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 prognosis of patients with advanced left heart failure is fairly dismal. It was not until recently that studies were conducted demonstrating the poor prognosis can be modulated by drug therapy. Of the many vasodilators tested, positive data have emerged only from trials of high-dose nitrates with hydralazine and, most importantly, angiotensin-converting enzyme inhibitors believed to constitute the biggest step forward in the treatment of chronic heart failure. The agents included in this group improve the symptomatology, increase exercise tolerance and improve the prognosis. At present, they are indicated in cases of severe heart failure, and the potential of their use in the more severe forms as well as in patients after myocardial infarction is being intensively investigated. Still, diuretic remain the mainstay of drug therapy. The role of digitalis in the treatment of heart failure is being currently reviewed; its administration is unnecessary in most patients, especially those with maintained sinus rhythm. A number of other positive inotropic drugs, both catecholamine-based agents and phosphodiesterase inhibitors (amrinone, milrinone, xamoterol, enoximone) have been tested. Their effect in the chronic form, unlike acute failure, is controversial, and there is no evidence documenting improved prognosis; some studies even show an adverse trend. As almost 50% of patients with heart failure die suddenly, it would have been only logical to administer antiarrhythmics to them. However, no data demonstrating an improved prognosis are available either. Results of studies conducted to date have proved to be rather disappointing, and a study with the most promising antiarrhythmic drug--amiodarone--is still under way.
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PMID:Can pharmacological therapy influence the mortality of chronic congestive heart failure? 128 41

During the acute phase of myocardial infarction, the generation of thrombin is reflected in the sudden rise of fibrinopeptide A (FPA) and the thrombin-antithrombin III (TAT) complex in blood. We have systematically determined the FPA and TAT plasma concentrations over a period of 14 days after acute myocardial infarction in 100 patients. Mean levels of both thrombin markers were the highest on admission, remained elevated over the following few days, and then gradually declined after day 5. Still, by the end of the first week two thirds of the patients had distinctly elevated TAT and FPA levels, and by the end of the second week such an abnormality was present in half of them. Continuous intravenous heparin infusion at a dose of 20,000 units/day, administered for 1 week to patients who had either received (n = 21) or not received (n = 17) streptokinase, led to a significant depression (p less than 0.05) of thrombin markers over the first 48 hours, an effect that did not persist over the subsequent days of treatment. In patients not assigned to heparin treatment, those in heart failure had significantly (p less than 0.05) higher mean TAT and FPA values on days 3, 5, and 7 compared with patients in whom heart failure was absent. Infarct extension, pulmonary embolism, and death were also associated with a rise in one or both thrombin markers, often preceding the onset of clinical symptoms. Thrombinogenesis was not accompanied by changes in mean plasma concentrations of prothrombin, antithrombin III, or alpha 2-macroglobulin.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Persistent generation of thrombin after acute myocardial infarction. 157 16

The mitomycins are antitumor antibiotics that are under investigation now for more than 30 years. Mitomycin C (MMC) is the best investigated subtype. It serves as a prototype for drugs with bioreductive alkylation, which is a unique feature of this class. MMC is mainly active under anaerobic circumstances. The pharmacokinetics are linear in a two-compartment model. The main toxicities of MMC are thrombocytopenia and leucocytopenia. Rare but severe side effects are a hemolytic uremic syndrome, pneumonitis and cardiac failure. MMC has a wide clinical antitumor spectrum with efficacy in various tumor types such as gastric cancer, pancreatic cancer, breast cancer, non-small cell lung cancer, cervical cancer, prostate cancer and bladder cancer. Still, the above mentioned side effects prevent a more widespread use. The most important features of the drug will be reviewed.
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PMID:Mitomycin C: mechanism of action, usefulness and limitations. 213 Oct 38

Fifty-three neonates and seven pediatric patients were treated with extracorporeal membrane oxygenation from September 1983 until April 1986. Venoarterial bypass was achieved by cannulating the right atrium via the right internal jugular vein and the aortic arch via the right common carotid artery. In the neonatal group, 40 infants with acute respiratory failure were treated, and 36 (90%) survived. Five infants with congenital heart disease were treated and three (60%) survived. Among the eight patients with congenital diaphragmatic hernia, there were three (38%) survivors. In the pediatric group, four patients were treated for ventricular failure after cardiac operations. Two were weaned from bypass, with one long-term survivor. Three patients with acute respiratory failure were treated, with one survivor. salvaging high-risk neonates with minimal morbidity and mortality. It has also been useful in the support of infants with congenital heart disease and congenital diaphragmatic hernia. In pediatric patients one cannot expect to get results that are comparable to those found in neonates. Still, this modality can be useful in salvaging some moribund patients with pulmonary or cardiac failure, or both.
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PMID:Extracorporeal membrane oxygenation for respiratory and cardiac failure in infants and children. 380 95

A number of animal models have been developed to study both the pathophysiology of heart failure and new therapeutic approaches to this complex syndrome. The most widely used preparations today are the models of rapid ventricular pacing in the dog and myocardial infarction in the rat. Other common approaches include surgically induced pressure or volume overload and toxic myocardial depression. There is no ideal animal model that both perfectly imitates human heart failure and is technically feasible in the laboratory. Each model has advantages and specific limitations, and extrapolations from experimental to clinical heart failure therefore require critical evaluation. Still, animal models have provided new insights into many aspects of the complex pathophysiology of this syndrome and have helped to investigate the efficacy of new therapeutic interventions.
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PMID:Characteristics and clinical relevance of animal models of heart failure. 761 74

