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

In acute and chronic left heart failure peripheral resistance is elevated due to increased sympathetic tone. This should compensate the decrease in stroke volume. In the diseased left ventricle however the augmentation of afterload leads to further reduction of stroke volume and to increase of heart size and myocardial oxygen consumption. This vitious cycle may be interrupted by vasodilators. Drugs like nitroglycerin, mainly acting on the venous system, reduce preload and thereby relieve symptoms of pulmonary congestion (backward failure). Phentholamin on the other hand primarily reduces afterload by an action on the resistance vessels and thereby increases cardiac output (forward failure). Nitroprusside has effects on both, the capacity and resistance vessels. So nigroglycerin is the remedy of choice in acute pulmonary edema. Nitroprusside in leftf heart failure in acute myocardial infarction and Phentolamin in acute left ventricular failure due to critical rise in blood pressure. For long term treatment of chronic left heart failure (coronary heart disease, cardiomyopathy, rheumatic heart disease) hydralazin or prazosin may be used as well as long acting nitrates.
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PMID:[Progress in the therapy of acute and chronic cardiac insufficiency by means of systemic vasodilators. Studies with prazosin and nitroglycerin]. 12 80

The purpose of the present study was to investigate the effect of the dose of nitroglycerin (NTG) on myocardial ischemic injury. In 20 closed chest dogs the anterior descending branch of the left coronary artery was occluded by inflating a balloon in its lumen. Compared with the untreated control group the sigma ST elevation was significantly lower when NTG was applied at a rate of 0.02 mg/min, but significantly higher when NTG was administered at a rate of 0.10 mg/min. In 12 patients with acute myocardial infarction NTG was infused at a rate of 3 mg in the first hour (0.05 mg/min) and 6 mg in the second hour (0.1 mg/min). Sigma ST elevation and sigma ST depression decreased during the lower infusion rate (p less than 0.001). When the rate of NTG infusion was raised to 6 mg/hr, the improvement in ST segment deviation was partially reversed. This effect, particularly evident in patients not in heart failure, was associated with a significant rise in heart rate (p less than 0.05) and a fall in diastolic arterial pressure (p less than 0.025). Patients with left ventricular failure were less sensitive to higher doses of NTG than those without failure. Thus, the effect of NTG on myocardial ischemic injury depends on the NTG dose and on the functional state of the injured left ventricle.
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PMID:Nitroglycerin in acute myocardial infarction. X. Effect of small and large doses of nitroglycerin on sigma ST segment deviation -- experimental and clinical results. 12 66

An investigation into the fractional composition of myocardial proteins and ATP-ase activity of myosine in 86 persons, who during their lifetime suffered from hypertensive disease and coronary incompetence, revealed significant changes therein. An increased content of actomyosine complex proteins in hypertensive disease was superseded by their considerable diminution in the event of developing cardiac insufficiency, which was at that accompanied by declining ATP-ase activity of myosine. The development of acute myocardial infarction led to a still drastically reduced concentration of sarcoplasmatic and contractile proteins of the heart muscle, as well as to their diminished enzymatic activity.
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PMID:[Contractile myocardial proteins and their enzymatic activity in hypertensive disease and coronary atherosclerosis]. 12 91

Sixty-four patient with acute transmural myocardial infarction had daily echocardiograms while in the coronary care unit. Patients with previous infarction were excluded. The electrocardiographic site of infarction was anterior wall in 28, inferior wall in 33 and both anterior and inferior wall in 3 patients. Echocardiograms satisfactory for interpretation were obtained in 92 percent of cases. Abnormal left ventricular wall motion corresponding to the electrocardiographic site of infarction was seen in the echocardiogram in 84 percent of cases. Exaggerated normal motion in noninfarcted areas was seen in 30 percent. The left ventricular internal dimension correlated with clinical heart failure (P less than 0.005) and was increased in 50 percent. Abnormal mitral valve closure, which reflects increased left ventricular end-diastolic pressure, was present in 33 percent. This finding did not correlate significantly with clinical heart failure. By combining the measurements of left ventricular internal dimension and mitral valve closure, it was possible to predict hospital mortality from the echocardiograms. The results indicate that echocardiography is a useful technique in the study and management of patients with acute myocardial infarction.
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PMID:Echocardiography in acute myocardial infarction. 12 33

In cardiac failure unresponsive to digoxin and diuretics, afterload reduction brings about a dramatic increase in cardiac output, renal perfusion and responsiveness to diuretics; furthermore, the decrease in venous pressure relieves the dyspnoea. Intravenous vasodilators should only be used when sophisticated haemodynamic monitoring equipment and experienced physicians are at hand. Indications for the use of these agents are severe cardiac failure, acute myocardial infarction complicated by left ventricular failure, persistent ischaemic pain and limitation of infarct size. A wide variety of oral vasodilator agents is available, all having different sites of action; the choice of vasodilator agents should be tailored to the needs of the patient. Treatment with these agents is indicated in patients in whom cardiac failure becomes refractory to conventional therapy with digoxin and diuretics. The utmost care must be taken to avoid further impairment of cardiac output by excessive reduction of the left ventricular end-diastolic pressure (LVEDP) and hypotension, which will jeopardize myocardial, renal and cerebral perfusion.
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PMID:The use of vasodilator agents in the treatment of heart failure. 15 2

