant difference was found between the heart failure group and the ;cold' controls in respect of lymphopenia, eosinopenia, and cortisol levels. The ;acute' control patients showed an overlap with both groups. It is concluded that this lymphopenia is part of a response to stress.Seventy-two hours after admission there was no significant change in these values although the figures suggest the beginning of a return to normal.
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PMID:Occurrence of lymphopenia in heart failure. 590 84

There is an ancient area in Northern Nigeria inhabited mainly by traditionally-oriented natives, mostly Hausas and Fulanis. Women of these tribes traditionally deliver their babies at home under the care of midwives, using hospitals only as a last resort. Since cold is thought to carry puerperal illnesses, it is the practice among these people to initiate hot baths for mothers immediately after delivery. 2 major complication of the practice are peripartal cardiac failure and burns. The case is reported of 1 woman who was taken to a hospital with superficial burns as a result of the practice. She had continued to follow this practice despite earlier experience of cardiac failure by doing so. It may be easier to persuade these natives to use slightly colder water than to give up completely this entrenched practice.
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PMID:A complication of a traditional puerperal practice in Nigeria. 611 May 89

Beta-adrenergic receptor blocking agents have been receiving attention as first-line agents for the treatment of hypertension. However, a number of significant side effects of these drugs have been brought to light. The most important of these--increases in "atherogenic" lipid concentrations--may place treated persons at risk of coronary artery disease and myocardial infarction. Other side effects, including bronchospasm, heart failure, cold extremities, reduced insulin secretion and central nervous system effects, may preclude their use in many patients. However, because several major trials have shown that controlling blood pressure reduces the incidence of coronary heart disease and stroke, the use of antihypertensive therapy is likely to increase and to continue for longer periods. The physician must prescribe an agent with the fewest and most minor side effects. Alternatives to beta-blocking drugs, such as the alpha-receptor blocking agent prazosin, should be considered and evaluated because of the limiting side effect profile of beta blockers.
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PMID:Beta-adrenergic receptor blocking drugs in hypertension. With special reference to their use as initial therapy. 614 20

The clinical diagnosis of orthostatic hypotension (OH) is straightforward and usually does not require extensive laboratory testing. Symptoms of cerebral hypoxia may not occur even with low BP because of compensatory cerebral vascular autoregulation. Autonomic function tests may pinpoint the lesion in OH, but they should be selected carefully. Heart rate response to standing, the valsalva maneuver, the cold pressor test, and plasma norepinephrine levels are the most useful. General measures in management, eg, nocturnal head up tilt and use of a pressure-support garment, often will provide major relief of symptoms. The mainstay of drug therapy is fludrocortisone acetate, but edema, supine hypertension, and heart failure occur frequently. Other agents (eg, vasopressors, prostaglandin inhibitors, and beta-adrenergic blockers) may enhance effectiveness of therapy when combined with fludrocortisone acetate.
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PMID:Orthostatic hypotension. II. Clinical diagnosis, testing, and treatment. 614 41

The heart rate, cardiac output, coronary sinus blood flow, systolic and end diastolic left ventricular pressures, femoral arterial pressure and coronary oxygen arterio-venous difference were measured in 12 patients with stable coronary artery disease without cardiac failure on long-term betablocker therapy, before and 45 minutes after 2 or 3 mg sublingual molsidomine. The measurements were repeated in 8 patients during a cold pressor test. Under basal conditions, molsidomine decreased the systolic and end diastolic left ventricular pressures, mean femoral arterial pressure, cardiac output and double product. The coronary oxygen arterio-venous difference was unchanged. Coronary sinus flow and myocardial oxygen consumption decreased. In the 2 patients who were given 3 mg molsidomine, a progressive reduction in systolic left ventricular pressure to 70% or less than its initial value, necessitated immediate treatment with volume expanders. During the cold pressor test before molsidomine the systolic and end diastolic left ventricular pressures, mean femoral arterial pressure and the double product increased. Coronary sinus flow was unchanged overall: it decreased in 6 patients, increased in 2 patients and remained the same in 1 patient. Coronary resistance increased in 6 patients and decreased in only one patient. During the cold pressor test after molsidomine there was a significant reduction in the increase of systolic left ventricular pressure, mean femoral artery pressure and double product. Coronary sinus blood flow increased in 5 patients and decreased in only one case. Coronary resistance decreased in half the cases.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effects of molsidomine during the cold test in stable coronary insufficiency under beta-blocker treatment]. 615 Jun 93

