Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Voluntary end-expiratory apnoea in a 23-year-old asymptomatic mild hypertensive patient consistently elicited bradyarrhythmias (complete heart block and sinus pause) and sympathetic activation to muscle blood vessels, indicating simultaneous sympathetic and parasympathetic activation during apnoea. The sympathetic bradyarrhythmic response to apnoea was potentiated by hypoxia and eliminated by atropine. Baroreflex activation also attenuated the bradycardic response to apnoea. A 43-year-old hypertensive patient with sleep apnoea also exhibited bradyarrhythmias (sinus arrest for up to 10 s) and a fall in perfusion pressure to less than 50 mmHg during episodes of sleep apnoea. These cardiovascular changes were associated with a reduction in oxygen saturation to levels as low as 35%. Neither patient was on any medication. Simultaneous sympathetic and parasympathetic activation during episodes of apnoea may predispose to cardiovascular catastrophe. These chemoreflex mediated autonomic changes are inhibited by baroreflex activation. We propose that patients with impaired baroreflexes (patients with hypertension or heart failure and premature infants) may be especially susceptible to excessive autonomic responses to chemoreflex stimulation during periods of apnoea. In these patient groups, bradyarrhythmias, hypoxia, hypoperfusion and sympathetic activation during apnoea may predispose to sudden death.
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PMID:Parasympathetic hyperresponsiveness and bradyarrhythmias during apnoea in hypertension. 149 63

The authors report a case of valvular pulmonary stenosis in a 60 years old patient, admitted to hospital with heart failure and angor pectoris. Four years previously a VVI pacemaker had been implanted for complete heart block. At the time of the admission he had two pacemakers leads in the right ventricle; one of them was retained and functionless since the changing of the generator which occurred 1 year before. The usual complications of endocardial pacemakers are discussed, as well as the natural course and surgery indications for valvular pulmonary stenosis in adults.
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PMID:[Pulmonary stenosis in adults. Report of a clinical case]. 161 Jun 11

A 27-year old African woman with history of regular chloroquine ingestion presented with progressive deterioration of vision, easy fatiguability, dyspnoea, dizziness progressing to syncopal attacks. Ophthalmological assessment revealed features of chloroquine retinopathy, cardiac assessment revealed features of heart failure and a complete heart block with right bundle branch block pattern. The heart block was treated by pacemaker insertion and the heart failure resolved spontaneously following chloroquine discontinuation. She however remains blind.
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PMID:Chloroquine related complete heart block with blindness: case report. 162 52

Age is one of the important prognostic factors for acute myocardial infarction. This study was performed to clarify the clinical characteristics and outcome of acute myocardial infarction in Chinese geriatric patients. The study subjects included 742 patients, divided by age into 2 groups: Group A greater than or equal to 65 years, 321 cases; and Group B less than 65 years, 421 cases. The following characteristics were compared between these 2 groups: sex composition; presence of chest pain, heart failure or shock at presentation; cardiac functional status; occurrence of various complications, and follow-up data. Males were less prominent in the older group: 229 patients (71.3%) in Group A, and 371 patients (88.1%) in Group B. At onset, the older patients presented with less chest pain (72% vs 86.5%) and more heart failure (35.2% vs 20.2%), but the occurrence of shock was similar (5.9% vs 4.5%, for Groups A and B, respectively). During hospitalization, more patients in Group A showed impaired cardiac function, as evidenced by a higher percentage of patients identified as in Killip class III or IV (35.4% vs 21.1%). Concerning complications, the older group showed a higher incidence of hypotension, low cardiac output, lung edema, frequent premature ventricular beats, atrial flutter and/or fibrillation, complete heart block and intraventricular conduction defects, but ventricular septal defects, ventricular tachycardia and ventricular fibrillation did not show any difference in occurrence. Life table analysis showed that the survival rate was significantly lower for Group A during the follow-up period of 5 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The clinical characteristics of acute myocardial infarction in aged patients. 167 3

In 24 patients with advanced heart block and normal sinus node function, a new single lead VDD pacing system was implanted. At implantation, the endoatrial, bipolar electrogram was recorded in all patients. The lead position was checked by means of chest X-ray. At discharge and after 1, 3, and 6 months, testing for myopotential inhibition, telemetric evaluation of the endoatrial potential, and Holter recordings were made. After discharge, 18 patients performed two cardiopulmonary exercise tests at two different rate-matched AV intervals. All investigations showed good AV synchrony and a lack of interferences by myopotentials. The maximum rate-matched AV interval provided a significantly improved exercise capacity, which was more evident in patients with signs of myocardial failure.
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PMID:A new single lead VDD pacing system. 170 65

In patients with sinus node disease (SND), VVI pacing seems an inappropriate method of cardiac stimulation because of its potential adverse hemodynamic and arrhythmic effects. AAI-DDD pacing, preferred because of lower morbidity, may also determine a higher survival rate. We examined retrospectively two groups of patients with SND. Stimulated respectively with VVI pacing (group 1 = 57 patients) and AAI pacing (group 2 = 53 patients). The mean duration of the follow-up interval was 40.1 months for group 1 and 45 months for group 2. Ten patients (17.5%) in the VVI group and five (9.4%) in the AAI died. During the follow-up, in the VVI group three patients developed congestive heart failure and ten developed chronic atrial fibrillation, whereas only one case of heart failure and two with atrial fibrillation have been recorded in the AAI group. Moreover, four patients had embolic complications in group 1. Five patients (9.4%) with AAI pacing were converted to sequential pacing due to the occurrence of second-degree heart block. The statistical analysis was developed by the X2 test for the comparison of the proportion of the events (atrial fibrillation, congestive heart failure, embolic accidents) in the two groups: a significantly higher morbidity (P less than 0.01) was recorded in the AAI group. Survival is also higher in AAI patients, but the survival rate difference, calculated using the Mantel-Cox method, is not statistically significant. The findings of our study show that in SND the superiority of AAI pacing over VVI is statistically significant as far as morbidity is concerned, and we have also noticed an evident but not statistically significant superiority regarding mortality.
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PMID:Morbidity and mortality of patients with sinus node disease: comparative effects of atrial and ventricular pacing. 170 96

