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

Therapy with phentolamine can improve the condition of patients with congestive heart failure due to the inotropic effect of this drug, as well as its vasodilating action. The use of oral therapy with phentolamine has not been adequately investigated in patients with chronic heart failure. Therefore, nine patients with chronic heart failure due to underlying valvular disease received 50 mg of phentolamine four times a day for two weeks. Echocardiograms and measurements of systolic time intervals were obtained prior to administration of phentolamine and two weeks after the introduction of therapy with the drug. As a result of therapy with phentolamine, the ejection fraction, the percentage of change in the minor axis, and the velocity of circumferential fiber shortening significantly increased, while the left atrial dimension decreased. Therapy with phentolamine produced a significant decrease in the preejection period index, as well as the ratio of the preejection period over the left ventricular ejection time. Thus, oral therapy with phentolamine improves left ventricular function in patients with chronic heart failure.
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PMID:Oral therapy with phentolamine in chronic congestive heart failure. 44 38

We studied 11 patients with congestive heart failure and 10 normal volunteers for in vivo platelet aggregate formation activity. The patients with heart failure had significantly (p less than 0.01) more circulating platelet aggregates than the normal volunteers. During sodium nitroprusside infusion, the number of circulating platelet aggregates declined to normal levels and in vitro platelet aggregation responses to epinephrine and adenosine diphosphate were also suppressed significantly (p less than 0.01). This was associated with a 30% decline in systemic vascular resistance and a 28% increase in cardiac output. In other in vitro experiments, sodium nitroprusside was found to have direct, dose-related platelet aggregation inhibitory actions. This study suggests that an increase in vascular resistance in certain heart failure patients may in part be related to an increase in circulating platelet aggregates. Direct inhibition of platelet aggregation by sodium nitroprusside may be a mechanism of its beneficial effects in heart failure.
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PMID:Platelet function studies in heart disease. VI. Enhanced platelet aggregate formation activity in congestive heart failure: inhibition by sodium nitroprusside. 45 12

To compare the hemodynamic effects of prazosin and nitroprusside in patients with severe congestive heart failure, nine patients with heart failure refractory to conventional therapy received oral prazosin and intravenous nitroprusside administered so as to produce a similar decrease in left ventricular filling pressure in each patient. By this comparison, both drugs produced similar decreases in mean right atrial pressure, mean pulmonary arterial pressure and systemic and pulmonary vascular resistance. However, with nitroprusside, cardiac index increased more (+0.97 versus +0.73 liters/min per m2, P less than 0.01) and mean arterial pressure decreased less (-13.7 versus -18.3 mm Hg, P less than 0.05) than with prazosin. Both drugs produced similar changes in stroke volume index (+11.7 cc/beat per m2 with nitroprusside and +12.5 with prazosin) and stroke work index (+8.1 g-m/m2 with nitroprusside and +6.6 with prazosin). Therefore, the differences in the hemodynamic responses observed with the two agents were due to the significantly greater decrease in heart rate with prazosin (-8 beats/min) than with nitroprusside (-2 beats/min, P less than 0.05). These clinical data support experimental evidence suggesting that there is a significant negative chronotropic action of prazosin independent of its peripheral vascular effects.
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PMID:Differences in hemodynamic effects of nitroprusside and prazosin in severe chronic congestive heart failure: evidence for a direct negative chronotropic effect of prazosin. 46 69

In nine patients with medically refractory left ventricular failure and/or ventricular arrhythmias, secondary to acute formation of a ventricular aneurysm, intra-aortic balloon pumping (IABP) was instituted 24 to 36 hours before diagnostic angiographic studies. Ventricular irritability was reduced and heart failure was controlled in all patients. Eight patients underwent operation, four within 3 weeks of an acute myocardial infarction and four within 3 months. All had resection of the recent infarction and two had myocardial revascularization as well. Two of the eight patients died in the early postoperative period from intractable ventricular fibrillation. All six patients who survived the operation (mean follow-up 12 months) had excellent clinical results. Ventricular irritability was suppressed and only one patient had residual heart failure. However, there was one late death 7 months after operation. The results suggest that surgical therapy may be effective in the management of medically unresponsive arrhythmias and/or congestive heart failure in the acute or intermediate postinfarction phase. IABP assistance was helpful in supporting the circulation and reducing ventricular irritability during the preoperative and postoperative periods.
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PMID:Treatment of early postinfarction ventricular aneurysm by intra-aortic balloon pumping and surgery. 47 Apr 26

Phantom tumors are accumulations of pleural effusion in the interlobular spaces of the lungs. They appear in patients with heart failure simulating a lung tumor but disappearing with medical treatment. The encystment of the fluid is apparently due to congenital defects in the pleura, which tends to store up the transudate produced by heart failure. Another pathogenetic possibility is the existence of pleural adherences. The most common localization is in the minor cissure, perhaps because it is more easily identified in the posterior view of the chest X-ray. In most of these cases the pleural effusion is due to left heart failure, though pleural effusion in normally associated with right congestive heart failure. On the posterior chest X-ray the fluid is observed as a round or fusiform mass. Differential diagnosis should be established for measotheliomas, pulmonary infarctions, pulmonary or metastatic tumoral nodules, hydatic cysts, and tuberculomas. Sixteen cases of phantom tumors are reported; nine of them were localized on the minor cissure, five on the right major cissure, one on the left major cissure, and one case of double localization on the left major cissure and minor cissure. All of them were due to left congestive heart failure.
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PMID:[Phantom tumor (author's transl)]. 47 May 7

