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

We studied a 48 years old woman, with chronic Chagasic cardiopathy, manifested with cardiomegaly, heart failure and syncope, due to a sustained ventricular tachycardia (SVT) of two different configurations (left bundle branch block and right bundle branch block). During electrophysiological testing, both types of ventricular tachycardia were reproduced. Successful ablation therapy of the right branch of His was performed due to suspicion of the bundle branch reentrant tachycardia, with a left bundle branch block. The patient continued to show SVT episodes, now with right bundle branch block pattern. Cardioverter Defibrillator was implanted. We report this case due to the rare frequency of Chagas' disease, where it could be a cause of heart disease, since the existence of the parasite (trypanosoma cruzi) and its vector (Triatoma) has been identified in some rural and suburban zones in the state of Aguascalientes, Mexico.
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PMID:[Automatic, implantible cardioverter-defibrillator in a patient with chronic Chagas cardiopathy and sustained ventricular tachycardia]. 1036 35

There have been some prospective randomized studies which compared primary angioplasty with intravenous thrombolysis in patients with an acute myocardial infarction (AMI). However, a substantial number of patients with AMI who would not have been included in those trials are treated with one of these two therapeutic options. To describe the proportions, characteristics, and outcome of these patients treated with primary angioplasty or thrombolysis we analyzed the data of the prospective "Maximal Individual Optimized Therapy for Acute Myocardial Infarction" (MITRA) trial. Out of 3308 patients treated with primary angioplasty or thrombolysis, 737 (22.3%) belonged to one of the following groups, not included in current randomized trials: Left bundle branch block, non-diagnostic first ECG, pre-hospital delay > 12 hours or unknown pre-hospital delay. Primary angioplasty was performed in 158/737 (21.4%) and thrombolysis received 579/737 (78.6%) of the patients. There were only minor differences regarding patients' characteristics and concomitant diseases between the two groups. Patients treated with primary angioplasty were 3 years younger (62 years median versus 65 years median (p < 0.036). They also more often showed overt heart failure at admission compared to patients treated with thrombolysis (primary angioplasty: 3.2% versus thrombolysis: 8.9%, OR = 0.34, 95% CI: 0.13-0.86). In-hospital time to intervention was 1 1/2 hours longer in patients treated with primary angioplasty (156 minutes median versus 47 minutes median, p = 0.001). beta-blockers were more often used with primary angioplasty compared to thrombolysis (70.31% versus 55.9%; OR = 1.87, 95% CI: 1.28-2.72), as well as ACE inhibitors (62% versus 49.9%; OR = 1.64, 95% CI: 1.14-2.35). Hospital mortality (8.2% versus 16.4%; OR = 0.46, 95% CI: 0.25-0.84), as well as a combined endpoint of death, reinfarction, postinfarction angina, advanced heart failure, and stroke (24.1% versus 42.3%, OR = 0.43, 95% CI: 0.29-0.64) were lower in patients treated with primary angioplasty compared to those treated with thrombolysis. Logistic regression analysis showed primary angioplasty to be independently associated with a lower rate of the combined endpoint (OR = 0.73, 95% CI: 0.59-0.91), after adjusting for confounding parameters. All subgroups showed a more favorable outcome in patients treated with primary angioplasty. In clinical practice, patients with AMI, not included in current randomized trials comparing primary angioplasty with thrombolysis, account for 22% of all patients with AMI treated with one of those two therapies. Primary angioplasty seems to be associated with a lower event rate compared to thrombolysis in these patients. This has to be confirmed by a prospective randomized trial.
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PMID:[Primary dilatation versus thrombolysis in patients with acute myocardial infarct, not included in randomized studies. Results of the MITRA Study. Maximal Individual Optimized Therapy for Acute Myocardial Infarct]. 1044 12

Chronic severe subclinical systemic hypertension was diagnosed in a 28-yr-old male western lowland gorilla (Gorilla gorilla gorilla). Thoracic radiography, electrocardiography, and echocardiography revealed an enlarged heart with a hypertrophied left ventricle, mitral regurgitation, and a persistent left bundle branch block. Enalapril, later combined with nifedipine, was of some value in reducing the hypertension, with partial reversal of cardiac enlargement and resolution of the bundle branch block. Two years after initiation of treatment, the gorilla developed lethargy and dyspnea. The diagnosis of heart failure was confirmed under anesthesia; the gorilla did not recover and was euthanized. Postmortem examination confirmed congestive heart failure with chronic, fibrosing cardiomyopathy similar to that in other gorillas.
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PMID:Chronic hypertension with subsequent congestive heart failure in a western lowland gorilla (Gorilla gorilla gorilla). 1048 43

