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

107 patients at the age of 80 years or more were operated for coronary or valvular heart disease between 1978 and 1984. The indication for surgery was instable angina in coronary patients and intractable heart failure in such with valvular lesions. 9 coronary and 5 valvular patients died postoperatively, 7 were early postoperative deaths, mainly due to myocardial failure. The majority of cases could be improved for 1 to 2 stages according to NYHA-classification. In this group pulmonary complications were predominant. According to this observation heart operations can also be indicated in the older age patient group without very much more risk than in younger ones.
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PMID:[Heart surgery in the aged patient]. 393 49

Echocardiography and radionuclide ventriculography were performed in 37 uremic patients on maintenance hemodialysis with no apparent coronary artery disease, pericardial effusion, valvular heart disease or heart failure. These non-invasive studies were performed during the interdialytic period (about 18 hours after a dialysis). Sixty-two percent of our patients had abnormal left ventricular function with one or more abnormal echocardiographic parameters. The significant abnormalities were enlargement of the left ventricular cavity, a reduction of myocardial contractility, and thickening of the left ventricular posterior wall. Similar findings were found in 10 undialyzed uremic patients. Measurement of cardiac index and ejection fraction were found to be inadequate for a full assessment of left ventricular function and other parameters such as the mean velocity of circumferential fiber shortening and mean normalized posterior wall velocity should be included. There is a significant number of hemodialysis patients (7/37) with congestive cardiomyopathic features on the echocardiogram. Their clinical features are no different from the other patients in this study, except they have a significantly higher prevalence of uremic hyperparathyroidism. Our findings support that the existence of a specific uremic cardiomyopathy and uremic hyperparathyroidism may play an important role in the pathogenesis.
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PMID:Left ventricular function in uremia: echocardiographic and radionuclide assessment in patients on maintenance hemodialysis. 398 3

Although it is well known that the pulmonary circulation is altered in patients with pulmonary arterial or venous hypertension, the resultant hemodynamic behavior has not been systematically studied. We undertook to do so in a group of patients with pulmonary hypertension of diverse etiology. We measured pulmonary arterial (PAP) and occlusive wedge pressures and cardiac output at rest (i.e., standing) and during progressive upright treadmill exercise in 51 patients. Forty-two had chronic, stable, cardiac failure secondary to ischemic, myopathic or valvular heart disease and were grouped according to whether their mean PAP was less than (normotensive) or greater than (hypertensive) 19 mm Hg, and nine had pulmonary vascular disease of diverse etiology and were considered separately. In the majority of patients, we found that irrespective of whether the hypertension was arterial or venous in origin or etiology: the mean PAP-flow relationship was linear; pulmonary capillary wedge pressure was greater than or equal to the average closure pressure of the pulmonary vascular bed and could therefore be used as the downstream pressure in calculating pulmonary vascular resistance; and pulmonary vascular resistance declined with exercise. Notable exceptions to the third observation were patients with valvular heart disease or a resting pulmonary vascular resistance greater than 800 dyne-sec-cm-5.
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PMID:The pressure-flow response of the pulmonary circulation in patients with heart failure and pulmonary vascular disease. 406 71

In order to evaluate cardiac contractile reserve, echocardiographic studies were performed on 59 patients with acquired valvular heart disease and 13 patients with atrial septal defect. After epinephrine loading, the 59 patients were classified into three groups. In group I, echocardiographically-obtained left ventricular posterior wall excursion (PWE) remained below 10 mm after the administration of 2 microgram/min epinephrine. This group included patients with PWE below 10 mm after 1 microgram/min epinephrine loading but who could not endure the 2 microgram/min infusion because of significant adverse effects. In group II, PWE was less than 10 mm before the loading, but exceeded 10 mm after the administration of 1 or 2 microgram/min epinephrine loading. In group III, PWE exceeded 10 mm without stress. The conclusions derived from our data are as follows: The PWE and mean left ventricular posterior wall velocity (mPWV) obtained by echocardiography reflect the stroke volume derived from the thermodilution technique. It is possible to estimate the cardiac contractile force in patients who have a paradoxical motion of the interventricular septum, in the preoperative and even in the early postoperative periods. Patients whose PWE and mPWV are less than 10 mm and 35 mm/sec, respectively, after 2 microgram/min loading of epinephrine (group I), are likely to have severe cardiac failure after surgery. Inotropic stimulation is considered to be a very useful indicator for prediction of cardiac contractile reserve. Patients having decreased PWE, mPWV, mVcf and EF before surgery may have arrested recovery in both short- or long-term follow-up. However, surgical treatment is recommended for these patients with low cardiac function, because some improvement can be expected after surgery.
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PMID:Contractile reserve of valvular heart diseases echocardiographically evaluated by epinephrine loading before and after cardiac surgery. 408 36

