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

The place of digoxin in the pediatric cardiologist's armamentarium remains uncertain. As an antiarrhythmic, its use in the Wolff-Parkinson-White syndrome is obsolete, but it remains useful in the treatment of the chronic atrial fibrillation seen in some patients postoperatively and in children with dilated cardiomyopathy. The efficacy of digoxin in heart failure is unproven. There is some evidence of improvement in non invasive left ventricular contractile indices in neonates and infants, but it is unclear whether this is associated with sustained clinical improvement. There is even less evidence of its effectiveness in the older child. Whilst the measurement of any effect will undoubtedly be difficult, the time has come for double-blind, placebo-controlled trials in selected groups of patients. These should be designed not only to test the notion that digoxin does not improve ventricular function, but also to embrace the possibility that its administration may result in clinical improvement over and above that following diuretics alone. An absence of proof of efficacy must be distinguished from no efficacy--more data are needed.
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PMID:Does digoxin have a place in the treatment of the child with congenital heart disease? 248 20

A fetal cardiac arrhythmia may cause misleading fetal heart rate tracings with unreliable signs of fetal distress. Assessment of such artifacts and of the hemodynamic relevance of a fetal arrhythmia by alternative methods is necessary for management and therapy. A 28-year-old healthy woman was referred at 30 weeks of gestation because of fetal tachy-brady-arrhythmia, but cw-Doppler assessment of umbilical artery blood flow revealed periods of pseudobradycardia during bigeminal and trigeminal fetal pulse. FHR turned to regular tachycardia, and transplacental digitalization was started. Between 32 and 34 weeks the patient discontinued her digitalis intake, and a fetal pericardial effusion indicated subsequent cardiac failure. Serial pulsed Doppler measurements of fetal aortic blood flow were performed and imminent heart failure was recognized after the digitalis was discontinued and before a pericardial effusion occurred. Furthermore, improvement of fetal cardiac performance secondary to restarting digitalis and also prior to resolution of the pericardial effusion. After spontaneous delivery a Wolff-Parkinson-White syndrome was diagnosed, and continuation of digoxin treatment was indicated. Cw-Doppler assessment of umbilical artery blood flow was a suitable method to evaluate questionable FHR recordings, and pulsed Doppler allowed monitoring of the therapeutic effect of transplacental digitalization by serial measurements of fetal aortic blood flow.
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PMID:Evaluation of fetal heart rate artifacts, hemodynamics and digoxin treatment in fetal tachyarrhythmia by Doppler measurement of fetal blood flow--case report of a pre-excitation syndrome. 269 45

The major antihypertensive mechanism of calcium antagonists is by decreasing the systemic vascular resistance, modified by the counter-regulatory responses of the baroreflexes and the renin-angiotensin-aldosterone system. In severe hypertension, the concept that calcium overload of the vascular myocyte could precipitate or aggravate peripheral vasoconstriction provides a logical basis for the use of these agents as first choice therapy; nifedipine, especially, has been well tested. As monotherapy for mild to moderate hypertension each of the three first-generation agents compares well with beta-blockers. Calcium antagonists may have a special role in the therapy of certain patient groups (elderly, black) or in those subjects whose life style involves intense physical or mental exertion (hemodynamics better maintained than with beta-blockade) or in patients with early end-organ damage such as left ventricular hypertrophy or renal insufficiency. However, the goal blood pressure may not be reached during monotherapy so that drug combinations may be required. Further indications for these compounds are as follows. Verapamil and diltiazem are frequently used in supraventricular tachycardias including acute and chronic atrial fibrillation. In the arrhythmias of the Wolff-Parkinson-White syndrome, there is the potential danger of provocation of anterograde conduction. Further indications for calcium antagonists, still under evaluation, include congestive heart failure (controversial), hypertrophic cardiomyopathy (verapamil), primary pulmonary hypertension (high doses required), Raynaud's phenomenon (nifedipine and diltiazem effective), peripheral vascular disease (proof not yet documented), cerebral insufficiency and subarachnoid hemorrhage (nimodipine promising), migraine, exertional bronchospasm, renal disease, atherosclerosis (experimental), and primary aldosteronism (nifedipine inhibits aldosterone release). Second-generation agents include dihydropyridines, such as nitrendipine, nicardipine, felodipine, amlodipine, nisoldipine, nimodipine, and isradipine. From these will be selected agents that are longer acting and provide higher vascular selectivity. New preparations of existing agents include slow-release formulations of nifedipine, verapamil, and diltiazem. Minor side effects include those caused by vasodilation (flushing and headaches), constipation (verapamil), and ankle edema. Serious side effects are rare and result from improper use of these agents, as when intravenous verapamil is given to patients with sinus or atrioventricular nodal depression from drugs or disease, or nifedipine to patients with aortic stenosis. The potential of a marked negative inotropic effect is usually offset by afterload reduction, especially in the case of nifedipine. Yet caution is required when calcium antagonists, especially verapamil, are given to patients with myocardial failure unless caused by hypertensive heart disease. Drug interactions of calcium antagonists occur with other cardiovascular agents such as alpha-adrenergic blockers, beta-adrenergic blockers, digoxin, quinidine, and disopyramide.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Calcium channel antagonists. Part III: Use and comparative efficacy in hypertension and supraventricular arrhythmias. Minor indications. 315 29

