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

During the period 1960 to 1978, 98 patients underwent intracardiac repair of Fallot's tetralogy after palliative operations. Preoperative symptoms were cyanosis, dyspnea, increased fatigue with squatting and hypoxic spells. The hemoglobin concentration varied from 19 to 22 g/100 ml. At correction only 65 of 95 shunts were patent and needed surgical closure. Seventeen early deaths occurred (19%), the main causes being cardiac failure and arrhythmia. One patient died 3 years after correction from pneumonia. The subjective clinical result was excellent or good in all surviving patients. At repeat heart catheterization in 26 patients a high percentage of residual ventricular septal defects and pulmonary stenosis/insufficiency was found. However, the majority of defects were of minimal haemodynamic significance, and so far did not seem to do harm to the patients' subjective function.
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PMID:Correction of Fallot's tetralogy after palliative operations. 8 99

Digitalis and diuretics constitute conventional therapy of congestive heart failure, but systemic vasodilators offer an innovative approach in acute and chronic heart failure of decreasing increased left ventricular systolic wall tension (ventricular afterload) by reducing aortic impedance and/or by reducing cardiac venous return. Thus, vasodilators increase cardiac output (CO) by diminishing peripheral vascular resistance (PVR) and/or decrease increased left ventricular end-diastolic pressure (LVEDP) (ventricular preload) by diminishing venous tone. Concomitantly, there is reduction of myocardial oxygen demand, thereby reliably reducing angina pectoris in coronary disease, and potentially limiting infarct size and ischemia provided systemic arterial pressure remains normal. The vasodilators produce disparate modifications of cardiac function depending upon their differing alterations of preload versus impedance: nitrates principally cause venodilation (decrease LVEDP); nitroprusside, phentolamine and prazosin produce balanced arterial and venous dilation (decrease LVEDP and increase CO) provided left ventricular filling pressure is maintained at the upper limit of normal; whereas hydralazine predominantly effects arteriolar dilation (increases CO). With depressed CO plus highly increased LVEDP and increased PVR, nitrates also induce some increase of CO by reducing PVR. Combined nitroprusside and dopamine synergistically enhance CO and decrease LVEDP. Mechanical counterpulsation aids nitroprusside in acute myocardial infarction. The 30-minute venodilator action of sublingual nitroglycerin is extended for 4 to 6 hours by cutaneous nitroglycerin ointment, by sublingual and oral isosorbide dintrate, and by oral pentaerythritol tetranitrate and sustained-release nitroglycerin capsules. Ambulatory oral vasodilator therapy is provided by long-acting nitrates (relieve pulmonary congestion); hydralazine (improves fatigue); prazosin alone, combined nitrate-hydralazine combined prazosin-hydralazine (improve both dyspnea and fatigue).
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PMID:Afterload reduction and cardiac performance. Physiologic basis of systemic vasodilators as a new approach in treatment of congestive heart failure. 9 30

One hundred consecutive cases of valve replacement for aortic regurgitation performed between 1967--1971 were analyzed to identify and quantitate factors related to a favorable result. Of 83 perioperative survivors, 78% (n = 65) became asymptomatic and 58% (n = 48) were alive 5--9 years postoperatively. The cause of aortic regurgitation affected both the speed of progression of symptoms and the postoperative result. Death due to myocardial failure may be prevented by optimal timing of operation. Accordingly, we identified variables that discriminated between patients who had an excellent postoperative result and those who died of myocardial failure. The most important discriminators were the severity (p = 0.03) and duration (p = 0.04) of dyspnea, the extent of therapy for heart failure (p = 0.001), physical findings of left ventricular failure (p = 0.002), the cardiothoracic ratio (p = 0.007), the resting pulmonary capillary wedge pressure (p = 0.01), and a cardiac index less than 2.2 1/min/m2 (p = 0.03). The data suggest that evidence of left ventricular failure, even of mild degree, is an indication for operation in patients with severe aortic regurgitation.
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PMID:Valve replacement for aortic regurgitation: long-term follow-up with factors influencing the results. 11 Apr 91

