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

Recent evidence suggests that the most common form of idiopathic cardiomyopathy in our altitudes, the dilated cardiomyopathy (DCM), is a post-infectious autoimmune disease which is triggered by virus infections. In animal experiments, the development of the coxsackie virus B3 myocarditis to a congestive cardiac insufficiency resembling the clinical picture of DCM was demonstrated. In mice, species-dependent varying disease courses could be observed, which point to a genetically different behaviour of the animals' immunological reactions, either humoral or T-cell mediated immune reactions being responsible. In comparison with non-DCM patients, patients with DCM and chronic myocarditis exhibit significantly higher coxsackie virus antibody titres. Obviously, also a differently long viral persistency in the cardiac muscle plays a role, as enterovirus-specific RNA was detected in myocardial biopsies from patients with DCM. Along with myocardial fibroses, endomyocardial biopsies in DCM frequently reveal mononuclear cellular infiltrates, which, however, only in 20-25% of the cases may be regarded as chronic persisting myocarditis. The clinical and paraclinical findings in DCM and in the so-called latent cardiomyopathy are presented. In congestive heart failure, the best therapeutic results are achieved by the ACE inhibitors, along with vasodilator agents, digitalis glycosides and diuretics. Ultima ratio is the orthotopic heart transplantation, as it is only this intervention that will be able to improve the primarily bad prognosis decisively. Whether the treatment with immunosuppressive drugs exerts an influence upon the prognosis, has thus far remained an open question.
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PMID:[Dilated cardiomyopathy--heart muscle disease of unknown origin or an autoimmune disease? New aspects of etiology, pathogenesis and clinical practice]. 268 30

Myocarditis and dilated cardiomyopathy both commonly present as new unexplained heart failure. This similarity raises the question of the interrelation of these disorders. What proportion of dilated cardiomyopathy begins as myocarditis, what other cardiac insults commonly lead to myocarditis and how often endomyocardial biopsy yields the diagnosis of myocarditis when present, are unknown. Proof that immunosuppressive treatment of myocarditis is beneficial is also lacking.
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PMID:Myocarditis and dilated cardiomyopathy: twins or distant relatives? 268 73

We report a case of a 22 year-old drug addict man with overt heart failure and cardiomegaly. The patient had no prior history of tuberculosis and not clinical features to suggest this diagnosis. Tuberculosis myocarditis was found at the necropsy. It is important to point out the frequency of this pathology, the uncommon clinical presentation of this case; as well as the lack of immunologic response to the tuberculous bacillus.
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PMID:[Tuberculous myocarditis. Presentation of a case and review of the literature]. 269 Jul 64

We studied the conduction system of 65 cases of proven active or healed myocarditis and related diseases among 7120 autopsy samples. For this purpose, we prepared serial sections by Lev's method. The pathological diagnoses were idiopathic acute myocarditis (5), giant cell myocarditis (3), chronic myocarditis (13), healed myocarditis (22), sarcoidosis (4), collagen or autoimmune disease (13) and complication of cachexia (5). Among all the autopsy cases, Fiedler's myocarditis was found in only one case, but myocarditis was revealed in 19 out of 30 cases of dilated cardiomyopathy, and 15 out of 25 cases of sick sinus syndrome. Conduction system lesions were divided into two groups. In older cases manifesting mainly arrhythmia, the SA node, atrial muscle and AV node were involved concomitantly with perimyocarditis. In younger cases mainly showing heart failure, the RBB, LBB and Purkinje fibers were damaged by endomyocarditis. Histologically, interstitial myocarditis was observed in the former group and parenchymatous myocarditis in the latter.
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PMID:Myocarditis and arrhythmia: a clinico-pathological study of conduction system based on serial section in 65 cases. 271 70

Two cases of rubella myocarditis are reported: a 6-year-old boy who developed a complete, distal to His, atrioventricular block, during the third day of illness; and a 12-year-old boy who developed myocarditis with congestive heart failure 20 days following rubella infection. Although permanent pacing was required in the first patient, six years later he showed a normal growth and maintained normal activity. The second patient has deteriorated markedly and 6 months after the initial illness he had severe heart failure. It should be noted that myocarditis with abnormalities of the conduction system or congestive heart failure may be a complication to postnatal rubella.
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PMID:Cardiac involvement in postnatal rubella. 291 17

To determine the value of cardiac catheterization and endomyocardial biopsy in patients with heart failure and dilated cardiomyopathy, the records of 61 patients (36 men, 25 women, ages 13 to 65 years) with this disorder were reviewed. Myocardial lymphocytic infiltration was present in 8 (13%). Three had myocyte degeneration and necrosis ("definite" myocarditis), whereas the other 5 had no degeneration or necrosis ("equivocal" myocarditis). Compared with the 53 without lymphocytic infiltration, these 8 patients more often had symptoms of a preceding viral illness (88 vs 30%, p = 0.002) and had a shorter duration of cardiac symptoms (18 +/- 18 vs 109 +/- 132 days [mean +/- standard deviation], p less than 0.001). Histologic features of the biopsy did not relate to survival, but right- and left-sided intracardiac pressures were higher (p less than 0.05) in nonsurvivors. Thus, (1) endomyocardial biopsy is most likely to show lymphocytic infiltration in patients with symptoms of a preceding viral illness and a short duration of cardiac symptoms, and (2) right- and left-sided hemodynamic variables at the time of biopsy may offer insight into prognosis.
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PMID:Diagnostic and prognostic utility of right-sided catheterization and endomyocardial biopsy in idiopathic dilated cardiomyopathy. 292 70

