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

Using hemodynamic monitoring by flow-directed heart catheterization in acute myocardial infarction, left ventricular dysfunction can be analyzed and quantified. Differential therapy concerning substitution of volume and administration of drugs with influence on pre- and after-load is facilitated. Since the introduction of the Swan-Ganz flow-directed catheter the monitoring has been technically improved with the additional advantage of lower incidence of catheter-induced arrhythmias and the possibility to measure the pulmonary capillary wedge pressure. The Swan-Ganz thermodilution catheter further improved the technical assessment of cardiac output. Using hemodynamic monitoring during acute myocardial infarction different phases of cardiac failure can be discerned, e.g., backward failure with increased filling pressure, foreward failure with decreased cardiac output, and cardiogenic shock with the combination of both. In some cases a hyperkinetic hemodynamic status is observed. The differential diagnosis of pulmonary embolism, and cardiac and pulmonary shock can be clarified. Complications of myocardial infarction as acute mitral insufficiency due to papillary muscle rupture in inferior myocardial infarction, rupture of the septal myocardium in septal infarction, as well as myocardial rupture with pericardial tamponade show characteristic diagnostic findings. Drug therapy with influence on pre- and after-load and therapy with positive-inotropic agents can be adjusted to the individual hemodynamic status and to the monitored drug effects.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Uses and risks of hemodynamic monitoring by inflow catheter in acute myocardial infarct]. 306 63

There were 37 maternal deaths among the 109,221 livebirths registered during the period 1977-86 in Bahrain, Arabian Gulf. The maternal mortality rate was 33.9/100,000 for the 10-year study period; however, disaggregation reveals a decline in this rate from 42.3/100,000 in 1977-81 to 26.9/100,000 in 1982-86. This decline presumably reflects streamlining of the Ministry of Health's maternity services, including a central maternity hospital with all modern facilities that serves as a referral center for all of Bahrain, 2 peripheral hospitals with provision for blood transfusion and surgical deliveries, and 3 maternity units managed by fully qualified midwives. About 80% of deliveries are covered by these maternity services; only 2.5% of deliveries occur in the home. Despite this highly developed maternity care system, 18 of the maternal deaths were due to direct obstetric cause: hemorrhage, 7; pre-eclampsia and eclampsia, 5; abortion septicemia, 2; bowel perforation during cesarean section, 1; thromboembolism, 2; and amniotic fluid embolism, 1. The causes of the 19 indirect maternal deaths were: pulmonary embolism, 5; infection, 7; cardiac failure, 2; cerebrovascular accident, 2; pulmonary hypertension, 1; and uncertain, 2. Of interest is the finding that sickle cell disease was the underlying cause of maternal death in 12 of the 37 deaths in this series. Sickle cell disease was implicated in 3 of the deaths from hemorrhage, all 5 deaths from pulmonary embolism, 2 deaths from septicemia, and the 2 cases of cardiac failure. In this series, 50% of the patients with sickle cell disease had thromboembolic crises following treatment of anemia with packed cell transfusion. Blood transfusion, especially of packed cells, should be given with caution to these patients since it may precipitate vaso-occlusive crisis by increasing blood viscosity. Since sickle cell disease represents a high risk during pregnancy in this Arab population, such patients should have frequent prenatal check-ups and deliver in a well-equipped hospital.
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PMID:Maternal mortality in Bahrain with special reference to sickle cell disease. 321 81

Locally delimited complications originating from the surgically treated organ were recorded in 7.8 per cent of 7,640 bile duct operations, between 1970 and 1984, while systemic complications accounted for 4.6 per cent. Overall lethality was 0.8 per cent. Inflammatory gall bladder as well as choledochus findings calling for therapeutic action and advanced age together with age-related diseases were factors of relevance to prognosis. Lethality among males was higher with significance than that among females. Postoperative pancreas necrosis, pulmonary embolism, and cardiac failure were predominant causes of death. Target-oriented perioperative antibiotic prophylaxis, broader postoperative use of medicamentous thrombosis prophylaxis, and limitation of papillary dilatation to widths up to 6 mm are considered to be possible approaches to reducing the surgical risk.
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PMID:[Incidence of complications and surgical risk in biliary tract surgery]. 340 48