Eleven critically ill patients with life-threatening cardiac arrhythmias refractory to currently approved antiarrhythmic drugs were treated with intravenous amiodarone. Two patients had acute myocarditis, five had acute myocardial infarction, two had left ventricular failure secondary to ischemic heart disease, one had Wolff-Parkinson-White syndrome, and one manifested postoperative atrial fibrillation. Eight of the patients had severe cardiac failure and five had hypotension requiring intravenous dopamine. Five patients were treated for recurrent ventricular fibrillation, two for recurrent ventricular tachycardia, and four for recurrent atrial arrhythmias. Six patients had repeated cardioversions. The arrhythmias had lasted a mean of 88.3 hours resistant to a mean of 2.7 different intravenous antiarrhythmic drugs. The ventricular arrhythmias did not recur after commencing intravenous amiodarone, but some minor atrial arrhythmias occurred for 24 hours. One patient died of intractable left ventricular failure, chronic obstructive lung disease, and respiratory arrest during treatment. The dose of amiodarone was 150 mg over 5 minutes, followed by 600 mg/24 hr for 3 to 4 days; one patient on total parenteral nutrition required intravenous amiodarone for 20 days. Hypotension, cardiac failure, and bradyarrhythmias were not induced by this treatment. Intravenous amiodarone can be used safely in critically ill patients with impaired left ventricular function to control life-threatening refractory cardiac arrhythmias.
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PMID:Intravenous amiodarone in the treatment of refractory life-threatening cardiac arrhythmias in the critically ill patient. 395 53

Amiodarone was used in 40 patients with life-threatening or refractory tachyarrhythmias. Eighteen patients had recurrent ventricular tachycardia of whom 13 had suffered a cardiac arrest. Control has been excellent or good in 17 of these 18 patients during an average follow-up period of 10 months. A further 22 patients had supraventricular arrhythmias, including three with Wolff-Parkinson-White syndrome and paroxysmal atrial fibrillation. In 20 of these control has been excellent or good. The mean daily maintenance dose of amiodarone was 300 mg for patients with ventricular tachyarrhythmias and 200 mg for those with supraventricular tachyarrhythmias. Side-effects were common and included corneal microdeposits, skin rash and discolouration, alteration in thyroid function, and symptomatic bradycardia. Serious adverse effects were uncommon however and necessitated discontinuation of the drug in only two patients. Amiodarone did not appear to precipitate or exacerbate cardiac failure in any patient although many had severe left ventricular dysfunction. We conclude that amiodarone is effective in the therapy of life-threatening or refractory cardiac arrhythmias.
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PMID:Amiodarone therapy for life threatening or refractory cardiac arrhythmias. 657 38

Three cases of perinatal paroxysmal supraventricular tachycardia are described. In two patients the tachycardia was present prior to delivery; in the third baby, who also had the Wolf-Parkinson-White Syndrome, the time of onset of tachycardia is not known. The risks of this condition to the foetus are largely unknown but severe intra-uterine cardiac failure can occur. Possible lines of management are discussed.
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PMID:Perinatal paroxysmal supraventricular tachycardia. 686 90

