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

Desensitization of myocardial beta-adrenergic receptors may result both from an impairment of the norepinephrine (NE) neuronal uptake function and from an increase in circulating NE concentrations. The respective role of these two mechanisms of desensitization was examined in 18 patients with congestive heart failure related to an idiopathic dilated cardiomyopathy. The neuronal NE uptake system was evaluated by [123I]metaiodobenzylguanidine (MIBG) scintigraphy. The desensitization level of beta-adrenoceptors was assessed as the net increase in peak positive left ventricular (LV) dP/dt during intracoronary dobutamine infusion. Arterial NE concentrations were determined at baseline. To obtain control values, we performed MIBG scintigraphy and determined baseline NE concentration in 12 normal subjects. Cardiac MIBG uptake was significantly decreased in patients as compared with controls. This decrease was related to the severity of the disease based on hemodynamic indexes. The inotropic response to intracoronary dobutamine infusion of heart failure patients correlated with both increased baseline NE concentration and diminished cardiac MIBG uptake (r = -0.63, p less than 0.01 and r = 0.73, p less than 0.001, respectively). These findings indicate that the desensitization process is related both to impaired neuronal NE uptake function and increased circulating NE concentrations. Moreover, a subset of 11 patients with moderate heart failure was identified who had diminished cardiac MIBG uptake but normal circulating NE concentrations. This suggests that impairment of the NE uptake function is an early mechanism of desensitization in idiopathic cardiomyopathy. Cardiac MIBG imaging may be a noninvasive means to assess severity of heart failure patients and may also be used to evaluate therapy effects on myocardial alterations of the adrenergic pathway.
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PMID:Myocardial beta-adrenergic desensitization and neuronal norepinephrine uptake function in idiopathic dilated cardiomyopathy. 137 74

The use of beta-receptor antagonists in the treatment of heart failure is controversial. Available data do not allow general recommendations regarding their use. In dilated cardiomyopathy, several studies suggest that long-term treatment in individual patients reduces symptoms and increases exercise capacity. Short-term treatment is usually not beneficial, except in patients with ischemically induced left ventricular dysfunction. In heart failure, post myocardial infarction and in chronic ischemic heart disease, no proper long-term study has been performed to evaluate its effects. However, patients with acute myocardial infarction tolerate beta blockers, despite the presence of left ventricular dysfunction and long-term prognosis is improved. Newer agents, some with ancillary properties, such as intrinsic activity and vasodilatation, may have advantages. In the future we need a better description of the cardiac status in our patients in order to be able to select those that will respond favorably to beta-receptor antagonists. The mechanisms by which some patients improve are still obscure. Protection against receptor downregulation, restoration of receptor density, protection against cardiotoxicity of catecholamines, and improvement in ischemic systolic and diastolic left ventricular function are all possible. The fear that beta-receptor antagonists are dangerous in heart failure is in most instances not warranted, but an initial deterioration may have to be accepted in order to gain long-term beneficial effects. Ongoing studies in both idiopathic cardiomyopathy and in postinfarction failure will hopefully help us to define the use of beta-adrenoceptor antagonists in the future.
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PMID:Beta receptor antagonists in the treatment of heart failure. 167 62

Attempts at treating idiopathic cardiomyopathy have been made both clinically and experimentally using the cardiomyopathic Syrian hamster. In recent years, the angiotensin converting enzyme (ACE) inhibitor has attracted considerable attention as an agent to treat heart failure. We administered the ACE inhibitor captopril to the cardiomyopathic hamster. In this study, 15 mg/kg body weight of captopril was administered to the cardiomyopathic hamster J2N at 5 weeks of age for 10 weeks; age matched J2N hamsters were used as non-treated control animals. At the end of captopril administration, blood was collected from the ventral aorta. Serum malondialdehyde (MDA), serum CPK, aldolase and LDH were determined, and myosin isoenzyme patterns of the extirpated myocardium were compared. Additionally, ECGs were compared and the fibrotic ratio of both ventricles determined. Serum MDA, CPK, and aldolase increased significantly in the cardiomyopathic hamster, whereas these indices were significantly inhibited in the hamster treated with captopril. The pathological ECG findings and the ventricular V3 predominant myosin isoenzyme patterns of the J2N were also much improved in the captopril group. However, the improvement in these parameters by enalapril administration was less than that seen with captopril. These results suggested that the effect of captopril is not only due to decrease of the angiotensin II level, but also due to increase in tissue kinin and vasodilatory prostaglandin which play an important role in the beneficial effect of captopril.
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PMID:Protective effect of ACE- and kininase-inhibitor on the onset of cardiomyopathy. 178 64

