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

The use of colloids in hypo-oncotic individuals to increase plasma volume has been shown to have distinct and consistent advantages compared with the use of crystalloid fluids. Colloids increase plasma colloid oncotic pressure, whereas crystalloids decrease it, an effect that can be extremely detrimental in individuals with low basal plasma colloid oncotic pressure. Increasing plasma volume in hypo-oncotic individuals without inducing large increases in interstitial water content is difficult when crystalloid fluids are used. However, colloids have much better plasma volume expansion ability without the induction of concurrent increases in interstitial water content, even in hypooncotic individuals. Review of the literature indicates that hetastarch is an extremely safe colloid for acute and long-term use in humans and dogs. Its excellent safety record probably is attributable to its structural analogy to the natural compound glycogen. The lack of availability of a substance analogous to human 5% serum albumin and the scarcity of plasma in veterinary medicine leaves hetastarch as the safest option of available colloids. Its ability to increase plasma volume and colloid oncotic pressure is equal to or better than dextran 70 and 5% albumin and is clearly better than plasma or whole blood. Increases in plasma volume and colloid oncotic pressure usually last approximately 48 hours after a single injection, but the duration of increases significantly after multiple infusions. Contraindications to its use include heart failure and oliguric renal failure, because of its excellent ability to increase plasma volume, and the presence of von Willebrand's disease, because of its ability to significantly lower all components of Factor VIII-related complex in humans.
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PMID:The use of hetastarch for plasma expansion. 128 53

The present study was designed to investigate the effect of the calcium-channel antagonist gallopamil on myocardial ischemia during percutaneous transluminal coronary angioplasty (PTCA). Twenty-four adult patients with coronary artery disease and significant proximal stenosis of the left anterior descending coronary artery (LAD) were randomly assigned to receive gallopamil or placebo under double-blind conditions. Patients with recent myocardial infarction, apparent collateralization of the LAD, myocardial failure, sinoatrial or atrioventricular block, severe hepatic disease, or renal failure were excluded from the study. PTCA was performed with use of at least two balloon inflations, each of 2 min in duration. Gallopamil (0.4 mg) or placebo (0.9% sodium chloride) was administered during the 10-min interval between the two inflations. For determination of myocardial lactate and hypoxanthine release, blood samples were taken simultaneously from the great cardiac vein and the femoral artery before and immediately after each inflation. Electrocardiogram changes were analyzed by measuring ST-segment deviations (80 ms after the J point) and maximal T-wave deviations of the leads I, II, III, and V2, V4, and V6. The most sensitive leads for identification of myocardial ischemia in the LAD area were V2 and V4. If compared to the first balloon inflation, the degree of ST-segment/T-wave changes induced by the second inflation was significantly reduced only in the presence of gallopamil. Furthermore, if compared to placebo, ischemia-induced lactate and hypoxanthine release was decreased in the presence of gallopamil. These results suggest that intracoronary application of gallopamil attenuates myocardial ischemia during PTCA.
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PMID:Intracoronary gallopamil during percutaneous transluminal coronary angioplasty. 128 55

Angiotensin-converting enzyme (ACE) inhibitors act by lowering the level of angiotensin II. The therapeutic benefits of these drugs and their potential side-effects therefore result from suppression of the physiological effects of angiotensin II. It is rational to prescribe an ACE inhibitor when the renin-angiotensin system is activated, as in renin-dependent essential hypertension, malignant hypertension and hypertension associated with heart failure. The beneficial effects of ACE inhibitor must be weighed against the special risks of renovascular hypertension: risk of renal artery thrombosis in case of unilateral stenosis and risk of renal failure if the stenosis is bilateral or affects a solitary kidney. In some situations the renin-angiotensin system is not directly involved in hypertension but may play a local haemodynamic role, as in some cases of primary or diabetic nephropathy. In such case the ACE inhibitors are thought to exert a protective effect. ACE inhibitors were reputed to be less effective in the elderly than in younger patients, but we now know that they can be prescribed with equal success in both instances to reduce peripheral resistance and improve regional blood flow as well as arterial compliance. Finally, ACE inhibitors can be prescribed, albeit with limited effectiveness, when the renin-angiotensin system is not activated, as in low renin hypertension and idiopathic hyperaldosteronism due to adrenal hyperplasia. They are ineffective in case of Conn's adenoma and contra-indicated in pregnant women.
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PMID:[For which hypertensive patient should angiotensin-converting enzyme inhibitor be prescribed or forbidden?]. 129 38

