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

Cyclic AMP plays a central role in modulating systolic and diastolic myocardial function. Consequently, the adrenergic nervous system, acting through myocardial beta-adrenergic receptors, very likely plays a significant role in regulating left ventricular systolic and diastolic function. Theoretically, beta-adrenergic agonists and antagonists may further modify myocardial systolic and diastolic function. Although the effects of beta-adrenergic agents are clearly demonstrable in vitro, it has been more difficult to evaluate the direct myocardial effects of beta-adrenergic agents in patients. These difficulties are related both to technical aspects of the measurement of systolic and diastolic parameters and to the potentially confounding effects of secondary nonmyocardial drug actions and reflex-mediated changes in myocardial and/or vascular adrenergic activity. A number of strategies for evaluating the direct myocardial actions of beta-adrenergic agents are discussed. Two promising approaches are the use of direct intracoronary drug infusion and the analysis of left ventricular pressure-volume relationships. The positive inotropic action of beta-adrenergic agonists is substantially attenuated in many patients with left ventricular failure due to end-organ desensitization of the beta-adrenergic pathway. Nevertheless, a beta-adrenergic agonist may still cause a substantial improvement in left ventricular pump function in such patients. There is less information available regarding the effect of beta-adrenergic agonists on myocardial relaxation. Preliminary data from the intracoronary infusion of dobutamine suggest that isovolumic relaxation is accelerated. Conversely, preliminary data suggest that a beta-adrenergic antagonist, esmolol, causes a slowing of isovolumic myocardial relaxation. Further studies will be needed to determine whether these drug effects result in a significant alteration in hemodynamic performance during diastole, and to evaluate the possibility that beta-adrenergic-mediated myocardial relaxation is attenuated in patients with heart failure.
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PMID:Effects of beta-adrenergic agents on systolic and diastolic myocardial function in patients with and without heart failure. 247 7

Water, sodium, and potassium balance and urinary excretion of norepinephrine and aldosterone were investigated in rats with left ventricular failure due to left ventricular infarction, and measurements were obtained of plasma levels of atrial natriuretic factor (ANF). Increased plasma levels of ANF in relation to the size of the infarction and to the right atrial and left ventricular end-diastolic pressure were found. The augmented levels of ANF were not able to prevent an accumulation of sodium in the rats with myocardial infarction in which urinary excretion of norepinephrine and aldosterone was unchanged in comparison to control values. Plasma levels of ANF in the pulmonary artery, aorta, and renal vein of six conscious dogs were studied during the development of heart failure due to rapid right ventricular pacing. A threefold increase in ANF was found: ANF levels did not differ between the pulmonary artery and the aorta, but a reduction in ANF of about 30% was reported in the renal vein in comparison to the arteries. A close positive correlation between right atrial pressure and plasma levels of ANF was noted. No correlation could be demonstrated between mean pulmonary arterial pressure and ANF or between the stimulated plasma renin concentration and plasma ANF values.
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PMID:Atrial natriuretic factor in acute and chronic cardiac failure. 248 23

The decline of the use of digitalis for the treatment of congestive heart failure was due to the introduction of oral diuretic therapy, the recognition of the frequency of digitalis induced arrhythmias and the uncontrolled observations that digitalis could frequently be withdrawn from patients with a history of heart failure without recurrence of heart failure. Subsequently, it has been well documented that digitalis has chronic beneficial hemodynamic effects in patients with chronic congestive heart failure. Moreover, digitalis has been shown to improve hemodynamics when added to other drugs including diuretics, ACE inhibitors and vasodilators. It is concluded that digitalis is a mild inotropic agent that is still a primary drug for the treatment of mild to moderate acute or chronic left ventricular failure.
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PMID:The use of digitalis for the treatment of congestive heart failure: a tale of its decline and resurrection. 248 99

