Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Altered renal function with renal NaCl-retention can be observed early in the course of congestive heart failure. The afferent pathway of this altered regulation involves changes occurring in the high pressure system as a consequence of foreward failure such as an increase in baroreceptor reflex activity. Efferent pathways may include the renin-angiotensin-aldosterone system, the sympathetic nervous system, prostaglandins, dopamine, ANF, and AVP. At present, the relative importance of these systems in mediating renal NaCl-retention in heart failure is still unclear. Expansion of the extracellular fluid volume as a consequence of renal NaCl-retention may, at least acutely, compensate for compromised myocardial function via the Frank-Starling mechanism. As a consequence of volume expansion, chronically increased cardiac preload and possibly afterload may however even aggravate cardiac failure. Diuretics may therefore induce variable effects in patients with congestive heart failure. Acutely, they may ameliorate symptoms of congestion in spite of the possibility of a further decrease in cardiac index. Chronically, they may reduce cardiac pre- and afterload. Through a variety of mechanisms, they may therefore increase cardiac performance in spite of a fall in filling pressures.
 ...
PMID:[The role of diuretics in the treatment of chronic heart failure]. 219 19

Heart failure is a complex cardiovascular syndrome affording many pharmacotherapeutic targets. Ibopamine affords a unique pharmacological profile for the treatment of this complex syndrome by virtue of its ability to stimulate DA-1 and DA-2 receptors in the vasculature in combination with its beta 2-agonist activity. The drug has been shown to improve the Frank-Starling relationship in the failing heart and augment cardiac output and ejection fraction at the same time that cardiac filling pressure is reduced. Concomitantly, the drug has been shown to attenuate the activated neuroendocrine responses activated in heart failure. Clinically, ibopamine has been shown to improve exercise tolerance, reduce the patient's symptom score, and NYHA classification, and reduce the requirement for additional anti-heart failure drugs. The influence of ibopamine on survival in heart failure awaits pragmatic tests, but the results of open monitoring studies are promising in this respect. Ibopamine does not appear to have any substantial adverse reactions that would inhibit its use in patients in heart failure. The unique pharmacotherapeutic profile of ibopamine affords a new pharmacologic vista for the treatment of patients with chronic heart failure.
 ...
PMID:Pharmacotherapeutic profile of ibopamine in heart failure. 248 37

1. Although heart failure is commonly associated with depressed systolic function, there is increasing evidence that impaired diastolic performance is also universally present and might be a key determinant of symptoms, physical capacity and even survival in some subsets of patients. 2. Reduced diastolic distensibility increases cardiac filling pressure not only at rest, but even more during exercise when diastolic filling time is reduced. The increases in filling pressure and diastolic wall stress lead to pulmonary congestion and subendocardial ischaemia, it also triggers myocardial hypertrophy and a detrimental remodelling of the ventricular cavity. Perhaps even more importantly, impaired ventricular distensibility limits the use of the Frank-Starling mechanism, impairing systolic pump function and cardiac output adaptation during exercise. Therapies able to improve the distensibility of the ventricle are, therefore, desirable in heart failure. 3. Nitrates, angiotensin converting enzyme (ACE) inhibitors and diuretics may indirectly increase left ventricular chamber compliance by their effects on the right side of the heart. Cardiac glycosides do not improve myocardial relaxation and may even cause diastolic contracture at toxic doses. The new beta 1-adrenoceptor partial agonist, xamoterol, on the other hand, consistently lowers left ventricular filling pressure at rest and during exercise, and produces an increase in left ventricular dynamic compliance through the direct lusitropic effect of beta 1-adrenoceptor stimulation. These beneficial effects are maintained during prolonged therapy and also appear sufficient to slow the remodelling of the ventricular cavity. The improvement in symptoms and in exercise tolerance observed during xamoterol (Corwin, Carwin, Corwil, Xamtol, ICI 118,587) therapy might, therefore, be related to the improvement in left ventricular diastolic distensibility induced by this drug.
 ...
PMID:Focus on diastolic dysfunction: a new approach to heart failure therapy. 257 54

