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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 (CHF) has kept its progressive nature despite significant advances in therapy. With more advanced disease, medical therapy is broadened. Even so, some patients remain severely symptomatic. However, before additional action is taken, it should be regarded if therapy really fails. Often, therapy is not increased sufficiently because of assumed rather than actual intolerability. Thus, increase in serum creatinine up to 30-50%, hyperkaliemia up to 5.5 mmol/l, and asymptomatic hypotension and bradycardia are usually acceptable. Cautious and slow start and uptitration are the more important the more severe heart failure is, but these patients also profit most from this therapy. If patients remain severely symptomatic despite adequate medical therapy, cardiac resynchronisation therapy (CRT) should be considered. It significantly improves both symptoms and prognosis. Although implantable defibrillators (ICD) are less effective in end-stage CHF, CRT and ICD may be combined as CRT may improve function status, making patients eligible also for ICD therapy. In selected patients, heart transplantation is still an option if no other therapeutic options are effective and there are no contraindications. In these patients, prognostic assessment of CHF is particularly important. Assist devices are used as bridge to transplant or more seldom to recovery only in many countries, but destination therapy may become more important in future therapy with improved devices. Many other therapies are under investigation at present. Thus, therapeutic options for end-stage CHF may further broaden in the near future.
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PMID:End-stage chronic heart failure. 1737 Jan 48

Sarcoidosis disease expression differs along racial/ethnic lines and black race has been cited as a poor prognostic factor. Besides genetic, healthcare, and socioeconomic factors, comorbid illnesses may influence sarcoidosis disease expression. We set out to investigate the association between comorbid illnesses and chest radiographic severity in a population of African-American sarcoidosis patients. The study was designed as a retrospective database analysis. The hospital and outpatient databases of the Grady Health System were searched to capture adult patients between November 1999 and December 2003 with the ICD-9 codes of 135 or 519.8, along with all associated secondary and tertiary diagnostic codes. Patient electronic pathology and radiographic reports were reviewed for tissue biopsies showing noncaseating granulomas and for chest radiographic Scadding stage. A total of 165 African-American patients were identified (64% female, 43 +/- 10 years old). Ninety percent (149/165) had comorbid illnesses. The most frequent chronic comorbid illnesses were hypertension (39%), diabetes mellitus (19%), anemia (19%), asthma (15%), gastroesophageal reflux disease (15%), depression (13%), and heart failure (10%). Females had increased frequency and clustering of chronic illnesses. Chest radiographic stages were more severe in patients with anemia, depression, and those less than 40 years old. Males, within each chronic illnesses category, had more severe CXR stages compared to females; however, significance was not achieved. We concluded that most adult patients with sarcoidosis have comorbid illnesses and these, in addition to gender differences, may influence sarcoidosis disease expression. Screening for comorbid illnesses should be an important aspect of sarcoidosis patient management.
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PMID:Comorbid illnesses and chest radiographic severity in African-American sarcoidosis patients. 1738 99

The effect of cardiac resynchronisation therapy on ventricular tachycardias (VT) has not been well established. This case-report demonstrates the favourable impact of biventricular pacing on ventricular arrhythmias. In 2004, a patient with dilated cardiomyopathy and ICD since 1999 was admitted to our Division for multiple VT. While left ventricular function was markedly reduced and mitral regurgitation was severe, he was asymptomatic for heart failure. Amiodarone was not administered on account of a documented proarrhythmic effect. The patient's ICD was upgraded to an ICD-biventricular system. After upgrading, a significant reduction in the number of VT was noted.
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PMID:The beneficial effect of biventricular pacing on ventricular tachycardia in a patient with non-ischemic cardiomyopathy. 1743 65

