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

This report describes a successful operative case of tricuspid infective endocarditis in a drug addict. A 24-year-old man with a history of drug addiction (6 months) complained of general fatigue and high fever. Echocardiography showed a large vegetation attached to the tricuspid valve and severe tricuspid regurgitation. Blood cultures revealed septicemia due to methicillin sensitive Staphylococcus aureus. He was treated for about 1 week with intravenous antibiotics. However, subsequent severe heart failure necessitated emergency operation. The tricuspid valve was replaced with Carpentier-Edwards bioprosthesis because of severe destruction of the tricuspid valve. The postoperative course was uneventful and he has remained free from endocarditis for 15 months after surgery.
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PMID:[A case of tricuspid infective endocarditis in a drug addict]. 1071 5

The aim of this investigation was an echocardiographic assessment of left ventricular structure and function in elderly women who were hospitalized due to congestive heart failure. Sixty-three women with heart failure aged 70-100 years (mean age, 82 years) were studied; medical histories were taken, medical examinations and chest X-ray studies, along with ECG and M-mode, 2D-mode and Doppler echocardiography were performed. Echocardiography revealed that the predominant structural lesions involved the cardiac valves; in the majority of cases, there was thickening and calcification of the mitral and aortic valves, but calcification of the mitral and aortic annulus was also frequent. Mitral regurgitation was noted in 84.1% of patients, and tricuspid regurgitation in 50.8%. More than one type of valvular dysfunction was characteristic of 57.1% of women. Among the evaluated cardiac dimensions, left atrial enlargement was observed in 84.1% of women, and ventricular septal hypertrophy in 60.3%. In the majority of patients (55.6%), the values of left ventricular ejection fraction ranged from 51% to 82%, while in the remaining 44.4% they oscillated between 18% and 50%. The most often detected underlying etiological factor in our elderly females with heart failure was coronary artery disease diagnosed in 88.9% of patients, followed by arterial hypertension (54%), and valvular defects (22.2%). In conclusion, the results indicate the presence of some characteristic lesions revealed by echocardiography in elderly patients treated for heart failure; valvular and annular degenerative lesions are commonly detected, valvular dysfunction is frequent, and in the majority of patients (55.6%) left ventricular systolic function is not impaired.
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PMID:Echocardiographic assessment of left ventricular structure and function in elderly women with congestive heart failure. 1074 31

The clinical diagnosis of heart failure is based upon history and physical examination. Careful questioning and examination requires understanding of the pathophysiology of this systemic disorder. Symptoms and signs of congestive heart failure need to be differentiated from the manifestations of the underlying cardiovascular disorder. Only then will the specific signs and symptoms be unraveled. Symptoms arise from pulmonary congestion and peripheral or organ-underperfusion. Findings related to congestion can be found over the lungs (rales, pleural effusion), or at the jugular veins displaying either frank central venous pressure elevation or paradoxic inspiratory venous pressure rise (Kussmaul sign), or the more discrete sign of right, left of biventricular failure, the hepatojugular reflux. Dilatation and hypertrophy of the cardiac chambers can clinically easily and reliably be assessed by careful palpation. Galopprhythm, right and/or left ventricular in origin, is a particularly reliable sign of a failing ventricle. While a presystolic, atrial sound indicates merely elevated resistance to ventricular filling, i.e. the presence diastolic dysfunction or increased chamber filling, is the ventricular diastolic galopp a reliable sign of ventricular failure. Especially the appearance of a quadruple rhythm or a summation galopp can be considered both highly specific as well as prognostically dubious. Relative mitral and/or tricuspid insufficiency as a sign of ventricular dilatation needs to be differentiated from organic valve disease. This requires often echocardiography. Oedema of cardiac origin is symmetric and more pronounced in the evening. It arises both from left and from right ventricular failure. History and physical examination are both reliable tools in the initial diagnosis, as well as during follow-up and for control of therapeutic measures. Technical methods, such as chest x-ray, echocardiography or else are used for quantification and documentation. Properly applied and utilized they allow the physician to sharpen his clinical acumen, thus allowing for both a reliable diagnosis and a semi-quantitative estimation of ventricular size, enddiastolic and atrial, as well as pulmonary pressures and valve function.
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PMID:[Clinical diagnosis of heart failure]. 1085 88