Forty-one patients, distributed among four centers, had left (33 patients), right (five), or bilateral (three) temporary ventricular assistance with textured (24) or smooth (17) surfaced diaphragm pumps, during an evaluation supported by the National Institutes of Health. Cardiac failure had occurred in 39 postoperative patients (after aorta-coronary bypass [23], valve replacement [four], both [nine], or other [three]), with total cardiopulmonary bypass time mean 306 minutes (range 69 to 600). Two patients had cardiomyopathy. Death of 35 nonsurvivors was due to myocardial necrosis (14), hemorrhage (nine), cerebrovascular accidents (three), infection (three), and other (six). Mean duration of support in all patients was 62 hours. In 16 patients (40%) whose condition improved, cardiac assist duration was mean 127 hours (range 48 to 264), compared with mean 19 hours (range 1 to 120) in 25 who did not. Of 17 patients in whom duration of support exceeded 72 hours, 15 (88%) improved, 11 were weaned, and six survived long term. Tissue examination (in 33 patients) by biopsy at pump implantation or autopsy revealed coagulation or contraction band myocyte necrosis, with or without hemorrhage, in 26 patients; of these, 10 improved and six were long-term survivors. Pump-related complications (two) included pulmonary embolism, most likely related to a cannulation site thrombus, and an aortic cannulation site infection in one patient each. This study suggests that mechanical cardiac assist may be accomplished with a low complication rate; should not necessarily be denied to patients with existing necrosis, because myocardial necrosis does not preclude improvement or survival; and frequently leads to functional myocardial recovery if patients survive early noncardiac complications, often the result of long duration of cardiopulmonary bypass.
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PMID:Clinical temporary ventricular assist. Pathologic findings and their implications in a multi-institutional study of 41 patients. 353 32

The authors describe the cases of 86 black african patients (75 males and 11 females), affected by a congestive primitive cardiomyopathy (CMP), confirmed by echocardiography. Echocardiographic investigation revealed, in all cases, stigmas of a developed CMP: cavitary dilatation, hypokinesia and thinness of walls, offsetting and miniaturization of the valvula mitralis. Pericardial effusion was associated in 20 cases, and thrombosis of left cavities was recognized through bi-dimensional investigation. Angiography and hemodynamics performed in 15 patients pointed out in all cases a significant falling off of the pumping function and the muscular function. Angiography, in 8 cases, displayed a left ventricular cavity distended and hypokinetic, with a moderate mitral incompetency. Evolution was characterized by the following complications: heart failure: 68 cases--systemic thromboembolism: 5 cases--pulmonary embolism: 2 cases--auricular rhythmic irregularity: 20 cases--ventricular rhythmic irregularity: 42 cases--second or third degree atrioventricular blocks: 5 cases. Death rate was 25% (22 patients). Taking into account these 86 cases, the position of the congestive CMP defined among the tropical CMP and its classification studied as well as its echocardiographic and evolutive peculiarities.
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PMID:[Primary congestive cardiomyopathies of the adult in a tropical environment: nosologic, diagnostic and developmental data]. 358 77

Haemodynamic studies were undertaken in 30 patients with chronic post-embolic pulmonary hypertension (CPEPH), and the findings were compared with those found in acute thromboembolism of the pulmonary artery. The study showed that radiocardiographic examination is a useful supplementary method for diagnosing postembolic lesions of pulmonary arteries and for dynamic examination of patients after pulmonary embolism. The appearance of a "single-hump" curve on the radiocardiogram was an unfavourable prognostic sign and attested both to an increase of pulmonary hypertension or to a latent heart failure. The importance of radiocardiographic examination for determining the prognosis of the disease and for choosing the most suitable method of its treatment is analysed.
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PMID:Haemodynamics in patients with chronic post-embolic pulmonary hypertension. 369 6

