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

A large-scale, prospective, 8-week, office-based study was conducted to evaluate the effects of adding captopril to a therapeutic regimen of diuretic and digoxin or diuretic alone in the management of patients with mild to moderate congestive heart failure (CHF). A total of 2218 primary care physicians evaluated 6669 patients over the study period for efficacy parameters, which included changes in a modified New York Heart Association (NYHA) functional classification, symptomatology, and daily activity levels. Overall, 63.8% of evaluated patients improved with regard to functional ability, with 19% improving two or more modified NYHA classes. Symptoms of CHF, including dyspnea on exertion, fatigue, and orthopnea and signs, including rales and peripheral edema, were reduced in 86% of these patients: 41.5% demonstrated mild improvement; 30.0%, moderate improvement; and 14.5%, marked improvement. Three parameters, with which patients reported having difficulty at study entry, were assessed serially to evaluate changes in functional capacity; 78.5% of patients reported an increased walking distance, 72.3% had increased capacity for climbing stairs, and 60.2% had improved capacity for individual recreational activities. Adverse experiences were reported in 18.1% of all patients; 4.9% of patients withdrew from the study because of an adverse effect. Combination therapy with captopril and diuretic for CHF was shown to be safe and effective regardless of patient age (less than 70 years vs. greater than or equal to 70 years), duration of heart failure (less than 1 year vs. greater than 1 year), presence of digoxin treatment, or the dosing schedule employed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A large-scale trial of captopril for mild to moderate heart failure in the primary care setting. 191 72

The histologic evidence of amiodarone pulmonary toxicity is interstitial pneumonia with foamy alveolar macrophages, which ultrastructurally show lamellar inclusion bodies due to lipid storage. Bronchoalveolar lavage (BAL) fluid findings include foamy macrophages, considered characteristic, and, in certain patients, differential cell counts suggestive of active alveolitis, giving rise to an immunologic explanation for its origin. The present study was undertaken in order to investigate the findings in BAL fluid in nontoxic patients taking amiodarone and to evaluate their clinical relevance. Eleven patients taking amiodarone chlorhydrate for severe ventricular arrhythmias (345 +/- 129 mg/day during 46 +/- 31 months and an accumulated dose of 440 +/- 337 g) and without clinical or radiological evidences of pulmonary toxicity, were clinically evaluated and studied by BAL. As shown in Table 1, cough and pulmonary rales were common findings (64% and 36% respectively), chest X-Rays were normal or indicative of cardiac failure and arterial blood gases showed slight hypoxemia (PaO2 83 +/- 10). As these are usual findings in advanced cardiac diseases, the patients were considered as having no amiodarone toxicity. BAL was done and the fluid obtained was processed for cytologic study. In every patient foamy macrophages were seen with light microscopy and lamellar bodies were detected by electron microscopy. In 5/10 evaluable patients BAL fluid cell count disclosed an increase in lymphocytes, leukocytes or both, indicative of alveolitis. This group of patient had lower PaO2 and PaO2/PAO2 than "non alveolitic" patients (76 +/- 9 mmHg vs 89 +/- 5 mmHg and 0.72 +/- 0.1 vs 0.85 +/- 0.08 - p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Cytologic changes in bronchoalveolar lavage in amiodarone treated patients]. 192 87

In spite of conventional treatment in a Coronary Unit, there is a group of patients with acute myocardial infarction who present a high mortality index. A more aggressive attitude (coronariography, angioplasty, and/or emergency coronary bypass) could improve the prognosis in some of these patients but can only be performed in a limited number of centers. In the present work, we have reviewed data obtained from the Emergency Room on 167 patients diagnosed of myocardial infarction. The variables that were correlated to mortality were: age, heart rate, blood pressure, presence of rales, radiologic heart failure cardiomegaly, ventricular extrasystoles in ECG and delay in arrival to hospital. We obtain a lineal function (z = 24.6 X1 - 0.4 X2 + 0.2 X3 + 11) which combining ventricular extrasystoles, diastolic arterial pressure, and heart rate permits to differentiate three risk groups: low, medium and high, associated to hospital mortality rates of 5.7, 36.4 and 83.3%. We suggest the use of a function of this type to select those patients who should be sent to a hospital with facilities for emergency coronary surgery.
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PMID:[The development of a linear function for stratifying the risk of hospital mortality in acute myocardial infarct]. 209 Oct 71

