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

The implementation of guidelines for medical therapy of heart failure may be problematic for the following reasons: 1. Elderly patients and women were underrepresented in large clinical trials which may limit their therapeutic impact in these patients. 2. Therapeutic decisions are influenced by co-morbidities like renal failure, obstructive airway disease (COLD, Asthma), stroke, and diabetes mellitus. We therefore discuss the differential therapy of heart failure in view of particular patient subgroups.
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PMID:[Differential therapy of heart failure. Which drug for which patient?]. 1552 78

During the dialysis procedure, arterial hypotension is one of the most common problems and it has been object of many studies. In hemodialysis, changes are produced in body volume through ultrafiltration that generate an increase in the production of thermic energy, which is removed during the treatment. The hypovolemia resulting from the removal of volume activates the sympathetic system, avoiding in this way heat loss and increasing body temperature that promotes vascular vasodilatation and interferes with the compensatory constrictive response to volume fall with consequent arterial hypotension. Patients with autonomic neuropathy would be the most affected by volume depletion and they are usually the ones that show the highest frecuency of hypotension episodes, typical of patients with diabetes. It has been proved before that the use of a cold bath does not decrease the efficiency of the dialysis treatment and improves the cardiovascular stability as well, mostly in patients proned to it, such as diabetics, elderly, and patients with cardiac failure. In this study, it was observed that patients showed low basal temperatures before dialysis treatment and that the use of bath temperature of 35.5 degrees C increased the temperature post dialysis less than with the standard bath at 37 degrees C. The bath at 35.5 degrees C decreased the episodes of arterial hypotension, with an improvement in patient's welfare, and lower requirement of attention and treatment costs.
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PMID:[Effect of the temperature of the dialysis bath in diabetics]. 1563 24

Two or three different solutions may be used to preserve thoracic and abdominal organs during a single procurement. The aim of this prospective, multi-center, noncomparative study was to evaluate the safety and efficacy of Celsior (study solution, solution S) as a flushing and cold storage solution for both thoracic and abdominal organs. Between August 1999 and July 2000, 72 consecutive multiple-organ procurements were performed using solution S as the sole solution for flushing out and cold-storing thoracic and abdominal grafts. Two hundred and sixty-four grafts were implanted into 245 recipients (131 kidneys, 9 kidney-pancreases, 69 livers, 34 hearts and 6 heart-lungs). The mean cold ischemia time was 21 h for kidneys (26%>24 h); 11 h 26 min for pancreases, 9 h 16 min for livers (23%>12 h), and 2 h 58 min for hearts and lungs. No cardiac failure or arrhythmia occurred on graft reperfusion. Fourteen percent of kidney recipients had delayed graft function. The mean serum creatinine level at 3 months was 123 +/- 41 micromol/l. All pancreas recipients were insulin-free at 3 months. Primary graft nonfunction occurred in one liver recipient. Complete hepatic artery thrombosis occurred in six liver recipients during the first month; four of these patients had a risk factor for thrombosis. All but three of the heart recipients were in sinus rhythm on day 1, and 65% were extubated on day 1. Inotropic drugs were necessary during the first 72 h in 25% of heart recipients. Twelve-month patient and graft survival rates were, respectively, 100% and 96% (kidney), 100% and 89% (pancreas), 88% and 83% (liver), 77.5% (heart) and 67% (heart-lung). These results suggest that Celsior, a ready-to-use solution, is safe and effective for multiple organ procurement and preservation.
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PMID:A single solution for multiple organ procurement and preservation. 1591 Feb 89

