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

Nine patients with chronic obstructive lung disease underwent right heart catheterization. Mean pulmonary arterial pressure was elevated, but none of the patients had clinical signs of cardiac failure. Mean arterial oxygen saturation and carbon dioxide tension were 89% and 47 mmHg, respectively. Plasma noradrenaline (NA) concentration averaged 0.51 ng/ml and was inversely correlated to arterial oxygen saturation and mixed venous oxygen saturation, and positively correlated to arterial carbon dioxide tension and mean pulmonary arterial pressure. Oxygen inhalation did not change plasma NA significantly. Eight months later, plasma NA was increased (mean 0.89 ng/ml), as compared to the first determination (P < 0.02), and to a group of normal subjects (mean 0.26 ng/ml, P < 0.005). Inverse correlation to arterial oxygen saturation and direct correlation to arterial carbon dioxide tension were still present. Plasma adrenaline concentration was normal. The results point to enhanced sympathetic nervous activity in patients with chronic obstructive lung disease, probably caused by the deranged blood gases. The pulmonary haemodynamic changes and increased pulse rate may, at least partly, be due to enhanced sympathetic nervous activity.
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PMID:Increased plasma noradrenaline concentration in patients with chronic obstructive lung disease: relation to haemodynamics and blood gases. 677 57

Nitroglycerin (Ng) is a potent and short-acting coronary and systemic vasodilator, widely used in anginal pain treatment. When given to patients with pneumonia or chronic lung disease, Ng was found to cause a further decrease in arterial oxygen tension (PaO2) by increased perfusion of poorly ventilated territories in the lungs. In order to investigate the potential hazard in Ng decreasing the PaO2 in ischemic heart disease patients, who develop acute pneumonia, we administered 0.4 mg Ng sublingually to 11 patients who suffered concomitantly from ischemic heart disease and acute pneumonia. Arterial blood gases were monitored before, 2, 5 and 10 min following Ng administration, as well as a standard 12-lead electrocardiogram that was monitored as the same time. 8 out of the 11 patients showed a decrease in PaO2 which was mild to moderate, during the study period of time, none of them showed an increase, and there was tendency for the lower (less than 60 mm Hg) initial PaO2 to show a lesser decrease in the PaO2 in comparison to the higher (greater than 60 mm Hg) initial PaO2. There was no statistical significant correlation between the decrease in PaO2 and patients' age, sex, coexisting chronic obstructive lung disease and severity of systemic heart failure. Our conclusion is that the hazard in lowering PaO2 by Ng in ischemic heart disease patients who develop acute pneumonia is minimal, but the drug should be used with caution.
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PMID:Arterial hypoxemia following the administration of sublingual nitroglycerin in patients with ischemic heart disease and pneumonia. 679 69

The objectives of this study were to determine the effects of low flow oxygen and isosorbide dinitrate on rest and exercise biventricular ejection fractions in patients with chronic obstructive pulmonary disease and to relate these ejection fraction responses to changes in pressure and flow. Nine patients with stable, moderate to severe chronic obstructive pulmonary disease who had no prior history of heart failure performed supine exercise with simultaneous hemodynamic and radionuclide ventriculographic monitoring. Eight patients performed a second exercise during low flow oxygen breathing and five performed a third exercise after ingesting 10 mg oral isosorbide. Oxygen led to a decrease in exercise pulmonary artery pressure in all subjects and a decline in total pulmonary resistance in five of the seven in whom it was measured. Right ventricular ejection fraction increased 0.05 or more only in subjects who had a decrease in total pulmonary resistance. Isosorbide fed to an increase in rest and exercise right and left ventricular ejection fractions with simultaneous decreases in pulmonary artery pressure, total pulmonary resistance, blood pressure and arterial oxygen tension. These results suggest that in patients with chronic obstructive pulmonary disease but without a history of right heart failure, the right ventricular systolic functional response to low flow oxygen and isosorbide at rest and exercise is, in part, determined by changes in total pulmonary resistance. The chronic relation between right ventricular ejection fraction and pulmonary hemodynamics in patients with chronic obstructive pulmonary disease remains to be evaluated.
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PMID:The acute effects of low flow oxygen and isosorbide dinitrate on left and right ventricular ejection fractions in chronic obstructive pulmonary disease. 688 28

