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)

Between 1983 and 1989, 69 patients underwent endocardial fulguration for drug-resistant VT which had several relapses per month, or were incessant. The etiologies were an old myocardial infarction, (25 cases) arrhythmogenic right ventricular dysplasia, (19 cases) dilated cardiomyocathy, (9 cases) left fascicular tachycardia, (9 cases) 5 right septal idiopathic tachycardia, and 2 congenital heart disease. The ejection fraction ranged between 12 and 30% in 25 cases. VT originated in 32 patients in the right ventricle, 31 in the left, and 6 had fulguration in both ventricles. 41 patients had 1 session, 22 needed 2, 4 had three sessions and 2 had 4. Five patients died during the procedure, four of low output, and three of them before the shocks. One died of tamponade. Two others had tamponade and were successfully drained. Four patients died during the first 3 months of preexisting heart failure without VT relapse. The remaining patients have a mean follow-up of 32 months, ranging from 3 to 72 months. 32 patients are off drug and had no relapse. 23 had early relapses, and are controlled by previously ineffective drugs. However 3 of these had a late sudden death (4, 14 and 22 months). 9 are treated with a combination of drug not tested before. The success rate ranges from 60% in septal VT to 74% in ARVD, 86% in MI and 100% in idiopathic left fascicular VT. The success rate increases with the number of sessiones. Fulguration alone, or combined with pharmacological agents can be considered as an effective therapy for VT, despite that it is neither simple, nor harmless.
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PMID:[Endocardial fulguration for the treatment of ventricular tachycardia. Experience with 69 cases]. 209 54

Flecainide, a Class IC antiarrhythmic agent, was used in 12 patients with an average age of 57 years to treat spontaneous monomorphic sustained ventricular tachycardia (S-VT, n = 9), with a ventricular rhythm of 203 +/- 41 bpm (5 right bundle branch and 4 left bundle branch block pattern) and non-sustained ventricular tachycardia (NS-VT, n = 3). The patients had ischaemic heart disease (n = 5, including 2 cases of aneurysm), idiopathic dilated cardiomyopathy (n = 1), ventricular dysplasia (right, n = 1; left n = 2; biventricular, n = 1). The remaining 2 patients had no overt cardiac disease on coronary angiography. None of the patients had signs of cardiac failure; the left ventricular ejection fraction was 0.49 +/- 0.7. Before treatment, programmed ventricular stimulation (PVS) induced 12 S-VT (214 +/- 41 bpm) which reproduced the clinical VT in 8 out of 10 cases. A second series of electrophysiological studies was performed after an average of 5 weeks treatment with Flecainide 300 mg/day (200-400 mg). It was not possible to induce VT in 2 patients (17% total prevention); NS-VT replaced S-VT in 4 patients (33%); S-VT was less rapid in 5 patients (at least 50 bpm slower) (41%); one patient had S-VT as rapid as before treatment (9%). The 12 patients were prescribed long-term Flecainide therapy. During follow-up there were 4 early (7, 10 and 15 days) and one late recurrence (16 months) (42% failure rate) whilst the other 7 patients had no further attacks of VT (follow-up of 19.1 +/- 5 months) (58% success rate).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Estimation of the long-term efficacy of anti-arrhythmia treatment with flecainide in ventricular tachycardia]. 210 8

Focal fibromuscular dysplasia of small coronary arteries is not so rare as it is unrecognized. Although sometimes occurring as an isolated abnormality, it more often accompanies a variety of other lesions including inflammation or infiltration. In this review based on personal study of over 1,000 human hearts, the 3 topics include a description of the morphologic characteristics of the lesion, a discussion of its functional consequences affecting coronary flow, and an iteration of theoretical explanations for its development. The typical lesion is focal in distribution, is comprised of both fibrous and smooth muscle elements, and the histologic organization is one of dysplastic array. Included among the subjects discussed in functional consequences are coronary spasm, coronary reserve, chest pain, electrical instability of the heart, and comments on the role of focal fibromuscular dysplasia of small coronary arteries in hypertension, myocardial hypertrophy and heart failure. Theories as to its development include primary faults of smooth muscle or collagen, and focal abnormalities of clotting or neurovascular relation, but it is likely that the cause is multifactorial.
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PMID:Morphologic characteristics and functional significance of focal fibromuscular dysplasia of small coronary arteries. 218 50

