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

A total of 189 patients with uncomplicated myocardial infarction were selected at random for early or late mobilization and discharge from hospital. Patients were admitted to the study after 48 hours in a coronary care unit if they were free of pain and showed no evidence of heart failure or significant dysrhythmia. Randomization was achieved by monthly cross-over of the three medical wards to which the patients were discharged. One group of patients was mobilized immediately and discharged home after a total of nine days in hospital, and the second group was mobilized on the ninth day and discharged on the 16th day. Out-patient assessment was carried out six weeks after admission. No significant differences were observed between the groups in terms of mortality or morbidity, as reflected by the incidence of recurrent chest pain or myocardial infarction, heart failure, dysrhythmia, or venous thromboembolism detected either clinically or by (125)I-labelled fibrinogen scanning.
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PMID:Comparison of mobilization after two and nine days in uncomplicated myocardial infarction. 483 62

The effect of intravenous atenolol on ventricular arrhythmias in acute myocardial infarction was assessed in 182 patients admitted within 12 hours of the onset of chest pain. Ninety-five patients were randomised to receive 5 mg intravenous atenolol followed immediately by 50 mg by mouth and 50 mg 12 hours later, then 100 mg daily for 10 days; 87 patients served as controls. The treated patients had significantly fewer ventricular extrasystoles; 58 control patients (67%) had R-on-T extrasystoles compared with only 25 treated patients (26%) (2p less than 0.0001); repetitive ventricular arrhythmias were detected in 64 control patients (74%) and 55 treated patients (58%) (2p less than 0.05). Heart rate was significantly reduced from 77 +/- 1 beats/min at entry to 65 +/- 1 beats/min (2p less than 0.001) in the first hour after intravenous atenolol, and in addition the rate was significantly different from that in the control group. There was no difference in the incidence of heart failure, but fewer patients in the treated group received other antiarrhythmic agents or digoxin. These results show that early intravenous atenolol prevents ventricular arrhythmias in suspected acute myocardial infarction.
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PMID:Reduction of ventricular arrhythmias by early intravenous atenolol in suspected acute myocardial infarction. 618 29

The optimal management of patients with small aortic anulus or left ventricular outflow tract obstruction remains unclear. Between 1976 and March, 1982; 18 patients have undergone enlargement of their left ventricular outflow tract by means of the Konno or a modification of the Konno procedure. Fourteen of these 18 patients had previous operations for aortic stenosis or tunnel left ventricular outflow tract, and two patients had undergone three previous operations. All 18 patients had symptoms of either heart failure of chest pain, or had electrocardiographic evidence of strain. They ranged in age from 4 years to 58 years, with 13 of the 18 patients being less than 20 years of age. A Dacron patch was used to enlarge the left ventricular outflow tract after incising down the ventricular septum. In all patients, at least a 21 mm valve could be placed, with between 50% and 65% of the valve anulus being made up of natural tissue. The remaining portion of the valve anulus was constructed from the Dacron patch. The patch was extended up to enlarge the ascending aorta, and a pericardial patch was used to close the defect in the right ventricular outflow tract. In all 18 patients the gradient was obliterated at the time of operation. There was one early death in a patient who had previous insertion of a left ventricular apical-aortic conduit in which the heterograft valve had degenerated. There has been one late death because of bacterial endocarditis in a child who also had a parachute mitral valve and evidence of pulmonary hypertension. The remaining 16 patients are functioning well after the Konno procedure. Three are receiving warfarin sodium, and 13 are receiving aspirin. These results suggest that this is an acceptable method of treating patients with small aortic anulus or left ventricular outflow tract obstructions and would appear to have advantages over a left ventricular apical-aortic conduit.
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PMID:Left ventricular outflow enlargement by the Konno procedure. 621 42

Fabry's disease (angiokeratoma corporis diffusum universale) is a disorder of sphingolipid metabolism affecting predominantly male patients. Renal damage is usually the cause of death in the fourth or fifth decade. Renal transplantation represents a new approach to correction of uremia and perhaps even of the basic congenital metabolic anomaly. In this case the patient, a 57-year-old man, developed renal failure at the age of 45 and received a renal allograft at that age. The transplantation was followed by complete remission of uremia and concomitant symptoms, but later complicated by progressive cardiac failure, anginal chest pain and arrythmia. Necropsy findings showed persistent deposition of ceramide in the myocardium and especially in the conduction system. This was documented, for the first time to the author's knowledge, by electron microscopic investigations. Cardiac manifestations of Fabry's disease are discussed in relation to patients with renal transplants.
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PMID:[Fabry's disease. Light and electron microscopic cardiac findings 12 years after successful kidney transplantation]. 629 21

