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

The present study assessed the prognostic value of hyperglycemia--a common feature in the early phase of acute myocardial infarction (AMI)--in 330 nondiabetic patients. Seventy-nine known diabetics and 10 (3%) unknown diabetics--diagnosed before discharge by stable glycosylated hemoglobin greater than 6.9% and by oral glucose tolerance testing--were excluded. Thirty-three (10%) patients died. The mortality rate was higher in women, in patients with anterior AMI, in older patients (greater than 65 years) and in the presence of heart failure. It was highest in patients with cardiogenic shock (24/36 vs 9/294; p less than 0.0001). Admission plasma glucose was significantly higher in nonsurvivors than in survivors (163 +/- 60 vs 114 +/- 36 mg/dl; p less than 0.0001). Mortality rate increased with increasing admission plasma glucose: 3% in normoglycemic patients (less than or equal to 120 mg/dl) versus 15% in patients with borderline plasma glucose (121 to 180 mg/dl) versus 43% in hyperglycemic patients (greater than 180 mg/dl) (p less than 0.0001). Multiple regression (stepwise) analysis identified cardiogenic shock, infarct site and age as the major determinants of mortality, while admission plasma glucose failed to reach full statistical significance (p = 0.067). Hyperglycemia was related to all 3 of these independent prognostic factors; when age and infarct site were accounted for, hyperglycemia was significantly associated with heart failure only and this association was characterized by a remarkable mortality rate. In nondiabetic patients with AMI, hyperglycemia is a correlate of heart failure and, therefore, an important factor of prognosis.
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PMID:Hyperglycemia and prognosis of acute myocardial infarction in patients without diabetes mellitus. 280 56

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

The records of 133 consecutive patients with spontaneous intracranial hemorrhage were reviewed to assess the frequency of systemic complications and their influence on outcome and neurological complications. The mean age of 63 patients with spontaneous intracerebral hemorrhage (ICH) was 11 years higher compared to 70 patients with spontaneous subarachnoid hemorrhage (SAH). Concomitant disease was more frequent in ICH than in SAH, and general atherosclerosis, chronic obstructive pulmonary disease and cardiac failure were associated with an increased mortality. 94% of all ICH and 79% of all SAH patients developed at least one systemic complication. A correlation was found between initial and late hyperglycemia, and high mortality rate and poor survival quality. In both groups an association of cardiac arrhythmias with intracranial pressure and an unfavourable outcome were observed. SAH patients with QT-prolongation had an increase in mortality and developed ischemic deficits more frequently. Pulmonary complications and disturbances of blood pressure regulation were associated with an unfavourable outcome, and in SAH patients with occurrence of neurologic complications.
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PMID:[Incidence and prognosis of internal medicine complications in spontaneous intracranial hematomas]. 321 Dec 45

Myocardial calcium uptake after isoproterenol (ISO) in the isolated, perfused heart was investigated at 24-h intervals after the injection of streptozocin (STZ) in rats. After 4 days, when hyperglycemia had persisted for 3 days, myocardial calcium uptake in response to this strong beta-adrenergic agonist fell significantly to the level of unstimulated hearts, which also was the level of propranolol-pretreated hearts exposed to ISO. Insulin, when given in vivo 60-90 min before perfusion, led to a complete normalization of this ISO response in diabetic rats (duration 8 days), while in vitro addition of insulin to the perfusate (0.1 U/ml) significantly increased, while not completely normalizing, the ISO-induced myocardial calcium uptake. Insulin, therefore, has a direct effect on this beta-adrenergic response in diabetic rats and streptozocin in itself does not cause the desensitization. Considering the essential role of this calcium transport for the electromechanical coupling in the heart, such metabolically induced changes in catecholamine sensitivity might hypothetically have relevance for the increased incidence of heart failure in diabetes.
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PMID:Abnormal myocardial calcium uptake in streptozocin-diabetic rats. Evidence for a direct insulin effect on catecholamine sensitivity. 388 96

