Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 64-year-old man developed severe hyperbilirubinemia of predominantly conjugated fraction in 1978, eight years after a myocardial infarction and development of congestive heart failure. In 1975, he was admitted elsewhere for symptoms suggestive of chronic hepatitis, but liver biopsy revealed replacement of hepatocytes by red blood cells which was interpreted as a result of left-sided cardiac failure. In 1978, liver biopsy showed congestive liver disease with cardiac sclerosis. Despite initial improvement, his condition deteriorated, he became encephalopathic, and died in a coma. This case is reported to illustrate that chronic congestive heart failure can present with severe jaundice and terminate in hepatic coma.
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PMID:Severe hyperbilirubinemia and coma in chronic congestive heart failure. 707 14

Alcohol decreases myocardial contractility through direct, toxic effect. Ingestion of more than 150 g per day for more than 10 years carries a high risk of developing alcoholic cardiomyopathy. The discontinuance of alcohol intake--if put into effect early in the natural history of patients with alcoholic cardiomyopathy--commonly but not invariably results in remission of heart failure. In order to evaluate the left ventricular (LV) function and to find out a possible correlation between the degree of cardiac dysfunction and the severity of the morpho-functional aspects of alcoholic liver disease, 20 chronic alcoholic patients without clinical evidence of heart disease were examined. Echocardiography, systolic time intervals, mechanical polygraphic recordings and liver biopsy were obtained. According to the morphological alterations showed by the needle biopsy of the liver, we separated 12 patients with liver steatosis (Group I) from 8 subjects with alcoholic hepatitis and fibrosis. In Group I LVET, ICT, PEP/LVET indices and LV fractional shortening (delta %) were not statistically different from control subjects. Patients of Group II showed marked impairment of myocardial function, as revealed by significant ICT, PEP, PEP/LVET prolongation and by an equally significant reduction of fractional shortening of the LV. The noninvasive method has proved to be quite useful in detecting early LV dysfunction in asymptomatic chronic alcoholics and has revealed a correlation between the severity of the morphological involvement of the liver and the impairment of cardiac performance.
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PMID:[Non-invasive evaluation of left ventricular function in chronic alcoholics. Histo-morphological and echo-polygraphic correlations]. 718 10

In 14 elderly male residents of a veterans' care complex who were receiving diuretic therapy for cardiac failure, oral potassium (K) supplements were withdrawn. Plasma and erythrocyte K levels were measured immediately before and six weeks after withdrawal of the supplements (38 mEq K daily). The controls comprised 19 elderly residents without disease and not taking drugs likely to influence K status. Study subjects and controls were receiving the same diet (average daily K content 100 mEq). After withdrawal of K supplements, the mean plasma K level fell significantly but the mean erythrocyte K level remained unchanged and did not differ from the control values. For a further six weeks after the withdrawal period, 7 subjects were treated with Aldactazide (diuretic hydrochlorothiazide plus K-sparing spironolactone). The plasma K level increased significantly but the erythrocyte K level remained unchanged. It was concluded that, in this setting, diuretic-induced hypokalemia is not necessarily accompanied by intracellular K depletion and that routine prophylaxis with K supplements or K-sparing agents is unnecessary and not without risk. Such therapy should be reserved for patients considered at special risk of K depletion because of known poor dietary intake, advanced liver disease, secondary hyperaldosteronism with renovascular hypertension, gastrointestinal losses, or nondiuretic medication known to affect K status adversely.
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PMID:Diuretics and the institutional elderly: a case against routine potassium prescribing. 720 9

In a detailed retrospective analysis of 81 patients with systemic lupus erythematosus (SLE), elevated serum "liver enzymes" were recorded in 45 (55%) subjects. In 9 cases, the cause was non-hepatic and in 14 cases liver dysfunction was probably drug induced. Aspirin was the most common offender. Of the remaining 22 patients, 3 had congested livers secondary to heart failure and 19 had no obvious cause for liver dysfunction other than SLE itself. Liver histology was reviewed in 7 of these 19 patients. An inflammatory infiltrate of the portal areas was seen in 5, fatty liver in one and chronic active hepatitis in one. The frequency of liver dysfunction and the associated portal inflammation support the view that subclinical liver disease is a concomitant feature of SLE.
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PMID:Subclinical liver disease in systemic lupus erythematosus. 1213 26

During the history taking and physical examination, several important diseases should be searched for before diagnosing essential hypertension. A critical investigation is repetitive abdominal auscultation for a bruit. In young patients with significant hypertension, coarctation of the aorta must be excluded by clinical examination. Investigations will especially be aimed at uncovering renal artery disease (relatively common) or a phaechromocytoma (relatively rare). The initial assessment must also diagnose associated diseases which will influence the type of therapy chose. Thus asthma and heart failure contraindicate beta-blockers, liver disease contraindicates methyldopa, severe depression contraindicates reserpine, methyldopa and beta-blockade, while diabetes or gout may be precipitated or aggravated by thiazide diuretics.
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PMID:Hypertension in general practice. Part I. Examination and investigation of a patient with hypertension. 744 97

