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)

Although digitalis preparations are effective in controlling the ventricular rate in atrial fibrillation and certain other supraventricular tachyarrhythmias, with consequent haemodynamic benefit, there is increasing controversy about significant sustained inotropic efficacy in patients in sinus rhythm. Digoxin toxicity is a serious hazard and subtherapeutic dosing a deception and waste of resources; blood levels are the key to optimum dosing. A considered withdrawal of the drug and reintroduction if haemodynamic deterioration ensues is probably the only way of proving in an individual patient if the drug is really worth using long-term. Diuretics have had a major place in management of cardiac failure, correcting the fluid overload. However there are a number of troublesome metabolic and other consequences, and excessive diuresis can be dangerous. Vasodilator therapy has recently had a major impact on management of more severe forms of cardiac failure, usually with coadministration of diuretics, but the predominant pattern of drug use in milder heart failure is to rely primarily or even exclusively on diuretics. Rational use of drugs in cardiac failure would be greatly facilitated by availability of simple non-invasive techniques to measure cardiac function and filling pressures. Until this becomes possible it will be difficult to alter the traditional pattern of long-term use of digoxin and diuretics whenever there have been symptoms attributable to heart failure.
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PMID:Digitalis and diuretics: still the standard therapy? 376 82

We describe a case of fatal falciparum malaria, with severe pulmonary insufficiency in the absence of fluid overload or cardiac failure. At autopsy the most striking change was a marked pulmonary interstitial edema. The endothelial cell was the most altered structure, showing marked cytoplasmic swelling which narrowed the capillary lumen. Monocytes were also found occupying the capillary lumen. The edematous interstitium also showed macrophages with endocytes and malarial pigment. There was no disseminated intravascular coagulation or other terminal complications. The patient's respiratory insufficiency seems not to have derived from the complications usually associated with the fatal malaria but from malaria-induced alveolar septal changes.
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PMID:Ultrastructure of the lung in falciparum malaria. 388 10

In acutely uremic animals, the contractile force of the heart is consistently increased; such an increase can be dissociated from changes of afterload or catecholaminergic drive. It is associated with diminished sarcolemmal Na,K-ATPase activity in the heart which, in turn, may be related to increased levels of endogenous digitalis-like substances (endigens) that have been postulated to represent a natriuretic factor. In patients with chronic uremia, myocardial contractility is usually normal, but occasionally there may be heart failure unrelated to pre-existing hypertension, coronary heart disease, anemia, fluid overload, or other recognizable factors. So far, the experimental basis for this clinical observation is uncertain. Possible causes for the clinical syndrome include an excess of parathyroid hormone or cardiodepressor substances. There is experimental evidence of impaired cardiac response to beta adrenergic agonists, e.g., decreased isoproterenol-dependent calcium uptake, diminished inotropic and chronotropic responses. In acutely uremic rats, cardiac cyclic AMP levels are high but can be reversed by beta blockers. Heart calcium content is variable and heart weight is constantly increased in acutely uremic rats, despite decreased skeletal muscle mass. The change in heart weight is not related to anemia, to an excess of parathyroid hormone, or to sympathetic activity; its cause remains unknown. Experimental studies to date have shown a variety of abnormalities, but do not provide a uniform concept of the mechanisms or an explanation for the cardiac dysfunction so often observed in patients with uremia.
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PMID:Cardiac function in experimental uremia. 636 51

A radiographic method for detecting excessive lung water in patients with pulmonary infiltrates of uncertain cause is described. The gravitational shift test uses bedside frontal films before and after prolonged lateral decubitus positioning. Excess lung water is identified by detecting a shift in infiltrate to the dependent lung while the opposite side clears or remains stable. The test was evaluated in 33 patients with infiltrates of well defined etiology. Twelve patients had heart failure or fluid overload (edema): 14 had pulmonary infection or parenchymal damage (inflammation); and seven had inflammation plus edema. Infiltrates shifted to the dependent lung in 85% of patients with lung edema, but did not shift in 78% of patients with inflammatory disease. The test also detected excess lung water in six of seven patients with underlying inflammatory disease. Each patient with a positive test showed clinical, physiologic, and radiographic improvement after therapy directed at mobilizing excessive lung water. When the differential diagnosis of a diffuse infiltrate is in question, a positive test represents a strong indication for a trial of diuretic therapy.
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PMID:Radiographic detection of mobilizable lung water: the gravitational shift test. 697 13

A case is presented in which a fatal acute respiratory distress syndrome, associated with disseminated intravascular coagulation, developed immediately after the insertion of a peritoneovenous shunt for management of refractory ascites. The absence of left-sided heart failure or fluid overload was established by (a) lack of diuresis from intravenous furosemide; (b) repeatedly normal pulmonary wedge pressures; and (c) autopsy findings. The nature of the toxic effect of this patient's ascites upon the alveolar membrane remains obscure.
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PMID:Acute respiratory distress syndrome after peritoneovenous shunt. 706 30