This article provides information and a commentary on trials relevant to the pathophysiology, prevention and treatment of heart failure, presented at the American College of Cardiology meeting in March 2007. Unpublished reports should be considered as preliminary data, as analyses may change in the final publication. The ALPHA study suggested that patients with heart failure (HF) due to idiopathic dilated cardiomyopathy who have a negative T-wave alternans test have a good prognosis and are unlikely to benefit from ICD therapy. EVEREST provides some evidence of short-term symptom benefit of tolvaptan in patients with acute decompensated HF but no clinically important long-term benefit. FUSION II failed to show a benefit of nesiritide in patients with chronic decompensated HF. Reducing blood pressure in hypertensive patients improved diastolic dysfunction in VALIDD. Eplerenone did not improve left ventricular remodelling in mild to moderate chronic HF. Selecting HF patients for revascularisation using FDG-PET imaging did not significantly improve outcome. Crataegus extract added to standard HF therapy did not reduce morbidity or mortality in SPICE. The COURAGE study, conducted in patients without HF or major cardiac dysfunction, showed that PCI did not reduce cardiac morbidity or mortality and can be safely deferred in patients with stable coronary disease on optimal medical therapy. The COACH study failed to show that HF nurse-intervention could reduce hospitalisations but did show trends to lower mortality, especially amongst patients with reduced ejection fraction; however, the smaller REMADHE study suggested striking benefits on morbidity and mortality. A large study of BNP provided additional information on its ability to distinguish cardiac and pulmonary breathlessness. The importance of dietary intervention in post-MI patients was highlighted by the findings of THIS-diet study.
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PMID:Clinical trials update from the American College of Cardiology 2007: ALPHA, EVEREST, FUSION II, VALIDD, PARR-2, REMODEL, SPICE, COURAGE, COACH, REMADHE, pro-BNP for the evaluation of dyspnoea and THIS-diet. 1748 46

The authors analyze the effectiveness of cardioresynchronizing therapy (CRT) in patients with cardiac insufficiency (CI) and intraventricular conductivity disorder. The results of completed randomized studies (CONTAK-CD, MIRACLE-ICD, MUSTIC-AF, RD-CHF, COMPANION, PATH-CHF, PATH-CHF II, MUSTIC-SR, MIRACLE, MUSTIC-AF, CARE-HF) and their metanalysis are evaluated; drawbacks of these studies are demonstrated. CRT has been demonstrated to increase survival rate due to slowing down CI progress; total mortality falls thanks to CRT even without defibrillation function. High efficacy and safety of CRT in patients with CI and profound systolic dysfunction have been demonstrated; quality of life increases by 7.6 points and by 8 points in patients with III to IV functional class CI. At the same time, there is a need for additional investigations of CRT for adequate selection of patients and optimization of stimulation modes. It is not quite clear yet for what functional class CI CRT will be most effective, which criterion is most important for patient selection, whether biventricular stimulation has advantages over left-ventricular one, and whether it is necessary to stimulate the atriums or their detection is enough. Few studies on chronic atrial arrhythmias have been conducted, thus it is not known to which extent CRT is effective in this category of patients.
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PMID:[Cardioresynchronizing therapy in treatment of cardiac insufficiency]. 1756 39

This article provides information and a commentary on trials relevant to the pathophysiology, prevention and treatment of heart failure, presented at Heart Rhythm 2007 organised by the Heart Rhythm Society which was held in Denver, USA and Heart Failure 2007 organised by the Heart Failure Association of the European Society of Cardiology which was held in Hamburg, Germany. Unpublished reports should be considered as preliminary data, as analyses may change in the final publication. The CARISMA study suggests that non-invasive screening tests may help to identify post-MI patients who may benefit from ICD therapy. Data from the PREPARE study show that more conservative ICD programming can reduce morbidity at the cost of an increased risk of arrhythmic syncope. DAVID II indicates that atrial pacing may be a safe alternative to ventricular back-up pacing in patients with left ventricular dysfunction and standard indications for an ICD. The incidence of persistent atrial fibrillation in patients with sinus node disease in SAVE-PACE was reduced by dual chamber minimal ventricular pacing compared to conventional dual chamber pacing. The pilot phase of the PROTECT studies confirmed 30 mg as the dose of the selective A1 adenosine receptor antagonist KW-3902 to be used in pivotal studies. AREA-IN-CHF failed to show a beneficial effect of canrenone on LV volumes compared to placebo however some beneficial effects on secondary clinical endpoints were observed.
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PMID:Clinical trials update from Heart Rhythm 2007 and Heart Failure 2007: CARISMA, PREPARE, DAVID II, SAVE-PACE, PROTECT and AREA-IN-CHF. 1764 12

