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

Central venous pressure (CVP) is an important physiological parameter, the correct measure of which is a clinically relevant diagnostic tool for heart failure patients. A current challenge for physicians, however, is to obtain a quick and accurate measure of a patient's CVP in a manner that poses minimum discomfort. Current approaches for measuring CVP involve invasive methods such as threading a central venous catheter along a major vein, or tedious physical exams that require physicians to grossly estimate the measurement. Our solution proposes a novel noninvasive method to estimate central venous pressure using ultrasound-guided surface pressure measurement. Specifically, our device works in conjunction with an ultrasound machine and probe that is used to visualize the interior jugular (IJ) vein below the surface of the skin on a patient's neck. Once the interior jugular vein is located, our device detects the pressure on the skin required to collapse the IJ and correlates this value to a central venous pressure reading reported to the operator. This quick and noninvasive measurement is suitable for emergency situations or primary care settings where rapid diagnosis of a patient's CVP is required, and prevents the need for further invasive and costly procedures. The measurement procedure is also simple enough to be performed by operators without extensive medical training.
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PMID:Ultrasound-guided noninvasive measurement of a patient's central venous pressure. 1794 83

Symptoms utilized in the clinical care of heart failure as markers of disease severity include, dyspnea, insomnia, low energy, fatigue, poor appetite, and diminished memory. This is despite the fact that physiologic variables such as cardiac ejection fraction and oxygen consumption do not accurately predict functional state in individuals with congestive heart failure (CHF). Distress (anxiety and depression) may amplify symptom complaints without associated physiologic aberration. Personality traits and psychiatric illness, such as mood, anxiety, and psychotic illnesses may also alter perception of somatic symptoms that are associated with this chronic illness. The impact of distress and its treatment on functional performance and CHF symptom reporting deserve additional attention. The need to screen for distress in all with serious symptomatic heart failure is certain.
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PMID:Symptom perception in CHF: (why mind matters). 1807 97

When amyloidosis affects the heart, a devastating and progressive process can lead to congestive heart failure, arrhythmias, conduction abnormalities, angina, and death. The signs and symptoms of cardiac amyloidosis are generally dominated by diastolic heart failure resulting from restrictive cardiomyopathy. Amyloid infiltration of the heart initially causes mild diastolic dysfunction, but late disease produces a thickened heart wall with a firm and rubbery consistency, which worsens cardiac relaxation and diastolic compliance. Patients usually complain of progressive dyspnea from congestive heart failure, chest discomfort secondary to microvascular involvement, and weight loss, which might be a manifestation of cardiac cachexia. Echocardiographic findings include nondilated ventricles with concentric left ventricular thickening, right ventricular thickening, prominent valves, dilated atria, and thickening of the interatrial septum. Recent advances in our understanding of the pathophysiology of amyloid have allowed the various types to be differentiated, which has led to targeted therapy for each unique pathophysiologic process.
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PMID:Cardiac amyloidosis: new insights into diagnosis and management. 1819 42

EuroQol-5D (EQ-5D) is a well-known generic instrument measuring quality of life in different diseases; it includes 5 dimensions (mobility, self-care, daily activities, pain-discomfort, anxiety and depression) and a Visual Analogue Scale that evaluates patients' perceived health status. The aim of this study was to verify the utility of the EQ-5D in the Italian Cardiac Rehabilitation setting. The study population consisted of 248 consecutive cardiac rehabilitation inpatients (176 males and 72 females, aged 65.3 +/- 10.75 years), 200 of whom had recently undergone cardiac surgery (aortocoronary by-pass and/or valve replacement). Patients filled in the EQ-5D and A-D schedule (on anxiety and depression) on their second day in hospital. Exploratory and Confirmatory Factor Analysis confirmed the robust nature of the EQ-5D and its mono-factorial structure (EFA: Total Variance 50.39% - CFA: chi2 = 3.596; p approximately equal .60; RMSEA = 00; CFI = 1.00; RMR = .007). The instrument showed a good internal consistency (a .73) despite the limited number of items. T test and ANOVA showed the independence of the EQ-5D dimensions and VAS evaluation with respect to patients' education level, but an influence of age and sex. In general, females reported a lower quality of life than males, and older patients a lower quality of life than younger. Furthermore, cardiac-surgery patients reported more problems in self-care and pain-discomfort than ischemic/heart failure patients, and patients in NYHA Classes III and IV reported more difficulties in mobility than patients in lower NYHA classes. In 15% of patients, of heterogeneous socio-demographic and clinical characteristics, no problems in any of the 5 EQ-5D dimensions were reported: this group was characterised by scores under the clinical cut-off on anxiety and depression and showed a better quality of life on the VAS. Results confirm the robustness of the EuroQol-SD psychometric properties and the instrument's utility for the routine assessment of quality of life in the Italian Cardiac Rehabilitation setting.
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PMID:[EuroQol-5D FOR quality of life assessment in cardiac rehabilitation]. 1857 59

