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)

It has long been recommended that one should be careful in prescribing drugs for the elderly. However, it has been shown that more than 20% of those over 65 use diuretics. With advancing age this percentage increases. The sign of ankle oedema appears to be an important factor in the decision to prescribe diuretics. If the oedema is not caused by heart failure, chronic renal failure or hypoproteinaemia, the use of diuretics in ankle oedema is controversial. We used a questionnaire survey to obtain information on the opinions of Dutch general practitioners about the differential diagnosis and treatment of ankle oedema in the elderly. In the questionnaire we presented the case of a 68-year-old woman who complained of ankle oedema without any symptom or sign of heart failure. The questionnaire was sent to 200 Dutch general practitioners (response rate 64%). Chronic venous insufficiency was mentioned by 86% and heart failure by 12% of the responders as the most probable cause of the oedema. The treatment proposed by 59% was advice and (or) compression therapy without drugs, while 40% would have prescribed diuretics.
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PMID:[The treatment of ankle edema in the elderly in family practice; when and how often are diuretics used?]. 221 20

Iatrogenic fistulae are sporadic but potentially serious complications of catheterization of central veins. The authors present the case-history of a 57-year-old patient with chronic renal failure where after 19 months following temporary insertion of a central venous catheter into the subclavian vein on the right from and infraclavicular approach a continual murmur was recorded in the right subclavicular area, along with increasing manifestations of left-sided cardiac insufficiency. Using digital subtraction angiography, the authors diagnosed an arteriovenous fistula between the internal thoracic artery and the right brachiocephalic vein. The described case draws attention to a rare complication of catheterization of the central veins and its possible haemodynamic sequelae.
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PMID:[Arteriovenous fistula complicating central venous catheterization]. 225 69

Changes of the functional indices of central and intracardiac hemodynamics during treatment with hemodialysis or peritoneal dialysis, as well as after cadaver kidney transplantation, were studied in 44 patients with the terminal stage of chronic renal failure by means of radiocardiography with 131I-albumin. The signs of cardiac insufficiency were evaluated according to the classes of the cardiologists' New York classification accepted in 1964. Four groups of patients were distinguished during the analysis: group 1-10 patients given intravenous detoxification therapy; group 2-19 patients treated by chronic programmed hemodialysis; group 3-4 patients kept on peritoneal dialysis; group 4-11 patients after allotransplantation of cadaver kidney. It was found that in group 1 patients the indices of central (mean arterial pressure, cardiac and stroke indices, total peripheral vascular resistance, work of the left ventricle) and intracardiac (time of circulation of blood in the heart cavities and lungs) hemodynamics were on the upper normal values and in occasional cases exceeded it. In patients of group 2 the indices of intracardiac hemodynamics grew worse and required an individual approach to the hemodialysis regimens with due account for the volemic disorders. In group 3 some indices of central and intracardiac hemodynamics corresponded to those in group 2, but the circulation volume, and mean arterial pressure were normal, which was reflected by better subjective tolerance to peritoneal dialysis. Analysis of indices in group 4 patients showed improvement of normalization of most parameters of central and intracardiac hemodynamics with gradual increase of diuresis, and abatement of the clinical signs of cardiac insufficiency after successful transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A comparative evaluation of the central hemodynamic indices in patients with the terminal stage of kidney failure during dialysis therapy and allografting]. 226 5

A one-year prospective study of the complications of hypertension was carried out in the Medical Wards of the John F. Kennedy Hospital in Monrovia, Liberia. Of all medical admissions 15.6% (105 out of 672) were due to hypertension with its complications. Of the hypertensives, 72.4% (76 of 105) came from the lower socio-economic class. Heart disease with 55.2% (58 of 105) was the commonest complication. Next was stroke with 31.4% (33 of 105). Of the cases of heart disease, only one had suffered a myocardial infarction, the rest had congestive cardiac failure (CCF) without coronary heart disease. Severe hypertensive retinopathy was found in only four patients all of whom had severe uraemia. Hypertensive CCF constituted 41.1% (57 of 139) of all cases of CCF admitted to our hospital. All the complications and deaths were more common in males than in females and they were not uncommon in the young. Chronic renal failure, with 100% mortality, had the worst prognosis. 60.0% of the patients had not previously been diagnosed as hypertensive. There is an urgent need for health education in Liberia to inform the people of the dangers of uncontrolled hypertension and to encourage them to get their blood pressure measured periodically thus improving the early detection and initiation of antihypertensive treatment to prevent the complications of hypertension.
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PMID:Complications of hypertension in adult urban Liberians. 233 99