The beneficial effect of chronic beta-blockade in patients with congestive heart failure has been repeatedly shown since its introduction into treatment for this condition in 1975. Still this kind of therapy remains controversial, it is sometimes regarded as a therapeutic paradox, and its use is mainly limited to specialist centers. Various favorable effects of beta-blockers in patients with heart failure due to idiopathic dilated cardiomyopathy and ischemic heart disease have been demonstrated, the principal among them being reduction in energy requirements and ischemia, antiarrhythmogenic effect, improvement of diastolic function, protection of myocytes against catecholamine overload, centrally mediated increase in vagal tone, upregulation of beta-adrenergic receptors, and possible blockade of autoantibodies against beta 1-receptors. Although most of the studies used metoprolol, these effects may be relevant to certain other beta-blockers. Despite very solid pathophysiological and pharmacological rationales for the use of beta-blockade, a major obstacle for a general acceptance of this therapeutic concept is the striking contrast between hemodynamic changes during the acute effect and long-term treatment. When titrated carefully from very low doses and used with a true commitment to long-term treatment, beta-blockers have been shown to prevent further deterioration of heart failure and to improve hemodynamics, exercise tolerance, quality of life, and prognosis.
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PMID:Use of beta-adrenoceptor blockers in patients with congestive heart failure. 766 94

One of the most frustrating aspects of restenosis is that it is the result of advances in medical care (there was no restenosis before the days of balloon angioplasty), yet it seems to be resistant to all that science has to offer. Still we believe there is reason to be optimistic. We are at last beginning to see some promise from clinical trials, and data being generated confirm some of the hypotheses previously generated from animal experiments. Thus the effects seen with the GP IIb/IIIa antibody 7E3 suggest that thrombosis may be as important in its long-term sequelae as it is for acute reocclusion. The jury is still out on whether antiproliferative approaches will be a therapeutic option, but local delivery paradigms using novel formulations delivered by catheter or impregnated in stents may allow the concept to be tested without the risk of systemic toxicity. Plans are also underway for gene therapy trials, although we may have to wait for better vector technology before taking these into the coronary bed. Perhaps we should move away from the "single pill" approach and accept that, like many infections, malignancies, or even heart failure, a multifaceted approach with combination therapy will provide the first glimmer of that brighter tomorrow.
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PMID:Restenosis: is there a pharmacologic fix in the pipeline? 916 Jan 19

SCD continues to be an important cause of death and morbidity. Despite expanding insight into the mechanisms causing SCD, the population at high risk is not being effectively identified. Although there is still much to do in the management phase of SCD (predicting the efficacy of various therapies), recent clinical trials have helped define the relative risks and benefits of therapies in preventing SCD. Trials are underway to determine whether treating other patient populations, including asymptomatic patients after MI, will improve survival rate. The approach to reducing mortality rate will always be multifaceted; primary prevention of coronary artery disease and prompt salvage of jeopardized myocardium are 2 important aspects of this approach. In addition to interventions for MI, such as myocardial revascularization when indicated, simple and easily administered therapies that are likely to remain the most effective prophylactic interventions are aspirin, ACE inhibitors, beta-blockers, and cholesterol-lowering agents. However, the MADIT and AVID data clearly demonstrate a role for ICD therapy in a subgroup of patients who have VT/VF and are at risk of cardiac arrest. Even though the absolute magnitude of benefit associated with ICDs is still to be determined, the AVID study and other recent reports provide convincing evidence that patients who have VT/VF fare better with ICDs than with antiarrhythmic drug therapy. For the high-risk population described in this article, in addition to aggressive anti-ischemic and heart failure therapy, ICDs are now a mainstay of life-saving treatment. Still to be surmounted is the challenge of identifying patients who have nonischemic substrates and of providing them with the appropriate therapy. Guided by genetic studies and new insight into the mechanisms of such problems as congenital long QT syndrome, life-saving and life-enhancing therapies may soon be available for the management of SCD.
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PMID:Sudden cardiac death. 1045 74

Most frequent complications in patients with liver cirrhosis are due to portal hypertension. Beside ascites circumvent vessels formate with vasodilatation. Due to counterregulation a secondary hyperaldosteronism develops with release of vasocontrictive agents. If conservative and endoscopic methods fail, indication for building a portosystemic shunt is given. The TIPSS procedure is less invasive than the surgical method of Warren-Shunt, so the radiological intervention has replaced surgery. Reducing the portal pressure by the shunt, the clinical complications change for the better. Still problems are defined as hepatic encephalopathy and right ventricular heart failure. Regular follow up investigations have to be performed to detect complications in the shunt. Using regular clinical and radiological check up TIPSS is of clinical benefit with good long term results.
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PMID:[Transjugular portosystemic stent shunt (TIPSS) as intervention in clinical complications of portal hypertension]. 1171 78

The problem of heart failure (HF) has become a topic of great interest. Until recently, the use of beta-blockers in patients with HF was considered as a contraindication. Times have changed and the contraindicated drug is now an advised and preferred one to be used in HF patients with certain advised recommendations for its use in a safe and beneficial way. Still we need to emphasize the benefits of these agents in order to achieve more application in HF patients. Here we try to stress the proved beneficial effects of beta-blockers by major studies in HF patients, and to supply the reader with practical information regarding the use of these agents with a look at the frequency of using them and the possible reasons behind their underuse. The files of heart failure patients admitted to 1st Internal Department in the University Hospital in Bratislava in the period between January and December 1997 were checked to show the magnitude of using beta-blockers in them. Among 150 patients admitted during the above mentioned period only 30 patients (20%) received beta-blockers. It seems that beta-blockers have to be used in all patients with HF with reduced ejection fraction unless a real contraindication exists, but the actual data shows that beta-blockers are still underused. (Tab. 2, Ref. 30.)
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PMID:Benefits of beta-blockers in heart failure. 1176 66


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