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

To be able to predict the clinical course of an acute myocardial infarction (AMI) at the first visit to the patient would be of great importance to a general practitioner considering home treatment for this disease. Therefore, we have analysed the presenting signs and symptoms and their relation to the course in 53 patients with AMI. Twenty-seven of the patients had an uncomplicated course, while 26 suffered continuous pain, cardiac failure, arrhythmias, or death during their hospital stay. The presenting signs and symptoms were remarkably similar in the two groups, the only significant difference being a higher incidence of abnormal pulse rate in the group with complications. We conclude that the initial presentation of AMI does not reliably predict later occurrence of complications. Doctors who want to treat patients with AMI at home must take this uncertainty into consideration.
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PMID:Initial presentation of acute myocardial infarction and the relation to short-term clinical course. 396 6

31 patients underwent embolectomy for acute embolism of the aortic bifurcation. In most instances paralysis of the extremity (84%) was present, sudden onset of pain (16%) was less common. Neurological disease had been considered in 55%. The heart was source of emboli in 92%. Postoperative complications were mainly due to renal failure (23%) and irreversible limb ischemia (10%) requiring amputation. Mortality after embolism of the bifurcation was 39%. The major cause of death was cardiac failure (58%) followed by renal failure and pulmonary embolism. Even after long delay (4 weeks) successful operation is possible due to adequate collateral circulation supplying the extremity until the blockade is removed.
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PMID:[Symptoms and therapy of aortic bifurcation embolism]. 398 34

Authors relate 22 non cardiac operations among 21 patients having previously undergone cardiac surgery. Oral anticoagulant therapy was discontinued before non cardiac operation while subcutaneous heparine therapy was initiated. There were no bleeding or thromboembolic complications during the perioperative period or later in the follow-up. In order to prevent bacterial endocarditis, prophylactic antibiotherapy was associated with careful surgical asepsis. No case of endocarditis was encountered during a mean follow-up of 22 months. Cardiac medications such as digitalis and beta adrenergic blockers were maintained as long as possible during the perioperative period while their dosage and clinical effects were closely monitored. No patient did present cardiac failure, significant arrhythmia or blood pressure impairment. No perioperative myocardial infarcts occurred in the group of coronary artery bypass graft patients. Those patients were managed in order to maintain their myocardial muscle work in optimal ranges thanks to selective premedication, brief interruption of beta adrenergic blockers, strict control of fluid balance and careful postoperative pain relief.
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PMID:[Surgery in patients with previous heart surgery. Apropos of 21 patients]. 401 87

A combination of isosorbide dinitrate (40-120 mg daily) and propranolol (80-160 mg) was administered to 146 patients during the early hours of myocardial infarction. The therapeutic effect was assessed for 10 days and compared to the effect observed in a control group of 70 patients selected at random. The combination used was shown to relieve the pain syndrome and extrasystolic arrhythmia during the early days of the disease. The occurrence of signs of heart failure was twice as low during the observation period, as compared to the control group. The treatment evoked typical hemodynamic changes: rhythm deceleration (by an average 7%), a fall in systemic arterial blood pressure (by 19%) and in "double product" (by 25%), a moderate reduction of cardiac output (by 15%) coupled with a marked drop in left-ventricular filling pressure (by 25%). The spread of infarcted area in the first days after the attack, as evidenced by serial electrocardiotopograms and the activity of serum CPK and its MB fraction, was recorded in 13.9% of the treated patients and in 44% of the controls (p less than 0.001).
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PMID:[Combined use of nitrates and beta-adrenergic blockaders in patients with acute myocardial infarct]. 402 Dec 67

Most major intra-abdominal fistulas result from trauma or surgery. Spontaneous fistulas are rare with less than 100 reported cases since 1831. From a review of hospital records, five such spontaneous fistulas were identified among 215 cases of abdominal aortic aneurysm between 1975 and 1983. These cases are presented and supplemented by 73 similar cases collected from a literature review for discussion of the salient features of clinical presentation and management of spontaneous major fistulas. Major intra-abdominal arteriovenous fistulas usually present with a machinery bruit over a pulsatile mass, but may present more subtly with pain and otherwise unexplained hematuria. Because these fistulas lead to refractory heart failure, surgery should be expeditious. Closure should be performed from within the aneurysm with arterial and pulmonary artery pressure monitoring. Care must be taken to prevent pulmonary embolization.
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PMID:Spontaneous major intra-abdominal arteriovenous fistulas: a report of several cases. 405 Dec 57