47 patients aged from 2 to 59 years affected by valvular congenital or mixed pulmonary stenosis including three fallot trilogies and one patient with right congestive cardiac failure are treated by percutaneous pulmonary valvulotomy between october 1986 and december 1990. All patients have been controlled with a mean follow-up of 6.5 +/- 1.1 years. The total gradient rate between pulmonary artery and right ventricule decrease from 112 +/- 55 mm Hg to 20 +/- 8 mm Hg on the last control with disappearance of infundibular inflammation and inter auricular shunt in all the concerned cases. We observe the regression of right cardiac failure symptoms with disappearance of tricuspid insufficiency in the cases of advanced pulmonary stenosis with right ventricular dysfunction. Percutaneous pulmonary valvulotomy by its simplicity and harmlessness, its long term efficiency is a good method of treatment of pure valvular or mixed pulmonary stenosis.
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PMID:[Evolution after 5 years of percutaneous pulmonary valvulotomy: report of 47 cases]. 1089 33

Diagnosis of twin reversed arterial perfusion (TRAP) syndrome is a rare fetal anomaly that can be misdiagnosed on prenatal ultrasound. We confirmed the use of colour-flow Doppler for prenatal diagnosis of TRAP syndrome and used serial fetal echocardiography for non-invasive evaluation of the fetus. A patient with twin intrauterine pregnancy was referred to our centre with suspected intrauterine fetal demise following a 16 week ultrasound. Serial colour-flow Doppler ultrasonography demonstrated retrograde arterial flow in an acardiac twin. Following diagnosis of TRAP syndrome, serial fetal echocardiography was employed to follow the normal twin for signs of heart failure, including right atrial dilation, tricuspid regurgitation and pericardial effusion. When early signs of fetal heart failure were suspected a viable female infant was delivered at 32 weeks' gestation. We suggest that serial fetal echocardiography represents a non-invasive approach that can be used to follow fetal cardiac function of the normal twin in TRAP syndrome.
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PMID:Prenatal diagnosis of fetal heart failure in twin reversed arterial perfusion syndrome. 1095 70

All methods for estimating the severity of heart failure, such as clinical and radiographic examination, measures of ventricular performance, and exercise capacity, when used independently, have major limitations. Echocardiography can be used, not only to assess left-ventricular ejection fraction but also other determinants of prognosis (i.e., left-ventricular size and shape, estimation of left atrial and pulmonary artery pressures, right side involvement). The availability of continuous-wave Doppler has permitted us to evaluate pulmonary artery systolic pressure from tricuspid regurgitation, and this contributes to additional powerful data. In long-standing heart failure, pulmonary artery wedge pressure is a predictor of survival, and aggressive therapy to reduce wedge pressure improves survival. Noninvasive estimation of left-atrial pressure and left-ventricular filling pressure have been attempted by continuous-wave Doppler echocardiography in patients with heart failure and mitral regurgitation and by tissue Doppler imaging at the mitral annulus level. A significant relation has been reported between profiles of pulmonary venous flow and left-atrial pressure, but pulmonary venous flow indexes can be better assessed by transesophageal echocardiography (TEE) in terms of detection rate. It has recently been recognized that TEE can provide valuable information on intracardiac hemodynamics and ventricular function. Two-dimensional evaluation of ventricular function and pulsed- and continuous-wave Doppler recordings from the pulmonary artery, pulmonary vein, and mitral inflow are combined to provide these data, which are both qualitative and quantitative, and permit estimation of ventricular ejection fraction, left-atrial pressure, and cardiac output. It would be important to be able to stratify patients with congestive heart failure according to groups with the highest risk for early death because heart transplantation or aggressive medical treatment could be specifically applied to this population. Serial echocardiographic evaluations of the classic variables of systolic left-ventricular function as well as Doppler transmitral flow may be useful in monitoring the progression of the disease and the effects of medical treatment. The degree of pulmonary hypertension is independently associated with the restrictive left-ventricular diastolic filling pattern and with the degree of functional mitral regurgitation. Future studies on the impact of these hemodynamic variables on the outcome of patients with left-ventricular dysfunction are desirable.
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PMID:Transthoracic and transesophageal echocardiography in the hemodynamic assessment of patients with congestive heart failure. 1099 52

