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

Congestive heart failure is a frequent and important manifestation of cardiovascular disease, but no uniform clinical criteria are available for use in epidemiologic studies. To develop diagnostic criteria, we related pertinent clinical findings to physiologic measures of left ventricular function in patients with coronary artery disease. When left ventricular end diastolic pressure or arteriovenous oxygen difference was used as the physiologic criterion, the following variables contributed significant (P less than 0.01) information: heart volume, ventricular gallop, heart rate, and blood pressure. The most reliable and valid set of descriptors determined in one group was tested in a second group of 1306 patients who had been followed for 6 to 36 months after initial evaluation. The validity of the descriptors was confirmed, and patients identified as having heart failure by these criteria experienced a worse survival rate (P less than 0.001). These criteria characterize patients likely to have impaired left ventricular function and a greater risk of death.
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PMID:Chronic congestive heart failure in coronary artery disease: clinical criteria. 83 34

Serial measurements of left ventricular systolic time intervals (STI) were carried out in 44 patients with acute myocardial infarction (AMI) in the first 5 days after onset, by indirect methods. The patients with heart failure showed significant decreases of ejection time (ET) (p less than 0.001) and of the ejection time index (p less than 0.005) and increases of Wiessler's ratio (PEP/ET) (p less than 0.001). The pre-ejection period (PEP), the isovolumetric contraction time and the total electromechanical systole were unsignificantly changed. Ejection time was shorter than 250 msec in the patients with acute pulmonary edema or congestive heart failure, in most of the patients with flutter or atrial fibrillation and in 16 of the 17 patients who died. Ejection time may have a prognostic significance and may be useful in the early detection of heart failure in AMI. The changes of STI after administration of lanatosid C show the positive inotropic effect of this drug in patients with AMI.
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PMID:Value of systolic time intervals in the estimation of heart failure secondary to acute myocardial infarction. 84 Dec 49

An instrumental and roentgenological examination was conducted in 164 patients who had survived myocardial infarction 1 to 10 years before the examination and having been free of any clinically manifest signs of congestive heart failure. The investigation included a study of the inotropic and pump function of the myocardium of the left ventricle, the electric and mechanical activity of the left atrium, the pulmonary haemodynamics under bicycle tests of growing power, and under identical conditions after premedication with cardiac glycosides (0.00036 mg/kg of body weight of Strophanthin K). Proceeding from the study of the readaptation of the circulation system and its transit to the initial stage of cardiac insufficiency the authors developed criteria of the onset of therapy for latent cardiac failure in patients with postinfarction cardiosclerosis.
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PMID:[Initial stage of cardiac insufficiency as a complication of a past myocardial infarct]. 87 Jul 38

1.26 of 340 patients with chronic heart failure (aortic-valve or mitral-valve disease, congestive cardiomyopathy) showed Cheyne-Stokes respiration in supine position. 2. The incidence of Cheyne-Stokes respiration in males is more than twice as high as in females with similar hemodynamic conditions. 3. Lung volumes and airway resistance did not appreciably deviate from the predicted values and are therefore of no etiologic significance. 4. Delay of the feedback between changes in the alveolar gas tensions and respiratory center caused by a prolonged circulation time (decreased cardiac index and increased central blood volume) is the predominant cause of Cheyne-Stokes breathing in patients with chronic heart failure. 5. Metabolic alkalosis (e.g. after diuretics) favors Cheyne-Stokes respiration in patients with congestive heart failure and low cardiac output, by lessening respiratory changes in pH of blood and cerebrospinal fluid.
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PMID:[Cheyne-Stokes respiration in chronic heart insufficiency]. 87 30

The renin-aldosterone system was studied in cardiomyopathic hamsters (CMH) before and after the onset of untreated clinical congestive heart failure. Age-matched random-bred hamsters (RB) served as controls. Before heart failure, there were no differences in body weight accretion, sodium balance, plasma renin activity or in vitro aldosterone production. After the onset of heart failure in CMH, body weight increased at a greater rate than in RB and positive sodium balance was nearly twice control levels. Although plasma renin activity was greater (P less than 0.005) in CMH than in RB (23.4+/-4.2 (mean+/-SEM) vs. 3.8+/-1.8 ng/ml/h), aldosterone production (101+/-15 vs. 95+/-16 ng/h) did not differ. Plasma aldosterone was low or undetectable in RB and in CMH in heart failure. In response to angiotensin stimulation, aldosterone production increased in both strains and did not differ. No difference in muscle potassium content, potassium balance or excretion was detected. Thus, in CMH, congestive heart failure is attended by increased plasma renin activity without a significant increase in aldosterone production, a dissociation which does not appear to be due to adrenal unresponsiveness to angiotensin II or to potassium depletion.
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PMID:Renin and aldosterone in the cardiomyopathic hamster in congestive heart failure. 88 11