In order to test the hypothesis that clinical and biochemical features of liver disease due to cardiac failure regress upon relief of cardiac decompensation, 38 patients with constrictive pericarditis were studied before and after pericardiectomy for periods ranging from 1 week to 25 years. All patients were judged to be free of clinical evidence of heart failure. Hepatomegaly was present in 10 of the 38 patients studied. Of the patients studied 1-25 years after operation, 96% had elevated serum levels of total and conjugated bilirubin. The percentage Bromsulphalein (BSP) retention at 45 minutes was abnormal in all 29 patients studied 1 year or more after surgery. There was no significant correlation between the level of bilirubin or the percentage BSP retained when these were compared with the pre-operative height of jugular venous pressure, degree of pulsus paradoxus, duration of symptoms or degree of hepatic congestion. Our study reveals that the liver lesion of cardiac failure persists for up to 25 years after restoration of normal cardiac function.
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PMID:Hepatic sequelae of congestive cardiac failure. Evidence for a liver lesion in patients in whom cardiac function has been restored to normal. 745 52

The case of an obese patient who developed massive centrilobular liver cell necrosis, severe coagulopathy, acute renal failure, and encephalopathy is presented. Hypovolemia and heart failure were absent, but the acute liver disease was associated with severe arterial hypoxemia due to obstructive sleep apnea that was shown by the nocturnal blood oxygen desaturation, the results of the polysomnographic study, and normal baseline pulmonary function tests. In this obese patient, liver cell necrosis was caused by severe liver cell hypoxia secondary to severe arterial hypoxemia as a consequence of obstructive sleep apnea associated with a Pickwickian syndrome. This observation is consistent with the hypothesis that liver ischemia was directly related to severe arterial hypoxemia.
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PMID:Ischemic hepatitis due to obstructive sleep apnea. 755 54

Leg edema is a common problem in older patients, with a wide range of possible causes. The diagnosis can be narrowed by categorizing the edema according to its duration (acute or chronic), distribution (unilateral or bilateral), and accompanying symptoms (such as dyspnea, pain, thickening of skin, and pigmentation). The differential diagnosis includes systemic illnesses such as heart failure, liver disease, malnutrition, and thyroid disorder; local conditions such as pelvic tumors, infection,, trauma, and venous thrombosis; and various medications known to increase the risk of edema of the lower extremities. Appropriate therapy is based on the presentation of edema and its identified cause.
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PMID:Leg edema: clinical clues to the differential diagnosis. 783 20

Carvedilol is an arylethanolamine that is a racemic mixture of 2 enantiomers. The S-(-)-enantiomer has beta-adrenoceptor blocking activity, while the racemate also has alpha 1-receptor blocking activity due to the activity of the R-(+)-enantiomer. The drug is rapidly absorbed and undergoes extensive first-pass metabolism in the liver. It reaches a peak concentration 1 to 2 hours postdose and has an elimination half-life of about 4 to 7 hours. Absorption is delayed by food. The drug is highly lipophilic and is highly protein bound. The drug is metabolised by the liver, with some metabolites having biological activity. The pharmacokinetic profile is not altered in the elderly or in patients with renal disease. However, bioavailability of the oral medication is greatly increased in patients with liver disease. Carvedilol lowers blood pressure as a result of its beta-blocking and vasodilatory activity. The reduction in blood pressure is similar to that achieved with other antihypertensive drugs, and there are no adverse effects on renal or cerebral blood flow. Carvedilol has been used in small numbers of patients with cardiac failure. It reduces left ventricular hypertrophy and has no significant adverse metabolic effects.
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PMID:Clinical pharmacokinetics and pharmacodynamics of carvedilol. 791 79

Carcinoid is a slowly growing type of tumor; its pathological effects are primarily due to its endocrine symptomatology. Among the main causes of death are heart failure, liver disease and complications due to the tumor size. The purpose of this study was to investigate carcinoid heart disease in a wide necropsy sample. We analyzed 26,921 necropsies performed at the Institute of Pathology of the University of Trieste from January 1, 1976 to December 31, 1985. Out of the 26,921 necropsies we found 59 cases with carcinoid tumor. It is interesting to underline the presence of a second primary tumor in 28.8% of cases and of multiple tumors in 2 cases. In the heart we observed valvular abnormalities with no peculiar features in 16.1% of cases, ischemic heart disease in 52.2% and endocardial thickening in 15.9%. Our series, although rather large, did not show the high frequency of carcinoid heart disease that has been reported by other authors; instead, we observed a rather high prevalence of lesions typical of ischemic heart disease. The endocardial thickening seems to be the most interesting and specific finding.
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PMID:[Carcinoid cardiopathy. A study of 40 cases]. 802 41


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