An open randomised parallel group comparison of the haemodynamic effectiveness of three different routes of nitrate administration was undertaken in 36 male patients aged 40-69 years who had developed acute left ventricular failure within 18 h of the onset of myocardial infarction. All patients had electrocardiographic and serum cardiac enzyme changes compatible with transmural myocardial infarction and all had both radiographic and haemodynamic evidence of left ventricular failure. None were hypotensive, all were in sinus rhythm and none were receiving other cardioactive drugs. Control haemodynamic measurements were made over a period of one h, following which patients were randomised to receive either intravenous isosorbide dinitrate (mean dose 12.9 mg; range 7.7-14.9), buccal nitroglycerine (5 mg) or transdermal nitroglycerin (nitro TTS 10). The raised left heart filling pressure was reduced by all nitrate preparations but none significantly changed the heart rate or cardiac output. Systemic arterial pressure and vascular resistance were reduced by i.v. ISDN and buccal NTG but not by a transdermal NTG. The only adverse circulatory reaction was hypotension in the three patients following buccal NTG. Nitroglycerin by the transdermal route appears to be equally effective in reducing the raised left heart filling pressure in patients with postinfarction heart failure without the practical disadvantages of monitoring its intravenous administration or the potential hazard of hypotension with buccal NTG.
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PMID:Haemodynamic comparison of different routes of nitrate administration in postmyocardial infarction left ventricular failure. 251 87

Owing to the development of transluminal angioplasty, coronary bypass surgery has now well-defined indications in patients who underwent thrombolysis. It may need to be performed in an emergency, but fortunately this only occurs in a few cases: in case of occlusion of the left main coronary vessel or equivalent lesions, when thrombolysis has failed and in case of failure of angioplasty with obliteration of large vessel and a still viable myocardium, and when the patient continues to suffer or shows signs of heart failure. The operative risk and the risk of haemorrhage then reach 10 p. 100. The installation, prior to surgery, of an intra-aortic counterpulsation system is useful in case of shock or left ventricular failure. Delayed coronary bypass is indicated mainly in case of three-vessel lesions with a less than 40 p. 100 ejection fraction, in case of stenosis of the left main coronary vessel or equivalent lesions, and in patients whose lesions are not amenable to angioplasty on a good caliber vessel, with a still viable myocardium. The operative risk in such cases is distinctly lower (2.4 p. 100). The long-term results obtained confirm the value of coronary bypass surgery when it becomes necessary after thrombolysis.
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PMID:[Coronary bypass after thrombolysis]. 251 76

Nitroglycerin and its derivatives have become widely used agents in the treatment of severe forms of heart failure. Their beneficial effects in this disease results from their ability to reduce preload and afterload of the heart muscle leading to an increase of cardiac index, a decrease in mean pulmonary artery and wedge pressures as well as pulmonary and peripheral vascular resistances. This is associated with reducing the patients' complaints. Intravenous nitrates are used in the treatment of myocardial infarction complicated by an increased left ventricular filling pressure as well as in various forms of acute and worsening left ventricular failure, mainly in pulmonary edema. Oral and transdermal nitrates are administered in chronic congestive heart failure NYHA class III and IV.
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PMID:[Use of nitroglycerin in the treatment of congestive heart failure]. 251 63

The natriuretic, diuretic, and hypotensive effects of atrial natriuretic peptide (ANP) were examined in rats 4 wk after myocardial infarction induced by left coronary artery ligation. Synthetic rat ANP (fragment 1-28) was infused intravenously in doses of 0.1, 0.3, and 1.0 micrograms.kg-1.min-1 for 30 min. There was a significant decrease in systolic blood pressure in controls and rats with infarction, although only in control rats was there a significant decrease in diastolic blood pressure. Changes in systolic and diastolic blood pressure were attenuated in rats with infarction compared with controls (P less than 0.01). The diuretic and natriuretic effects of ANP were observed in both groups of rats, but the effects were significantly less in rats with infarction (P less than 0.01). The ANP infusion did not induce significant changes in heart rate or hematocrit in controls or rats with infarction. The results indicate that rats with chronic left heart failure are less sensitive to the natriuretic, diuretic, and hypotensive effects of ANP when compared with controls. The attenuated renal response to ANP may contribute to the impaired sodium and water excretion in chronic heart failure, although other mechanisms are involved.
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PMID:Attenuated response to atrial natriuretic peptide in rats with myocardial infarction. 252 77