A 57-year-old female patient with known cardiac disease developed a 4 to 6 week history of diarrhea, followed by onset of orthopnea and subsequent right-sided cardiac failure. On hospital admission she was found to have pure tricuspid regurgitation, without evidence of cardiac ischemia, pulmonary embolism, bacterial endocarditis or pericardial disease. A 24-hour urine collection for 5-HIAA was elevated, and a subsequent octreotide scan documented abnormal uptake in the pelvic cul-de-sac. Bilateral ovarian masses were found at laparotomy, which on pathological examination were found to be a benign left ovarian cystic teratoma, and a right carcinoid tumor of the ovary. This patient presented with systemic complaints of diarrhea, and orthopnea and right sided heart failure that on evaluation were ultimately found to be due to a unilateral primary carcinoid tumor of the ovary, which accounts for less than 0.1% of all ovarian carcinomas, and only 5% of all carcinoids. Treatment of this malignant carcinoid syndrome presentation consisted of debulking of the tumor and continuation of her diuretics and digoxin. Diarrhea and orthopnea ceased within 2 weeks after her oophorectomy. On evaluation 6 weeks and 6 months postoperatively, her cardiac function was stable, though unchanged. 5-HIAA levels were within normal limits, demonstrating the curative function of surgery in patients with unilateral ovarian carcinoid without evidence of metastases, as well as preserved cardiac function in otherwise stable patients.
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PMID:A case of diarrhea and orthopnea in a 57-year-old female. 1106 Oct 23

We describe an elderly case of idiopathic dilatation of the right atrium in which right-sided heart failure was exacerbated by drug-induced bradyarrhythmia. An 84-year-old man, who had a 10-year history of episodic edema, was treated with proscillaridin and verapamil hydrochloride at another hospital. He had experienced a poor appetite and general malaise 2 months previously, and exertional dyspnea 10 days previously. On admission, he had jugular venous dilatation, systemic edema, and hepatomegaly. On auscultation, a third heart sound originating from the right ventricle and systolic murmur of tricuspid regurgitation were heard. An admission electrocardiogram showed an atrial standstill and junctional escape rhythm with a QRS rate of 31 beats/minute. Chest roentgenogram revealed a bilateral pleural effusion and cardiomegaly with a cardiothoracic ratio of 76%, but no pulmonary congestion. Echocardiogram disclosed idiopathic dilatation of the right atrium and secondary tricuspid regurgitation. He was given a diagnosis of right-sided heart failure due to idiopathic dilatation of the right atrium exacerbated by bradyarrhythmia, which was suspected to derive from the side effects of proscillaridin and verapamil hydrochloride. Thus, these agents were withheld. In addition, the patient reduced sodium intake and was treated with diuretics and beta-adrenergic agonist. Thereafter, right-sided heart failure markedly improved. At the time of the last follow-up 16 months after discharge, he felt well.
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PMID:[An elderly case of idiopathic dilatation of the right atrium in which right-sided heart failure was exacerbated by drug-induced bradyarrhythmia]. 1152 70