Newer cancer therapies have improved the survival of patients with cancer and, in some cases, turned cancer into a chronic disease. Patients are now surviving long enough for the adverse cardiovascular effects of some cancer therapies to become apparent. The anthracyclines are perhaps the most notorious offenders. Acute reactions include chest discomfort and shortness of breath consistent with a myopericarditis. Toxicity can also develop months after the last chemotherapy dose and typically presents as new onset heart failure with left ventricular systolic dysfunction. Late reactions are seen years after presentation as new-onset cardiomyopathy, often in patients who were treated for childhood neoplasms. 5-Fluorouracil, its prodrug capecitabine, and trastuzumab, a tumor-specific antibody, have also been associated with cardiotoxicity. Until adequate predictive models, prevention modalities, and treatments can be identified, the clinician's focus should be on aggressive monitoring for early signs of cardiac dysfunction in order to prevent severe systolic dysfunction and its concomitant morbidity and mortality.
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PMID:Chemotherapy and cardiotoxicity. 1866 Jul 28

Diuretic use and overactive bladder syndrome are common in older adults. However, the relationship between the two has not been well studied. Data were collected by self-administered questionnaires including the Urge Urinary Distress Inventory (Urge-UDI) and the Urge Incontinence Impact Questionnaire (Urge-IIQ), and by outpatient chart abstraction. Patients (n=172) had a mean age of 79+/-7.5 (+/-S.D.), 76% were women, and 48% were African Americans; 76% had hypertension, 32% had heart failure, and 66% were receiving diuretics (57% loop diuretics). Overall, 72%, 68%, and 73% of patients, respectively, reported urinary frequency, urgency and urge incontinence. Diuretic use was associated with increased frequency (81% versus 55% non-diuretic; odds ratio (OR)=3.48; 95% confidence interval (CI)=1.73-7.03) and urgency (74% versus 57% non-diuretic; OR=2.17; 95% CI=1.11-4.24) but not with incontinence (OR=1.74; 95% CI=0.87-3.50). When adjusted for propensity scores, diuretic use had independent associations with frequency (adjusted OR=3.09; 95% CI=1.20-7.97) and urgency (adjusted OR=2.50; 95% CI=1.00-6.27). In addition to frequency and urgency, loop diuretic use was also associated with incontinence (OR=2.54; 95% CI=1.09-5.91), which lost significance after propensity adjustment (adjusted OR=1.88; 95% CI=0.57-6.17). Overall summary mean Urge-IIQ score was 1.83+/-0.85 with 1.75+/-0.86, 1.68+/-0.76, and 2.03+/-0.88, respectively, for no diuretic, non-loop, and loop-diuretic patients (one-way analysis of variance (ANOVA) p=0.063). Overactive bladder symptoms were common among ambulatory older adults and were associated with diuretic use, and had stronger associations with loop diuretic use.
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PMID:Association of diuretic use and overactive bladder syndrome in older adults: a propensity score analysis. 1875 58

