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

Anthracycline derivatives may produce early or late cardiotoxic reactions in man. Early effects include: (a) pericarditis-myocarditis which can affect patients with no previous history of cardiac disease and which carries a high mortality rate ( approximately 20%); (b) left ventricular dysfunction which may lead to clinically significant heart failure in patients with limited cardiac reserve; and (c) arrhythmias, the most common of which is sinus tachycardia. Symptomatic supraventriclar tachycardia, heart block, and ventricular arrhythmias can occur, however, and may reflect primary effects on cardiac muscle or the conduction system. Late effects of anthracyclines are directly related to the degree of associated myocyte damage and include subclinical left ventricular dysfunction and overt heart failure. The implications for prognosis and further treatment are discussed for each of these entities and a common pathogenetic mechanism is proposed.
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PMID:Clinical spectrum of anthracycline antibiotic cardiotoxicity. 66 61

Data are presented on 282 patients who began taking prazosin before March, 1975, and whose progress was followed until March, 1976. The following conclusions can be drawn. (i) Prazosin is an effective and useful antihypertensive agent, best used with a diuretic and a beta-blocker. (ii) For patients with suspected or definite coronary artery disease, prazosin should not be used without a beta-blocker. (iii) In patients suspected of having incipient heart failure, prazosin should not be used without a diuretic, and the latter should be given first. (iv) many patients have little or no rise in heart rate with prazosin. However, patients with sinus tachycardia or a history of arrhythmias should preferably not be treated with prazosin. (v) The initial dose should be kept small (0-25 to 0-5 mg). Subsequent increments should also be small, not more than 2 mg/day. (vi) If prazosin is added to a regimen containing an adrenergic neurone-blocking drug, the dose of the latter should first be reduced. (vii) Prazosin should not, in the meantime, be used concomitantly with a phenothiazine, as the combination appears to be capable of causing agitation and confusion. (viii) There seems to be no long-term toxicity.
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PMID:Initial experience with prazosin in New Zealand. A multicentre report. New Zealand Hypertension Study Group. 91 29

A follow-up study was made of 29 patients aged 21 to 45 years, some 15-158 months after acute myopericarditis. The mean follow-up period was 72.9 months. The follow-up investigation included recording of history, physical examination, laboratory tests, radiologic examination of the heart and lungs and electrocardiography. All but one of the patients were fit for fulltime work. Nine had residual cardiac symptoms, but the physical examination was negative in all but 2 of them. One patient had chronic cardiac insufficiency and hepatic enlargement. Another had sinus tachycardia and cardiac enlargement of moderate degree and impaired working capacity in relation to heart size. Cardiac murmurs without clinical significance were audible in three cases. The resting ECG was pathologic in only 6 cases. Orthostatic ECG evoked ECG abnormalities in 6 more cases. Exercise tolerance tests showed reduced working capacity in relation to heart volume in 5 of the 29 cases (17%). Four of these 5 patients had cardiac enlargement. There was thus good correlation between increase in heart volume and reduction of physical capacity. The prognosis in regard to cardiac function was good, as was also found in other comparable series in which the observation time was somewhat shorter.
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PMID:Acute myopericarditis. A long-term follow-up study. 101 66

Rhythm and conductive disturbances were established in 170 (63,8%) out of 266 patients with fresh cardiac infarction, in the greatest part with prophylactically applied lidocain i.m. With age advancing a growth in their incidence is established but no statistical difference between the age groups 20-59 and 60-90 was found. Rhythm disturbances are found more frequently in women (81,6%) as compared with the men 58,7%) while the incidence in patients with posterior (62, 5%) and anterior (65, 7%) infarction is the same. Th-disturbances due to electrical instability and failure are more frequent in anterior infarction. Statistical difference (P less than 0,001) was established concerning the rhythm disturbances in patients with heart failure and without it, with a prevalence of sinus tachycardia, auricular fibrillation, ventricular extrasystoles, ventricular tachycardia and bundle branch block. The timely diagnosis and the treatment with medicaments led to the restoration of sinus rhythml in 79 out of 94 disturbances and with electrical shock in 12 out of 16. Parallelly with the classica netirhythm medicines (chinidine and procainamid), newer ones are used as tachmalin, lidocaine, abta-blockers, sympaticomimetics and temporary intracardial electric stimulation.
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PMID:[Rhythmic and conductive disorders in the acute stage of cardiac infarct]. 122 73

