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

Although it is now recognised as a rare complication of cardiac surgery, constrictive pericarditis was diagnosed in three patients after coronary artery bypass surgery. The time interval between cardiac surgery and the development of constrictive features varied from two to six weeks. All three patients presented with severe congestive heart failure. Haemodynamic findings were characteristic of constrictive pericarditis. Pericardial thickening detected by computed tomography in one patient was useful in establishing a definite diagnosis. One of the patients had a serous constrictive effusive pericarditis, and surgical pericardial drainage was needed. The other patient underwent pericardiectomy with preservation of the grafts. The diagnosis of constrictive pericarditis should be considered in patients presenting with unexplained right sided heart failure after cardiac surgery.
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PMID:Constrictive pericarditis as a complication of coronary artery bypass surgery. 660 61

Thirty-one patients with proven acute myocardial infarction (MI) were studied prospectively at the time of admission to hospital and at 3, 7 and 18 days using 4 immune complex (IC) assays. Each assay showed an increased incidence of IC activity in MI with 76% of patients being positive in at least 1 assay on one or more of the sampling days. A positive IC assay did not show a significant correlation with cardiac failure, pericarditis, post MI syndrome or previous infarction. The presence of IC was found to correlate with serum C-reactive protein (CRP), serum enzymes and ESR and suggested that complexed CRP or other acute phase proteins may account for some of the IC activity found with less specific assays. The measurement of IC levels in MI has not proved helpful in the diagnosis, management or prediction of outcome in this disorder.
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PMID:Circulating immune complexes in myocardial infarction. 660 58

34 patients (pts.) with chronic constrictive pericarditis (CCP) were investigated by right and left heart catheterization and were followed at Hannover Medical School between 1975 and 1981. 12 pts. in NYHA stage II were treated medically (group I); 22 pts. (group II) in NYHA stages III or IV underwent surgery (pericardectomy). 7 pts. of group I and 12 pts. of group II underwent cardiac catheterization twice; the time interval between the two studies was at least 12 months, averaging 34 +/- 16 months in group I and 34 +/- 19 months in group II. 2 pts. of group I underwent pericardectomy after the second investigation. In group I the mortality was 16.7% (2 out of 12 pts.), both pts. being in stage IV. Hospital mortality in group II amounted to 20.8% (5 out of 24 pts.); late mortality was 4.2% (1 out of 24 pts.). However, 2 of 5 pts. who died in hospital had also undergone aortic and/or mitral valve replacement, and one was on chronic hemodialysis. Additional disorders of liver, lung, and/or kidney function or aortic and/or mitral valve replacement increased the operative risk considerably. Cardiac catheterization performed in 7 out of 12 pts. of group I yielded slight but significant hemodynamic deterioration under conservative management, and 2 of these pts. required surgery after reinvestigation. Cardiac catheterization performed postoperatively in 12 pts. of group II demonstrated normal hemodynamics, especially a decrease in right and left atrial and ventricular enddiastolic pressures (p less than 0.001) and an improvement in cardiac index (p less than 0.05) and stroke index (p less than 0.01). These observations suggest the following conclusions: Pts. in NYHA stage II can be treated medically as long as additional disorders are absent. Hemodynamic deterioration, however, is unpredictable, and approximately one third of pts. may deteriorate rapidly. Therefore, careful clinical observations and repeated hemodynamic studies are necessary. Pericardectomy is still associated with a rather high mortality, depending on additional disorders of liver, lung, and/or kidney function, which accumulate in pts. with long histories of right heart failure. On the other hand, late postoperative results are favorable. When the patient has liver, lung, and/or kidney damage or a long history of cardiac insufficiency, or is advanced in age, operation should be performed even in NYHA stage II because of the increasing operative risk attending higher stages of cardiac insufficiency.
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PMID:[Constrictive pericarditis: results and problems of conservative and surgical treatment]. 663 33

