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

Two patients with left ventricular thrombosis diagnosed by echocardiography are presented. The first patient was a 6-week-old girl with supraventricular tachycardia. Cross-sectional echocardiography showed a rounded and mobile structure protruding from the left ventricular wall. The girl was in heart failure and had signs of peripheral embolization. After sinus rhythm had been restored the thrombus diminished gradually and the girl recovered. The second patient was a newborn boy with severe aortic stenosis and a large massive thrombus along the left side of the interventricular septum. The boy died after valvotomy, the post-mortem examination confirmed the diagnosis of a large thrombus. Left ventricular thrombosis is uncommon in neonates and infants but may appear secondary to abnormal hemodynamics.
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PMID:Left ventricular thrombosis during infancy: report of two cases. 756 64

Atrial premature beats are caused by premature and abnormal depolarization of the atria, responsible for an anticipated QRS complex. Usually, the shape of this complex is identical to that of sinus beats. The diagnosis is made by electrocardiography, but it may meet with problems due to lack of recognition of premature P waves (and the more so as these may not give a ventricular response) or to the deformation of the QRS complex by a bundle branch block mimicking a ventricular premature beat. As in all instances, premature atrial beats are generally followed by a pause. Atrial premature beats, isolated in most cases, may trigger off supraventricular tachycardia episodes of varying duration. The clinical expression of atrial premature beats ranges from perceptible palpitations to complete latency. The decision to treat is determined by the functional repercussions of the disorder. Supplementary data are always useful to evaluate the significance of the disorder. Using the Holter recording system makes it possible to count the premature beats over a 24 h period, to find out whether they are preponderant in day time (suggesting an adrenergic factor) or at night (suggesting vagotonic disorders), and to identify bouts of atrial fibrillation that would have not been felt. Investigations for an underlying heart disease are mandatory. Any one of the cardiopathies of adulthood, and notably mitral valve lesions, may be encountered, as well as congenital heart diseases such as interatrial communication. The frequency of atrial premature beats tends to increase as cardiac failure develops, and its course can be made worse by some drugs (such as digitalis compounds) or by metabolic disorders (e.g. hypokaliaemia). However, there are many cases where no cardiopathy is detected. Within the group of isolated atrial premature beats, disorders found in athletes (in theory manifestations of hypervagotonia) can be individualized. In practice, therapeutic abstention is the rule, especially when premature beats are latent. In cases with poor functional tolerance, nervous sedatives of beta-blockers may be useful. Antiarrhythmic drugs are rarely necessary, but they may be prescribed if episodes of paroxysmal atrial fibrillation are present.
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PMID:[What is a practical approach to atrial extrasystole?]. 769 54

In a 4 1/2 year period fetal, echocardiographic studies were performed on 1600 fetuses. In 55 with arrhythmia, 44 had supraventricular ectopic beats, resolved in all, and none had heart disease. Sustained arrhythmias occurred in 11 fetuses. Atrial flutter was present in 3 all with heart disease (Ebstein disease, right atrial tumour and WPW diagnosed after birth). Another 3 fetuses had supraventricular tachycardia (SVT), all with a normal heart. In the bradycardia group, 2 had complete heart block (CHB) associated with AVSD; 2 sinus bradycardia and one had non conducted atrial ectopic beats. Digoxin was the first choice drug for tachyarrhythmia therapy; association with Verapamil, Flecainide, Quinidine and Procainamide was used in 4 of the 6. One fetus with CHB received Orciprenaline with no results. Atrial flutter resolved or improved; in SVT 2 fetuses converted to sinus rhythm and one died in utero. All fetuses with CHB died in cardiac failure. Mortality was 27% (3 cases) in utero and global 36%. In our experience most fetal arrhythmias (90%) were transitory ectopic beats or non lasting bradycardia in normal heart and did not trigger other kinds of arrhythmias. In sustained arrhythmias, heart failure and heart disease had a negative effect on prognosis.
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PMID:[Fetal arrhythmia. A case load of 4 years and a half]. 777 Dec 7

