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

Fifty-one parasitic cardiomyopathies studied for periods ranging from 1 to 14 years were analyzed. In 32 cases chagasic etiology was demonstrated and in 19 cases toxoplasmic etiology. In the chagasic cases the diagnosis was confirmed by serological study and/or xenodiagnosis. In one of these patients an aneurysmatic dilatation of the left ventricular cavity was found. The clinic picture showed cardiac insufficiency and deleterous arrhythmias in 18 of the 32 cases. The rest of the patients had precordial pains. The mortality of the group was 12.5%. In toxoplasmic patients the diagnosis was made by periodical serological study, considering only those cases where concomitant clinical activity and pathological antibody response was demonstrated. In three cases the parasite was recovered from the myocardium and in another from a peripheral gland. The clinical picture in these groups consisted of precordial pain and arrhythmias in 14 cases, and cardiac failure in 13 cases. The mortality rate for the group was 42%.
Infection 1976
PMID:Parasitic cardiomyopathies. 82 6

Sixteen cases of chronic Q fever are described. In eight there was a history of exposure to infection from farms or farm products. All had valvular heart disease, involving the mitral valve in nine and the aortic valve in seven. Infection occurred on a prosthetic valve in two patients. Arterial embolism was common. Venous thrombosis occured in three patients, and pulmonary embolism occurred in three other patients. Complement fixing antibodies to phase 1 antigen were found in a titre of 1:200 or greater in all except two patients. In one of these post-mortem examination revealed rickettsial bodies in mitral valve vegetations, and in the other Coxiella burneti was isolated from heart valve tissue. The majority presented with infective endocarditis but two presented primarily with liver disease. All patients had evidence of liver involvement and in one this led to death from cirrhosis. Abnormal tests of liver function, particularly hyperglobulinaemia, raised alkaline phsophatase and abnormal bromsulphthalein retention were found in all patients. Hepatic histology was abnormal in all eight patients in whom it was studied. The commonest features were mononuclear cell infiltration of the portal tracts and prominence of the sinusoidal Kupffer cells. Patchy focal necrosis of parenchymal cells, granulomata, fatty change, and eosinophilia of the sinusoidal walls were also noted in several patients and cirrhosis developed in one. Six patients had a purpuric rash, and in 12 there was thrombocytopenia. It is suggested that the presence of hepatomegaly and liver involvement and thrombocytopenia may help to differentiate Q fever endocarditis from bacterial endocarditis. Raised serum IgM and IgA levels occured frequently, but with only a moderate dominance of IgM. Sheep cell agglutination and latex fixation tests for rheumatoid factor were occasionally positive. Several features of the disease suggest the possibility that immune-complex mechanisms may play a role in chronic Q fever. Treatment was with prolonged courses of tetracycline usually combined with lincomycin. Seven patients underwent valve replacement surgery for haemodynamic reasons. Five patients died; two from heart failure, one from cirrhosis, one seven days after valve replacement and one from intraperitoneal haemorrhage following percutaneous liver biopsy. Three patients have survived for more than five years, and another six for more than three and a half years after diagnosis. Of these nine patients, three received medical therapy alone and six required valve replacement as well. Antibiotics have been discontinued in four patients who have had valve surgery and three others. Six patients had received antibiotics for continuous periods varying from 29-62 months. In the period after stopping therapy varying from 15-21 months, no relapse has occured. A seventh patient, who had received antibiotics for four months prior to valve replacement, has survived 43 months after the withdrawal of antibiotics...
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PMID:Chronic Q fever. 94 Sep 18