In a prospective study (from April, 1980 to April, 1981) of 110 patients with moderately severe to severe pneumonia 11 were found to have 12 manifestations of Legionnaires' disease. Diagnosis was proven by indirect immunofluorescence tests, either a quadruple titre rise to 1 : 128 or a single titre of at least 1 : 256. The clinical picture in all 11 patients was the typical one of severe pneumonia, usually involving the lower lobes, high fever between 39 and 40.4 degrees C, as well as WBC counts between 6.8 and 28.9 X 10(9)/l. In nine cases artificial ventilation was required, in four there was acute renal failure requiring dialysis, in four other definite renal insufficiency. All patients had underlying disease, in some severe, such as chronic obstructive lung disease, diabetes mellitus, heart failure, liver cirrhosis, renal transplantation or extensive operations. Eight patients died, four of them of Legionnaires; disease. The relatively high infection rate (10%) indicates that in patients with risk factors, as well as those with a pneumonia unresponsive to the standard treatment within five to seven days, Legionnaires' disease should be considered in the differential diagnosis.
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PMID:[Legionnaires' disease: prospective study of its incidence, clinical features and prognosis. (author's transl)]. 706 Apr 96

The course of chronic obstructive pulmonary disease (COPD) is described over a 3-7 year period in 201 patients treated by family physicians and in the same hospital. The probability of survival after 3 years is 63% (normal population of same age 85%) and after 5 years 48% (normal 75%) for all patients. These figures are comparable with data in the literature of the last 12 years (42-69% 5-year survival). The patients in our study are 68 years old on average and have an FEV1 of 1.3 liters. The prognosis of COPD is significantly influenced by the following factors: ECG signs of cor pulmonale, clinical signs of heart failure, vital capacity, FEV1 and paCO2. For example, within a 3 year period 63 of 124 patients with heart failure died as compared to only 3 of 57 without. Retrospective analysis shows inhalation therapy by motor-driven nebulizers to have a favourable effect on survival. For IPPB home therapy a favourable effect can only be shown after stratification for the two most significant prognostic factors to exclude therapeutic bias. No effect on survival was noted with long-term steroid therapy. 11% of patients who have never smoked, and those who have stopped smoking, live significantly (p less than 0.002) longer than those who continued to smoke more than 3 cigarettes per day during the observation period.
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PMID:[Probability of survival and prognostic factors in chronic obstructive lung disease]. 715 68

The effect of steady-state exercise and of increased afterload by angiotensin infusion on the right ventricular function was examined in 21 patients with chronic obstructive lung disease (COLD). 15 of them were always free from cardiac failure and 6 of them have had clinical signs of failure at the time of examination. Despite significant differences in various parameters between compensated (C) and decompensated (D) subjects, only the right ventricular filling pressure during both experimental procedures was able to differentiate the majority of individual C and D patients. The authors discuss the mechanisms of haemodynamic response to both stress tests and their significance for clinical evaluation of patients with COLD and for research into right ventricular contractility.
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PMID:Haemodynamic reaction to exercise and increased afterload in the detection of right heart failure in pulmonary diseases. 744 97

Studies performed since 1968 have shown that in patients with chronic obstructive pulmonary disease (COPD) the prognosis is worse in cases with pulmonary artery hypertension (PAH), especially when the mean pulmonary artery pressure (PPA) is greater than 30 mmHg. Author's data are based on the study of a group of 175 patients with COPD, catheterized between 1968 and 1972. The fate of the patients, at least five years after the initial catheterization, was known in all the cases. The survival rate was calculated according to the "actuarial method". The results suggest that PPA has a good prognostic value, but that FEV1 and PaCO2 are as good predictors of mortality as PPA. Furthermore the influence of age is to be taken into account: prognosis is worse in patients older than 65 years. Longitudinal studies of pulmonary haemodynamics was made in 85 patients who underwent two right heart catheterizations with an interval of greater than 3 years (mean = 5 years) between them. The results indicate that PPA varies very slightly: the average increase for the whole group is 3.1 mmHg, that is less than 1 mmHg per year. There was a good negative correlation between chronological variations of PaO2 and PPA. A long survival time could be observed after the first heart failure episode or after ascertaining pulmonary hypertension.
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PMID:Prognosis of pulmonary hypertension in chronic obstructive pulmonary disease. 747 56

