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

A salt-free diet is usually useless or dangerous in the elderly subject. It has at present only rare indications, such as after acute pulmonary oedema or congestive heart failure during initial treatment. In all other cases, it may be replaced by a reasonable diet; sodium intake remains permitted, but naturally one should not fall in the opposite extreme. As in younger subjects, and provided one takes into consideration the subjacent renal condition, properly prescribed diuretics have transformed the situation in the treatment of heart failure as in essential hypertension. Naturally the patient still requires regular clinical supervision and laboratory tests which may in practice be limited to periodical estimation of blood urea and serum potassium, less regularly, blood sugar and uric acid.
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PMID:[Salt-free diet and diuretics in the elderly (author's transl)]. 21 98

The case files of 4,456 medical admissions in 1975--1976 at Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria, included 354 cardiovascular patients. The most common causes were hypertension (45.5%), cardiomyopathy (20.6%) and chronic rheumatic heart disease (14.4%). The mean age of hypertensive and cardiovascular patients was lower than in Europe. The majority of hypertensive patients suffer from essential hypertension. Congestive cardiac failure is the commonest complication of hypertension and cardiomyopathy. Rheumatic valvular disease with mitral incompetence is frequent and sometimes severe in young people. Other cardiovascular diseases included pericardial disease, bacterial endocarditis, cor pulmonale, anaemic heart failure, congenital and syphilitic heart disease. Coronary heart disease was only encountered in non-Africans. Cardiovascular mortality in hospital was high (20%).
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PMID:Cardiovascular disease in Northern Nigeria. 31 94

The pathological changes in blood vessels observed in primary (essential hypertension) are similar to those seen in secondary hypertension due to renal disease or other causes. In benign hypertension, the major changes are in the small arteries and arterioles especially in the kidney. Interlobular arteries exhibit intimal thickening and duplication of the elastic lamina (elastosis) and there is hyaline change in the media of many arterioles. In some respects these changes are an accentuation of vessel ageing. Malignant hypertension usually presents in a younger age group (35--50 years) and is characterized pathologically by fibrous endarteritis in the interlobular arteries of the kidney and fibrinoid necrosis in the walls of a proportion of the efferent glomerular arterioles. Similar vessel changes are seen in other organs but many of the pathological changes in the heart and brain of patients with benign hypertension are related to the accentuation of arterosclerosis. There is an increased mortality from cardiac failure, myocardial infarction, cerebral haemorrhage and subarachnoid haemorrhage due to ruptured berry aneurysms in patients with benign hypertension. Although there is ischaemic damage to the kidneys in benign hypertension, death from renal failure is uncommon. Severe ischaemic damage to renal glomeruli and renal failure does, however, occur in malignant hypertension.
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PMID:Vascular pathology in hypertension. 46 85

The tolerance and antihypertensive action of acebutolol, as a sole drug and in combination with a diuretic, were studied in a population of 34 female subjects aged over 65 years, with a mean of 81 years, suffering from well tolerated essential hypertension. The study was carried out in the form of double blind permutations, each subject receiving successively in an order determined by random selection each of three therapeutic phases: acebutolol, acebutolol in combination with a diuretic and a placebo. The results showed that in the elderly acebutolol had a moderate diuretic action which was remarkably potentialised by diuretics. The tolerance of this beta-blocker was excellent: no cases of cardiac failure, and no disturbances in atrioventricular conduction developed during the phases with active treatment.
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PMID:[The treatment of hypertension in the elderly using a beta-blocker: acebutolol (author's transl)]. 49 93

Tienilic acid (TA) is a common new diuretic agent with a potent uricosuric action. In a double-blind cross-over study its antihypertensive effect was compared to that of hydrochlorothiazide (HCT). 20 patients with essential hypertension were studied: after I weeks of placebo wash-out 10 patients received TA (dose range 250-750 mg/die) and 10 HCT (dose range 50-150 mg/die), for 5 weeks. Systolic and diastolic blood pressures were significantly and equally reduced (p < 0.001) after the first week of treatment in both groups. While serum uric acid concentration increased after HCT, it was significantly reduced (p < 0.001) after TA treatment. Serum potassium was slightly reduced with both treatments. Serum tryglicerides, unchanged after HCT, showed a slight tendency to reduction on TA treatment. Ten patients with congestive heart failure, on full digitalis treatment, were given TA (dose range 250-1000 mg/die): in each patient a prompt diuretic effect was observed, associated to a significant reduction of body weight and to a marked improvement of the clinical signs of heart failure. Therefore, TA is an effective diuretic agent which may be conveniently used in the treatment of arterial hypertension and congestive heart failure, as it induces a diuretic effect comparable to that obtained with HCT, reducing at the same time, serum uric acid levels.
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PMID:[Tienilic acid in the treatment of arterial hypertension and congestive cardiac insufficiency]. 54 82

The effect of intravenous digoxin (0.01 mg/kg) on ventricular function, coronary arterial haemodynamics and myocardial oxygen uptake was studied in 12 patients with essential hypertension but no heart failure, significant left ventricular hypertrophy and normal coronary arteriogram. There was a definite, velocity-related increase in the inotropic function of the left ventricle, by 19.4%, 50 min after digoxin injection, while ventricular pumping function decreased by between 6.5 and 11.2%. Coronary blood flow through the left ventricle decreased by 8.8%. On the other hand, coronary vascular resistance and coronary arteriovenous oxygen difference increased by 11 and 5.9%, respectively. Oxygen uptake remained essentially unchanged (-2.1%). These results indicate that the increase in inotropism caused by intravenous digoxin in essential hypertension without heart failure produces not only no therapeutically useful improvement in left ventricular pumping function: there is also a coronary constrictor and ischaemia-inducing effect on the coronary arterial system.
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PMID:[The hypertensive heart. VI. Ventricular function and coronary artery haemodynamics as influnced by digitalis glycosides (author's transl)]. 69

