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

Inappropriate implantable cardioverter-defibrillator (ICD) shocks continue to be a major source of distress to patients and a drain on the health care system. Expanding indications for ICD implantation include a large portion of patients with heart failure. This study investigated the relation between inappropriate ICD shocks and the severity of heart failure symptoms. Predictors of the time to first inappropriate ICD therapy were investigated in 230 consecutive patients implanted in 2001 and 2002. Thirty-two patients received 42 inappropriate shocks during a median follow-up of 501 days. Inappropriate shocks were due to atrial fibrillation (AF) or tachycardia (n = 31), other supraventricular tachycardias (n= 6), sinus tachycardia (n = 3), and noise or double counting (n = 2). The time to first inappropriate ICD shock was earliest in patients with advanced classes of heart failure (1- and 2-year shock-free survival of 79% and 70% for patients in New York Heart Association [NYHA] class III or IV vs 92% and 88% for patients in NYHA class I or II, respectively, p = 0.02). After correcting for age, gender, the presence of coronary artery disease, the presence of AF, the use of beta blockers, and indication for ICD implantation in a Cox regression model, advanced heart failure (NYHA class III or IV) remained an independent predictor of first inappropriate ICD shocks (hazard ratio 2.7, p = 0.01). Other predictors of the time to first inappropriate ICD shock included the presence of AF as the baseline rhythm at the time of the ICD implantation and the absence of coronary disease. In conclusion, inappropriate ICD shocks are predominantly due to AF. Advanced heart failure is an independent predictor of the time to first inappropriate ICD shocks. The effect of ICD programming and antiarrhythmic drug therapy on the incidence of inappropriate shocks deserves further investigation.
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PMID:Relation of advanced heart failure symptoms to risk of inappropriate defibrillator shocks. 1646 Oct 53

Thyroid hormone metabolic disarray has been identified as a risk factor for the progression of heart disease and the development of heart failure (HF). Both hyper- and hypothyroidism have been associated with a failing myocardium. Poor cardiac contractility and low cardiac output due to hyperthyroidism is a rare occurrence and is mostly seen in patients with preexisting heart disease. Referred to as a "rate related" phenomenon, hyperthyroid-induced sustained sinus tachycardia or atrial fibrillation may further reduce ventricular contractility. Increasingly, the hypothyroid state, and in particular a low triiodothyronine level, has been associated with a reduced cardiac performance and poor prognosis in HF, even in the presence of normal thyroid-stimulating hormone levels. Low thyroid hormone levels alter cardiac gene expression and increase systemic vascular resistance, both resulting in a reduction of cardiac contractility and cardiac output. This review summarizes current data on thyroid dysfunction and HF as well as the emerging implications of the "low triiodothyronine state."
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PMID:Thyroid hormone and heart failure. 1691 3

Clinical myocarditis is uncommon in infants and children. The most common pathogen is Coxsackievirus B. The offending agent triggers an immune response, which results in myocardial edema with subsequent impairment of systolic and diastolic function. Newborns and infants are more severely affected because the immature myocardium has limited ways of adapting to an acute insult. Children typically present with sinus tachycardia and gallop on auscultation, cardiomegaly on chest x-ray and small voltages on electrocardiogram. The echocardiogram shows reduced ventricular function. Viral studies can isolate the pathogen. Myocardial biopsy is useful diagnostically, but carries a significant risk for the sick infant. The first line of treatment includes measures such as rest, oxygen and diuretics. Inotropic agents are useful in moderate to severe heart failure. The role of immunosuppressive therapy is not yet clearly established in the paediatric age group. Prognosis is guarded in newborns but more favourable in older children.
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PMID:Myocarditis in infants and children: A review for the paediatrician. 2008 24

Cardiac failure is the leading cause of mortality in patients with thyroid storm. But the underlying cardiac pathology is unclear. Here, we report a 46-year-old woman who presented with hyperpyrexia and sinus tachycardia subsequent to accidental neck contusion. Her hyperthyroidism was verified by abnormal biochemical changes. Despite vigorous antithyroid treatment including a beta-blocker, glucocorticoid and potassium iodide, the patient eventually succumbed to refractory congestive heart failure in 4 days. Autopsy revealed lymphocytic myocarditis. We propose that lymphocytic myocarditis played a prominent role in her demise.
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PMID:Thyroid storm and lymphocytic myocarditis. 2022 98

Study quantified incremental cost of cardiovascular (CV) events in 6 high-risk and compelling indication subgroups: post-myocardial infarction (MI), diabetes, diabetic nephropathy, elderly, chronic kidney disease, and prior stroke. Based on claims data from privately insured individuals with 2+ hypertension (HTN) diagnoses in 2004-2006, we estimated regression-adjusted per-member-per-month healthcare costs after CVE. Costs were compared between patients with and without a CV events, and before and after CV events in each subgroup. The following CVevents were studied: acute MI, acute coronary syndrome, angina, ventricular arrhythmia, atrial arrhythmia, heart failure, coronary artery disease, left ventricular hypertrophy, stroke, and sinus tachycardia. Of 1,598,890 HTN patients, 510,118 had >/=1 CV event. Compared with controls, healthcare costs among patients with events were significantly greater across all cost components (inpatient, outpatient, and prescription drug). Acute MI and congestive heart failure generally had the largest incremental total healthcare costs. First-quarter post-event costs were attributable to inpatient costs. CV events are costly sequelae of hypertension in high-risk and CI subgroups.
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PMID:Costs associated with cardiovascular events in patients with hypertension in US managed care settings. 2040 83

