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)

The aim of this study was to determine the prevalence of stroke in a hospital-derived cohort of patients with chronic Chagas' disease. Seventy-nine patients with chronic Chagas' disease were prospectively followed at the Cardiomyopathy Clinic of the Santa Casa Hospital from January 1990 to June 1993 (mean follow up = 17 +/- 12 months). Mean New York Heart Association functional class was 2.42 +/- 1.24. Fifty-six (70%) patients were on angiotensin-converting enzyme inhibitors at maximum tolerated doses, but no patient was on anticoagulation therapy. Atrial fibrillation was detected on the resting ECG in twelve (15%) patients. On echocardiography, mean left ventricular ejection fraction was 49.07 +/- 17.96% and mean left ventricular diastolic dimension 60.12 +/- 10.97 mm; mitral regurgitation was detected in 20 (29%) patients. Left ventricular thrombus was seen in three (4%) patients; all of them were in sinus rhythm and had left ventricular dysfunction on echocardiography. No thromboembolic event, however, was detected during the follow-up. One patient (1%) had a fatal stroke during the study period; she was in sinus rhythm on the resting ECG, and had mild mitral regurgitation, normal left ventricular function and no intracavitary thrombus on Doppler echocardiography. The prevalence of stroke is low in a hospital-derived cohort of patients with mild to moderate heart failure due to chronic Chagas' disease. Routine prophylactic anticoagulation, therefore, seems not to be warranted.
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PMID:Stroke in a hospital-derived cohort of patients with chronic Chagas' disease. 1070 56

A 44-year-old woman had tako-tsubo-like ventricular dysfunction with chest pain and ST segment elevation on the ECG. Echocardiography revealed a bicuspid aortic valve with moderate to severe aortic regurgitation. She developed mild heart failure during the clinical course, but the medication (furosemide, enalapril, and asprin) had to be stopped because of skin eruptions. Four weeks after ceasing the antiplatelet agent, she was re-admitted with acute renal infarction. Enhanced chest computed tomography revealed a filling defect in the left ventricle and echocardiography showed a high echogenic mass in the left ventricular apical wall. These findings strongly suggested that the renal infarction was caused by an embolism derived from a left ventricular thrombus that formed during the clinical course of the transient left ventricular apical ballooning. Anticoagulation therapy with urokinase and warfarin successfully lysed the thrombus. Left ventricular thrombus should be considered a complication of transient left ventricular apical ballooning, especially in patients with organic heart disease.
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PMID:Transient left ventricular apical ballooning in a patient with bicuspid aortic valve created a left ventricular thrombus leading to acute renal infarction. 1550 92

Left ventricular thrombus (LVT) can be a consequence of cardiac diseases such as heart failure with reduced ejection fraction and acute myocardial infarction. Currently, the guidelines recommend the use of warfarin for the treatment of this condition. However, there are increasing reports of patients with LVTs being treated with direct oral anticoagulants (DOACs), for several reasons. We set out to review the available literature to assess the safety and the efficacy of this approach. We analyzed 52 cases, extrapolated by 34 papers contained in literature, focusing on the characteristics of patients, treatment, outcome, and follow-up. Rivaroxaban was the most commonly used DOAC, followed by apixaban. The diagnosis of LVT and the follow-up were mainly performed by transthoracic echocardiography. The thrombus resolved in 45 patients (92%) of 49 (there are no data available regarding the outcome of 3 patients) and failed to resolve in 4 patients treated with DOACs. The resolution occurred in a median of 32 days. DOACs are shown to be a reasonable and valid option for the treatment of LVT. Our study provides a rationale for a prospective randomized controlled trial.
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PMID:Direct Oral Anticoagulants for the Treatment of Left Ventricular Thrombus-A New Indication? A Meta-summary of Case Reports. 3218 66