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

Three cases of ruptured aneurysm of the aortic sinus of Valsalva (one each into the right atrium, right ventricle and pulmonary artery) are reported and clinical as well as haemodynamic features described. It is pointed out that the right sinus is most frequently involved, the non-coronary one only rarely, and the left one only quite exceptionally. The clinical findings depend on the size, site and direction of the rupture and its haemodynamic consequences. Rupture occurs most frequently into the right attrium or ventricle, much more rarely into the pulmonary artery or left ventricle. Cardinal clinical signs are retrosternal pain, marked shock with dyspnoea and tachycardia or rapidly progressive cardiac failure. Auscultation reveals either a continuous systolic-diastolic murmur or a holosystolic crescendo-decrescendo murmur followed by a high-frequency diastolic murmur, maximal parasternally in the second to fourth left intercostal spaces. As effective surgical treatment is available, early diagnosis is essential.
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PMID:[Ruptured aneurysm of the aortic sinus of Valsalva (author's transl)]. 112 62

Eleven elderly patients with idiopathic pericarditis are reported. All but one were older than 60 yr. Evidence of ischemic cardiovascular disease was present in 8 patients. The initial diagnosis was heart failure with pulmonary complications in 4 cases and myocardial infarction in 3. Respiratory infection preceded the onset of pericarditis in 5 cases. Presenting symptoms were typical precordial pain, fever and dyspnea. Pericardial friction was found in 7 cases and transient rhythm disturbances in 5. Four patients had ST elevation and 3 had ST depression in their electrocardiograms. Other findings included an increased sedimentation rate, leukocytosis, elevated venous pressure and normal SGOT levels. Antibiotics were of no avail but prednisone had a dramatic effect. Two patients had a relapsing course lasting 2 yr or more. One patient, who died at the age of 75 from bleeding ulcer, had patent coronary arteries and mild perimyocardial fibrosis. The diagnosis of idiopathic pericarditis in the aged is difficult because the disease simulates ischemic heart disease in patients who frequently have evidence of arteriosclerotic cardiovascular involvment.
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PMID:Acute idiopathic pericarditis in the aged. 114 70

From 1960 through 1972, 236 cases of amyloidosis with histologic proof were found. The amyloidosis was primary (without evidence of preceding or coexisting disease) in 132 cases (group 1) and associated with multiple myeloma in 61 (group 2). Secondary amyloidosis appeared in 19 cases (associated with rheumatoid arthritis or osteomyelitis in two-thirds of them). There were 22 patients with amyloid localized to a single organ (bladder, lung, skin, or larynx in more than half of them). Two patients had familial amyloidosis. In group 1 and group 2, the most common presenting symptoms were fatigue, weight loss, edema, dyspnea, light-headedness or syncope, and paresthesias. Symptoms of the carpal-tunnel syndrome were frequent. The liver was palpable in almost 50% of the series, but splenomegaly was an initial finding in less than 10%. Macroglossia was recorded in 26% of group 2 and in 12% of group 1. Enlargement of submandibular structures was noted in about 10% of cases; and purpura, particularly around the eyes, was a significant feature. Substantial numbers of the patients had carpal-tunnel syndrome, nephrotic syndrome, congestive heart failure, sprue, peripheral neuropathy, or orthostatic hypotension. Approximately 50% of patients had renal insufficiency at the time of diagnosis. Proteinuria was found in more than 90%. A monoclonal protein was found in the serum of 49% of group 1 and in 74% of group 2. Monoclonal proteins were found in the urine of 35% and 81%, respectively. Only 12% of patients in group 1 had no monoclonal protein when both serum and urine were analyzed, and all patients of group 2 had a monoclonal protein in the serum or urine when both were analyzed. Lambda light chains were more common than kappa. None of the patients in group 1 had more than 15% plasma cells in the marrow, whereas more than half of group 2 had more than 15% plasma cells. Roentgenograms showed no evidence of skeletal disease in 94% of group 1, but 50% of group 2 had skeletal abnormalities. Rectal biopsy was positive for amyloid in 84% of cases. Kidney, liver, and carpal-tunnel biopsies were positive in 90% or more. Follow-up of all 193 patients in groups 1 and 2 revealed that 80% of group 1 and 97% of group 2 had died. The median survival was 14.7 months in group 1 and 4 months in group 2. Cardiac failure was the most common cause of death, accounting for 30% of the fatalities. We also reclassified all cases by the method of Isobe and Osserman (105), which is based on clinical patterns: pattern I--principal involvement of tongue, heart, gastrointestinal tract, muscle, nerves, skin, and carpal ligaments; pattern II--principal involvement of liver, spleen, kidneys, and adrenals; and mixed pattern I and II. This analysis failed to reveal predictive value in the clinical pattern classification, and did not discern the survival differences between primary amyloidosis (group 1) and amyloidosis with myeloma (group 2). Consequently, for the present we prefer the classification used in this study.
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PMID:Amyloidosis: review of 236 cases. 115 71

