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

To characterize an unusual, sex-linked recessive neuromuscular disease, we studied two families with 37 males who had involvement of distal leg and proximal arm muscle groups. Electromyography and muscle biopsy in five subjects showed features of both neuropathy and myopathy. Bradycardia and syncope in 15 involved subjects were associated with early death (before the age of 50 years). Electrocardiograms in 15 others showed a spectrum of atrial abnormalities that ranged from abnormal P waves to permanent atrial paralysis and from first-degree atrioventricular block to complete heart block. No patient exhibited clinical muscle disease without electrocardiographic atrial disease. Dilated, hypertrophied left ventricles with normal indexes of function were found in three cases with permanent atrial paralysis and chronic junctional bradycardia. Cardiomegaly and cardiac failure were not present in the other cases. We conclude that permanent ventricular pacing (instituted four patients) is indicated in many of these patients to prevent serious sequelae.
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PMID:Cardiac features of an unusual X-linked humeroperoneal neuromuscular disease. 117 8

We are presenting a case of a young woman with sudden onset of heart failure and several episodes of syncope, after a prolonged labor. The findings at physical examination suggested the diagnosis of acute aortic insufficiency, that was confirmed by cardiac catheterization. At surgery, the aortic valve showed a round perforation in the non coronary cusp. Pathological examination of the valve showed no significant abnormality. We conclude that the stress of labor was the cause of the rupture of a previously normal aortic valve.
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PMID:[Acut aortic insufficiency caused by rupture of a normal valve during labor]. 119 Sep 6

The aim of this study was to assess the long term prognosis of congenital atrioventricular block (AVB). From 1965 to 1990, 42 cases of congenital AVB (22 antenatal or natal diagnoses and 20 presumed congenital AVB according to Yater's criteria). The AVB was isolated in 28 cases and associated with cardiac disease in 14 cases (8 of which were corrected transposition of the great arteries). The average age of the patients was 14 years (range 32 years to 18 months) at the time of the study. There was a clear female predominance (64%). Maternal connective tissue disease was present in 18% of cases (in the group of children born after 1977 when maternal connective tissue diseases was systematically looked for). Cardiac failure was present in 10 cases (8 with associated AVB); syncope and sudden death were observed in 11 cases. The indication for pacemaker therapy was the presence of poor prognostic factors: syncope, poorly controlled cardiac failure, low heart rate, increased QRS duration, prolonged QTc, infrahisian AVB, long pauses or arrhythmias on Holter monitoring. The only significant prognostic factors in this series were a previous history of syncope, increased QRS duration and a QTc of over 0.45 seconds. Fourteen patients were paced (endocavitary pacing only from 1981), usually in the DDD mode: 8 for syncope, 2 for cardiac failure, 4 for a poor prognostic factor.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Long-term prognosis of congenital atrioventricular block]. 129 88

To determine the factors relating to prognosis, the records of 15 neonates with persistent prolongation of the QT interval on the electrocardiogram after the fourth day of life were reviewed. Patients were admitted for symptoms (syncope, cardiac failure, or seizures), abnormal auscultation with an irregular heart rate or bradycardia, or because of a family history of a long QT syndrome. All infants had a long QTc, ranging from 0.46 to more than 0.70 second. Eight patients who had a QTc over 0.60 second developed severe ventricular arrhythmias (torsades de pointes, ventricular tachycardia) or second-degree AV block. Twelve of 15 were treated with beta-blocking agents, combined with ventricular pacing in five cases. Four infants died in the first month of life; they all had a very long QT interval and had experienced ventricular arrhythmias and AV block. Six children are still being treated with beta-blocking agents for the long QT syndrome and are doing well. In five infants, electrocardiographic abnormalities were transient and the QT interval returned to normal within 1 year. Therefore (1) prolongation of the QT interval in neonates may be transient or may represent an early form of the long QT syndrome and (2) the length of the QT interval may provide data on prognosis: those with a QTc less than 0.50 second returned to normal; those with a QTc greater than 0.60 second were associated with severe arrhythmias and four of eight infants died.
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PMID:Prolonged QT interval in neonates: benign, transient, or prolonged risk of sudden death. 135 80