Paroxysmal supraventricular tachycardia causing an intrauterine congestive heart failure was diagnosed in a fetus at 33 week's gestation. After maternal digitalization the tachycardias and the signs of heart failure disappears. Postpartum a Wolff-Parkinson-White syndrome was recognised by electrocardiography. The paroxysmal supraventricular tachycardias of the newborn was terminated abruptly by intravenous application of propafenon. Recurrences were prevented by the oral administration of propafenon.
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PMID:[Wolff-Parkinson-White syndrome with paroxysmal supraventricular tachycardias of the fetus and the newborn--case report]. 714 49

Eleven pediatric Wolff-Parkinson-White (WPW) syndrome patients underwent surgery. Four had left, 5 right cardiac type and 2 had right septal type WPW syndrome. Two patients had 2 accessory conduction pathways (ACP). Ebstein's anomaly and secundum type atrial septal defect were the association congenital cardiac diseases in one patient each. Indications for surgery included repeated and/or long-lasting paroxysmal supraventricular tachycardia (PSVT), ineffective drug therapy, cardiac failure due to frequent tachycardia, short effective refractory period of the ACP, and simultaneous surgery for associated congenital cardiac diseases. Pre- and intra-operative examinations, including ECG, VCG, UCG, body surface mapping, intracavitary recording by catheter electrodes, computerized epicardial mapping, and endocardial mapping, were performed for the precise localization of the ACP. The surgical method was basically the same as is used for adults. Anterior median stermotomy was used primarily in right cardiac and right septal type and left anterior thoracotomy was used in 3 of 4 cases of the left cardiac type. Eight of 11 cases, two of which had 3 ACPs, were completely cured and in 3 there was evidence of postoperative pre-excitation. However, the PSVT attacks disappeared almost completely and drug therapy is not required at present.
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PMID:Surgical treatment of the Wolff-Parkinson-White syndrome in infants and children. 728 37

Encircling endocardial cryoablation, consisting of circumferential cryoablation of the infarct scar, can be curative in selected patients with ventricular tachycardia (VT). We describe our experience with and long-term outcome in 33 patients undergoing this procedure. The interval between myocardial infarction and the onset of tachycardia varied from 2 weeks to 22 years (mean 38 +/- 63 months and median 3 months). All patients had a left ventricular aneurysm (anterior in 20, posterior in 12, and lateral in 1) and significant coronary artery disease. Fourteen patients had clinical evidence of heart failure preoperatively. Twenty-eight patients had sustained monomorphic VT (incessant in 3); 3 had polymorphic or nonsustained tachycardia; 2 had primary ventricular fibrillation; and 1 had associated Wolff-Parkinson-White syndrome. Surgery was undertaken after failed drug therapy and consideration of left ventricular anatomy and function. At surgery, 32 patients had encircling endocardial cryoablation, and 1 patient had partial right ventricular free-wall disconnection (right ventricular infarct). Thirteen patients underwent concomitant coronary artery bypass grafting. An implantable cardioverter defibrillator (ICD) was implanted in 2 patients and prophylactic ICD patches in 1. One patient died postoperatively; 3 had recurrent VT perioperatively; 1 was treated with amiodarone; and 2 had ICD implantation. During long-term follow-up (mean 5 years), all patients who were free of tachycardia at discharge remained alive and free of arrhythmias or syncope. The patient receiving amiodarone sustained a cardiac arrest subsequently and received an ICD implant. One patient with an ICD continued to receive appropriate shocks frequently and died 2 years after surgery. Nine patients had congestive heart failure postoperatively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Encircling endocardial cryoablation for ventricular tachycardia after myocardial infarction: experience with 33 patients. 794 92

A 27-year-old woman with systemic lupus erythematosus and Wolff-Parkinson-White syndrome complicated with refractory tachycardia and class III heart failure treated with pacemaker implantation was described. She had cardiomyopathy that could be due to lupus erythematosus or tachycardia-induced. Nonpharmacologic therapeutic alternative was used and a universal DDD pulse generator with selected programming was chosen. Twenty-four months follow-up showed tachycardia control and regression of symptoms of heart failure to class I as well as improvement of left ventricular function evaluated by echocardiographic method. Thus, pacemaker implant may be an useful alternative approach in patients with tachycardiomyopathy in whose other nonpharmacologic therapeutic options could not be performed.
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PMID:[Regression of tachycardiomyopathy after implant of pacemaker with antitachycardial function]. 824 39


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