Nine cases of the combination of coarctation of the aorta and mitral stenosis were evaluated over a seven-year period. Symptoms did not usually cause distress in infancy, but began subtly with pneumonia or cardiac failure at about 2 years of age. Important clues were differences in blood pressure between the arms and legs, paroxysmal dyspnea, congestive heart failure, right ventricular hypertrophy, and left atrial enlargement. Cardiac catheterization studies showed elevated right ventricular and main pulmonary artery wedge pressures. These features in patients with coarctation of the aorta should suggest associated mitral valve disease. The importance of demonstrating associated valvular lesions, particularly mitral stenosis, is emphasized. Two of our children had successful repair of the coarctation of the aorta and mitral stenosis simultaneously. In a third child, resection of the coarctation was followed in six years by mitral valve replacement.
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PMID:Associated coarctation of the aorta and mitral valve disease: nine cases with surgical correction of both lesions in three. 12 22

Peripheric circulatory disturbances and acrocyanosis in Moselle vinedressers injured by arsenic. During the years 1972--1975 a total number of 100 vine-dressers came for medical treatment because of late injures caused by arsenic intoxication. That is an average of 400 examinations per year 1600 control examinations within four years. These patients belonged to the age-classes 1890--1923, and the average time of exposure to arsenic was 20 years. After years of being exposed to arsenic, and even years after the exposure to it has stopped, there are those so-called late injures caused by arsenic. There are typical arsenic melanisms on the forehad-temple-rim where the hair begins to grow, on the nape of the neck, on the shoulders, chest, arms, and on the back of the hands which pass into precanceroses and carcinomas. The average time until the first late injuries caused by arsenic occur is 26 years. However, there have been latence periods of up to 50 years. This depends mainly on the amount of arsenic absorbed during the time. There are skin alterations which resemble very much an acrodermatitis chronica atrophicans Herxheimer. Histological examinations rather showed the symptoms of an endangiitis obliterans with atrophy of the cutis. These symptoms were found in 60--70% of the 50--60 years old patients, in 80--90% of the 60--70 years old patients, and in 90--95% of the 70--80 years old patients. Simultaneously there are distinct peripheric circulatory disturbances, cyanosis of the lips, dyspnoea, and an emphysema together with typical cardiac insufficiency. Foot and finger pulse are distinctly slower, and the temperature of the skin is remarkably lower. While people grow older the cyanosis gets worse. With a control group of patients who hadn't been exposed to arsenic these symptoms had only been found on 1--2%.
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PMID:[Peripheral circulatory disorders and acrocyanosis in arsenic exposed Moselle wine-growers]. 13 69

In cardiac failure unresponsive to digoxin and diuretics, afterload reduction brings about a dramatic increase in cardiac output, renal perfusion and responsiveness to diuretics; furthermore, the decrease in venous pressure relieves the dyspnoea. Intravenous vasodilators should only be used when sophisticated haemodynamic monitoring equipment and experienced physicians are at hand. Indications for the use of these agents are severe cardiac failure, acute myocardial infarction complicated by left ventricular failure, persistent ischaemic pain and limitation of infarct size. A wide variety of oral vasodilator agents is available, all having different sites of action; the choice of vasodilator agents should be tailored to the needs of the patient. Treatment with these agents is indicated in patients in whom cardiac failure becomes refractory to conventional therapy with digoxin and diuretics. The utmost care must be taken to avoid further impairment of cardiac output by excessive reduction of the left ventricular end-diastolic pressure (LVEDP) and hypotension, which will jeopardize myocardial, renal and cerebral perfusion.
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PMID:The use of vasodilator agents in the treatment of heart failure. 15 2

