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

Since September 1970, we have operated on 55 patients with intractable right-sided endocarditis. All patients were addicted to heroin. Fifty-three underwent tricuspid valvulectomy without replacement and in addition two had pulmonic valve excision. Twenty-four patients (49%) returned to their drug addiction. Six patients (11%) required prosthetic heart valve insertion 2 days to 13 years later for medically refractory right-sided heart failure, and four of these died. Overall, 16 patients (29%) died, six (11%) within 45 days after the tricuspid valvulectomy. One (2%) of these deaths was related to the operation and five were due to uncontrollable infection. Ten (18%) deaths occurred 9 months to 13 years after the tricuspid valvulectomy. Nine were due to drug addiction and one to progressive right ventricular failure 2 months after prosthetic heart valve insertion and 10 years after the initial valve removal. Of the 39 patients who are alive, 37 (67%) have not required prosthetic heart valve insertion. From our observations we reached the following conclusions: (1) Drug addiction is a recurrent and lethal disease. Among these patients, tricuspid valvulectomy without replacement is the operation of choice for the management of intractable right-sided endocarditis; (2) after tricuspid valvulectomy without replacement, only six of 55 patients (11%) had required prosthetic heart valve insertion to control medically refractory right-sided heart failure; (3) in a small percentage of patients the absence of the tricuspid valve may lead to severe and permanent impairment of right ventricular function.
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PMID:Tricuspid valvulectomy without replacement. Twenty years' experience. 196 Sep 98

The cause of severe right heart failure and of equal diastolic pressures in both ventricles (as seen in constrictive pericarditis) in a 56-year-old woman was suspected to be cardiac amyloidosis on the basis of findings in both the echocardiogram (biventricular hypertrophy) and the electrocardiogram (prominent Q waves, absent hypertrophy signs). The endomyocardial biopsy was at first unremarkable. But later, serial modified Congo-red staining unequivocally demonstrated amyloid deposits. In a second case, a 66-year-old man with global cardiac failure and echocardiographic pointers towards hypertrophic cardiomyopathy, was treated with verapamil, 240 mg daily. When this was not tolerated he was hospitalized. He, too, had prominent Q waves but no signs of ventricular hypertrophy. Cardiac amyloidosis was confirmed by biopsy. Both cases underline the special importance of echo- and electrocardiographic changes, taken together, in the diagnosis of cardiac amyloidosis.
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PMID:[Significance of electro- and echocardiogram for the diagnosis of cardial amyloidosis]. 198 99

Thirty-eight cases of infective endocarditis (IE) were observed between 1976 and 1989 (1.3% of all cardiac disease). Thirty two cases were retained for study based on Von Reyn's criteria: 28 native valve endocarditis (27 left and 1 right heart valves) of which 18 occurred on previously undiseased valves (56.3%); 4 cases of left heart prosthetic valve endocarditis. The average age of the patients was 27.5 +/- 14 years and the group comprised 24 women and 8 men (p less than 0.001). Blood cultures were negative in 13 cases, revealed a Gram negative pathogen in 8 cases, a streptoccocus in 3 cases. Blood cultures were not performed in 2 cases. The IE was acute in 18 cases (56.7%) and subacute in 14 cases (43.7%). The dominant clinical signs were of massive and sometimes acute valvular regurgitation (mitral: 21 cases; aortic: 10 cases; mitral and aortic: 3 cases; tricuspid: 1 case). Twenty-six patients had cardiac failure (81.2%): LVF: 15 cases, congestive cardiac failure: 10 cases, RVF: 1 case. The other complications were embolic: cerebral (3 cases), mesenteric (1 case), pulmonary (4 cases). Antibiotic therapy was prescribed in all patients; surgery was required in 9 cases. There were 12 fatalities (37.5%), 10 in the medically treated group and 2 in the surgical group (p less than 0.05). The results show that the prognosis of IE in underdeveloped regions remains poor. Effective strategies of early diagnosis and treatment are urgently required to reduce the high mortality. Prophylaxis of IE should commence with measures to counter the portals of entry of the pathogens and the valvular sequellae of acute rhumatic fever.
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PMID:[Infectious endocarditis in the University Hospital Center of Brazzaville. A study of 32 cases]. 212 13

We evaluated the limits of recovery of decompensated hearts experimentally and clinically and studied the problems of applying a left ventricular assist device (LVAD). In the chronic experiments, 16 adult goats were studied as follows: Group I consisted of seven with left ventricular infarction in a 70-80% area of the free wall induced by the multiple-ligation method; Group II, three with infarcted areas larger than 80% of the free wall; Group III, three with a 30 min anoxic arrest, and Group IV, a 45-min anoxic arrest. An LVAD was applied in all goats, and a right ventricular assist device was applied simultaneously for two goats in Group IV. Clinically, 21 patients receiving treatment with an LVAD from December 1982 to September 1988 in our center were examined. No goat in Groups II and IV could be weaned from the LVAD. Thus, the severity of artificial heart failure in Groups I and III was considered to be the limit for accomplishing restoration. In successfully-weaned cases, both in experimental and clinical settings, periods of LVAD therapy with or without IABP were less than two weeks, which was thought to be the upper time limits for LVAD application. All but one successfully-weaned patients were alive in the experiment, while clinically many patients died of multiple organ failures regardless of the results of the LVAD assistance. Analysis of data suggested that the difference was caused by the durations of the LVAD applications and weanings, the degree of right ventricular failure, the doses of catecholamine used, and the systemic care afforded, especially during tracheal intubation.
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PMID:[Recovery of severely decompensated hearts with a left ventricular assist device]. 213 10

