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

Six patients whose standare electrocardiograms showed multiform ventricular ectopic rhythm were studied. All patients had advanced organic heart disease and a significant intraventricular conduction defect (left bundle branch block in five and right bundle branch block plus left anterior hemiblock in one). The ventricular arrhythmia was generally resistant to antiarrhythmic therapy. Five of the six patients died after 2 to 6 months form the period of observation from terminal heart failure. None died suddenly. The ventricular arrhythmia did not seem to be directly related to mortality in any patient. Critical analysis of several long rhythm strips in each case revealed that discharge from multiple ventricular parasytolic foci shared in the multiform ventricular activity. The concurrent discharge of a minimum of three parasytolic foci and a maximum of six foci was found in the same case with a total of 24 parasystolic foci in the six patients. There was a remarkable constancy of the QRS configuration of all parasytolic foci over periods of observation of up to 16 months. However, 22 out of 24 parasystolic rhythms showed significant variation in the apparent rhythm or the administration of drugs. Fourteen parasytolic foci showed evidence of exit block, some of which were exaples of a rapid parasystole with a high degree of exit block. The study suggests that multiform ventricular ectopic rhythm may, in part, be due to the concurrent discharge of multiple parasystolic foci.
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PMID:Multiform ventricular ectopic rhythm. Evidence for multiple parasystolic activity. 4 29

The incidence of intraventricular conduction defects was examined retrospectively in 449 consecutive patients with acute myocardial infarction (AMI). The incidence of left anterior hemiblock (LAH), right bundle branch block (RBBB), left bundle branch block (LBBB) and RBBB+LAH was 12.2, 4.2, 3.8 and 2.5%, respectively. At least 24 patients (5.8%) developed LAH as a result of the AMI. LAH was present in 20% (33/164) of patients with anterior infarction, in 14% (18/131) of those with infarction of undetermined localization, and in 3% (4/143) of patients with diaphragm infarction. The incidence of complete atrioventricular (AV) block in patients with LAH was 6% and in patients with no intraventicular conduction defects 7%. In patients with RBBB, RBBB+LAH and LBBB, the incidence of complete AV block was 37, 45 and 18%, respectively. Severe pump failure occurred with the same low incidence in patients with LAH as in patients without intraventricular conduction defects, but was much more common in patients with complete bundle branch block (BBB). The mortality rate for patients with LAH was 22% and for patients with no intraventricular conduction defects 21%. In patients with RBBB, RBBB+LAH and LBBB, the mortality rates were 53, 55 and 53%, respectively. Patients with complete BBB had a higher age and a higher incidence of previous AMI than the others. Compared to patients with no intraventricular conduction defects, the presence of LAH did not increase the mortality rate, or the risk of developing severe heart failure or complete AV block, in contrast to the serious prognosis in patients with complete BBB.
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PMID:Left anterior hemiblock in acute myocardial infarction. Incidence and clinical significance in relation to the presence of bundle branch block and to the absence of intraventricular conduction defects. 66 20

The examination was carried out in 787 patients with macrofocal myocardial infarction. The most frequently encountered variant of intraventricular block in males was the right bundle branch block, in females--the left bundle branch block. The rarest variant of intraventricular conductivity disorders in myocardial infarction was the left-posterior hemiblock. The prognostically severest variant of bilateral block consists in a combination of the right bundle branch block with the left-posterior hemiblock. The leading causes of death among the patients with myocardial infarction and intraventricular blocks were acute (cardiogenic shock, pulmonary oedema) and chronic cardiac insufficiency. In patients with bilateral blocks the frequent causes of death were, along with cardiac insufficiency, also arrhythmias (ventricular fibrillation, asystole).
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PMID:[Intraventricular blocks in myocardial infarct]. 97 66

Recurrent automatic atrial tachycardia can induce dilated cardiomyopathy. We present clinical and therapeutic problems of 16 years old male with ectopic left atrial tachycardia refractory to pharmacological therapy. In this patient long periods of atrial tachycardia 200-240/min due to lack of effective medication caused cardiac failure. Uncontrolled taking of various antiarrhythmic drugs and persistent tachycardia led to cardiogenic shock. The electrophysiologic study revealed focus of the tachycardia localized in the area of left cardiac auricle. The rate of the tachycardia was changing from 84 to 240/min, with periods of Mobitz I block in the AV node. In periods of 1:1 AV conduction the tachycardia had sometimes LBBB QRS morphology. The atrial tachycardia provoked unsustained ventricular one. The patient was operated. Resection of left auricle and mitral valvuloplasty were performed. After the operation the patient regained undisturbed sinus rhythm and symptoms of heart failure disappeared.
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PMID:[Indications for emergency surgical treatment of ectopic atrial tachycardia]. 175 65

