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)

A 24-year-old woman with a history of syncope and recurrent hemopericardium was urgently hospitalized with signs of severe right-sided heart failure. Two-dimensional echocardiography demonstrated a largedechogenic mass that compressed the right ventricle. The patient was referred for emergency surgery. A large angiosarcoma originating in the right atrium was excised, and the patient was treated with chemotherapy. The role of echocardiography in the detection of cardiac tumors is discussed.
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PMID:Primary angiosarcoma of the heart detected by two-dimensional echocardiography. 357 Jul 36

The fate of patients with aortic valve disease of varying degrees of severity and the relationship between symptoms and haemodynamic status have been studied in 190 adults undergoing cardiac catheterization during the last two decades. During the follow-up period, 41 patients died and 86 underwent aortic valve replacement; these two events were the endpoints for the calculation of 'event-free' cumulative survival. First-year survival in haemodynamically severe disease was 60% in aortic stenosis and 96% in aortic regurgitation; in moderate and mild disease (in the absence of coronary artery disease) first-year survival was 100% in both groups. After 10 years, 9% of those with haemodynamically severe aortic stenosis and 17% of those with severe regurgitation were event-free, in contrast to 35% and 22%, respectively, of those with moderate changes and 85% and 75%, respectively, of those with mild abnormalities. In the presence of haemodynamically severe disease, 66% of the patients with stenosis and 14% of those with regurgitation were severely symptomatic (history of heart failure, syncope or New York Heart Association class III and IV); 23% of patients with moderate stenosis and 14% with moderate regurgitation were also severely symptomatic. Only 40% of those with disease that was severe both haemodynamically and symptomatically with either stenosis or regurgitation survived the first two years; only 12% in the stenosis group and none in the regurgitation group were event-free at 5 years. Patients with haemodynamically severe aortic stenosis who had few or no symptoms had a 100% survival at 2 years; the comparable figure for the aortic regurgitation group was 94%; 75% of the patients in the stenosis group and 65% in the regurgitation group were event-free at 5 years. In the moderate or mild stenosis and regurgitation groups there was no mortality within the first 2 years in the absence of coronary artery disease, regardless of symptomatic status. Haemodynamically and symptomatically severe aortic stenosis and regurgitation have a very poor prognosis and require immediate valve surgery. Asymptomatic and mildly symptomatic patients with haemodynamically severe aortic stenosis are at low risk and surgical treatment can be postponed until marked symptoms appear without a significant risk of sudden death. In severe aortic regurgitation, the decision for surgery should depend not only on symptoms but should be considered in patients with few or no symptoms because of risk of sudden death. In the absence of coronary artery disease, moderate aortic valve disease does not require valve operation for prognostic reasons.
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PMID:Spontaneous course of aortic valve disease. 360 42

In a retrospective study of 29 dogs with congenital pulmonic stenosis, we evaluated the clinical, radiographic, angiocardiographic, and cardiac catheterization data. Eighteen dogs had no clinical signs of disease and were referred for evaluation of a previously detected cardiac murmur, 5 dogs had congestive right-sided heart failure, and 5 dogs were examined for exercise intolerance or syncope. Dogs with heart failure tended to be older than dogs without clinical signs of heart failure (19.3 months vs 12 months). All dogs had radiographic or electrocardiographic evidence of right ventricular enlargement. Poststenotic dilatation of the main pulmonary artery and apparent pulmonary undercirculation were observed frequently on survey radiographs. Isolated pulmonic valve dysplasia, representing a range of angiographic pulmonic valve abnormalities, was evident in 88% of the available 26 angiographic studies, whereas subvalvular stenosis was uncommon and observed in only 2 dogs. Muscular hypertrophy of the right ventricular infundibulum and supraventricular crest were observed in 96% and 25% of the angiocardiograms, respectively. Poststenotic dilatation of the main pulmonary artery was observed in every dog. A ratio between the width of the main pulmonary artery and the valve annulus was useful in identifying pulmonic stenosis and distinguishing this anomaly from other congenital malformations. The degree of poststenotic dilatation did not appear to be related to the severity of the systolic pressure gradient, which ranged from 20 to 228 mm of Hg (mean, 93 mm of Hg).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pulmonic stenosis in the dog: 29 cases (1975-1984). 374 83

