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

The hemodynamic monitoring of acute myocardial infarctions has been carried out in patients less than 75 y.o. who showed: a) extensive anterior myocardial infarction; b) inferior myocardial infarction and ST segment depression of the anterior chest leads; c) acute myocardial infarction and cardiac failure. The hemodynamic measurement were carried out at the 12 hours (mean) from the beginning of chest pain on 65 patients who suffered the first myocardial infarction and were protracted to 60 hours (mean). The hemodynamic findings were classified according to the relationship between the stroke work index of the left ventricle (LVSWI) and the mean pulmonary artery pressure (MPAP) as following: normals: 6 pts; hypovolemia: 15 pts; reduced compliance: 2 pts; mild LV failure: 19 pts; severe LV failure or shock: 23 pts. 35 pts have carried out a complete rehabilitation programme has shown an inverse linear relationship to the MPAP of the first recording in CCU. The incidence of death was 29% one year after the myocardial infarction and showed a significant relationship to the hemodynamic findings. The LVSWI resulted more sensitive than MPAP; 90% of patients who showed a LVSWI less than 20 gmb/m2 died.
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PMID:[Correlations among the haemodynamic effects in acute myocardial infarction. Function evaluation and prognosis 12 months later (author's transl)]. 732 21

To evaluate the significance of mitral regurgitation in coronary artery disease (CAD), clinical, electrocardiographic, and angiographic data in 100 coronary artery disease patients with mitral regurgitation were compared to data in 100 coronary artery disease patients without mitral regurgitation. Mitral regurgitation was mild (1+) to moderate (2+) in 94 patients. Heart failure, cardiomegaly, and anterior myocardial infarction were more common in mitral regurgitation patients than in controls (33 vs 4;47 vs 8;22 vs 5, respectively, P < 0.001). The frequency of inferior myocardial infarction was equal in both groups. Significant left anterior descending and circumflex disease was equally frequent; however, right coronary disease was more frequent in patients with mitral regurgitation (87 vs 68, P < 0.001). Total vessel occlusions and triple-vessel disease were more frequent in patients with mitral regurgitation (113 vs 78, P < 0.01; 60 vs 40, P < 0.001, respectively). No localized area of asynergy was more common in patients or controls,, but left ventricular aneurysms and generalized hypokinesis were more common in patients with mitral regurgitation (6 vs 0; 23 vs 2; P < 0.001). These data suggest that mitral regurgitation is most often mild, but is associated with significant left ventricular dysfunction and advanced CAD.
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PMID:The clinical and hemodynamic significance of mitral regurgitation in coronary artery disease. 744 54

A 42-year-old man presented with acute myocardial infarction. The ECG on admission to hospital showed "Q wave" inferior myocardial infarction and "non-Q wave" anterior infarction. Subsequently, he was readmitted to hospital on many different occasions for cardiac failure. About 15 months after the patient was first seen, two-dimensional echocardiogram (2D echo) showed dilatation of all 4 cardiac chambers and severe global hypokinesia of the left ventricle. In addition, a large echo dense mass was seen at the apex of the left ventricle and 2 smaller echo dense masses were present at the right ventricular apex. The echocardiographic characteristics of these 3 masses strongly suggest that they represent mural thrombi. Two-dimensional echocardiographic detection of biventricular thrombi has rarely been described in the past. This case together with the previously reported case by Friedman and Buda suggest that 2D echo may be a valuable test for the diagnosis of biventricular thrombi.
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PMID:Two-dimensional echocardiographic detection of biventricular thrombi. 757 Jan 24

An 87-year-old woman was admitted to another hospital with acute inferior myocardial infarction on May 31, 1991. On the 6th hospital day she suddenly developed transient complete A-V block and ventricular tachycardia. She was transferred to our hospital for the treatment of intractable heart failure on the 18th hospital day. Two-dimensional echocardiography showed a saccular chamber with a narrow-necked connection to the left ventricle. Color Doppler echocardiography showed bidirectional blood flow between the left ventricle and saccular chamber during systole and diastole. There was 35% left to right shunt in the ventricular level on right heart catheterization. Acute myocardial infarction complicated with left ventricular pseudoaneurysm and ventricular septal perforation was diagnosed. She died on the 26th hospital day without aggressive medical treatment. Autopsy demonstrated the pseudoaneurysm in the posterior wall of the left ventricle and the connection to the right ventricle. The so-called double rupture could be diagnosed before death.
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PMID:[A case of acute myocardial infarction complicated with left ventricular pseudoaneurysm and ventricular septal rupture]. 805 46

A 79-year-old man was admitted to our hospital with heart failure following acute inferior myocardial infarction. An echocardiogram demonstrated severe mitral insufficiency, and coronary arteriography revealed double vesel disease. Following diagnosis of ischemic papillary muscle dysfunction, PTCA was performed, but the mitral insufficiency was not eliminated. Follow-up echocardiography disclosed rupture of the posterior papillary muscle. He underwent surgery on the 30th day after onset of acute myocardial infarction. Partial rupture of the posterior papillary muscle was found at surgery, and mitral valve replacement and single coronary artery bypass to Lcx were performed. His postoperative course was uneventful, and he was discharged on the 46th day after operation.
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PMID:[Mitral valve replacement and coronary artery bypass grafting for postinfarction mitral papillary muscle rupture]. 896 4