Critical mitral stenosis in selected patients may be treated successfully with percutaneous mitral valvuloplasty. Complications of this procedure, particularly an atrial septal defect following transseptal approach, are generally of minor clinical significance. We describe a woman who initially underwent a successful percutaneous double-balloon mitral valvuloplasty via the transseptal approach. Three months later she presented with right-sided heart failure. Color Doppler echocardiography and cardiac catheterization demonstrated an atrial septal defect (ASD) as well as restenosis of the mitral valve. We conclude that significant ASDs may occur following transseptal mitral valvuloplasty with appearance of right ventricular failure and that color Doppler imaging aids in the diagnosis of this new variant of the classical Lutembacher syndrome.
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PMID:Acquired Lutembacher syndrome or mitral stenosis and acquired atrial septal defect after transseptal mitral valvuloplasty. 220 72

The effect of digoxin in the treatment of decompensated chronic cor pulmonale was investigated in a randomized double-blind, cross-over, placebo-controlled trial. A total of 34 successive patients with evident right heart failure were included in the study. The mean maintenance daily dose of digoxin was 0.30 +/- 0.03 mg with the mean serum level of 1.7 +/- 0.7 nmol/L. The severity of heart failure was assessed according to a clinicoradiographic scoring system (Heart Failure Score). The heart failure worsened during the placebo-period in eight (23.5%) patients (four with atrial fibrillation, two with a third heart sound (S3), one with a cardiothoracic ratio of more than 0.5 and one with sinus rhythm). By regression analysis, the heart failure significantly worsened only in the subgroup of patients with atrial fibrillation. Digoxin was successfully (without worsening of the heart failure) discontinued in 26 (76.5%) patients. No significant improvement was observed in the patients with S3 gallop. It was concluded that digoxin had no beneficial effect in chronic cor pulmonale patients with heart failure, except in those with atrial fibrillation.
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PMID:Role of digoxin in right ventricular failure due to chronic cor pulmonale. 222 40

To evaluate the effectiveness of a pediatric ventricular assist device (VAD), hemodynamic effects of the VAD were investigated experimentally in two types of postoperative profound heart failure models of congenital heart disease. In the model I Fontan or modified Fontan operation model, right ventricular pump function was excluded surgically and a shunt between the right atrium and the pulmonary artery was constructed in four dogs. With a VAD between the left atrium and the aorta, pressure gradient across the lung and the cardiac output increased. Right ventricular failure was induced surgically and high pulmonary vascular resistance was made by injection of glass beads in five dogs in model II. Cardiac output increased and the right atrial pressure decreased when a VAD between the right atrium and the pulmonary arterial trunk was activated. In conclusion, the VAD will become a promising modality to manage pediatric profound heart failure cases.
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PMID:A pediatric ventricular assist device: its development and experimental evaluation of hemodynamic effects on postoperative heart failure of congenital heart diseases. 230 77

We have reviewed the clinical and investigative findings in 13 patients with chronic pericardial disease and seropositive rheumatoid arthritis. In eleven cases the diagnosis was made on clinical grounds, while the diagnosis was confirmed only at post-mortem in two patients. Pleural effusions were present in seven patients, while pulsus paradoxus was found in only one case. Echocardiograms were undertaken in ten patients and all showed evidence of pericardial effusions, which were usually small and sited posteriorly. A delayed ventricular filling pattern indicating abnormal ventricular relaxation was seen in two patients with cardiac tamponade. The surviving 11 patients were reviewed a median of three years after diagnosis of their pericardial disease. Pericardectomy had been performed in six, all of whom were asymptomatic and had a normal chest radiograph. Steroids alone had been given to the other five, and three of these remained dyspnoeic with cardiomegaly. The clinical features distinguishing chronic pericardial disease from other causes of right heart failure in rheumatoid arthritis patients are subtle. As management is fundamentally different, serious consideration should be given to the diagnosis of chronic pericardial disease in any patient with rheumatoid arthritis who presents with right-sided heart failure.
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PMID:Chronic pericardial disease in patients with rheumatoid arthritis: a longitudinal study. 238 97

Right ventricular failure is relatively frequent and constitutes one of the causes of post-operative heart failure. Few drugs are available to treat right ventricular failure. We present a simple and effective means of mechanical support available in all cardiovascular units: counterpulsation in the pulmonary artery. Our experience and a review of the literature have enabled us to determine the indications for this method to support a failing heart.
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PMID:[Right ventricular assistance by intrapulmonary counterpulsation]. 249 74

Unlike the left ventricle, the right ventricle is a thin-walled, low-pressure, volume-displacement pump that ensures adequacy of left ventricular filling and maintains a low pressure in the venous system. In healthy human subjects, there is no burden for right ventricular systolic emptying, because normal pulmonary vessels have a low impedance and show a passive recruitment when cardiac output increases. However, under a pathological condition like right-sided heart failure, the right ventricle may exert profound influences on the circulatory state. Right-sided heart failure most often results from primary or secondary pulmonary arterial hypertension. Pharmacologic vasodilation of the hypertensive pulmonary vascular bed is an ideal therapy for right-sided heart failure. The bipyridine derivative amrinone has positive inotropic and direct vasodilator properties, and therefore seems suitable for the therapy of right ventricular dysfunction accompanied by pulmonary arterial hypertension. In one study, 12 patients with right ventricular failure due to mitral valve stenosis were evaluated, and it was found that amrinone increased cardiac output by 25% and decreased pulmonary artery pressure by 30% to 50%. In a second study, the hemodynamic properties of amrinone versus sodium nitroprusside were compared in patients with aortic or mitral valve failure (n = 17), when both agents lowered systemic vascular resistance equally. Pulmonary vascular resistance decreased significantly (25%) only in the amrinone group.
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PMID:Effects of amrinone on the right side of the heart. 252 Oct 50


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