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

Although it has been known for more than a century that digitalis glycosides exert a powerful beneficial effect on patients with heart failure, atrial fibrillation and a rapid ventricular rate, it was believed for many years that the drug exerts this clinical effect primarily by slowing the heart rate. It was also thought that the extra-cardiac vascular actions of digitalis might be responsible for its therapeutic effect. It has now been established that cardiac glycosides cause arteriolar and venous constriction in a variety of mammalian species including human beings, and that this vasoconstriction involves the coronary vascular bed as well, but it is believed that these actions are not responsible for any beneficial clinical effect. A variety of investigations on cardiac muscle in vitro, anesthetized and conscious dogs and anesthetized and conscious human subjects have shown that cardiac glycosides improve the contractility of failing mammalian myocardium. It has become clear that digitalis also stimulates the contractility of the nonfailing heart. The degree of augmentation of contractility induced by cardiac glycosides is related inversely to the baseline contractile state. Myocardial oxygen consumption, which is increased in the normal heart by the positive inotropic action of glycosides, is actually reduced or remains constant in the failing heart. Cardiac glycosides increase the contractility of the globally ischemic heart, but their actions in chronic ischemic heart disease with regional impairment of function are complex. Deterioration of segmental performance occurs in ischemic and necrotic segments, while improvement of contractility occurs in adjacent normal segments.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of digitalis on the normal and the failing heart. 388 52

On the basis of clinical examination and the results of bicycle ergometry and echocardiography in 58 patients with chronic ischemic heart disease the authors determined the contingent of patients in whom long-acting nitrates were most effective. The high clinical effectiveness of the agents in patients with symptoms of the initial stage of cardiac insufficiency is proved and the absence of any essential differences between long-acting nitrates in the character of their effect on hemodynamics is shown. It is established that nitroglycerin and long-acting nitrates cause a qualitatively similar effect on myocardial contractile function and intracardiac hemodynamics in patients with ischemic heart disease.
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PMID:[Modern aspects of nitro preparation use]. 678 20

Three children with congenital heart disease died after surgical procedures involving the placement of valved extracardiac conduits; their deaths were caused by myocardial ischemia following coronary artery compression by the metallic stent of the conduit valve. The first and second patients died of acute myocardial ischemia or infarction during the immediate postoperative period, whereas the third patient died of chronic myocardial ischemia and progressive heart failure several months after the operation. In a fourth patient the problem of possible coronary artery compression was suspected on completion of the surgical procedure, and the valve stent was then repositioned away from the coronary artery; this resulted in marked hemodynamic improvement. Fatal myocardial ischemia from coronary artery compression is a rare but potential complication of valved extracardiac conduit placement in children with congenital heart disease. Preoperative assessment of coronary artery distribution is indicated in those patients with prior intrapericardial operations and subsequent pericardial adhesions. Such assessment in previously unoperated patients may be undertaken at the time of conduit operation. Proper conduit placement and intraoperative recognition of possible coronary artery compression by the conduit are important in preventing significant ischemic complications.
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PMID:Coronary artery compression with fatal myocardial ischemia. A rare complication of valved extracardiac conduits in children with congenital heart disease. 683 74

The ultrastructure of the contractile myocardium of the left ventricle of the heart in chronic ischemic heart disease was studied in 24 puncture myocardial biopsies. Marked dystrophic changes were revealed in the cell organelles, both in the membrane systems and in the myofibrillary apparatus, which the authors believe were caused by long-term increasing ischemia of the organ. Besides dystrophy, signs of intracellular regeneration were found in some myocytes. These signs were the presence of euchromatin in the nuclei of the myocytes, and increase in the amount of RNA granules and granular sarcoplasmic reticulum in the sarcoplasm. The prevalence of dystrophic changes on the level of the myocyte ultrastructure may be among the causes of cardiac insufficiency in patients with chronic ischemic heart disease.
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PMID:[Ultrastructure of the contractile myocardium in chronic ischemic heart disease]. 739 78