Relaxation delay is an important feature of hypertensive heart disease which impairs diastolic coronary flow and ventricular filling and therefore contributes to heart failure. We investigated the hypothesis that impaired relaxation is a property of the myocardium, rather than the consequence of ischaemia or interstitial fibrosis. A new videomicroscope system was used to define the contraction-relaxation cycle of isolated cardiac myocytes from spontaneously hypertensive rats (SHR) and normotensive control (Wistar-Kyoto, WKY) rats. The SHR cells showed a marked relaxation delay. Angiotensin II (Ang II) increased the contraction maximum by about 35% in WKY rats and induced a relaxation delay. In SHR Ang II greatly potentiated this relaxation delay. Our results demonstrate that impairment of relaxation is a property of the single cardiomyocyte. Angiotensin II induces a relaxation delay that is independent of blood pressure. The combination of hypertrophy and high levels of Ang II potentiates relaxation impairment and may therefore contribute to hypertensive left ventricular failure.
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PMID:Impaired relaxation of the hypertrophied myocardium is potentiated by angiotensin II. 253

We measured plasma concentrations of norepinephrine, cyclic AMP, cyclic GMP, atrial natriuretic peptides (ANP) and beta-adrenoceptor density (Bmax) and affinity (Kd) of lymphocytes in patients with congestive heart failure and correlated these parameters with symptoms and hemodynamic indices. Plasma concentration of norepinephrine, cyclic AMP, cyclic GMP and ANP significantly increased in patients with congestive heart failure. Plasma concentrations of norepinephrine were related to the severity of the heart failure, plasma cyclic AMP concentrations, and pulmonary artery pressures. Cyclic AMP concentrations fell rapidly after treatment of acute left ventricular failure. Peripheral blood lymphocytes were stimulated by isoproterenol, and cyclic AMP level in lymphocytes was assayed. In normal subjects the generation of cyclic AMP after stimulation decreased with age. The response of lymphocytes in patients of NYHA classes III and IV was significantly lower than in the normal age-matched controls. A significant correlation between plasma norepinephrine concentration and increase of lymphocyte cyclic AMP was demonstrated. From these results it was suggested that beta-adrenergic receptors in congestive heart failure were desensitized. Beta receptor numbers of lymphocytes significantly decreased in NYHA class III and IV, but did not decrease in class I and II. There was no significant difference in Kd associated with congestive heart failure. Plasma concentrations of cyclic GMP also depended on the severity of heart failure and the pulmonary artery pressure, and decreased sharply with treatment, although remaining at a high value. A significant correlation between the cyclic GMP and ANP concentration was found in patients with congestive heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pathophysiologic and prognostic considerations in circulatory insufficiency in congestive heart failure: receptor function. 254 Dec 67

The present study comprises 62 patients with Chronic Chagas' Heart Disease. In addition to clinical examination, serologic, roentgenologic, hemodynamic, electrocardiographic, left cineventriculographic and cinecoronariographic studies were performed, with subsequent evaluation apical left ventricule. Thirty two patients were women and 30 were men, varying between 21 and 64 years of age, all with positive serological tests, all with cardiovascular symptoms, 26 with myocardial failure (11 with left ventricular failure and 15 with congestive heart failure), heart size was normal on X-ray in 37 patients with cardiomegaly in 25 (slight in 10; moderate in 8 and accentuate in 7). The electrocardiogram revealed in 41 instance of conduction defects. The left ventriculogram showed an apical lesion in 52 patients (83.87%) with: localized hypokicinetic in 4 (6.45%), diffuse hypokicinetic in 6 (9.68%) and, apical lesion in 48 (77.42%). The shaped apical lesion as a nipple in 17 (27.42%), as finger in 17 (27.42%), and half-moon in 14 (22.18%). The apical lesion was observed in 20 of 26 patients with myocardial failure (76.92%). In 9 patients was associated with others aneurysms. In 3 patients apical thrombus was detected.
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PMID:[Apical left ventricular involvement in chronic Chagas' cardiopathy: clinical and ventriculographic aspects]. 259 98


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