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

The syndrome of chronic heart failure (CHF) becomes increasingly prevalent in older patients, and while mortality rates are declining in most cardiovascular diseases, both prevalence and mortality in CHF remain high. The heart is unable to meet the demands of the skeletal musculature, and symptoms manifest as dyspnoea and signs of fatigue during exercise. The cardiopulmonary exercise test (CPET) can provoke symptoms which may be useful in improving the accuracy of diagnosis in CHF in a non-invasive setting. CPET also provides important information on the pathophysiology of exercise limitation, risk stratification and can establish exercise-training protocols. The information provided by the CPET allows suitable pharmacological or device-based adjustments to be considered in the management of CHF, which can be crucial in maintaining a patient's quality of life. This manuscript provides a useful insight into the theoretical rationale and practical recommendations for CPET in patients with CHF. Prior to CPET, it is important to consider the mode of exercise, as cycle ergometry or treadmill protocols will yield different outcomes in patients with CHF. We discuss how pre-CPET set-up procedures should be conducted and also the significance of electrocardiographic abnormalities found in CHF patients, and how these should be interpreted. The assessment of lung function is integral to the underlying pathophysiological basis of exercise limitation and we explain how this should be performed. CHF patients display the following abnormal exercise responses which can be identified by CPET: peak oxygen uptake ( [Formula: see text] peak), anaerobic threshold (AT), DeltaVO(2)/Delta work rate (WR), peak oxygen pulse, estimated peak stroke volume and predicted peak heart rate are reduced. The [Formula: see text] slope is abnormally high and the breathing reserve is normal or high. An immediate post-exercise increase in O(2) pulse is evident, and/or a regular oscillatory breathing pattern has been observed at lower exercise intensities in some CHF patients. Symptoms of breathlessness, fatigue, and/or leg pain occur earlier during CPET and may cause the CPET to be aborted early. We explain the significance of the 9-panelled array, and how it can help to determine the underlying pathophysiology of exercise intolerance in these patients.
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PMID:Theoretical rationale and practical recommendations for cardiopulmonary exercise testing in patients with chronic heart failure. 1739 6

We report about a 56-year-old man with dyspnoea and leg pain diagnosed with Leriche syndrome and chronic heart failure caused by dilated cardiomyopathy (DCM) with acute cardiac decompensation. Optimising of chronic heart failure therapy with diuretic and antihypertensive drugs leaded to recompensation. A defibrillator was implanted, and afterwards surgical therapy of Leriche syndrome was planned.Leriche syndrome is an uncommon variant of atherosclerotic occlusive disease characterised by total occlusion in abdominal aorta and/or both iliac arteries. If aortic stenosis develops slowly, collateral vascular circulation can be found frequently. Typical symptoms are claudication, symptoms related to an arterial insufficiency of the lower extremities, erectile dysfunction and weight loss. Risk factors of Leriche syndrome are diabetes mellitus, hypertension, hyperlipaemia and smoking. Further it is often associated with chronic renal failure and coronary artery disease. Diagnosis is normally made by computed tomography (CT) or magnetic resonance imaging (MRI). Standard therapy is surgical revascularisation.DCM is a common cause of a congestive heart failure, which could be induced by coronary artery disease, hypertension, toxic, metabolic, inflammatory and infectious agents, and inherited gene defects.
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PMID:A 56-year-old man with co-prevalence of Leriche syndrome and dilated cardiomyopathy: case report and review. 2434 41

This study compares the living situation, morbidity and mortality and related factors between two different communities, one in eastern Finland (with high mortality in cardiovascular diseases) and another in Lisbon, Portugal (representing the Mediterranean area with low ischaemic heart disease but nigh cerebrovascular mortality). The representative samples of 65-74 year old population were examined using the same study protocol, and official mortality statistics were analyzed from these countries. The results show that elderly Finns have more facilities at home than elderly Portuguese. Self reported diabetes mellitus, stroke and chronic bronchitis as well as obstipation, urinary problems, leg pain and chest pain, and cough in the morning were more prevalent in Portugal but cardiac failure was more common in Finland. Reported hypertension and antihypertensive drug treatment were equally prevalent in both countries, but diastolic blood pressure level was clearly higher in Portugal. Total CVD mortality in this age group is higher in Finland among men but lower among women, stroke mortality is higher but ischaemic heart disease lower among both genders in Portugal.
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PMID:Comparison of health status between Portuguese and Finnish elderly people. 2438 62

