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

The effects of hyperdynamic therapy on patients with cerebral vasospasm following subarachnoid hemorrhage (SAH), under normal blood pressure (BP) and normal blood volume conditions, are reported. Forty-four patients, who underwent surgery for aneurysms in acute stage, received hydroxyethyl starch (500 ml/day) postoperatively to prevent dehydration. Twenty-four of the 44 patients with prominent SAH on the computed tomographic (CT) scan, anticipating to develop cerebral ischemia due to vasospasm, were given dobutamine (DOB). The BP was maintained within the normal range, and the heart rate was kept below 130/min. In the 24 patients treated with DOB, cerebral blood flow (CBF) was measured repeatedly by the 133Xe intravenous injection method. In 8 of these 24 patients, the cardiovascular function was monitored with Swan-Ganz (S-G) catheters. Twelve of the 44 patients (27%) developed delayed neurological deficits associated with cerebral vasospasm. The neurological deficits were reversed by the administration of DOB, at a dose of 8-25 (average 12.4) micrograms/kg/min. In 43 patients, the ischemic lesions associated with vasospasm did not appear on CT scan and the patients were of normal condition at discharge. However, one patient showed multiple low-density lesions on CT scan. This was because of the failure of hyperdynamic therapy due to pulmonary complications. No case of pulmonary edema or heart failure due to volume overload was noted. In the 24 patients with prominent SAH, CBF increased significantly by up to 20% following DOB administration, although the BP stayed in the normal range.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hyperdynamic therapy for cerebral vasospasm. 169 47

The influence of type II diabetes on the success rate of arterial bypass operations in the leg was assessed in a prospective study, since 1984, of long-term results of infrainguinal arterial reconstruction in 67 type II diabetics (41 men and 26 women; mean age 71.2 [47-90] years) and compared with 133 nondiabetics (90 men and 43 women; mean age 71.5 [45-91] years). All had a bypass for chronic critical ischaemia of the legs. Graft patency, leg preservation and survival rate were calculated and compared by the actuarial method. Coronary heart diseases and cerebral ischaemia were a little more common in the diabetic group, but the incidence of heart failure was the same (20%). A venous bypass was used in 73% of diabetics, polytetrafluoroethylene grafts in 27% (nondiabetics: 79% and 21%). Bypass occlusions occurred in 9 diabetics and in 24 nondiabetics (not significant). During the observation period of 5 years 37 diabetics (55%) and 39 nondiabetics (29%) died (P less than 0.001). These data indicate that the results of infrainguinal arterial bypass operations are equally good in diabetics and nondiabetics. Amputation was avoided in 80% of legs at risk in both groups. Primary amputation is indicated only in exceptional circumstances.
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PMID:[Long-term results after infrainguinal arterial reconstruction in patients with type 2 diabetes mellitus and without diabetes mellitus]. 186 Apr 20

Thirty out of 287 patients (10.4%) admitted to hospital for infective endocarditis between December 1970 and January 1990 had neurological complications. Twenty-three patients had native valve infectious endocarditis and 7 had prosthetic valve endocarditis. The clinical features were characterized by the frequency of aortic valve involvement (23 out of 30) and other complications, especially cardiac failure (16 cases) and peripheral vascular manifestations (7 cases). The commonest organism was the staphylococcus (53% of identified organisms) but the number of negative blood cultures was high (50% of cases). The neurological complication was often the presenting symptom of the endocarditis (19 cases) but it occurred after bacteriological cure in 4 cases. The complications observed were cerebral ischemia (16 cases), cerebral haemorrhage (11 cases), coma (2 cases), and one peripheral neuropathy causing a Claude Bernard Horner syndrome. These complications presented with hemiplegia in 17 cases, a meningeal syndrome in 8 cases, a convulsion in 1 case, a Von Wallenberg syndrome in 1 case, and a Claude Bernard Horner syndrome in 1 case. Twelve patients had a transient or permanent neurological coma. Cerebral CT scan showed ischemic lesions in 7 cases and haemorrhagic lesions in 10 cases. Carotid angiography demonstrated mycotic aneurysms in 6 patients. Twelve patients died: the cause of death was neurological coma (7 cases), low cardiac output (4 cases) and haemorrhagic shock (1 case). Four patients underwent neurosurgery: 3 for clipping a mycotic aneurysm and 1 for drainage of an intracerebral haematoma. Poor prognostic factors were: coma, cardiac failure, cardiac valve prosthesis and, above all, the extent and multiplicity of the neurological lesions. The authors propose the following measures to improve the prognosis: early surgery in cases of large and/or mobile vegetations especially when the infecting organism is a staphylococcus and when a systemic embolism has occurred; routine CT scanning and/or digitised cerebral angiography in all patients with infective endocarditis to detect surgically accessible mycotic aneurysms.
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PMID:[Neurologic manifestations of infectious endocarditis]. 201 89

