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)

In heart failure the maximal capacity for dilation, especially in skeletal muscle arteries, is reduced. This may be due to changes in sympathetic tone, in hormonal stimulation (both by circulating and intramurally released compounds like angiotensin II with additional presynaptic effects) or in endothelium mediated vasodilation. The loss of endothelium-mediated, flow-dependent dilation in large arteries may originate from endothelial impairment induced by, e.g., chronic hypoxia or hypercholesterolemia. Similar effects result from suppressed local dilator autacoid release brought about, e.g., by circulating atrial natriuretic factor in the presence of a fully functioning endothelium. Finally, attenuated augmentations in flow may be secondary to changes in muscular metabolism, and an increased alpha-adrenergic neurogenic constriction may be present. This may be further enhanced by a local, beta-receptor-mediated angiotensin II release. An impaired dilation at the level of resistance vessels may result from a combination of the mechanisms listed above.
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PMID:Consideration of conduit and resistance vessels in regulation of blood flow. 326 33

We studied the frequency of heart disease and association with other coronary risk factors in 243 consecutive patients (124 male and 119 female) suffering from arterial hypertension (Group HT). The mean age was 67.5 +/- 9.6 years. This group was compared to a group of 357 subjects (217 male and 140 female) without arterial hypertension (Group noHT) and mean age of 63.5 +/- 13 years. In our group the patients with arterial hypertension presented smoking habits in 35%, hypercholesterolemia in 22%, left ventricular hypertrophy (LVH) in 18%, alcoholic habits in 15%, hypertriglyceridemia in 12%, diabetes in 9% and hyperuricemia in 7%. 15% of the patients suffering from arterial hypertension turned out with coronary heart disease (62% angina and 38% myocardial infarction), 19% with atrial fibrillation and 13% with heart failure. Compared to the patients without hypertension we found significant statistical correlation with the age (67.5 +/- 9.6 HT and 63.5 +/- 13 no HT, p < 0.001), the LVH (18% HT and 4% no HT, p < 0.001) and number of coronary risk factors (2 +/- 1 HT and 1.1 +/- 0.9, p < 0.001). The percentage of people without cardiac disease is lower among the group with arterial hypertension (53% HT and 71% noHT, p < 0.001), showing as well a higher incidence of atrial fibrillation (19% HT and 11% noHT, p < 0.05) and heart failure (13% HT and 7% noHT, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Study of associated risk factors and prevalence of heart diseases in patients with arterial hypertension]. 754 43

From January 1982 to October 1991, 42 consecutive patients 80 years of age and older underwent a combined cardiac procedure with coronary revascularization and valve repair or replacement. There were 20 women and 22 men. Mean age at operation was 82.8 years (range, 80 to 89.7 years). Twenty-seven patients (64%) were in New York Heart Association (NYHA) functional class III or IV preoperatively. Six patients (14.3%) had undergone previous cardiac procedures. There were six hospital deaths (14.3%). The only significant preoperative risk factor identified for the event hospital death was aortic insufficiency (p = 0.005). The 36 hospital survivors were followed up at a mean of 21.1 months after hospital discharge. There were nine (21%) late deaths occurring at a mean of 21.3 months postoperatively: two from acute myocardial infarctions and seven from chronic heart failure. Survival analysis indicated that higher preoperative NYHA class (p = 0.0003), hypertension (p = 0.015), hypercholesterolemia (p = 0.03), and elevated left atrial/left ventricular gradient (p = 0.04) were incremental risk factors for overall mortality. The actuarial survival at 40 months was 51.9%, with no significant difference as compared with an age-, sex-, and race-matched population. Of the 27 late survivors, 26 were in NYHA class I or II. We conclude that octogenarians may undergo complex cardiac surgical procedures with an expectation of an acceptable mortality rate and significant improvement in their functional status. These results must be taken into consideration in light of reported strategies to ameliorate health-care costs by limiting availability of complex medical care to the elderly.
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PMID:Efficacy of combined coronary revascularization and valve procedures in octogenarians. 755 62

We analyzed data on 69 Japanese patients who had been affected with systemic lupus erythematosus (SLE) for more than 10 years to clarify the clinical and social features of the chronic phase of this disease. There were 3 men and 66 women. Mean age at disease onset was 24.3 years, and the mean duration of disease was 17.4 years. In these patients, the mean number of relapses was 1.5, and the mean duration of the relapse was 4.7 years. These patients were receiving prednisolone at a mean dosage of 9.2 mg/day. While only 4 patients were thought to be in the active disease stage at the time of evaluation, hypercholesterolemia was present in 33.3% (20 patients out of 60) and 64. 3% (27 patients out of 42) showed a decrease in bone mineral content by DEXA method. Ten patients out of 69 patients (14.5%) had aseptic necrosis of the head of the femur (ANF). ANF was related to the relapse and the administration of immunosuppressant in the initial therapy. Seventeen female patients had gotten married after the onset of SLE and 14 patients became pregnant and gave birth. Of the 9 deaths that occurred, only 3 cases were thought to be due to SLE. Two patients died suddenly, and there was 1 case of acute heart failure. Mean age at death was 39.8 years old. However, data suggest that many patients in the chronic phase of SLE may have a reasonably high quality of life, despite the disease.
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PMID:[Outcome of patients with chronic systemic lupus erythematosus]. 757 Feb 3