Complications after heart valve replacement remain a substantial source of morbidity and mortality despite continuing advances in surgical care and prosthetic design. Infectious endocarditis occurs in about 4 percent of patients and may appear early (within 60 days) or late after operation. Endocarditis of early onset is commonly due to staphylococcal, fungal or gram-negative organisms and is fatal in 70 percent or more of cases. Infection of late onset is more often of streptococcal origin and the mortality rate is lower, about 35 percent. With either type, prompt recognition, vigorous and appropriate antimicrobial therapy and early consideration of surgical intervention are crucial. The postperfusion and postpericardiotomy syndromes are relatively common and relatively benign syndromes associated with postoperative fever. Their recognition is important to prevent confusion with endocarditis or sepsis and thus to reassure the patient and physician. Treatment is primarily symptomatic. Intravascular hemolysis occurs with most prosthetic heart valves but is more common with certain prostheses and with paraprosthetic valve regurgitation, with significant hemolytic anemia in 5 to 15 percent. Oral iron replacement therapy is effective in the majority of patients, but occasionally blood transfusion or reoperation for leak around the prosthesis is necessary. Prosthesis dysfunction due to thrombus may be recognized clinically by recurrence of heart failure, syncope, cardiomegaly and altered prosthetic valve sounds or new murmurs. Hemodynamic studies verify the diagnosis, and prompt reoperation is indicated for this potentially lethal problem. Systemic embolization has decreased markedly with the introduction of cloth-covered prostheses and is frequently related to erratic or ineffective anticoagulant therapy. We continue to recommend anticoagulant therapy for all patients with prosthetic heart valves unless there is a major contraindication.
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PMID:Diagnosis and management of complications of prosthetic heart valves. 109 75

Human parvovirus B19 is a recently recognized cause of hydrops fetalis. It is a small, single-stranded DNA virus, which preferentially infects late erythroid precursors and produces red blood cell (RBC) aplasia, fetal anemia, and cardiac failure. Infection is accompanied by characteristic intranuclear inclusions in fixed and circulating RBC precursors. These inclusions have been shown to contain virus particles by electron microscopy and in situ hybridization. Infection of the fetus, mother, and newborn infant can be diagnosed by serological and molecular methods selected to match the stage of the infection. Recent work has shown that parvovirus B19 can infect cells other than erythroid precursors, and that additional mechanisms such as myocarditis may contribute to hydrops fetalis in some cases. Infected fetuses are not always hydropic. Maternal infection results in increased abortion and stillbirth even in the absence of transplacental transmission, which occurs in approximately one third of infected mothers. The overall risk of fetal loss following maternal exposure is much less than previously thought, and may be less than 3% in the first 20 weeks of gestation or approximately 10% if the mother is actually infected. Although parvoviruses are teratogenic in animals, there is no evidence that B19 is a significant teratogen in man. The long-term outlook of survivors of intrauterine infection, including those successfully treated by intrauterine blood transfusion, appears to be good, but requires further study.
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PMID:Parvovirus infection of the human fetus and newborn. 156 88

Deep sternal wound infection following open-heart surgery caused sternal osteitis in eight patients and mediastinitis in 27 during 1980-1989. The incidence of such infection was 0.5%. Infection was more common during the last 2 years than in 1980-1987 (0.8% vs. 0.4%), and when bilateral internal mammary artery grafts were dissected (3.2% vs. 0.6% when only one internal mammary artery was used). Cure of mediastinitis was achieved by primary closed irrigation in four of 13 patients and by primary open treatment in five of ten. Muscle flap was employed in totally ten patients and omentum in four before final elimination of infection. Of the 27 patients with mediastinitis, eight (30%) died in the post-operative period of cardiac failure (3 cases), disseminated infection (2), bleeding (2) or aspiration (1). The 5-year survival rate was 43%. Prosthetic value endocarditis caused one late death and necessitated one reoperation. If eradication of postoperative mediastinitis is not achieved by early diagnosis, debridement and closed irrigation, transposition of muscle or omentum should be considered.
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PMID:Management of deep sternal wound infection after cardiac surgery--Hanuman syndrome. 194 4

B19 virus infection is common in the population and is frequently asymptomatic. However, a viraemia and prompt antibody response occurs in normal individuals and this is associated with mild, non-specific respiratory tract symptoms at the time of the viraemia and/or a rash-illness a week or ten days later. Infection of red cell precursors is a regular occurrence and this leads to aplastic crisis if B19 virus infection occurs in an individual with chronic heamolytic anaemia. Fetal infection sometimes takes place if infection occurs during pregnancy and some fetuses fail to clear the infection, develop anaemia leading to heart failure and hydrops fetalis. Some immunocompromised patients also fail to clear the viraemia and this results in a persistent or relapsing anaemia.
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PMID:The pathogenesis of diseases associated with B19 virus. 217 86

