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

Tricuspid atresia is one of the rarest heart defects, and it is rarely associated with prolonged survival. This paper describes the third known case of pregnancy associated with tricuspid atresia. This is the first detailed report of the clinical course of a patient with this disorder. Complications included heart failure, multiple pulmonary emboli, cerebral embolization, and premature labor. Recommendations are made regarding patient care.
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PMID:Tricuspid atresia and pregnancy. 87 48

The beta-agonists have found wide clinical use as racemic mixtures for 20 years, but information on their pharmacokinetics is not comprehensive. They are well absorbed orally, but have low systemic availability due to extensive first-pass sulphation. When administered by inhalation, very little of the administered dose reaches the lungs, but the small amount that does produces effective bronchodilatation. Plasma protein binding of most beta-agonists is negligible, and there is substantial extravascular distribution of the administered dose. Elimination of intravenous drug is predominantly renal, whereas oral doses are mostly eliminated by biotransformation. Renal clearance correlates with creatinine clearance; therefore, dose reduction should be considered if renal function is impaired, such as in the elderly or in cardiac failure. The elimination half-life of most beta-agonists is relatively short, and pharmacokinetics are independent of dose and duration of treatment. Differences in the pharmacokinetics of the enantiomers are evident. There is very large variation in pharmacodynamic response for a given plasma beta 2-agonist concentration among different subjects, and as treatment proceeds in an individual subject. Therefore, in most cases therapeutic response and side effects are more useful for the monitoring of beta 2-agonist treatment than measurement of plasma drug concentrations. The pharmacokinetics of beta 2-agonists are not greatly altered in pregnancy although these agents cause a marked reduction in maternal renal function. Placental transfer is relatively rapid, and side effects are observed in fetus and neonate. Elimination may be somewhat faster in children (8 to 15 years) than in young adults. Asthma does not appear to influence the pharmacokinetics of beta 2-agonists; the only recorded drug interaction of clinical significance is an increase in theophylline clearance by intravenous isoprenaline (isoproterenol). Controlled release oral preparations do not reduce side effects, but may improve compliance due to less frequent dosing. The application of pharmacokinetic principles may improve the clinical usage of beta-agonists, at least when they are used in premature labour and in cardiac failure.
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PMID:Clinical pharmacokinetics of beta-agonists. 196 85

Salbutamol (albuterol) is a beta 2-selective adrenoceptor agonist which accounts for its pronounced bronchodilatory, cardiac, uterine and metabolic effects. During the intervening years since salbutamol was first reviewed in the Journal (1971), it has become extensively used in the treatment of reversible obstructive airways disease. Numerous studies in this disease (including severe acute, childhood and exercise-induced asthma) have confirmed the bronchodilatory efficacy of salbutamol, and it has been shown to be at least as effective as most of the currently available bronchodilators, if not more effective. The onset of maximum effect of salbutamol is dependent on the formulation used and the route by which it is administered. In most patients inhaled salbutamol is a first-line therapy, since it offers rapid bronchodilation, usually relieving bronchospasm within minutes. Although oral salbutamol has often proved to be less efficacious than the inhaled formulation, it still affords clinically significant bronchodilation, and it is particularly useful in those patients unable to coordinate the use of inhalers. Parenteral formulations of salbutamol are generally reserved for the treatment of severe attacks of bronchospasm and they are one of the treatments of choice in these life-threatening situations. Studies of the concomitant use of salbutamol and other agents such as anticholinergics, methylxanthines and beclomethasone dipropionate have usually shown a complementary response in the majority of patients, as might be expected from the different mechanisms of action of these groups of drugs. Salbutamol is generally well tolerated and any side effects observed are a predictable extension of its pharmacology. Since the frequency of side effects is dose related, and therefore dependent on the route of administration, it is not surprising that they are much more common following intravenous and oral rather than inhalation therapy. Tremor, tachycardia and hypokalaemia are the most frequently reported adverse effects. After nearly 20 years of use, salbutamol is well established as a 'first-choice' treatment in reversible obstructive airways disease. Indeed, throughout this time many new bronchodilatory agents have been studied but none have proved more effective. Clinical evaluation of salbutamol in the treatment of premature labour, hyperkalaemia and cardiac failure awaits further studies, although to date some encouraging results have been reported.
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PMID:Salbutamol in the 1980s. A reappraisal of its clinical efficacy. 267 May 12

Maternal endoxin (digoxinlike substance) is proposed as arising in the fetal area of the fetal adrenal cortex. Its function may be to sensitize the uterus for labor, much as does cortisol in the sheep fetus. Because endoxin is a sodium-potassium-adenosine triphosphatase inhibitor, however, it may also induce maternal vasoconstriction. On our service, normal pregnant women have detectable endoxin after 35 weeks with increasing amounts at term. Specimens of cord blood often have "digoxin" in the therapeutic range. We find that about 40% of women in premature labor and 65% of pregnant women with hypertension have elevated levels of serum endoxin. Postdate gravid women sometimes have very low endoxin levels. Pregnant women with complications and elevated digoxin (endoxin) levels could have specific antidigoxin therapy if endoxin proves to be a modulator of their symptoms. Digoxinlike substances are also sometimes elevated in ill nonpregnant persons, such as those with renal, liver, or heart failure, or hypertension.
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PMID:Fetal endoxins and complications of pregnancy. 284 75