Cardiac involvement in 75 cases (mean age 21.1 +/- 6 years) with non-specific aorto-arteritis was studied. Detailed clinical examination, echocardiography and cardiac catheterization, including angiography, were done in all the cases, as was coronary angiography. Features of cardiac failure like sinus tachycardia, cardiomegaly, left ventricular third heart sound gallop and pulmonary congestion were detected in 27 cases with reduction of left ventricular ejection fraction (25-48%). Systemic hypertension was seen in 60 cases. Central aortic pressure, left ventricular systolic pressure and left ventricular end-diastolic pressure were increased in 66 cases. Pulmonary hypertension and increased pulmonary vascular resistance were detected in 6 cases. Aortic and mitral regurgitation were seen in 15 and 12 cases, respectively. Three patients had features of dilated cardiomyopathy such as generalized cardiomegaly, systemic and pulmonary congestion but without any cardiac murmurs and with normal central aortic pressure. The coronary angiogram revealed obstruction of the left anterior descending artery in 3 cases and right coronary artery obstruction in another 3 cases. Histopathological studies revealed non-specific inflammatory changes with fibrosis in cardiac musculature and the great vessels.
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PMID:Cardiac involvement in non-specific aorto-arteritis. 134 27

Activation of the adrenergic nervous system appears to play a crucial role in the genesis of fatal arrhythmias associated with the very early stages of acute myocardial infarction. The second messenger of beta-adrenergic catecholamine stimulation, cyclic adenosine monophosphate (AMP), has established arrhythmogenic qualities, acting by an increase in cytosolic calcium, which potentially has three adverse electrophysiologic effects. First, stimulation of the transient inward current by excess oscillations of cytosolic calcium can invoke delayed afterdepolarizations, so that triggered automaticity can develop in otherwise quiescent ventricular muscle. Second, cyclic AMP can evoke calcium-dependent slow responses in depolarized fibers, so that conditions for reentry are favored. Third, excess cytosolic calcium can cause intercellular uncoupling with conduction slowing. Focal changes in cyclic AMP and cytosolic calcium promote the development of ventricular fibrillation. Beta-adrenergic blockade can limit the formation of cyclic AMP in ischemic tissue. Furthermore, by reducing sinus tachycardia it can lessen cytosolic calcium overload. Hence, beta-adrenergic blockade helps to prevent ventricular fibrillation in the early stages of acute myocardial infarction and protects from sudden death in the postinfarction phase. In congestive heart failure, abnormalities of cytosolic calcium patterns exist with cytosolic calcium overload. It is proposed that the adverse effects of phosphodiesterase inhibitors on the mortality rate in patients with congestive heart failure can be explained by increased rates of formation of cyclic AMP and the development of calcium-dependent arrhythmias. Because calcium is the ultimate messenger of cyclic AMP-induced arrhythmias and because cytosolic calcium is increased in heart failure, it will be difficult to develop positive inotropic agents that are free of the risk of sudden death.
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PMID:Potential arrhythmogenic role of cyclic adenosine monophosphate (AMP) and cytosolic calcium overload: implications for prophylactic effects of beta-blockers in myocardial infarction and proarrhythmic effects of phosphodiesterase inhibitors. 135 May 97

The authors investigated the effect of intravenous nitroglycerin and trimepranol on the haemodynamics of patients with acute myocardial infarction. They found that nitroglycerin has a favourable effect on haemodynamics as it leads to a reduction of the pressure in the wedged pulmonary artery and to a reduction of oxygen requirement of the cardiac muscle, while the changes of the minute volume and pulse rate are insignificant. Trimepranol leads to a rise of pressure in the wedged pulmonary artery, sometimes to critical values, and to a decline of the cardiac minute output. The authors conclude that trimepranol is suitable for a selected group of patients with sinus tachycardia and without signs of cardiac failure while the pulmonary pressure is carefully monitored. Nitroglycerin can be administered to the majority of patients with acute myocardial infarction. To ensure safe administration it is sufficient to monitor the heart rate and in particular the systemic pressure. It is best to administer it to patients with extensive myocardial infarctions with a high filling pressure of the left ventricle.
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PMID:[Hemodynamic effects of nitroglycerin and trimepranol in acute myocardial infarct]. 135 22