Since April 1986, 40 total artificial hearts (TAH) were implanted as a bridge to transplantation in our institution. In an attempt to identify factors affecting survival of TAH recipients we reviewed our experience over 1000 days of mechanical support. There was no postoperative bleeding requiring surgery nor were there any clinical episodes of thromboembolic complications. Over a total functioning period greater than 3 years there were no mechanical failures in the driving system but one artificial ventricle had to be replaced because of mechanical dysfunction. Infections and multiple organ failure were the primary causes of morbidity and mortality during mechanical support. When the patients who underwent staged transplantation (no. 17) were compared with those who died during mechanical support (no. 23) there were no differences in TAH driving mode or hemodynamic variables between the groups. Although preoperative pulmonary, hepatic and renal functions were found to be similar between the groups, there were significant differences in the early evolution (3 days) of hepatic and renal functions following TAH implant (p less than 0.01). Urinary output was found to be the earliest variable discriminating recovery and survival (p less than 0.01). Finally, univariate analysis indicated age (less than 40 vs greater than 40 years) and modality of cardiac decompensation (acute vs chronic) as the most important factors affecting survival after TAH implantation. Since young patients (less than 40 years of age) with acute decompensation were successfully transplanted in 82% of cases while 100% of older patients with chronic decompensation died before or after transplantation, TAH should be advised in young patients with acute or chronic heart failure and in selected older candidates with recent, acute cardiac failure.
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PMID:Mechanical circulatory support as a bridge to transplantation: current status of total artificial heart in 1989 and determinants of survival. 221 4

Acute, uncontrollable heart failure in young candidates for transplantation should be considered an indication for implantation of an artificial heart or artificial support of the hear ventricle, if a suitable graft for transplantation is not available at the time. It may be assumed that the two systems will ensure an adequate circulation and will improve organ function. The success of two-stage transplantation is cca 50%. Postoperative haemorrhage and infection are a major problem. Infection after implantation of an artificial heart is frequently incurable and is a clear contra-indication for further implantation. Thromboembolism caused by the artificial blood pump does not seem to be a serious complication when used temporarily. As none of the patients died due to failure of the pump and as also the other problems associated with the use of an artificial heart or a supporting device were successfully resolved, research and development of artificial blood pumps should proceed. Clinical results also confirmed the success of two-stage transplantation of the heart.
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PMID:[Use of an artificial heart and ventricular support system before heart transplantation]. 233 43

We have defined the clinical presentation and course of X-linked agammaglobulinemia (X-LA) by means of a multi-center retrospective survey of 96 patients. Infections were the most common presenting feature of patients with X-LA. The most frequent infections involved the upper respiratory tract (75%), lower respiratory tract (65%), gastrointestinal tract (35%), skin (28%), and central nervous system (16%). Clinical clues to the diagnosis of X-LA were the chronic or recurrent nature of infections, a family history of immunodeficiency, and infections at more than one anatomic location. Infections remained a significant problem after the diagnosis of X-LA was made and gamma-globulin prophylaxis had been instituted. One or more chronic infectious diseases occurred in 71% of patients. The respiratory tract was the most common site of disease, and the gastrointestinal tract was relatively spared. Patients died at a mean age of 17 years. The two major causes of death were chronic pulmonary disease with resultant cardiac failure, and disseminated viral infections which characteristically caused a dermatomyositis-like syndrome, hepatitis, pneumonitis, and meningoencephalitis.
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PMID:X-linked agammaglobulinemia: an analysis of 96 patients. 258 Nov 10

46 Staphylococcus aureus endocarditis episodes diagnosed with strict criteria in non drug addict patients, and 25 episodes in drug addict patients have been comparatively analyzed. Infection was found in the left side of the heart in 87% of the non addict patients and in 16% of the addicts. On the contrary, 84% of the addicts had endocarditis of the tricuspid and pulmonary valves while only 13% of the non addicts had right heart involvement. The right side endocarditis in the non addicts was always due to intracardiac catheters. 54% of the endocarditis episodes in the non addicts were fatal. Only two addicts, both when had left side endocarditis, died. Mortality was conditioned by infection of the left side of the heart as well as by the existence of heart failure. No significant differences were found between the evolution of patients treated with only one agent or of those treated with a beta-lactam antibiotic plus gentamicin. The emergency valve replacement significantly improved the prognosis of patients with prosthetic valve endocarditis.
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PMID:[Endocarditis caused by Staphylococcus aureus in drug addicts and non-addicts: the same microbe in 2 diseases]. 262 24


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