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

Adenosine has recently become widely available for the treatment of paroxysmal supraventricular tachycardia. In order to evaluate its role in the management of arrhythmias, we have reviewed the literature on the cellular mechanisms, metabolism, potential for adverse effects, and clinical experience of the efficacy and safety of intravenous adenosine. Adenosine produces transient atrioventricular nodal block when injected as an intravenous bolus. This is of therapeutic value in the conversion to sinus rhythm of the majority of paroxysmal supraventricular tachycardias, which involve the atrioventricular node in a re-entrant circuit. The mean success rate was 93% from over 600 reported episodes. Compared with other antiarrhythmic agents, adenosine is remarkable for its rapid metabolism and brevity of action, with a half-life of a few seconds. It commonly produces subjective symptoms, particularly chest discomfort, dyspnea, and flushing, which are of short duration only. No serious adverse effect has been reported. Arrhythmias may recur within minutes in a minority of patients. Comparative studies have shown that adenosine is as effective as verapamil in the treatment of supraventricular tachycardia, and has less potential for adverse effects. Patients with supraventricular tachycardia should initially be treated using vagotonic physical maneuvers. Immediate electrical cardioversion is indicated if the arrhythmia is associated with hemodynamic collapse. Adenosine is the preferred drug in those patients in whom verapamil has failed or may cause adverse effects, such as those with heart failure or wide-complex tachycardia. The safety profile of adenosine suggests that it should be the drug of first choice for the treatment of supraventricular tachycardia, but only limited comparative data to support this view are available at present.
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PMID:Adenosine and the treatment of supraventricular tachycardia. 160 47

Failure of right atrial pressure to normalize after pericardial pressure is relieved suggests persistent effusive-constrictive physiology, myocardial failure, or cardiomyopathy which may have indistinguishable hemodynamic pressure waveforms. Clinical characteristics, ancillary testing, and endomyocardial biopsy may be required to obtain a definite diagnosis in such cases. The hemodynamic waveforms obtained during pericardiocentesis provide insight into the pathophysiologic processes, producing symptoms of dyspnea in this interesting patient group.
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PMID:Interpretation of cardiac pathophysiology from pressure waveform analysis: pericardial compressive hemodynamics, Part III. 160 5

Peripartum cardiomyopathy (PPCM) is a relatively rare form of acute heart failure. Onset is from the last trimester of pregnancy to 5 months postpartum. Diagnosis is made by excluding other causes of acute heart failure, such as infections or toxins, and by determining that the patient does not have an underlying cardiac problem that has been unmasked by pregnancy. Diagnosis in the last trimester is complicated by the fact that the early symptoms of this disorder may mimic the symptoms of normal pregnancy. PPCM must be considered in any patient who presents with new onset peripheral edema, dyspnea on exertion, or paroxysmal nocturnal dyspnea during late pregnancy or up to 5 months postpartum. Limited studies suggest that early and aggressive therapy is associated with a better outcome. Therapy is directed toward decreasing preload and improving cardiac function. Return of cardiac size to normal is associated with a better prognosis than continued cardiomegaly.
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PMID:Peripartum cardiomyopathy: a case report. 160 22

A report of a rare case of successful repair of rupture of an aortic aneurysm into the pulmonary artery. A 55-year-old male was transferred to our hospital because of dyspnea with sudden onset, hemoptysis and palpitation. A loud, continuous, "machine-like" murmur was heard on the anterior wall of the chest. Various examinations revealed an acquired shunt between the thoracic aortic aneurysm and the pulmonary artery and high-output heart failure. Aortic arch replacement was performed expeditiously and the patient recovered, and was able to return to work. 108 cases of rupture of a thoracic aortic aneurysm into the pulmonary artery have been reported in the literature. Operation for repair was performed in only thirteen of these. Only four cases have been reported in the literature in which the patients were successfully treated.
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PMID:[A case of successful repair of aorto-pulmonary artery fistula secondary to aortic arch aneurysm]. 162 Sep 99

A case of aortic dissection ("DeBakey type III") in an asymptomatic 78-year-old woman is described. The patient underwent a mitral valve replacement (bioprosthesis Sorin) in June 1990 for severe mitral stenosis; in October 1990 she was admitted to our hospital for severe dyspnea and cardiac failure with good response to medical treatment. The routine echo color Doppler examination showed only a hint of paraprosthetic leak, which required further investigation by transesophageal echocardiography. This approach revealed the presence of a regurgitant jet extending from the prosthetic mitral valve toward the atrial septum. The examination of the thoracic aorta revealed the presence of a dissection flap; the color Doppler technique showed a bidirectional flow through the site of communication between the two lumina. The extension of the dissection from the aortic arch to the origin of the renal branches was confirmed by computerized axial tomography. We emphasize the importance of the transesophageal approach in elderly patients with aortic dissection, often asymptomatic.
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PMID:[Asymptomatic aortic dissection associated with a mitral prosthetic leak: a clinical case report]. 162 68

A 27-year old African woman with history of regular chloroquine ingestion presented with progressive deterioration of vision, easy fatiguability, dyspnoea, dizziness progressing to syncopal attacks. Ophthalmological assessment revealed features of chloroquine retinopathy, cardiac assessment revealed features of heart failure and a complete heart block with right bundle branch block pattern. The heart block was treated by pacemaker insertion and the heart failure resolved spontaneously following chloroquine discontinuation. She however remains blind.
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PMID:Chloroquine related complete heart block with blindness: case report. 162 52

