Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

To evaluate the prognostic significance of diastolic function in hypertrophic cardiomyopathy (HC), technetium-99m gated equilibrium radionuclide angiography, acquired in list mode, was performed in 161 patients. Five diastolic indexes were calculated. During 3.0 +/- 1.9 years, 13 patients had disease-related deaths. With univariate analysis, these patients were younger (29 +/- 20 vs 42 +/- 16 years; p less than 0.05), had a higher incidence of syncope (p less than 0.025), dyspnea (p less than 0.001), reduced peak filling rate (2.9 +/- 0.9 vs 3.4 +/- 1.0 end-diastolic volume/s; p = 0.09) with increased relative filling volume during the rapid filling period (80 +/- 7 vs 75 +/- 12%; p = 0.06) and decreased atrial contribution (17 +/- 7 vs 22 +/- 11%; p = 0.07). Stepwise discriminant analysis revealed that young age at diagnosis, syncope at diagnosis, reduced peak ejection rate, positive family history, reduced peak filling rate, increased relative filling volume by peak filling rate and concentric left ventricular hypertrophy were the most statistically significant (p = 0.0001) predictors of disease-related death (sensitivity 92%, specificity 76%, accuracy 77%, positive predictive value 25%). Discriminant analysis excluding the diastolic indexes, however, showed similar predictability (sensitivity 92%, specificity 76%, accuracy 78%, positive predictive value 26%). To obtain more homogeneous groups for analysis, patients were classified as survivors (116) or electrically unstable (40), including sudden death, out-of-hospital ventricular fibrillation and nonsustained ventricular tachycardia during 48-hour ambulatory electrocardiography, and heart failure death or cardiac transplant (5).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Prognostic significance of radionuclide-assessed diastolic function in hypertrophic cardiomyopathy. 230 87

Double balloon percutaneous transluminal aortic valvuloplasty (PTAV) was performed on 149 patients (76 male (51%), mean age 76 +/- 11 years) whose symptoms included severe congestive heart failure in 127 cases (82%), syncope in 21 (14%) and angina in six (4%). Significant changes (P less than 0.05) in peak systolic (83 +/- 36 to 38 +/- 30 mmHg) and mean gradient (68 +/- 25 to 36 +/- 21 mmHg), and aortic valve area (0.6 +/- 0.2 to 1.0 +/- 0.4 cm2) were achieved in 130/149 patients (87%). Complications included an overall in-hospital mortality of 13%, (10.0% excluding the six deaths occurring in 18 moribund patients), a neurologic deficit incidence of 3%, and surgical arterial entry site repair 3.0% (14/47) of patients. Multivariate analysis identified congestive heart failure (NYHA Class IV), left ventricular ejection fraction, cardiac output and coronary artery disease as independent variables significantly affecting in-hospital mortality. Predictors of poor long-term survival were degree of heart failure, and coronary artery disease. The cumulative probability of survival at 24 months was 52 +/- 5% (excluding non-cardiac deaths, was 66 +/- 3%). Follow-up (mean time: 16 +/- 7 months) of 130 patients discharged alive revealed 41 late deaths (26 cardiac related). Sixty-two patients (70%) were symptomatically improved; 17 patients had symptom recurrence and underwent repeat valvuloplasty, and 10 patients valve replacement. Follow-up catheterization of 18 asymptomatic patients revealed that 11 patients had silently restenosed. These data indicate that aortic valvuloplasty is a palliative therapy for elderly patients, who are poor surgical candidates, with symptomatic calcific aortic stenosis with reasonable clinical success and long-term survival when considering their clinical status, but with a significant restenosis rate.
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PMID:Percutaneous transluminal aortic valvuloplasty--the acute outcome and follow-up of 149 patients who underwent the double balloon technique. 235 4

The selection of antiarrhythmic drug therapy requires a careful assessment of the benefits of ventricular arrhythmia suppression compared with the risks of antiarrhythmic drug use. Since reduction in sudden cardiac death from ventricular arrhythmia suppression has not been demonstrated, the only indications for antiarrhythmic drug suppression involve the reduction of hemodynamic symptoms such as syncope (a major benefit) or the reduction of nonhemodynamic symptoms such as palpitations or dizziness (a minor benefit). Noncardiac adverse effects and organ toxicity as well as cardiac side effects must be considered when antiarrhythmic drug therapy is initiated. For reduction of nonhemodynamically important symptoms in patients with benign or potentially lethal ventricular arrhythmias, beta blockers are chosen as first-line therapy. Because of moricizine's relatively high effectiveness in suppressing ventricular arrhythmias and its low potential for noncardiac adverse effects and organ toxicity as well as a low incidence of induced proarrhythmia and heart failure, moricizine is selected as the next drug in line. All other class I antiarrhythmic drugs either have been shown to have the potential for increasing sudden cardiac death or have major rates of noncardiac adverse effects or organ toxicity that preclude their use in these patient groups except in special circumstances. In patients with malignant ventricular arrhythmias who present with hemodynamic consequences such as syncope or worse, moricizine also is preferred as an initial drug for consideration. When compared to drugs with class IA and IB action, moricizine has comparable efficacy yet lower rates of noncardiac adverse effects, organ toxicity, proarrhythmia and heart failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Placement of moricizine in the selection of antiarrhythmic drug therapy. 240 93