Dobutamine was infused at a rate of 8 mcg/kg/min in 17 patients with or without congestive heart failure. Cardiac output increased from an average 2.92 to 4.45 1/min/m2(p less than 0.001) with no change in mean aortic pressure (93.4 to 97.8 mmHg) and only a slight increase in heart rate (78 to 87 beats/min). Left ventricular end-diastolic pressure decreased from an average 19 to 13.7 mmHg (p less than 0.01). Peak left ventricular dp/dt was doubled (1147 to 2370 mmHg/sec, p less than 0.001) and Vmax increased from 1.08 to 2.18 circ/sec (p less than 0.001). In 10 patients given equi-inotropic doses (100 per cent increase in peak dp/dt) Isoproterenol produced a greater increase in cardiac output (71 percent) than Dobutamine /51 percent). Isoproterenol caused mean aortic pressure to fall significantly (8 percent) while no change was noted with Dobutamine. Accordingly, peripheral vascular resistances were reduced to a greater extent with Isoproterenol than with Dobutamine (p less than 0.05). Mean pulmonary arterial pressure decreased significantly (25 +/- 5.9 to 22 +/- 5.7 mmHg, p less than 0.05) with Isoproterenol infusion and remained unchanged with Dobutamine infusion. Dobutamine increased both stroke work (57 percent) and minute work (83 percent). With Isoproterenol however, only minute work was significantly increased (90 percent). Dobutamine therefore is a potent inotropic drug, with mild chronotropic and peripheral vascular effect and may be valuable in the management of severe heart failure not associated with hypotension.
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PMID:Comparative haemodynamic effects of dobutamine and isoproterenol in man. 89 74

In 17 patients with coronary heart disease, hemodynamic measurements were performed before and after sublingual application of 10 mg isosorbide dinitrate (ISDN). 10 patients showed signs of heart failure with pulmonary congestion and a left ventricular filling pressure above 15 mmHg, resting hemodynamics were normal in 7 patients. Eight of the patients with left ventricular failure had sustained acute myocardial infarctions the size of which was assessed by serial determinations of serum creatine phosphokinase. Application of ISDN resulted in a significant decrease of systemic and pulmonary artery pressures and pulmonary capillary wedge and right atrial pressures of patients both with and without left ventricular failure. Cardiac index and stroke index as well as systemic and pulmonary resistances did not change significantly. ISDN did not affect left ventricular stroke work in patients with elevated filling pressures; however, a decrease of normal filling pressures was associated with a decrease of stroke work. Thus, in coronary patients with chronic congestive heart failure, sublingual application of nitrates results in a beneficial hemodynamic unloading. However, if the acute infarct size is taken into account, it can be demonstrated that hemodynamic improvement after ISDN--judged by the relation stroke work/filling pressure--becomes less pronounced with increasing infarct size.
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PMID:[Effect of sublingual isosorbide dinitrate on hemodynamics in coronary patients with and without congestive heart failure (author's transl)]. 89 50

In 12 patients with severe congestive heart failure (CHF) due to ischemic heart disease or nonischemic cardiomyopathy the hemodynamic response to intravenous infusion of sodium nitroprusside (N) was compared to that of dobutamine (D) 10 microgram/kg/min. D and N produced comparable increases in cardiac output (CO) (2.8 to 5.8 L/min and 2.9 to 5.0 L/min, respectively), but, compared to N, D caused a higher arterial pressure (99.3 vs 86.2 mm Hg, P less than 0.01) and heart rate (102.5 vs 95.3, P less than 0.05) and less reduction in pulmonary wedge pressure (PWP) (28.9 to 20.2 mm Hg vs 29.1 to 16.6 mm Hg, P less than 0.05). In five additional patients N and D were studied separately and then were infused together. The combination resulted in a higher CO, lower PWP and greater reduction in systemic and pulmonary vascular resistances than either drug alone. Brachial arterial infusion of nitroprusside produced prominent forearm vasodilation in a dose less than 10% of the systemic dose, whereas vasodilation with dobutamine was only modest even when 50% of the systemic dose was infused. Therefore, potent inotropic and vasodilator drugs produce similar and additive augmentation to left ventricular performance in heart failure. Reduction in vascular resistance with dobutamine probably is largely of reflex origin, but the vasodilation itself may be an important determinant of the rise in cardiac output.
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PMID:Comparative hemodynamic effects of inotropic and vasodilator drugs in severe heart failure. 90 77

Successful management of severe congestive heart failure secondary to a hepatic hemangioma was accomplished by ligation of the hepatic artery in a 2-month-old infant. In the two years since the operation, follow-up observations including liver biopsy and hepatic angiography have indicated complete regression of the tumor. This report provides reassurance that this procedure is effective in the prompt control of severe heart failure, as well as in safely providing time for the spontaneous regression of the vascular tumor.
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PMID:Hepatic hemangiomatosis. Successful management by hepatic artery ligation. 93 85

The conditions associated with prolapse of the posterior leaflet of the mitral valve are multiple. The mechanisms of mitral valve prolapse as well as the pathogenesis of pain and ectopic impulse formation are reviewed. Propranolol appears to be the drug of choice for the symptomatic treatment of patients with this syndrome since it decreases myocardial oxygen demand and wall tension thus reducing or abolishing the discrepancy between myocardial oxygen demand and supply within the mitral apparatus. It has also been reported to modify the auscultatory findings associated with this condition. The frequency of this mitral valve abnormality in patients with obstructive coronary artery disease is reviewed. It appears that prolapse of the posterior leaflet scallops in patients with significant obstructive coronary artery disease represents an intermediate stage before mitral insufficiency occurs. This group of patients with papillary muscle dysfunction includes those with prolapsed leaflets without mitral insufficiency, those with systolic murmurs and compensated heart failure and others with progressive cardiac decompensation and severe mitral regurgitation.
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PMID:Mitral valve prolapse. Recent concepts and observations. 93 60


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