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

Two thirds of the patients with peripheral arterial occlusive disease have to be treated conservatively, for only up to 30% can be revascularized by operative methods. Using the pharmacological differential treatment the grade of compensation and localization of the obliterative process has to be considered. Ignoring the usual basic therapy (elimination of heart failure and pathological bradycardia, systemic walking-exercise, anticoagulation etc.) intrafemoral long-term application of energetic phosphate (i.e. nucleotid-nucleosid-mixtures) leads to a positive result in nearly two thirds (n = 97 legs) with a degree of II to IV of Fontaine. Whereas the snakes' encyme Ancrod with the effect of defibrination was successful in almost 70% of the patients with arterial insufficiency (n = 45) including the degree II B (painless walking-distance under 100 meters). Energetic phosphates, applied to the arteria femoralis, are most successful in degree II with claudication intermittens. Ancrod should be used respectively for patients with pain during rest. These results are discussed with respect to compensation and localization of arterial occlusive disease, acute and chronic measurements of the hemodynamics by use of Doppler ultrasound and strain gauge plethysmography and with respect to variation of the concentration of the metabolic parameters lactate and pyruvate--the latter when defibrination was performed.
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PMID:[Pharmacological treatment of chronic arterial occlusive disease (author's transl)]. 49 58

Echocardiographic predictors of clinical outcome were examined in subjects from the Framingham Heart Study with overt coronary artery disease. The study population consisted of 185 men and 147 women with coronary artery disease who underwent M-mode echocardiography and were followed for a mean of 3.90 years. At baseline, 37 men (18.4%) and 16 women (10.9%) had reduced fractional shortening, 43 men (23.2%) and 28 women (19%) had left ventricular (LV) dilatation, and 76 men (41%) and 76 women (51.7%) had LV hypertrophy. During the follow-up period new cardiovascular disease events (coronary disease, stroke, transient ischemic attack, claudication, heart failure and deaths from cardiovascular disease) occurred in 60 men (32%) and 58 women (39%). With use of age-adjusted proportional hazards analyses, LV mass/height in men (relative risk [RR] = 1.25/50 g/m increment, 95% confidence interval [CI] 1.01 to 1.55) and LV end-diastolic diameter in women (RR = 1.36/5 mm increment, 95% CI 1.05 to 1.76) were predictors of new cardiovascular disease events. Cardiovascular risk was also associated with LV end-systolic diameter in both sexes (in men RR = 1.28/1 SD increment, 95% CI 1.02 to 1.63; in women RR = 1.40/1 standard deviation increment, 95% CI 1.09 to 1.82). Reduced fractional shortening alone (RR = 1.91, 95% CI 1.11 to 3.31) and in combination with LV dilatation (RR = 2.13, 95% CI 1.13 to 4.02) was associated with the incidence of new cardiovascular disease outcomes in men.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Echocardiographic determinants of clinical outcome in subjects with coronary artery disease (the Framingham Heart Study). 141 14

The risk for cardiovascular complications is already substantially increased in persons with borderline elevation of arterial pressure (141-159/90-94 mmHg and transiently below). It increases progressively with higher grades of hypertension. The main aim of treatment is thus a significant improvement in survival for the patient. Persons with raised blood pressure (BP) have often additional cardiovascular risk factors such as deranged carbohydrate metabolism, dyslipidemia, left ventricular hypertrophy, smoking and others. Treatment of hypertensive patients should thus not only normalize BP but should at the same time reduce associated risk factors or at least not increase them. Conventional antihypertensive treatment based on thiazides in high doses or beta-blocking agents led to marked reduction of strokes and heart failure, but did not satisfactorily reduce coronary heart disease or sudden cardiac death. It has been suspected that other cardiac risk factors are insufficiently influenced or eventually even deteriorated by conventional therapy, thus counteracting partly a beneficial effect of lowered BP. Beta-blockers however have at least a secondary preventive effect after myocardial infarction. Newer antihypertensive drugs such as ACE-inhibitors, calcium antagonists and alpha 1-blockers reduce left ventricular hypertrophy and are at least neutral with regard to metabolism of lipids and carbohydrates. The non-thiazide diuretic indapamide and the serotonin (S2-) blocker ketanserin likewise are neutral with regard to glucose and lipid metabolism. The efficacy of these new drugs regarding long term survival is as yet undetermined. Persisting borderline or established hypertension should as a rule always be approached with basic non-pharmacologic measures: loss of overweight, reduction of alcohol intake, exercise, avoidance of high salt foods, abstention from smoking and withdrawal of BP-raising drugs. If antihypertensive medication is indicated, potential first line drugs are ACE-inhibitors, calcium antagonists, beta-blockers, thiazides at low dose, indapamide, ketanserin, the alpha 1-blocker prazosin and others; initially as monotherapy, if needed in combinations of 2 or 3. Older patients or those will with additional disturbances such as diabetes, hypercholesterolemia, nephropathy, heart failure, ischemic heart disease, arrhythmias, claudication, asthma and others need problem-adjusted modifications of treatment.
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PMID:[Antihypertensive therapy in the nineties]. 153 54