Depression is a common psychiatric disorder, characterized by a persistent lowering of mood, loss of interest in routine activities and diminished ability to experience pleasure. There are several depression classification systems and diagnostic tools based on clinical symptoms, i.e. the International Classification of Diseases (ICD-10), the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the Hamilton Depression Rating Scale, the Montgomery-Asberg Scale and Beck's Depression Inventory. Depression frequently occurs in patients with heart failure, as similar pathophysiological mechanisms of neurohormonal activation, arrhythmia, inflammation and hypercoagulation are present in both these diseases. Prognosis in patients with depression is also affected by insufficient cooperation between a patient and his doctor as regards the lifestyle and medication intake of a patient. Depression is usually accompanied by remission and relapse periods which might be related to the current heart failure status of a patient and despite intensive medical treatment they may recur. Depression is often difficult to diagnose or even left undiagnosed and thus untreated, because its symptoms: fatigue, apathy and decreased exercise tolerance, are common in the general population. Furthermore, safety and efficacy of antidepressant therapy in patients with cardiovascular diseases are not well established. Evidence from clinical trials evaluating the influence of depression behavioral and pharmacological treatment on morbidity and mortality in patients with heart failure is also limited. Taking into account that depression affects prognosis in patients with variety of disorders and common pathological mechanisms present both in depression and heart failure, screening tests for depression should be considered not only in patients with diagnosed heart failure but also those at risk of heart failure development.
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PMID:Is depression a problem in patients with chronic heart failure? 1840 73

Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly. The usual clinical course is severe left sided heart failure and mitral valve insufficiency presenting during the first months of life. However, in some cases collateral blood supply from the right coronary artery is sufficient and symptoms may be subtle or even absent. Arrhythmias or sudden cardiac death in adult life may be the first clinical presentation in patients with ALCAPA. We report a case, where a 39-year old woman presented with ventricular fibrillation during phycial exertion. Coronary angiography and CT-angiography revealed an anomalous origin of the left coronary artery, and an aortic reimplantation of the left coronary artery was performed followed by ICD implantation. A review of the literature on ALCAPA is presented along with CT images before and after surgery.
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PMID:Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) presenting with ventricular fibrillation in an adult: a case report. 1850 13

We present a case of a 58-year-old man. Due to high-degree mitral regurgitation an anuloplasty device (MONARCtrade mark) was inserted. During continuous pacing, inter- and intraventricular asynchrony occurred and heart failure worsened. The indication for cardiac resynchronization was established. A biventricular ICD was successfully inserted with the left ventricular approach via the coronary sinus over the MONARCtrade mark device (Edward Lifescience, Irvine, CA, USA). Biventricular pacing significantly shortened the QRS duration and improved the clinical status as well as the 6-minute walking test.
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PMID:Cardiac resynchronization therapy in a patient with a mitral annuloplasty device. 1868 68

All patients with coronary heart disease (CHD) are at risk for sudden cardiac death (SCD) multiple factors in addition to reduced ejection fraction (EF) have been demonstrated to contribute to the risk for SCD after myocardial infarction (HI), these include the presence of non sustained ventricular tachycardia (NSVT), symptomatic heart failure (HF), and sustained monomorphic VT inducible by EP testing. The only specific antiarrhythmic treatment proved consistently is effective to reduce risk of SCD and total mortality is the ICD. ICD therapy is indicated to reduce the risk of SCD in 2 patient groups; patients whose LVEF is less than or equal to 35% as a result of prior MI and who have spontaneous NSVT and sustained monomorphic VT inducible by EP testing, and patients of and MI than occurred greated than or equal to 40 days earlier when HF (NYHA) functional class II or III symptoms) is present. Amiodarone therapy has been thought to be relatively safe in patients with prior MI who had symptomatic arrhythmias that required suppression. Although randomized trials have not demonstrated a survival benefit when empiric amiodarone is initiated early after MI, mortality was not increased, and arrhythmic deaths showed a consistent trend toward reduction with amiodarone treatment.
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PMID:[Primary prevention of sudden cardiac death implanted cardioverter defibrillator (ICD) versus antiarrhythmic drugs]. 1893 11


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