The persistence of the hemodynamic effects of prazosin was studied in 12 patients with chronic congestive heart failure. Multidose evaluation involving five 5-mg doses showed the initial decrease in systemic vascular resistance and increase in cardiac index, stroke work index, and stroke volume index to be transient. Doubling the dose did not restore effect. Modest decreases in pulmonary capillary-wedge and mean arterial pressures persisted throughout the study. In six patients, plasma prazosin concentration measured at times of hemodynamic observations showed the initial hemodynamic effect of prazosin to attenuate upon further administration despite mean plasma concentrations that exceeded those measured after the first dose. In patients with chronic heart failure, resting hemodynamic studies suggest a rapid attenuation of prazosin-mediated hemodynamic effect in the presence of adequate plasma concentration. Recognizing this phenomenon, if long-term prazosin therapy for congestive heart failure is contemplated, we suggest the hemodynamic response in individual patients be monitored.
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PMID:Attenuation of prazosin effect on cardiac output in chronic heart failure. 47 64

53 children with infective pericarditis were seen at the University College Hospital, Ibadan, between 1967 and 1976. Their ages ranged from 10 days to 15 years but 53% of them were aged 5 years and below. Cough, fever, and breathlessness were the most common symptoms; cardiac decompensation was evident in over 30% of them, 23% had muffled heart sounds, but a pericardial friction rub was audible in only one. The main pathogens identified were Mycobacterium tuberculosis (11 cases), Staphylococcus aureus (11 cases), Escherichia coli (4 cases), Pneumococcus and Pseudomonas (3 cases each). Most of the patients had some other associated infection--such as, bronchopneumonia (12 cases), empyema thoracis (10 cases), lung abscess (10 cases), septicaemis (6 cases), and osteomyelitis (3 cases). Errors in diagnosis were common, the diagnosis having been missed in 72% of the cases identified at necropsy. Even if the correct diagnosis had been made during life and appropriate treatment given, the mortality rate (36%) was high. It is suggested that the onset of cardiac failure in any child with bronchopneumonia, empyema, or lung abscess should always arouse a suspicion of infective pericarditis.
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PMID:Infective pericarditis in Nigerian children. 47 15

Hemodynamic changes during exercise were evaluated in 20 patients with severe, chronic congestive heart failure. Two groups were identified by their stroke work response to maximal exercise. Group I (eight patients) showed an increase in stroke work index. This occurred because the stroke volume increased and the difference between mean systolic pressure and left ventricular filling pressure increased. Group II (12 patients) showed a decrease in stroke work index. This occurred because stroke volume decreased while the difference between mean systolic pressure and left ventricular filling pressure did not change. Despite hemodynamic differences, the groups could not be distinguished by the usual clinical criteria for heart failure including etiology, New York Heart Association functional class, heart size on chest X-ray film or duration of heart failure. Clinical criteria are relatively insensitive in predicting the exercise hemodynamics of any given patient with chronic severe heart failure. Determining the exercise hemodynamics may be helpful as a means of assessing left ventricular functional reserve in heart failure. Prognostic implications, drug therapy and prescription of activities may require adjustment based on this spectrum of hemodynamic response to exercise in patients with chronic heart failure.
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PMID:Detection of left ventricular functional reserve by supine exercise hemodynamics in patients with severe, chronic heart failure. 49 99

In order to determine and compare the pharmacodynamic responses to single and multiple dose prazosin therapy in cardiac failure, 14 patients with severe low-output heart failure underwent central and regional hemodynamic measurements after random placement in one of two prazosin dosing schedules. A single 5 mg oral dose of prazosin (Group A, no. = 7) significantly increased the cardiac index and stroke volume index while significantly decreasing systemic, pulmonary and pulmonary capillary wedge pressures and vascular resistances. Hepatic plasma flow and limb blood flow increased after the single dose. Striking attenuation of these hemodynamic effects occurred when the same dose was administered after 24 hours of pretreatment with oral prazosin, 2 mg every 8 hours (Group B, no. = 7). The plasma prazosin levels of the two groups, drawn 2 hours after administration, were 24.5 and 30.5 ng/ml, respectively. Repeated administration of prazosin in patients with congestive heart failure results in rapid attenuation of its beneficial central and regional hemodynamic effects. The usefulness of this vasodilator as a preload- and afterload-reducing agent in the clinical setting of chronic congestive heart failure may be limited by the development of pharmacodynamic tolerance.
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PMID:Development of pharmacodynamic tolerance to prozosin in congestive heart failure. 49 12

Optimal therapy for congestive cardiac failure requires identification of correctable factors that aggravate it as well as an understanding of its etiology. Increased sympathetic nervous system activity, reduced renal blood flow, and cardiac hypertrophy and dilation are the main compensatory processes that occur in response to cardiac failure. Although they may be of initial benefit in supporting a reduced stroke volume, they may ultimately prove self-defeating. New drugs for the treatment of severe congestive heart failure include dopamine, which has a selective nonadrenergic dilator effect on the renal vascular bed, and dobutamine, which has potent inotropic effects, lowers the left ventricular filling pressure and does not increase the heart rate or the systemic vascular resistance. By reducing both the resistance to left ventricular ejection and the venous return to the right heart, vasodilators result in improved peripheral perfusion and reduced pulmonary congestion. Optimal therapy for refractory cardiac failure can be rationally determined by characterizing the hemodynamic profile through measurement of the mean arterial pressure, the left ventricular filling pressure, the cardiac output and the systemic vascular resistance. The specific therapy can then be effectively and safely delivered by a careful analysis of the dose-response relation as identified by hemodynamic monitoring.
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PMID:Contributions of hemodynamic monitoring to the treatment of chronic congestive heart failure. 49 82


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