A prospective study was undertaken to assess the response of patients with idiopathic dilated cardiomyopathy to programmed electrical stimulation (PES). Fifteen patients undergoing evaluation of congestive heart failure were studied. All patients underwent cardiac catheterization and coronary angiography as well as endomyocardial biopsy to exclude known causes of heart failure. No patient had a history of syncope or sustained ventricular arrhythmias. All patients were found to have severe left ventricular dysfunction (mean ejection fraction 17%), as well as nonsustained ventricular tachycardia on ambulatory monitoring or exercise testing. A protocol using up to two premature stimuli and burst pacing, from two right ventricular sites, induced up to four repetitive ventricular responses but failed to induce a sustained ventricular arrhythmia in any patient. Patients with dilated cardiomyopathy, advanced ventricular arrhythmias, and depressed left ventricular function respond differently than do patients with coronary artery disease, advanced ventricular arrhythmias, and depressed left ventricular function, to PES. PES appears to have limited value in the evaluation of patients with dilated cardiomyopathy and nonsustained ventricular arrhythmias.
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PMID:The response of patients with complex ventricular arrhythmias secondary to dilated cardiomyopathy to programmed electrical stimulation. 375 63

Fifteen patients with intracavitary cardiac tumors were operated on at the Kobe University Hospital between September 1977 and January 1984. Three of the patients were men and twelve were women. They ranged in age from 9 to 75 years. Their symptoms were chest pain, dyspnea, cough, palpitation and syncope. Definite diagnosis was confirmed by echo- and cineangiocardiography. There were 14 benign tumors consisting of 13 myxomas, one leiomyoma and one malignant myxosarcoma. The left atrium was the most common chamber involved (12 instances), followed by the right atrium (3). Surgery was performed in all cases under cardiopulmonary bypass with moderate hypothermia and cold crystalloid cardioplegia. Tumors were removed en bloc at the base with their attachment to the atrial septum or free wall in all cases. Three patients underwent concomitant mitral annuloplasty or mitral commissurotomy. Two cases with left atrial myxoma died postoperatively: one case associated with mitral annuloplasty died of congestive heart failure due to newly developed chordal rupture two months after surgery, and the other died of congestive heart failure 13 months after the first operation. Re-excision for recurrence of the myxosarcoma in the left atrium was performed in the latter case as a second surgical procedure. The remaining 13 cases with benign tumors are doing well and are without recurrence. From these favorable results, surgical intervention should be recommended prior to the occurrence of heart failure and severe complications such as coronary or peripheral embolism whenever cardiac tumors are detected by non-invasive echocardiography and cineangiocardiography.
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PMID:Surgical management of intracavitary cardiac tumors. A review of fifteen patients and current status in Japan. 378 67

Coronary care units (CCUs) have now been in use for 20 years, and it is generally acknowledged that they have helped to reduce hospital mortality for patients with acute myocardial infarction. In recent years the indications for admission to a CCU have been greatly expanded to include all patients with suspected myocardial infarction and a variety of other manifestations of cardiovascular disease including primary arrhythmias and heart failure. The focus of the CCU has also broadened to include the prevention of major complications and the use of a variety of invasive and noninvasive diagnostic and therapeutic interventions before, as well as in response to, complications. With the changing indications for CCU admissions and the changing use of the CCU, new problems have arisen. The number of patients who might benefit from CCU care is now much larger and may at any given time greatly exceed the number of beds available. Decisions regarding who should be admitted to the CCU, how long a patient should stay in the CCU and which of the large and growing armamentarium of diagnostic and therapeutic interventions should be used are now increasingly important. These decisions have not only medical but also economic implications. Based on a 5-year experience with an intensive care unit computer data bank, strategies for more cost-effective CCU use have been explored. This has involved identification of high- and low-risk subsets of patients and modifications of standard operating procedures. The common clinical problems of chest pain, arrhythmias, syncope, pulmonary edema and myocardial infarction will be used as examples.
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PMID:Making the coronary care unit cost-effective. 392 96

Incidence, clinical picture, ECG features, as well as chosen diagnostic and therapeutic measures were investigated in patients attending the Basel University Medical Outpatients Department with the diagnosis of sick sinus syndrome. A retrospective study was conducted by selecting patients' charts with this diagnosis during the period 1979-1983. Forty-four patients (17 women, 27 men, mean age 64.5 +/- 14.5 years) were "discovered" and divided into three groups: Group 1: asymptomatic patients with pathological ECG (n = 7), Group 2: symptomatic patients with pathological ECG (n = 22), Group 3: main symptom syncope (n = 15). All patients had had an ECG and 15 a 24-hour-ECG. Carotid sinus massage was performed in three patients and sinus node recovery time was measured in another three. Seventeen patients remained without treatment, 13 received a permanent pacemaker, 9 of whom had additional medication, while 12 were anticoagulated. Three patients who were not anticoagulated suffered a stroke. More invasive electrophysiological investigations should be undertaken only with caution. In group 1, further diagnostic or therapeutic consequences need to be drawn. In the symptomatic patients from group 2, 24-hour-ECG is indicated when there is a history of palpitations, dizziness or severe heart failure. The immediate implantation of a pacemaker is justifiable in group 3 patients. Drugs with antiarrhythmic activity should be avoided in these patients before pacemaker implantation.
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PMID:[Sick sinus syndrome--clinical presentation, diagnostic and therapeutic measures in an ambulatory patient sample]. 398 2