During a 12-year period, when more than 106,000 women were delivered, 28 women with peripartum heart failure of obscure etiology that initially was diagnosed as peripartum cardiomyopathy were studied. None had obvious underlying cardiac disease or iatrogenic fluid overload, and in all an assiduous search for underlying cardiovascular disease was launched. In 21 of these 28 women, heart failure was attributed to chronic underlying disease (chronic hypertension in 14, forme fruste mitral stenosis in four, and morbid obesity in one) or viral myocarditis. Importantly, these women also had multiple compounding cardiovascular factors--preeclampsia, cesarean section, anemia, and infection--which, when superimposed on those of pregnancy, acted in concert to cause heart failure. In seven women, the cause for cardiomegaly and global hypokinesis was not found, and peripartum cardiomyopathy was diagnosed. Compared with women with explicable causes of peripartum heart failure, these women did poorly: six had persistent cardiomegaly and heart failure, and four of these died within four months to eight years. From these observations, the authors conclude that idiopathic peripartum cardiomyopathy is uncommon, and that in most women with peripartum heart failure of obscure etiology, underlying chronic disease will be identified. Heart failure in these women ensues when the cardiovascular demands of normal pregnancy are amplified further by common pregnancy complications superimposed upon these underlying conditions that cause compensated ventricular hypertrophy.
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PMID:Peripartum heart failure: idiopathic cardiomyopathy or compounding cardiovascular events? 293 58

The role of endomyocardial biopsy may be restricted to the diagnosis of myocarditis. On the other hand, a broad utilization of the biopsy technique may be championed by those who believe that the light and electron microscopic characteristics of the tissue are important and that the biochemical features of the tissue may hold important clues to the diagnosis and therapy of dilated cardiomyopathy. The popularity of endomyocardial biopsy arises from the ease and safety of the procedure. Light microscopy of the tissue is useful not only to diagnose myocarditis but also to discover infiltrative cardiomyopathies and to characterize the dilated cardiomyopathies by the amount of fibrosis and cellular hypertrophy. Electron microscopy supplies more detailed information on the myofibrils, nuclei, tubular structures, mitochondria, glycogen, and lipofuscin. At present, these data are clinically applicable only to the anthracycline cardiomyopathies. On an investigational basis, subcellular characteristics may help us better understand the etiology and pathogenesis of dilated cardiomyopathy. The greatest promise lies in the biochemical assessment of tissue, which may uncover single or multiple biochemical abnormalities in heart failure. Although the clinical usefulness of endomyocardial biopsy is quite restricted at present, its future looks quite promising.
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PMID:Value of endomyocardial biopsy. 293 39

Endomyocardial biopsy was performed on eight children 5 to 12 years old, who were in post myocarditic state. They were evaluated within 2 to 25 months (mean lyr and 1 m) after the onset of the symptoms. Two of the patients developed heart failure and six patients developed other cardiac manifestations such as syncope, palpitation or ECG abnormalities at onset. Definite elevation of viral antibody titer was observed in four patients. Radionuclide angiography was also performed in all eight patients. An abnormal perfusion area was observed in six patients as a focal hypoperfusion area by T1-201 myocardial imaging. Ejection fraction was examined by Tc-99m-HSA gated equilibrium ventriculography. LVEF was reduced in 3 patients and RVEF was reduced in 2 patients. Judging from the histopathological findings, these patients were divided into three categories: chronic or smoldering myocarditis (3 patients); healing or healed myocarditis (4 patients); and post myocarditic hypertrophy (1 patient). Measurement of left ventricular function was obtained by cardiac catheterization and left ventriculography (LVG), which revealed some abnormal findings such as increased left ventricular mass index, increased left ventricular end diastolic volume index (LVEDVI) and reduced left ventricular ejection fraction (LVEF). Therefore, endomyocardial biopsy findings of pediatric patients in a post myocarditic state reveal certain histopathological abnormalities even in the long-term follow-up period in the absence of cardiac dysfunction.
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PMID:Endomyocardial biopsy findings in pediatric patients with post myocarditic state. 295 Feb 54

We report a case of idiopathic giant cell myocarditis accompanied by asymmetric septal hypertrophy. A 64-year-old woman was admitted because of dyspnea. There was no past history of hypertension or heart disease and no family history of hypertrophic cardiomyopathy. Laboratory examinations revealed general inflammatory changes and mild elevation of serum CK and GOT. The clinical course was fulminant and the patient died of heart failure one day after admission. On autopsy, asymmetric septal hypertrophy was revealed and the pathohistological examination revealed panmyocarditis with mononuclear cell infiltration, interstitial edema, necrosis of myocytes, and giant cells. The inflammatory changes were most severe in the ventricular septum with asymmetric septal hypertrophy. The extent of myocardial fibers with disarray was within normal limits. Thus, the asymmetric septal hypertrophy appeared to be due to marked interstitial edema and inflammatory cell infiltration in the septum. This case suggests that myocardial inflammation and edema may cause thickening of the ventricular wall during the course of acute myocarditis.
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PMID:Idiopathic giant cell myocarditis accompanied by asymmetric septal hypertrophy. 295 39


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