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

Most inotropic agents risk aggravating atrial and ventricular hyperexcitability associated with cardiac failure by their catecholergic-like effects. The aim of this study was to evaluate the electrophysiological effects of a powerful inotropic agent, enoximone, and to determine whether it had any arrhythmogenic effects. Endocavitary electrophysiological studies of conduction, induction of supraventricular tachycardia (SVT) by programmed atrial stimulation up to two extrastimuli and induction of ventricular tachycardia by programmed ventricular stimulation using up to 3 extrastimuli were undertaken before and 15 minutes after an injection of 1 mg/kg of enoximone in 10 minutes followed by an infusion of 0.75 mg/kg over 20 minutes. The studies were undertaken in 14 patients with severe cardiac disease (average ejection fraction: 26%): all had complex ventricular arrhythmias on Holter monitoring but only 7 had inducible sustained VT less than 270/mn under basal conditions. The following effects were observed with enoximone: significant shortening of all parameters of conduction; no aggravation of supraventricular excitability; no significant inducible ventricular arrhythmias in subjects without inducible sustained VT under basal conditions; facilitation of induction and acceleration of VT induced in 6 of the 7 patients with inducible sustained VT under basal conditions (VT cycle shortening from 307 +/- 13 to 240 +/- 34 ms). In conclusion, enoximone has no supraventricular arrhythmogenic effects and does not facilitate the induction of ventricular arrhythmias in subjects without inducible sustained VT under basal conditions. However, it can accelerate the VT rhythm in patients who have inducible sustained VT under basal conditions.
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PMID:[Electrophysiologic effects of enoximone]. 214 38

We report on a 33-year-old para II who was admitted to our hospital in her 29th gestational week with extensive fetal hydrops. Examinations showed a fetal supraventricular tachycardia with biventrical cardiac insufficiency. Digoxin was given both to the mother and to the fetus. At first, this treatment seemed to have no effect. Over a period of several weeks, however, oral therapy with digoxin and verapamil resulted in a stabilized fetal heart rate (175-180 beats/min). Signs of fetal cardiac insufficiency disappeared almost completely. In the 39th week the child was born spontaneously. Clinical examination revealed only a slight cardiac insufficiency. New possibilities of intrauterine therapy are discussed in the light of this case and other reports in the literature.
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PMID:[Hydrops fetalis in tachycardia: diagnostic and therapeutic procedures]. 218 95

Chronic use of digitalis is common amongst the institutionalized elderly. Associated with digitalis use is the potential for toxicity and/or adverse reactions. In this study maintenance digoxin was withdrawn from 14 elderly nursing home residents in sinus rhythm. Subjects were followed over 18 months for evidence of dysrhythmia or heart failure. One resident had an episode of supraventricular tachycardia which required digoxin to be restarted. One resident developed left heart failure, treated with oral diuretic. For 12 of the 14 residents, withdrawal of maintenance digoxin was achieved without deleterious effect. This study suggests that maintenance digoxin may be withdrawn safely in elderly nursing home residents in sinus rhythm and without history of atrial dysrhythmia.
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PMID:Withdrawal of maintenance digoxin from institutionalized elderly. 192 37

All patients with supraventricular tachycardia during the first 12 months of life who presented between 1977 and 1988 were identified by a retrospective survey of records in this hospital and by a questionnaire sent to paediatricians in the Northern region. Twenty two of 29 patients (76%) were in heart failure and seven (24%) had cardiogenic shock. Seven patients (24%) were free of symptoms. All had narrow QRS tachycardia at 215-315 beats/minute (mean (SD) 292 (21)). Initial treatment included digoxin (effective in seven of 14 patients, with overdose in three), verapamil (effective in three of three but fatal in one), cardioversion (effective in all 10 who were treated in this way), iced water applied to the face (effective in all 16 patients on 53 of 59 occasions, 90%). Initial treatment in local hospitals was less effective and associated with more complications than that given in the regional referral centre. Digoxin is often ineffective, return to sinus rhythm is delayed, and overdosing is common. Cardioversion is effective but tachycardia often recurs. Iced water is safe and effective, and should become the treatment of choice for termination of supraventricular tachycardia in neonates and young infants.
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PMID:Supraventricular tachycardia in infants: response to initial treatment. 230 75

Persistent supraventricular extrasystoles are antepartally, intrapartally and postpartally the most frequent form of arrhythmias, and do not cause fetal congestive heart failure (hydrops fetalis). The premature beats often disappear spontaneously prenatally, but in most cases within the first two weeks of life. The extremely rare observation of the occurrence of a supraventricular tachycardia in the 37th week of gestation in a fetus with persistent supraventricular extrasystoles from the 20th week of gestation onward and with a postnatally diagnosed Wolff-Parkinson-White syndrome is described. Because of the importance of this complication of supraventricular extrasystoles (a supraventricular tachycardia of the fetus can cause a cardiac failure with hydrops fetalis and eventually intrauterine death), it is important that all fetuses with supraventricular extrasystoles be closely monitored by frequent observation of the fetal heart rate using ultrasound (M-mode-echocardiography), cardiotocography and auscultation. Postpartally a cardiologic examination of these newborn infants is necessary, particularly in order to exclude the presence of a preexcitation.
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PMID:[Supraventricular tachycardia of the fetus in the 3d trimester of pregnancy following persistent supraventricular extrasystole]. 244 24

