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

Thrombotic obstruction, a rare but often fatal complication of cardiac valve prostheses, appears to occur more frequently in tilting-disc valves than in other valve designs. Its diagnosis and surgical treatment remain a challenge. Ten consecutive patients who had thrombosis of a tilting-disc valve prosthesis were treated in Chang Gung Memorial Hospital from November 1982 to August 1990. Preoperative clinical features, including exertional dyspnea, new murmur, and absence of a metallic click from the prosthetic valve, occurred in all of the patients. Symptoms were present for 1 week or more before reoperation in 70% of the patients; nevertheless, many patients were referred only after acute exacerbation of heart failure and development of pulmonary edema. Echocardiography confirmed prosthetic valve malfunction in 90% of the patients. One unconfirmed case was later documented by cardiac catheterization. Anticoagulant therapy was in the therapeutic range for only half of the patients at the time of admission. Prompt reoperation was performed for thrombectomy (8 patients, all survived) or valve replacement (2 patients, one death). Long-term outcome was satisfactory in all survivors with a mean follow-up of 31.6 months. These findings emphasize the importance of considering the diagnosis of thrombosis in patients with mechanical heart valve prostheses who are first seen with nonspecific symptoms and minor changes of their physical findings. The diagnosis could be easily made by echocardiography. Thrombectomy is an easy, fast, and safe procedure, especially for these critically ill patients.
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PMID:Surgical management of thrombotic disc valve. 841 19

The pathophysiologic mechanism for exertional dyspnea, the main symptom of patients with heart failure, has not been fully clarified. To determine the relationship between exercise hyperpnea and the lactic acidosis in patients with heart failure, we evaluated ventilation during incremental exercise both below and above the lactic acidosis threshold in 16 normal subjects and in 48 patients with cardiovascular disease while expired gas was analyzed continuously. The peak oxygen uptake and oxygen uptake at the lactic acidosis threshold decreased significantly as the New York Heart Association (NYHA) functional class severity increased. the slope of the increase in ventilation to the increase in oxygen uptake (delta VE/delta VO2) at work rates below the lactic acidosis threshold did not differ between normal subjects and patients with heart failure. Above the lactic acidosis threshold, however, the slope of delta VE/delta VO2, which was higher than that below the lactic acidosis threshold in each of four groups, was steeper in patients in NYHA Class II (60.8 +/- 17.9) and Class III (66.5 +/- 21.2) when compared with that in the normal subjects (46.6 +/- 13.5) or the patients in NYHA Class I (46.1 +/- 10.3). The lactic acidosis caused by decreased oxygen transport to working muscles accounts for the higher ventilation during exercise in cardiac patients. These data suggest that the increased ventilation during exercise, which must be related to exertional dyspnea, in patients with cardiovascular disease is primarily the consequence of a stimulus to regulate arterial pH.
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PMID:Respiratory control during exercise in patients with cardiovascular disease. 821 35

In 1992, a 49-year-old woman was admitted to the hospital because of exertional dyspnea. Three years earlier sarcoidosis had been diagnosed, and the patient was found to have bilateral hilar lymphadenopathy. The eye, skin, and knee joint were also involved. During the second hospital stay, atrial flutter with advanced A-V nodal block, scattered defects on a 201T1 scintigram, and marked cardiomegaly on chest roentgenogram led to the diagnosis of cardiac sarcoidosis. Signs and symptoms of cardiac failure subsided after placement of an artificial cardiac pacemaker, but the patient still complained of mild muscle weakness in the lower extremities on exertion. 67Ga scintigraphy revealed marked accumulation in the lower extremities, and muscle biopsy of the left gastrocnemius revealed numerous epithelioid cell granulomas with muscle fiber degeneration. Oral corticosteroid therapy was effective. A review of the 24 cases of sarcoid myopathy reported in Japan indicated that the male-to-female ratio is 1:3.8. As compared to patients in whom myopathy led to the diagnosis of sarcoidosis, those in whom myopathy developed after sarcoidosis was diagnosed were (1) relatively older, (2) more likely to have multiple organ involvement, and (3) more likely to have cardiac sarcoidosis. Corticosteroids were beneficial in about three quarters of these 16 cases, who received corticosteroid therapy.
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PMID:[Cardiac sarcoidosis with myopathy and advanced A-V nodal block in a woman with a previous diagnosis of sarcoidosis]. 854 84