The National Insurance Administration, through the system of blue prescription forms, refunds part of the cost of drugs used to treat a number of chronic diseases. To obtain a refund, the indication for prescribing the drug must be included in the list of diagnoses which entitle a refund through the system. The list is a long one, and costs are refunded for prophylactic drugs (e.g. against hypertension and hypercholesterolemia), drugs to alleviate symptoms (e.g. for certain skin diseases and heart failure) and curative measures. The qualitative criteria for a refund, over and above the diagnosis, are not precisely defined, and doctors are free to choose the drug they prefer, regardless of price. The authors discuss whether the list of diagnoses should be extended to include osteoporosis, and recommend that doctors should be able to prescribe the relevant preventive and palliative drugs on a blue form. Many think that this refund system is a good initiative.
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PMID:[Osteoporosis drugs prescribed on blue forms!]. 853 31

During 1984 to 1991, 54 out of 569 lupus nephritis patients at Siriraj Hospital were male (F:M sex ratio = 10:1). Mean age of the males was 29.8 +/- 14.6 years, range 12 to 69. The three most common extrarenal manifestations were anemia, cutaneous, and musculoskeletal involvement (74.5, 51.1, and 43.9%, respectively). The major renal manifestations were edema (75.9%) with heavy proteinuria over 3.5 g/day in 62.2% and nephrotic/nephritic findings in 51.9% of cases. Hypertension was found in 35.2%. Mean serum creatinine was 2.0 +/- 1.4 mg/dl while 60.5% of cases had creatinine clearance below 50 ml/minute. Mean serum albumin was 2.6 +/- 0.8 g/dl, cholesterol 262.8 +/- 129.5 and triglycerides 343.2 +/- 244.6 mg/dl. Interestingly, hypercholesterolemia (> 250 mg/dl) was found only in 44.8% of cases with nephrotic syndrome. Antinuclear antibody was demonstrated in 91.5%, anti-dDNA antibody in 64.4% and LE cells in 40.4% of cases. Renal biopsy was done in 45 patients and 30 cases (66.7%) were classified as diffuse proliferative nephritis (WHO type IV), 15.6% of type II, 6.7% each of type III and V, with the rest of type V plus IV (4.4%). Tubulointerstitial inflammation was found in 77.3% of cases. During the follow-up period (42 +/- 35.8 months), 6 patients died. The cause of death were uremia in 3, infection in 2, and cardiac failure in 1. By life-table analysis, the probabilities of survival for 1 and 5 years were 89.5 and 80.6%, respectively. In comparison between sexes, except for a higher amount of urinary protein excretion (4.5 +/- 3.1 vs 3.5 +/- 3.0 g/day, p < 0.05), there were no statistically significant differences in clinical and pathological parameters, and probability of survival.
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PMID:Lupus nephritis in males: 8-year experience at Siriraj Hospital. 761 14

A retrospective analysis without exclusion of 369 consecutive cases of myocardial infarction admitted between January 1988 and March 1992 studied the risk factors, previous medical history and treatment in this period during which medical practice seemed to be standardised with acknowledged benefits of thrombolysis, beta-blockade and aspirin therapy. The population observed is divided in three age groups (< 65, > 65 < 75 and > 75). A Cox model multivariate analysis for age, sex, diabetes, hypertension, hypercholesterolaemia, tobacco smoking, previous infarction, coronary artery disease and cardiac failure underlined the risk related to age which was 3.2 for patients 65-75 years of age and 4 for patients over 75 years of age. The risk was high in women (1.4), diabetes (1.5) and previous infarction (1.7). The excess mortality of the elderly age groups could also have been related to medical management as the most effective treatments were less commonly used. Thrombolysis was used in 44% of patients under 65 years of age but in only 9.7% of patients over 75 years; betablockers were prescribed in 77.6% of the younger but only in 27.4% of the older patients. The same tendency was observed in the administration of aspirin, with 81.6% receiving this drug in the younger patients compared to only 61% in older patients. Differences in survival at 6 months according to age (93.6%, 74% and 54.9%) show that there is a clearly defined therapeutic objective over 65 years of age with a large field of action and a probability of significant improvement in mortality and morbidity.
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PMID:[Survival in acute myocardial infarction in a group of 369 patients consecutively admitted between 1988 and 1992. Analysis of risk factors and medical procedure]. 770 28