The authors report a case of right auricular and left intraventricular double thrombus involving the tricuspid valve, diagnosed by two-dimensional echocardiography. This double thrombus developed in a male of 54 years presenting dilated cardiomyopathy with heart failure who was admitted as an emergency case due to cerebral embolism. Surgery and fibrinolytic agents were contraindicated and heparin treatment was initiated. The right auricular mass subsided in 24 hours without symptomatology. Only venous pulmonary digitalized angiography showed a moderate defect. Bearing in mind literature reports, the present observation is particularly interesting on three counts: simultaneous double localization, the fortuitous detection of a right auricular clot before development of pulmonary embolism and the rapid subsidence of the thrombus under heparin treatment as wall as the satisfactory progress without symptomatology of pulmonary embolism.
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PMID:[Left intraventricular and right auricular double thrombus. Apropos of a case with favorable development under medical treatment]. 375 87

Thirteen ambulatory patients with severe congestive heart failure were treated with weekly, outpatient 48-hour infusions of dobutamine. All 13 patients had at least a 25% increase in cardiac output during initial dobutamine titration, with a corresponding improvement in systemic vascular resistance. Improvement in functional class was achieved in only seven patients. Additionally, only three patients survived the 26-week study period. Although no change in ventricular ectopy was noted during the initial dobutamine infusions, six patients experienced sudden death; three other patients died of progressive heart failure and one died from pulmonary embolism. These data suggest that chronic intermittent ambulatory dobutamine infusions are only partly successful in improving symptoms and probably do not prolong survival in patients with severe congestive heart failure. Administration of this form of therapy on a clinical basis should be undertaken cautiously until safety and efficacy are demonstrated in prospective, controlled trials.
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PMID:Intermittent, ambulatory dobutamine infusions in patients with severe congestive heart failure. 376 79

Amrinone is a new positive inotropic agent available in oral and intravenous preparations. Twelve patients with Stage III cardiac failure of ischaemic (6 cases), myocardial (5 cases) or valvular (1 case) origin, were treated with oral amrinone. The protocol included a complete clinical, radiological and biochemical work-up, an exercise stress test, cardiac catheterisation and echocardiography before entering the trial. The patients underwent clinical examination, stress testing and echocardiography at the 4th, 8th and 12th week of treatment with 300 mg daily of amrinone. Two patients had to be withdrawn from the trial because of thrombocytopaenia; one patient deteriorated and eventually died of pulmonary embolism. There was a marked improvement in the 8 patients who achieved the trial, with an average gain of 40 watts on exercise testing, a mean reduction of 16 mm Hg in diastolic pulmonary pressures, and an increase of 11 p. 100 in EF and velocity of circumferential fibre shortening. Four additional patients were given intravenous amrinone (1 cc/kg relayed with an infusion of 1 ng/kg/min). Ventricular end-diastolic pressures fell by 9 mm Hg and cardiac index rose by 1.02 1/min/m2. Tolerance was good with no arrhythmic complications or significant variations in mean arterial pressure or heart rate. Although certain reserves have to be made with regards of tolerance of oral amrinone, the drug would seem to be useful and effective in the intravenous form. Further studies are under way.
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PMID:[Effects of amrinone administered orally and by injection in heart failure]. 389 92

In July 1983, a heart transplant program was initiated. Up to September 1985, 72 orthotopic transplants in 69 patients (62 men, 7 women, age 9 to 55 years, mean 40.1 years) have been performed. All patients suffered from end-stage heart failure, which was due to coronary artery disease in 15 patients, congestive cardiomyopathy in 53 patients and endocardial fibrosis in one woman. All patients survived the operation, but there were 6 deaths within the first 30 postoperative days. Eight more patients died subsequently. Causes of death were rejection in 6, infection in 3, cerebral hemorrhage in 2, sudden death in 2 and pulmonary embolism in one patient. Actuarial survival at one and two years was calculated at 75%. The detection of allograft rejection was the major postoperative problem. This was achieved by serial endomyocardial biopsy and myocardial voltage monitoring via a telemetry pacemaker system. The lowest rate of organ toxicity, rejection and infection was achieved using a triple immunosuppressive regime including Azathioprine, Cyclosporine A and steroids with initial doses of antithymocyte globulin. It is concluded that heart transplantation can be regarded as a routine procedure for patients with intractable heart failure. The operative risk is limited, and an elaborate immunosuppressive regimen makes long-term survival possible without obvious allograft deterioration. Cardiac transplantation should be seriously considered in patients under 55 years, who suffer from life-threatening heart failure not amenable to other modes of therapy.
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PMID:Heart transplantation--a two-year experience. 391 80


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