The one year mortality of patients with severe congestive heart failure ranges between 30 and 70%. The effect was investigated of a stepped care program, including weekly monitoring and frequent adjustment of medical treatment, on the prognosis of 18 consecutive outpatients with severe congestive heart failure (NYHA class III and IV, 60 +/- 3.5 years). The diagnosis of congestive heart failure was proven by an invasively measured cardiac index below 2.5 l/min/m2 or by a left ventricular ejection fraction below 30%. Plasma adrenaline and noradrenaline values and plasma renin activity were substantially increased in all patients compared with 20 normals. 11 of the heart failure patients had coronary heart disease, 10 with a large left ventricular aneurysm, 6 patients had congestive cardiomyopathy and one patient had valvular heart disease with aortic insufficiency. In 9 patients ventricular tachycardias were registered, four had recurrent syncopes, and in 7 other patients atrial fibrillation, atrial flutter and paroxysmal supraventricular tachycardias were found. Medical treatment in all patients included pre- and afterload reduction by vasodilators. 11 patients received digoxin and 8 antiarrhythmic drugs. After a mean follow-up of 25 +/- 3.3 months, the one-year mortality was 7% and the two year mortality 15%. The favorable prognosis in patients in this special care program shows the favorable effects of individualized therapy, of frequent patient monitoring and the influence of strict compliance on survival and symptoms in patients with chronic congestive heart failure.
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PMID:[Does closely monitored control and therapy adjustment improve the prognosis in patients with severe heart insufficiency?]. 408 81

Magnesium levels in serum, erythrocytes, skeletal muscle, and bone were measured in 10 patients with valvular heart disease who had received diuretic therapy for heart failure for an average of 3.3 years. Five patients were found to have diminished values for skeletal muscle, indicating significant magnesium deficit. Values for erythrocytes were low in only two of the five patients, and none had low values for serum ultrafiltrate and bone: Magnesium replacement therapy restored skeletal muscle values to normal. Clinical features consistent with the presence of magnesium deficiency were found in all five magnesium-deficient patients. These features were, with few exceptions, corrected by magnesium replacement. The latter also corrected low skeletal muscle potassium values present in all five patients with low skeletal muscle magnesium, four of whom showed clinical features of digoxin poisoning before magnesium therapy was given. Concomitant secondary aldosteronism, inadequate dietary intake, and digoxin therapy had probably augmented the magnesium loss due to diuretic therapy.
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PMID:Magnesium deficiency in patients on long-term diuretic therapy for heart failure. 507

Sixteen patients with terminal cardiac failure due to valvular heart disease had emergency operation for value replacement. Four patients did not survive, because of irreversible myocardial or secondary organ involvement. The remainder, however, had immediate reversal of heart failure after operation, and all became fully active following discharge. Recognition of refractory decompensation in valvular heart disease demands prompt consideration of surgical intervention.
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PMID:Emergency heart valve replacement. 572 75