Congenital heart block (CHB) can result in intrauterine cardiac failure leading to fetal or neonatal loss. To establish perinatal hemodynamic factors which might predict adverse outcome, six fetuses with CHB diagnosed between 20 and 30 gestational weeks were examined by echocardiography at 2-week intervals. Neonatal morbidity and outcome in infancy are detailed. The fetuses showed a significant decrease in ventricular rate (VR) with advancing gestation (60 +/- 7 vs 51 +/- 4 beats/min, p = 0.03). Cardiac decompensation defined as hydrops or pericardial effusion was associated with VR of lower than 55 beats/min in two fetuses. Three mothers had a therapeutic trial with a sympathomimetic and digoxin. Salbutamol increased VR 10% in one of three fetuses treated. Digoxin decreased pericardial effusion in one hydropic fetus with autoimmune myocarditis. In this fetus, poor left ventricular fractional shortening (LVFS) was accompanied with high umbilical artery resistance index (RI). High amniotic fluid erythropoietin indicated severe hypoxia preceding death. Pacemaker was indicated in all the newborns. At the age of 2 weeks all the surviving infants had tricuspid regurgitation and a shunt through foramen ovale due to asynchronized atrioventricular contraction. During the 12-month follow-up two of five surviving infants had no symptoms. One had symptomatic neonatal lupus. Two infants had patent ductus arteriosus, one with dilated cardiomyopathy. In conclusion, poor fetal outcome was associated with low VR, low LVFS, and high RI. Despite early pacing, morbidity was high in infancy due to cardiomyopathy and associated heart defects. Regular echocardiographic monitoring during pregnancy and after delivery is required in order to optimize care and timing of any interventions.
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PMID:Congenital complete heart block in the fetus: hemodynamic features, antenatal treatment, and outcome in six cases. 1152 12

Partial left ventriculectomy (PLV) is regarded as one of the alternatives to heart transplantation for idiopathic dilated cardiomyopathy (d-CMP). Between June 1996 and March 2000, 20 patients underwent left ventricular volume reduction surgery at five major cardiac centers in Korea. PLV was performed in 16 patients with d-CMP and in 1 patient with ischemic CMP. The modified Dor procedure was performed in three patients; two patients with d-CMP and one patient with ischemic CMP. Median age was 35 years (range 3-64 years). There were 13 male and 7 female patients; there were 4 patients in Class III and 16 patients in Class IV. Among the 16 patients in Class IV, 5 patients were inotropic dependent, 2 patients were resuscitated from cardiac arrest or shock in hospital, and 1 patient was treated with intra-aortic balloon pumping. Operative technique for PLV was the same as described by Batista and colleagues. For the modified Dor procedures, the apical left ventricle was opened and a circumferential pursestring suture was placed at the base of both papillary muscles to reduce the diameter of the left ventricle concomitant with mitral annuloplasty. Mitral valve repair was performed in 15 patients and mitral valve replacement was performed in 1 patient. Moderate-to-severe tricuspid regurgitation was noted in 12 patients (with tricuspid annuloplasty in 11 of these patients and replacement in 1 patient). Postoperatively, there were seven operative deaths after PLV and one death after the modified Dor procedure. Cause of death after PLV was right heart failure in four of the seven cases, sepsis in one case, and ventricular tachyarrhythmia in the remaining two cases. After the modified Dor procedure, there was one operative death with left ventricular failure. Postoperatively, mean ventricular end-diastolic dimension markedly decreased from 75.3 mm to 50.9 mm. However, this dimension had increased slightly to 58.2 mm, an average observed 22 months later. Mean left ventricular ejection fraction (LVEF) improved significantly from 20.6% to 33.5% (p < 0.0001), but decreased to 28.5% on average 22 months later (p = 0.058). Eleven patients were discharged from the hospital and followed-up for a mean of 20.2 months (range 1-41 months). During the early postoperative period, most were in good condition. However, heart failure progressed with mitral regurgitation in four patients, two of whom underwent heart transplantation. In conclusion, PLV for d-CMP seems to be an effective alternative surgical procedure to heart transplantation in Korea. The modified Dor procedure may be another alternative to transplantation for left ventricular volume reduction. However, in patients showing progression of heart failure, early intervention with ventricular assist or heart transplantation will be necessary. Also, further studies will be necessary for selection criteria and for prevention of ventricular tachyarrhythmia.
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PMID:Volume reduction surgery for end-stage heart failure: experience in Korea. 1176 35


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