A total of 1,431 patients (mean age 63.4 +/- 14.1) with pacemakers (96.2% VVI) primoimplanted between 1967 and 1985 were followed for a mean duration of 78.2 +/- 40 pacing months, with 0.6% loss to follow-up. Cumulative survival for 1, 3, and 10 years was 0.9427, 0.9136, and 0.7536, respectively. There was no significant difference in survival between atrioventricular block (AVB) and sick sinus syndrome (SSS) patients. In addition to age and gender, factors existent prior to implantation that independently affected prognosis included manifest coronary heart disease (CHD), congenital/acquired heart lesions, heart failure, noncardiac internal disease, syncope, and generalized fatigue. After implantation, the most important factor was generalized fatigue, then age, stroke, myocardial infarct (MI), gender (male), heart failure, and syncope. Patients with no underlying disease showed an extremely high cumulative survival (0.9173 at 10 years). Compared to the general population of Yugoslavia, the pacemaker patients showed a similar yearly mortality rate until 1981. After that, elderly males (70+) had a significantly lower yearly mortality than the matched population. Thus, in this large series of pacemaker patients followed into the most recent period with an extremely low loss to follow-up, short- and long-term survival was very high. Pacemaker patients of any age who are otherwise in good health have an excellent prognosis.
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PMID:Survival in 1,431 pacemaker patients: prognostic factors and comparison with the general population. 137 12

The pacemaker syndrome is a complex of symptoms consisting of heart failure, near fainting, sensations of pulsation in the neck or abdomen or cough which develop or are aggravated after cardiac pacing. Objectively, a fall in systolic blood pressure is observed in the majority of cases and also canon waves in the neck veins, signs of heart failure, retrograde arterial activation and possibly canon-a-awaves in the central venous pressure. The syndrome occurs in approximately 15% of the patients with ventricular pacing. The condition is most probably caused by lack of atrioventricular synchrony with resultant distension of the atria which results in a reflex mediated decrease or defective increase in the total peripheral resistance and, thus, a fall in systolic blood pressure. Treatment consists of establishing normal atrioventricular synchrony either by implantation of an atrial or AV-sequential pacemaker or by re-programming so that the patient has, primarily, his own rhythm. Ensuring normal atrioventricular synchrony has also other advantages as several investigations have shown that 60-80% of the patients prefer this form of pacing rather than ventricular pacing. The working capacity improves and the patients feel subjectively better and the risk for development of chronic atrial fibrillation and heart failure decreases.
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PMID:[The pacemaker syndrome]. 141 81

A 62-year-old woman was admitted our hospital because of concussion of the brain. The level of consciousness improved within several days. Cardiac examination was performed because the patient had experienced feelings of fainting since one year previously, and heart murmur also was heard. The electrocardiogram showed WPW configuration. At the same time that she complained of feelings of fainting, the electrocardiogram showed supraventricular tachycardia. The echocardiogram showed displacement of the septal tricuspid leaflet and mild tricuspid valve, regurgitation. Cardiac catheterization was performed and, using the intracardiac electrocardiogram, we confirmed atrialized right ventricle. We diagnosed this patient as having Ebstein's anomaly with WPW syndrome. The clinical manifestations of this anomaly are quite variable, depending upon the spectrum of pathology and the presence of associated malformations. It is well documented that a considerable proportion of these patients are able to survive into adult life. However, the patient who survives into the sixth decade without a sign of heart failure is extremely rare. We speculate that this patient had not developed right ventricular failure until her 60's because she had a milder form of Ebstein's anomaly and did not have any other congenital heart disease.
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PMID:[A 62-year-old survivor with Ebstein's anomaly without right ventricular failure]. 148 Aug 34