Electrical and mechanical integration between myocytes is mediated by three types of intercellular junction, the fascia adherens, desmosome and gap junction. Gap junctions are responsible for electrical coupling, and consist of clusters of plasma membrane channels that directly link the cytoplasmic compartments of neighbouring cells. Each channel consists of two hemichannels (connexons; one from each plasma membrane) aligned across the narrow extracellular gap, and each hemichannel is constructed from six connexin molecules. Using specific anticonnexin43 antibodies for immunofluorescence localization in combination with confocal laser scanning microscopy, alterations in the expression of connexin43 gap junctions have been investigated in chronic ischaemic heart disease and heart failure due to ischaemic cardiomyopathy. Two major alterations are apparent: (1) disturbance in the spatial distribution of gap junctions at the border zone of healed infarcts, and (2) reduction in the quantity of immunodetectable connexin43 in regions of normal gap junction distribution distant from infarct scars. These changes are likely to contribute to electromechanical dysfunction in ischaemic heart disease and heart failure, and appear to form part of a wider pattern of altered expression of different connexin types in the diseased heart.
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PMID:Gap junction alterations in the failing heart. 771 14

The objective of this study was to describe the health problems of a group dementia patients on admission and during residence in a Dutch nursing home and to compare these with figures of patients of 75 years and over from general practice. In 890 nursing home patients suffering from dementia prevalence of health problems on admission and the incidence during the residence were classified by means of the ICHPPC-2-defined. The differences between men and women were studied as was the influence of the season on the incidence during the stay. Results were compared with figures of patients of seventy five year and over from the continuous morbidity registration (CMR) from 'Nijmegen'. The most frequently occurring health problems on admission were: varicose veins of legs, acquired deformation of the spine, presbyacusis, hypertension, arthrosis, COPD, cerebrovascular disorders, heart murmur, cataract and chronic ischemic heart disease. During the residence the following health problems were frequently diagnosed: urinary tract infection, side effect of medicine, constipation, pneumonia, pressure sore, feeding problem, contusion, heart failure, cold and conjunctivitis. There were clear differences between men and women. Especially the incidence of intercurrent diseases showed great differences from the patterns in general practice. Prevalence of health problems on admission to the nursing home home agreed mor with figures from general practice. Respiratory tract infections frequently occurred in winter and urinary tract infections, pressure sores and conjunctivitis seemed to occur more in the summer. Nursing home patients with dementia have a lot of chronic and intercurrent health problems. They differ clearly from patients in general practice.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Incidence and prevalence of health problems in a group of nursing home patients with dementia. A comparison with family practice]. 780 16

The noninvasive assessment of myocardial viability has proved clinically useful for distinguishing hibernating myocardium from irreversibly injured myocardium in patients with chronic ischemic heart disease or recent myocardial infarction who exhibit marked regional and global left ventricular dysfunction. Noninvasive techniques utilized for detection of viability in asynergic myocardial regions include single-photon-emission CT perfusion imaging with 201Tl or one of the new 99mTc-labeled perfusion agents, positron emission tomographic imaging of perfusion and glucose uptake, low-dose dobutamine echocardiography for assessment of inotropic reserve, and contrast echocardiography for evaluation of microvascular integrity. The greater the number of viable myocardial segments by any of these techniques, the greater is the probability of improvement in regional and global left ventricular function, improvement in heart failure symptoms and functional capacity, and enhanced survival after revascularization. Patients with a decreased left ventricular ejection fraction and extensive myocardial viability treated medically have a high cardiac event rate. Similarly, patients with poor viability preoperatively who still undergo coronary bypass surgery have a high rate of early and late cardiac death or need for transplantation compared with patients with greater viability. Finally, some patients with severe ischemic cardiomyopathy referred for cardiac transplantation may have substantial zones of hibernation and may still be candidates for coronary bypass surgery, even in the absence of angina.
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PMID:Assessment of myocardial viability. 935 73

Using a model of chronic ischemic heart disease (recurring coronary insufficiency against the background of chronic hypercholesterolemia), regularities were studied of the microcirculation rearrangements in the myocardium. Employed in the studies were methods of light optics, electron microscopy, injection, as was morphometry. All structural and functional links of the myocardial microcirculation system were put to study, such as resistive, metabolic and blood-drawing segments of the microhemocirculatory channel, intramyocardial tracts of lymph outflow, and interstitium as a direct carrier of the intratissue milieu, as well as subepicardial portion of the lymphatic network of the heart. There have been determined the morphofunctional equivalents and morphogenesis of those changes disorganizing the transport processes in the myocardium under the above type disorder, such as changes in microhaemodynamics, permeability of the histohematic barrier, lymph outflow, and intermediary exchange; there have also been analysed the pathogenetic interrelations thereof. The results obtained suggest that dysfunction of the myocardial system of microcirculation should have a part as a local tissue factor of pathogenesis of cardiac insufficiency in ischemic heart disease.
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PMID:[The transport-trophic support of myocardial function in the modelling of chronic ischemic heart disease]. 947 76

