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

Cardiac arrhythmias (CA) are a frequent and dangerous complication of respiratory and cardiac failure in patients with chronic obstructive pulmonary disease (COPD). The aim of the study was to investigate the effects of mexiletine on CA in patients with cor pulmonale in a state of cardio-respiratory decompensation. We studied 32 COPD patients with severe airways obstruction; mean VC 2.35 +/- 0.53 litres; FEV1, 0.92 +/- 0.3 litres and respiratory failure, PaO2 = 56 +/- 5 mm Hg, PaCO2 = 47 +/- 9 mm Hg allocated by random numbers to 20 treated and 12 controls. Continuous 24-hour Holter monitoring was performed for 3 consecutive days after admission to the department following routine treatment which consisted of low-flow oxygen, antibiotic, bronchodilators and diuretics. On the first day, the type and frequency of CA were analysed. Then the treated patients were given mexiletine 250 mg i.v. + 200 mg orally followed by 200 mg every 8 h for the next 48 h. Controls continued the routine treatment only. Mexiletine treatment resulted in a highly significant reduction in the mean number of premature ventricular beats from 163 to 28 and 30/24 h, respectively (p less than 0.01). Episodes of ventricular tachycardia were abolished. The mean number of premature supraventricular beats also fell from 85 to 67 and 48/24 h (p less than 0.01). Number of episodes of sinus tachycardia fell from 17 during the first day to 13 and 10 on the 2nd and 3rd days, respectively. In the controls, the frequency and type of CA remained unchanged.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effects of mexiletine on cardiac arrhythmias in patients with cor pulmonale. 263 53

Non-apnoeic oxygen desaturation related to rapid eye movement (REM) sleep in a patient with hypothyroidism, obesity, respiratory failure, and cardiac failure was improved by treatment with nasal continuous positive airway pressure of 10 cm H2O.
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PMID:Non-apnoeic REM sleep induced nocturnal oxygen desaturation treated by nasal continuous positive airway pressure. 266 26

Plasma ADH, PA and PRA in patients with respiratory failure (RF) were studied. RF patients were divided into 4 groups, i.e. acute RF (ARF) and chronic RF (CRF), with or without hypercapnia. The levels of these hormones were significantly higher in RF than those in control subjects, moreover, they were markedly elevated in ARF than those in CRF. In multiple regression analysis, ADH correlated with PaO2, pH and PRA in RF patients, but correlated with serum osmolality in control subjects. It was considered that ADH in RF was affected by the direct effect of blood gases and circulatory disorder. The mechanism of elevated PA and PRA in RF probably was mediated through restriction of intake of water and Na, reduction of renal blood flow and decreased ACE often occurred in RF. Abnormally elevated hormones are more often recognized in edematous patients than in nonedematous patients. It was suggested that many patients with RF develop heart failure or edema due to hormonal abnormalities.
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PMID:[ADH (anti-diuretic hormone), aldosterone (PA) and renin activity (PRA) in patients with respiratory failure]. 269 88

Size limitations and technical barriers prohibit the use of many conventional mechanical circulatory support systems for postcardiotomy ventricular dysfunction in pediatric populations. Extracorporeal membrane oxygenation (ECMO), frequently used to treat neonatal respiratory failure, can provide cardiac support and is effective treatment of postoperative myocardial failure in children. From 1981 to 1987, 10 patients aged 2 days to 5 years were maintained on ECMO for 15 to 144 hours (mean duration, 92 +/- 16 hours) after cardiotomy. Operative procedures included repair of tetralogy of Fallot (2 patients), closure of a ventricular septal defect (2), the Senning procedure for transposition of the great arteries (1 patient), repair of interrupted aortic arch with closure of a ventricular septal defect (1), repair of a partial atrioventricular septal defect (2), closure of a ventricular septal defect with excision of an anomalous muscle bundle (1), and the Fontan procedure (1). Venoarterial ECMO was established in all 10 children. Six patients underwent transthoracic right atrium-ascending aorta cannulation, 3 had right internal jugular vein-right common carotid artery cannulation through a cervical incision, and 1 had right internal jugular vein-left axillary artery cannulation. Eight of the 10 patients were successfully weaned from ECMO, and 7 are long-term survivors. There were 3 deaths; 1 was caused by cardiac and acute renal failure complicated by sepsis two days after decannulation, another occurred 19 days after atrioventricular septal defect repair, and 1 was caused by massive pulmonary hemorrhage. Major hemorrhage developed in 3 patients while on ECMO; 2 required premature decannulation for mediastinal bleeding from operative sites and ultimately survived, and 1 died of respiratory failure as a result of endobronchial bleeding. We conclude that the use of ECMO in pediatric populations for transient postoperative ventricular dysfunction improves survival with limited overall morbidity.
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PMID:Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock in children. 275 47