In 67 consecutive patients with inferior wall acute myocardial infarction (AMI), 99m-technetium pyrophosphate scintigraphy was performed 36 to 72 hours after the onset of chest pain to detect right ventricular (RV) involvement. All patients were continuously monitored during at least 3 days to detect rhythm and conduction disturbances. In 29 patients RV involvement was diagnosed by scintigraphy. None of these 29 patients showed clinical signs of right-sided heart failure. Fourteen of the 19 patients showing atrioventricular (AV) nodal condution disturbances in the setting of inferior AMI also had RV involvement. Therefore, the incidence of high-degree AV nodal block in patients with RV involvement (14 of 29 patients) was 48% compared to only 13% (5 of 38) in patients with inferior AMI without RV involvement.
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PMID:Right ventricular involvement with acute inferior wall myocardial infarction identifies high risk of developing atrioventricular nodal conduction disturbances. 632 59

The hour of day of primary ventricular tachycardia (VT) in the acute phase of myocardial infarction was studied in 63 consecutive patients without cardiac failure or antiarrhythmic therapy, admitted to hospital less than 6 hours after the onset of chest pain. There were 19 women and 44 men, with an average age of 63 years. The site of infarction was anterior in 23 cases, posterior in 34 cases and circumferential in 6 cases. The cardiac rhythm was analysed from the 6th hour following the onset of chest pain for 4 days, using a HP 98220 A computerised analyser CPK levels were measured daily. Ventricular tachycardia occurred in 73% of cases with no significant difference between daytime (18 patients) and night time (28 patients). The patients developing VT did not differ from the remainder with respect to age, sex, or site of ECG changes, but peak CPK levels were significantly higher than in patients without VT. The risk of VT decreased slowly as the interval from the onset of chest pain increased and fell practically to zero after the 40th hour. Diurnal and nocturnal VT were independent of age, sex or site of infarct. However, nocturnal VT correlated independently of the time of onset of chest pain to high values of CPK. There was no difference with respect to age, sex, location of infarct or incidence of ventricular tachycardia between infarcts with pain starting during the day, and infarcts with pain starting at night. However, when the pain started during the day, the peak CPK was significantly higher and there were significantly more attacks of nocturnal ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Time of occurrence of primary ventricular tachycardia in the acute phase of myocardial infarction]. 643 67

Thirty of 33 patients (ages 18-67) with acute dissection of the ascending aorta underwent surgical intervention. There were four deaths. There were eight male and five female patients and 15 patients were known to be hypertensive. Severe chest pain, widened mediastinum (demonstrated radiographically), and varying degrees of aortic insufficiency were present in each patient. Heart failure was present in 13 patients, numbness and coolness of an extremity in seven patients, and central nervous system changes were present in three patients. The diagnosis in each instance was confirmed by aortography. Three patients treated nonoperatively died during hospitalization following aortic rupture into the mediastinum and pericardium. The remaining 30 patients were managed by insertion of a woven Dacron((R)) graft sutured distal to the coronary arteries and proximal to the origin of the great vessels. This was accompanied with resuspension of the aortic valve in 24 patients and valve replacement in six patients. Each of the latter six patients had a history of aortic valve disease. The goals of the operation were: 1) correction of the accompanying aortic insufficiency, either by valve replacement or resuspension of the valve and 2) placement of a prosthetic graft into the ascending aorta, thereby obliterating the false lumen and preventing involvement of the coronary arteries or rupture into the mediastinum or the pericardium. Hypertensive patients were managed pre- and postoperatively with nitroprusside and then with propranolol HCI, methyldopa, or hydralazine HCI and hydrochlorothiazide. One late death occurred six months after myocardial infarction and a second late death occurred from a presumed cardiac arrhythmia. One patient had a femorofemoral graft two months after the initial operation and another patient has mild aortic insufficiency. It is concluded that prompt surgical management is mandatory in acute ascending aortic dissection, and in most patients aortic valve competency can be re-established with resuspension of the valve preventing the added morbidity associated with a prosthetic valve. Four patients have been followed for five years and additional follow-up data will better define long-term survival.
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PMID:Acute ascending aortic dissection. 644 83