Recovery of renal function was observed in 10 out of 300 patients (3.3%) treated by CAPD. These 10 patients presented the following primary renal diseases: 4 nephroangiosclerosis, 4 interstitial nephropathies, 1 diabetic nephropathy, 1 unknown nephropathy, and were treated by CAPD for a mean period of 10.2 +/- 5.5 months. CAPD was discontinued when residual renal function reached 12 ml/min. After recovery 8 patients were still alive, including 1 patient who returned to dialysis. 2 patients died. When risk factors such as uncontrolled hypertension, cardiac failure, severe nephrotic syndrome, rapidly progressive renal failure, analgesics or non steroidal anti-inflammatory drug treatments or abuses, chronic urinary obstruction, cholesterol emboli were associated with end stage renal failure, CAPD should be the dialysis treatment of choice, expecting the preservation of the kidney capacities and further a recovery of renal function.
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PMID:Recovery of renal function in patients treated by CAPD. 257 29

Since March 1986, coronary artery bypass grafting (CABG) by utilizing the right gastroepiploic artery (GEA) has been performed in 60 patients during 3 year period. There were 52 males and 8 females, and age ranged from 34 to 73 year old with the mean of 56.2 year old. Triple vessel disease and the left main disease involved 90% of the patients. There were two patients under hemodialysis for chronic renal failure, one patient with idiopathic thrombocytopenic purpura, one patient with aneurysm of the abdominal aorta, and two patients with arteriosclerosis obliterance, preoperatively. Five patients were second CABG. GEA was used as an in-situ graft in 57 patients and as a free graft in 3 patients and was anastomosed to 3 left anterior descending, 3 diagonal (all "free" graft), 5 circumflex, and 49 right coronary arteries. To bypass the other coronary arteries, the internal mammary artery graft (unilateral 38, bilateral 20, sequential 5) with or without saphenous vein graft was used. The mean number of distal anastomoses was 3.3 (1-5) and the mean number of arterial graft anastomoses was 2.4 (1-4) per patient with the mean aortic cross clamp time of 62.4 minutes (23-137 minutes) and the mean cardiopulmonary bypass time of 120.8 minutes (69-210 minutes). Splenectomy, Y graft replacement of the abdominal aorta, and ascending aorta-bifemoral bypass were concomitantly carried out in each one patient. Two patients (3.3%) died of renal and cardiac failure within 30 postoperative days. One patient (1.7%) died of stroke lately. New Q wave was noted in 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Coronary artery bypass grafting using gastroepiploic artery]. 260 5

Many patients with chronic renal failure experience profound hypotension during hemodialysis. This has been attributed both to autonomic and ventricular dysfunction. In an attempt to distinguish which, if either, is important in this role, we assessed both autonomic and left ventricular function in 10 such patients. Cardioactive medication was stopped 24 hours prior to the investigations. Autonomic function was assessed from day/night blood pressure and heart rate variation and from the hemodynamic response to tilting and the Valsalva maneuver using an intra-arterial ambulatory monitoring technique. Left ventricular function was assessed scintigraphically both before and during hemodialysis. Day/night variation was significantly reduced in the patients with chronic renal failure (BP 13/7 +/- 8/6 mmHg, HR 5 +/- 4) compared with a control population (BP 36/28 +/- 10/5 mmHg, HR 19 +/- 6). Nine patients had a "square wave" response to the Valsalva maneuver. Both of these abnormalities are usually seen in patients with heart failure and are attributed to volume overload and a consequent failure of baroreceptor response. Blood pressure fell during hemodialysis (mean fall 40/22 +/- 20/10 mmHg) in all patients, but heart rate did not change (-2 +/- 16) despite the hypotension. All patients had a normal or high resting ejection fraction (mean 66%, range 55-79%), and there was no change during dialysis. This indicates that the hypotension was not due to left ventricular dysfunction in this group of patients, but to a failure of the baroreceptor response to volume depletion during hemodialysis.
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PMID:Baroreceptor, not left ventricular, dysfunction is the cause of hemodialysis hypotension. 258 52

