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

Five cases of cardiac beriberi occurring in chronic alcoholics are described. The clinical diagnosis was based on the presence of biventricular failure, low dietary intake of thiamine and the therapeutic response to oral thiamine. Complicating cardiac disease was excluded by haemodynamic studies, left ventriculography; coronary angiography and endomyocardial biopsy. Haemodynamic measurements including quantitative left ventriculography are reported. They indicate that left ventricular function is depressed despite elevated cardiac output. Biopsy material was studied by light and electron microscopy. No lesion specific to beriberi was detected by either technique although the biopsies were quantitatively abnormal. The histological changes resemble those in early reports based on necropsy material, and consist of vacuolation and intercellular oedema in the early stages with myofibre hypertrophy, fibrosis and cellular infiltration in the chronic cases. The transketolase test and response to intravenous thiamine during catheter studies are valuable diagnostic tests. Plasma renin, angiotensin II and aldosterone levels were lower than in patients with low output heart failure. The incidence of cardiac beriberi appears to be greater than is generally realized.
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PMID:The haemodynamic, histopathological and hormonal features of alcoholic cardiac beriberi. 734 67

Hepatic morphologic changes in seven patients in heart failure who were initially thought to have hepatitis are reported. In each instance, percutaneous liver biopsy or post mortem tissue examination disclosed a striking lesion involving all perivenular areas, with replacement of hepatocytes by erythrocytes. Four patients were in pure left-heart failure, while three were in biventricular failure. Upon treatment of the heart failure, the conditions of all patients improved clinically, and liver-function tests returned to normal or near normal. In two patients who later had refractory heart failure and died, there was no evidence of hepatic-vein thrombosis or occlusion post-mortem. A hypothesis is offered for the pathogenesis of this lesion, and its clinico-pathologic differential is discussed.
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PMID:A distinctive perivenular hepatic lesion associated with heart failure. 735 61

Cytomegalovirus (CMV) infections are commonly found in patients on immunosuppressive therapy following liver transplantation. However, acute myocarditis is an extremely rare manifestation of CMV infection in this setting. We report the case of a patient who developed acute myocarditis with severe biventricular failure with a cardiac ejection fraction of less than 10%, 6 weeks following orthotopic liver transplantation. Systemic CMV infection was diagnosed on the basis of a clinical viraemia, the presence of CMV antigen in urine, blood, and throat swab, and an associated four-fold rise in serum antibody titres to CMV. A full recovery ensued following treatment with standard anti-cardiac failure therapy and a 10 day course of intravenous ganciclovir.
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PMID:Cytomegalovirus myocarditis following liver transplantation. 797 35

This brief review summarizes abnormalities of arterial and cardiopulmonary baroreflex control of heart rate and sympathetic nerve activity. The potential role of these abnormalities in the development of the neurohumoral excitatory state associated with heart failure is discussed. Major emphasis is placed on the identification of important issues still to be investigated in this area. The potential importance of altered cardiovascular reflexes in the context of the interaction of the patient with heart failure and environmental stresses is discussed. The use of the canine rapid ventricular pacing model of biventricular failure in the investigation of abnormalities of baroreflexes in heart failure is emphasized. Insights obtained from this model should be extended to human investigations.
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PMID:Abnormalities of baroreflex control in heart failure. 810 6

The histopathology, ultrastructure, and clinicopathologic correlations in six patients with cardiac failure and iron encrustation of lung elastic tissue were examined at autopsy. Transmission electron microscopy (TEM) and energy dispersive x-ray analysis were applied to two cases. Of the group, five patients had cardiac failure due to systemic hypertension (4 patients), valvular disease (4 patients), or coronary atherosclerosis (4 patients). Biventricular failure in one patient was associated with sleep apnea. Both iron and calcium, identified by histochemical stains, impregnated degenerated alveolar and vascular elastic fibers and were associated with a foreign body reaction and focal interstitial fibrosis. Energy dispersive x-ray analysis and TEM demonstrated iron and calcium on the microfibrillar portion of elastin. Morphometry indicated vascular changes of pulmonary venous hypertension. The authors concluded that mineral deposition probably represents nonspecific precipitation of metallic ions on altered elastic fibers in patients with cardiac failure. "Mineralizing elastosis" potentially contributes to lung restriction and, occasionally, can be a source of diagnostic confusion.
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PMID:Mineralizing pulmonary elastosis in chronic cardiac failure. "Endogenous pneumoconiosis" revisited. 827 51

