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

Cardiac arrhythmias (CA) are a frequent and dangerous complication of respiratory and cardiac failure in patients with chronic obstructive pulmonary disease (COPD). The aim of the study was to investigate the effects of mexiletine on CA in patients with cor pulmonale in a state of cardio-respiratory decompensation. We studied 32 COPD patients with severe airways obstruction; mean VC 2.35 +/- 0.53 litres; FEV1, 0.92 +/- 0.3 litres and respiratory failure, PaO2 = 56 +/- 5 mm Hg, PaCO2 = 47 +/- 9 mm Hg allocated by random numbers to 20 treated and 12 controls. Continuous 24-hour Holter monitoring was performed for 3 consecutive days after admission to the department following routine treatment which consisted of low-flow oxygen, antibiotic, bronchodilators and diuretics. On the first day, the type and frequency of CA were analysed. Then the treated patients were given mexiletine 250 mg i.v. + 200 mg orally followed by 200 mg every 8 h for the next 48 h. Controls continued the routine treatment only. Mexiletine treatment resulted in a highly significant reduction in the mean number of premature ventricular beats from 163 to 28 and 30/24 h, respectively (p less than 0.01). Episodes of ventricular tachycardia were abolished. The mean number of premature supraventricular beats also fell from 85 to 67 and 48/24 h (p less than 0.01). Number of episodes of sinus tachycardia fell from 17 during the first day to 13 and 10 on the 2nd and 3rd days, respectively. In the controls, the frequency and type of CA remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effects of mexiletine on cardiac arrhythmias in patients with cor pulmonale. 263 53

A three-decade examination of the prevalence, incidence, secular trends, and prognosis of cardiac failure in the Framingham Study provides insights into its epidemiology. Annual incidence of CHF is observed to increase from 3 to 1000 at ages 35-64, to 10 per 1000 at ages 65-94. There is a slight male predominance, owing to a higher rate of coronary disease, which conferred a fourfold risk of cardiac failure. Most cardiac failure is on the basis of long-standing hypertension or CHD. Silent infarctions were as predisposing for CHF as symptomatic MIs surviving 1 year. Hypertension is a major predisposing factor that at least triples the CHF risk, the systolic component being more predictive than the diastolic component. Correctable predisposing risk factors for CHF include: elevated blood pressure, impaired glucose tolerance, elevated cholesterol, low HDL-cholesterol, obesity, and a high hematocrit. Risk factors reflecting deteriorating cardiac function also were highly predictive, including: an enlarged heart, poor vital capacity, sinus tachycardia, and ECG-LVH. Commonly encountered ECG abnormalities such as intraventricular block, nonspecific repolarization abnormality, and ECG-LVH are all associated with a substantial risk of CHF. ECG-LVH carries a higher risk than x-ray enlargement. Sudden death was a common feature with CHF, occurring at 5 times the general population rate, even excluding those with overt CHD. Using the standard cardiovascular risk factors (age, systolic blood pressure, cholesterol, glucose, cigarettes, and ECG-LVH) jointly, it is possible to identify one tenth of the population from which 40% of CHF events evolve, in the absence of interim CHD or RHD.
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PMID:Epidemiology and risk profile of cardiac failure. 315 46

An analysis of 41 trials of angina of all varieties confirms that calcium antagonists are an important advance and are now established therapy for these syndromes. In effort angina, verapamil in a dose of 360-480 mg daily is better than propranolol in standard doses. Although nifedipine is highly effective against vasospastic angina, its use in threatened myocardial infarction or severe unstable angina is not supported by recent studies, unless combined with a beta-blocker. Diltiazem has recently been tested with apparent benefit in non-Q-wave myocardial infarction. Otherwise, these calcium antagonist agents all seem to have approximate equipotency in clinical ischemic syndromes including effort and vasospastic angina. Subjective side effects seem most troublesome in the case of nifedipine. All three calcium antagonists, especially nifedipine, have been successfully combined with beta-blocker therapy, yet occasional additive negative inotropic or chronotropic or dromotropic interactions may occur when verapamil or diltiazem is added to beta-blockade, and occasionally the direct negative inotropic potential of nifedipine may become evident. The choice between the calcium antagonists is determined not only by the clinical picture but also by the anticipated side effects in a given patient and by the overall cardiovascular status. In patients with supraventricular tachycardias or sinus tachycardia, verapamil or diltiazem is preferred, whereas in patients with a resting bradycardia or borderline heart failure nifedipine is likely to be chosen.
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PMID:Calcium channel antagonists. Part II: Use and comparative properties of the three prototypical calcium antagonists in ischemic heart disease, including recommendations based on an analysis of 41 trials. 315 77