Striking variability has been observed in the presenting features in infancy of patients subsequently shown to have tetralogy of Fallot. Some patients presented with severe cyanosis in the neonatal period while others had a systolic murmur and cyanosis only on crying. In these latter patients cyanosis became present at rest over the subsequent months. Yet others presented with episodic attacks of unconsciousness, and a final group presented with dyspnoea and heart failure, accompanying a left-to-right shunt. Angiography demonstrates corresponding variations in the anatomy of the ventricular outflow tracts. In the severely cyanosed patients, the conus septum was deviated so as to obstruct the pulmonary outflow tract, and was best visualized in the lateral projection. In the patients with increasing cyanosis or episodic attacks of unconsciousness, the conus septum again obstructed the pulmonary infundibulum, but was obliquely orientated, not being seen clearly on either lateral or frontal projections. The episodic attacks were considered to be related to infundibular spasm, as previously shown to occur in Fallot's tetralogy. In contrast, increasing cyanosis was believed to be related to hypertrophy of infundibular musculature. In the patients with an initial left-to-right shunt, the arteries were orientated side-by-side so that the conus septum was observed in the frontal projection. Again, subsequent cyanosis was related to ventricular hypertrophy producing outflow tract obstruction. These findings are interpreted in the setting of a recent study, indicating that Fallot's tetralogy is produced by rotation of the embryonic conus together with sinistro-anterior deviation of the conus septum.
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PMID:Variations in clinical presentation of Fallot's tetralogy in infancy. Angiographic and pathogenetic implications. 119 55

The frequency with which pulmonary embolism remains unrecognized clinically is well known and explains the value of pulmonary scintigraphy when there is the slightest suspicion of pulmonary embolism or in cases of unexplained dyspnoea of effort after a standard cardiac and pleuro-pulmonary examination. The practical value of a regular pre-operative electrocardiogram and of anticoagulant treatment during the acute phase of myocardial infarction are emphasized. Certain precautions to be observed during the use of antivitamins K in cases of heart failure are outlined.
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PMID:[Cardiologist's approach to deep phlebitides of the leg]. 120 21

200 in-patients with rheumatoid arthritis (RA) were examined with regard to the diagnostic criteria for early recognition of rheumatoid heart involvement. 75 patients showed some evidence (37.5%). The criteria are: subjectively, reduced general state, feeling of oppression, disproportional tachycardia and dyspnea: objectively, changes in the electrocardiogram (tachycardia, T-inversions sometimes resembling to infarct pictures, disturbances of repolarization, extrasystoles and AV blocks). The severity of the change may alter rapidly. Severe myocarditides may manifest as heart failure and dilatation of rapid onset. For prognostic and therapeutic reasons the recognition of a heart involvement, despite these often minimal appearances, is important. It is remarkable that there was no correlation between the activity of rheumatoid process, the titre of rheumatoid factor, and the degree of heart involvement. Age and age of onset, duration of disease and sex also showed no correlation with rheumatoid heart involvement.
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PMID:[Diagnostic-therapeutic problems on heart involvement in chronic polyarthritis]. 122 8