Left ventricular outflow obstruction can be divided into three distinct categories: valvular aortic stenosis, the most common form; supravalvular aortic stenosis, which is often seen in early childhood; and subvalvular stenosis, which can be further subdivided into muscular, tunnel, and fibromembranous subtypes. All may be found in a patient seen with symptoms of angina, syncope, or heart failure as a precursor to sudden death. Prompt clinical recognition is essential as is a high degree of suspicion when these signs are associated with a systolic ejection murmur on clinical examination. Echocardiography and a meticulous Doppler examination are very useful in the diagnosis of these disorders as well as in further distinguishing among the different subtypes. The authors describe the case of a 40-year-old woman with chest pain refractory to medical therapy and a long systolic ejection murmur.
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PMID:Chest pain secondary to membranous subaortic stenosis in a young woman. 148 84

Between 1982 and 1988, we observed 312 patients who were affected by syncope or presyncope and whose spontaneous symptoms could be reproduced by means of carotid sinus massage (CSH); no other definite cause of syncope could be identified. The clinical outcome during a 2- to 8-year follow-up period (mean 44 +/- 24 months) was assessed in 262 of them (mean age, 71 +/- 11 years; 183 men) and was compared with that of a group of 55 patients who were affected by unexplained syncope (control patients) who were matched 4:1 for age and sex with CSH patients. CSH patients had an overall mortality rate of 7.3 per 100 person-years (cardiovascular, 66%; sudden death, 9%); overall predicted cumulative survival rates at 1, 3, 5, and 7 years were 92%, 80%, 66% and 53%. Survival was similar in control patients; mortality rate was 5.8 per 100 person-years (cardiovascular, 82%; sudden death, 18%); cumulative survival rates at 1, 3, 5, and 7 years were 85%, 80%, 73%, and 69%. Standardized mortality rate of the general population with similar age and sex distribution, as calculated by means of Italian Istituto Centrale di Statistica death-rate data (1987 edition) was 8 per 100 person-years. Of 13 clinical variables, age, sex, abnormal electrocardiogram, and heart failure (but not CSH type or related arrhythmias) were independently linked to mortality in CSH patients (Cox model). In the vasodepressor form of CSH, patients were younger than those with other forms of CSH and the percentage of women was higher.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term outcome in symptomatic carotid sinus hypersensitivity. 153 20

The real incidence of pacemaker implants for carotid sinus syndrome (CSS) and the relation between CSS and sick sinus syndrome (SSS) is not precisely known. Patients who needed pacing therapy because of atrial bradyarrhythmias were investigated by means of carotid sinus massage, dynamic ECG, and invasive electrophysiological sinus node evaluation. Of 298 consecutive patients receiving a pacemaker implant, 36 (12%) had a severe cardioinhibitory carotid sinus reflex with reproducible spontaneous symptoms (CSS), 33 (11%) had sinus bradycardia less than 50 beats/min or an abnormal electrophysiological evaluation (SSS) and 24 (8%) had both (CSS + SSS). The annual incidence was 40, 37, and 26, respectively, implants per year/million of inhabitants (total incidence 325). Patients affected by CSS, if compared with those affected by SSS, showed: a higher prevalence of syncope (97% vs 42%); more syncopal episodes per patient (2.9 +/- 2 vs 1.8 +/- 0.9); a lower prevalence of associated cardiac diseases (53% vs 100%); cardiac enlargement (36% vs 88%); heart failure (6% vs 36%) and paroxysmal atrial fibrillation (0% vs 42%); and a more frequent indication for VVI pacing (75% vs 3%). In patients with CSS + SSS, intermediate characteristics were present. In conclusion, CSS is as frequent an indication to cardiac pacing as SSS; clinical differences justify a distinction between them, even if they are associated in 26% of cases.
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PMID:Pacing for carotid sinus syndrome and sick sinus syndrome. 170 95


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