Since January 1985, the date of the first dynamic cardiomyoplasty, until April 1992, 52 patients with end-stage heart disease were operated on in our institution. Mean preoperative New York Heart Association functional class was 3.3 and ventricular ejection fraction 16% +/- 3%. Associated procedures in 23 patients comprised ventricular aneurysm resection (10), valve surgery (9), coronary artery bypass (8), and tumor resection (3). Thirty-eight patients had a ventricular reinforcement, 13 a ventricular substitution, and 1 an atrial reinforcement using the left latissimus dorsi muscle. Preassist mortality rate before full latissimus dorsi muscle stimulation was 7 of 13 patients (54%) in the 1985 to 1987 period and 5 of 39 (12%) in the 1988 to 1992 period. The causes of death were heart failure (4), multiorgan failure (4), septicemia (2), ventricular fibrillation (1), and sudden death (1). Multivariate analysis of factors influencing hospital mortality showed that age, cardiac suture technique, associated surgical procedures, biventricular heart failure, and hemodynamic instability plus inotropic drug support were predictors of unfavorable outcome. All patients were followed up for from 2 months to 7 years (mean 21 months). Postassist mortality rate was 8 of 40 (20%). Causes of death included heart failure (5), ventricular fibrillation (1), myocardial infarction (1), and gastric bleeding (1). Preoperative risk factors influencing long-term mortality were permanent New York Heart Association functional class IV, biventricular heart failure, atrial fibrillation, cardiothoracic ratio greater than 60%, and ejection fraction less than 15%. Actuarial survival at 7 years was 70.4% (preassist mortality excluded). Surviving patients were in a mean New York Heart Association functional class of 1.8 (preoperatively 3.3, p < 0.05). The average ejection fractions (rest/stress) were 25%/28% at 1 year, 26%/30% at 2 years, and 23%/28% at 3 years. Average cardiothoracic ratios were 57% +/- 3% at 1 year, 56% +/- 2% at 2 years, and 57% +/- 2.5% at 3 years. Catheterization obtained in 20 patients showed no significant changes at rest in capillary wedge pressure, pulmonary artery pressure, and diastolic left ventricular pressure when compared with preoperative pressures. Average ejection fractions increased from 24% to 30.6%. Maximal oxygen consumption increased from 12.8 +/- 3.5 to 18.6 +/- 4 ml/min per kilogram. The number of rehospitalizations resulting from congestive heart failure was reduced to 0.4 hospitalizations per patient per year (preoperatively 2.4, p < 0.05). In 62% of the patients, pharmacologic therapy was diminished after the operation. Three patients required orthotopic heart transplantation 6 months, 4 years, and 5 years after cardiomyoplasty.
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PMID:Dynamic cardiomyoplasty at seven years. 832 Oct 4

Dynamic cardiomyoplasty, the use of skeletal muscle to assist the heart, is a new therapy for the treatment of heart failure. However, the effects of cardiomyoplasty on biventricular function and the synchrony of ventricular contraction are not fully known. We assessed the efficacy of latissimus dorsi muscle (LDM) dynamic cardiomyoplasty in a chronic model of biventricular failure. Five dogs received doxorubicin (1 mg.kg-1.wk-1) for up to 12 weeks to induce heart failure and then underwent a biventricular cardiomyoplasty. After operation, the muscle was progressively stimulated according to an established protocol. When training was complete (10 weeks), radionuclide ventriculographic and catheterization data were obtained. Peak left ventricular (LV) systolic pressure and its first derivative were unchanged, whereas LV end-diastolic pressure decreased slightly with LDM assistance (11.0 +/- 1.6 to 9.6 +/- 1.5 mm Hg; p < 0.05). Right ventricular (RV) systolic pressure increased significantly with LDM assistance from 21 +/- 2 to 26 +/- 3 mm Hg (p < 0.05), whereas its first derivative and RV end-diastolic pressure were unchanged. Dynamic cardiomyoplasty significantly improved LV ejection fraction from 0.18 +/- 0.07 without LDM assistance to 0.31 +/- 0.05 with LDM assistance (p < 0.05); similarly RV ejection fraction increased from 0.32 +/- 0.07 to 0.45 +/- 0.06 with LDM assistance (p < 0.05). The temporal sequence of LV wall motion was assessed by phase analysis of the radionuclide ventriculograms. With skeletal muscle assistance, standard deviation ("spread") decreased from 31.6 +/- 17.4 to 20.0 +/- 15.4 degrees (p < 0.06), whereas skewness ("symmetry") was unchanged. Dynamic cardiomyoplasty improved both LV and RV ejection fractions without increasing diastolic pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effects of cardiomyoplasty on biventricular function in canine chronic heart failure. 846 45