We evaluated left ventricular function in 10 scleroderma patients with signs and symptoms suggestive of congestive heart failure. M-mode and two-dimensional echocardiography demonstrated normal to increased systolic function in all patients. The presence of pulmonary venous congestion on the chest radiograph was not useful in assessing left ventricular systolic function. Five of nine patients with normal to increased left ventricular ejection fraction (LVEF) had increased cardiothoracic ratios and increased pulmonary vascular markings. Left ventricular hypertrophy was associated with a worse New York Heart Association functional class, more pulmonary vascular congestion, and greater left atrial size. In the presence of normal systolic function and ventricular hypertrophy, diminished left ventricular diastolic compliance may account for the cardiac dysfunction in these patients. Cold pressor testing induced peripheral Raynaud's phenomenon in nine of nine patients; however, no ST segment changes or chest pain was provoked. In seven of nine patients there was no abnormal fall in LVEF. The mechanism for the fall in ejection fraction seen in two patients may be related to an increase in afterload or myocardial ischemia secondary to coronary atherosclerosis. We found little to suggest that a myocardial Raynaud's phenomenon affects left ventricular perfusion or systolic function. Clinical signs and symptoms of congestive failure as well as chest radiographs are poor indicators of impaired systolic function in scleroderma patients. Based on these findings, it appears that evaluation of left ventricular systolic function should include echocardiographic or angiographic study before such patients are treated for heart failure with inotropic agents.
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PMID:Left ventricular function at rest and during Raynaud's phenomenon in patients with scleroderma. 650 43

A multivariate step-wise analysis with death or heart failure as prognostic end-points was utilized in 62 patients with an acute myocardial infarction (AMI), to evaluate the age related short-term prognostic significance of selected M-Mode and two dimensional echocardiographic parameters, and to identify, among them, the best predictors of the clinical outcome. The echocardiographic examination was performed within 24 hours from the occurrence of cardiac chest pain. After a three months follow-up study, the patients were divided into groups: 9 patients who died (Group A), 53 patients who survived (Group B), subdivided into 41 asymptomatic patients (Group B1) and 12 patients with clinical signs of heart failure (Group B2). The selected parameters were: age, left ventricular end-diastolic and end-systolic diameters (LVEDD, LVESD), left atrial diameter (LAD), the electrocardiographic PR interval minus AC interval from the mitral echogram (PR-AC), the distance between the mitral E point and the septum (EPSS), total aortic excursion (TAE), and two dimensional wall motion score. From the step-wise analysis of groups A and B we classified the parameters as follows, the relative prognostic significance being highest on the left side: score greater than TAE greater than AGE greater than PR-AC greater than LVEDD (LAD, LVESD, EPSS). For groups B1 and B2 the following results were obtained: score greater than PR-AC greater than AGE greater than LVESD greater than EPSS (TAE, LVESD, LAD). In parenthesis are indicated the variables whose prognostic value did not reach any significant level. When a discriminant function was applied to the 5 most significant variables, we could identify 78% of the patients of group A, and 77% of those of the group B; of groups B1 and B2 we identified correctly 83% and 92% of the patients respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Prognostic value of echocardiography in acute myocardial infarct: comparison, by multivariate analysis, between mono- and bidimensional parameters]. 651 Jun 20

Retrospective analysis was performed to assess the natural history in relation to clinical and haemodynamic features in 37 patients in whom hypertrophic cardiomyopathy had been diagnosed in childhood. At diagnosis they were aged 1 to 14 years (mean 9 years). Eighteen presented with chest pain and either dyspnoea or symptoms of impaired consciousness or both; 19 were asymptomatic and were referred for evaluation of abnormalities detected during physical examination. During a mean follow up of nine years, 18 patients died, a cumulative annual medical mortality of 4.8%. Five patients experienced severe dyspnoea or chest pain: two of these had progressive dyspnoea and died in cardiac failure, and three died after myectomy. The 19 survivors were compared with the 11 sudden deaths. Eleven of the survivors and five of the sudden deaths were asymptomatic. Of 18 clinical, electrocardiographic, and haemodynamic features only syncope and electrocardiographic evidence of right ventricular hypertrophy were associated with sudden death. In children with hypertrophic cardiomyopathy sudden death was common and was not well predicted by clinical, electrocardiographic, or haemodynamic findings. Hypertrophic cardiomyopathy indicates a poor prognosis even if symptoms are absent or mild.
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PMID:Hypertrophic cardiomyopathy: an important cause of sudden death. 654 94


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