Severe bleeding from gastric varices occurred in an 18-year-old male known, since he was three years old, to have liver cirrhosis with beginning protal hypertension. The cause of the portal hypertension was chronic cholestasis due to hypoplasia of the interlobular bile ducts. There was also peripheral pulmonary stenosis with pulmonary hypertension (106 mmHg systolic), and a posterior embryotoxon (arcus juvenilis). Skeletal anomalies, particularly of the vertebrae, and a striking facial dysmorphism provided the features of arteriohepatic dysplasia, Alagille's syndrome, an autosomal dominant disease generally becoming manifest during childhood. As the patient's liver functions were only slightly abnormal, liver transplantation was not indicated and a shunt operation performed. A septicaemia developed on the third postoperative day after an at first complication free course, and he died from right-heart failure.
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PMID:[The Alagille syndrome in an adult]. 239 Sep 42

The cardiothoracic ratio was measured in 410 normal fetuses and in a group of 73 fetuses with functional or structural heart disease. In normal fetuses it was fairly constant throughout pregnancy, but of those with congenital heart disease it was raised in cases of Ebstein's anomaly, tricuspid dysplasia, atrioventricular septal defect, and complete heart block. In some forms of congenital heart disease, however, it was within the normal range. There was a significant positive correlation between the cardiothoracic ratio and fetal hydrops in the group of 15 fetuses with supraventricular tachycardias. In these fetuses the cardiac size decreased significantly once the fetus reverted to sinus rhythm after the mother had been treated. Measurement of the cardiothoracic ratio is essential in the evaluation of fetal hydrops, as an increased value may point to the diagnosis of an intermittent fetal tachycardia if the fetus is assessed during a period of sinus rhythm. The measurement of this index forms a part of the complete prenatal evaluation of structural heart disease. The degree of cardiomegaly may provide useful information about secondary lung compression or cardiac failure and therefore assist in giving an accurate prognosis for postnatal survival.
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PMID:Prenatal measurement of cardiothoracic ratio in evaluation of heart disease. 240 98

Twenty patients aged 55 +/- 16 years with 40 chronic ventricular tachycardias (VT) refractory to 4.6 +/- 1.9 antiarrhythmic drugs, used alone or in combination, were managed by low doses of beta-blocker agents combined with oral amiodarone (Am), either after loading (1.2 g for 7 days, n: 5) or reloading (1.2 g for 4 days, n: 15) of Am. All patients proved refractory to Am alone. Seven VT were also refractory to endocardial catheter fulguration in six patients. Thirteen patients had coronary artery disease, three had arrhythmogenic right ventricular dysplasia, two had dilated cardiomyopathy, one had valvular disease, and one had no structural heart disease. Ten patients had an EF less than 30%. Ten patients were in NYHA functional class three. VT was permanent in three patients, daily in three, weekly in seven, paroxysmal in seven. In 11 patients, VT occurred both at day and night. In 11 patients, decrease of the sinus cycle preceeded VT. Oral administration of a daily low dose of a beta blocker agent (acebutolol 100 mg, betaxolol 5-10 mg, metoprolol 50 mg, nadolol 20-40 mg, pindolol 2.5 mg, propanolol 30 mg, sotalol 80-160 mg, terta-tolol 2.5 mg) combined with 400 mg/day of Am suppressed VT episodes in all patients. None presented heart failure or collapse. The mean reduction of the heart rate was 15% (65 to 55/min). At discharge, exercise ECG (n: 14) induced non sustained VT in two patients. At programmed electrical stimulation (PES) (n: 15), VT was no longer inducible in 4 patients, was slower, well-tolerated in nine patients, and remained inducible at the same rate in only two patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Efficacy and safety of low doses of beta-blocker agents combined with amiodarone in refractory ventricular tachycardia. 246 76