Clinical outcome and hemodynamic effects of unilateral mechanical ventricular support (UMVS) were evaluated in 19 patients with postcardiotomy heart failure refractory to conventional treatment. Adequate circulation with UMVS was maintained in about 75% of the patients. UMVS initiated circulatory stabilization in 5 of 6 patients with biventricular failure, in 2 of 3 patients with right ventricular failure, and in 7 of 10 patients with left ventricular failure. Eight (42%) patients were successfully weaned from UMVS and discharged from hospital. Six (32%) patients died despite a prolonged, stabilized circulation by UMVS. In 5 (26%) patients, the UMVS could not secure stable circulation. Application of the left UMVS induced increases in cardiac output and systemic blood pressure and a decrease in left atrial pressure without changes in pre- and afterload of the right ventricle. It is concluded that application of UMVS may induce adequate circulation in patients with postcardiotomy heart failure refractory to treatment with inotropes and intraaortic counterpulsation. The outcome of UMVS in left, right, and biventricular failure is acceptable. Thus, this treatment may be recommended for patients with postcardiotomy heart failure.
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PMID:BioMedicus ventricular assistance for postcardiotomy heart failure: evaluation of univentricular assistance. 857 95

Extraaortic counterpulsation using skeletal muscle powered ventricles (SMPVs) has been studied mainly for the purpose of assisting the systemic circulation. The purpose of this study was to investigate the possibility of assisting both the systemic and pulmonary circulations using a single SMPV. An SMPV that counterpulses the systemic circulation is placed beside the right atrium (RA) or the right ventricle (RV), the former after procedures such as a Fontan operation, and the latter in cases of biventricular failure. Because the SMPV dilates passively during cardiac systole, it is designed to press the RA or the RV directly from outside. This study is a preliminary report, and only the ability of a specially constructed SMPV to dilate was assessed. Using seven dogs with heart failure, the SMPV dilated with an internal pressure of 88 mmHg and 1.0 cm, while the volume inside increased by 10.8 ml. From these results, it is suggested that the SMPV has enough dilating power to press the RA or to assist the RV while counterpulsing the systemic circulation.
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PMID:A single skeletal muscle powered ventricle that assists both systemic and pulmonary circulations. 857 49

In an experiment dog model of acute biventricular failure, the effects of left ventricular (LV) assist on renal hemodynamics and function were evaluated. After the induction of severe cardiac failure by multiple ligation of the coronary arteries, LV assist with a 40 ml pneumatic pulsatile pump was initiated, and the aortic flow was maintained at control values. The right atrial pressure (RAP) rose to 21.3 mm Hg with the appearance of profound right ventricular (RV) failure. Renal arterial blood flow (RAF) decreased to about 60% of the control value after 2 h of LV assist. The urine volume decreased and renal function deteriorated progressively. RV assist decreased the RAP to 4.8 mm Hg, and the reduced RAF recovered. After 3 h of RV assist, the RAF returned to initial values and the urine volume increased, but renal function did not recover. Advanced biventricular failure with elevated RAP during LV assist reduced renal perfusion and impaired renal function and may be an indication for early RV assist.
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PMID:Effects of right ventricular failure on renal function during pneumatic left ventricular assist. 869 94


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