The central and peripheral vascular haemodynamic effects of glucagon were studied in 29 patients. With a single dose method of 2 or 5 mg. glucagon intravenously the inotropic action of the drug produced immediate increased myocardial contractility with significant increase in cardiac output and enhanced cardiac performance, and lowering of pulmonary arterial pressure and pulmonary vascular resistance. No primary peripheral vascular effect was evident, and the increased systemic pressure and lowered systemic resistance appear to be secondary to the central action of the drug. With the dosage used there were no undesirable side-effects apart from a feeling of slight nausea. Though the haemodynamic effects are abrupt, reaching their maximum values in the first 10 minutes after injection, they tend to be dissipated within half an hour, presumably due to the very rapid destruction of the drug. Repeated booster doses rather than continuous infusion may be the method of choice to maintain an increased cardiac output. The positive chronotropic action of the drug may cause transient palpitations. Glucagon increased the cardiac output in the acute phase of myocardial infarction by 42 per cent. The haemodynamic effects in chronic rheumatic heart disease are more varied, and it may increase left atrial pressure in mitral stenosis, which is undesirable. Hyperglycaemia results from liver glycogenolysis but blood sugar levels rarely exceeded 200 mg./100 ml. These results warrant further study of the value of glucagon as a positive inotropic agent in low output heart failure, especially in acute myocardial infarction with cardiogenic shock, or after cardiac surgery, or in unrelieved chronic congestive heart failure.
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PMID:Haemodynamic effects of glucagon. 542 74

Two cases of severe beta-blocker overdose are presented that were treated successfully with glucagon therapy. The effects of glucagon in reversing the cardiovascular depression of profound beta-blockade, including its mechanism of action, onset and duration of action, dosage and administration, cost and availability, and side effects are reviewed. Medical complications of beta-blocker overdose include hypotension, bradycardia, heart failure, impaired atrioventricular conduction, bronchospasm and, occasionally, seizures. Atropine and isoproterenol have been inconsistent in reversing the bradycardia and hypotension of beta-blocker overdose. Glucagon increases heart rate and myocardial contractility, and improves atrioventricular conduction. These effects are unchanged by the presence of beta-receptor blocking drugs. This suggests that glucagon's mechanism of action may bypass the beta-adrenergic receptor site. Because it may bypass the beta-receptor site, glucagon can be considered as an alternative therapy for profound beta-blocker intoxications. The doses of glucagon required to reverse severe beta-blockade are 50 micrograms/kg iv loading dose, followed by a continuous infusion of 1-15 mg/h, titrated to patient response. Glucagon-treated patients should be monitored for side effects of nausea, vomiting, hypokalemia, and hyperglycemia. The high cost and limited availability of glucagon may be the only factors precluding its future clinical acceptance.
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PMID:Glucagon therapy for beta-blocker overdose. 614 98

Hyperthermia is a totally different modality from existing treatment modalities. Systemic hyperthermia (S-HT) is effective against advanced tumors which make resistance to conventional cancer therapies. In S-HT, it is essential and very important to manage cardio-pulmonary function in good condition. Especially, PEEP (about 7 cm H2O) is very effective to prevent lung edema. Fifty-four patients with a variety of neoplasms were subjected to S-HT, alone or in combination with chemotherapy, radiotherapy, and immunotherapy. S-HT was performed under general anesthesia by using extracorporeal circuit in corporating a heat exchanger. Usually, S-HT was given for 4-8 hours with 41.5-42.0 degrees C at 2 weeks intervals. Out of 25 evaluable cases, response was obtained in 11 cases (44%) including 2 cases of complete response. Cardio-pulmonary performance was evaluated using a flow directed pulmonary artery catheter (Swan-Ganz catheter). At treatment temperature, all patients showed hyperdynamic conditions and developed a two-fold mean increase in cardiac index. Altogether 172 treatment sessions were associated with sinus tachycardia and a reduction in diastolic pressures. Laboratory abnormalities included thrombocytopenia without sign of D.I.C., moderate hyperglycemia, mild degree of hypophosphatemia, hypolcalemia and transient elevations in liver enzymes. Serum creatinine levels were elevated in all treatment sessions without elevation of serum BUN. Serum levels of calcium and magnesium were stable. All of abnormalities and toxicities were decreased within 1 to 2 weeks after treatments. It is suggested that with carefully monitored conditions S-HT be performed safely without heart failure.
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PMID:[Clinical practice of systemic hyperthermia therapy and physiological responses of the host]. 687 Feb 90

