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

Unstable angina and acute coronary syndromes (ACS) without ST-segment elevation are frequent in the elderly and is associated to a very poor prognosis. The cause of mortality excess in the elderly has not yet been fully elucidated, even though the numerous comorbidities present in this age range play a non-negligible role. In every case, age is the most powerful prognostic factor for ACS without ST-segment elevation. The presentation and clinical characteristics of coronary disease in the elderly are particular and are essential to be recognized. Patients are mostly women with history of heart failure and myocardial infarction, and risk factors are predominantly diabetes and hypertension. The usual presentation is a "silent" MI or with atypical symptoms. Instead of typical chest pain, the coronary artery disease will be presented by dyspnea, neurological symptoms such as confusion, cognitive disorders aggravation, digestive disorders. This atypical presentation will have direct consequences on the therapeutic management of ACS, and sometimes it will even remain undiagnosed, and these explain also why complications will be more severe than in younger counterparts. Due to this atypical presentation, the physician should be careful and suspect an ACS in case of any non-explicated modification of physical and behavioral change in the elderly.
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PMID:[Clinical specificities of coronary artery disease in the elderly]. 1723 67

Heart failure is a disease with several definitions. The term "heart failure" is used by has brougth about confusion in the terminology. For this reason, the value of the ejection fraction (< 0.40 or < 0.35) is used in most meganalyses on the treatment of heart failure, avoiding the term "heart failure" that is a confounding concept. In this paper we carefully analyze the meaning of contractility, ventricular function or performance, preload, afterload, heart failure, compensation mechanisms in heart failure, myocardial oxygen consumption, inadequate, adequate and inappropriate hypertrophy, systole, diastole, compliance, problems of relaxation, and diastolic dysfunction. Their definitions are supported by the original scientific descriptions in an attempt to clarify the concepts about ventricular function and heart failure and, in this way, use the same scientific language about the meaning of ventricular function, heart failure, and diastolic dysfunction.
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PMID:[Understanding heart failure]. 1731 22

In clinical practice it is essential to bear stress-induced cardiomyopathy (SICMP) in mind as it is an insufficiently known cardiac pathology that mimics acute coronary syndromes (ACS), often with signs of cardiac failure. In the chronic phase, it poses differential diagnostic problems with regard to coronary artery pathology. Taxonomic confusion, due to the pathology also being called "takotsubo" or "ampulla cardiomyopathy", has resulted in inappropriate diagnoses and therapy. Available evidence strongly suggests that, in the presence of several cardiac risk factors, excessive sympathetic stimulation may induce this cardiomyopathy. The predilection of this cardiomyopathy for Mediterranean and Indo-Asian women, who represent 85% of cases, is probably explained by the fact that there is a significant correlation between female gender, a short (<158 cm) stature, a small (<1.9 m(2)) body surface area, and hypoplastic coronary arteries. Furthermore, 40% of SICMP patients have a hypoplastic branching of the coronary arteries in the apical region of the heart. This anomaly strongly favors the apical localization of the dyskinesia. The prognosis of SICMP is good as far as life expectancy is concerned. However, in most cases, the symptoms become chronic, medical treatment rarely improves dyspnea and chest pain, and the quality of life is, therefore, reduced. In this paper, we address diagnostic misunderstandings and we review the clinical and pathophysiological features of SICMP.
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PMID:Stress-induced cardiomyopathy: A review. 1769 25

We describe three cases of thyroid storm who developed sudden cardiorespiratory arrest soon after the administration of propranolol orally. CASE 1: A 43 years old Chinese lady presented with complaints of fever and chills. She had a urinary tract infection and also had signs of overt thyrotoxicosis. She was diagnosed to have thyroid storm and was started on oral propranolol, carbimazole and intravenous hydrocortisone and ceftriaxone. Soon after propranolol was given orally she developed an asystolic cardiorespiratory arrest. CASE 2: A 72 years old Chinese gentleman presented with confusion, fever and rapid atrial fibrillation. He was diagnosed to have thyroid storm and was started on oral propranolol, carbimazole and intravenous hydrocortisone and ceftriaxone. He developed a cardiorespiratory arrest about 6 hours after commencement of therapy. CASE 3: A 48-year-old Chinese gentleman presented with complains of dyspnoea and palpitations. He was diagnosed to have thyroid storm and was started on oral propranolol, carbimazole, intravenous hydrocortisone and antibiotics. About 12 hours after admission, he developed a cardiorespiratory arrest. All three patients developed cardiorespiratory arrest soon after the administration of propranolol orally. We conclude that in selective patients who have low output cardiac failure in association with severe thyrotoxicosis, it maybe advisable to avoid use of a beta blocker. A safer alternative is the use of ultra short-acting beta-blockers, such as intravenous esmolol, with extreme caution.
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PMID:Cardiovascular collapse associated with beta blockade in thyroid storm. 1770 86

An 81 year old female patient with chronic heart failure and atrial fibrillation receiving anticoagulant therapy, was admitted with progressive pain on her right leg for the past 24 hours, associated to local erythema, edema and warmth. The lesion evolved at the same site where she presented a chronic ulcer for the previous 5 months managed only with local care. At admission a necrotic plaque on the affected site was perceived; there was no hypotension or mental confusion but signs of a deep venous thrombosis on the involved leg were found. She was febrile (37.8 degrees C) and with tachychardia (126 per minute). Laboratory evaluation revealed normal white blood cell count and a subtherapheutic anticoagulant INR value. A chest x-ray showed infiltrates on the left lower lung lobe. On the following hours the lesion evolved with increasing pain, haemorrhagic bullae and a purulent discharge through the ulcer, with the patient developing mental deterioration, hypotension, respiratory failure and shock. The patient received intravenous ciprofloxacin and clindamycin and was operated 15 hours after admission performing an over-the knee amputation. A cardiac catheterization demonstrated a low cardiac output (2.3 L/min), and both a high systemic vascular resistance (2888 din.s.cm(-5)) and pulmonary capillary wedge pressure (17 cm H(2)0), results compatible with cardiogenic shock. Evolution was progressively worse and she died of multiple organic failure 36 hours after admission. Two blood culture samples grew Serratia marcescens. No necropsy was performed and cultures taken from the leg remained negative.
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PMID:[Fatal necrotizing fasciitis due to Serratia marcescens]. 1772 22