A case of polysplenia with congenital heart block, infarction of a splenic mass, and a short pancreas was reported. The infant died of severe heart failure at the age of 28 days. Deformity of the SA node was suspected to be the cause of congenital heart block but could not be demonstrated because of some limitations of autopsy procedure. Redundant splenic pedicle might cause infarction of a splenic mass after birth. The author suggests that, in addition to the semi-annular pancreas, the pancreatic anomalies of this syndrome should include the short pancreas.
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PMID:Polysplenia syndrome: a case with congenital heart block, infarction of a splenic mass, and a short pancreas. 174 42

A 32-year-old woman with systemic lupus erythematosus was found to have a fetus with heart block and fetal ascites at 23 weeks gestation. Treatment with high-dose corticosteroids ameliorated the early signs of heart failure, although the fetal heart rate gradually fell from 48 beats/min to 42 beats/min by 34 weeks. Sudden deterioration of the fetal state occurred at 35 weeks, and this only partially responded to digitalisation. Neonatal death occurred on Day 18 from the consequences of severe birth asphyxia. The relationship and pathogenesis of anti-Ro antibodies, congenital heart block and hydrops fetals are discussed, together with the in utero management of this condition.
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PMID:Congenital heart block with hydrops fetalis treated with high-dose dexamethasone; a case report. 176 11

Poisoning is a significant problem in the elderly. The majority of poisonings in older people are unintentional and may result from dementia and confusion, improper use of the product, improper storage or mistaken identities. Depression is also common in the elderly and suicide attempts are more likely to be successful in this age group. The elderly patient's recuperative abilities may be inadequate as a result of numerous factors including impaired hepatic or renal function as well as chronic disease processes. General management of poisoning in the elderly parallels management of younger adults, but it is especially important to ascertain underlying medical conditions and concurrent medications. In most poisonings, activated charcoal and cathartic are sufficient. Haemodialysis or haemoperfusion may be required at lower plasma drug concentrations in elderly patients. While the specific indications for antidotes are the same for all age groups, dosage alterations and precautions may need to be considered in the elderly. Drugs most often implicated in poisonings in the elderly include psychotherapeutic drugs, cardiovascular drugs, analgesics and anti-inflammatory drugs, oral hypoglycaemics and theophylline. Cardiovascular and neurological toxicities occur with overdoses of neuroleptic drugs and, more frequently and severely, with cyclic antidepressants. Patients with pre-existing cardiovascular disease are at particular risk of worsening ischaemic heart disease and congestive heart failure. Benzodiazepines only appear to produce significant toxicity during long term administration or in combination with other CNS depressants. Digoxin can cause both chronic and acute intoxication, most seriously cardiac toxicity including severe ventricular arrhythmias, second or third degree heart block or severe refractory hyperkalaemia. Immune Fab antibody is indicated for the management of digoxin toxicity, although patients dependent on the inotropic effect of digoxin may develop heart failure after digoxin Fab antibody administration. Nitrates can cause toxicity including headache, vomiting, hypotension and tachycardia from excessive sublingual, transdermal or intravenous doses. Conduction disturbances and hypotension occur with overdoses of antihypertensive drugs; these effects are mild with angiotensin converting enzyme (ACE) inhibitors, occasionally severe with beta-blockers and of significant concern with calcium channel antagonists. The elderly commonly use aspirin and other salicylates, are more likely to develop chronic intoxications to these agents, and are more susceptible to severe complications such as pulmonary oedema. Salicylate poisoning, recognition of which is often delayed, should be considered in elderly patients with neurological abnormalities or breathing difficulties, especially in the setting of acid-base abnormalities. The clinical effects of NSAID overdose are mild and usually involve the central nervous system and gastrointestinal tract.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Poisoning in the elderly. Epidemiological, clinical and management considerations. 179 7

Fifteen cases of chronic heart block were studied. Eight of them could be designated as idiopathic or primary heart block; the others were associated with hypertension, diabetes and ischaemic heart disease, either singly or in various combinations. In six cases, the whole heart was available for histopathological study of the conduction system. In the other 9 cases, only a portion of the heart muscle was available for examination. A V nodal fibrosis extending upto the proximal bundle of His was seen in all the six whole heart autopsy materials. Fibrosis of the adjacent myocardium was seen in five cases. In three cases, conducting system fibrosis was associated with atherosclerotic (1 case) or diabetic changes (3 cases) of the intramural vessels. In the 9 partial autopsy studies, myocardial fibrosis was seen in two cases, diabetic microangiopathy in one and atherosclerotic changes in two including an old thrombus in one. Thus, diabetic microangiopathy was seen in total four cases. These changes may be responsible for the cardiomegaly and cardiac failure associated with conduction defects observed in diabetes. In the idiopathic group also, heart block could be considered as a significant facet of a primary myocardial degenerative process.
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PMID:Cardiac changes implicated in chronic heart block. 181 5


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