A specific treatment for Chagas' disease has not yet been discovered, even though the condition is endemic in large parts of the Region of the Americas. Earlier studies have addressed the possibility that the sulfatide galactocerebroside in Trypanosoma cruzi behaves as an immunogen involved in the production of the high antisulfatide antibody levels found in patients with chronic infestation with the parasite. This may be an important factor in the pathogenesis of the cardiac symptoms and peripheral neuropathy seen in Chagas' disease, which is the most important cause of myocarditis in Central and South America and the second most important cause of heart failure in several of the countries located in these subregions. The present study was conducted in order to ascertain whether patients with Chagas' disease and other patients not afflicted with the ailment differ insofar as the presence of antibodies against sulfatide is concerned, and it describes antisulfatide antibody levels in 124 hospital patients (74 men and 50 women) between the ages of 15 and 94 who were in the cardiology unit of Vargas Hospital in Caracas from 1 July to 30 June 1995. Antisulfatide antibody titers were determined by means of enzyme-linked immunosorbent assays (ELISA), and the antigen employed was sulfatide cerebroside obtained from bovine brain tissue. Of the 124 patients under study, 39 (31.5%) suffered from Chagas' disease and had antisulfatide antibody levels higher than those detected in patients without Chagas (P = 0.0298) and in 28 seemingly healthy controls (P = 0.0035). Serum levels of antisulfatide antibodies in patients with other forms of heart disease were also compared with those seen in the control group, and significantly higher levels were found in patients with acute ischemic heart disease (P = 0.0049), rheumatic valvular heart disease (P = 0.0075), chronic ischemic heart disease (P = 0.0464) and bradiarrythmias (P = 0.0157), and significantly lower ones in subjects with hypertensive heart disease (P = 0.0367). These antibody levels showed no correlation with clinical or paraclinical variables indicative of the degree of cardiac compromise. Our results support the notion that antibodies against sulfatide may play a role in the pathogenesis of Chagas' cardiomyopathy and other forms of heart disease and should be further studied in an effort to determine their potential role in these processes.
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PMID:[Anti-sulfatide antibody titers in patients with chronic Chagas disease and other forms of cardiopathy]. 960 14

Cardiac transplantation is the treatment of reference for refractory cardiac failure but the limited number of donors, the complications inherent to transplantation and the relative and absolute contra-indications has made it necessary to find alternative surgical solutions. The detection of myocardial viability by Thallium scintigraphy, Dobutamine echocardiography and/or position emission tomography in coronary disease, allows identification of zones which are capable of recovering contractile function after revascularisation. The authors report the results of a series of 91 operated patients with a 10 year follow-up having a 72% 5 year actuarial survival and improved ejection fraction. The other alternative which may improve symptoms and prognosis in patients with severe ischaemic heart disease with left ventricular dysfunction is apical remodelling or Dor's procedure. The results of a haemodynamic study at 1 year of 171 patients clearly show a functional improvement and an increase of the ejection fraction. The advantage of this method is that it can be used in patients with dyskinetic and akinetic plaques resulting from antero-septo-apical infarction. Finally, even if mitral regurgitation is relatively uncommon in chronic ischaemic heart disease, a simple procedure (annuloplasty) is often sufficient to correct the mitral regurgitation and reduce the afterload of a failing ventricle. On the other hand, in dilated cardiomyopathy, two new options have been developed; one, suggested by Steven Bolling, proposes simple mitral annuloplasty whatever the underlying cause (primary or ischaemic cardiomyopathy) with symptomatic improvement and better haemodynamics in terms of increased cardiac output and oxygen consumption on exercise and an actuarial survival much higher than that of cardiac transplantation at one and at two years. The most recent innovation is the Batista procedure which is a method of ventricular reduction associated with correction of mitral regurgitation. The authors have assessed 20 patients for this operation at the Foch Hospital by Dobutamine echocardiography and 5 patients underwent the procedure. All 5 patients reported symptomatic improvement but some had an unchanged haemodynamic status. Others improved at rest and some improved on exercise. The Cleveland Clinic series reported results in 57 cases. Whichever alternative method tested, there is a significant functional improvement but the cardiac output does not always increase. There are no comparative prospective randomised studies and strict selection of patients is required, a problem not yet resolved for all indications. The advantages of these procedures are certain as there is no waiting list, the functional results in good indications have been demonstrated and, if necessary, secondary orthotopic cardiac transplantation is always possible.
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PMID:[Alternative surgical options to heart transplantation]. 986 12


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