This article describes a new technique of LV lead insertion, using transseptal catheterization performed through the right internal jugular vein, to obtain a totally endocardial biventricular chronic pacing in end-stage heart failure. Three patients with QRS widening (> 180 ms) linked to complete left bundle branch block (n = 2) or right ventricular pacing (n = 1) were included in this preliminary study. Catheterization was performed under fluoroscopy and transesophageal echocardiography guidance. Transseptal catheterization was achieved by puncture of the right internal jugular vein at the base of the neck and by using a Brockenbrough needle, the tip curve of which was more curved than the standard model. A flexible long sheath was advanced in the left atrium through the interatrial septum and then a unipolar electrode was placed easily in the LV. The proximal tip of the LV lead was tunneled from the neck to the subclavian area and connected to the ventricular channel of a dual (n = 1) or simple (n = 2) chamber pacemaker. Efficient acute sensing (V wave amplitude = 13 +/- 3 m V) and pacing (acute pacing threshold = 0. 7 +/- 0.4 V) were obtained in the three patients. Early loss of capture occurred in two patients requiring lead replacement. Functional status dramatically improved in all three patients. At 6-month follow-up, biventricular pacing was maintained in all patients (mean threshold 1.4 V) who were free of clinical embolic event with oral anticoagulation therapy. This modified technique of jugular transseptal catheterization appears promising for the development of left heart pacing.
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PMID:Left ventricular lead insertion using a modified transseptal catheterization technique: A totally endocardial approach for permanent biventricular pacing in end-stage heart failure. 1091 83

An 82-year-old woman was admitted with severe chest pain and orthopnea on January 17, 1997. Physical examination revealed bilateral leg edema and cyanosis at the periphery of the extremities. The serum CK level was 488 IU/l on admission and increased to a maximum value of 4,866 IU/l 8 hours after admission. An echocardiogram demonstrated diffuse severe hypokinesis in the left ventricle. Serial electrocardiograms showed transient right bundle branch block, left bundle branch block, and normal sinus rhythm. The patient was diagnosed as having congestive heart failure. Artificial ventilation was performed, and furosemide, isosorbide dinitrate and dopamine were administered. A right ventricular endomyocardial biopsy performed on the 13th hospital day demonstrated moderate hypertrophy and disparity of cardiac myocytes and fibrosis around the myocytes, and few inflammatory cells in the specimens. This biopsy finding was not compatible with acute myocarditis but with the chronic stage of myocarditis. The patient was discharged on the 45th hospital day, but returned because of a recurrence of congestive heart failure. After an improvement of the heart failure, a coronary angiography was performed on the 20th hospital day. The coronary angiography revealed significant stenosis in three vessels. This elderly patient had congestive heart failure and triple-vessel coronary artery disease with transient alternating bundle branch blocks on serial electrocardiograms. Alternating bundle branch blocks and diffuse left ventricular dysfunction was considered to be induced by the aging process, postmyocarditic change of myocytes, and triple-vessel coronary artery disease in this case.
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PMID:[An elderly case of triple-vessel coronary artery disease with alternating bundle branch blocks in serial electrocardiograms]. 1061 29