The authors studied 32 patients with ventricular arrhythmias--ventricular tachycardia (VT) or frequent ventricular extrasystoles (VES) and/or runs of extrasystole and cardiomyopathy with dilatation. This diagnosis was retained on the following criteria: absence of angina or electrical changes in infarction, normal coronary angiography in patients over the age of 50, diffuse abnormalities of ventricular contraction on 2D echocardiography or angiography, and on the absence of organic valvular heart disease. Thirteen patients had sustained paroxysmal VT, 18 patients had runs of VT and only 8 patients had isolated VES without repetition. The arrhythmia was polymorphic in 25 patients. All possible combinations of morphology of right of left sided delay with variable axes were observed. There were 25 right sided delays and 18 left sided delays; the association of left sided delay and vertical axis was only present in 5 occasions. Twelve patients underwent electrophysiological investigations for sustained VT but the arrhythmia could only be induced by ventricular extrastimulation in 4 cases. Eight patients were investigated during VT; the arrhythmia could only be terminated easily in 2 cases. Three of these 12 patients had biventricular tachycardia. Of the 11 patients with chronic alcoholism, only 2 had sustained VT, 8 had polymorphic VES and 1 monomorphic VES. Conversely, of the 21 patients without alcoholism, 11 had sustained VT, 6 had polymorphic VES, and 4 had monomorphic VES. There was a correlation between the polymorphism of the arrhythmia and the degree of ventricular dysfunction: of the 16 patients in overt cardiac failure (EF less than 30%), only 1 had monomorphic VT; the 15 others all had polymorphic arrhythmias. Only 2 had sustained VT.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Ventricular rhythm disorders in congestive myocardiopathy]. 620 93

In the clinical setting of heart failure, combined use of M-mode and 2D echocardiography is a useful tool for the differentiation of cardiomegalies of an unknown cause. In combination with careful clinical examination echocardiography allows differentiation between pericardial effusion, congenital or acquired valvular heart disease, or cardiomyopathy as the underlying cause of heart failure. M-mode echocardiographic parameters relating to left ventricular dimensional change can be helpful in the quantitative evaluation of left ventricular function, especially when no abnormal segmental wall motion is present. However, due to the poor reproducibility of the echo parameters, this method is only of limited usefulness for follow-up studies or for the evaluation of the effect of drug interventions. In the evaluation of left ventricular performance during dynamic exercise, currently used echocardiographic techniques have not proved practical due to technical limitations.
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PMID:Is echocardiography a reliable tool? 622 Sep 2

10 patients suffering from refractory heart failure were treated with an oral angiotensin converting enzyme inhibitor captopril. The etiology of heart failure in 9 patients was related to ischemic heart disease, and to valvular heart disease in 1 patient. All patients experienced subjective improvement and feeling of well-being. The functional capacity improved to class II-IIB. Serial chest X-ray films showed improvement in pulmonary congestion. The time course of the hemodynamic effect appeared to 0.5-1.5 h after intake, and tended to disappear about 6 h later. The optimal dose of the drug achieving maximal hemodynamic benefit without excessive hypotension was 50 mg. Some of the patients exhibited a triphasic response. The cardiac index increased from 1.99 +/- 0.1 to 2.69 +/- 0.151/min/m (p less than 0.001), while pulmonary capillary wedge pressure decreased from 25.3 +/- 5.86 to 13.67 +/- 4.14 mm Hg (p less than 0.001). Mean peripheral arterial blood pressure decreased from 90.06 +/- 3.7 to 71.4 +/- 2.7 mm Hg. The total peripheral resistance decreased from 1,942 +/- 169 to 1,170 +/- 109 dyn X s X cm-5. The total pulmonary resistance decreased from 272.6 +/- 42.9 to 142.34 +/- 13.76 dyn X s X cm-5. Heart rate decreased from 83.4 +/- 10.9 to 70.8 +/- 10.14 bpm (p less than 0.01). During a 6-month follow-up period the beneficial clinical effects of captopril were sustained, without late vasodilator tolerance. 1 death, unrelated to captopril, occurred. 2 patients developed transient rash, and 1 experienced transient dysgeusia.
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PMID:Captopril in refractory heart failure: clinical and hemodynamic observations. 637 Apr 33


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