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

The authors report 25 cases of patients, average age 67 years with severe coronary or valvular heart disease, with conduction disorders. The conduction disorder occurred alone in 8 cases and was associated with a disorder of excitability in 17 cases. It was either obvious, as in 14 cases, or latent, as in 11 cases, and precipitated by various forms of treatment, the disadvantage of which was the negative dromotrope effect. This treatment was prescribed for permanent resting angina (amiodarone and prenylamine), heart failure (digitoxin) or excitability disorder (beta-blockaders or procainamide). 11 patients had one or several fainting attacks. Permanent electro-systolic pacing with stimulation on demand, is necessary in all patients to palliate the consequences of treatment. In 11 cases out of 25, prior temporary pacing permitted the authors to assess the efficacy of treatment. The high post-operative mortality (40%) is not due to the apparatus but depends on the severity of the coronary heart disease or heart failure in these patients, In 60% of cases, the result of stimulation was excellent and was maintained permanently.
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PMID:[Indications for permanent electrosystolic pacing in arrhythmia revealed or aggravated by treatment]. 17 99

In the period from 1968 to 1977, in the Departments of Cardiology of the S. Camillo Hospital, a study has been made about 200 cases of Congestive Cardiomyopathy (MPC) and 100 about hypertrophic obstructive (MP0). Congestive cardiomyopathies constitute 1.5% of hospitalizations with a constant trend in the long run. In comparing these two forms, Authors have noticed some differences in the symptomatology of clinical and instrumental signs: 1) in case of MPO prevail angina, syncope, ejection systolic murmur, left ventricular overload in the ECG; 2) in case of MPC they find more frequently heart failure, embolism, diastolic gallop, cardiomegaly, A/V and intraventricular conduction disturbs. The AA. conclude, in accordance with Goodwin's classification, that there is not an uniformity of these two kinds of cardiomyopathies.
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PMID:[Epidemiological and clinical observations on 300 cases of primary myocardiopathy]. 45 5

Nineteen patients, aged 58-80 years, with severe isolated aortic valve stenosis, severely reduced ejection fraction and clinical heart failure underwent aortic valve replacement between January 1970 and April 1977. Ten had concomitant coronary artery disease (all underwent additional coronary bypass surgery), 17 had angina pectoris and four had syncope. Aortic valve area index was 0.32 +/- 0.03 cm2/m2 (mean +/- SEM); left ventricular (LV) end-diastolic volume index was 117 +/- 9 ml/m2 and LV ejection fraction was 0.37 +/- 0.02. There were four operative deaths and one late death. The follow-up time ranged from six to 74 months (38 +/- 6 months). Actuarially determined three-year survival is 74 +/- 10%; the expected five-year survival is the same. One patient had a serious cerebrovascular accident. Of the remaining survivors, seven were initially Functional Class IV and six Class III; currently, six are Class I and seven Class II (New York Heart Association classifications). The cardiothoracic ratio has decreased from 0.54 +/- 0.03 to 0.49 +/- 0.03. Repeat hemodynamic evaluation has been performed in 10 patients, 22 +/- 6 months after surgery. In these 10 patients, the aortic valve gradient decreased from 55 +/- 7 11 +/- 1.3 mm Hg; LV end-diastolic pressure from 22 +/- 2.4 to 9 +/- 1.9 mm Hg; LV end-diastolic volume index from 119 +/- 16 ml/m2 to 107 +/- 11 ml/m2. LV ejection fraction has increased dramatically from 0.34 +/- 0.03 to 0.63 +/- 0.05 and mean velocity of circumferential fiber shortening from 0.57 +/- 0.08 to 1.3 +/- 0.18 circ/sec. The encouraging long-term survival, improved functional class and the marked improvement in left ventricular function that occurred in our patients indicate that all patients with severe aortic stenosis in clinical heart failure should be offered aortic valve replacement.
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PMID:Severe aortic stenosis with impaired left ventricular function and clinical heart failure: results of valve replacement. 66 73

The effect of permanent pacing on chronic complete atrioventricular block complicated by cardiac failure was studied in 6 patients by measurement of indirect left atrial pressure 15 minutes after institution of pacing and again 3 to 12 months later. In addition, 21 patients with complete heart block and clinical plus radiological evidence of cardiac failure at the time of pacing 3 to 6 years earlier were also reviewed. Only 1 of 6 patients studied haemodynamically improved and 1 died in cardiac failure. Of 21 patients assessed clinically, 10 had improved and 8 had died after a mean follow-up of 53 months. In the absence of syncope, pacing was of little symptomatic benefit but still may be justified to prolong survival. Both studies indicated a particularly poor prognosis for patients known to have coronary artery disease. No reliable means were found of determining the prognosis in the individual patient with cardiac failure before pacing.
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PMID:Value of pacing in cardiac failure associated with chronic atrioventricular block. 68 87