The aim of this study was to assess the long term efficacy of DDD pacing mode in selected patients with idiopathic dilated cardiomyopathy (IDCM) and drug refractory heart failure. The patients were evaluated according to the long term alteration of the sympathovagal balance (SVB). Patients with IDCM were considered eligible for DDD pacing if during temporary VDD pacing a 15% or more increase in the resting cardiac output was demonstrated. From the 29 patients studied, finally 20 patients (15M, 5F, 69 +/- 10 years) fulfilled the aforementioned criterion and therefore were considered candidates for permanent DDD pacing (NYHA class: 3.5 +/- 0.3, Ejection fraction: 27 +/- 7%, Resting cardiac index (CI) 2.6 +/- 0.4 l/min). The ECG of the patients demonstrated LBBB in 13, RBBB in 4 and RBBB + LAH in 3, with a PR interval of 232 +/- 28 ms and QRS duration of 138 +/- 15 ms. The pacemaker was programmed at 40-150 bpm, and AV delay of 105 +/- 20 ms. The lower heart rate programmed, in conjunction with the heart failure state of these patients, was responsible for essentially continuous atrial tracking, ventricular pacing. We evaluated the SVB in the pre- and post-implant periods (3rd and 6th month), using the hourly power spectral analysis (PSA) of heart rate variability during 24 hour Holter monitoring. As SVB we considered the ratio: low (0.04-0.15 Hz) to high frequency (0.15-0.40 Hz). We compared the SVB (LF/HF) during the day and night time for the pre- and post-implant periods. Post-pacing, the NYHA class was significantly improved (2.9 +/- 0.2 and 2.7 +/- 0.3 the 3rd and 6th month respectively). The mean heart rate was 78 +/- 8 bpm in the 3rd and 80 +/- 7 bpm in the 6th month postoperatively, which was lower than the 84 +/- 9 bpm preoperatively, but this difference did not reach statistical significance. During the night time the LF/HF decreased from 1.45 +/- 0.2 (LF: 7.19 +/- 0.43, HF: 4.95 +/- 0.54) in the pre-implant period to 0.9 +/- 0.09 (p < 0.001) (LF: 6.96 +/- 0.63, HF: 7.73 +/- 0.48) in the 3rd month. No further changes were observed in the 6th month (0.82 +/- 0.05, p = NS) (LF: 6.83 +/- 0.51, HF: 8.53 +/- 0.86) compared to the 3rd month. During the day time the LF/HF decreased from 1.5 +/- 0.5 (LF: 7.87 +/- 0.67, HF: 5.24 +/- 0.32) to 1.43 +/- 0.6 (p = NS) (LF: 7.34 +/- 0.71, HF: 5.24 +/- 0.42) in the 3rd month and to 1.41 +/- 0.09 in the 6th month (p = NS) (LF: 7.51 +/- 0.74, HF: 5.36 +/- 0.63). Comparing the LF/HF of day and the night time period, while in the pre-implant period there was no significant difference (1.5 +/- 0.5 vs 1.45 +/- 0.2, p = NS), the difference became significant in the 3rd (1.43 +/- 0.6 vs 0.9 +/- 0.09, p < 0.001) and 6th month (1.41 +/- 0.09 vs 0.82 +/- 0.05, p < 0.001). In conclusion, DDD pacing with individualized AV delay as an adjunct therapy could be a valuable method in selected patients with IDCM and drug refractory heart failure. DDD pacing improves the SVB over the long term. This improvement is attributed to sympathetic activity withdrawal and is more pronounced during night and less during day time.
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PMID:Modulation of the sympathovagal balance in drug refractory dilated cardiomyopathy, treated with permanent atrioventricular sequential pacing. 1080 27

The concept of left bundle branch block (LBBB) was recognised at the beginning of the 20th century but confusion, due to the extrapolation data from animal experimentation, persisted for many years between the electrocardiographic appearances of LBBB and right bundle branch block (RBBB). The typical appearances of LBBB are now well known and consist of: 1) increased duration of the QRS complex > 0.12 seconds; 2) a wide, exclusive R wave with a plateau or notched summit in the left precordial leads and usually in D1 and aVL; 3) an important delay in the intrinsecoid deflection in the left precordial leads (0.08 to 0.12 seconds after the onset of QRS); 4) an axis of repolarisation opposite that of the QRS complex with so-called "secondary" abnormalities. The authors emphasise that some electrocardiographic variants carry a poor prognosis, in particular those with major QRS axis deviation to the left or, much less commonly, to the right. The diagnosis of left ventricular hypertrophy is possible in cases of LBBB by using the criteria of QRS amplitude in the left precordial leads. On the other hand, the diagnosis of myocardial infarction is more difficult, the criteria being very specific but having a sensitivity < 50%. The deleterious effects of LBBB on the haemodynamics are well known but their study has become a new firld of research since the introduction of bi-ventricular pacing for the treatment of cardiac failure. In dilated cardiomyopathy, LBBB increases the duration of functional mitral regurgitation and decreases left ventricular filling times. The prognostic implications of LBBB have been the object of many studies: the reports in the literature indicate a large increase in mortality when LBBB develops in patients over 44 years of age. The progression to complete atrioventricular block is common only when the HV interval exceeds 100 ms. In other cases, the prophylactic implantation of a cardiac pacemaker does not improve the prognosis which depends on the severity of the underlying cardiac disease.
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PMID:[Left bundle branch block. Electrocardiographic and prognostic aspects]. 1081 99