Based on the findings of 50 patients with infective endocarditis, 37 affecting the aortic, six the mitral and seven both the aortic and mitral valves, in addition to analysis of predisposing factors, prominent signs and symptoms distinctive for the clinical entity were assessed (Tables 1 to 3). Preexistent conditions such as aortic valve lesions including bicuspid aortic valve as well as mitral valve lesions including mitral valve prolapse were proven in 66%. Factors which may have compromised host defense mechanisms such as cachexia and chronic alcohol or intravenous drug abuse were present in isolated cases. In 38% of the patients, a diagnostic or therapeutic manipulation, suspected to have given rise to the bacteremia, antedated the onset of endocarditis. Malaise, fatigue and chills were the most frequent symptoms (Table 4). Fever and cardiac murmurs were observed in all patients, anemia and bacteremia in 74% of the patients, respectively (Tables 4 to 6). In blood cultures, the most common microorganisms were found to be hemolytic and nonhemolytic streptococci accounting for 65% of positive findings, followed by enterococci and gram-negative bacteria each with 14% respectively (Table 6). Congestive heart failure predominated among cardiac complications with its occurrence in 84% of the patients. Valvular ring or myocardial abscess, aortic or sinus of Valsalva aneurysm, occasionally with perforation, were found in 24% of our patients. Coronary embolism was documented in 6%; infection-associated pericarditis was observed only rarely (Table 7). Extracardiac complications involved the skin, central nervous system, spleen and kidneys, respectively, in 20 to 30% of the patients. Complications afflicting the eyes, lungs, gastrointestinal tract and the musculo-skeletal system were seen with a lesser frequency of 0 to 12% (Table 8). The diagnosis of infective endocarditis, rendered highly-probable by the constellation of fever, cardiac murmur, bacteremia and anemia, necessitates, however, confirmation through cardiac examinations. In this respect, electrocardiographic and radiologic findings are of limited value, although they may be useful in the detection of cardiac complications. In 6% of the patients, positive criteria for myocardial infarction were indicative of coronary embolism and, i 30%, atrioventricular or fascicular block suggested the presence of abscess formation (Table 9). As radiologic evidence of heart failure, 74% of the patients were found to have pulmonary vascular congestion (Table 10).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Detection and evaluation of infectious endocarditis]. 664 98

The incidence, diagnostics and significance of pericarditis in acute myocardial infarction (AMI) were studied, depending on some factors - sex and age of the patients and site of infarction in four patients groups and deceased: I-132 deceased with AMI abd cardiac rupture; II 337 deceased with AMI, 46 of them with aneurysms; III-334 deceased and 153 patients with subendocardial infarction and IV - 140 patients with AMI. Pericarditis was diagnosed in 8.1 per cent of the patients with AMI, in 16.6 per cent of the deceased with AMI and aneurysms, in 24,2 per cent of those with cardiac rupture and very rarely in the deceased with subendocardial infarction. It is more frequent in males, with anterior infarction and in the younger subjects. Pericardial friction occurred on 2-3 day, localized behind the sternum and in IV left intercostal space, whereas in posterior infarction - a little below. Pain is an important sign of pericarditis. imposing a very careful search of pericardial friction. ECG signs of acute pericarditis are not very often. The presence of pericarditis suggests a possibility of aneurysm formation, manifestation of cardiac insufficiency, increases the probability of cardiac rupture and mortality rate is greater with pericardial complications, hence it is an unfavourable prognostic sign.
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PMID:[Pericarditis in acute myocardial infarct]. 667 51

A high performance liquid chromatographic method was used to determine myocardial norepinephrine and epinephrine concentrations in 66 biopsy specimens obtained from the right or left ventricle during routine diagnostic cardiac catheterization of 45 patients with dilated (congestive) or hypertrophic cardiomyopathy, or with heart disease other than cardiomyopathy, such as acute perimyocarditis, postmyocarditis and constrictive pericarditis. The validity of catecholamine determination in a 2 to 6 mg biopsy specimen to assess overall ventricular myocardial catecholamines was demonstrated. Norepinephrine concentrations in the myocardium were inversely correlated with the grade of hypertrophy in patients with congestive cardiomyopathy or heart disease other than cardiomyopathy, but not in patients with hypertrophic cardiomyopathy. The fact that the myocardial norepinephrine concentration was always lower in the left than in the right ventricle of the same patient may be explained by the simple dilution of sympathetic nerve endings in the left ventricle. There were some cases of hypertrophic cardiomyopathy in which the concentration of myocardial norepinephrine was exceptionally high, although its mean value was not significantly higher than that in patients with other types of heart disease who served as a control group without cardiomyopathy. Some patients with dilated cardiomyopathy had lower levels of myocardial norepinephrine than would be expected for the degree of interstitial fibrosis and the severity of heart failure. The mean plasma norepinephrine and epinephrine levels were significantly elevated in patients with dilated cardiomyopathy.
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PMID:Myocardial catecholamines in hypertrophic and dilated (congestive) cardiomyopathy: a biopsy study. 668 49

