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)

Hypertension in childhood is diagnosed according to age-adjusted values for each sex. It is more commonly diagnosed now than it was 2 decades ago because blood pressure is more frequently measured in children today. Surgically curable forms of hypertension are not common but usually present as moderate or severe hypertension (diastolic blood pressure greater than or equal to 110 mm Hg). Although many patients in this group are asymptomatic, some present with Bell's palsy, enlarged hearts, heart failure, encephalopathy, or stroke. Newer imaging techniques have proved particularly useful for localizing tumors, such as pheochromocytoma. Many antihypertensive drugs are now available, and therapy should be tailored to the patient's needs, with as few adverse or side effects as possible.
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PMID:Evaluation and management of childhood hypertension. 407 63

Eleven of 12 patients with severe congestive heart failure who were pretreated with diuretics and digitalis benefited from long-term therapy with prazosin which was titrated to the individual's maximally tolerated dose. Nine of the 11 patients improved their functional state by one (n = 4) or two (n = 5) New York Heart Association (NYHA) classes. Within 4 weeks the stroke volume index increased from 23 +/- 10 to 29 +/- 9 SD (ml/beat/m2) while pulmonary capillary pressure decreased from 29 +/- 8 +/- 9 mm Hg (p less than 0.05 for both) and peripheral vascular resistance fell from 2,245 +/- 792 to 1,603 +/- 355 dyn/s cm-5 (p less than 0.01). Hemodynamics results were similar on the same regimen in eight patients assessed for 6 months. Death of three patients (week 5 and week 17) was unrelated to prazosin therapy. Prazosin resulted in improved cardiac performance during leg-up-tilt or supine ergometry. Increase in stroke volume index was related to the fall in peripheral vascular resistance (r = -0.79, p less than 0.01). Plasma adrenaline (301 +/- 480 pg/Ml), noradrenaline (1,312 +/- 1,382 pg/ml), and renin activity (22 +/- 30 ng/ml/h) were in the range observed with pheochromocytoma; variables did not change on prazosin. This reflects an important role of alpha-adrenoceptor-mediated vascular regulation in patients with heart failure in whom long-term treatment with prazosin produces a sustained and well-tolerated vasodilator effect without further rise in catecholamines and renin.
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PMID:Clinical and hemodynamic improvement of congestive heart failure by long-term vasodilator therapy with postjunctional alpha 1-adrenoceptor blockade. 617 37

Labetalol is a combined alpha- and beta-adrenoceptor blocking agent for oral and intravenous use in the treatment of hypertension. It is a nonselective antagonist at beta-adrenoceptors and a competitive antagonist of postsynaptic alpha 1-adrenoceptors. Labetalol is more potent at beta that at alpha 1 adrenoceptors in man; the ratio of beta-alpha antagonism is 3:1 after oral and 6.9:1 after intravenous administration. Labetalol is readily absorbed in man after oral administration, but the drug, which is lipid soluble, undergoes considerable hepatic first-pass metabolism and has an absolute bioavailability of approximately 25%. There are no active metabolites, and the elimination half-life of the drug is approximately 6 hours. Unlike conventional beta-adrenoceptor blocking drugs without intrinsic sympathomimetic activity, labetalol, when given acutely, produces a decrease in peripheral vascular resistance and blood pressure with little alteration in heart rate or cardiac output. However, like conventional beta-blockers, labetalol may influence the renin-angiotensin-aldosterone system and respiratory function. Clinical studies have shown that the antihypertensive efficacy of labetalol is superior to placebo and to diuretic therapy and is at least comparable to that of conventional beta-blockers, methyldopa, clonidine and various adrenergic neuronal blockers. Labetalol administered alone or with a diuretic is often effective when other antihypertensive regimens have failed. Studies have shown that labetalol is effective in the treatment of essential hypertension, renal hypertension, pheochromocytoma, pregnancy hypertension and hypertensive emergencies. In addition, preliminary studies indicate that labetalol may be of value in the management of ischemic heart disease. The most troublesome side effect of labetalol therapy is posture-related dizziness. Other reported side effects of the drug include gastrointestinal disturbances, tiredness, headache, scalp tingling, skin rashes, urinary retention and impotence. Side effects related to the beta-adrenoceptor blocking effect of labetalol, including asthma, heart failure and Raynaud's phenomenon, have been reported in rare instances.
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PMID:Labetalol: a review of its pharmacology, pharmacokinetics, clinical uses and adverse effects. 631 May 29

A 22-year-old woman was admitted to hospital in shock, the admission diagnosis being lobar pneumonia with septic shock. Ultrasound demonstrated a tumour in the region of the left adrenal, but because of the absence of hypertensive symptoms and hypoglycaemia this was interpreted as a non-contributory finding. Despite intensive therapeutic measures the patient died within a few hours. At autopsy a phaeochromocytoma of the left adrenal gland was found. "Catecholamine myocarditis" resulting in acute cardiac failure, was demonstrated histologically. Phaeochromocytoma with predominant adrenaline or dopamine secretions often takes a normotensive or hypotensive course. Sudden excessive catecholamine release can, as in the described case, cause so-called adrenaline shock. The catecholamine-induced hypoxic-toxic myocardial changes determine the likely outcome.
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PMID:[Hypotension and shock in pheochromocytoma]. 649 90

