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

Continuing evaluation of coronary care is necessary to determine its present effectiveness and to establish direction in the effort to decrease mortality after myocardial infarction. Data have been collected on 157 consecutive patients diagnosed as having myocardial infarction who were admitted to the coronary-care unit at St. Joseph's Hospital and Medical Center, Phoenix, Ariz. The hospital is a teaching hospital with a 560-bed capacity. Data sheets were completed on each patient at the time of transfer from the coronary-care unit. The accumulated data were processed by a computer at the end of a 13-month period. The overall mortality for the group was 16.5 per cent. The factors which were found to have a significant effect on mortality were: (1) location of infarction, (2) presence of heart failure, (3) occurrence of cardiogenic shock, (4) age, and (5) the presence of intraventricular conduction defect. In 19 of the 26 deaths after myocardial infarction, the terminal event was associated with congestive heart failure, pulmonary edema, or cardiogenic shock. Three patients died of resistant arrhythmia, four of ventricular rupture. These figures indicate that arrhythmia is not a primary cause of death after myocardial infarction and that attention must also be directed to the early diagnosis and treatment of left ventricular failure if coronary care survival rates are to improve.
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PMID:Continuing evaluation of coronary care. 103 78

The results of aorto-coronary shunting in 36 patients with preinfarction angina and of urgent direct myocardial revascularization in 17 patients with acute myocardial infarction are presented. The surgical mortality comprised 28% in the group of patients with preinfarction angina. Twenty-two patients were followed-up for 8 months to 4 years. Good results were obtained in 9 patients, satisfactory--in 7, unsatisfactory--in 4. One patient died of cardiac insufficiency 1 1/2 year after surgery. The diagnosis of preinfarction angina is a direct indication for urgent coronary angiography and aorto-coronary shunting in case suitable coronary arteries are available for anastomosing. The indications for urgent revascularization of the myocardium in cases of infarction included the inefficacy of drug therapy within 2-3 hours of its onset, an unarrested pulmonary oedema and cardiogenic shock in cases of localized proximal occlusion of the coronaries revealed by elective or urgent coronary angiography. Four patients were operated on in the state of cardiogenic shock (one of them after reversing the state of clinical death), and two patients were operated on with pulmonary oedema. All these patients (with the exception of the one with pulmonary oedema) recovered. Four patients died. The follow-up covered a period of 9 months to 3 years. Good results were obtained in 4 patients, satisfactory--in 3, unsatisfactory--in 4. No late mortality cases were observed. The obtained results permit to analyse the preinfarction angina and acute myocardial infarction from the standpoint of modern coronary surgery.
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PMID:[Preinfarct stenocardia and acute myocardial infarct from the viewpoint of modern coronary surgery]. 108 96

Bilateral electrolytic lesions of the anterior hypothalamus in unrestrained rats resulted in the development, within 2 hours, of arterial hypertension, tachycardia, hyperthermia, and increased locomotor activity, often leading to pulmonary edema and death. Similar lesions in paralyzed, artificially ventilated rats produced comparable changes in arterial blood pressure and body temperature with a similar time course. The arterial hypertension was a consequence of an increase in total peripheral resistance to 15% of control with a reduction in cardiac output to 49% of control. Arterial hypertension, elevated peripheral resistance, and diminished cardiac output were reversed toward normal by alpha-receptor blockade with phentolamine (1 mg/kg, iv). Bilateral adrenalectomy, adrenal demedullation, or adrenal denervation performed prior to lesion placement prevented the development of arterial hypertension and pulmonary edema as well as the changes in peripheral resistance, cardiac output, and body temperature. We conclude that arterial hypertension following lesions of the anterior hypothalamus is due to a neurally mediated increase in peripheral resistance initiated by the release of adrenal medullary catecholamines and that pulmonary edema is due to myocardial failure secondary to the ensuing ventricular overload. Structures originating in or passing through the anterior hypothalamus may exert selective control over the adrenal medulla independent of vasomotor neurons.
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PMID:Fulminating arterial hypertension with pulmonary edema from release of adrenomedullary catecholamines after lesions of the anterior hypothalamus in the rat. 114 97

Three cases of acute myocardial infarction treated with intra-aortic balloon counterpulsation (IABP) are reported. In the first patient cardiogenic shock and pulmonary oedema were the complicating features; the second one had pulmonary oedema refractory to medical treatment. Both patients promptly improved, shock and heart failure having been reverted to clinically satisfactory conditions. Nevertheless the first patient could not be weaned efficiently and died on the sixth admission day. A huge myocardial involvement was found autoptically. The second patient died on the third day mainly because of a haemorrhagic complication. The third patient started the treatment with IABP at the 68th hour because medically unresponsive left heart failure and persisting ECG signs of widespread myocardial ischemia. Improvement of haemodynamic parameters and disappearance of subepicardial lesion were achieved. Eventually this patient was discharged on the usual rehabilitation regimen.
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PMID:[Intra-aortic balloon counterpulsation: first clinical experiences (author's transl)]. 114 66

71 of 840 patients admitted to an intensive care unit (I.C.U.) between 1970 and 1974 because of acute myocardial infarction were aged over 80 years. Age was thus an important determinant of infarction and the death-rate rose steeply with age, the hospital death-rate being 61% in those over 80 but only 8.4% in those under 50 years. The high incidence and severity of haemodynamic complications (pulmonary oedema, generalized heart failure, cardiogenic shock) were the main cause of the high death-rate. Supraventricular arrhythmias (atrial flutter and fibrillation) were frequent. Early treatment in an I.C.U. improved prognosis even in the elderly patient, by control of conduction disturbances and other arrhythmias but also by early recognition and treatment of haemodynamic complications.
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PMID:[Clinical course and prognosis of acute myocardial infarction in the elderly (author's transl)]. 116 88