Findings are reviewed of isolated Patent Ductus Arteriosus after infancy as seen in 181 patients studied at the University Hospital, Kuala Lumpur, during the period 1967 to 1975. The ages of patients ranged from nine months to 54 years. Eighty-two patients underwent cardiac catheterization. More than 50% of patients were above ten years of age; the sex ratio was 1 male: 2.93 females. Thirty-two per cent of the patients had significant effort dyspnoea or were in heart failure. The complications noted were elevated pulmonary vascular resistance, Eisenmenger syndrome, bacterial endocarditis and cardiac failure.
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PMID:Patent ductus arteriosus in Malaysia. 28 60

A 55-year-old man had progressive dyspnea, recurrent atrial arrhythmias, and severe right heart failure following coronary bypass surgery. His condition improved only slightly with the usual decongestive therapy. When transferred for further studies 5 months after the operation, he had typical clinical and hemodynamic findings of constrictive pericarditis. Review of chest films following the bypass operation revealed a large pericardial effusion or hematoma, the incomplete resolution of which probably caused the pericardial constriction confirmed at thoracotomy. The man was treated by pericardiectomy. A recent report on the incidence of overt tamponade soon after bypass surgery suggests that a significant volume of pericardial fluid accumulates in the early postoperative course in many instances and that late constriction may not be a rare complication. In treating patients who have circulatory congestion after such operations, it is important that the physician consider constrictive pericarditis and not assume that the clinical findings are the consquence of myocardial failure.
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PMID:Pericardial constriction as a late complication of coronary bypass surgery. 30 90

To evaluate the antiarrhythmic efficacy of the new beta adrenergic blocking agent acebutolol, 15 monitored patients with supraventricular arrhythmias received, in double-blind fashion, an intravenous infusion of either acebutolol or saline solution after a control period. Patients treated with saline solution demonstrated no change (P greater than 0.05) in heart rate or arterial blood pressure or conversion to sinus rhythm. After administration of acebutolol, significant (P less than 0.05) reductions in heart rate were noted at 5 minutes. Peak reduction occurred at 10 to 30 minutes and correlated with maximal acebutolol plasma concentrations, antiarrhythmic activity persisted for 24 hours. Mild reductions in systolic blood pressure were observed in the majority of patients. Two patients with atrial fibrillation and one with multifocal atrial tachycardia had conversion to sinus rhythm. Frequent premature atrial complexes noted in one patient were greatly suppressed after administration of the drug. In the nine patients with clinical evidence of chronic obstructive lung disease acebutolol was well tolerated. Adverse reactions were limited to transient dyspnea in one patient with prior heart failure and a decrease in systolic blood pressure to less than 90 mm Hg in three patients who remained asymptomatic. In the patients studied, acebutolol was an effective agent for the treatment of supraventricular arrhythmias and appeared to be of special value in those with chronic obstructive lung disease.
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PMID:Effective treatment of supraventricular arrhythmias with acebutolol. 38 21

53 children with infective pericarditis were seen at the University College Hospital, Ibadan, between 1967 and 1976. Their ages ranged from 10 days to 15 years but 53% of them were aged 5 years and below. Cough, fever, and breathlessness were the most common symptoms; cardiac decompensation was evident in over 30% of them, 23% had muffled heart sounds, but a pericardial friction rub was audible in only one. The main pathogens identified were Mycobacterium tuberculosis (11 cases), Staphylococcus aureus (11 cases), Escherichia coli (4 cases), Pneumococcus and Pseudomonas (3 cases each). Most of the patients had some other associated infection--such as, bronchopneumonia (12 cases), empyema thoracis (10 cases), lung abscess (10 cases), septicaemis (6 cases), and osteomyelitis (3 cases). Errors in diagnosis were common, the diagnosis having been missed in 72% of the cases identified at necropsy. Even if the correct diagnosis had been made during life and appropriate treatment given, the mortality rate (36%) was high. It is suggested that the onset of cardiac failure in any child with bronchopneumonia, empyema, or lung abscess should always arouse a suspicion of infective pericarditis.
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PMID:Infective pericarditis in Nigerian children. 47 15


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