Intra-aortic balloon counterpulsation (IABC) augments cardiac output (CO) and pulse pressure (PP) allowing patients with low output heart failure to be supported for a period of time. Augmentation of CO and PP may also be beneficial to the patient with acute cerebral ischaemia. In this paper we investigated the possibility of using IABC to increase local cerebral blood flow (CBF) in ischaemic brain. In 12 anaesthetized mongrel dogs, a canine stroke model was produced by occluding the left internal carotid and middle cerebral arteries with aneurysm clips. Six dogs were then treated with IABC for 2 h, and 6 other dogs acted as controls (no IABC). Haemodynamic data were measured continuously and CBF (microsphere technique) and CO measurements were performed pre- and post-occlusion, and then twice during the treatment period. In the IABC-treated animals, PP increased from 32 +/- 5.9 to 39 +/- 7.8 mmHg (p less than 0.01) but CO and local CBF in the ischaemic brain did not change significantly during IABC. However, in 4 dogs with significant increases in CO due to IABC [1.7 +/- 0.3 to 2.8 +/- 0.7 l/min (p less than 0.05)], local CBF in ischaemic brain also increased significantly from 22 +/- 12 to 26 +/- 11 cc/100 g/min (p less than 0.05). In the control animals, CO and local CBF did not change significantly during the observation period. These data suggest that augmentation of CO and PP by IABC results in an increase in local CBF in ischaemic brain. IABC may be an effective treatment for ischaemic stroke in those patients with compromised cardiac performance whose cardiac output and pulse pressure can be augmented by IABC.
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PMID:Intra-aortic balloon counterpulsation: a treatment for ischaemic stroke? 256 81

On extensive clinical monitoring of nocturnal oxygen saturation (Minolta Pulsox 7) we observed three groups with an increased risk of nocturnal hypoxemia. The hypoxemia was classified in terms of severity, frequency and duration into six groups of findings. The degree of oxygen desaturation was positively correlated to the severity of disease. In the group of patients with heart failure (NYHA III-IV) (n = 13) four had severe hypoxemia, and a history of previous cardiac infarction; three of them wore a pacemaker. Decrease in saturation after acute cerebral ischemia was seen in particular in patients with oropharyngeal disorders (dysphasia and dysphagia). In the group with suspected myocardial infarction (n = 16) we measured frequent short drops in saturation in ten patients, eight of whom were heavy snorers. Because of its simplicity, non-invasiveness and high information yield, especially in acute patients, pulse oximetry is important for clinical diagnosis, with immediate consequences for many patients.
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PMID:[The value and consequences of nocturnal pulse oximetry in severe heart failure, suspected myocardial infarct and acute cerebral ischemia]. 260 50

We have developed a new method producing total cerebral ischemia (TCI) in dogs; clamping ascending aorta with aorto-atrial bypass formation. Clamping ascending aorta provides TCI, the duration of which can be controlled up to the periods of 10 min. Beyond this interval, it is difficult to maintain TCI because of heart failure from high afterload. Blood outflow from left ventricle is completely obstructed except for coronary circulation which is small relative to the blood volume expelled from left ventricle, even if venous return to the heart is reduced. Aorto-atrial bypass formation during aortic clamping provides two distinctive advantages. First, adjusting aortic pressure in an appropriate level low enough not to overload myocardium but still high enough to maintain sufficient coronary blood flow is possible by regulating the blood flow through the bypass tubing, and secondly drug administration and blood volume control is possible through the tubing. These result in better preservation of myocardium, enabling longer TCI and longer survivals after TCI. We were successful in having up to 18 min of TCI with this method. Seventy-five percent of dogs of 12 min TCI and 40% of 15 min TCI survived 7 days, limit of experiment, after TCI, but no dogs of 18 min TCI survived for more than 3 days.
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PMID:A new model for total cerebral ischemia in dogs. 302 Jun 61