A retrospective analysis of patients with hypertrophic obstructive cardiomyopathy treated by left ventricular myotomy and myectomy from 1972 to 1994 is reported. There were 158 patients (81 male and 77 female) with a mean age of 50.2(+/-17.2) years (range 12 to 80 years). One hundred nine patients (69%) were 60 years of age or younger, and 49 patients (31%) were older than 60 years. The overall mean follow-up period was 6.1(+/-4.8) years (range 0.1 to 19.3 years) and was 94% complete with a cumulative total of 956 patient-years. Preoperative exertional dyspnea was present in 84%, chest pain in 70%, presyncope in 54%, syncope in 31%, and cardiac arrest in 5% of patients. Preoperative cardiac catheterization was done in 150 patients, with mitral regurgitation detected in 104 patients (67%). The average maximal provocable left ventricular outflow tract gradient was 118 (+/-46) mm Hg (range 25 to 250 mm Hg). The average preoperative echocardiographic gradient at rest was 64 mm Hg, 20 mm Hg in the early postoperative period and 10 mm Hg in the late postoperative period. The mean septal thickness was 2.2 (+/-0.6) cm, 1.9 (+/-0.7) cm in the early postoperative period (p < 0.05 vs preoperative) and 1.7 (+/- 0.5) cm in the late postoperative period (p < 0.05 vs preoperative). The overall 30-day operative mortality rate was 3.2% (5/158), and 0% for 109 patients 60 years of age or younger. Causes of death included myocardial infarction and left ventricular free wall rupture, myocardial failure from septal perforation, sepsis, cerebrovascular accident caused by thromboembolism, and delayed cardiac tamponade in one patient each. Concomitant coronary artery bypass grafting was performed in 22 patients (19.3% of patients > or = to 40 years of age) and mitral valve replacement in 5 patients (3.2%). One hundred nine patients (69%) are alive, 10 patients (6.3%) were lost to follow-up, and 39 patients died (24.7%), including operative deaths). Actuarial survivals at 1, 5, 10, and 15 years were 92.4% +/- 2.2%, 85.4% +/- 3.1%, 71.5 +/- 4.6%, and 46% +/- 9%, respectively. The overall linearized death rate for discharged patients was 1.9%/pt-yr, and for cardiac related deaths it was 1.7%/pt-yr. Thirty-nine (36%) of the 109 survivors received beta-adrenergic blockers, and 30 (28%) received calcium channel blockers. Ninety-four patients had improvement in New York Heart Association functional class, 10 had improvement in symptoms but not in functional class, and 5 had no improvement in functional class or symptoms. Neither preoperative hemodynamic values nor routine echocardiographic measurements significantly correlated with quality of postoperative results. Left ventricular myotomy and myectomy is a safe and reproducibly effective operative treatment for medically refractory hypertrophic obstructive cardiomyopathy, especially for patients 60 years of age or younger. Improvement in functional class and symptoms can be expected in nearly all patients 60 years of age or younger. Improvement in functional class and symptoms can be expected in nearly all patients. The results of myotomy and myectomy serve as a standard for comparison with other interventions for medically refractory cardiomyopathy.
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PMID:Long-term results of left ventricular myotomy and myectomy for obstructive hypertrophic cardiomyopathy. 860 73

We report a rare case of Basedow's disease associated with high output heart failure and angina pectoris over the age of 80 years. An 85-year-old woman was admitted with palpitation, finger tremor, hyperidrosis and weight loss. Basedow's disease was diagnosed by physical (diffuse goiter) and laboratory (free T3 19.4 pg/ml, free T4 > 8.0 ng/dl, TSH < 0.1 microU/ml, TRAb positive, 123I uptake high) findings and was treated with methimazole. Chest oppression and dyspnea on exertion with negative T wave, cardiomegaly and pulmonary congestion appeared after methimazole. Cardiac catheterization showed a high cardiac output (CI 5.01/min/m2, PCW 26 mmHg, PA 57/26 mmHg, RA 15 mmHg) and a significant coronary stenosis (LAD [symbol: see text] 99%). High output heart failure and angina pectoris responded to treatment. They subsequently worsened, because she stopped taking methimazole for a month and serum levels of thyroid hormones increased again. After retreatment with methimazole, serum levels of thyroid hormones decreased to within normal limits, and high output heart failure and angina pectoris also improved.
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PMID:[An 85-year-old case of Basedow's disease associated with high output heart failure and angina pectoris]. 864 96

A 77-year-old woman with hypertension was admitted to our hospital because of exertional dyspnea end peripheral edema. Chest X-ray showed cardiomegaly, pulmonary congestion and right pleural effusion. Hypertensive heart failure was diagnosed and treated, and right pleural effusion disappeared in 2 weeks. Abnormalities on laboratory data, i.e. anemia and increased ESR et al. continued after the improvement of heart failure. Serum IgG was elevated (2570 mg/dl), while IgA and IgM were decreased. Immunoelectrophoresis indicated the presence of monoclonal IgG-lambda in the serum. Bone marrow puncture revealed an increase in atypical plasma cells (38.4%). Multiple myeloma was diagnosed from these findings and treated with melphalan and prednisolone. But increases in atypical plasma cells (43.2%) and serum IgG (2573 mg/dl) continued. During treatment, right pleural effusion increased again. Thoracocentesis showed bloody effusion with numerous atypical plasma cells, and the presence of monoclonal IgG-lambda was indicated by immunoelectrophoresis. The patient died of renal and heart failure 2 months after the onset of malignant pleural effusion. Cytological examination and immunoelectrophoresis are necessary for pleural effusion in multiple myeloma.
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PMID:[A case of multiple myeloma associated with abnormal plasma cells and M-protein in pleural effusion]. 864 97