The paper presents the results of use of intraaortic balloon counterpulsation (IABC) in complex therapy for cardiogemic shock in 31 patients with perioperative myocardial infarction (PMI) developed during aortocoronary bypass surgery under extracorporeal circulation (EC) and cold cardioplegia. The diagnosis of PMI was confirmed by the ECG data (the emergence of new Q waves) and by the high level of CPC-MB (more than 6%). IABC was performed, by using a Kontron M-7000 apparatus. The time elapsed from the onset of myocardial infarction to the start of IABC averaged 15.7 + 4.3 hours and the duration of the latter did 105 +/- 13 hours. IABC was initiated in 4 (12.9%) patients in the operating room before EC, in 20 (64.5%) during disconnection from EC, in 7 (22.6%) patients, who were unresponsive to pharmacological therapy, 6-26 hours after surgery. All the patients were divided into 2 groups: (1) 22 patients who had benefited from complex therapy using IABC; they were all successfully disconnected from the balloon pump; (2) 9 patients with refractory heart failure who had died during IABC. The latter has been shown to be one of the effective treatments of PMI and cardiogenic shock during aortocoronary bypass surgery, which achieves hemodynamic stabilization in 70.9% of cases. The results of complex therapy for cardiogenic shock depend on the site and extent of myocardial infarction. Lesions to the anterolateroposterior or anteroseptal area of the left ventricle belong to poor predictors. The outcomes of treatment are poor if there are significant hemodynamic disorders that require, besides cardiotonic agents, the administration of large doses of agents having a potent vasopressor effect (adrenaline and noradrenaline). Improvements in left ventricular pump function, cardiac output, and a significant reduction in the doses of sympathomimetics within the first 12 hours of IABC should be considered to be a good predictor. With the complex treatment of cardiogenic shock, by using counterpulsation after aortocoronary bypass surgery is 51.6%. The early initiation of IABC within 6 hours following the development of myocardial infarction allows mortality to be reduced.
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PMID:[Intraaortic balloon counterpulsation in the treatment of perioperative cardiogenic shock-complicated myocardial infarction during aortocoronary bypass surgery]. 1593 96

A woman aged middle thirties presented with common cold-like symptoms, and was hospitalized due to hypotension and tachycardia. Echocardiography revealed pericardial effusion and preserved left ventricular fractional shortening (28%). Cardiac index, pulmonary capillary wedge and right atrial pressure were 1.8 l/min/m2, 15 and 13 mmHg, respectively. After drainage of pericardial effusion, cardiac index increased to 3.4 l/min/m2. On the fifth hospital day, left ventricular dysfunction developed (fractional shortening: 16%, cardiac index: 1.5 l/min/m2, pulmonary capillary wedge pressure: 18 mmHg, right atrial pressure: 12 mmHg), so percutaneous cardiopulmonary support was introduced. However, the heart failed in asystole and the cavity was occupied by massive thrombus, probably related to heparin-induced thrombocytopenia. This case of fulminant myocarditis passed through various clinical features of heart failure. She died on the 12th hospital day.
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PMID:[Fulminant myocarditis causing severe left heart failure and massive thrombus formation following cardiac tamponade: a case report]. 1609 28

The American lobster is a poikilotherm that inhabits a marine environment where temperature varies over a 25 degrees C range and depends on the winds, the tides and the seasons. To determine how cardiac performance depends on the water temperature to which the lobsters are acclimated we measured lobster heart rates in vivo. The upper limit for cardiac function in lobsters acclimated to 20 degrees C is approximately 29 degrees C, 5 degrees C warmer than that measured in lobsters acclimated to 4 degrees C. Warm acclimation also slows the lobster heart rate within the temperature range from 4 to 12 degrees C. Both effects are apparent after relatively short periods of warm acclimation (3-14 days). However, warm acclimation impairs cardiac function at cold temperatures: following several hours exposure to frigid (<5 degrees C) temperatures heart rates become slow and arrhythmic in warm acclimated, but not cold acclimated, lobsters. Thus, acclimation temperature determines the thermal limits for cardiac function at both extremes of the 25 degrees C temperature range lobsters inhabit in the wild. These observations suggest that regulation of cardiac thermal tolerance by the prevailing environmental temperature protects against the possibility of cardiac failure due to thermal stress.
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PMID:Temperature acclimation alters cardiac performance in the lobster Homarus americanus. 1695 43

A five-year-old boy with recurring tonsillitis and sleep apnea was admitted for tonsillectomy and tympanic membrane tubing. He presented with a history of bronchial asthma and hereditary spherocytosis without obvious cardiac failure symptoms. Anesthetic agents for induction included nitrous oxide, oxygen, and sevoflurane. Because oxygen saturation decreased immediately to 90%, tracheal intubation was performed. The patient began to wheeze. Sevoflurane concentration was increased but cardiac murmur (gallop), cold limbs and jugular vein distension were noted. Acute cardiac failure was diagnosed following a chest X-ray and cardiac echo showing an enlarged heart, CTR of 80%, left ventricular dilation, and contractile failure. Tympanic membrane tubing only was performed. Sevoflurane was discontinued and the patient was treated for the cardiac failure under an ICU oxygen tent. The patient was discharged when his general condition improved. He showed elevated levels of viral antibodies, suggesting myocarditis. Later he was treated for dilating cardiomyopathy before undergoing a heart transplant.
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PMID:[Cardiac failure in a child during anesthetic induction with sevoflurane]. 1698 22