The authors report the long term results of His bundle ablation for supraventricular tachycardia in a series of 49 patients. This retrospective study was based on a patient population of 27 men and 22 women with an average age of 59 at the time of ablation, between 1984 and 1993. The indication for His bundle ablation was invalidating supraventricular tachycardia resistant to antiarrhythmic therapy in all cases. One group of patients (Group I, n = 31 patients) underwent high energy electrical shock and the second group (Group II, n = 18 patients) recruited after 1991, underwent radiofrequency catheter ablation. Complete atrioventricular block was obtained in the first group in 1 to 4 sessions whereas 17 patients of Group II were treated in a single session. During a follow-up period of an average of 40 months, 2 patients were lost to follow-up and 6 died, 3 of cardiac failure, 1 of a cerebrovascular accident, 1 of pulmonary carcinoma and 1 of unknown cause. In Group I, atrioventricular conduction persisted in 1 patient (primary failure) and reappeared in one other patient, but, in Group II, complete atrioventricular block persisted even in the patient in whom the interruption was not obtained with a single session of radiofrequency ablation. The patients were generally physically improved and satisfied not to have any palpitations. A decrease in exercise capacity estimated by the NYHA classification was observed in 38% of patients without apparent cardiac disease who developed dyspnea. On the other hand, 43% of patients with cardiac disease and in NYHA class > or = 2 were improved.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Long-term course after electric ablation of the bundle of His in the treatment of supraventricular tachycardia]. 777 91

Our aim was to assess clinically whether there was any benefit in adding a single dose of sublingual nifedipine (a slow calcium channel blocker) to prazosin in the management of the cardiovascular manifestations of envenoming by the Indian red scorpion (Mesobuthus tamulus). A total of 163 patients stung by this species was admitted to hospital at Mahad between January 1991 and October 1993. Cardiovascular abnormalities were hypertension (59), of whom 42 had bradycardia and 17 had tachycardia; pulmonary oedema (14), of whom eight had hypertension and six hypotension; supraventricular tachycardia (eight), of whom three had hypotension and one died. Of the remaining patients, 78 demonstrated severe excruciating local pain at the site of sting but had no systemic involvement. Nineteen patients with hypertension and tachycardia were given a single dose of sublingual nifedipine plus prazosin on admission, then prazosin alone repeated 6 hourly. Five patients with massive life-threatening pulmonary oedema recovered after being given intravenous sodium nitroprusside. Prazosin alone helped to alleviate cardiovascular manifestations in the remaining 52 victims. One patient was admitted in a deep coma, 12 hr after the sting, and died. Eight victims whose blood pressure had been controlled in hospital by nifedipine plus prazosin developed acute pulmonary oedema necessitating additional doses of prazosin for recovery. Fifty-two victims treated with prazosin alone did not develop pulmonary oedema and the drug appeared to hasten the recovery. In the presence of high blood pressure, tachycardia, a murmur and impending myocardial failure, nifedipine appeared to contribute to cardiopulmonary instability and to augment myocardial oxygen consumption. In this situation calcium channel blockers should probably be avoided.
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PMID:Vasodilators: scorpion envenoming and the heart (an Indian experience). 780 38

Anesthetic management of patients with dilated cardiomyopathy (DCM) was analyzed. From January 1991 to June 1993, we had 7 patients with DCM; 5 patients received general anesthesia and 2 patients received spinal anesthesia. General anesthesia was induced and maintained generally with diazepam and fentanyl. There were two patients who suffered from intraoperative arrhythmia. One patient who received spinal anesthesia suffered from ventricular fibrillation suddenly before the operation and we performed cardiopulmonary resuscitation successfully but the operation was cancelled. One patient who underwent emergency operation for gastric perforation suffered supraventricular tachycardia during the operation, and we were required to use antiarrhythmic agent that was thought to be deleterious to cardiac function. There was no patient who died perioperatively. There was one patient in the group IV of classification of Inoh which predicts the highest risk of dying from cardiac failure. In conclusion, it is important to control arrhythmia during the management of patients with DCM under anesthesia.
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PMID:[Anesthetic management of patients with dilated cardiomyopathy]. 786 11

