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

The role of hypertension in cardiovascular disease was studied in the hypertensive coarcted monkey during the feeding of an atherogenic and nonatherogenic diet. During the 15-month period of observation, half of the hypertensive coarcted monkeys developed cardiovascular disease which included heart failure, ischemic heart disease, stroke, and sudden death. There were no cardiovascular complications in the control normotensive monkeys except for one cholesterol-fed animal. The incidence of ischemic heart disease and sudden cardiac death was higher in monkeys with both hypertension and hypercholesterolemia than in those with hypertension or hypercholesterolemia alone. Postmortem studies revealed that the former monkeys had both hypertensive and atherosclerotic heart disease, whereas the monkeys with hypertension or hypercholesterolemia had either hypertensive or atherosclerotic heart disease. Hypertensive heart disease was characterized not only by hypertrophy of the left ventricle but also by focal myocardial degeneration and fibrosis and by focal thickening and narrowing of the small coronary arteries, particularly the sinus node artery and the atrioventricular node artery. The finding of transmural myocardial infarction in two monkeys with patient coronary arteries suggests a possible role of coronary artery spasm in ischemic heart disease in hypertension. The cerebral vascular complications of hypertension included hypertensive encephalopathy, transient "ischemic" attacks, and hemorrhagic stroke. The complications were associated with severe hypertension and with hypertensive vascular disease or hypertensive and atherosclerotic vascular disease of the cerebral arteries.
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PMID:Role of hypertension in ischemic heart disease and cerebral vascular disease in the cynomolgus monkey with coarctation of the aorta. 14 28

The risk for cardiovascular complications is already substantially increased in persons with borderline elevation of arterial pressure (141-159/90-94 mmHg and transiently below). It increases progressively with higher grades of hypertension. The main aim of treatment is thus a significant improvement in survival for the patient. Persons with raised blood pressure (BP) have often additional cardiovascular risk factors such as deranged carbohydrate metabolism, dyslipidemia, left ventricular hypertrophy, smoking and others. Treatment of hypertensive patients should thus not only normalize BP but should at the same time reduce associated risk factors or at least not increase them. Conventional antihypertensive treatment based on thiazides in high doses or beta-blocking agents led to marked reduction of strokes and heart failure, but did not satisfactorily reduce coronary heart disease or sudden cardiac death. It has been suspected that other cardiac risk factors are insufficiently influenced or eventually even deteriorated by conventional therapy, thus counteracting partly a beneficial effect of lowered BP. Beta-blockers however have at least a secondary preventive effect after myocardial infarction. Newer antihypertensive drugs such as ACE-inhibitors, calcium antagonists and alpha 1-blockers reduce left ventricular hypertrophy and are at least neutral with regard to metabolism of lipids and carbohydrates. The non-thiazide diuretic indapamide and the serotonin (S2-) blocker ketanserin likewise are neutral with regard to glucose and lipid metabolism. The efficacy of these new drugs regarding long term survival is as yet undetermined. Persisting borderline or established hypertension should as a rule always be approached with basic non-pharmacologic measures: loss of overweight, reduction of alcohol intake, exercise, avoidance of high salt foods, abstention from smoking and withdrawal of BP-raising drugs. If antihypertensive medication is indicated, potential first line drugs are ACE-inhibitors, calcium antagonists, beta-blockers, thiazides at low dose, indapamide, ketanserin, the alpha 1-blocker prazosin and others; initially as monotherapy, if needed in combinations of 2 or 3. Older patients or those will with additional disturbances such as diabetes, hypercholesterolemia, nephropathy, heart failure, ischemic heart disease, arrhythmias, claudication, asthma and others need problem-adjusted modifications of treatment.
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PMID:[Antihypertensive therapy in the nineties]. 153 54

Fifty-four patients hospitalized in Niger for complications from hypertension between September 1988 and October 1989 were studied. The following complications were observed: left ventricular hypertrophy (56%), coronary vascular defect (35%), left heart deficiency (26%), cardiac failure (32%), retinopathy (56%), renal insufficiency (35%), and stroke (24%). The most frequent risk factor was Type A personality (76%), followed by stress (48%), excess weight (37%), tobacco use (35%), hyperuricemia (35%), hypercholesteremia (17%), and diabetes (15%). Complications from hypertension may well become a major problem for African countries as they develop.
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PMID:Hospitalizations in Niger (West Africa) for complications from arterial hypertension. 158 Oct 14