The renin-angiotensin-aldosterone system (RAAS) is critical in regulating systemic blood pressure, water and electrolyte balance, and pituitary gland hormones. These physiologies appear to be primarily mediated by the angiotensin II/AT(1) receptor subtype system. Overstimulation of this system can predispose cardiovascular disease (CVD) characterized by excessive vasoconstriction, fibrosis, and cardiac remodeling. If untreated, the patient typically displays a continuum of pathophysiologic conditions progressing from atherosclerosis to left ventricle hypertrophy (LVH), coronary thrombosis, myocardial infarcts, with heart failure as an endpoint. Intervention with antihypertensive therapy is necessary to inhibit this progression. RAAS blocking drugs appear to be the most effective approach. Diastolic heart failure patients benefit from treatment with angiotensin converting enzyme (ACE) inhibitors and angiotensin AT(1) receptor blockers (ARBs). Elderly CVD patients evidence age-related changes in body composition that alter the distribution and half-life of medications, thus presenting special challenges to treatment. The presence of comorbidities such as diabetes, renal dysfunction, liver insufficiency further complicates any therapeutic strategy. In addition, noncompliance because of cognitive impairment, depression, confusion due to the complexity of dose regimens, and lack of an appropriate social support system can disrupt positive outcome. The present review discusses the roles of an overactive RAAS and sympathetic nervous system as primary contributors to CVD. In addition, treatment strategies are discussed, focusing on middle aged and elderly hypertensive and heart failure patients.
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PMID:Pathways involved in the transition from hypertension to hypertrophy to heart failure. Treatment strategies. 1798 82

A 63-year-old woman with confusion and disorientation was referred to the Pulmonary Medicine Department of Afyon Kocatepe University. She was uncooperative and her peripheral oxygen saturation was 75%. She was on diuretic therapy for heart failure. An emergency intubation was planned due to the development of respiratory acidosis and hypoxemia, but the patient could not be intubated. After several attempts, intubation was successful only by digital manipulation of a lateral pharyngeal mass noticed incidentally. She was inadvertently extubated on the third day of intubation and an emergency tracheotomy was performed. Otolaryngological examination revealed a mass originating from the right palatine tonsil, and a computed tomography scan showed a hypodense mass extending from the uvula to the epiglottis. Under general anesthesia, the patient underwent a right tonsillectomy and a lipomatous mass (3.6x3.2x2.2 cm) and the palatine tonsil (3.5x1.1x0.8 cm) were resected. Microscopically, the tumor consisted of mature adipocytes with thin fibrous septae. It should be borne in mind that patients may be unaware of a tonsillar mass that may lead to serious dyspnea and difficult intubation.
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PMID:Tonsillar lipoma causing difficult intubation: a case report. 1818 98

The release of brain natriuretic peptide (BNP) is increased in heart failure (HF). The plasma concentrations of BNP and N terminal pro-BNP (NT-proBNP) fall after effective pharmacologic treatment of HF, which suggests that measurements of plasma BNP may be helpful in evaluating therapy. Despite the initial reports that suggested a positive effect of levosimendan on short- and long-term survival in patients with severe HF, the results of the recently presented large-scale clinical trials provided rather controversial results. Further clinical studies are needed to end the confusion regarding the effects of levosimendan on prognosis in patients with decompansated HF.
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PMID:The prolonged lowering effect of levosimendan on brain natriuretic peptide levels in patients with decompansated heart failure: clinical implications. 1788

A recent survey commissioned by The American Association of Heart Failure Nurses, The Preventive Cardiovascular Nurses Association, and The Society for Chest Pain Centers found that respondents had a striking lack of awareness and knowledge about heart failure. This article reviews the confusion and misperceptions surrounding heart failure, discusses implications of the survey findings, and offers suggestions for patients at risk for heart failure as well as professionals who work with these patients-including clinicians, researchers, and those in larger groups such as institutions and government bodies.
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PMID:Heart failure: a call to action. 1906 81

The number of people with heart failure is continually rising. Despite continued medical advances that may prolong life, there is no cure. While typical heart failure trajectories include the risk of sudden death, heart failure is typically characterized by periods of stability interrupted by acute exacerbations. The unpredictable nature of this disease and the inability to predict its terminal phase has resulted in few services beyond medical management being offered. Yet, this population has documented unmet needs that extend beyond routine medical care. Palliative care has been proposed as a strategy to meet these needs, however, these services are rarely offered. Although palliative care should be implemented early in the disease process, in practice it is tied to end-of-life care. The purpose of this study was to uncover whether the conceptualization of palliative care for heart failure as end-of-life care may inhibit the provision of these services. The meaning of palliative care in heart failure was explored from three perspectives: scientific literature, health care providers, and spousal caregivers of patients with heart failure. There is confusion in the literature and by the health care community about the meaning of the term palliative care and what the provision of these services entails. Palliative care was equated to end-of-life care, and as a result, health care providers may be reluctant to discuss palliative care with heart failure patients early in the disease trajectory. Most family caregivers have not heard of the term and all would be receptive to an offer of palliative care at some point during the disease trajectory.
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PMID:Heart failure and palliative care: implications in practice. 1950 32


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