Following episodes of pulmonary embolism, the presence of thrombi in the pulmonary arteries leads to severe respiratory insufficiency and chronic right heart failure. We have operated upon 16 such patients, nine men and seven women from 23 to 68 years of age. All had severe dyspnea, 14 had chronic cor pulmonale, six had mental disturbances with syncope, and four had severe cardiac failure. The presence of clots was demonstrated by pulmonary angiography, and the permeability of the distal arterial bed was ascertained by selective injection of the bronchial arteries. In all cases but two a lateral thoracotomy was used so that the obstructed arterial branches could be approached distally. The inferior vena cava was always ligated to prevent recurrences. There were six operative deaths, three from cardiac failure, one from acute pulmonary edema, one from hemothorax, and one following a pyothorax. Ten patients are surviving after 6 months to 10 years. One is still limited because of significant pleuropulmonary sequelae. Six are enjoying good results with marked improvement in their functional limitations, a significant drop in the pulmonary artery pressure, and radiological permeability of previously obstructed arteries. Three are excellent condition--completely asymptomatic.
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PMID:Surgical correction of chronic postembolic obstructions of the pulmonary arteries. 70 66

The sick sinus syndrome is caused by dysfunction of the sinus node and includes various forms of arrhythmia. In its chronic form the underlying disease may affect not only the sinus node but also the atrial, junctional and intraventricular conduction tissue. The most important clinical symptoms are, in decreasing order, dizziness, syncope, palpitations, cardiac failure, systemic embolism, and cerebrovascular insult. The main diseases causing dysfunction of the sinus node are coronary heart disease, myocarditis, and rheumatic fever. The diagnosis is based on history, clinical findings, ECG, specific provocative tests and, if necessary, long-term ECG monitoring. The sick sinus syndrome is most frequently seen in patients aged over 50 years. Treatment with drugs alone, such as atropin, catecholamines, digitalis or antiarrhythmic drugs is often difficult becuase of the frequent changes between bradycardic and tachycardic arrhythmia. In chronic and progressive cases, the best treatment is implantation of a cardiac pacemaker.
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PMID:[Sinus node syndrome]. 100 72

Complications after heart valve replacement remain a substantial source of morbidity and mortality despite continuing advances in surgical care and prosthetic design. Infectious endocarditis occurs in about 4 percent of patients and may appear early (within 60 days) or late after operation. Endocarditis of early onset is commonly due to staphylococcal, fungal or gram-negative organisms and is fatal in 70 percent or more of cases. Infection of late onset is more often of streptococcal origin and the mortality rate is lower, about 35 percent. With either type, prompt recognition, vigorous and appropriate antimicrobial therapy and early consideration of surgical intervention are crucial. The postperfusion and postpericardiotomy syndromes are relatively common and relatively benign syndromes associated with postoperative fever. Their recognition is important to prevent confusion with endocarditis or sepsis and thus to reassure the patient and physician. Treatment is primarily symptomatic. Intravascular hemolysis occurs with most prosthetic heart valves but is more common with certain prostheses and with paraprosthetic valve regurgitation, with significant hemolytic anemia in 5 to 15 percent. Oral iron replacement therapy is effective in the majority of patients, but occasionally blood transfusion or reoperation for leak around the prosthesis is necessary. Prosthesis dysfunction due to thrombus may be recognized clinically by recurrence of heart failure, syncope, cardiomegaly and altered prosthetic valve sounds or new murmurs. Hemodynamic studies verify the diagnosis, and prompt reoperation is indicated for this potentially lethal problem. Systemic embolization has decreased markedly with the introduction of cloth-covered prostheses and is frequently related to erratic or ineffective anticoagulant therapy. We continue to recommend anticoagulant therapy for all patients with prosthetic heart valves unless there is a major contraindication.
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PMID:Diagnosis and management of complications of prosthetic heart valves. 109 75

"Sick sinus syndrome" is characterized by alternating tachyarrhythmias and bradyarrhythmias, diverse origin, generalized conduction abnormalities, and symptoms of heart failure, systemic embolization, and syncope. Proper treatment requires demand atrial or ventricular pacing. A patient with this syndrome was treated with a new transvenous atrial electrode catheter which has successfully controlled her symptoms for 33 months with unrestricted physical activity and without further paroxysms of atrial arrhythmia.
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PMID:The sick sinus syndrome: treatment by permanent transvenous atrial pacing (a new approach). 112 18

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

The long-term effect of pacemakers in the management of bradycardic heart failure with or without syncope was tested on 337 patients. The cumulative survival rate of patients with Adams-Stokes attacks without heart failure (group I) was 91% at the end of one year, 73% at the end of three and 35% at the end of eight years. Among patients with Adams-Stokes attacks and accompanying heart failure (group II) 81% survived one year, 64% three and 46% five years, but only 25% eight years. Among patients in whom heart failure was the only indication for pacemaker implantation (group III), 70% were still alive after one year, 56% after three and 17% after five years. Related to the severity of heart failure before and after pacemaker implantation, most of the patients of group II (mild or moderately severe failure) had definite improvement, while of those in group III (mainly severe failure) only about half had less cardiac failure. In patients with severe heart failure and bradycardia (without syncope) long-term results are not likely to be very good, as regards both duration of survival and physical capacity.
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PMID:[Pacemaker implantation for heart failure with bradycardia (author's transl)]. 116 77


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