Three-hundred and nine patients, 242 males and 67 females diagnosed of myocardial infarction were studied during the acute phase and followed for a year to evaluate any differences. The corrected incidence was greater amongst males, 11.1 vs 3.6/10,000 inhabitants. The presenting age was significantly lower in males below 50 and greater in women above 70. Hypertension, hypercholesterolemia and sedentariness were more prevalent amongst women; smoking was more prevalent amongst males. Infarction presentation was typical in both sexes being significant a 5 hour delay in arriving to the hospital in female patients. On hospital admission Killip III-IV was significantly more frequent amongst women (17% vs 4.6%). Hospital mortality although it was higher in women this was not statistically significant (19.4% vs 14.4%). During follow up there was a better control of risk factors in the male patients. Heart failure and mortality were greater amongst women during the first three months (p less than 0.001). Mortality differences continued being statistically significant during the following three months. From the sixth month to the first year, mortality rates were similar. The study suggests that infarction prognosis is worse in females.
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PMID:[Differences by sex in the presentation and follow-up in the first year of acute myocardial infarct]. 223 67

A 6-year retrospective study of 341 cases of acute myocardial infarction admitted to JN Medical College Hospital, Aligarh in respect of the incidence, complications and mortality in relation to age, sex, religion, smoking habit occupation and risk factors was made. The incidence was found to be 9 per 1000 hospital admissions. Maximum number of cases was in the age group of 51-60 years and male to female ratio was 7:1. There was no significant difference in incidence and mortality between Hindus and Muslims of both sexes. Highest incidence was noted among sedentary workers and smokers. Hypercholesterolaemia was found in only 17.01% cases, the rest having normal serum cholesterol levels. Hypertension and diabetes mellitus were associated in 24.05% and 12.32% cases respectively. Cardiac complications were noted in 43.4% of patients, the commonest being cardiac failure. Overall in-hospital mortality was observed to be 11.41% of which 79.49% had cardiac complications. Diabetics had significantly (p less than 0.05) higher mortality rate (21.43%) as compared to non-diabetics. Smokers had higher mortality rate compared to non-smokers (p less than 0.01). Although those with hypertension and with hypercholesterolaemia had higher mortality, the results were not statistically significant. The average day of expiry after acute myocardial infarction was 3.82 days during hospital stay.
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PMID:Morbidity and mortality of acute myocardial infarction in and around Aligarh. 226 65

The study was undertaken to examine a random representative sample from the nonorganized male and female population from on of the Moscow districts. The survey covered 1238 males and 1241 females; the response-rate was 71% and 74%, respectively. Routine epidemiological tools and consistent criteria for their assessment were applied to the survey of the population. The authors examined the following risk factors: arterial hypertension, hypercholesterolemia, hypertriglyceridemia, hypoalphacholesterolemia, and cigarette smoking in relation to a particular CHD: acute myocardial infarction, heart failure, etc.
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PMID:[Comparative characteristics of the incidence of ischemic heart disease and its risk factors among men and women aged 20-69 years (epidemiological study)]. 259 71

Over 8 years, 20 cases of infarction with normal coronary angiography have been reported, representing 0.9% of the patients who underwent a coronary angiography after a myocardial infarction. The main characteristics of these patients are compared with those taken from the literature. The occurrence of this disease mainly depends on the age: especially higher when the patients are younger, ranging between 1 and 4% in major series, but it may reach 25% in case of infarction occurring before the age of 30. Therefore, this entity mainly affects young patients (mean age in the literature: 34.3 years), with a large proportion of women (27%). The main risk factor is smoking, found in 3 out of 4 men an more than half of the women; on the contrary, hypercholesterolemia and arterial hypertension are only seldom found. In women, administration of estro-progestative medications in mentioned in almost every other case. Coronary heredity is mentioned in one out of 3 cases. In 68% of the cases, the infarction is the original manifestation and frequently occurs during stress: 60 p. cent of the cases. The site of the necrosis is insignificant. Mortality is low: 2 p. cent but in 5 p. cent of the cases, the course may be complicated by recurrence or heart failure. According to recent findings on coronary angiography during the acute phase, the pathogenesis could involve an arterial coronary thrombosis, perhaps developing on minimal coronary lesions, caused by a spasm and/or a platelets hyperaggregation; then this coronary thrombosis is revascularized.
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PMID:[Infarction with angiographically normal coronary vessels. (20 cases)]. 266 Jul 27