A 32-year-old female patient presented with cardiac failure because of systolic dysfunction. Five years before, a DDD pacemaker had been implanted because of complete atrioventricular block. Echocardiographic examination disclosed left ventricular hypertrabeculation/non-compaction. Because of sinus tachycardia, ivabradine was started and the patient's left ventricular function returned to normal within 4 months. Recurrent creatine-kinase elevation and reduced nicotinamide adenine dinucleotide staining on muscle biopsy suggested metabolic myopathy.
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PMID:Complete atrioventricular block and reversible systolic dysfunction in left ventricular hypertrabeculation/non-compaction with metabolic myopathy. 2113 15

We report the case of a 76-year-old woman with mild-to-moderate mitral regurgitation due to rheumatic disease, severe dyspnoea, pulmonary hypertension and a recent episode of heart failure with paroxysmal atrial fibrillation. Transthoracic echocardiography at rest showed a mild-to-moderate mitral regurgitation, which was unable to justify the acute worsening of heart failure symptoms. During transesophageal echocardiography (TEE), deep anxiety induced sinus tachycardia and high SBP followed by pulmonary subedema. The TEE study ascertained a new-onset transient severe mitral regurgitation induced by stress and tachycardia. We speculate that the mechanism underlying the increasing of mitral regurgitation was related to the restricted motion of the posterior leaflet worsened by tachycardia. A further TEE, performed in the operating room under general anesthesia, thus without the emotional involvement of the patient, was not able to provoke a heart failure, even after dobutamine infusion, thus, downgrading the anatomical and functional mitral regurgitation severity.
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PMID:Downgrading mitral regurgitation in the echo laboratory: a case of rheumatic mitral restricted motion unmasked by emotional stress. 2129 86

We present the case of a patient with a heart failure episode induced by acute right ventricular pacing. After reversal of beta-blockers because of chronic obstructive pulmonary disease (COPD) exacerbation, the following sinus tachycardia caused a 2:1 atrioventricular block and consequent continuous right ventricular pacing. He was treated with the selective I(f) inhibitor ivabradine, that reduced both ventricular pacing percentage and heart rate without affecting atrioventricular conduction. Ivabradine may be a valuable option in treatment of patients with atrioventricular conduction disturbances.
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PMID:Usefulness Of Ivabradine To Treat "unexpected" Heart Failure Caused By "acute" Right Ventricular Pacing. 2199 73

We have studied the frequency and structure of cardiac rhythm (CR) disturbances in the women presenting with abdominal obesity (AO) in the postmenopausal period. The single-step study involved 210 postmenopausal women (median age 57 years) who were examined by 24-hour ECG monitoring, measurement of arterial pressure, body mass index, and the relationship between waist and hip circumferences. CR disturbances were revealed in all 159 women with abdominal obesity, ischemia in 16.9%, supraventricular extrasystole in 89.3%, ventricular extrasystole (VE) in 58.5%, high-grade extrasystole in 23.9%, paroxysms of supraventricular tachycardia in 1.9%, periods of asystole in 1.3%, synoatrial and atrioventricular blockade in 9.9%, His bundle branch block in 3.3%, sinus tachycardia in 48.8%, and sinus brachycardia in 23.9% of the patients. The risk of development of VE in the women with AO increased by 3.8 times in the presence of concomitant coronary heart disease and by 2.9 times in case of chronic cardiac failure. The frequency of VE was significantly higher in the patients with abdominal obesity than without it (odds ratio 2.2). It is concluded that women presenting with abdominal obesity during the postmenopausal period are characterized by the high frequency of cardiac rhythm disturbances and ischemia, with each fourth patient being at high risk of sudden death. The elevated risk of ventricular extrasystole in the postmenopausal period is associated with AO, coronary heart disease, and chronic heart failure. The frequency of VE is unrelated to ulcer disease, chronic cholecystitis, cholelithiasis, chronic pancreatitis, and impaired function of the thyroid gland.
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PMID:[The frequency and structure of cardiac rhythm disturbances in the women presenting with abdominal obesity during the postmenopausal period]. 2264 66

Myocarditis is defined as acute inflammation of the myocardium, usually following a non-specific flu-like illness, and encompasses a wide range of clinical presentations ranging from mild or subclinical disease to heart failure. We report a 12-day-old healthy full-term neonate who presented with abrupt onset of congestive cardiac failure (CCF) following a viral prodrome. Examination revealed persistent sinus tachycardia, lymphocytosis, gross cardiomegaly, nonspecific electrocardiogram changes with echocardiography showing Swiss cheese ventricular septal defect (VSD). VSD alone very rarely presents as early-onset cardiac failure in the absence of other precipitating factors like anemia, sepsis, hypoglycemia etc. Myocarditis, however, can mimic VSD and can present as fulminant cardiac failure in an otherwise healthy newborn. Myocarditis is usually diagnosed based on circumstantial evidence such as a recent viral infection and the sudden onset of cardiac dysfunction while ruling out other diagnostic possibilities. Elevated troponin T level is one of the most crucial noninvasive diagnostic modalities. Several trials have concluded that levels >0.055 ng/ml are statistically significant for diagnosing myocarditis in children. In our case an abrupt onset of cardiac failure following a viral prodrome and markedly elevated cardiac troponin T without sepsis and in the presence of normal coronary anatomy clinched the diagnosis of myocarditis. An early and aggressive treatment for CCF along with regular long-term follow-up plays a key role in the management of myocarditis. Role of high-dose Intravenous immunoglobulin in myocarditis has been studied by many trials with different outcomes. This is the first case report showing coexistence of VSD with myocarditis in a neonate presenting as early-onset acute cardiac failure. The report highlights the importance of screening for myocarditis in all previously normal babies presenting primarily with cardiogenic symptoms even if a structural heart disease is coexistent early in life. A simplified algorithm for work-up of CCF in a neonate is proposed.
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PMID:Swiss cheese ventricular septal defect with myocarditis - a rare coexistence in a neonate. 2271 60


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