In a nine-year-old female, cardiac failure was erroneously attributed to idiopathic cardiomyopathy and cardiac transplantation was planned. The actual cause of cardiac failure was permanent junctional reciprocating tachycardia (PJRT), a rare form of supraventricular tachycardia. The diagnostic error was discovered before transplantation was performed and the arrhythmia was treated surgically. This resulted in return of near normal cardiac function.
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PMID:Permanent junctional reciprocating tachycardia misdiagnosed as 'cardiomyopathy'. 187 52

Controversies exist about the functional evaluation of chronic heart failure; aim of this study has been the assessment of the feasibility of the Goldman classification, based on the metabolic cost of various daily physical activities, in a cohort of patients with mild to moderate heart failure, its relation to NYHA class and to the main clinical parameters currently used. We evaluated 114 patients (mean age 61 years) with mild to moderate heart failure due to idiopathic cardiomyopathy (78%), ischemic heart disease (14%) and others (8%). Based on the Goldman classification there were 82 patients (72%) in second and 28 (24%) in third class while 83 (73%) were in NYHA II class and 31 (27%) in NYHA III class. The concordance rate between Goldman second and NYHA II class was 84% and 64% between Goldman third and NYHA III class. The cardiothoracic ratio was statistically different in all 3 Goldman classes while this happened only in NYHA IIM and III versus IIS. Double product and duration of exercise were statistically different in all Goldman classes but only in NYHA II and III class. No relation was observed with ejection fraction on echocardiogram. In the subgroups analysis there was a linear positive relation between duration of exercise versus double product and cardiothoracic ratio versus cardiac volume. We conclude that Goldman class is a feasible method to assess quality of life in chronic heart failure and is more helpful and objective than NYHA class in determining the functional class of the patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The clinical evaluation of the severity of chronic heart failure: a comparison between the NYHA functional class and the Goldman scale]. 207 46

Hypothyroidism and hyperthyroidism are both associated with clinically significant cardiovascular derangements. In hypothyroidism, these include pericardial effusion, heart failure, and the complex interrelationship between hypothyroidism and ischemic heart disease. Cardiovascular disorders associated with hyperthyroidism include atrial tachyarrhythmias, mitral valve dysfunction, and heart failure. Although these usually occur in individuals with intrinsic heart disease, thyroid dysfunction alone rarely causes serious but reversible cardiovascular dysfunction. Patients with commonly encountered cardiac disorders, e.g., idiopathic cardiomyopathy and atrial fibrillation, should be screened for potentially contributing subclinical thyroid diseases. In patients with heart failure and hypothyroidism, initial management should focus on diagnosis and optimal management of any primary cardiac disease, whereas in hyperthyroidism, aggressive measures to control excess thyroid hormone action should generally have the highest priority.
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PMID:Recognition and management of cardiovascular disease related to thyroid dysfunction. 223 96

One hundred thirty-three patients with dilated heart failure, 80 with coronary artery disease, and 53 with idiopathic dilated cardiomyopathy were followed for a mean of 29 months. Patients with ischemic heart disease had a worse prognosis than those classified as having idiopathic cardiomyopathy. Features from history, physical examination, and diagnostic tests done when patients were referred to our clinic were checked for univariate association with survival and were used in Cox model survival analysis to define risk groups. Neither the overall group nor either subgroup showed a relationship between ejection fraction and survival. The best variables for predicting long-term mortality included underlying coronary artery disease, basal systolic blood pressure of less than 120 mm Hg, presence of congestion on chest radiogram, and age over 64. Other variables did not improve risk prediction in the overall group. Among patients with ischemic heart disease, blood pressure, congestion, maximal heart rate on treadmill test, and the presence of left bundle branch block on the initial electrocardiogram all contributed. Only systolic blood pressure and the symptom score were related to survival in idiopathic cardiomyopathy.
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PMID:Prediction of outcome in late-stage cardiomyopathy. 233 Aug 70