This observational study used repeated measures over 24 hr to investigate ambulatory blood pressure (BP) and physical activity (PA) profiles in community-based individuals with heart failure (HF). The aims were to (a) compare BP dipping and PA between two groups of HF patients with different functional statuses, and (b) determine whether the strength of the association between ambulatory BP and PA varies by functional status in HF. Ambulatory BP was measured every 30 min with a SpaceLabs 90207; a Basic Motionlogger actigraph was used to measure PA minute-by-minute. Fifty-six participants (54% female, age 66.96 + or - 12.35 years) completed data collection. Functional status was based on New York Heart Association (NYHA) ratings. Twenty-seven patients had no limitation of PA (NYHA Class I HF), whereas 29 had some limitation of PA but no discomfort at rest (NYHA Class II or III HF). Patients with Class I HF had a significantly greater degree of BP dipping than those with Class II/III HF after controlling for left ventricular ejection fraction. In a mixed-model analysis, PA was significantly related to ambulatory systolic and diastolic BP and mean arterial pressure. The strength of the association between PA and BP was not significantly different for the two groups of patients. These findings demonstrate differences between Class I and Class II/II HF in BP dipping status and ambulatory BP but not PA. Longitudinal research is recommended to improve understanding of the influence of disease progression on changes in 24-hr PA and BP profiles of patients with HF.
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PMID:Ambulatory blood pressure and physical activity in heart failure. 1961 34

A 79-year-old patient repeatedly presented with chest discomfort and dyspnea on exertion. With echocardiography a prominent left ventricular and septal hypertrophy was detected with reduced left ventricular function. Despite successful revascularization and excellent results after stenting, the patient showed persistently elevated troponin levels. To investigate the abnormal findings of persistent troponin elevation, septal hypertrophy, and heart failure we performed endomyocardial biopsies which showed widespread myocardial amyloidosis. Amyloid subtyping revealed transthyretin amyloidosis. This is the first case showing persistent troponin elevation in a patient with tranthyretin amyloidosis. Very few other cases have been published on the topic of cardiac amyloidosis and troponin elevation so far. Our case serves as an illustrating example in the differential diagnosis of nonischemic causes of persistent troponin elevation. It is important to consider cardiac amyloidosis in patients with troponin elevation and heart failure since the clinical management differs significantly from other causes of heart failure.
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PMID:Persistent troponin elevation in a patient with cardiac amyloidosis. 1981 77

Nutrition in palliative care and at the end of life should be one of the goals for improving quality of life. It is important to address issues of food and feeding at this time to assist in the management of troublesome symptoms as well as to enhance the remaining life. While this paper focuses upon the nutritional aspects of cancer in palliative care, the sentiments are applicable to other serious chronic illnesses such as advanced cardiac failure, chronic obstructive pulmonary disease and dementia. Cancer and its treatments exert a major impact upon physical and psychological reserves and at the end of life problems with appetite and the ability to eat and drink compound such impact. The aims of nutritional care minimize food-related discomfort and maximize food enjoyment. Identification of any nutritional problems can facilitate the employment of strategies which need to be discussed with the patient and their families and reviewed regularly as conditions change. Ethical questions will be raised concerning the provision of food and fluids to a person nearing the end of their life. Nurses need to acknowledge that food has greater significance than the provision of nutrients.
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PMID:Nutrition in palliative care. 1996 82

An 83-year-old man presented with worsening of respiratory discomfort and underwent close examination, which revealed a large mediastinal lipoma measuring 15 x 10 cm. The patient showed heart failure symptoms due to heart compression by tumor. The tumor was completely removed safely and reliably by cutting the ascending aorta, main pulmonary artery and superior vena cava. Although preoperative examination could not determine whether the tumor was lipoma or liposarcoma, we selected an invasive surgical therapy because neither radiation therapy nor chemotherapy was considered effective for either type of tumor. We report here a very rare case of heart-compressing mediastinal tumor.
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PMID:Complete removal of heart-compressing large mediastinal lipoma: a case report. 2052 69


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