Heart rate changes during the immediate postoperative period were studied in 190 patients that underwent revascularization surgery. At the same time, other cardiovascular complications in those patients were analyzed. In 89 patients (46.8%), cardiovascular antecedents were found. Ischemic heart disease was found in 84 patients (44.2%). The most common cardiac arrhythmia was found to be sinus tachycardia, which was seen in 87 patients (45.7%). Following in order of frequency were supraventricular extrasystoles together with ventricular extrasystoles in 18 patients (9.4%) and isolated ventricular extrasystoles in 16 (8.4%). The most common cardiovascular and hemodynamic complications, both associated and as predisposing causes, were high blood pressure in isolation or combined with heart failure found in 58 (30.5%) and 8 (4.3%) patients, respectively. Hypokalemia played an important role since it was found in 105 patients (55.3%), 90 of whom had cardiac arrhythmia (85.7%). Seven revascularized patients (3.7%) died due to cardiovascular causes.
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PMID:[Disorders of the heart rhythm in the immediate postoperative period in patients who have undergone vascular surgery]. 184 20

Analysis of 34 years of follow-up of Framingham Study data provides clinically relevant insights into the prevalence, incidence, secular trends, prognosis, and modifiable risk factors for the occurrence of heart failure in a general population sample. Heart failure was found to be highly prevalent, affecting about 1% of persons in their 50s and rising progressively with age to afflict 10% of persons in their 80s. The annual incidence also increased with age, from about 0.2% in persons 45 to 54 years, to 4.0% in men 85 to 94 years, with the incidence approximately doubling with each decade of age. Women lagged slightly behind men in incidence at all ages. Male predominance was because of a higher rate of coronary heart disease, which confers a fourfold increased risk of heart failure. Heart failure, once manifest, was highly lethal, with 37% of men and 33% of women dying within 2 years of diagnosis. The 6-year mortality rate was 82% for men and 67% for women, which corresponded to a death rate fourfold to eightfold greater than that of the general population of the same age. Sudden death was a common mode of exitus and accounted for 28% of the cardiovascular deaths in men and 14% in women with heart failure. Hypertension and coronary disease were the predominant causes for heart failure and accounted for more than 80% of all clinical events. Factors reflecting deteriorating cardiac function were associated with a substantial increase in risk of overt heart failure. These include low vital capacity, sinus tachycardia, and ECG evidence of left ventricular hypertrophy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Epidemiology of heart failure. 200 Jul 73

A 57-year-old man was given 40 mg of activated carbon aclacinomycin (ACM) emulsion into mesenteric lymph nodes during anesthesia with enflurane, nitrous oxide, oxygen and epidural anesthesia. He had no complications preoperatively. Immediately after the injection, his skin turned to red, and 5 minutes later, sinus tachycardia, R wave amplitude reduction, T wave amplitude elevation, QT prolongation and PVCs were noted, and then, ventricular fibrillation (Vf) occurred 15 minutes after the injection. We succeeded in electrical defibrillation within about 180 seconds. At that time, both arterial blood gas and electrocytes were normal. Serum ACM concentration was remarkably elevated 60 minutes after the administration, and remained high 22 hrs later. Postoperative course was uneventful and he was discharged on the 17th postoperative day. It has been said that ACM has relatively low cardiotoxicity compared with adriamycin because of rapid distribution and metabolism. However, it might cause cardiac complication such as ECG abnormality, heart failure, pericarditis, though the effects are transient and reversible. Therefore we should be ready for its rapid treatment. Coenzyme Q10 could counteract cardiotoxicity of ACM.
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PMID:[Ventricular fibrillation after administration of aclacinomycin emulsion into mesenteric lymph nodes in a patient anesthetized with enflurane, nitrous oxide and oxygen]. 238 61


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