Since March 1986, coronary artery bypass grafting (CABG) by utilizing the right gastroepiploic artery (GEA) has been performed in 60 patients during 3 year period. There were 52 males and 8 females, and age ranged from 34 to 73 year old with the mean of 56.2 year old. Triple vessel disease and the left main disease involved 90% of the patients. There were two patients under hemodialysis for chronic renal failure, one patient with idiopathic thrombocytopenic purpura, one patient with aneurysm of the abdominal aorta, and two patients with arteriosclerosis obliterance, preoperatively. Five patients were second CABG. GEA was used as an in-situ graft in 57 patients and as a free graft in 3 patients and was anastomosed to 3 left anterior descending, 3 diagonal (all "free" graft), 5 circumflex, and 49 right coronary arteries. To bypass the other coronary arteries, the internal mammary artery graft (unilateral 38, bilateral 20, sequential 5) with or without saphenous vein graft was used. The mean number of distal anastomoses was 3.3 (1-5) and the mean number of arterial graft anastomoses was 2.4 (1-4) per patient with the mean aortic cross clamp time of 62.4 minutes (23-137 minutes) and the mean cardiopulmonary bypass time of 120.8 minutes (69-210 minutes). Splenectomy, Y graft replacement of the abdominal aorta, and ascending aorta-bifemoral bypass were concomitantly carried out in each one patient. Two patients (3.3%) died of renal and cardiac failure within 30 postoperative days. One patient (1.7%) died of stroke lately. New Q wave was noted in 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
 ...
PMID:[Coronary artery bypass grafting using gastroepiploic artery]. 260 5

The relationship of plasma norepinephrine levels to the adaptational changes in ventricular-load coupling were studied at rest and during exercise in subjects with variably depressed ventricular function. Peak body oxygen consumption (VO2) and gas exchange anaerobic threshold (ATge) were measured to assess exercise capacity. Ventricular contractile properties were expressed by the slope (Ees) of the end-systolic pressure-volume relation and mechanical arterial properties were expressed by the slope (Ea) of the end-systolic pressure-stroke volume relation. Resting plasma norepinephrine was significantly elevated in patients with severe heart failure (New York Heart Association class III, IV) and correlated well with the magnitude of reduction in peak VO2 and ATge. In these patients, Ea/Ees ratio was also increased and correlated with the levels of resting plasma norepinephrine. Although pump efficiency of the left ventricle progressively fell with the development of heart failure, stroke volume was maintained within normal range by virtue of a compensatory increase in end-diastolic volume. Sympathetic activity was much higher in anaerobic exercise than in aerobic exercise. However, Ees (ventricular contractility) remained at the same value throughout the exercise period. Thus, an increase in stroke volume during anaerobic exercise was caused more by an increase in end-diastolic volume than by an enhanced contractility. Our results suggest that the level of resting plasma norepinephrine can be a good predictor of the modulation of ventricular-load coupling in patients with heart failure and that when contractile reserve is decreased, the Frank-Starling mechanism plays an important role in the control of stroke volume.
 ...
PMID:Relationship of plasma norepinephrine to ventricular-load coupling in patients with heart failure. 271 74

With physiologic stress to the cardiovascular system, some circulatory compensatory mechanisms are designed to restore homeostasis quickly (e.g., sympathetic nervous system activation and the Frank-Starling mechanism). These compensatory mechanisms are not nearly as effective when there is a chronic pathologic stress such as congestive heart failure (CHF). In this circumstance, other mechanisms that operate with longer time constants come into play (e.g., activation of the renin-angiotensin-aldosterone system, myocardial hypertrophy and deconditioning). The most successful chronic drug therapies of CHF are those that are designed to reverse the latter group of compensatory mechanisms, a process that is slow. It takes especially long to reverse those CHF-induced changes in blood vessels and skeletal muscle metabolism that are activated to cope with inadequate delivery of oxygenated blood to working muscles. The concept that compensatory mechanisms have either short or long time constants for activation, effectiveness and reversal may help explain why the improvement in exercise tolerance with effective heart failure therapy lags behind hemodynamic improvement.
 ...
PMID:Regional blood flow in congestive heart failure: concept of compensatory mechanisms with short and long time constants. 297 Jul 84