Recent multicenter studies have shown that the implantable cardioverter defibrillator (ICD) is superior compared to antiarrhythmic agents after sudden cardiac death (SCD) in patients with congestive heart failure. Further ICD studies have to be performed for primary prevention of SCD in patients with heart failure. Primary prevention studies of SCD with Amiodarone or new class III agents (e.g., Dofetilide) were not able to lower cardiac mortality in these patients. How much the new method of biventricular pacing in patients with heart failure and left bundle branch block will reduce cardiac mortality has to be proven in future prospective trials.
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PMID:[Heart failure and sudden cardiac death: pharmacological and nonpharmacological treatment possibilities from the viewpoint of the rhythmologist]. 1109 60

Permanent cardiac pacing has been proposed for the treatment of atrioventricular and intraventricular conduction defects and related hemodynamic alterations which may worsen the performance of the failing heart. The initial positive results of right sided atrioventricular synchronous pacing have not been confirmed in later studies involving a larger number of patients with different clinical characteristics. The reason of these conflicting results may be related to the poor understanding of the complex interaction between the adopted pacing mode and the different type, grade and hemodynamic significance of conduction defects. The negative hemodynamic effects of the altered sequence and synchrony of ventricular activation during right sided pacing may outweigh the benefits of an optimal atrioventricular synchrony. Biventricular stimulation has been proposed to improve the electromechanical activation of the left ventricle in patients with left bundle branch block. Ongoing prospective studies are evaluating the potential benefits of biventricular stimulation versus alternative treatments. Although there are no standard indications to cardiac pacing in heart failure it seems that this therapeutic tool may be of value in selected patients with conduction defects which unfavorably affect the cardiac function and that are amenable to be corrected by an appropriate pacing modality. Doppler echocardiography, in its different applications, emerges has a key technique for the selection of patients who may benefit from permanent pacing and for the selection of the best pacing modality. Doppler echocardiography criteria may also be useful in the selection of homogeneous groups of patients to be enrolled in prospective studies aimed at assessing the potential benefits of permanent pacing versus alternative treatments.
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PMID:[Role of echocardiography in the treatment of heart failure with permanent electric stimulation]. 1110 93

New forms of ventricular pacing are increasingly studied as an option in the management of patients with heart failure. Coronary artery disease (CAD) is the most frequent cause of heart failure, and patients with complete left or right bundle branch block (LBBB and RBBB) and a reduced left ventricular ejection fraction (LVEF) are the best candidates for this new therapy. However, the prevalence of this clinical presentation is uncertain. During a 1-year period, 433 patients with documented CAD (mean age 64 +/- 10 years, 79% men) who were referred for myocardial perfusion imaging were prospectively studied. All patients underwent a 2-day stress-rest gated 99mTc-Tetrofosmin SPECT study with evaluation of resting LV enddiastolic (LVEDV) and endsystolic (LVESV) volumes and LVEF. The resting ECG was examined in all patients for the presence of complete LBBB or RBBB. Of the 433 patients with CAD 36 patients (8.3%) had LBBB (n = 14) or RBBB (n = 22) and a QRS width > 120 ms. These 36 patients were in general older and more frequently had diabetes and atrial fibrillation. Patients with LBBB or RBBB had a significantly lower LVEF (41 +/- 16% vs 48 +/- 14%, P < 0.01) and significantly higher LV volumes compared to patients without LBBB or RBBB (177 +/- 79 mL vs 131 +/- 53 mL, P < 0.001 for LVEDV and 116 +/- 76 mL vs 73 +/- 49 mL, P < 0.001 for LVESV). In total, 112/433 (26%) had an LVEF < or = 40%; 16 had also a LBBB or RBBB (3.7% of the whole population, 14% of the patients with a LVEF < or = 40%). Within the group of patients with a LVEF > or = 40%, patients with BBB had comparable LVEF (26 +/- 9% vs 30 +/- 8%, P = NS) but significantly higher LVEDV and LVESV (230 +/- 70 mL vs 190 +/- 64 mL, P < 0.05 for LVEDV and 170 +/- 65 mL vs 135 +/- 56 mL, P < 0.05 for LVESV). In this prospective registry 3.7% of all patients with known CAD had LBBB or RBBB in combination with a LVEF < or = 40%. This represented 14% of all patients with a LVEF > or = 40%. These limited numbers should be kept in mind when considering biventricular pacing as a new therapeutic options in patients with heart failure.
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PMID:Prevalence of potential candidates for biventricular pacing among patients with known coronary artery disease: a prospective registry from a single center. 1113 8


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