Thirty-two consecutive preterm infants with birth weights under 1,500 grams and with respiratory distress syndrome (RDS) complicated by a patent ductus arteriosus (PDA) underwent ligation of PDA. The indications for operation were massive left-to-right shunting associated with heart failure (cardiomegaly and pulmonary edema) unresponsive to medical treatment. The clinical manifestations of heart failure were related to the severity of RDS. Infants with mild-to-moderate RDS (21) often recovered and later developed typical findings of PDA (bounding pulses, hyperactive precordium, and murmur). They are now operated upon as soon as respiratory support is required. Infants with severe RDS (11) develop cardiomegaly earlier, and retrograde aortography may show massive left-to-right shunting before the presence of a murmur. Ligation is indicated when blood-gas values deteriorate despite medical treatment. Nineteen (59 per cent) of these extremely preterm infants survived to be discharged and 16 (50 per cent) are developing normally. Three have neurologic impariment. None of the survivors has clinical respiratory disease, and their radiologic findings of bronchopulmonary dysplasia are improving.
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PMID:Improving the results of ligation of patent ductus arteriosus in small preterm infants. 124 41

The observation was conducted in 96 patients with micro-focal myocardial infarction who developed recurrences within the acute or subacute period (up to 2 months). In 47 patients the secondary infarction was of a micro-focal nature, in 49 -- macro-focal. Recurrence of micro-focal infarctions was observed predominantly in aged patients with a long history of angina pectoris who have had repeated myocardial infarctions earlier. Recurrent macro-focal myocardial infarctions were more often noted in younger patients with a brief coronary history, their primary infarction having been of a micro-focal nature. In both groups of patients congestive cardiac insufficiency and pulmonary oedema were often noted. Cardiogenic shock was mainly seen in those with relapses of macro-focal myocardial infarction. Recurrent microfocal myocardial infarction was often characterized by the development of rhythm and conductivity disorders and high mortality rate, especially when the recurrence was of a macro-focal type.
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PMID:[Micro-focal myocardial infarct with a relapsing course]. 127 27

A traumatic transection of the upper descending thoracic aorta, undiagnosed, was complicated on the tenth day by an acute obstruction of the descending thoracic aorta. The upper body hypertension resulted in generalised convulsions and cardiac failure with pulmonary oedema. The lower body ischemia resulted in paraplegia, acute ischemia of the lower limbs, liver failure and anuria. An emergency revascularisation of the lower body was achieved by axillary-bifemoral bypass. The improvement of the clinical status allowed complete repair of the aortic transection two days after the extra-anatomic revascularisation. This case emphasizes the severity of the cases with impaired blood flow to the lower body and the benefit of the extra-anatomic bypass in pathology of the upper descending thoracic aorta when complete repair of the aortic transection is associated with an extremely high risk.
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PMID:[Traumatic rupture of the aortic isthmus revealed by acute obstruction of the descending thoracic aorta]. 128 8

Forty three men and 3 women, with an average age of 59 years (13 to 78 years) underwent aorto-coronary bypass surgery despite severe left ventricular dysfunction (ejection fraction < 35%); 96% of the patients had previous infarction; 60% (N = 28) had unstable angina, 52% (N = 24) had had pulmonary oedema or an episode of congestive cardiac failure. The average ejection fraction was 29 +/- 4%, range 17 to 35%. Thirteen patients had ventricular aneurysms, 4 had grade 3 or 4 mitral regurgitation. The coronary lesions were usually multivessel left main coronary (6), triple vessel disease (27), double vessel disease (12), single vessel disease (1). The average number of bypass grafts per patient was 2.3. The average aorting clamping time was 63 minutes (range 26 to 133 minutes). There were 4 mitral valve replacements, 4 resections of ventricular aneurysms and 1 double procedure (aneurysmectomy and valve replacement). The operative mortality was 2.1% (1 death). During an average follow-up period of 27 months (range 3 to 90 months), there were: 2 recurrent infarctions, 13 episodes of cardiac failure and 8 cardiac deaths (cardiac failure: 5, sudden death: 2, recurrent infarction: 1). Two patients underwent cardiac transplantation. The regression of angina (90% of operated patients were asymptomatic) and the low operative risk, justify aortocoronary bypass surgery despite left ventricular dysfunction in patients with severe symptoms (unstable angina, chronic, invalidating angina). The medium-term results indicate a high risk of cardiac failure which is partially responsible for the secondary mortality rate of 17% at 2 years.
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PMID:[Can patients with severe left ventricular dysfunction be treated by coronary artery bypass surgery?]. 130 Sep 51

In the postoperative period the alterations of blood pressure are the main hemodynamic complications. Hypotension or hypertension may compromise the coronary circulation and increase the metabolic demand of the myocardium. Pulmonary oedema is the most frequent manifestation of heart failure. The aim of its treatment is to increase myocardial contractility and decrease the metabolic demand. Myocardial ischemia is mostly silent and is an important correlate of adverse cardiac outcomes. The treatment of these hemodynamic events starts during the peroperative period by prevention of their risk factors.
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PMID:[Hemodynamic complications during the recovery period after anesthesia]. 130 45


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