We studied 58 cases of arrhythmogenic right ventricular dysplasia (ARVD). Sustained monomorphic ventricular tachycardia (VT) was present in 50 patients, ventricular fibrillation (VF) in three (two also having VT), and non-sustained VT in the remaining seven. Different morphologies of VT were documented in 24 of the 50 patients with sustained VT. They had a left bundle branch block pattern in 96% of cases, without extreme deviation of the QRS axis, and a QRS relatively narrow and ample. These sustained VTs were triggered by provocative techniques. Holter recordings showed frequent ventricular extrasystoles in the great majority of cases. They were polymorphic in 78%, with runs of VT in 59% of patients. Spontaneous onset of VT occurred during exercise in 60% of cases, preceded by a sinus rate increase when recording was available. This is more frequent in angiographically localized forms of ARVD than in diffuse forms, and tends to disappear during follow-up. Only four cardiac deaths occurred after a follow-up of 8.8 +/- 7.2 years: three by acute heart failure, and only one by recurrent VF. Spontaneous disappearance of VT which became non-inducible was seen in four cases. Single antiarrhythmic drug therapy was judged satisfactory in 21 cases, and combined therapy in 19 other cases. Surgery of fulguration was performed in 17 cases, with 14 successes (nine of them with combined antiarrhythmic therapy). Despite a frequent lack of control of VT by antiarrhythmic drugs, the follow-up of ARVD seems good in patients with sustained VT. Some arguments favour the concept of a diffuse and progressive disease.
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PMID:Characteristics, prognosis and treatment of the ventricular arrhythmias of right ventricular dysplasia. 257 22

Thirty one patients aged 56 +/- 16 years with chronic ventricular tachycardias (VT) refractory to 4.4 +/- 1.8 antiarrhythmic drugs, used alone or in combination, were managed by low doses of beta-blocker agents combined with oral amiodarone, either after loading (1.2 g for 7 days, n : 7) or reloading (1.2 g for 4 days, n : 24) of amiodarone. All patients proved refractory to amiodarone alone. Nine VT were also refractory to endocardial catheter fulguration in 8 patients. Twenty one patients had coronary artery disease, 4 had arrhythmogenic right ventricular dysplasia, 4 had dilated cardiomyopathy, 1 had valvular disease, and 1 had no structural heart disease. Twelve patients had an ejection fraction less than 30 p. 100. Ten patients were in NYHA functional class 3. VT was permanent in 3 patients, daily in 5, weekly in 7, paroxysmal in 16. In 14 patients, VT occurred both at day and night. Oral administration of a daily low dose of a beta-blocker agent (acebutolol 100 mg, betaxolol 5-10 mg, metoprolol 50-100 mg, nadolol 20-40 mg, pindolol 2.5 mg, propranolol 30 mg, sotalol 80-160 mg, tertatolol 2.5 mg) combined with 400 mg per day of amiodarone suppressed VT episodes in all patients. None presented heart failure or collapse. The mean reduction of the heart rate was about 17 p. 100. One patient need a definite pacemaker to correct sinus bradycardia. At discharge, exercise ECG (n: 20) induced non sustained VT in 2 patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Efficacy of the combination of low doses of beta-blockers and amiodarone in the treatment of refractory ventricular tachycardia]. 257 26

A middle-aged man with long-standing polyostotic fibrous dysplasia had severe progressive restrictive lung disease with hypoxemia and pulmonary hypertension with heart failure because of exuberant intrathoracic, extraosseous proliferation of dysplastic tissue. Subtotal resection of this benign tissue mass ameliorated the respiratory insufficiency and led to sustained improvement in exercise tolerance, increase in pulmonary reserve, and decrease in signs of heart failure and pulmonary hypertension.
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PMID:Surgical palliation of respiratory insufficiency secondary to massive exuberant polyostotic fibrous dysplasia of the ribs. 257 78

Right ventricular dysplasia, also named right ventricular cardiomyopathy, cardiac lipidosis and partial absence of the right ventricular myocardium, is an uncommon disease in which the myocardium is partially replaced by fat and fibrous tissue. The clinical picture is usually characterized by complex arrhythmias, causing sudden death in adolescents and young adults, and cardiac failure. In this report, an association between this disease and "Ebstein-type" tricuspid valve malformation has been diagnosed in a 22 year old female patient with cianosis and dyspnea on exertion.
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PMID:[Right ventricular dysplasia associated with Ebstein type malformation of the tricuspid valve. A case report]. 262 79


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