Constrictive pericarditis can be associated with ICD patch electrodes. During a mean follow-up of 24 months, in a population of 35 patients who received ICDs with a patch electrodes configuration, we identified three patients with clinical and hemodynamic signs compatible with this event. Patient 1, a 35-year-old male, underwent implantation of an ICD because of a primary electrical disease complicated by cardiac arrest. Fourteen months later he complained of exertional dyspnea without any signs of heart failure. Right heart catheterization showed high filling pressures and diastolic dip and plateau in pressure curves. Thoracotomy and pericardial exploration were performed. Three months after removal of the patches and insertion of an endocardial lead system, the patient had normal respiration. Patients 2 and 3, who suffered from coronary heart disease without heart failure, exhibited a hemodynamic profile suggestive of constrictive pericarditis: in one patient, 10 months after ICD implantation, associated with right heart failure; and in the other, 18 months after ICD implantation with left heart failure. Patch electrodes were removed in these two patients and replaced by endocardial lead electrodes with subsequent clinical improvement. It is concluded that constrictive pericarditis related to epicardial patch is not an uncommon occurrence during ICD therapy and should be considered in patients who show clinical signs of cardiac decompensation.
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PMID:Symptomatic pericardial disease associated with patch electrodes of the automatic implantable cardioverter defibrillator: an underestimated complication? 899 57

Blood cysts of the heart valves are commonly reported at postmortem examination of infants but are rare seen in older children and adults. A 42-year-old woman was referred to our hospital for cardiac evaluation because of dyspnea on exertion and heart murmur. There was no history of cyanosis or cardiac failure. Cardiac catheterization revealed valvular pulmonary stenosis and atrial septal defect. Right ventricular angiography showed the circular filling defect 0.7 x 0.7 cm in size at the suprapulmonary valve. However, this preoperative abnormal finding was diagnosed as a blood cyst after surgery. At operation a blood cyst originating from the right cusp of the pulmonary valve was found and resected, and was followed by commissurotomy of the pulmonary valve and direct closure of the atrial septal defect. Her postoperative course was uneventful.
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PMID:[Blood cyst of the pulmonary valve in an adult--a case report]. 917 Aug 73

A 70-year-old woman underwent radical mastectomy for carcinoma of the left breast in 1982. Postoperative radiation therapy was given in a total dose of 50 Gy for parasternal and left subclavian nodes. Symptoms of heart failure such as exertional dyspnea, facial edema, and hepatomegaly manifested in 1992. Cardiac catheterization revealed marked elevation of mean right atrial pressure and right ventricular end-diastolic pressure. The pressure wave form of the right ventricle showed the so called "dip and plateau" feature. Pericardiectomy without using extracorporeal circulation was performed in 1994. Operative findings and pathological study results were compatible with radiation-induced constrictive pericarditis. She rapidly recovered from heart failure after this operation, and has done very well to date.
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PMID:[A case of post-radiation constrictive pericarditis developing 12 years after radiation therapy]. 943 Sep 74

Hereditary hemorrhagic teleangiectasia, or M. Osler (Osler-Weber-Rendu disease), is an autosomal dominant, systemic fibrovascular dysplasia. This may lead to increased liver blood flow from arteriovenous fistulas. A 45-year-old woman with a known M. Osler was admitted for liver transplantation. On admission, exertional dyspnea was the predominant symptom. Radiological investigations revealed multiple intrahepatic arteriovenous fistulas and consecutive high-output heart failure. Laboratory findings revealed remarkably elevated bilirubin and alkaline phosphatase. To alleviate the high-output cardiac failure, the hepatic artery was ligated. Fourteen months later, the patient presented again with increased levels of bilirubin and recurrent bleeding episodes from esophageal varices grade IV. The patient underwent liver transplantation and post-transplant recovery was excellent. A hyperdynamic circulatory state due to a hepatic M. Osler has been treated in several cases by ligation or embolization of the hepatic artery. This procedure, however, is recommended only for patients with normal liver function and carries a considerably risk of bile duct necrosis.
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PMID:Effective therapy for hepatic M. Osler with systemic hypercirculation by ligation of the hepatic artery and subsequent liver transplantation. 970 2


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