The purpose of this study was to characterize the heart in patients with Friedreich's ataxia by two-dimensional echocardiography, systolic time intervals, and heart biopsy. Ten patients with Friedreich's ataxia (seven females and three males, age 15 +/- 7 years) were compared with 10 age-matched normal subjects (five males and five females, age 16 +/- 7 years). The mean systolic blood pressure in the patients with Friedreich's ataxia was lower (114 +/- 9 mm Hg) than that in the control subjects (122 +/- 8 mm Hg; p less than 0.05); diastolic blood pressures were the same. The heart rate in the patients with Friedreich's ataxia (102 +/- 17 beats/minute) was greater than that in the control subjects (76 +/- 12 beats/minute; p less than 0.001). The interventricular septal wall thickness was much greater in Friedreich's ataxia (13 +/- 2 versus 8 +/- 1 mm, p less than 0.001) as was the posterior wall thickness (13 +/- 3 versus 8 +/- 1 mm, p less than 0.001). The left ventricular end-diastolic diameter was smaller in Friedreich's ataxia (35 +/- 6 mm versus 47 +/- 6 mm; p less than 0.01), and the fractional change of the left ventricular minor axis with systole was greater in Friedreich's ataxia (40 +/- 9 percent versus 33 +/- 5 percent; p less than 0.05). An 11th patient with Friedreich's ataxia (age 33) had clinical heart failure, but his course was complicated by alcohol abuse. Heart biopsy in three patients with Friedreich's ataxia demonstrated myocyte hypertrophy (21.5 +/- 2.0 microns diameter; normal, 14 to 17 microns) and increased fibrosis (16 +/- 9 percent; normal, less than 5 percent). Thus, heart disease in Friedreich's ataxia is characterized by myocyte hypertrophy, interstitial fibrosis, increased left ventricular wall thickness, decreased left ventricular cavity size, sinus tachycardia, and normal systolic function. Further biochemical analysis of tissues may lead to the link of the neurologic and cardiac diseases and eventually to more effective therapy of this condition.
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PMID:Morphologic and functional characteristics of the heart in Friedreich's ataxia. 379 93

Between June 1979 and June 1984 the authors observed 40 fetal arrhythmias in 11,122 births (0.36%). Initially there were problems of differential diagnosis with cardiotokography and fetal abdominal ECGs. However, these problems were surmounted with real-time sonography, supplemented with split-image echocardiography (M-mode technique) with video recording. In three-quarters of the cases supraventricular and ventricular extrasystoles were found. These forms of arrhythmias were clinically harmless. Follow-up examinations of the children confirmed the favorable long-term prognosis. One-quarter of the arrhythmias were high-risk cases. Supraventricular tachycardias, total AV block, sinus tachycardia and bradycardia, and congenital atrial fibrillation were found. There were five cardiac abnormalities in this group. Heart failure occurred in six fetuses and neonates. Four of ten infants died. Three infants remained in pediatric cardiologic care. In the light of the authors' experience, it is still too early to invest great hope in intrauterine treatment of the fetus. Intrauterine diagnosis at the earliest possible time and intensive cardiologic care, starting immediately after birth, can improve the prognosis in cases with high-risk arrhythmias.
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PMID:[Fetal arrhythmias. Differential diagnosis, clinical significance and prognosis]. 389 45

In rare instances, chronic alcoholism leads to the congestive heart failure which is characteristic of alcoholic beriberi with edema. The affected patients is usually a young man with longstanding alcoholic intoxication and often with neurologic features. Onset is often sudden, with dyspnea on exertion, orthopnea, and palpitations. The clinical sings of cardiac failure are unequivocal. Roentgenography shows cardiomegaly mainly due to enlargement of the right cavities and of the pulmonary artery. ECG shows sinus tachycardia and abnormal repolarisation in the precordium. The cardiac output and the cardiac index are increased, as well as the coronary output. Pyruvic acid levels exceed 15 mg/l, the provoked hyperpyruvicemia test is abnormal, thiamine levels are low, and the tryptophane test is normal. The course is variable. Cardiac beriberi progresses by exacerbation and remissions. Prognosis is poor, with a risk of sudden death. However, with adequate treatment combining rest, a low sodium diet, alcohol withdrawal, diuretics, and vitamin B1 (IV) recovery occurs. Our two observations clearly fit this description.
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PMID:[Congestive heart failure due to chronic alcoholism (author's transl)]. 628 71

