Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Acute right ventricular failure due to persistent pulmonary hypertension is a risk factor for premature death after cardiac transplantation. The purpose of this study was to follow changes in pulmonary haemodynamics in patients with pulmonary hypertension undergoing heart transplantation, and to examine whether postoperative changes can be predicted from a preoperative nitroglycerin (NTG) challenge. Seventeen consecutive patients with NYHA class IV heart failure and pulmonary hypertension (pulmonal vascular resistance (PVR) > 2.5 Wood units) underwent an NTG infusion before cardiac transplantation and were followed up using measurements of pulmonary haemodynamics before, early (24 h) and late (6 months) after cardiac transplantation. The effect of NTG was measured preoperatively and compared with posttransplantation values. Postoperative (24 h) PVR was reduced in all patients when compared with preoperative findings (PVR from 4.1 +/- 0.2 to 1.9 +/- 0.2 Wood units, Mean +/- SEM, p < 0.05). Mean pulmonary artery pressure (mPAP) was lowered in 16 of out 17 patients (41 +/- 2 to 26 +/- 1 mmHg, p < 0.05). None of the parameters were significantly changed during the subsequent 6 months. Postoperative PVR and mPAP were accurately estimated by preoperative NTG infusion (NTG vs 24 h posttranspl: PVR 2.2 +/- 0.2 vs 1.9 +/- 0.2 Wood units, p > 0.05; mPAP 30 +/- 2 vs 26 +/- 1 mmHg, p > 0.05). Heart transplantation candidates with pulmonary hypertension responsive to NTG can be expected to obtain a postoperative immediate fall in pulmonary pressures and PVR. The magnitude of this circulatory improvement can be predicted from a preoperative NTG infusion and is not different from values measured 6 months after transplantation.
 ...
PMID:Effect of nitroglycerin in patients with increased pulmonary vascular resistance undergoing cardiac transplantation. 945 82

Acute right ventricular failure in the setting of pulmonary arterial hypertension (PAH) often requires hospitalisation in intensive care units (ICU) to manage the subsequent low cardiac output and its consequences. There are very few data on these acute events. We recorded demographic, clinical and biological data and therapy in consecutive patients suffering from acute right heart failure requiring catecholamine treatment in the ICU of the French referral centre for pulmonary hypertension. These variables were analysed according to the survival status in ICU. 46 patients were included, the mean age was 50.3 yrs. ICU mortality was 41%. We found no difference in terms of demographics, clinical data, last haemodynamic measurements at admission. Systemic arterial pressure was significantly lower in the subgroup of patients whose clinical course was fatal. Plasma brain natriuretic peptide (BNP), C-reactive protein (CRP), serum sodium and creatinine at admission correlated with survival. Demonstration of an infection during the ICU stay was associated with a worse prognosis. These preliminary results underline the importance of some simple clinical and biological parameters in the prognostic evaluation of acute heart failure in the setting of PAH. Whether these parameters can guide therapy needs to be further investigated.
 ...
PMID:Prognostic factors of acute heart failure in patients with pulmonary arterial hypertension. 2051 8

Acute right ventricular failure is increasingly seen in the emergency room and intensive care unit. Acute right ventricular failure is associated with high central venous pressure (CVP) and altered liver and kidney enzymes. Several studies suggested that high CVP might markedly reduce renal blood flow by increasing renal backpressure. A strong relationship was observed between CVP and renal blood flow both in the acute and chronic heart failure setting. Likewise, reducing CVP markedly improved renal function. Accordingly, in patients with heart failure, congestion is the major determinant of renal dysfunction. Thus, vasodilators might be best indicated in heart failure patients with predominant signs of congestion. Their effect to reduce CVP might be very beneficial as it may improve renal blood flow.
 ...
PMID:Congestion and cardiorenal syndromes. 2042 63