The anaesthetic considerations of patients presenting for extracorporeal shock wave lithotripsy are described. Regional anaesthesia with sedation may be preferable to general anaesthesia for patients undergoing this form of therapy. If regional anaesthesia is contra-indicated, general anaesthesia using controlled ventilation with muscle relaxation, supplemented with a narcotic and a low concentration of volatile anaesthetic has been found to be a suitable alternative. The additional epidural preparation time has to be balanced against the benefits of easier patient transfer, especially during multi-stage procedures, and better postoperative analgesia. The epidural catheter can be left in situ in patients who require multiple treatments or who may experience severe ureteric pain as the resulting 'sand mass' is passed. Epidural space localisation using a 'loss of resistance to saline' technique is recommended, in order to avoid the possible risk of damage to the spinal cord and emerging nerves (due to the presence of an air-water interface). Patients with cardiac insufficiency need special consideration, in view of the effects of immersion on right and left heart filling pressures.
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PMID:Anaesthesia for extracorporeal shock wave lithotripsy. 407 22

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

Beta antagonists competitively block beta 1-adrenoceptors that mediate both the rate and force of myocardial contraction. Their precise mechanism of anti-anginal action is uncertain. A reduction in oxygen demand may relative pain and improve effort tolerance. Alternatively inhibition of the adrenergic drive to contraction may offset the increased ventricular wall tension due to incomplete relaxation. Partial agonist activity in a beta-antagonist does not influence efficacy nor protect against airflow obstruction. Membrane stabilising activity is clinically trivial. Cardioselectivity makes airflow obstruction less likely at low but not at high blood concentrations of drug. Alpha-receptor antagonism may also prevent broncho-constriction; it has not been assessed in coronary vasospasm. The dosage and choice of drugs are based on pharmaco-kinetic and dynamic data in animals and man. The major side-effects of beta-blockade are heart failure and airflow obstruction. Cardiotoxicity from overdosage may be treated with isoprenaline, dopamine or glucagon while beta 2-agonists will reverse bronchoconstriction. Since beta-antagonists raise-peripheral vascular impedance, reduction of preload with nitrates enhances their antianginal efficacy. Combining a beta-antagonist with nifedipine seems especially useful. Beta-blockade is worth trying in angina with normal coronary arteries. In acute coronary insufficiency beta-blockade reduces both the work-load on the heart and the somatic features of anxiety, so preparing patients for investigations, like coronary arteriography, aimed at definitive treatment.
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PMID:Clinical pharmacology of beta-adrenoceptor antagonism in angina pectoris: an overview. 611 11

We performed a double-blind controlled crossover trial of perhexiline maleate versus identical placebo in daily doses of 100-400 mg in 20 male patients who were severely limited with angina pectoris despite therapy with beta-adrenoreceptor blockers. All patients had documented coronary artery disease and were awaiting coronary artery bypass grafting. Beta-blocker therapy was continued unchanged. A significant response compared to placebo was evident after 100 mg of perhexiline, and incremental therapeutic effects were evident up to 400 mg. The mean weekly angina rate fell from 18.2 +/- 2.8 basal to 6.2 +/- 1.5 on 200 mg (P less than 0.05) to 2.8 +/- 0.9 on 400 mg perhexiline (P less than 0.05). Nitroglycerin consumption fell in parallel. The mean exercise duration increased from 261 +/- 57 sec to 384 +/- 75 sec (P less than 0.05). Five patients became asymptomatic on perhexiline, and the number of pain-free days increased 100% (P less than 0.01) compared to placebo. No patient experienced hypotension or heart failure. This study shows that the addition of perhexiline to beta-adrenoreceptor antagonists in patients with severe angina pectoris is effective and represents an alternative therapy.
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PMID:Antianginal efficacy of perhexiline maleate in patients refractory to beta-adrenoreceptor blockade. 613 84

Treatment of angina with a single drug often proves unsatisfactory because of dose-related unwanted effects or occasionally an adverse effect on the angina. A combination of a beta-blocking agent and a calcium antagonist drug might achieve satisfactory control of angina at acceptable doses of each drug. Widespread application of combination therapy would, however, be inappropriate if the beta-blocker component were to have adverse effects among patients with rest pain as a prominent symptom, suggestive of coronary 'spasm'. The reported adverse effects of beta-blocking agents are likely to be related to bradycardia and are not apparent if excessive slowing is avoided by individual dose adjustment or if bradycardia is corrected by pacing. Supposed failure of these agents to control cardiac pain not infrequently results from inadequate dosage. Combination therapy will attenuate the increases in heart rate and contractility resulting from stress while coronary perfusion will be maintained and the associated level of arterial blood pressure reduced. The theoretical benefits have been confirmed in clinical investigations in which the effect of combination therapy has been compared with that of one or both of the constituent drugs given alone. Reports of bradycardia (specific to inclusion of verapamil in the combination), hypotension or cardiac failure developing during combination therapy emphasize the need for careful dose titration of both beta-blocker and calcium antagonist in each patient. The possible additional role of nitrates is undefined, but inclusion of these agents is likely to prove especially valuable where left ventricular function is grossly impaired and in the management of unstable angina.
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PMID:Calcium antagonists and beta blockade--a useful combination. 613 60


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