Treatment with angiotensin-converting enzyme (ACE) inhibitors can begin at any time when a left ventricular dysfunction has been diagnosed. In the absence of rare contra-indications (renal artery stenosis, connective tissue disease, severe renal failure), all patients with asymptomatic or, a fortiori, symptomatic chronic heart failure can benefit from ACE inhibitors, whatever the origin of the heart failure. Among the ACE inhibitors now available, the benefits of captopril (3 daily doses) and of enalapril (2 daily doses) on all the targets of cardiac failure treatment are now well established. The effects of lisinopril on mortality are not yet known, but the haemodynamic and symptomatic benefits of this drug are also well established (with the advantage of once daily administration). Other ACE inhibitors with less numerous and less convincing trial reports can be used or rejected depending on the physician's faith in the effects of this pharmaceutical class. With all ACE inhibitors the initial dose must be very low, to be gradually increased over several days or even weeks until the highest dose tolerated is reached. ACE inhibitors can be associated with the classical treatment of cardiac failure. A previous diuretic treatment with sodium depletion may increase the risks of first dose effect and renal intolerance due to the introduction of the ACE inhibitors. Theoretically, the combination of ACE inhibitors and spironolactone is to be avoided for fear of hyperkalaemia and renal deterioration. Yet, provided some precautions are taken this combination may improve the benefits of ACE inhibition when the renin-angiotensin-aldosterone system inhibition is not optimal. However, this has yet to be demonstrated by prospective clinical trials.
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PMID:[Management of the treatment with converting enzyme inhibitors in chronic heart failure]. 129 41

The natriuretic peptide system consists of at least three endogenous ligands: atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP) and C-type natriuretic peptide (CNP), and three receptors, ANP-A receptor (guanylate cyclase A), ANP-B receptor (guanylate cyclase B) and clearance receptor (C receptor). ANP, the prototype of natriuretic peptides, is mainly produced in the atrium and secreted into the circulation as a cardiac hormone. ANP is also produced in the ventricle and in the central nervous system. BNP, first isolated from the porcine brain, has a marked divergence in its molecular size and sequence among species. In humans and rats, the major site of production of BNP is the ventricle of the heart. BNP is also secreted into the circulation as a cardiac hormone. The plasma BNP level in normal subjects is approximately one sixths of the plasma ANP level; however, the plasma BNP level markedly increases in heart failure, renal failure and hypertension and the augmentation of the BNP secretion is much larger than that of the ANP secretion. In addition, clearance of BNP from the circulation is slower than that of ANP. Furthermore, BNP is secreted more urgently than ANP in acute heart failure. CNP distributes mainly in the central nervous system and pituitary gland. No significant amount of CNP is detectable in the heart and plasma. Thus, CNP is a local regulator rather than a cardiac hormone. Three natriuretic receptors have ligand selectivity.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Natriuretic peptide family]. 134 67

A 68-year-old man presented with renal failure, heart failure, gastrointestinal bleeding, and a pulmonary infiltrate. Serologic evaluation revealed a perinuclear antineutrophil cytoplasmic antibody (ANCA) at a titer of 1:1280, which on immunoblot and enzyme immunoassay showed antimyeloperoxidase specificity. Autopsy showed microscopic polyarteritis based on the presence of necrotizing alveolitis and crescentic glomerulonephritis. The extent and activity of the glomerular disease was modified by a right renal artery stenosis (RAS). Twenty percent of glomeruli on the right and 82% glomeruli on the left contained crescentic lesions. Furthermore, predominantly active lesions were associated with renal artery stenosis, while the contralateral kidney contained mostly organized crescents. This observation suggests that hemodynamic factors or its sequelae can influence the onset and severity of ANCA-associated disease.
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PMID:Renal artery stenosis modifies glomerular injury in antineutrophil cytoplasmic antibody-associated disease. 135 84