Progress over the last 40 years has greatly reduced morbidity and mortality in the constantly changing field of thoracic surgery. The first part of this review focuses on current indications and limitations in lung surgery. Technical procedures for pneumonectomy, lobectomy, bronchial resection and conservative surgery are well established. Although major respiratory or cardiac failure still limit indications bronchogenic cancer extension is no longer a contraindication. Exeresis after 70 years of age is not an exception. Surgery for non-small cell lung cancer has given promising results with a 5-year survival rate of 60-80% for patients in stage I and II. For stage III, two recent comparative studies have demonstrated the effectiveness of preoperative adjuvant chemotherapy which should logically be proposed with or without radiotherapy in patients with resectable tumours. Surgical removal of lung metastases and mesotheliomas has also made considerable progress. Unfortunately, except for therapeutic trials, exeresis of small cell lung cancer does not provide any beneficial effect and cannot be proposed. Indications for surgery in patients with chronic obstructive pulmonary disease however has been quite successful and now goes beyond classical exeresis of large compressive bullae. In many situations patients with diffuse emphysema can benefit from surgical reduction in lung volume before proposing transplantation. Lung transplantation is indicated for pulmonary fibrosis, pulmonary vascular disease and obstructive lung pulmonary disease with an overall survival rate of 50% at 5 years and 43% at 6 years. The rate of successful bilateral lung transplantation for cystic fibrosis remains to be determined.
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PMID:[New techniques in thoracic surgery. I]. 756 9

Degenerative aortic stenosis represents the most common form of aortic stenosis. The aim of this study was to evaluate the relationship between symptoms, valvular disease severity and prognosis. We studied the evolution of valvular aortic stenosis in 65 patients (39 males and 26 females, mean age 77.78 +/- 6.2 years) for a period of 7 years. All patients were submitted to accurate anamnestic examination, ECG, color Doppler echocardiography. Sixteen patients (26%) underwent cardiac catheterization. Associated diseases were: hypertension (45%), diabetes (40%), dyslipidemia (29%), chronic obstructive lung disease (6%). In 64% patients, the diagnosis of aortic stenosis was made after symptoms onset, and in 36% was occasional. Mean age at symptoms onset was 70 +/- 17 years: dispnoea was present in 81%, chest pain in 32%, and syncope in 8%. At the beginning of the follow-up, echocardiography showed, aortic stenosis to be mild in 21.73%, moderate in 60.8% and severe in 17.4%. At the end of the follow-up, mild stenosis was present in 9.5%, moderate in 38.7%, and severe in 51.8%. At entry, 56.6% had pure aortic stenosis, 34.78% had steno-insufficiency and 8.7 had an associated mitral valve insufficiency. At the end of the follow-up pure aortic stenosis was present in 17%, steno-insufficiency in 40%, and associated mitral valve insufficiency in 4.3%. Surgery was performed in 21% of the patients (77% valve replacement and 23% valve replacement and aortocoronary bypass). The mortality, at the end of the follow-up, was 31%. Causes of death were: heart failure (61%), arrhythmias (23%), and surgical complications (16%).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Characteristics and clinical course of degenerative aortic stenosis in the elderly]. 767 Dec 73

A 73-year-old man with pre-existing cardiac failure, coronary artery and chronic obstructive pulmonary disease was presented for an acute mesenteric ischaemia, resulting from an embolic obstruction of the superior mesenteric artery. An intra-arterial fibrinolysis with a bolus of 250 000 units of streptokinase, followed by an infusion of 150 mg rtPA with adequate heparin dosage was performed 10 hours after the first symptoms. An abdominal guarding occurred 24 hours later, despite radiological improvement, justifying emergency surgery which confirmed the partial efficiency of the medical therapy. Unfortunately, a cardiogenic shock occurred preoperatively and the patient died five days later from intractable cardiovascular failure.
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PMID:[Intra-arterial thrombolysis of acute mesenteric ischemia]. 767 83


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