A total of 136 patients with trans- and 200 with non-transmural myocardial infarction (MI) were examined over time for chlorine-soluble mucoprotein (MP), serum hexoses (SH), their fraction-hexoses of glycosaminoglycans (H-GAG), and hexoses of glycoproteins (H-GP), serum, plasma and urine hydroxyproline (SHP, PHP, UHP). The computation of regressions made it possible to prove multidirectional changes in chlorine-soluble MP, SH, H-GAG, SHP, PHP, and in UHP. Approximation of the curves enabled MI patients to be distributed into subgroups marked by rapid and moderate repair tempo. The factors that prolong MI repair according to the X-square test are as follows: age over 60 years, heart aneurysms, recurrent MI, chronic grade 2A heart failure, diabetes mellitus, chronic bronchitis combined with lung emphysema and stage 2 respiratory failure. That whether MI is transmural or non-transmural is not per se the sole factor determining MI repair.
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PMID:[Clinical regularities of myocardial infarction repair]. 276 91

Seventy-seven patients with drug-refractory sustained ventricular tachycardia (VT) (28 patients) or ventricular fibrillation (VF) (49 patients) underwent implantation of an automatic cardioverter defibrillator (AICD). The 67 men and 10 women, with a mean age of 60 +/- 12 years (range 18 to 79), had coronary artery disease (60 patients), idiopathic cardiomyopathy (eight patients), mitral valve prolapse (four patients), hypertensive heart disease (one patient), Ebstein's anomaly (one patient), long QT syndrome (one patient), and primary electrical disease (two patients). The mean left ventricular ejection fraction was 35 +/- 16% (range 10% to 75%). Sustained VT/VF was induced in 64 patients (83%) at baseline electrophysiologic testing. A mean of 4.1 +/- 1.3 antiarrhythmic drugs failed to control the arrhythmia. Associated surgery at AICD implantation included coronary artery bypass in 19 patients, coronary bypass with aneurysmectomy in six patients, and aneurysmectomy alone in one patient. Five patients had only prophylactic patches implanted during aneurysmectomy or coronary bypass and the AICD device was subsequently implanted under local anesthesia to prevent arrhythmia recurrence or to control persistently inducible VT. Operative mortality was 2.6% with two deaths from intractable VF. Fifty-two patients (69%) continued receiving antiarrhythmic drugs to suppress spontaneous VT. During a mean follow-up of 15 +/- 13 months (range 1 to 63), six patients died: two suddenly due to probable pulse generator failure (greater than 2 years old), one of acute myocardial infarction, two of heart failure, and one of respiratory failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical experience in seventy-seven patients with the automatic implantable cardioverter defibrillator. 277 68

Mechanical ventilation is now considered a therapeutic option for respiratory failure associated with Duchenne's muscular dystrophy (DMD). Through the monitoring of forced vital capacity and PCO2, prediction of impending respiratory failure is possible. This knowledge allows the patient to choose institution of mechanical ventilation before acute respiratory failure or no intervention and preparation for a natural death. To assist patients and families in this decision making, a special clinic was established. Thirty adolescent boys with DMD were followed up. Eighteen boys reached the end stage of their disease. Three died of cardiac failure. Prediction of respiratory failure was possible in 14 of the remaining 15; 11 of the 15 were able to make educated choices regarding respirator assistance or a natural death. The clinic has shown that in the majority of cases, when properly educated, patients and families can be active participants in life-and-death decisions.
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PMID:Patient and family participation in the management of respiratory failure in Duchenne's muscular dystrophy. 292 May 77