34 patients have been controlled after beta-blocking therapy, for a mean period of 5 years. Symptoms and evolution: syncope disappeared, angoy passed from 47% to 23%, dyspnea from 65% to 47%, dizziness from 70% to 54%, weakness from 30% to 37%. A systolic murmur was present in 75% of the cases. Two patients died by heart failure. Phonocardiogram: the systolic murmur was unchanged, like the carotid pulse. Paradoxical splitting of the 2 degrees sound was more frequent, atrial sound unimodified, isometric contraction shortened (60%) and the Q-1 degree sound interval prolonged (90%). Electrocardiogram: 1 degree A/V block appeared in 24% of the cases, complete A/V block in 9%, atrial fibrillation in 3%. Left atrial enlargement was more frequent; left ventricular hypertrophy unchanged. Heart catheterization (10 cases, after a mean period of 5.5 years): left ventricular pressure gradient passed from 80% to 90%; a low cardiac index from 20% to 30%; telediastolic pressure of left ventricle was unmmodified in 10% of cases, more elevated in 50%, less elevated in 40%. Chest X ray: cardiac size was unchanged in 65% of cases, enlarged in 32%; smaller in 3%. In conclusion, symptoms improved in most of the patients; no case of sudden death was observed. Some data however show that the evolution of the myocardiopathy goes on to congestive heart failure and arise doubts on the real usefullness of beta-blocking drugs in the disease.
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PMID:[beta-Blocking therapy in obstructive hypertrophic cardiomyopathy. Long term results (author's transl)]. 610 83

92 patients (mean age 54 +/- 14.7 years, 54 men) with unexplained syncopes were investigated by Holter monitoring, exercise testing and His-bundle-electrography (high-rate and programmed atrial stimulation). The diagnoses on 43 patients were sinus node dysfunction, in 32 cases atrio and/or intraventricular block, and in 6 patients idiopathic atrial fibrillation, whereas 8 patients had a history of ventricular tachycardia, 48 patients received a pacemaker (mean age 58 +/- 12.9 years), and 44 patients were discharged without a pacemaker (mean age 49 +2- 15.6 years). The mean duration of follow-up was 56 +2- 17.1 months. There were 13 deaths, 9 patients died from heart failure, 1 died suddenly, and 3 patients died from non-cardiac causes. 7 patients were lost to follow-up. 54 patients had no syncope any longer, while in 18 cases syncope was still present, 14 patients without pacemaker and 4 patients with pacemaker still had attacks. The cardiac mortality was 18.8% (with pacemaker) and 2.3% (without pacemaker). The only sudden cardiac death was observed in a patient with pacemaker. This study shows that pacemaker implantation bases on electrophysiologic study is able to improve symptoms in patients with syncope. However, the long-term prognosis of the patients is mainly depending on the severity of their underlying heart disease.
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PMID:[Electrophysiological findings and follow-up in patients with syncope (author's transl)]. 617 27

After implantation of a ventricular demand pacemaker (VVI), occasional patients continue to have dizziness, syncope, or near syncope ("pacemaker syndrome"). To identify patients in whom VVI pacing may have deleterious effects, we compared cuff blood pressure responses to VVI pacing with blood pressure responses to atrioventricular sequential pacing (DVI) or sinus rhythm in 50 consecutive patients. Patients with intact ventriculoatrial conduction had a much greater decrease in systolic blood pressure with VVI pacing (24 +/- 11 mm Hg) than those with ventriculoatrial dissociation (-4 +/- 15 mm Hg) (P less than 0.005). Patients who were in heart failure had a lesser decrease in blood pressure with VVI pacing than did those without failure (P less than 0.05); 13 of the 14 heart failure patients lacked ventriculoatrial conduction. Ten patients had symptomatic dizziness after VVI pacing; the incidence of symptoms was higher in patients with ventriculoatrial conduction (9 of 23) than in those without ventriculoatrial conduction (1 of 27) (P less than 0.003). We conclude that the presence of intact ventriculoatrial conduction appears to be a crucial determinant of the hemodynamic response to VVI pacing, and its presence may identify patients who are at risk for "pacemaker syndrome."
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PMID:Hemodynamic and symptomatic consequences of ventricular pacing. 618 93


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