Hypertension is a major contributor to cardiovascular disease, which imparts a threefold increased risk over that of normotensive persons the same age. It accelerates atherogenesis-promoting premature coronary disease, now its most common sequela. The effect of elevated blood pressure on cardiovascular disease morbidity and mortality in general and on coronary disease incidence in particular is independent of the influence of other predisposing atherogenic cofactors but is greatly affected by them. Elevated blood pressure is more often than usual associated with hyperlipidemia, hyperglycemia, hyperuricemia, excessive weight, elevated fibrinogen, and electrocardiogram (ECG) abnormalities, which enhance its impact. Hypertensive coronary candidates usually have an increased low-density lipoprotein/high-density lipoprotein (LDL/HDL) cholesterol ratio, impaired glucose tolerance. ECG abnormalities, or a cigarette smoking habit. These coexisting risk factors exert a greater influence than the character of the blood pressure elevation. Those at risk for hypertensive stroke have left ventricular hypertrophy (LVH), atrial fibrillation, cardiac failure, coronary disease, diabetes, or a cigarette habit. Cardiovascular risk ratios for hypertension diminish with advancing age, but this is offset by a higher absolute risk, making hypertension an important precursor of cardiovascular disease in the elderly.
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PMID:Hypertension as a risk factor for cardiac events--epidemiologic results of long-term studies. 769 48

Freeze tolerance in the wood frog, Rana sylvatica, is promoted by multiple, integrated physiological responses to ice forming within body tissues. By analyzing the freezing responses of the sympatric, but freeze intolerant, leopard frog (R. pipiens), we sought clues to the evolution of anuran freeze tolerance. Physiological responses critical to R. sylvatica's freeze tolerance, such as the synthesis and distribution of the cryoprotectant glucose, protective dehydration of organs, and deferred cardiac failure, were present, but comparatively less pronounced, in R. pipiens. Both species were innately tolerant of hyperglycemia. Glucose supplements did not enhance the freezing viability of R. pipiens, although in vitro tests of cryoprotectant efficacy revealed that glucose and glycerol provided comparable protection to erythrocytes of both species. We conclude that the evolution of freeze tolerance in R. sylvatica is not only promoted by its desiccation tolerance and the fortuitous biophysical consequences of freezing (e.g., exothermic induction of cardioacceleration and moderation of cooling rate) but also involves a progressive enhancement of fundamental physiological stress responses.
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PMID:Physiological responses of freeze-tolerant and -intolerant frogs: clues to evolution of anuran freeze tolerance. 823 38

Diabetes mellitus is one of the diseases with the greatest risk of developing coronary disease (CD), with the estimation of this risk in relation to the general population being from 2 to 4-fold greater. The existence of diabetes worsens the prognosis of CD and thus, postinfarction mortality in these patients is double that observed in non-diabetic patients. Together with the risk factors found in the general population, those of special interest are those derived from diabetes itself, such as hyperglycemia, dyslipemia, coagulation disorders and hyperinsulinemia or insulin resistance. Among these, the most important is probably the hyperglycemia which may contribute to the appearance of CD by different mechanisms such as proteic glycosylation, accumulation of sorbitol, increase in the synthesis of protein kinase C or oxidative stress. It must not be forgotten that an old controversy has recently been brought up suggesting that sulphonylureas may have a certain cardiotoxic effect, probably acting on the potassium channels dependent on ATP. Acute myocardial infarction in diabetic patients carries a greater risk of congestive heart failure, recurrent infarction, arrhythmia and cardiogenic shock, with one of its characteristics being the possibility of being silent when autonomic neuropathy is present. The prognosis of CD may be markedly improved by obtaining optimum glycemic control during the hours following infarction using intensified treatment. Diabetic myocardiopathy as a differentiated nosology responsible for alterations in myocardial contractile function and greater prevalence of heart failure in these patients seems to be clearly demonstrated although its etiology remains unknown.
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PMID:[Heart pathology of extracardiac origin. XI. Cardiac repercussions of diabetes mellitus]. 978 Jul 81


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