Atherosclerosis and hypertension are, by far, the most common cardiovascular diseases affecting women, and both are influenced by diet. Atherosclerosis occurs more commonly in men than women; generally women are 10 to 15 years older than men when symptoms develop. The prevalence of hypertension is about equal in the two sexes, particularly in middle aged and older persons. These cardiovascular diseases are major causes of death and disability in this country. Atherosclerosis results in myocardial infarction, thrombotic strokes, and claudication. Hypertension, when severe, damages small blood vessels, causing kidney failure, hemorrhage, strokes, and heart failure; when the condition is mild to moderate, it produces atherosclerosis. Nutritional factors are of primary importance in both atherosclerosis and hypertension. Risk factors for atherosclerosis related to nutrition are hypercholesterolemia, hyperglycemia-diabetes, and for hypertension, obesity, high salt intake, and excessive use of alcohol. Of all these risk factors, obesity seems to be the most important because it is strongly linked to hypertension and diabetes. Dietary intake of saturated fat is a potent factor in determining the blood cholesterol level, and reducing intake often decreases the level, thus lessening the risk of atherosclerotic complications. Although high salt intake and excessive alcohol use produce hypertension in susceptible people, less is known about the frequency of this adverse effect than is known about obesity.
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PMID:Nutrition and cardiovascular diseases of women. 312 Feb 15

CSAD provides a challenge for the vascular surgeon. Patients are older, sicker, and at greater risk than are patients with unisegmental disease. Similarly, symptoms are more severe and limb loss is more frequent. A multitude of different reconstructive techniques are available, but their injudicious or untimely use can not only fail to improve the patient but can also cause limb loss or death. Their use must be predicated by a differentiation of which arterial segments are hemodynamically involved, yet this determination may not be possible even after extensive noninvasive and invasive investigation. To optimize the approach to these patients, the following principles should be employed. First, incapacitating claudication is a valid indication for a suprainguinal inflow procedure in a good-risk patient. However, indications for surgery should usually be limited to limb salvage, especially if an infrainguinal procedure is contemplated. Medical conditions such as heart failure and diabetes should be improved before arteriography. The latter should delineate the entire infrarenal arterial system, with special attention to the iliac, deep femoral, and pedal arteries. Oblique views may be of critical importance. Noninvasive hemodynamic tests should be used to confirm the need for arterial reconstruction and help delineate areas of functional stenosis. Direct pull-through pressure measurements may be required for ultimate confirmation. If proximal disease is thus defined, as proximal inflow operation should usually be sufficient unless there is extensive gangrene of the foot, in which case synchronous distal grafts may be required. If the proximal graft alone is performed, the patient must be followed closely since approximately 10% of patients may need subsequent distal reconstructions. The role of the "runoff" segments such as the deep femoral artery, popliteal trifurcation, and pedal arteries may be critical. Every effort should be made to ensure flow through these vessels. Profundoplasty alone is seldom indicated but is often a valuable adjunct to other reconstructive procedures. Lumbar sympathectomy is seldom required. PTA is becoming a valuable adjunct to treatment of CSAD, and intraoperative dilatation also has potential attributes. If such an approach is followed, lasting limb salvage with minimal morbidity should be achieved in most patients with CSAD.
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PMID:Combined segment arterial disease. 315 27

Between January 1986 October 1987, extended profundaplasty was performed on 11 severely ischemic limbs of eight patients with extended arteriosclerotic occlusions, associated with surgery for improvement in inflow. The subjects were all males, and ages ranged from 62 to 84 years (mean: 72.8 years). Symptoms were disabling claudication in one limb (1 case), rest pain in 5 (4 cases), and gangrene of the foot or ulcer of the toes in 5 (3 cases). Preoperative ankle pressure index (API) was 0 in 7 limbs (5 cases), and between 0.11 and 0.27 in the remaining 4 limbs (3 cases). Thrombectomy was performed in two cases, axillo-bifemoral bypass in 5, femoro-femoral bypass in one, and aorto-bifemoral bypass in one, as surgery for improvement in inflow. Although postoperative API remained 0 in 4 limbs, it increased between 0.36 and 0.56 in the remaining limbs. One subject died of heart failure on the 22nd postoperative day, and two limbs required below-knee amputation. Limb salvage rate was 81.8%. Extended profundaplasty seems to be a worthwhile choice of treatment as a limb salvage operation for severely ischemic limbs due to extended arteriosclerotic occlusions involving not only aorto-iliac but also femoro-popliteal or crural segment.
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PMID:[A clinical study of extended profundaplasty for severely ischemic limbs]. 323 Dec 10