We describe our experience in treating a 69-year-old man with spinal progressive muscular atrophy (SPMA), who underwent a mitral valve replacement. He was admitted for dyspnea, and surgery was indicated for severe mitral insufficiency associated with inferior myocardial infarction. He had been aware of muscle weakness and received a diagnosis of SPMA 18 years previously. Worsening muscle atrophy had led to the need for him to use a wheelchair in his daily life. A preoperative examination revealed markedly reduced pulmonary function (% volume capacity = 44.8%). Because of an acute exacerbation of heart failure, the patient underwent an urgent mitral valve replacement with a 27-mm pericardial bioprosthesis. Although it took 42h to wean him from the mechanical ventilation and he suffered from pulmonary atelectasis after extubation, he was discharged from our hospital in a wheelchair 16 days after surgery. Respiratory management with bilevel positive airway pressure was thus found to be quite useful for patients with neuromuscular disease.
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PMID:Mitral valve surgery in a patient with spinal progressive muscular atrophy: report of a case. 1450 97

A 54-year-old man with ischemic mitral regurgitation and severe heart failure due to broad myocardial infarction successfully underwent mitral valve plasty and coronary artery bypass grafting under beating heart. He had an old anterior myocardial infarction and was admitted to our hospital with acute inferior myocardial infarction. Two weeks later, the cathetelization revealed moderate mitral regurgitation and triple vessel coronary artery disease. We selected antegrade continuous blood perfusion for myocardial protection on operation. He recovered uneventfully and discharged on postoperative day 31. We could perform this procedure safety and satisfactorily, we could this procedure for heart valve operation with other complications.
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PMID:[Mitral valve plasty and coronary artery bypass grafting under beating heart cardiopulmonary bypass for severe left ventricular dysfunction; report of a case]. 1555 34

Most patients with acute myocarditis manifest particular clinical signs and symptoms, including marked cardiac failure and/or a high degree of atrioventricular block on admission. However, a 78-year-old man did not have symptoms and was hospitalized as a result of abnormalities observed on an incidentally obtained electrocardiogram (ECG). Several days later, he developed cardiogenic shock and fulminant myocarditis, which required percutaneous cardiopulmonary support; however, the cardiac failure persisted and he died approximately 4 months later. The ECG showed findings similar to those of acute inferior myocardial infarction, and on left ventriculography, diffuse hypokinesis was observed most prominently in the inferoposterior wall. During autopsy, interstitial fibrosis was marked in the inferoposterior wall, with small, round, cell infiltration prominent at the same site. Clustering of these cells is a characteristic feature of chronic myocarditis.
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PMID:Clinical course of myocarditis through the acute, fulminant and fatal chronic stages: an autopsy case. 1686 47

Nitrates are potent venous dilators and anti-ischemic agents. They are widely used for the relief of chest pain and pulmonary congestion in patients with acute coronary syndromes and heart failure. Nitrates, however, do not reduce mortality in patients with acute coronary syndromes. Combination of nitrates and hydralazine when given in addition to beta-blockers and angiotensin-converting enzyme (ACE) inhibitors reduce mortality and heart failure hospitalizations in patients with heart failure due to left ventricular systolic dysfunction who are of African-American origin. Side effects during nitrate therapy are common but are less well described in the literature compared with the reported side effects in patients with stable angina pectoris. The reported incidence of side effects varies highly among different studies and among various disease states. Headache is the most commonly reported side effect with an incidence of 12% in acute heart failure, 41-73% in chronic heart failure, 3-19% in unstable angina and 2-26% in acute myocardial infarction. The reported incidence of hypotension also differs: 5-10% in acute heart failure, 20% in chronic heart failure, 9% in unstable angina and < 1-48% in acute myocardial infarction, with the incidence being much higher with concomitant nitrate therapy plus angiotensin-converting enzyme inhibitors. Reported incidence of dizziness is as low as 1% in patients with acute myocardial infarction to as high as 29% in patients with heart failure. Severe headaches and/or symptomatic hypotension may necessitate discontinuation of nitrate therapy. Severe life threatening hypotension or even death may occur when nitrates are used in patients with acute inferior myocardial infarction associated with right ventricular dysfunction or infarction, or with concomitant use of phosphodiesterase-5 inhibitors or N-acetylcysteine. Despite the disturbing observational reports in the literature that continuous and prolonged use of nitrates may lead to increased mortality and recurrent myocardial infarction in patients with stable coronary artery disease, no such adverse effects of nitrates have been reported in the large randomized trials in patients with acute myocardial infarction or chronic heart failure.
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PMID:Side effects of using nitrates to treat heart failure and the acute coronary syndromes, unstable angina and acute myocardial infarction. 1768 82

Right ventricular (RV) function is essential in cardio--pulmonary physiology and physiopathology. RV dysfunction has prognostic impact in inferior myocardial infarction, significant valvulopathies, congenital cardiopathies, arterial pulmonary hypertension and in patients suffering from acute or chronic heart failure. RV analysis relies on non invasive (echocardiography-Doppler, isotopic technology, cardiac magnetic resonance imaging) and/or invasive approaches (right cardiac catheterization). Neglected a short time ago, RV assessment has regained interest with tissular Doppler imaging, strain imaging and 2D speckle tracking. We review echocardiography and Doppler -parameters used for right -ventricular assessment.
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PMID:[Right ventricular assessment with echocardiography]. 1948 Aug 33


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