After acute beta-adrenergic blockade (5 mg atenolol intravenously) in 11 patients with essential hypertension but no heart failure arterial blood pressure and inotropic state fell slightly (-5.4% and -7.5%, respectively), but there was a definite decrease in heart rate (-13.8%), cardiac index (-11.5%) and cardiac work (-14.3%). There was a marked decrease in coronary blood flow (-14.5%) and myocardial oxygen uptake (-13.6%), while the coronary arterio-venous oxygen difference remained normal. Coronary vascular resistance increased significantly (+12.7%). Atenolol increased the coronary reserve of the left ventricle by about 21% in the five patients in whom it was measured. The results indicate that during acute beta-adrenergic blockade in essential hypertension there is an effective lowering of the left ventricular systolic load, with an equivalent decrease in myocardial energy requirement. The change in coronary vascular resistance and increase in coronary reserve of the left ventricle during this blockade is apparently the result of metabolic changes.
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PMID:[The hypertensive heart. VII. Effect of atenolol on the function, coronary haemodynamics and oxygen uptake of the left ventricle (author's transl)]. 71 Feb 88

Baroreflex sensitivity (BRS) has not been assessed in coarctation, though it is diminished in renal and essential hypertension. Previous experimental studies of coarctation have dealt primarily with renal mechanisms of hypertension, and have relied on constricting the aorta in adult animals. We banded the thoracic aorta in newborn puppies, and performed studies 2 yr later. Blood pressure (BP) elevations, abundant chest wall collaterals, the absence of heart failure, and subsequent necropsy confirmed the full syndrome of natural coarctation in all dogs. Transient BP elevations were induced in conscious, unrestrained dogs with intravenous phenylephrine injections. Reflex bradycardia was quantitated by plotting each pulse interval in microseconds against BP of the preceding beat, and expressing BRS as the linear regression coefficient (slope) in ms/mmHg. Mean BRS in 10 dogs with coarctation did not differ significantly (P greater than 0.1) from 8 normal controls. Carotid sinus diameter (CSD) was also assessed. Carotid arteries were fixed in vivo by prolonged exposure to glutaraldehyde to prevent contraction, then were excised and measured in a calibrated microscope. Mean CSD in 10 dogs with coarctation was significantly greater (P less than 0.01) than in 10 control dogs. The unexpectedly normal BRS in experimental coarctation may be due to changes in CSD induced by hypertension; such changes may only develop in growing animals. Experimental studies of coarctation should use a preparation that mimics the natural lesion.
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PMID:Baroreflex sensitivity and carotid sinus dimensions in dogs with coarctation. 78 71

The results of a long-term observation (for 1 to 4 1/2 years) of haemodynamic changes in 32 non-treated patients with stage II essential hypertension are presented. In 18 patients the lesion did not progress throughout the observation period (group I). At re-examination the haemodynamic parameters in this group of patients did not change significantly, although in some of them the haemodynamic mechanism of maintenance of hypertension underwent certain changes: the cardiac output decreased and the total peripheral resistance increased. In 14 patients (Group 2) their essential hypertension was progressively developing. At the same time a deceleration of the heart contractions rate, a reduction of the cardiac and stroke outputs, a decrease of the circulating blood volume, and an increase of the total peripheral resistance were noted. The reduction of the cardiac output was directly proportional to its initial value (r = +0.78, P less than 0.01) and to the elevation of the arterial pressure (r = +0.71, P less than 0.01). The most distinct changes were noted in 3 patients who developed signs of cardiac insufficiency during the period between the two examinations. The possible mechanisms of haemodynamic changes under the progression of essential hypertension are discussed.
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PMID:[Change in hemodynamic indices in progressive hypertension]. 101 52

Whether a person is medically fit to engage in sports depends not only on his or her present state of health but also on his or her previous medical history, age, personality, and of course, the nature of the particular sport in question. Anyone that feels fit, is physically in good condition, abstains from tobacco, alcohol and other intoxicant stimulants, and passes a thorough medical examination is healthy and fully capable of taking part in any sport whatever. Participation in any form of sport, on the other hand, is absolutely contra-indicated for persons suffering from severe or malignant hypertension, inflammatory or bacterial heart disease, severe angina pectoris - especially with an attendant risk of myocardial infarction - or haemodynamically significant arrhythmias that manifest themselves during, or are aggravated by, physical exertion. Physical activity is generally deleterious in patients with advanced pulmonary disease and chronic cor pulmonale, severe decompensated heart failure or severe renal insufficiency. Severe intercurrent infections also constitute an absolute contra-indication for sport. Between these two extremes of absolute fitness and absolute unfitness there are many intermediate states, e.g. diseases like essential hypertension (WHO Stages I and II), coronary disease and peripheral arterial circulatory disorders, in which patients can derive considerable benefit from properly chosen and carefully graded sporting activity.
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PMID:[Medical fitness for sports, with particular reference to cardiovascular conditions]. 102 Apr 74


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