New method for measuring plasma and urinary Na-K-ATPase inhibitor (ATPI) was developed. Plasma and urine were extracted with reversed phase cartridge column and sample was reconstituted by assay buffer. Na-K-ATPase inhibitory activity of sample was monitored by continuously recording the absorbance of NADH at 340 nm, which coupled to the dephosphorylation of ATP. Ouabain was used for standards of Na-K-ATPase inhibition and this standard showed good linearity ranged 5-100 nmol/ml. Using this new method, P-ATPI and U-ATPI were quantitatively evaluated and paradoxical Na-K-ATPase stimulating phenomenon which observed in conventional method (Hamlyn et al) was diminished. Adopting of this new method for measuring plasma(P-) and urinary(U-)ATPI, and radioimmunoassay for P- and U-digitalis-like substance(DLS)--using crossreactivity to anti digoxin antibody--, these substances were estimated in patients with essential hypertension (EHT), chronic heart failure(CHF), primary and idiopathic hyperaldosteronism(HA), hyperthyroidism(BA) and chronic renal failure(CRF). In EHT, U-DLS, P-DLS, U-ATPI, P-ATPI were significantly higher than those of control(C). In CHF and BA, U-DLS and -ATPI were also significantly higher than those of C. In HA, U-ATPI, DLS distributed in wide range, and a few patients showed high levels of U-DLS and -ATPI. In CRF, P-DLS and -ATPI levels were significantly higher than those of C in prehemodialytic state but P-ATPI was significantly decreased after hemodialysis. From these results it is suggested that 1) DLS and ATPI might contribute to the etiology of hypertension. 2) Volume expansion stimulates the secretion of DLS and ATPI. 3) Stimulatory effect of volume expansion and inhibitory effect of mineralocorticoid may be responsible for wide distribution of these factors in HA. 4) DLS and ATPI are not the same substances.
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PMID:[Endogenous digitalis-like substance and Na-K-ATPase inhibitor in cardiovascular and renal disease]. 283 14

To elucidate further the possible role of atrial natriuretic peptide (ANP) and hypothetical natriuretic hormone (NH) in volume and BP regulation in chronic renal failure (CRF) we measured plasma ANP, digitalis-like substances (DLS) and Na+-K+-ATPase activity (using 86Rb influx into RBC) in 9 patients with CRF before and after hemodialysis. Volume expansion between consecutive dialyses led in all patients to the elevation of plasma ANP (83.4 +/- 14.2 pmol/l) reaching in some overhydrated subjects and/or patients with concomitant cardiac insufficiency concentration greater than 150 pmol/l. Reduced 86Rb influx into RBC before hemodialysis (37.7 +/- 4.9% of controls) was accompanied by higher DLS concentrations (201 +/- 32 pmol/l). Ultrafiltration during hemodialysis with ECFV reduction lowered both ANP and DLS concentrations to 28.1 +/- 9.4 pmol/l and to 151 +/- 23 pmol/l, respectively, and abolished partly the inhibition of Na+-K+-ATPase activity (64.9 +/- 7.6% of controls). These changes corresponded to the degree of ECFV alteration. Our results suggest that both natriuretic principles are activated during ECFV expansion in CRF, probably as a corrective mechanism, with a tendency to normalize when ECFV is reduced during hemodialysis.
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PMID:Atrial natriuretic peptide concentration and natriuretic hormone activity in plasma of patients with chronic renal failure. 285 Sep 86

Recombinant human erythropoietin is a major advance in the management of patients with chronic renal failure. The sustained dose-dependent rise in haematocrit which it produces effectively abolishes symptoms of anaemia, but at the cost of an increase in blood viscosity. This in turn predisposes to increased vascular resistance and the development of hypertension. Over half of all deaths of patients with end-stage renal failure are from cardiovascular disease, notably myocardial infarction, heart failure, and stroke, for which hypertension is a known risk factor. Erythropoietin-related increases in blood pressure are therefore of particular concern, and seem to be most severe in previously hypertensive patients. There is now a need to establish the optimum rate and extent of rise of haematocrit required to alleviate symptoms without incurring undue risk.
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PMID:Hypertension, blood viscosity, and cardiovascular morbidity in renal failure: implications of erythropoietin therapy. 289 90


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