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

The authors report a case of arrhythmogenic right ventricular dysplasia in a 61year old male with a 9 year history of recurrent ventricular tachycardia with a left bundle branch block configuration and without any signs of cardiac failure. A right ventricular angiography showed morphological changes suggestive of Uhl's anomaly and left ventricular angiography showed segmental wall dysfunction. In the absence of coronary artery disease, this case raises the questions of left ventricular extension of right ventricular dysplasia and of the value of left ventricular angiography in adult forms of Uhl's anomaly.
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PMID:[Recurrent ventricular tachycardia due to right ventricular dysplasia. Association with left ventricular anomalies]. 679 22

Right ventricular dysplasia is characterized by an abnormality in the development of part of the right ventricular musculature. Patients with right ventricular dysplasia may present with ventricular tachycardia, supraventricular arrhythmias, right-heart failure or asymptomatic cardiomegaly. Twenty-two adult patients with right ventricular dysplasia who had recurrent ventricular tachycardia were seen during a 7-year period. The male/female ratio was 2.7:1. The mean age at the time of hospitalization was 39 years. All but one of the patients had ventricular tachycardia of a left bundle branch block configuration. With few exceptions, the T waves were inverted over the right precordial leads. The heart was usually enlarged and the pulmonary vasculature was usually normal. In six patients who had two-dimensional echocardiograms, all showed increased right ventricular diastolic dimensions. All patients had right ventricular angiography; the diagnosis of right ventricular dysplasia was substantiated during surgery in 12 patients and at autopsy in another. Two other patients who did not have arrhythmias had right ventricular dysplasia diagnosed by right- and left-heart angiography. Our unique experience, when combined with a literature review of 34 adult cases, permits a composite clinical profile of this condition in the adult.
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PMID:Right ventricular dysplasia: a report of 24 adult cases. 705 99

Typical symptoms of acute myocardial infarction led to admission of a 66-year-old female. Creatine kinase (CK) was 720 U/l on admission and together with CK-MB of 108 U/l fitted the clinical picture. The ECG showed complete left bundle branch block. The patient died a few hours later in cardiac failure. Massive hypercalcaemia of 6.2 mmol/l and hyperphosphataemia of 1.6 mmol/l suggested acute primary hyperparathyroidism already clinically which later could be verified by a parathormone level of more than 100 000 ng/l ("C-terminal assay"). At necropsy chief cell adenoma of the epithelial bodies was found, typical changes of primary hyperparathyroidism in the skeleton and kidneys, and disseminated calcifications and fresh necroses of cardiac muscle. The coronaries were normal. This is the first clinical report of fatal acute primary hyperparathyroidism due to hypercalcaemia-induced myocardial necroses.
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PMID:[Calcium induced necroses of cardiac muscle causing death in acute hyperparathyroidism (author's transl)]. 735 14

Prognosis in acute myocardial infarction has been compared in patients with and without diagnostic ECGs. Of 817 patients, 89.4% had ST elevation, 2.4% had left bundle branch block, and 8.2% had no ST elevation. Patients without ST elevation had a hospital mortality rate of 3.0% compared with 14.0% and 40.0%, respectively, in patients with ST elevation and left bundle branch block (p = 0.0001). Event-free survival at 6 months in patients without ST elevation was 85.6% (74.1% to 92.3%), compared with 72.9% (69.4% to 76.0%) and 31.0% (12.0% to 52.3%) in patients with ST elevation and left bundle branch block (p < 0.001). The excess risk associated with ST elevation was largely attributable to the severity of infarction: after adjustment for Q-wave development and heart failure, the hazard ratio fell from 2.24 (1.43 to 4.38) to 1.76 (0.86 to 3.59). In conclusion, acute myocardial infarction has a considerably better prognosis when it is unassociated with ST elevation or left bundle branch block. This finding may have important implications for interventional management.
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PMID:Prognosis in acute myocardial infarction: comparison of patients with diagnostic and nondiagnostic electrocardiograms. 757 76

Right-sided heart failure was diagnosed in a young dog with clinical and pathologic features of isolated right ventricular cardiomyopathy. This disorder, also referred to as right ventricular dysplasia, is an infrequent cause of heart failure and sudden death in people. Echocardiography of this dog revealed right ventricular and right atrial dilatation and severe right ventricular systolic dysfunction. Left ventricular size and function were normal. Electrocardiography revealed ventricular bigeminy. The configuration of the ectopic beats was similar to that seen with left bundle branch block. The dog died suddenly, and histologic examination of the heart revealed fibroadipose replacement of right atrial and right ventricular myocardium.
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PMID:Isolated right ventricular cardiomyopathy in a dog. 760 95

Evaluation of operative risk in coronary artery disease patients before non-cardiac surgery is a frequent problem concerning 100,000 patients each year in France. Perioperative cardiac morbidity is the first cause of death associated with non-cardiac surgery, with infarction rates of the order of 1 to 2% in coronary disease patients. These infarcts are followed by the death of the patient in 25 to 50% of cases. Evaluation of anesthetic risk is based upon three points: type of surgery, clinical findings and results of investigations. The risk is markedly increased in emergency surgery, and in thoracic, intraperitoneal and above all vascular surgery, in particular when clamping of the aorta is involved. From a clinical standpoint, only a history of infarction and signs of peripheral cardiac failure are independent predictive factors of postoperative complications. Other criteria, e.g. age, uncontrolled hypertension, diabetes and above all the severity of angina are also associated with the onset of perioperative-complications. This evaluation can be refined by electrocardiogram (Q wave, ST segment anomalies, ventricular hypertrophy and left bundle branch block) and chest X-ray. The usefulness and predictive value of exercise tests, when possible in a preoperative context, are particularly precious when the result is positive at low work-load. Many publications have studied the value of myocardial isotope scan, in particular before vascular surgery. They report the excellent negative predictive value (95 to 100%) of this investigation. Furthermore, the predictive value of isotope scan is all the greater when the clinical risk factors seen in the patients and the number of areas with ischemia are taken into account.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Evaluation of the anesthetic risk in patients with coronary disease prior to non-cardiac surgery]. 812 64