Despite the progress of the medical and surgical therapy of cardiac failure, the prognosis of this syndrome remains severe. We studied in a group of cardiac failure patients (n = 203; 18-74 years old) admitted in our division from 1982 to 1987 the most significant clinical and instrumental parameters of prognostic importance. The clinical parameters considered were: age, sex, heart rate, blood pressure, NYHA class, presence of mitral insufficiency, episodes of acute heart failure. The instrumental parameters were: presence of complete left bundle branch block (LBBB), atrial fibrillation, episodes of ventricular tachycardia, cardiothoracic index (C/T), end-diastolic and end-systolic diameters, ejection fraction (EF). Statistical analysis was performed in order to correlate single parameters with mortality. The total survival at 5 years was 50%, being higher in patients with coronary artery disease than in patients with primary dilated cardiomyopathy. The parameters worsening the prognosis were: mitral insufficiency, III-IV NYHA class, occurrence of repeated episodes of acute heart failure in the last year, complete LBBB, C/T greater than 0.55 and EF less than 20%. In conclusion, considering instrumental parameters high risk patients are detected with a precision of 80%.
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PMID:[The prognosis of the patient with heart failure: an analysis of the most significant clinical and instrumental parameters]. 176 26

Thirty-two complete bundle branch blocks were observed during 16,500 exercise stress tests between 1973 and 1988: there were 7 right bundle branch blocks and 25 left bundle branch blocks. Exercise stress testing was indicated in 15 cases for stable angina, in 15 cases for different functional disturbances and in 2 cases as a systematic investigation. All patients underwent coronary angiography and selective left ventriculography. Right bundle branch block occurring at a heart rate of 105 +/- 25/mn were associated with typical anginal pain at the time of apparition in 5 patients. Coronary angiography showed triple vessel disease in 3 cases, double vessel disease in 2 cases and an isolated proximal lesion of the left anterior descending artery in 2 cases. Left bundle branch block occurring at a heart rate of 125 +/- 12/mn was associated with normal coronary angiography in 7 cases. Eighteen patients had pathological coronary angiogrammes with severe lesions of the left anterior descending artery. Two women suffered from chest pain when the block developed and coronary angiography was normal in one of them. During follow-up (average 62 months), 16 coronary events were observed including 2 infarcts, and 6 patients developed cardiac failure. In conclusion, complete right bundle branch block appearing during exercise stress testing was constantly associated with atherosclerotic coronary artery disease. The predictive value of complete left bundle branch block on effort was 72%. Complete left bundle branch block occurring at heart rates of less than 120/mn was frequently associated with a proximal stenosis of the left anterior descending artery.
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PMID:[Complete bundle branch block during exercise test. Clinical and coronary angiographic data]. 202 Dec 77

A group of 73 patients with idiopathic dilated cardiomyopathy were followed up for an average of 22 +/- 7 months to assess the medium term evolution of echocardiographic parameters of left ventricular function and, in particular, the consequences of cardioversion of atrial fibrillation. Seventy nine per cent of patients presented with cardiac failure. Left bundle branch block was observed in 20% and ventricular arrhythmias were frequent in 31%, complex in 62% with episodes of non-sustained ventricular tachycardia in 10% of cases. Left ventricular dilatation was greater in patients with complete left bundle branch block (p less than 0.003). Atrial fibrillation was present in 14 patients (19%) who were generally older than the rest of the study population (p less than 0.02) and was associated with less severe left ventricular dysfunction (p less than 0.01). Return to sinus rhythm was obtained in 9 patients. Echocardiographic data was obtained in 64 patients after an average of 6.2 +/- 1.7 months. Left ventricular function improved during the follow-up period and returned to normal in 12% of cases. Reduction of atrial fibrillation to sinus rhythm was the only predictive factor of normalisation of left ventricular function (p less than 0.02). The changes in left ventricular end diastolic dimension and fractional shortening was less marked in the group of 56 patients in sinus rhythm or chronic atrial fibrillation (normalisation of left ventricular function in 8% of cases) than in the group of 8 patients in which atrial fibrillation was converted to sinus rhythm (normalisation of left ventricular function in 50% of cases).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Effect of cardioversion of atrial fibrillation on left ventricular function in dilated cardiomyopathy. A multicenter study]. 210 1