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.
 ...
PMID:Drugs in feto maternal medicine. 331 58

Pregnancies in which fetal cardiac arrhythmias are present are associated with an elevated perinatal and neonatal mortality. In this group various major and minor fetal malformations, including heart malformations, are more common. FECG and phonocardiogram give some information on the type of arrhythmia in favorable cases. Real-time imaging detects fetal heart malformations and late signs of heart failure. Fetal echocardiogram is of great aid for the classification of the arrhythmia and for the detection of heart malformations. By applying combined real-time linear array and pulsed Doppler technique in cases of fetal cardiac arrhythmia, important information on the fetal circulatory state can be obtained. Estimations of the volume blood flow guide the clinician in the practical handling of these cases. Volume blood-flow estimations can probably detect imminent fetal heart failure. Therapeutic effects can be followed, and the timing of delivery can be optimized taking the circulatory state into account. Within the fetal heart rate range 50 to 250 beats/min adequate blood circulation is usually maintained in the fetus. The peak velocity, the acceleration, and the rising slope are all increased in the postextrasystolic beat, indicating the existence of postextrasystolic potentiation in the fetal heart. These three parameters can be related to the ventricular filling time, supporting the opinion that the fetal heart follows the rules of the Frank Starling relationship. Fetal arrhythmias constitute also an experimental model for the study of fetal cardiac physiology.
 ...
PMID:Fetal cardiac arrhythmias: Doppler assessment. 332 55

By means of abdominal fetal ECG and non-invasive ultrasound blood flow studies 113 cases of fetal cardiac arrhythmia were classified according to the origin of arrhythmia. Pregnancy outcome was characterized by an increased frequency of fetal distress and heart malformation, and increased fetal and neonatal mortality. The following types of arrhythmia were identified: supraventricular extrasystoles (n = 84), paroxysmal tachycardia (n = 6), sinus bradycardia (n = 3), atrial flutter (n = 1), ventricular extrasystoles (n = 14), and atrioventricular block (n = 5). In 37 cases the combined Doppler and real-time ultrasound technique was used to measure fetal aortic blood flow as a means of studying the circulatory effects of the arrhythmia. Increased peak velocity, rising slope and acceleration were found in the first post-pausal beat after a supraventricular extrasystole or a missed beat; this supports the validity of Frank-Starling law for the fetal heart and suggests that a strong relationship exists between these variables and myocardial contractility. In two cases of intra-uterine heart failure, the effect of digoxin treatment in utero on the fetal aortic flow variables was studied, results indicating a positive inotropic effect of the drug on the fetal myocardium. The estimation of fetal aortic volume blood flow in cases of fetal cardiac arrhythmia is useful for early detection of fetal cardiac failure, and for monitoring the effects of intra-uterine treatment.
 ...
PMID:Clinical outcome and circulatory effects of fetal cardiac arrhythmia. 347

Cardiac (or myocardial) failure, a major health problem, can be defined using physiologic criteria that consider the adequacy of O2 delivery relative to the body's O2 requirements. In clinical terms, cardiac failure may be described in terms of its chronicity or the extent to which signs and symptoms of right- versus left-sided heart failure are dominant. Congestive heart failure is a clinical syndrome that consists of a constellation of signs and symptoms that arise from congested organs and hypoperfused tissues. Acute cardiac failure occurs because of a decrease in myocardial contractility that can be offset by the Frank-Starling mechanism. In chronic cardiac failure dilatation and myocardial hypertrophy serve to restore ventricular function. Other compensatory responses that are invoked include a salt avid kidney, which mediates an expansion of the intravascular space, and the activation of the adrenergic nervous and renin-angiotensin-aldosterone systems and an increase in circulating arginine vasopressin. The management of acute and chronic cardiac failure can be derived from an understanding of the pathophysiologic mechanisms responsible for their appearance and include improving cardiac performance, as well as the distribution of systemic blood flow to tissues based on physiologic priorities and moment to moment variations in O2 requirements.
 ...
PMID:Pathophysiology of acute and chronic cardiac failure. 361 18


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>