A 19-year-old boy, who complained of fever and fatigue was hospitalized in November 1986. On physical examination, he had a temperature of 37 degrees C, cervical lymphadenopathy and hepatosplenomegaly. Serum transaminase was elevated moderately, while serum alkaline-phosphatase was elevated severely. Extremely elevated antibody titers to the EBV capsid antigen (IgG: 2560x, IgA: 160x), early antigen (IgG: 1280x, IgA: 160x) and nuclear antigen (160x) were noted. PPD and DNCB skin test were negative. Severe mobilization of Kupfer cells and mild proliferation of pseudoductule were seen in liver biopsied specimen. Cervical lymphnode biopsy showed necrotizing lymphadenitis associated with proliferation of histiocyte. In February 1987 his temperature was elevated to 40 degrees C and he had arthralgia and exanthema. Intravenous Acyclovir (500 mg every 8 hours) and Interferon alpha (6 million u/day) were administered together for 1 month. After that he improved for about a week. In March 1987 he had dyspnea. Arterial blood gas analysis in room air showed a PO2 of 51.8 mmHg, a PCO2 of 28.9 mmHg. A chest radiograph showed thickening of bilateral bronchial walls and obscurity of pulmonary vascular shadows. The effects of transfer factor and Interleukin-2 were unremarkable. High antibody titers to EBV, liver dysfunction and hypo-oxygenemia continued. He died of respiratory and heart failure on 24 October 1987. The most interesting finding of autopsied specimens was stenosis of pulmonary artery associated with interstitial pneumonitis. Hemophagocytosis was seen in liver, spleen and bone marrow.
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PMID:[An autopsied case of chronic active Epstein-Barr virus (EBV) infection with various symptom]. 164 35

A case of atypical coarctation of the suprarenal aorta with symptoms of acute hypertensive heart failure is reported. A 62-year-old man was admitted because of dyspnea associated with severe hypertension. Chest x ray demonstrated mild pulmonary congestion. Following antihypertensive management, symptoms of congestive heart failure improved. Abdominal computed tomography and digital subtraction angiography undertaken several days later demonstrated a narrowed segment of the suprarenal aorta. Control of hypertension was poor with currently available antihypertensives and a bilateral axillo-femoral bypass operation with artificial grafts was undertaken. Postoperative blood pressure was maintained at a normal level with a small dose of atenolol. The patient had an uneventful hospital course and remains well.
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PMID:Atypical coarctation of the abdominal aorta as a cause of acute hypertensive heart failure. 167 64

Refsum's disease is a polyneuropathy due to a hereditary error in the metabolism of a fatty acid, phytanic acid, usually leading to cardiac failure only at an advanced stage of the disease. The authors report the case of two brothers with Refsum's disease revealed by a heart failure before the clinical stage of the peripheral neuropathy. In the younger brother, the affection started at the age of 22 years by an acute pulmonary oedema which revealed a dilated, hypokinetic myocardiopathy, associated with retinitis pigmentosa, ptosis, anosmia and biological myolysis. The normal plasma concentration of phytanic acid measured several times led to the conclusion of Kearns-Sayre syndrome even if certain aspects were atypical (moderate conduction disorders, no characteristic aspect in the muscle biopsy). Five years later, the older brother, aged 28, presents a dyspnea on effort which leads to the discovery of a hypokinetic, hypertrophic myocardiopathy, slightly dilated, associated with cardiac conduction disorders, retinitis pigmentosa, anosmia and biological myolysis. The plasma concentration of phytanic acid being very high. Refsum's disease was diagnosed and the diagnosis of younger brother was corrected. From the study of these two cases, the characteristics of the cardiac disorders can be specified: the cardiopathy can reveal the disease and correspond to a dilated or hypertrophic myocardiopathy. The diagnosis of the disease can be difficult because the plasma phytanic acid may remain at normal level, thus requiring the assay of the activity of phytanate oxydase. The existence of ophthalmologic signs (retinitis pigmentosa or progressive ophthalmoplegia externa) associated with a myocardiopathy must systematically lead to a search for Refsum's disease, this diagnosis having fundamental therapeutic implications (died, even plasmapheresis).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Refsum's disease. Apropos of 2 cases disclosed by myocardiopathy]. 169 53

516 patients with New York Heart Association class III and IV heart failure despite treatment with diuretics and angiotensin converting enzyme inhibitors were randomised in a double-blind between-group comparison to xamoterol 200 mg (352) or placebo (164) twice daily for 13 weeks. There was no difference between the treatments in loss of clinical signs. Visual analogue scale and Likert scores indicated that breathlessness was less severe with xamoterol, but there was no difference in exercise duration or total work done. Xamoterol reduced maximum exercise heart rate and systolic blood pressure, did not affect the number of ventricular premature beats after exercise, showed no arrhythmogenic activity, and had variable (agonist and antagonist) effects on 24 h heart rate. On intention-to-treat analysis 32 (9.1%) patients in the xamoterol group and 6 (3.7%) patients in the placebo group died within 100 days of randomisation (p = 0.02).
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PMID:Xamoterol in severe heart failure. The Xamoterol in Severe Heart Failure Study Group. 197 33


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