The purpose of this study was to determine whether there are any consistent spirometric or Dsb findings in patients with LV dysfunction characterized by a clinical diagnosis of CHF and an EF less than 40 percent. We performed spirometry and Dsb in 34 patients, and found that EF correlated only with Dsb. When we separated the patients into those with rales and those without, Dsb correlated strongly with EF only in those with rales. There was no correlation with other spirometric values. Mean Dsb percent predicted was significantly lower in patients with rales despite similar mean EF. Only two of 23 patients without rales had a reduced Dsb while only one of 11 with rales had a normal Dsb. We conclude that Dsb is a good predictor of clinically evident heart failure. When rales are absent, Dsb should be normal in patients with LV dysfunction; when present, Dsb will be diminished in proportion to the EF.
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PMID:Pulmonary diffusing capacity in left ventricular dysfunction. 211 44

754 cases of acute myocardial infarction survivors were followed up for 28 days to 14 years, the missing rate was 1.86%. The factors influencing long-term prognosis were analyzed. Single factor analysis revealed sex, occupation, age, amount of cigarette smoked, history of stroke, and COPD, complications of heart failure, and arrhythmia, stroke and COPD, heart rate higher than 110/min, lung rales, frequency of infarction, quit smoking after infarction exerted significant influence on over all and cardiac death rate. Multiple factors Cox model analysis revealed quit smoking, complications of stroke heart failure, arrhythmia and occupation were the independent predicting factors for over-all causes of death. Frequency of myocardial infarction, quit smoking, amount of cigarette smoked, occupation, stroke were the independent prognostic factors of cardiac death.
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PMID:[Long-term prognosis after recovery from acute myocardial infarction]. 228 72

102 patients with myocardial infarction (MI) were examined by three clinicians, who independently recorded the following symptoms and signs: dyspnoea, a displaced apex beat, S3-gallop, rales, neck vein distension, hepatomegaly, and dependent oedema. Chest X-ray, radionuclide ventriculography, and (in 40 patients) right heart catheterization were carried out immediately after the physical examination. The clinicians frequently disagreed as to the presence of physical signs of heart failure in individuals. Moreover, these signs were of limited value in identifying patients with pulmonary vascular congestion on chest X-ray, reduced left or right radionuclide ventricular ejection fractions, enlarged ventricular volumes or haemodynamic evidence of ventricular dysfunction. We conclude that clinicians frequently disagree in the recognition of physical signs of heart failure, and that these signs have an unpredictable relationship to radiographic, radionuclide and haemodynamic measures of ventricular performance in patients with MI. Nevertheless, physical signs are useful in identifying patients with high risk of cardiac death.
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PMID:Symptoms and signs of heart failure in patients with myocardial infarction: reproducibility and relationship to chest X-ray, radionuclide ventriculography and right heart catheterization. 259 93

The cardiovascular physical examination is used commonly as a basis for diagnosis and therapy in chronic heart failure, although the relationship between physical signs, increased ventricular filling pressure, and decreased cardiac output has not been established for this population. We prospectively compared physical signs with hemodynamic measurements in 50 patients with known chronic heart failure (ejection fraction, .18 +/- .06). Rales, edema, and elevated mean jugular venous pressure were absent in 18 of 43 patients with pulmonary capillary wedge pressures greater than or equal to 22 mm Hg, for which the combination of these signs had 58% sensitivity and 100% specificity. Proportional pulse pressure correlated well with cardiac index (r = .82), and when less than 25% pulse pressure had 91% sensitivity and 83% specificity for a cardiac index less than 2.2 L/min/m2. In chronic heart failure, reliance on physical signs for elevated ventricular filling pressure might result in inadequate therapy. Conversely, the adequacy of cardiac output is assessed reliably by pulse pressure. Our results facilitate decisions regarding treatment in chronic heart failure.
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PMID:The limited reliability of physical signs for estimating hemodynamics in chronic heart failure. 291 85