The purpose of this study was to investigate, if besides the hypocontractility, which is the main finding in Primary Cardiomyopathy (PDC) there was some other mechanism in the development of heart failure and if this fact could influence in it's prognosis. We studied 13 patients with PDC in the hemodynamic cardiac laboratory from January 1982 to January 1988, these with systemic arterial hypertension. Coronary heart disease, myocarditis, primary valvular lesion, infiltrative disease, nephropathy, congenital heart disease, diabetes and alcoholism, were excluded. The control group was formed by 12 healthy subjects, which were studied for another purpose. We analyzed nine variables, including ejection fraction, peripheral vascular resistance, systolic and diastolic circumferential stress, left ventricular mass, left ventricular end diastolic and systolic volumes as well as force-velocity and force-fiber length relationship. The patients were followed up from 8 to 60 months (average 39 months). The cases with PDC were divided in two groups, "compensated" and "decompensated". The last ones with low ejection fraction and significantly increases systolic stress. We investigated which was the mechanism of compensation and decompensation through the force-velocity and force-fiber length relation. We found that compensation is associated with great increase of the after-load forces, the more end systolic volume at the end of the systole is not only controlled by the "force", but the decompensation is developed when the hypocontractility is added to the incompetence to compensate the after load. We found that the three deaths in this study had these hemodynamic characteristics, being the cause of death: the presence of heart failure in two patients and ventricular fibrillation in one.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prognostic indexes in primary dilated cardiomyopathy]. 234 26

Lack of donor availability has heightened our awareness of the need for suitable long-term management of heart failure in patients awaiting heart transplantation. Frequently patients become dependent on intravenous inotropic agents despite attempts to discontinue these agents. This can lead to prolonged hospitalizations, separation anxiety and depression in families, high hospitalization costs, and poor quality of life. Between June 1987 and April 1988 three patients awaiting heart transplantation at the University of Cincinnati Hospital were sent home while receiving constant intravenous infusion of dobutamine. All three patients had had prolonged hospitalizations and were unable to be weaned from dobutamine without clinical compromise. The patients were New York Heart Association functional class III to IV, had cardiac indices between 1.5 to 2.13 L/min/m2, cardiac output less than 4.0 L/min, pulmonary capillary wedge pressures 17 to 27 mm Hg, and left ventricular ejection fraction less than 20% in two of the patients (idiopathic cardiomyopathy), and 30% in the third patient who was awaiting retransplantation (refractory repeated acute rejections). Dobutamine was infused by means of a constant-rate portable cassette pump at 3.17 micrograms/kg/min in patient 1, 10 micrograms/kg/min in patient 2, and 5 micrograms/kg/min in patient 3. A critical care home health nursing agency was used for follow-up home care. All three patients had central lines placed before discharge from the hospital. Each patient was instructed in proper care of the central line and infusion pump and was able to demonstrate accurate technique before being discharged home. Complications were minimal and were related to central line placement. No patient required rehospitalization for complications. No wound infections were reported.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Home intravenous dobutamine therapy in patients awaiting heart transplantation. 235 73

Since our initial orthotopic heart transplant (OHT) in 1968, the first in Europe, 1130 patients with ages ranging from 1 month to 66 years have been referred to us. The cause of irreversible myocardial damage was idiopathic cardiomyopathy in 74%, ischemic heart disease in 19% and left ventricular failure after valvular replacement in 7%. A total of 540 transplantations, 463 orthotopic, 40 heterotopic and 37 heart-lungs were carried out. Features of the early post-operative course include temporary (first week) cardiac instability treated by isoproterenol. Later complications included rejection (95%) and side-effects of immunosuppressive therapy; infection (83%), osteoporosis, malignancy, graft atherosclerosis (2%). Cyclosporine (Cy) was responsible for diastolic hypertension, renal dysfunction, hirsutism, hyperplasia of the gingiva, hepatic dysfunction, and seizures. The survival rate of the Cy-treated patients was 68% at 7 years. All survivors have virtually normal social and professional lives, included the longest survivor 14 years after the operation. Recently in 34 patients in acute irreversible cardiac failure and who cannot have a transplant in time, we implant a total artificial heart (TAH) type JARVIK 7 during a period from 1-150 days. There has been no mechanical failure, hemolysis or thrombo-embolism and only one right ventricular device malposition; 20 patients died before transplantation, 13 were successfully transplanted, 1 is still on the artificial heart. Heart transplantation, and TAH used as a bridge to transplantation are now an accepted therapeutic means for irreversibly cardiac failure in selected patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Current problems in cardiac transplantation. 266 Sep 20


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