Development of cardiopulmonary bypass has contributed to pediatric cardiac surgery, but at the dawn of cardiac surgery, simple deep hypothermia was used to avoid the deleterious effect of cardiopulmonary bypass. Between 1981 and 1990, 45 patients with simple cardiac anomalies underwent definitive surgery under deep hypothermia. Age at operation was 35 days to 20 months, and body weight was 2.3 to 8.0 kg. Under morphine and ether anesthesia, a median sternotomy was performed when the esophageal temperature reached 26.3 degrees C +/- 1.3 degrees C by the application of surface cooling. At a minimum esophageal temperature of 19.6 degrees C +/- 2.3 degrees C, inflow occlusion and cold cardioplegia were applied to induce circulatory arrest for 32.4 +/- 10.2 min. Direct cardiac massage was used to restore cardiac activity during rewarming. All but one patient was in New York Heart Association functional class I postoperatively. The latest cardiothoracic ratio was 49.8% +/- 4.7%. All but 2 patients are free from medication. Five of 30 patients showed developmental delay in the long-term; 2 of these had a long circulatory arrest period, and 3 had prolonged heart failure postoperatively. The other 25 patients had excellent physiologic and mental development. The long-term outcome of perfusionless hypothermic cardiac surgery is satisfactory when applied appropriately.
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PMID:Long-term outcome of intracardiac repair under simple deep hypothermia. 1713 Mar 18

When dilated cardiomyopathy (DCM) is surgically corrected, intraoperative intracardiac hemodynamic changes and additional ischemia of the disabling myocardium make special demands for anesthesia, prevention of cardiovascular insufficiency, and maintenance of circulatory oxygen-transporting function (COTF). For the development and evaluation of an anesthetic support protocol for patients with DCM, clinical parameters, hemodynamics and oxygen transport was comprehensively analyzed in 50 DCM patients aged 16-68 years in the intraoperative period of surgical correction of myocardial pathology. All the patients underwent implantation of an extracardiac mesh framework in combination, if required, with correction of mitral insufficiency under extracorporeal circulation (EC), drug-induced cold cardioplegia. Analysis of comprehensive clinical studies made it possible to provide scientific evidence and to successfully use the anesthetic support protocol for correcting operations of chronic heart failure in patients with DCM, the basic principles of the support being an effective preoperative preparation of a patient to attenuate the signs of congestive heart failure; preventive intraaortic balloon contrapulsation before surgery; overall monitoring of hemodynamics and oxygen transport; balanced use of anesthetic agents in the doses that exert no cardiosuppressive effect; preload optimization and postload reduction; the minimum use of catecholamines; prevention of arrhythmias; and a reduction in the duration of myocardial ischemia.
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PMID:[Anesthesiological provision of surgical correction of dilated cardiomyopathy in patients with chronic heart failure]. 1718 53

KT is the most effective therapeutic option for ESRF. We present our first experiences in a developing country. All children who underwent kidney transplantation since the inception of this program in July 2004 until 30 September 2005 were studied. Their demographic data, operative and peri-operative details, graft and host survival, and drug compliance are described here. Data were collected from patient records and nursing observation records. Eleven children were transplanted during this period (median recipient age 10.75 yr, range: 8-16). The median age of the donors was 41 yr (range: 38-45) and was the mother in eight, father in two and uncle in one. The median (range) follow-up period following transplantation was 12.5 months (7-12). The vascular anastomotic site was aorta and inferior vena cava in nine patients and the cold ischemia time was mean (s.d.) 1.9 h (0.96). All patients received steroids, cyclosporine and MMF for immunosuppression. Hypotension, heart failure and septicemia were common medical complications. Four were treated for acute rejection. Vascular anastomotic leak, burst abdomen, intestinal obstruction, intra-abdominal leak of supra pubic catheter and vesico-ureteric junction obstruction were surgical complications. There were no graft losses or deaths. Despite limited resources good outcomes are possible following renal transplantation in children in developing countries.
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PMID:First experiences of pediatric kidney transplantation in Sri Lanka. 1749 21


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