The aim of this study was to determine whether an antiarrhythmic, Ajmaline, could have proarrhythmic effects on the atrium and to compare the results with those of other antiarrhythmic drugs. A total of 1950 patients without cardiac failure or recent (less than 6 weeks) myocardial infarction were given 1 mg/kg of Ajmaline intravenously during electrophysiological investigation. A proarrhythmic effect was defined as the occurrence of supraventricular tachycardia (SVT) in a patient without this arrhythmia before the test or the facilitation of its induction. Fifty five patients developed SVT (mainly atrial tachyarrhythmias: 48 cases, and some junctional tachycardia: 7 cases) which occurred spontaneously in 22 patients and during fixed atrial pacing in 33 patients. Fifteen patients developed ventricular tachycardia (VT). The predisposing factors for the development of SVT were: a previous history suggesting spontaneous SVT (28 patients; 51 p. 100); sinoatrial block (14 patients--the only abnormality in 10 cases). Seventeen patients had none of these factors but 8 had known cardiac pathology and the other 9 were relatively elderly patients (79 years). Twelve of the patients developing VT had known cardiac disease, bundle branch block in 12 cases and previous VT in 6 cases. In conclusion, proarrhythmic effects of Ajmaline are infrequent if its contraindications are respected, but they do exist at both atrial (2.8 p. 100) and ventricular levels (0.8 p. 100): the risk factors are comparable: previous spontaneous arrhythmias or ECG changes (SA block at the atrial and bundle branch block at the ventricular level).
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PMID:[Arrhythmogenic effect of ajmaline on the atrial level]. 251 24

For the past few years, a new method for the investigation and treatment of arrhythmias has been used: transoesophageal atrial pacing and recording (TAPR). In the light of 6 cases observed recently, we review the technical aspects and the indications for TAPR. A bipolar stimulation catheter is inserted in the oesophagus and positioned in the area where the atrial wave of greater amplitude is recorded. Atrial stimulation is done with impulses of long duration obtained with a special stimulator. Two cases validated this technique which was effective to correct atrial flutter in a neonate with heart failure resistant to medical treatment as well as in a 5 year-old child. The value of TAPR as a diagnostic tool in cases of tachycardia is discussed in the context of 2 cases: a 5 week-old with wide QRS and a 14 month-old with narrow QRS. Finally, the value of TAPR for monitoring the efficacy of anti-arrhythmia medications is illustrated by 4 cases of supraventricular tachycardia, in whom the optimal dosage of the anti-arrhythmic drug used was determined with the help of TAPR-induced tachycardia. The current literature concerning the technique, indications and results of TAPR are reviewed. This method is likely to take a great importance for the study and treatment of supraventricular arrhythmias in children.
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PMID:[Value of the esophageal approach in the diagnosis, treatment and therapeutic surveillance of arrhythmia in children]. 265 57

At present nitrates remain the initial treatment for relief or prevention of angina in patients with coronary artery disease. In cases where nitrates and beta blockers have been used and are ineffective for managing effort angina, calcium antagonists may be substituted or added to the beta-blocking treatment. When the predominant symptom is rest angina, and there is evidence suggesting coronary artery spasm, nitrates and a calcium antagonist can be effective therapy. In patients with heart block, bradyarrhythmias, heart failure, or hypertension nifedipine may be the drug of choice. In contrast verapamil merits choice when supraventricular tachycardia is present. Diltiazem appears intermediate between nifedipine and verapamil and may be particularly useful when hypotension or other side effects must be avoided.
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PMID:Calcium antagonists. 286 40

The hemodynamic and clinical response to oral and intravenous piroximone was examined in 25 patients with chronic cardiac failure secondary to ischemic or myopathic heart disease: 14 with severe failure, who were clinically unstable (group I), and 11 with stable failure of mild to moderate severity (group II) in whom maximal O2 uptake (VO2 max) to treadmill exercise could be monitored serially. Intravenous (0.5 to 1.0 mg/kg) and oral (0.7 to 4.9 mg/kg) piroximone significantly (p less than 0.05) improved right and left ventricular pump function in both groups while causing an insignificant rise in heart rate and reduction in arterial pressure. Myocardial O2 uptake was not altered acutely or subacutely after piroximone, and myocardial lactate production was not observed. The salutary hemodynamic response to oral piroximone was sustained for 5 hours and there was no evidence of tolerance to the third and fourth doses. In group II, VO2 max was increased (p less than 0.05) at 4, 8, 12, 24, and 48 weeks of oral piroximone therapy. Adverse gastrointestinal effects were observed in two patients and a supraventricular tachycardia in another. Thus, piroximone may prove useful in the long-term management of chronic cardiac failure. Controlled clinical trials should be undertaken to determine the ultimate efficacy and safety of piroximone in these patients.
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PMID:Piroximone (MDL 19,205) in the treatment of unstable and stable chronic cardiac failure. 331 May 66

The study of drug distribution in pregnancy was limited by ethical, technical and medico-legal considerations as samples of body fluids could only be taken at delivery. In recent times fetal blood samples have been taken with the fetoscope and will provide a new tool to monitor fetal concentrations and metabolic pathways. The advanced technology of ultrasound allows non invasive study of the fetal circulation and early experience of sympathomimetic drugs administered to the mother will be discussed. Auto immune disorders carry high perinatal wastage. New drugs have made reproductive life possible and when used prudently can improve maternal state and increase fetal salvage. The author has personally managed nearly 52 cases of systemic lupus erythematosus and 16 cases of idiopathic thrombocytopenic purpura. The use of steroids and low dosage aspirin therapy with elevated lupus anticoagulant levels will be described. Two cases of early hydrops in the fetus owing to heart failure due to supraventricular tachycardia were treated with digoxin given to the mother. The potential of therapeutic agents in fetal medicine will be discussed as it recognises the fetus as a patient and provides effective intra uterine therapy.
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PMID:Drugs in feto maternal medicine. 331 58


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