Flecainide, a Class IC antiarrhythmic agent, was used in 12 patients with an average age of 57 years to treat spontaneous monomorphic sustained ventricular tachycardia (S-VT, n = 9), with a ventricular rhythm of 203 +/- 41 bpm (5 right bundle branch and 4 left bundle branch block pattern) and non-sustained ventricular tachycardia (NS-VT, n = 3). The patients had ischaemic heart disease (n = 5, including 2 cases of aneurysm), idiopathic dilated cardiomyopathy (n = 1), ventricular dysplasia (right, n = 1; left n = 2; biventricular, n = 1). The remaining 2 patients had no overt cardiac disease on coronary angiography. None of the patients had signs of cardiac failure; the left ventricular ejection fraction was 0.49 +/- 0.7. Before treatment, programmed ventricular stimulation (PVS) induced 12 S-VT (214 +/- 41 bpm) which reproduced the clinical VT in 8 out of 10 cases. A second series of electrophysiological studies was performed after an average of 5 weeks treatment with Flecainide 300 mg/day (200-400 mg). It was not possible to induce VT in 2 patients (17% total prevention); NS-VT replaced S-VT in 4 patients (33%); S-VT was less rapid in 5 patients (at least 50 bpm slower) (41%); one patient had S-VT as rapid as before treatment (9%). The 12 patients were prescribed long-term Flecainide therapy. During follow-up there were 4 early (7, 10 and 15 days) and one late recurrence (16 months) (42% failure rate) whilst the other 7 patients had no further attacks of VT (follow-up of 19.1 +/- 5 months) (58% success rate).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Estimation of the long-term efficacy of anti-arrhythmia treatment with flecainide in ventricular tachycardia]. 210 8

One hundred thirty-three patients with dilated heart failure, 80 with coronary artery disease, and 53 with idiopathic dilated cardiomyopathy were followed for a mean of 29 months. Patients with ischemic heart disease had a worse prognosis than those classified as having idiopathic cardiomyopathy. Features from history, physical examination, and diagnostic tests done when patients were referred to our clinic were checked for univariate association with survival and were used in Cox model survival analysis to define risk groups. Neither the overall group nor either subgroup showed a relationship between ejection fraction and survival. The best variables for predicting long-term mortality included underlying coronary artery disease, basal systolic blood pressure of less than 120 mm Hg, presence of congestion on chest radiogram, and age over 64. Other variables did not improve risk prediction in the overall group. Among patients with ischemic heart disease, blood pressure, congestion, maximal heart rate on treadmill test, and the presence of left bundle branch block on the initial electrocardiogram all contributed. Only systolic blood pressure and the symptom score were related to survival in idiopathic cardiomyopathy.
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PMID:Prediction of outcome in late-stage cardiomyopathy. 233 Aug 70

We studied 58 cases of arrhythmogenic right ventricular dysplasia (ARVD). Sustained monomorphic ventricular tachycardia (VT) was present in 50 patients, ventricular fibrillation (VF) in three (two also having VT), and non-sustained VT in the remaining seven. Different morphologies of VT were documented in 24 of the 50 patients with sustained VT. They had a left bundle branch block pattern in 96% of cases, without extreme deviation of the QRS axis, and a QRS relatively narrow and ample. These sustained VTs were triggered by provocative techniques. Holter recordings showed frequent ventricular extrasystoles in the great majority of cases. They were polymorphic in 78%, with runs of VT in 59% of patients. Spontaneous onset of VT occurred during exercise in 60% of cases, preceded by a sinus rate increase when recording was available. This is more frequent in angiographically localized forms of ARVD than in diffuse forms, and tends to disappear during follow-up. Only four cardiac deaths occurred after a follow-up of 8.8 +/- 7.2 years: three by acute heart failure, and only one by recurrent VF. Spontaneous disappearance of VT which became non-inducible was seen in four cases. Single antiarrhythmic drug therapy was judged satisfactory in 21 cases, and combined therapy in 19 other cases. Surgery of fulguration was performed in 17 cases, with 14 successes (nine of them with combined antiarrhythmic therapy). Despite a frequent lack of control of VT by antiarrhythmic drugs, the follow-up of ARVD seems good in patients with sustained VT. Some arguments favour the concept of a diffuse and progressive disease.
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PMID:Characteristics, prognosis and treatment of the ventricular arrhythmias of right ventricular dysplasia. 257 22


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