To examine gender differences in the long-term prognosis of patients with myocardial infarction, 1000 patients with myocardial infarction were studied after coronary arteriography. Over a follow-up period of 3.3 +/- 2.0 years, 65 patients died from cardiac causes and 301 experienced cardiac events (death, reinfarction and revascularization). Overall, the 5-year cardiac mortality was 8%: that in females (12.4%) was significantly higher than that in males (6.6%) (p = 0.0073). The overall 5-year cardiac event-rate was 35%, with no significant difference between females and males (41.1% vs 33.3%). Univariate analysis revealed that differences in age (57.8 +/- 9.8 years in males vs 64.8 +/- 8.9 years in females, p < 0.0001), presence of smoking habit, obesity, hypercholesterolemia, hypertension, heart failure, right coronary artery disease, nicorandil administration, hypolipidemic, diuretic and anti-hypertensive treatment, and warfarin administration were present between men and women. The mortality rate in elderly females tended to be higher than that in their male counterparts. Multivariate analysis demonstrated that number of diseased vessels, post-infarction angina and left main trunk disease were significant predictors for cardiac death in both sexes, while gender was not. Therefore, gender did not appear to affect the long-term prognosis after age-adjustment among patients with myocardial infarction in the Western part of Japan.
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PMID:Gender difference in long-term prognosis after myocardial infarction--clinical characteristics in 1000 patients. The Kyoto and Shiga Myocardial Infarction (KYSMI) Study Group. 775 40

The poor prognosis of arterial hypertension is mainly determined by its cardiac organ damages. Even borderline arterial hypertension significantly increases coronary morbidity and mortality, particularly in the presence of other risk factors such as hypercholesterolemia, diabetes, and cigarette smoking. Arterial hypertension causes myocardial hypertrophy and fibrosis, and affects coronary microcirculation by structural and functional changes of the small intramural resistance arteries, rarefiction of arterioles and capillaries and a distinct disturbance of endothelial vasomotion (i.e. "hypertensive remodeling"). Moreover, the presence of arterial hypertension predisposes to atherosclerotic coronary artery disease. Regarding the benefit-risk-ratio of antihypertensive therapy, benefit is much greater than risk: 1) An antihypertensive treatment with ACE-inhibitors, calcium channel blockers, beta-receptorblockers and anti-sympathicotonic substances leads to both reversal of LV hypertrophy and improvement of coronary flow reserve. Incidence of hypertensive heart failure has dropped considerably during the last 20 years. 3) Intervention studies have shown at least a clear tendency of a reduction in coronary morbidity and mortality. 4) In patients with coronary artery disease diastolic blood pressure should not be lowered under 85 mm Hg (J-curve). 5) An antihypertensive treatment should not adversely influence blood lipids when cholesterol is elevated. 6) Even in very elderly patients medical intervention to lower blood pressure is indicated from the cardiologic point of view (SHEP- and SHOP-studies).
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PMID:[Benefits and risks of hypertension therapy from the cardiac viewpoint]. 817 41

Patients surviving acute myocardial infarction are susceptible to heart failure, recurrence of angina, reinfarction, arrhythmias, and sudden cardiac death. Most deaths occur in the first six months after infarction. Advancing age is the most important nonmodifiable prognostic factor for long-term prognosis, whereas left ventricular function assessed clinically or measured as either ejection fraction or end-systolic volume is the most important modifiable factor. Other significant long-term prognostic factors include: postinfarction angina at rest, inducible ischemia during exercise testing with or without radioisotope imaging, severity and extent of coronary artery disease, patency of the infarct-related artery, late ventricular arrhythmias, decreased heart rate variability, cigarette smoking, hypercholesterolemia, and diabetes mellitus. Identification of these adverse prognostic factors permits risk stratification and enables physicians to determine the most appropriate and cost-effective treatment. Most patients should have a stress test for inducible ischemia and a non-invasive (echo or radionuclide) assessment of left ventricular function. For high-risk patients such as those with prior infarction, heart failure, early postinfarction angina, or frequent late ventricular arrhythmias, coronary angiography and ventriculography prior to discharge are recommended. Assessment of late potentials and heart rate variability will help identify a subgroup of patients at risk for ventricular arrhythmias and cardiac death. However, a more accurate prediction of reinfarction is not possible at present, and no reliable test for atherosclerotic plaque instability has been developed.
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PMID:Factors affecting outcome after recovery from myocardial infarction. 819 87


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