An analysis has been made of long-term ECG recordings in 11 patients, 9 men and 2 women, mean age 69 +/- 7 years, who were carrying ECG recording equipment at the time of sudden death. Nine patients had coronary heart disease, one patient a dilatative cardiomyopathy and another one a combined aortic valve defect. Seven patients had a history of syncope. All patients had signs of cardiac insufficiency (NYHA index 3.0 +/- 0.6, heart-thorax quotient 0.55 +/- 0.05). Sudden death occurred predominantly whilst resting. In one patient it was due to bradyarrhythmia, in 10 to tachyarrhythmia, mostly ventricular tachycardia (initial heart rate 198 +/- 43/min; n = 8) which degenerated into ventricular fibrillation. Atrial fibrillation was present in 8 patients at the time of sudden death. Premonitory warning arrhythmias were not consistently detectable: comparison of arrhythmias in the first and last hour showed significant increases only in single ventricular extrasystoles (135 vs. 278 VES/h, P less than 0.05), not however in repetitive arrhythmias. An R-on-T phenomenon, as trigger mechanism of ventricular tachycardia, occurred in 5 cases. A synopsis of the published reports on approximately 110 patients with sudden death during long-term electrocardiographic monitoring confirmed that acute death is caused by bradyarrhythmias in approximately 15% (17 patients), and by tachyarrhythmias in 85% (94 patients). An increase in ventricular arrhythmias in the hour prior to death was observed in about 50% of patients and the R-on-T phenomenon, as the initiating mechanism for ventricular tachycardia, in 42%.
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PMID:[Sudden cardiac death in long-term electrocardiography]. 241 Feb 15

Sustained ventricular tachyarrhythmias and sudden death are particularly prevalent in patients with idiopathic dilated cardiomyopathy (IDC). In contrast to patients with ischemic heart disease, the value of electrophysiological stimulation (EPS) in patients with IDC has not yet been established. To clarify the role of EPS in these patients, we studied 19 patients (58 +/- 11 years) with IDC who had symptomatic ventricular tachycardia (VT) or ventricular fibrillation (VF). The mean left ventricular ejection fraction was 26 +/- 9%. Ten patients had survived out-of-hospital cardiac arrest, eight had documented sustained monomorphic VT and one patient had non-sustained VT associated with syncope. Thirteen of the 19 patients (68%) had their clinical ventricular tachyarrhythmias induced at EPS (12 VT, 1 VF). In nine of 13 patients (69%), the arrhythmias were subsequently suppressed during serial electrophysiological drug testing. During 17 +/- 11 months of follow-up, 10/19 (53%) patients experienced recurrence of their arrhythmias and nine out of 19 (47%) patients died; six died suddenly and three secondary to heart failure. There was no difference in arrhythmia recurrence between patients with and without inducible ventricular tachyarrhythmias at initial study. Furthermore, suppression of arrhythmia during serial testing did not predict outcome; recurrences were observed in five out of nine patients whose arrhythmias were suppressed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Electrophysiological evaluation of sustained ventricular tachyarrhythmias in idiopathic dilated cardiomyopathy. 245 34

This is a retrospective study of 16 children with congenital complete atrioventricular block (CAVB) who were fitted with a pacemaker in infancy. All were neonates admitted at the age of 1 to 9 days for bradycardia; 3 had a cardiopathy. In 8 children a permanent pacemaker was implanted in the first two days of life on account of a heart rate slower than 50 beats/min, accompanied with threatening symptoms (heart failure or syncopes) in 4 cases. In 6 children the pacemaker was implanted at the age of 2 to 3 months; in spite of reassuring electrocardiograms, 5 of them were readmitted in an emergency for heart failure or syncope with slow heart rate; the 6th patient had disorders of ventricular excitability. Finally, 2 asymptomatic infants underwent pacing: one at 20 days for bundle branch block, the other at 6 months for slow phase abnormalities. Pacing was epicardial in all patients, the chamber being positioned in the space that separates the kidney from the parietal peritoneum. Ventricular synchronous pacing (VVI) was applied in 14 cases and atrioventricular pacing (DDD) in the two most recent cases. Two children died post-operatively, due to inadequate attachment of the electrode resulting in loss of ventricular capture in one case, and to extensive left atrial thrombosis in the other case. Two children died at a later stage of severe respiratory pathology. The 12 survivors were followed up for a mean period of 3.7 +/- 3.1 years. Three pacemakers were replaced: one at 28 months for infection, the others at 3 and 6 years respectively for running down of the batteries.2 +
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PMID:[Artificial cardiac stimulation in the newborn infant with complete congenital atrioventricular block. Study of 16 cases]. 250 99