A 4-month-old male Labrador Retriever was presented for recurrent bouts of pulmonary edema associated with tachycardia. Initial physical examination and echocardiography were unremarkable, and the electrocardiogram revealed only an intraventricular conduction disturbance. Subsequent recordings showed paroxysmal supraventricular tachycardia (SVT) (340 beats/min), which consistently produced pulmonary edema. The supraventricular tachycardia was unresponsive to adenosine, esmolol, and propranolol; was variable and transiently responsive to various vagal maneuvers and precordial thumps; and was always responsive to IV diltiazem. Multiple life-threatening episodes of SVT occurred, however, despite the chronic administration of oral diltiazem, propranolol, and procainamide. Diastolic cardiac dysfunction was documented by Doppler echocardiography and was thought to contribute to the development of pulmonary edema. A subsequent electrophysiologic study confirmed the presence of an atrioventricular posteroseptal accessory pathway that participated in orthodromic reciprocating tachycardia. This pathway was determined to conduct only in the retrograde direction ("concealed accessory pathway"). Intraoperative IV procainamide titration terminated the arrhythmia, which could not be reinduced when procainamide blood concentration approximated 20 micrograms/dL. Increasing the oral procainamide dose to achieve such plasma concentrations was successful in eliminating orthodromic reciprocating tachycardia, preventing heart failure, and returning Doppler indices of diastolic function to normal.
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PMID:Orthodromic reciprocating tachycardia and heart failure in a dog with a concealed posteroseptal accessory pathway. 789 62

Emergencies in pediatric cardiology are heart failure, cyanosis and rhythm disturbances. The signs of heart failure are tachycardia, tachypnea and hepatomegaly. The therapy consists of oxygen, diuretics and digoxin. Occasionally, intubation with mechanical ventilation and intravenous catecholamines are needed. Cyanosis is often the only sign of a severe heart malformation, and prompt hospitalization is mandatory. Oxygen and warm environment is important during transport, correction of a possible metabolic acidosis and prostaglandin infusion are done in the hospital. Beyond the newborn period, so-called cyanotic spells are seen, particularly in tetralogy of Fallot. In supraventricular tachycardia, vagal manoeuvres can be tried first, if not successful, intravenous adenosine or electroconversion will restore sinus rhythm. In the older child, intravenous isoptin can be given. Slow heart rates from total AV block or sinus node affection are treated with atrophic, isuprel or electrical pacing.
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PMID:[Pediatric cardiological emergencies]. 797 84

Sixty-two patients with opium and ephedrone abuse were studied. They underwent 24-hour Holter monitoring, resting ECG and echocardiography, 18 of them having volumetric loading with polyglucine, 400.0 ml, i.v. Sinus tachycardia was detected in 67.4%, ventricular extrasystole in 4.7%, supraventricular extrasystole with infrequent paroxysms of supraventricular tachycardia in 11.6%. Despite the fact that signs of heart failure were absent and myocardial contractility was normal at rest, echocardiography along with volume loading allow one to reveal in patients some abnormal contractile alterations in the left ventricle. These include its increased volumes, decreased ejection fraction and circulatory shortening rate of myocardial fibers, which suggests that the compensatory potentials of the myocardium are reduced in drug abuse.
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PMID:[Cardiac arrhythmia and myocardial contraction in opium and ephedrone addiction]. 803 35

The clinical profile of 19 patients with dilated cardiomyopathy ages 2-18 years (mean 13.4 +/- 4 years) was reviewed to detect any factors that might be predictive for their survival. Follow-up range from 5 to 105 months (mean 39 +/- 33 months). Routine treatment consisted of digitalis and diuretics: 14 patients received antiarrhythmics, 6 received vasodilators, and 12 were managed with immunosuppression. There were 12 survivors and 7 nonsurvivors: The 1-year mortality was 21.2% and the 2-year mortality 35.8%. All deaths were within first 2 years. Of the 12 patients who survived 2 years, a significant improvement was noticed in 9. In 3 patients tachycardia-induced cardiomyopathy was diagnosed, and abolition of supraventricular tachycardia was followed by improvement and regression of cardiomegaly. Endomyocardial biopsy was performed in 16 patients. Four with a histologic diagnosis of active myocarditis survived, and in 3 of them a considerable improvement was noticed. Of the 12 patients with nonspecific histologic findings, 6 died (p < 0.05). There were no significant differences between survivors and nonsurvivors for any of the following parameters: incidence of severe heart failure (NYHA class III-IV) and severe ventricular arrhythmias (Lown class III-V), relative heart volume, echocardiographic left ventricular diastolic diameter and shortening fraction, and the hemodynamic parameters of cardiac index, left ventricular ejection fraction, left ventricular end-diastolic pressure, and left ventricular end-diastolic volume index.
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PMID:Dilated cardiomyopathy in children: clinical course and prognosis. 804 93


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