The radiologic appearance of atypical cardiogenic pulmonary edema (ACPE) is presented in 10 cases admitted from 1983 to 1985, with age ranges from 74 to 89, and with diagnosis of ischemic heart disease, with myocardial infarction in 50% of them. Clinically they had asthenia, adynamia and anorexia in 80%, cough and weight loss in 50%. All of them had tachycardia, pulmonary rales and 50% pericardial rub. ECG showed in 80% anterior subepicardial ischemia, 60% posteroinferior subepicardial ischemia, 60% bifascicular block, and 50% left anterior fascicular block. Chest films were interpreted at first as pulmonary fibrosis in 90% of the cases with superior lobe involvement in 50%. Heart enlargement was present in 50%. A chronic lung disease was disclosed on clinical and pulmonary physiological grounds. It is concluded that asthenia, adynamia and anorexia were atypical manifestations of heart failure in the elderly. Silent myocardial infarction was observed in half of our patients and it was complicated with pericardial involvement in 50%. Irregular distribution of fluids in pulmonary edema was attributed to anatomic changes in elder lung. These atypical behaviour of pulmonary edema, has been misinterpreted on radiologic basis with pulmonary infection, tumours, metastasis or fibrosis. Those radiologic changes disappeared or improved in 72 hrs. with treatment of left ventricular failure.
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PMID:[Radiologic characteristics of cardiogenic pulmonary edema in the elderly]. 296 66

The left ventricular (LV) ejection fraction (EF) is known to be an independent predictor of late prognosis after acute myocardial infarction. Despite a previous report that early heart failure (evidenced only by advanced pulmonary rales in the hospital) can predict prognosis in the absence of severe depression of the LVEF at hospital discharge, the potentially strong influence of various measures of in-hospital heart failure on the predictive ability of LVEF has not been generally appreciated. Accordingly, in 972 patients with acute myocardial infarction the effect on late mortality of the presence or absence in-hospital of both clinical and radiographic signs of LV failure in subgroups of patients with normal, moderately or severely depressed LVEF was examined and measured close to hospital discharge. Patients were divided into 3 groups according to LVEF: group I LVEF less than or equal to 40, n = 265; group II LVEF 0.41 to 0.50, n = 241 and group III LVEF greater than or equal to 0.51, n = 466. When clinical signs of LV failure were present at any time during the coronary care unit period, the 1-year mortality rate after hospital discharge in groups I, II and III was 26, 19 and 8%, compared with 12% (p less than 0.01), 6% (p less than 0.01) and 3% (p less than 0.02), respectively, when signs of LV failure were absent.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Influence on prognosis and morbidity of left ventricular ejection fraction with and without signs of left ventricular failure after acute myocardial infarction. 337 78

To identify prognostic factors in elderly persons who have survived acute myocardial infarction, 113 patients, aged 70 to 91 years (median 76), were followed for an average of 122 months (range 94 to 170). Eighty-four patients died, 61 (73%) from coronary artery disease. Overall mortality rates were 20.4% at 1 year, 30.1% at 2 years, 31.9% at 3 years, 45.1% at 4 years, 51.3% at 5 years and 69% at 10 years. Almost half (44%) of all deaths from coronary causes occurred in the first 2 years. Univariate analysis of 21 historical and clinical variables found several of prognostic significance: age, prior myocardial infarction, previous diastolic hypertension, history of diabetes mellitus, history of heart failure, presence of rales above the scapula, ventricular gallop, Killip class, cardiomegaly on admission chest x-ray and prescribing digitalis or diuretic at discharge. When these prognostic factors were entered into multivariate analysis, only Killip class (p less than 0.001) emerged as an independent predictor of survival.
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PMID:Prognosis in survivors of acute myocardial infarction occurring at age 70 years or older. 367 14


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