The effects of oral digoxin and placebo in 41 geriatric in-patients were compared using a randomized, double-blind, cross-over method. The patients were in sinus rhythm or had atrial fibrillation. The observation period was two months on digoxin or placebo. Patients with symptoms of cardiac failure at rest or during light physical activity, X-ray signs of pulmonary congestion, proven need of digoxin therapy following earlier withdrawal, atrial fibrillation with a ventricular rate greater than 95 beats/min and patients in whom digitalis intoxication was suspected were excluded from the study. Five (14%) of 37 patients deteriorated during the placebo phase. Four of these developed rapid atrial fibrillation and one patient developed sinus tachycardia and symptoms of heart failure.
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PMID:Digoxin and the geriatric in-patient. A randomized trial of digoxin versus placebo. 636 40

The study was made in order to determine the relationship between myocardial infarct size and the incidence of cardiac arrhythmias during acute myocardial infarction (AMI). In 317 consecutively admitted patients infarct size was estimated from serial serum CK-MB measurements. The ECG was continuously monitored during 18 days in hospital, and all electrocardiographic recordings were analysed daily. All patients were followed up one year after discharge. The median infarct size was larger among the 220 patients with arrhythmias than among the 97 patients without (814 Ul-1 vs 419 Ul-1, P less than 0.0001). There was a significant relationship between the estimated infarct size and the following arrhythmias: ventricular ectopic beats, sinus tachycardia, and atrioventricular block, whereas supraventricular ectopic beats showed no such relation. Patients with heart failure, however, had a high incidence of ventricular arrhythmias regardless of the size of their infarcts. The follow-up study demonstrated that the ventricular arrhythmias positively correlated with infarct size were also associated with significantly increased one-year mortality among hospital survivors. Thus, the present study indicates that not only pump failure, but also cardiac arrhythmias are connected with the negative influence of infarct size on prognosis.
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PMID:Myocardial infarct size: correlation with cardiac arrhythmias and sudden death. 647 89

Alinidine is a new sinus node inhibitor which does not interact with the beta adrenergic receptors. Its haemodynamic effects were studied in 57 patients; 24 with unstable angina, 9 with myocardial infarction and heart rate greater than 100 bpm but without heart failure. 10 with myocardial infarction treated with vasodilators and 14 with severe heart failure or shock. After dosages up to 40 mg alinidine, heart rate decreased by 14 +/- 7 bpm, mean arterial pressure was reduced by 3 +/- 6 mmHg, stroke volume remained unchanged while cardiac output decreased 0.5 +/- 0.61 min-1 and systemic vascular resistance increased. Signs of heart failure developed in 3 patients, although overall left ventricular filling pressure remained unchanged. The haemodynamic response to alinidine warrants further studies of its efficacy in patients with angina or sinus tachycardia.
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PMID:Haemodynamic effects of alinidine, a specific sinus node inhibition, in patients with unstable angina or myocardial infarction. 672 92

Hyperthermia is a totally different modality from existing treatment modalities. Systemic hyperthermia (S-HT) is effective against advanced tumors which make resistance to conventional cancer therapies. In S-HT, it is essential and very important to manage cardio-pulmonary function in good condition. Especially, PEEP (about 7 cm H2O) is very effective to prevent lung edema. Fifty-four patients with a variety of neoplasms were subjected to S-HT, alone or in combination with chemotherapy, radiotherapy, and immunotherapy. S-HT was performed under general anesthesia by using extracorporeal circuit in corporating a heat exchanger. Usually, S-HT was given for 4-8 hours with 41.5-42.0 degrees C at 2 weeks intervals. Out of 25 evaluable cases, response was obtained in 11 cases (44%) including 2 cases of complete response. Cardio-pulmonary performance was evaluated using a flow directed pulmonary artery catheter (Swan-Ganz catheter). At treatment temperature, all patients showed hyperdynamic conditions and developed a two-fold mean increase in cardiac index. Altogether 172 treatment sessions were associated with sinus tachycardia and a reduction in diastolic pressures. Laboratory abnormalities included thrombocytopenia without sign of D.I.C., moderate hyperglycemia, mild degree of hypophosphatemia, hypolcalemia and transient elevations in liver enzymes. Serum creatinine levels were elevated in all treatment sessions without elevation of serum BUN. Serum levels of calcium and magnesium were stable. All of abnormalities and toxicities were decreased within 1 to 2 weeks after treatments. It is suggested that with carefully monitored conditions S-HT be performed safely without heart failure.
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PMID:[Clinical practice of systemic hyperthermia therapy and physiological responses of the host]. 687 Feb 90


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