This cross-sectional study presents the first normative data on pedometer-determined ambulatory activity, defined as steps/day, in 160 (98 males, 62 females; age=52.4 +/- 5.3 years; BMI=32.3 +/- 5.7) free-living individuals with type 2 diabetes. Participants took 6662 +/- 3077 steps per day, less than that reported in nondiabetic samples and more than that reported for samples living with more restrictive chronic conditions including claudication, joint replacement, chronic obstructive lung disease, and chronic heart failure. Steps/day and BMI were inversely and significantly correlated (r=-0.27, P<0.01). Further, there was a significant difference between BMI categories (from normal weight to obesity class III) with regard to steps/day (F=2.96, P<0.05). The difference was most apparent between the highest obesity classes (II and III) and normal weight categories. This data is useful for sample comparison purposes. In addition the standard deviation or variance estimates can be used to calculate samples sizes for intervention efforts. Objective quantification of ambulatory activity via simple and inexpensive pedometers permits researchers and practitioners to easily screen for level of activity along a continuum. This study opens the door for future research and clinical applications including identifying threshold values related to important health outcomes and evaluating incremental change due to various interventions in this population.
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PMID:Pedometer-determined ambulatory activity in individuals with type 2 diabetes. 1185 95

A 54-year-old woman was admitted to our hospital because of heart failure, upper-limb hypertension, and lower-limb claudication. A loud systolic bruit was audible along the middle lower back. An arteriogram confirmed long-segment stenosis from the lower thoracic to the upper abdominal aorta with normal aortic arch. The patient was diagnosed as having middle aortic syndrome. This case was atypical because most cases of this disease are seen in children and young adults. After administration of diuretics and ACE-I, the heart failure and hypertension were both improved. However, the lower limb claudication was aggravated because of decreased blood pressure of the lower limb. In this patient, percutaneous angioplasty or surgical treatment will be required to prevent the recurrence of heart failure and to improve long-term quality of life by relief from intermittent claudication.
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PMID:Middle aortic syndrome diagnosed at 54 years of age--a case report. 1236 71

Patients with peripheral arterial disease (PAD) report profound limitations in all domains of quality of life that are worse than those for patients with chronic pulmonary disease and moderate to severe heart failure. While claudication has detrimental effects on quality of life, little is understood about the factors that influence quality of life and whether these determinants are similar for men and women with PAD and claudication. The purpose of the present investigation was to evaluate the effect of claudication on quality of life in 71 men and 26 women (mean age 72 and 73 years respectively) with PAD. Disease severity as assessed by ankle brachial index (ABI) and community-based walking was similar for men and women, although men reported greater comorbid conditions than women. Despite the similarity in disease severity, women reported decreased physical functioning (p = 0.01), more bodily pain (p = 0.04) and greater mood disturbance (p = 0.012) than men. Claudication and PAD had a greater impact on women than on men and may result from the higher prevalence of mood disturbance and bodily pain reported by women.
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PMID:Gender differences in perception of PAD: a pilot study. 1451 10

The prevalence of peripheral arterial disease (PAD) increases with age. PAD in elderly persons may be asymptomatic, may be associated with intermittent claudication, or may be associated with critical limb ischemia. Other atherosclerotic vascular disorders, especially coronary artery disease (CAD), may coexist with PAD. Elderly persons with PAD are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from CAD. Modifiable risk factors should be treated in persons with PAD such as cessation of cigarette smoking and control of hypertension, dyslipidemia, and diabetes. Statins have been shown to reduce the incidence of intermittent claudication and to improve treadmill exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, should be administered to all persons with PAD. Persons with PAD should be treated with angiotensin-converting enzyme inhibitors and also with beta blockers if CAD is present. Cilostazol should be given to persons with intermittent claudication to improve exercise capacity unless heart failure is present. Exercise rehabilitation programs improve exercise time until claudication. Indications for lower extremity angioplasty, preferably with stenting, or bypass surgery are 1) incapacitating claudication in persons interfering with work or lifestyle; 2) limb salvage in persons with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene; and 3) vasculogenic impotence. However, amputation should be performed if tissue loss has progressed beyond the point of salvage, if surgery is too risky, if life expectancy is very low, or if functional limitations obviate the benefit of limb salvage.
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PMID:Management of peripheral arterial disease of the lower extremities in elderly patients. 1499 33


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