Serial chest x-rays were used as a means of evaluating the hemodynamic status of 43 patients in acute left ventricular power failure (LVPF) complicating acute myocardial infarction who were assisted with balloon pumping. The following findings were reported: 1. In patients with acute myocardial infarction, prediction of the hemodynamic status on the basis of chest x-rays is less reliable when severe LVPF is present as a complication. 2. The incidence and severity of roentgenographic findings of congestive heart failure and pulmonary edema are increased in patients with severe LVPF compared to patients with uncomplicated myocardial infarction. 3. Improvement in the roentgenographic degree of heart failure with positive clinical and hemodynamic responses to 24 hr or less of balloon pumping is an indication that patients in severe acute LVPF may survive. Patients with deteriorating or unchanging chest x-ray findings have an extremely poor prognosis. These patients should be evaluated by cardiac catheterization and coronary arteriography to determine the appropriateness of emergency surgical correction.
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PMID:The chest x-ray in acute left ventricular power failure: an aid to determining prognosis of patients supported by intraaortic balloon pumping. 17 71

To date, pump failure and its extreme manifestation, cardiogenic shock are the most common cause of death in patients with acute myocardial infarction. Post-mortem studies have shown that primary (myocardial) cardiogenic shock does not occur until some 40 to 50% of the myocardium has been rendered nonfunctional. Not infrequently, cardiogenic shock is mainly the result of a mechanical lesion (mitral regurgitation secondary to papillary muscle dysfonction or rupture, or ventricular septal defect) superimposed upon an ischemic and infarcted ventricle. In both situations medical therapy usually produces only a limited effect. Numerous physiological studies have shown that balloon pumping can reduce the workload and oxygen demands of the heart while increasing coronary blood flow and cardiac output. Most patients with cardiogenic shock can be at least temporarily stabilized, but many patients are balloon-dependent in the sense that when circulatory support is temporarily discontinued, shock or severe heart failure recurs. In these patients, some attempt to correct the underlying anatomic abnormalities appears necessary if they are to survive. Early intra-aortic balloon pumping (IABP) and surgery is much more effective in patients with cardiogenic shock secondary to mechanical complications. Finally, the combination of IABP and surgery has resulted in survival of approximately 50% of patients with cardiogenic shock either primary or secondary.
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PMID:[Cardiogenic shock in acute myocardial infarction (author's transl)]. 22 Jul 24

In patients with severe heart failure there is increased sympathetic-adrenergic activity functioning as a compensatory mechanism. Despite of increased plasma catecholamine levels myocardial sensivity to catecholamines administered for therapeutic reasons is not diminished. The positive inotropic effect of catecholamines is more pronounced as compared to digitalis glycosides. The therapeutic efficacy of catecholamines, particularly their capability to increase cardiac output, is strongly dependent on their action on alpha- and beta2-receptors. In order to enhance cardiac performance, catecholamines are mainly used under three clinical settings: 1. severe heart failure and cardiogenic shock secondary to acute myocardial infarction, 2. 'Low cardiac output syndrome" following cardiac surgery, and 3. chronic congestive heart failure refractory to therapy with glycosides and diuretics. The use of catecholamines in the presence of acute myocardial infarction may be hazardous due to the accompanying increase of myocardial oxygen consumption. Among the available catecholamines, clinical interest recently focused on dopamine and dobutamine. Particularly with the primarily cardioselective beta-stimulating agent dobutamine a marked positive inotropic effect can be achieved in a range of dosage not significantly affecting heart rate and peripheral resistance. Positive inotropic agents may be even more effective when used in combination with vasodilators, which decrease impedance to left ventricular ejection.
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PMID:[Catecholamines for treatment of severe heart failure (author's transl)]. 22 42

Twenty-one patients with postinfarction angina (2 to 15 days after acute myocardial infarction) unresponsive to medical therapy were treated by intra-aortic balloon pumping (IABP). Anginal pain and electrocardiographic (ECG) ST-segment changes were prevented in all patients. Coronary angiograms were obtained during IABP without complication and confirmed severe coronary artery disease. Of the four nonoperated patients, three had reinfarction and two died of cardiogenic shock. Seventeen patients underwent aorta-coronary bypass grafting, associated with aneurysmectomy in two patients and closure of a ventricular septal defect in one. Sixteen patients survived the operation. All survivors are in clinically improved condition and 14 are pain free from 9 to 28 months postoperatively, but three have mild heart failure.
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PMID:Treatment of post-myocardial infarction angina by intra-aortic ballon pumping and emergency revascularization. 30 68

The work demonstrates the efficacy of glucagon in acute myocardial infarction and its complications, particularly in bradycardia, hypotension, disorders of cardiac rhythm and conduction, cardiogenic shock, cardiac insufficiency in complete atrioventricular heart block and recurrent forms of ventricular fibrillation. A differential approach and dynamic control over the effect of the drug on the values of hemodynamics, respiration, and metabolism are necessary under the conditions of units of intensive therapy and cardioresuscitation.
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PMID:[Differential use of glucagon in acute period of myocardial infarct]. 31 54


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