The impact of diabetes was prospectively studied during a 5-year period in 428 unselected and consecutive patients with acute cerebrovascular disease of whom 18% were diabetic. Cerebral infarction was more frequent in diabetics (81 vs 70%, p less than 0.02) whereas transient cerebral ischaemia was less frequent (4 vs 14%, p less than 0.01). Case fatality rate during hospitalization was higher in the diabetic than in the non-diabetic patients (28 vs 15%, p less than 0.02). Patients who died during hospitalization, diabetic as well as non-diabetic, had significantly higher blood glucose concentrations on admission compared with patients who survived. Hematocrit values were higher in the diabetic than in the non-diabetic patients (p less than 0.02). Diabetics had higher systolic blood pressure levels than the non-diabetics in the acute phase (p less than 0.005). The diabetic stroke patients more often had a history of hypertension, atrial fibrillation, heart failure and angina pectoris than non-diabetics stroke patients and diabetic control patients without stroke. Stroke patients, not known to be diabetic, had larger mean oral glucose tolerance test curve areas when compared with healthy controls but not when compared with hospitalized controls. We propose that diabetes increases the risk for stroke through other concurrent risk factors, cardiac disorders in particular.
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PMID:Clinical characteristics in diabetic stroke patients. 339 27

Percutaneous transfemoral valvuloplasty was performed in 20 patients (aged 25-83 years; mean 62) with marked signs of aortic valve stenosis, some calcified, others noncalcified. The transvalvar systolic pressure gradient was reduced from a mean of 104 +/- 7 mm Hg to a mean of 46 +/- 4 mm Hg, the valvar opening area from 0.38 +/- 0.04 cm2 to 0.74 +/- 0.04 cm2. The result was judged to be unsatisfactory in four patients and required aortic valve replacement after initially good results from the balloon dilatation. Serious complications were reversible ventricular fibrillation and reversible cerebral ischemia with partial hemiparesis in one patient each. In three patients the femoral artery had to be repaired at the site of puncture, twice the balloon ruptured without sequelae, once reversible pericardial effusion occurred, and twice there were reactions to antibiotics given after the procedure. Invasive re-catheterizations were performed in four patients, at intervals of three months: no increase in pressure gradient was observed. The results indicate that reduction of the transvalvar pressure gradient by 40 mm Hg can produce rapid reversal of heart failure and a symptom-free state even in patients who were already decompensated.
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PMID:[Percutaneous transfemoral valvuloplasty of calcified and non-calcified aortic valves]. 359 66

A 23-month-old infant with an extensive dural arteriovenous malformation (AVM) developed a heart murmur and cardiomegaly. The AVM involved the occipital and suboccipital dura mater and the tentorium, bilaterally. We embolized the AVM with Gelfoam and polyvinyl alcohol particulates, subtotally resected it, and embolized residual vessels with isobutyl cyanoacrylate. In spite of this extensive therapy, the malformation was not totally eradicated and an occipital pial AVM developed. This infant and the eight infants with posterior dural AVMs reported previously emphasize the difficulty of eradicating these lesions in infancy. We contrast the clinical features and therapy of infants and adults with posterior dural AVMs. Infants develop heart failure and cranial bruits because of arteriovenous shunts, whereas adults complain of headache and intracranial bruits. Infants need therapy to prevent progressive heart failure, intracranial hypertension, and perhaps cerebral ischemia. Ligation of arterial tributaries is inadequate therapy for these lesions. Embolization and resection of the malformation, when feasible, offers the best chance of curing posterior dural AVMs with extensive arterial tributaries.
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PMID:Posterior dural arteriovenous malformations in infancy. 688 91

Six aneurysms in five patients with acute aneurysmal subarachnoid hemorrhages were treated with direct thrombosis using cellulose acetate polymer within 4 hours of rupture. The aneurysms involved the internal carotid and posterior communicating arteries (two patients), the anterior choroidal artery (one patient), the bifurcation of the basilar artery (one patient), and the middle cerebral artery (two patients). Four patients underwent aggressive volume expansion after direct thrombosis with cellulose acetate polymer. The aneurysms remained thrombosed until operations on the necks were performed 2 to 7 weeks after the subarachnoid hemorrhages. Three patients were given intrathecal tissue plasminogen activator. One patient, who remained at neurological Grade V, was not treated surgically and died from cardiac failure. Five aneurysms in the remaining four patients were successfully clipped. These preliminary data suggest that immediate aneurysmal thrombosis, then aggressive preoperative prophylactic volume expansion and/or administration of intrathecal tissue plasminogen activator, can help prevent new bleeding and reduce delayed cerebral ischemia in patients after aneurysmal subarachnoid hemorrhages.
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PMID:Prophylactic thrombosis to prevent new bleeding and to delay aneurysm surgery. 759 94


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