Our study group included 12 patients (4 males, 8 females), mean age 60 yr, with symptomatic or threatening tachyarrhythmias (Lown classes IV A, B, V); 2 patients were suffering from mitral valve prolapse syndrome, 2 from ischemic heart disease; 4 from cardiac insufficiency caused by hypertensive or ischemic heart disease; 4 had no evident clinical signs of cardiopathy. Patients suffering from: cardiac insufficiency (F.C. III e IV NYHA); II and III degree BAV; atrial flutter and fibrillation; long QT syndrome; acute ischemic heart disease were excluded from the study. During short-term treatment, patients received placebo for four days and subsequently flecainide 200 mg daily for four days. During medium-term treatment patients received flecainide 200 mg daily (for six months). Several Holter/24-hour monitorings were performed for evaluation of therapy. No significant reduction in the number of ectopic ventricular beats (B.E.V.) was found with placebo whereas reductions of B.E.V. number (97% and 95%, respectively) were found during short and medium-term treatment with flecainide. Flecainide produced: changes in Lown class: from IV A, B and V to II and I; a marked reduction of subjective symptoms (dyspnea, giddiness syncope, precordial pain); ECG changes: increases in: PR: 5-25%; QRS: 11-12%; QT: 11-22%. Flecainide produced no pro-arrhythmic effects or changes in echocardiographic ventricular function index. Flecainide can be considered one of the most effective new antiarrhythmic drugs.
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PMID:[Short- and medium-term treatment of ventricular hyperkinetic arrhythmia with flecainide]. 252 12

Intravenous leiomyomatosis (IVL) is a rare neoplastic disease which is defined as the extension into venous channels of histologically benign smooth muscle tumors arising either from a uterine myoma or from the walls of a uterine vessel. We report a case of IVL originating from the uterus, growing up in the inferior vena cava, and extending into the right pulmonary artery. The patient was a 42-year-old woman, who was admitted to our hospital with clinical signs of right-side heart failure and syncope in December 1987. Her medical history included a total hysterectomy in August 1986. On examination, two dimensional echocardiography showed a freely floating tumor in the right atrium and right ventricle, which protruded via the inferior vena cava. Cavography confirmed the above findings. Because of the clinical disability caused by the tumor localized in the right heart, emergency operation was performed, extracorporeal circulation was instituted through the femoral vein, the superior vena cava, and the femoral artery. Opening the right atrium confirmed that a white sausage-like mass quite free from the wall extended into the right ventricle, and the head of the tumor was adherent to the right pulmonary artery. After detaching the head of the tumor from the right pulmonary artery, the remaining tumor in the inferior vena cava was also successfully pulled out. The operative specimen was measured 55 cm in length, but the basal end of the tumor was supposed to be left in place. Two months later, the second-stage operation for the remaining tumor was carried out through a median laparotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[A case report of intravenous leiomyomatosis of the uterus with extension into the right pulmonary artery]. 269 64

In this prospective study, we evaluated pacing therapy in 60 consecutive patients affected by syncopes or pre-syncopes and cardioinhibitory or mixed carotid sinus hypersensitivity. We preferred DDD/DVI pacing for the 26 patients who had: 1) the cardioinhibitory form and presence of symptomatic pacemaker effect, or 2) the mixed type I form and presence of symptomatic pacemaker effect, ventriculo-atrial conduction, or orthostatic hypotension, or 3) the mixed type II form, or 4) the presence of severe sinus bradycardia. We preferred VVI mode in the other 34 patients. Syncope or pre-syncope persisted in one patient of the VVI group after the pacemaker implant and in one patient of the DDD/DVI group. Therefore, we obtained the suppression of severe symptoms in 97% of cases (58/60 pts). Yet minor symptoms persisted in 35% and 38% of patients of the two groups, respectively. No patient developed clinical signs of cardiac insufficiency or intolerance to pacing therapy. Besides, in DDD/DVI patients, we performed a single-blind, randomized, cross-over study for a comparison between the DDD/DVI and VVI mode: each patient was paced for two months using each mode and for each period symptoms were analyzed. The VVI period, compared to the DDD/DVI, resulted in a significantly higher incidence of symptoms: syncope 8% vs. 0%; pre-syncope 31% vs 0%; minor symptoms 58% vs. 31%; cardiac failure 19% vs. 0%. So the DDD/DVI mode was preferred by 69% of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[The choice of stimulation mode in patients with cardioinhibitory or mixed carotid sinus hypersensitivity, with or without associated sinus dysfunction]. 274 11

We have described six centenarians who have benefited from permanent pacemakers. In all of these patients, their initial symptoms of syncope, presyncope, dyspnea, and transient cerebral ischemic attacks resolved promptly after pacemaker implantation. In most of these patients quality of life, as measured by lifestyle and independence, improved after pacemaker implantation. None of these patients exhibited evidence of ischemic heart disease or cardiac failure. Because of increasing longevity and age-related degenerative and destructive changes in the conduction system and the sinus node, we expect that the number of patients requiring pacemakers in this age group will continue to grow. Ischemic heart disease as an underlying pathology necessitating pacemaker implantation appears to be rare in this age group.
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PMID:Permanent pacemakers in centenarians. 275 61


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