For patients with late congenital heart diseases and advanced heart failure, heart transplant is the one of the most effective known treatment methods. With the development of immunosuppressive medicines, it is possible to prevent and treat rejection, and survival after organ transplant has increased rapidly. Calcineurin inhibitors (tacrolimus and cyclosporine), mycophenolate mofetil, and corticosteroids are used together in many centers as immunosuppressive medications. Although the use of calcineurin inhibitors is essential, therapy is switched to sirolimus in some specific cases and when significant adverse effects occur. The most seen sirolimus-based adverse effects are diarrhea, constipation, vomiting, nausea, abdominal pain, leg pain, acne, headache, and sleep problems. Here, we present a patient who had abdominal pain, nausea, vomiting, and ventricular extrasystole attacks due to sirolimus toxicity, which improved with dose adjustment during follow-up after heart transplant. Pain associated with the use of calcineurin inhibitors improving with sirolimus has been previously reported before; however, because we did not encounter pain syndrome associated with use of sirolimus, we chose to report our experience with this patient.
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PMID:Pain Syndrome and Ventricular Arrhythmia Induced by Sirolimus and Resolved by Dosage Adjustment in a Child After Heart Transplant: A Case Report. 2721 56

Autoimmune pathology of acute disseminated encephalomyelitis (ADEM) is generally restricted to the brain. Our objective is to expand the phenotype of ADEM. A four-year-old girl was admitted to the pediatric emergency room of a university medical center five days after a common upper respiratory tract infection. Acute symptoms were fever, leg pain, and headaches. She developed meningeal signs, and her level of consciousness dropped rapidly. Epileptic seizure activity started, and she became comatose, requiring intubation and mechanical ventilation. Serial brain magnetic resonance imaging (MRI) illustrated the fulminant development of ADEM. Treatment escalation with high-dose corticosteroids, immunoglobulins, and plasma exchange did not lead to clinical improvement. On day ten, the patient developed treatment-refractory cardiogenic shock and passed away. The postmortem assessment confirmed ADEM and revealed acute lymphocytic myocarditis, likely explaining the acute cardiac failure. Human metapneumovirus and picornavirus were detected in the tracheal secrete by PCR. Data sources-medical chart of the patient. This case is consistent with evidence from experimental findings of an association of ADEM with myocarditis as a postinfectious systemic autoimmune response, with life-threatening involvement of the brain and heart.
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PMID:Acute Disseminated Encephalomyelitis with Seizures and Myocarditis: A Fatal Triad. 3251 53

We report a case of severe sensory-motor axonal neuropathy on the lower extremities associated with diabetic ketoacidosis (DKA). A sixteen-year-old boy developed coma and admitted to our hospital. We diagnosed him with DKA based on remarkable hyperglycemia, severe acidosis with hyperketonemia. Intensive glycemic control with insulin was immediately started. He had complications of heart failure, rhabdomyolysis, and renal failure, which required intensive care including mechanical ventilation and hemodialysis. When recovered from the critical condition, he noticed severe weakness, numbness, and pain on the lower limbs, and urinary retention. On nerve conduction studies, both motor and sensory action potentials were absent. Serum anti-ganglioside antibodies were negative. Albuminocytologic dissociation was evident in the cerebrospinal fluid. MRI study revealed marked gadolinium enhancement of the cauda equina. After high-dose intravenous immunoglobulin treatment, he was relieved from leg pain, but the leg weakness and bladder bowel dysfunction did not show immediate improvement. It took approximately six months until he became able to stand and walk using ankle orthosis. Acute neuropathy is a rare complication of diabetes mellitus. Painful neuropathy is known to emerge in association with diabetic treatment, but it seldom causes severe motor disturbance. On the other hand, motor-dominant polyneuropathy has been reported to occur acutely along the treatment of DKA and hyperosmolar hyperglycemia syndrome (HHS). Present case and previous cases with DKA and HHS suggest that rapid correction of glucose level is one of the underlying factors of acute neuropathy related with diabetic treatment.
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PMID:[Severe sensory-motor axonal neuropathy following diabetic ketoacidosis]. 3277 97