Continuous ambulatory peritoneal dialysis (CAPD) was selected and introduced as a primary dialysis method in two infants with cardiac failure. CAPD was started at 14 days after birth with body weight of 2125 gm and at 7 months of age with body weight of 2325 gm. In both cases, cardiac failure was due to large ventricular septal defect (VSD) and renal failure was due to dysplastic kidneys. In the first case (case 1), direct closure of atrial septal defect and patch closure of VSD were successfully completed at 9.5 months of age with body weight of 4844 gm. CAPD has been managed well for 1 year and 8 months and the child reached a body weight of 8440 gm. In the second case (case 2), CAPD was managed well for 11 months with body weight increasing to 4920 gm at the age of 1 year and 7 months. This marked deterioration of this boy's physical growth was mainly caused by the delay in introducing CAPD and partly due to his cardiac dysfunction which has not been corrected surgically. Both cases show almost normal mental development and are managed well at home. Although CAPD introduction yielded water balance and physical growth in these infants, earlier introduction of CAPD may result in better clinical outcomes including management following open heart surgery. Selection of CAPD as a primary dialysis maneuver is strongly recommended for uremic infants with cardiac failure.
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PMID:Successful management of CAPD in infants with cardiac failure. 136 40

One to ten years after laser coagulation for diabetic retinopathy, 229 type I diabetics (mean age 44.3 years) and 157 type II diabetics (mean age 65 years) were re-studied for morbidity and mortality (progression of late damage, duration of survival, cause of death). The duration of diabetes at the first laser coagulation averaged 23.1 years for type I diabetics (15.9 years for type II). Average period from the first laser coagulation to the re-examination was 6.5 years for type I, 5.1 for type II diabetics. Of those patients still alive 6.7% had gone blind (type II: 7.3%). 2.1% and 4.6%, respectively, were receiving dialysis treatment, while renal transplantation had been performed in 3.1 and 1.8%, respectively. Stroke was the most frequent macrovascular complications (8.4 and 16.5%), followed by leg amputation (3.6 and 14.7%) and myocardial infarction (3.7 and 18.3%). 83 patients had died: 35 (15.3%) type I and 48 (30.6%) type II diabetics. Causes of death were septicaemia 14.3% (0%), uraemia 11.4% (8.3%), myocardial infarction 14.3% (33.3%), heart failure 8.6% (29.2%) and stroke 5.7% (6.3%). 10.7% (24.2%) had died within the first 5 years after laser coagulation. Despite a lower incidence of blindness in patients with diabetic retinopathy, the vascular disease progresses in other vascular regions so that a large proportion of diabetics will develop renal failure or die early from macrovascular complications.
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PMID:[Morbidity and mortality in type 1 and type 2 diabetes mellitus after the diagnosis of diabetic retinopathy]. 142 83

Secondary amyloidosis is an important complication that may have a strong influence on the prognosis of patients with rheumatoid arthritis (RA). We studied 21 RA patients with secondary amyloidosis. The two major initial signs were gastrointestinal symptoms and renal involvement. When 15 of the 21 patients were diagnosed as having secondary amyloidosis, they displayed renal involvement including proteinuria, hematuria and hypercreatininemia. The 15 patients with amyloidosis were either subjected to dialysis or died within 35 months on the average. The causes of death in 13 patients were cardiac failure, gastrointestinal bleeding and infection, which were strongly implicated with renal failure. Dialysis was applied to seven patients. Three of them were maintained with chronic dialysis. We discussed the induction-time and the method of dialysis in patients with amyloidosis secondary to RA.
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PMID:[Clinical characteristics and prognosis of secondary amyloidosis in patients with rheumatoid arthritis--renal involvement and therapy]. 144 80

Sixty-three patients (aged from 4 to 75 years) who had suffered severe head injury or cerebrovascular disease were placed on barbiturate regimens in which intravenous administration was given in amounts of 1-4 mg/kg/hr. Dobutamine and dopamine were also administered to prevent cardiac failure and renal failure. Immediate and delayed complications caused by barbiturate therapy were investigated and analyzed. Immediate complications included tachycardia which was seen in 16 cases (25%), and hypotension in 14 cases (22%), respectively. Higher incidence of those complications was noted among the patients who underwent surgery. Delayed complications included hypokalemia (41 cases, 65%), liver dysfunction hypernatremia (24 cases, 38%), infection (21 cases, 33%), cardiac failure (8 cases, 13%) and renal failure (1 case, 2%), respectively. Therefore, in patients treated under barbiturate regimens great care should be taken in order to avoid above mentioned complications.
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PMID:[Problems in general management during barbiturate therapy]. 148 90


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