A fatal case of pulmonary edema is reported after prolonged treatment with beta-mimetics during pregnancy for threatened premature labor. The mother had received betamethasone in order to enhance fetal lung maturity. Myocardial failure occurred 5 days after discontinuation of betamimetics. The potential toxic effects of beta-adrenergic agents and their association with corticosteroids are discussed. Caution is recommended when high doses of betamimetics are to be delivered to prevent premature labor. No patient should be treated unless her cardiac condition is normal. Cardiovascular evaluation should be regularly performed during the course of treatment. No patient should be discharged after treatment without a normal cardiovascular check-up.
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PMID:A case report of maternal death associated with betamimetics and betamethasone administration in premature labor. 610 79

Hydrops fetalis was diagnosed in one of two twins, while the other suffered from cardiac failure. Indomethacin administered to the mother to arrest premature labor, seemed to be the predisposing factor resulting in the hydrops fetalis. The possible relationship between intrauterine closure of the ductus arteriosus and the pathogenesis of hydrops fetalis is discussed.
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PMID:Hydrops fetalis caused by maternal indomethacin treatment. 711 95

The effect of terbutaline sulfate on left ventricular size and performance was studied by M-mode echocardiography in pregnant women with premature labor. Patients with uterine activity initiated during either oxytocin challenge testing or induction of labor served as a comparison group. During terbutaline therapy, heart rate, ejection fraction, and cardiac output increased significantly. End-diastolic volume and systolic blood pressure (BP) were unchanged, and diastolic BP and end-systolic volume fell. No changes in echocardiographic or hemodynamic parameters were present during oxytocin-induced uterine activity. Terbutaline, as currently used to prevent premature labor, is a potent inotropic and chronotropic agent. Pulmonary edema accompanying terbutaline treatment is probably not due to cardiac failure.
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PMID:Terbutaline and maternal cardiac function. 731 Sep 63

Rhabdoid tumors of the kidney are highly lethal malignancies of infancy. We report the prenatal detection of a renal rhabdoid tumor with mesoblastic components in a fetus at 27 weeks of gestation. The tumor presented as a large mass in the left renal area and there was concomitant massive polyhydramnios. Though the sonographic features alone did not allow distinction from a benign lesion, the aggressive tumor growth indicated malignancy. Amniotic fluid cytology was performed but failed to confirm the diagnosis. Corticosteroids were administered for lung maturation. Tocolysis, including betamimetics, magnesium and indomethacin, was performed to prevent premature labor. Additionally, serial amniodrainage was performed. At 30 weeks of gestation fetal hydrops developed and a Cesarean section was performed. After delivery, ventilation of the preterm infant was insufficient due to diaphragm elevation by the huge tumor, requiring immediate tumor surgery. However, though ventilation was improved the infant died of cardiac failure 4 h after surgery.
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PMID:Prenatal sonographic features of a rhabdoid tumor of the kidney. 1506 95

Sacrococcygeal teratomas (SCTs) are the most common germinal cell neoplasms of the fetus and neonate. They originate during embryonic development when the primitive streak fails to differentiate among mesodermal, ectodermal, and endodermal tissues in the embryonic disc. This article discusses the fetal pathophysiology of SCTs and the impact of the condition on the newborn. Fetal SCTs can have life-threatening physiologic effects--such as premature labor, dystocia, and high-output cardiac failure--if not managed appropriately. Clinical manifestations, prenatal diagnosis, therapeutic approaches and treatment options for the fetus and newborn, and current research related to SCTs are addressed to aid practitioners caring for a fetus or infant diagnosed with an SCT.
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PMID:Sacrococcygeal teratoma in the newborn: a case study of prenatal management and clinical intervention. 1855 66

A 36-year-old woman was admitted to the obstetric department because of possible premature labor of twins at 35 weeks. She had been treated by ritodrine hydrochloride, a tocolytic agent, for 1 week, and delivered healthy twins by cesarean operation. After the operation, she suddenly complained of dyspnea with associated hypoxemia and was admitted to our hospital. She presented with hypoxemia and was given a diagnosis of pulmonary edema. She was given a diuretic with ventilator therapy, and improved rapidly. However, an echocardiogram showed continuing left ventricular systolic dysfunction after 3 months. From these results, this case was suspected to be pulmonary edema due to ritodrin after myocardial failure, including peripartum cardiomyopathy.
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PMID:[A suspected case of acute respiratory failure caused by ritodrine hydrochloride]. 2068 17


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