We have assessed the value of M-mode echocardiography in diagnosing the presence and the extent of pericardial effusion after an acute myocardial infarction, in a group of 105 patients. The relations between pericardial effusion and the extent of the infarction, the possible presence of heart failure, the clinical electrocardiographic and radiographic signs of pericarditis have also been investigated. At last we have evaluated the possible influence of the anticoagulant therapy. Our results show a poor (22%) sensitivity of the traditional methods (ECG, X-ray, physical examination) in comparison with echocardiography. This holds true both for the entire group (x2 = 85,8; p less than 0,001), and for the large effusions taken separately (x2 = 59,6; p less than 0,001). A close relation between the area and the extent of myocardial infarction and the presence of pericardial effusion was observed. On the contrary no statistically significant relation between anticoagulant therapy and the extent and frequency of pericardial effusion was found. This type of therapy seems to influence only the duration of pericardial effusion (8,875 +/- 3,1 versus 5,72 +/- 4,9 days). Haemodynamic efficiency is poorly related with the presence of pericardial effusion (X2 = 3 p greater than 0.05). This relation probably depends on the extent of myocardial necrosis. Echocardiographic investigation of the presence and extent of pericardial effusion after myocardial infarction could help to define both the prognosis and the treatment of these patients.
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PMID:[Echocardiographic evaluation of pericardial effusion in acute myocardial infarct]. 670 54

Rupture of the left ventricle after myocardial infarction results either in sudden death from cardiac tamponade or, when pericardial adhesions are present, in bleeding that is confined to a limited space, which gradually expands as the blood flows through a small communicating orifice under high pressure, forming a false aneurysm. In three such patients a false aneurysm of the left ventricle after myocardial infarction was successfully treated by operation. The interval from the initiating event to the time of surgery averaged 10 months. Two of the patients had pericarditis and all presented at some stage of the illness with tachyarrhythmias and cardiac failure. All the patients survived operation and have improved functionally. Because of the propensity of false aneurysms to rupture, early diagnosis and aggressive surgical treatment are recommended.
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PMID:Surgical treatment of false aneurysm of the left ventricle after myocardial infarction. 684 58

From 1972 to 1980, 23 patients (Group A) with native valve infective endocarditis underwent surgical intervention, often for multiple indications, during the active stage of the infective process because of progressive class III and IV (New York Heart Association) heart failure (12 patients), persistent severe hypotension (3 patients), uncontrolled infection for over 21 days (11 patients), aortic root abscess (2 patients), and pericarditis (1 patient). Eighty-five patients (Group B) with active native valve endocarditis, matched for severity of illness, were treated medically. Two patients (9%) in Group A and 43 patients (51%) in Group B died during the hospital admission (p less than 0.001). Any difference in long-term cumulative survival rate between the 2 groups was largely due to the beneficial impact of surgical management on the hospital mortality. Of 23 patients in Group A, 11 (48%) had an entirely uncomplicated postoperative course. Long-term mortality rates in those with aortic valve endocarditis treated medically (79%) were significantly higher than in those with mitral valve involvement (47%) (p less than 0.05). Patients with aortic valve involvement treated surgically had a better hospital (p less than 0.005) and long-term (p less than 0.0005) survival rate than those treated medically. Two groups at risk for postoperative complications were identified; 3 of 11 patients (27%) with uncontrolled infection had an early postoperative recurrence, and 4 of 7 patients (57%) with an aortic root abscess had postoperative prosthetic paravalvular regurgitation. Surgery therefore effects a substantial reduction in hospital mortality in patients with complicated active infective endocarditis (9% versus 51%), but patients with preoperative prolonged periods of uncontrolled infection or with aortic root abscess are liable to postoperative complications.
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PMID:Analysis of surgical versus medical therapy in active complicated native valve infective endocarditis. 685 71

The incidence of primary mediastinal lymphoma in adults was investigated in 184 patients with non-Hodgkin's lymphoma. This entity was defined as disease within the mediastinum in patients who presented with symptoms due to an enlarging mediastinal mass. Of 184 patients, 17 presented with primary mediastinal lymphoma. All had a diffuse histologic pattern. The most common pathologic type was poorly differentiated lymphocytic lymphoma, diffuse (PDL-D), (11 cases). In nine of these 11 cases the patients had tumors of convoluted lymphocytes. The presentation was rapid in onset, with heart failure, pericarditis, dyspnea and superior vena caval syndrome predominating. Eleven of the 17 were clinical stage I or II, but eight of these had widespread disease on pathologic staging or rapid dissemination soon after diagnosis. In conclusion (1) primary mediastinal lymphoma is always diffuse in histology. (2) The most frequent pathologic type is PDL-D, with convoluted morphology. (3) Compression of vital intra-thoracic structures is common. (4) Although seemingly localized at presentation, this entity usually implies disseminated disease.
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PMID:Primary mediastinal lymphoma in adults. 689 53


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