Maitotoxin is a substance extracted from a dinoflagellate and certain tropical poisonous fish. It is considered as the most potent marine toxin (50 times more potent than tetrodotoxin). In isolated mammalian atria, maitotoxin produces at low doses a positive inotropic effect not modified by reserpine pretreatment and suppressed by Mn2+ ions. In the anaesthetized cat, it induces cardiac arrhythmias and tachycardia leading to cardiac failure. On the other hand, maitotoxin strongly inhibits Na+-K+ ATP-ase from microsomes of cat and human kidneys. In a rat pheochromocytoma cell line, it has been shown to promote a norepinephrine release and an increase in Ca2+ influx. The purpose of this work is to study the effect of maitotoxin on action potential of isolated perfused rat heart to check the existence of a direct effect on the myocardium.
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PMID:Effects of highly purified maitotoxin extracted from dinoflagellate Gambierdiscus toxicus on action potential of isolated rat heart. 654 Aug 11

The course of the disease of six cases with pheochromocytoma was analyzed in patients, aged from 19 to 65, with manifestations mainly of the cardiovascular system. The diagnosis was verified in five of them at necropsy and in one of them--intraoperatively. The arterial hypertension accompanied by distinct vegetative symptomatics were the basic clinical signs and in some of the cases--disturbances in the carbohydrate metabolism. In four patients the arterial hypertension was permanent, in two of them--with paroxysmal elevation opresf blood pressure. In the other two--with hypertonic crises on the background normal blood pressure. The duration of the hypertension--from a single hypertonic crisis during pheochromocytoma attack, had a lethal end, till the fifth year. In three of the patients rhythm disorders (supraventricular tachycardia or tachyarrhythmia) originated in a pheochromocytoma paroxysm and in three--acute left ventricular insufficiency (gallop rhythm, pulmonary edema). The clinical picture resembles heart defect, myocardial infarction with congestive cardiac insufficiency and rhythm disorders, renal insufficiency with symptomatic arterial hypertension and decompensated hypertonic heart, epilepsy, coggagenosis . The authors admit that the development of acute left ventricular failure in hypertonic patients, that could hardly be explained only by the increase of the heart afterloading (in advanced age, not enlarged and no data about grve heart lesions) or the origination of severe rhythm disorders, not coped by the modern antirhythm agents, are signs, indicating, the existence of pheochromocytoma. The catecholamine affection of myocardium, that was found in three of the deceased patients, very likely, contributes to the origination of left ventricular failure.
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PMID:[Cardiological problems in pheochromocytoma patients]. 674 Nov 6

A family with a very high prevalence of pheochromocytoma (62%, i.e. 100% in the 1st generation and 75% of the second one) is described. The proband was a 19-year-old woman with a 30 g right-side tumor, who died at 24 years because of a heart failure. Both sisters of the proband developed a right-side pheochromocytoma at 13 and respectively 14 years of age and are now normotensive after surgical exeresis. One of them had 3 sons: 2 with pheochromocytoma and a third one dead at 9 years of age for pulmonary oedema. Accuracy is needed in studying relation of all subjects with pheochromocytoma.
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PMID:[Familial pheochromocytoma: a family studied for 3 generations]. 764 34

Whenever a patient is evaluated as a possible candidate for heart transplantation, potential causes of reversible cardiomyopathy must always be considered. Although rate, it is well-known that pheochromocytoma can result in a dilated cardiomyopathy, which can be partially or completely reversible. We report a case of a 33-year-old woman with heart failure that was caused by a severe dilated cardiomyopathy who was referred for urgent heart transplant evaluation. The diagnosis of bilateral adrenal pheochromocytomas was made, and within 3 weeks of medical therapy, left ventricular systolic dysfunction completely reversed, avoiding the need for heart transplantation. The patient later underwent successful adrenalectomy. Unique features of this case of pheochromocytoma-induced cardiomyopathy include (1) serial norepinephine measurements over 3 weeks documenting the efficacy of medical therapy, (2) unique cutaneous manifestations that resolved with medical therapy, and (3) familial multiple endocrine neoplasia syndrome with medullary carcinoma of the thyroid in three generations of this patient's family.
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PMID:Reversal of severe cardiac systolic dysfunction caused by pheochromocytoma in a heart transplant candidate. 791 46

A woman with a pheochromocytoma crisis initiated by cardiogenic shock showed severely impaired left ventricular contraction at the time of admission. Heart failure was improved rapidly, and an endomyocardial biopsy performed on the 11th day of admission showed findings compatible with "catecholamine cardiomyopathy". Regarding the pathogenesis of short-duration left ventricular dysfunction, catecholamine-induced cardiotoxicity would probably be the initial consideration. However, in this case, after considering the electrocardiogram on admission and a series of left ventriculograms, "myocardial stunning" following diffuse coronary vasospasm induced by catecholamine crisis may have also contributed to the dysfunction.
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PMID:"Myocardial stunning"-like phenomenon during a crisis of pheochromocytoma. 796 19

A case of cardiomyopathy secondary to an unrecognised pheochromocytoma is reported. It was cured by successful outset with congestive cardiac failure with an ejection fraction of 11%. Following medical treatment including a beta-blocker and converting enzyme inhibitors, the situation remained so disturbing that cardiac transplant was envisaged. It was nevertheless decided to first remove the tumour, with mechanical circulatory assistance cover if necessary. Surgical excision proved to be relatively easy. Cardiac failure disappeared clinically within a few days, though a degree of myocardial impairment revealed by paraclinical investigations persisted after ten months. The pathophysiology, beneficial effect of beta-blockers and the SvO2 usefulness blood during the perioperative period are discussed. The prognosis of the cardiomyopathy, considered up to the present to be uncertain, new seems favourable once it is possible to completely excise the tumour.
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PMID:[Cardiac failure caused by cardiomyopathy disclosing pheochromocytoma. Perioperative treatment]. 817 73


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