The hemodynamic effect of dobutamine infusion (DI) was studied in 19 patients with septic shock. DI resulted in hemodynamic improvement as indicated by a significant increase in cardiac index (+36%, p less than 0.001), stroke index (+15%, p less than 0.01), mean arterial pressure (+20%, p less than 0.01), and a significant decrease in aVDO2 (-27%, p less than 0.01). This hemodynamic improvement occurred concomitantly with a fall in both right and left filling pressures. Mean systemic arterial resistance remained unchanged with a scatter of individual responses depending on other factors, such as infusion rate, initial vascular resistance, and underlying hemodynamic setting. In patients mechanically ventilated, venous admixture in the lung (Qs/Qt) during DI increased significantly (+30%, p less than 0.001) and insignificantly reduced PaO2, but this adverse effect was not observed when PEEP was used in patients mechanically ventilated. It is concluded that dobutamine can be useful in management of septic shock, particularly when filling pressures are high because of fluid overload or cardiac failure.
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PMID:Dobutamine: a hemodynamic evaluation in human septic shock. 721 44

Left ventricular ejection fraction was measured by radionuclide left ventriculography before and immediately after hemodialysis in 20 uremic patients, 11 of whom presented with congestive heart failure. Ejection fraction and contraction were normal in 15 patients (Group A), six of whom had signs of congestive failure; they were abnormal in five patients (Group B), all of whom were in clinical heart failure. Mean arterial pressure and body weight decreased by a similar amount after dialysis in both groups, and heart rate did not change. In Group A ejection fraction was unchanged by dialysis (0.63 +/- before vs. 0.62 +/- 0.09 after) (mean +/- S.D.), but in Group B it was improved significantly (0.32 +/- 0.04 before vs. 0.44 0.08 after) (P less than 0.01). In three patients in Group B cardiomegaly and ejection fraction returned to normal with long-term hemodialysis. In end-state renal failure, radionuclide left ventriculography can separate patients with circulatory congestion due to fluid overload from patients with left ventricular dysfunction in whom hemodialysis can provide immediate and long-term improvement.
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PMID:Uremic cardiomyopathy--effect of hemodialysis on left ventricular function in end-stage renal failure. 735 89

Congestive heart failure causes substantial patient morbidity and mortality in the United States. Symptoms and physical findings can be helpful in diagnosis but have limited sensitivity and specificity. Objective measurement of ventricular function is essential in virtually all patients in whom a diagnosis of heart failure is suspected. Reversible causes of heart failure must be sought. Outpatient management includes education and counseling, emphasis on and assessment of compliance with diet, and pharmacologic treatment. Angiotensin-converting enzyme inhibitors are the mainstay of treatment but are underused, and maximal doses are not given apparently because of concern about side effects. Diuretic therapy should be administered only as needed to manage fluid overload. Calcium channel blockers are relatively contraindicated in patients with impaired ventricular function. Patient follow-up should be guided by the results of the medical history and physical examination. Routine serial testing of ventricular function and exercise performance is discouraged.
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PMID:Diagnosis and outpatient management of congestive heart failure. 747 38

Eleven DCM patients who were found to have significant background hypertension from an echocardiographic assessment of the role of hypertension in DCM form the subject of this follow-up study. This was to test the reliability or otherwise of this investigative method which is supposed to identify DCM patients who would be expected to manifest hypertension with traditional anti-heart failure treatment. Results suggest a sensitivity of about 73% and specificity of 36%. It has a false positive potential in young females with the "Zaria-type" peripartum cardiomyopathy where fluid overload and not intrinsic myocardial failure is responsible.
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PMID:Behaviour of blood pressure in dilated cardiomyopathy patients suspected significantly hypertensive at echocardiography. 767 59

Nephrogenic ascites is a clinical diagnosis defined as persistent ascites in an uremic patient without evidence for a causative (specific) underlying disease. The incidence is not known. Contributing mechanisms may include peritoneal membrane changes, fluid overload, hyperparathyroidism, reduced lymphatic drainage, heart failure and hypoproteinemia. Rigid fluid control, intensive hemodialysis, high-protein diet, intravenous albumin infusion, intraperitoneal steroid injections and paracenteses as well as implantation of a peritoneatrial pump have all been found ineffective as treatment. Peritoneal dialysis has been shown to resolve ascites, however, the only effective treatment is so far renal transplantation. The development of nephrogenic ascites is associated with a poor prognosis. Thus, one year after the development of nephrogenic ascites 1/3 had died.
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PMID:Nephrogenic ascites. Case report and review of the literature. 781 79


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