Clinical and laboratory findings were compared in 65 women and 238 men with invasively documented idiopathic dilated cardiomyopathy. Women had more severe symptoms (New York Heart Association class > or = III in 48 vs 39%; p < 0.05), presented more frequently with heart failure signs (63 vs 41%; p < 0.01), and had a higher cardiothoracic ratio (0.56 +/- 0.06 vs 0.53 +/- 0.06; p < 0.05) and higher frequency of left bundle branch block (41 vs 29%; p < 0.05). Echocardiographic measurements in women showed significantly greater left ventricular (LV) end-diastolic (42 +/- 7 vs 39 +/- 6 mm/m2; p < 0.0001) and end-systolic (36 +/- 7 vs 33 +/- 6 mm/m2; p < 0.001) diameters, and mean myocardial thickness (11 +/- 2 vs 10 +/- 2 mm; p < 0.05). Exercise duration was shorter in women than in men (7 +/- 3 vs 10 +/- 4 minutes; p < 0.001). After 18 +/- 16 months, 9 women and 27 men died, and 7 and 17, respectively, received transplants. Transplant-free survival was not significantly different according to gender. By Cox multivariate analysis, LV ejection fraction was a significant independent predictor of cardiac death or heart transplantation in both sexes (p < 0.05 in men, and p < 0.005 in women), together with left atrial diameter index (p < 0.01) in women, and mean pulmonary artery pressure (p < 0.001) in men. In conclusion, women with idiopathic dilated cardiomyopathy present a more advanced phase of the disease with greater LV dilation, but do not have a different prognosis.
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PMID:Comparison of clinical findings in idiopathic dilated cardiomyopathy in women versus men. The Italian Multicenter Cardiomyopathy Study Group (SPIC) 818 30

The prognostic significance of electrocardiographic variables was retrospectively investigated in 88 patients with dilated cardiomyopathy and with normal coronary arteriograms. During an average follow-up of 3.7 +/- 2.9 years, 43 patients died, 26 of progressive heart failure, 15 patients with sudden death, and one due to cerebral embolism. Excluding one patient, who died of esophageal cancer, the cumulative survival rate was 73% at 2 years and 60% at 5 years. By univariate life table analysis, abnormal Q-waves, a QRS duration > or = 0.12s, a cardiothoracic ratio > or = 60%, systolic blood pressure < 110mmHg, and left ventricular end-diastolic pressure > or = 15mmHg were significantly associated with increased mortality within 5 years. Multivariate analysis using Cox's proportional hazards model determined the major independent risk factors in the following order: (1) for all patients; the presence of abnormal Q-waves, left bundle branch block or intraventricular conduction disturbances, left ventricular end-diastolic pressure, systolic blood pressure and the cardiothoracic ratio; (2) for patients without left bundle branch block or intraventricular conduction disturbances; abnormal Q-waves, left ventricular end-diastolic pressure and systolic blood pressure. The present study thus demonstrated that the electrocardiogram could provide independent prognostic predictors in patients with dilated cardiomyopathy, possibly reflecting the severity of myocardial damage.
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PMID:Prognostic significance of electrocardiographic findings in patients with dilated cardiomyopathy. 845 62

Conventional ECG still plays an important role in the overall knowledge of Chagas' cardiopathy, because of its importance in longitudinal and epidemiological studies, its diagnostic value, and its utility in prognostic evaluation. The authors discuss these aspects, as well as the use of eCG in the acute phase and the significance of a normal ECG in Chagas' disease. Correlations were made between ECG and Hemodynamic/angiographic variables among 1010 patients with positive laboratory tests for Chagas' disease: a) in the group with normal ECG there was no significant differences between symptomatic and non-symptomatic patients with regard to ejection fraction and angiographic abnormalities; b) slight abnormalities on the ECG corresponded to an intermediate level of severity of the disease, that is, between normal ECG and ECG with significant abnormalities C) fibrosis on the ECG was not predictive of akinesia in the related area on the angiography; d) combined ECG abnormalities generally correlated with greater myocardial compromises compared to isolated abnormalities; e) under multiple regression analysis the ECG abnormalities that independently correlated with depressed ejection fraction were: premature ventricular beats, ventricular tachycardia, left bundle branch block, atrial fibrillation, complete AV block, and anterior and inferior fibrosis. Male sex, cardiac insufficiency and cardiomegaly on the throat radiography were also significantly related.
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PMID:Electrocardiography in Chagas' heart disease. 865 Apr 80

A 9-month-old boy and 4-month-old girl presented with severe heart failure. The electrocardiogram showed complete and "incomplete" left bundle branch block, respectively. In both infants noncompaction of the ventricular myocardium was diagnosed with two-dimensional echocardiography. These cases are thought to be the first descriptions of the occurrence of left bundle branch block with noncompaction of the ventricular myocardium. Noncompaction of the ventricular myocardium should be added to the list of the causes for left bundle branch block in children.
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PMID:Ventricular conduction defect in isolated noncompaction of the ventricular myocardium. 866 34


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