The epidemiology and etiology, pathophysiology, diagnosis, and treatment of congestive heart failure (CHF) are reviewed. CHF affects as many as 4 million Americans and is one of the most prevalent causes of death in hospitalized patients. Major risk factors for developing CHF include advanced age, male sex, hypertension, coronary artery disease, smoking, hypercholesterolemia, diabetes mellitus, and rheumatic heart disease. Heart failure results from decreased intrinsic myocardial contractility caused by one or more of three changes: (1) altered adrenergic nervous system function, (2) impaired delivery of calcium to contractile elements in the heart, and (3) reduced myosin-ATPase activity in the myocardium. The disease is progressive, and no intervention has yet been found to stop it effectively. CHF is diagnosed based on subjective signs and symptoms and objective assessment using auscultation, ECG, chest roentgenogram, laboratory tests, and noninvasive and invasive tests. Treatment of CHF begins with restriction of physical activity and sodium intake. Pharmacologic interventions start with either digitalis glycosides or thiazide diuretics; both may be used concomitantly as the disease progresses. Current studies are focusing on the use of angiotensin-converting enzyme inhibitors as first-line agents for CHF. When CHF worsens, loop diuretics are substituted for or added to the thiazide diuretics, and vasodilators are added to reduce the workload on the heart. Other inotropic agents, including the new bipyridine derivatives, may also be used. In patients not responding to these and other aggressive therapeutic interventions, cardiac transplantation is the only option. Despite advances in management of CHF, little improvement in overall survival has been demonstrated, and no intervention has stopped or reversed the progression of CHF.
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PMID:Current concepts in clinical therapeutics: congestive heart failure. 287 92

Atherosclerosis and hypertension are, by far, the most common cardiovascular diseases affecting women, and both are influenced by diet. Atherosclerosis occurs more commonly in men than women; generally women are 10 to 15 years older than men when symptoms develop. The prevalence of hypertension is about equal in the two sexes, particularly in middle aged and older persons. These cardiovascular diseases are major causes of death and disability in this country. Atherosclerosis results in myocardial infarction, thrombotic strokes, and claudication. Hypertension, when severe, damages small blood vessels, causing kidney failure, hemorrhage, strokes, and heart failure; when the condition is mild to moderate, it produces atherosclerosis. Nutritional factors are of primary importance in both atherosclerosis and hypertension. Risk factors for atherosclerosis related to nutrition are hypercholesterolemia, hyperglycemia-diabetes, and for hypertension, obesity, high salt intake, and excessive use of alcohol. Of all these risk factors, obesity seems to be the most important because it is strongly linked to hypertension and diabetes. Dietary intake of saturated fat is a potent factor in determining the blood cholesterol level, and reducing intake often decreases the level, thus lessening the risk of atherosclerotic complications. Although high salt intake and excessive alcohol use produce hypertension in susceptible people, less is known about the frequency of this adverse effect than is known about obesity.
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PMID:Nutrition and cardiovascular diseases of women. 312 Feb 15

A three-decade examination of the prevalence, incidence, secular trends, and prognosis of cardiac failure in the Framingham Study provides insights into its epidemiology. Annual incidence of CHF is observed to increase from 3 to 1000 at ages 35-64, to 10 per 1000 at ages 65-94. There is a slight male predominance, owing to a higher rate of coronary disease, which conferred a fourfold risk of cardiac failure. Most cardiac failure is on the basis of long-standing hypertension or CHD. Silent infarctions were as predisposing for CHF as symptomatic MIs surviving 1 year. Hypertension is a major predisposing factor that at least triples the CHF risk, the systolic component being more predictive than the diastolic component. Correctable predisposing risk factors for CHF include: elevated blood pressure, impaired glucose tolerance, elevated cholesterol, low HDL-cholesterol, obesity, and a high hematocrit. Risk factors reflecting deteriorating cardiac function also were highly predictive, including: an enlarged heart, poor vital capacity, sinus tachycardia, and ECG-LVH. Commonly encountered ECG abnormalities such as intraventricular block, nonspecific repolarization abnormality, and ECG-LVH are all associated with a substantial risk of CHF. ECG-LVH carries a higher risk than x-ray enlargement. Sudden death was a common feature with CHF, occurring at 5 times the general population rate, even excluding those with overt CHD. Using the standard cardiovascular risk factors (age, systolic blood pressure, cholesterol, glucose, cigarettes, and ECG-LVH) jointly, it is possible to identify one tenth of the population from which 40% of CHF events evolve, in the absence of interim CHD or RHD.
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PMID:Epidemiology and risk profile of cardiac failure. 315 46


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