Two cases of primary pulmonary artery sarcoma are reported. The patient in the first case was a 61-year-old male with a two-year history of cough and exertional dyspnea, who died of intractable cardiac failure two months after admission without establishment of a diagnosis related to the etiology of cardiac failure. Autopsy revealed a sessile tumor within the pulmonary trunk and a solitary metastatic lesion in the lung. Histologic, immunohistochemical and electron microscopic studies were performed and a diagnosis of malignant mesenchymoma was made. The patient in the second case was a 32-year-old male complaining of exertional dyspnea and back pain. Radiologic studies indicated a mediastinal tumor involving the pulmonary artery. Exploratory thoracotomy revealed that the mediastinal mass arose from the left pulmonary artery. He died of respiratory failure 26 months after onset of his initial symptoms. Histologic, immunocytochemical and electron microscopic studies of both surgical and autopsy materials revealed a malignant fibrous histiocytoma. One hundred ten previously reported cases of this tumor are reviewed, and its clinicopathologic and morphologic features and probable histogenesis are discussed.
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PMID:Primary pulmonary artery sarcoma. Report of two autopsy cases studied by immunohistochemistry and electron microscopy, and review of 110 cases reported in the literature. 305 9

The combined transplantation of heart and lungs, first done successfully by the Stanford Team (USA) in 1982, at present seems to be superseding lung transplantation alone, and has broadened the indications of heart transplantation to include terminal heart failure with fixed pulmonary arterial hypertension. After reviewing the causes for failure in lung transplants, the authors stress the superiority of heart-lung transplants compared to isolated lung transplantations: healing of the tracheal anastomosis, ease of detection of rejects by endomyocardial biopsy and the lack of inhomogeneity of the ventilation/perfusion ratios. This operation still poses problems of surgical technique as the mediastinal nerves need to be preserved and the risk of haemorrhage linked to the mediastinal dissection or to the eventual pulmonary separation under cardiopulmonary bypass is important. Donor subjects for cardiopulmonary transplantation are rare as they ought to have a thoracic cage of matching size to the recipient and to be free of pulmonary infection and trauma. The post-operative complications are essentially those of immediate haemorrhage, graft rejection, pulmonary oedema and infection. The late complications are coronary atherosclerosis and bronchiolitis obliterans. The indications of such a transplant are currently reserved for primary or secondary pulmonary hypertension and to respiratory failure with a normal thoracic cage and ventilatory mechanics.
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PMID:[Heart-lung transplantation]. 310 71

Ten patients with respiratory failure and nocturnal hypoventilation were treated for three to nine months by nasal intermittent positive pressure ventilation. Four patients had chronic obstructive lung disease (median FEV1 19% predicted) and six restrictive chest wall disorders (median FVC 25% predicted); eight of the patients also had cardiac failure. The median daytime arterial oxygen tension, measured before and after at least three months' treatment, increased from 6.2 (range 5.4-9.6) to 9.1 (7.1-9.8) kPa in those with restrictive disease (p less than 0.05), and from 6.0 (5.7-6.5) to 7.1 (6.3-7.7) kPa in the four with airflow limitation (NS). Median values for arterial carbon dioxide tension over the same time fell from 8.2 (range 6.7-9.8) to 6.5 (6.0-6.9) kPa in the group with restrictive disease (p less than 0.05) and from 8.2 (7.0-9.2) to 7.1 (4.9-7.7) kPa in those with airflow limitation (p less than 0.02). Total sleep time while patients were using nasal positive pressure ventilation varied from 155 to 379 (median 341) minutes, and included 4-26% rapid eye movement sleep (median 14%). The percentage of monitored time during the night in which the arterial oxygen saturation was less than 80% fell from a median (range) of 96 (3-100) to 4 (0-9) in the six patients with restrictive disease and from 100 (98-100) to 40 (2-51) in those with airflow limitation. There were no changes in spirometric values but exercise tolerance improved in all patients. The technique may prove an acceptable alternative to long term domiciliary oxygen therapy in selected patients.
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PMID:Control of nocturnal hypoventilation by nasal intermittent positive pressure ventilation. 314 60


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