From November 1977 to January 1981, 10 consecutive patients underwent intracardiac repair of the complete atrioventricular canal at our institution. Ages ranged from 14 months to 4.5 years (mean age 20 months). Four patients were predominantly of type A, while 6 were predominantly of type C according to Rastelli's classification. Three patients had associated cardiac anomalies (2 tetralogy of Fallot and one parachute mitral valve). Standard repair and correction of the associated anomalies were performed under cold cardioplegic cardiac arrest and deep hypothermia with low-flow perfusion or circulatory arrest. Two patients died early postoperatively in severe renal failure and one died 6.5 months postoperatively in cardiac failure due to progressive mitral valve incompetence. One patient, with parachute mitral valve, was reoperated and the mitral valve was replaced because of persistent mitral insufficiency. The patients were followed up for a period of 4 to 35 months (mean 14 months) with a total of 112 patient months. The result of the operation was very good and all patients with retarded growth curve preoperatively showed a marked acceleration of their growth curve after operation. The operative results in this group of patients are independent of age and weight at the time of operation but appear to be influenced by associated cardiac anomalies and by the quality and quantity of atrioventricular valve tissue available for reconstruction.
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PMID:Repair of complete atrioventricular canal in early childhood. 617 52

Both postural abnormalities and autonomic dysfunction have been identified in patients with chronic congestive heart failure (CHF). However, the effect of long-term vasodilator therapy on these phenomena has not been assessed. In this study the hemodynamic and plasma norepinephrine (PNE) responses to upright posture, as well as the cold pressor test and Valsalva's maneuver in 12 patients with severe chronic CHF during both acute and long-term captopril (CPT) therapy, were evaluated. This revealed an absence of the normal hemodynamic adjustments to upright posture and a blunted response of PNE. The heart rate and blood pressure responses to the cold pressor test and Valsalva's maneuver were similarly blunted. The reflex adjustments of systemic resistance during tilt improved with CPT therapy, but the absence of reflex tachycardia in the upright posture persisted. Additionally, there was improvement of the PNE response, and the responses of heart rate and blood pressure to the cold pressor test were virtually normalized during long-term CPT therapy. The abnormal response to the Valsalva maneuver persisted. In conclusion, hemodynamic and reflex-mediated responses to upright posture and the standard assessment of autonomic control mechanisms revealed abnormal patterns in heart failure. While the hemodynamic adjustment to postural changes and sympathetic responsiveness were improved with CPT, complete correction of these abnormalities did not occur. Whether the improvement was a nonspecific vasodilator effect or the result of specific CPT therapy remains to be determined.
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PMID:The effect of captopril on postural hemodynamics and autonomic responses in chronic heart failure. 629 65

We evaluated left ventricular function in 10 scleroderma patients with signs and symptoms suggestive of congestive heart failure. M-mode and two-dimensional echocardiography demonstrated normal to increased systolic function in all patients. The presence of pulmonary venous congestion on the chest radiograph was not useful in assessing left ventricular systolic function. Five of nine patients with normal to increased left ventricular ejection fraction (LVEF) had increased cardiothoracic ratios and increased pulmonary vascular markings. Left ventricular hypertrophy was associated with a worse New York Heart Association functional class, more pulmonary vascular congestion, and greater left atrial size. In the presence of normal systolic function and ventricular hypertrophy, diminished left ventricular diastolic compliance may account for the cardiac dysfunction in these patients. Cold pressor testing induced peripheral Raynaud's phenomenon in nine of nine patients; however, no ST segment changes or chest pain was provoked. In seven of nine patients there was no abnormal fall in LVEF. The mechanism for the fall in ejection fraction seen in two patients may be related to an increase in afterload or myocardial ischemia secondary to coronary atherosclerosis. We found little to suggest that a myocardial Raynaud's phenomenon affects left ventricular perfusion or systolic function. Clinical signs and symptoms of congestive failure as well as chest radiographs are poor indicators of impaired systolic function in scleroderma patients. Based on these findings, it appears that evaluation of left ventricular systolic function should include echocardiographic or angiographic study before such patients are treated for heart failure with inotropic agents.
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PMID:Left ventricular function at rest and during Raynaud's phenomenon in patients with scleroderma. 650 43


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