The CAST was a randomized, double-blind placebo-controlled multicentre trial of antiarrhythmic medications designed to suppress ventricular arrhythmias in patients after an acute myocardial infarction (MI). A collection of 21 items derived from established scales was used to assess aspects of quality of life in CAST. The questions focused on symptoms, mental health, physical functioning, social functioning, life satisfaction, and life expectancy. Additional aspects included exposure to major stressful life events, and perceived social support and social integration. Work status was also recorded. Using the baseline values of 1465 (98%) out of 1498 patients enrolled in the CAST main study between 15 June 1987 and 19 April 1989, the reliability and validity of the scales used in CAST were computed. High internal consistency reliability (> or = 0.70) was found for Symptoms, Mental Health, and Physical Functioning. The discriminative validity, in particular for Symptoms, Mental Health, Physical and Social Functioning, showed that patients with heart failure and previous MI, as well as those suffering from angina and dyspnea, had a worse quality of life than those patients who were not experiencing these symptoms. It was concluded that the scales selected to form the CAST quality of life questionnaire were both reliable and clinically valid for this patient population and therefore could be used to detect disease progression and treatment effects.
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PMID:Methods for assessing quality of life in the cardiac arrhythmia suppression trial (CAST). 130 Nov 28

The autopsy findings and clinical features in 60 patients with fatal pulmonary embolism (PE) in University College Hospital, Ibadan, between 1985 and 1989 are analysed in the current study. Pulmonary embolism occurred in 3,8 pc of all autopsied patients during this period. There was a male to female ratio 1,4 to one and average age was 47 years. Malignant neoplasms, infections and cardiac failure were the leading predisposing factors to PE identified. The ante-mortem clinical features consisted largely of non-specific respiratory symptoms of dyspnoea, cough, chest pain and haemoptysis. Of these patients, 15,6 pc were diagnosed ante-mortem as having PE. Pulmonary infarction occurred in 13,3 pc of the cases and was commoner in females and in patients with underlying cardiac diseases. This study emphasises the need for a high clinical index of suspicion to improve the antemortem diagnosis of this potentially fatal condition and to advocate a greater use of prophylactic anti-coagulant therapy in high risk patients.
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PMID:Pulmonary embolism in Ibadan, Nigeria: five years autopsy report. 130 38

This report is on three double aortic arch cases. They were diagnosed in our department between 1982 and 1992. The first case was complicated by dilated cardiomyopathy whose diagnosis was delayed due to a lack of clinical experience. Corrective surgery relieved the airway obstruction and his breathing improved postoperatively. The patient finally died of heart failure due to concurrent progressive dilated cardiomyopathy one and half years later. The second and third cases were diagnosed on the day of admission by a barium esophagogram and echocardiogram. MRI (Magnetic resonance image) of the cardiovascular system on these two patients revealed no other associated abnormalities. No angiography was done on the third case. They underwent surgery with excellent results. In any infant younger than 3 months with dyspnea and dysphagia, double aortic arch should be suspected. The esophagogram can show extrinsic compression. An echocardiogram can reveal two aortic arches. Both procedures can be performed easily and safely at the bedside. We recommend that these to be considered as routine examinations in such patients.
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PMID:[Double aortic arch-three cases report and operative treatment]. 133 31

Exercise capacity in patients with stable heart failure may be influenced by prolonged drug treatment or exercise training, but acute interventions are generally thought to have little effect. Cardiorespiratory responses to exercise were studied in 12 consecutive patients with chronic congestive heart failure who underwent serial submaximal and maximal exercise tests at inspired oxygen concentrations of 21% (room air), 30%, and 50%. Mean (SD) exercise duration during progressive testing to maximum exercise capacity was prolonged from 548 (276) s on room air to 632 (285) s on 50% oxygen (p = 0.012). During steady-state exercise at 45 W, oxygen enrichment to 50% was associated with significantly increased arterial oxygen saturation (94.6 [1.9]% to 97.5 [1.3]%), and significantly reduced minute ventilation (36.1 [8.6] l/min to 28.1 [5.9] l/min), cardiac output (7.5 [2.3] l/min to 6.5 [1.9] l/min), and subjective scores for fatigue and breathlessness (13.9 [3.1] to 11.5 [3.5]) compared with room air intermediate changes were observed with 30% inspired oxygen. Increased inspired oxygen concentrations can improve exercise performance acutely and modify the ventilatory response to exercise in patients with heart failure. Hyperoxia reduces ventilatory response and circulatory demand while maintaining oxygen delivery at a given workload. The potential benefits of increased inspired oxygen concentrations in the treatment of chronic heart failure merit further assessment.
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PMID:Effects of increased inspired oxygen concentrations on exercise performance in chronic heart failure. 135 2


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