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

Systemic causes of leg edema include idiopathic cyclic edema, heart failure, cirrhosis, nephrosis and other hypoproteinemic states. Lymphedema may be primary, or secondary to neoplasm, lymphangitis, retroperitoneal fibrosis and, rarely (in the U.S.), filariasis. Thrombophlebitis and chronic venous insufficiency are not uncommon causes. Finally, infection, ischemia, lipedema, vascular anomalies, tumors and trauma can be responsible for the swollen leg.
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PMID:The swollen leg. 18 30

Diuretic therapy was discontinued in 15 elderly patients. None of these patients had evidence of uncontrolled cardiac failure or hypertension, and they all had received diuretics long-term. Two patients required resumption of diuretics due to the development of cardiac failure or severe leg oedema. In the remaining 13 patients, mean leg volume increased by 8.2%. Discontinuation of diuretic therapy in elderly patients is associated with a small but significant worsening of lower limb oedema.
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PMID:Stasis oedema in the elderly: are diuretics necessary? 195 81

A left lower quadrant bruit, reduced left dorsalis pedis pulse, and left leg edema were found in an elderly male presenting with chest pain, hypotension, heart failure, and azotemia. Measurement of cardiac output, 12.3 1/minute, systemic vascular resistance, 349 (normal, 770-1500), and arterial-mixed venous oxygen differential, 1.3 (normal, 10-20) confirmed the suspicion of AV fistula, which was shown by arteriogram to be left common iliac artery to iliac vein. Repair was accomplished without incident and the patient made an excellent recovery. This patient's AV fistula is an excellent example of a treatable cause of high output congestive heart failure. Further, his rapid recovery after fistula repair undertaken in the setting of hypotension, renal failure, and refractory heart failure emphasizes the need for aggressive surgical intervention.
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PMID:Spontaneous arteriovenous fistula between the left common iliac artery and iliac vein. 292 43

Seven patients with arteriovenous fistulae of the internal iliac artery are reported. Ages varied from 6 to 50 years (mean 32 years). Cutaneous angiomata , leg oedema and pain was present in 4 cases each, bleeding in 2 cases whilst only one was asymptomatic. Only 1 patient had cardiac insufficiency. In six patients the lesion was a congenital malformation but in one it was posttraumatic. Arteriography both global and selective, intravenous pyelography and cardiac output are routine. Recently, pelvic computerised tomography has been most helpful. Embolization is recommended in all cases with surgery within 24 hours unless the lesion is very extensive and considered to be inoperable. Repeat embolization is used for recurrence or very extensive lesions. Results were good in five patients; in two patients the results were clinically good but control angiograms showed a recurrence.
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PMID:Arteriovenous fistulae of the internal iliac vessels. 672 88

Water restriction is a slow and difficult way to treat dilutional hyponatremia during diuretic therapy of congestive heart failure. An i.v. infusion of 400-1 400 mmol hypertonic saline combined with repeated i.v. injections of loop diuretics was used instead in 9 cases (6 patients). In 4 cases with dominating left heart failure the serum sodium concentration increased and the heart failure was not aggravated as judged from pulmonary rales and body weight. Two of the five cases with dominating right heart failure responded in the same favourable way, but body weight increased 1-2 kg and hyponatremia reappeared in three. The only difference observed between responders and non-responders was that the responders were free from leg edema. This treatment of dilutional hyponatremia seems worth further cautious use in situations in which water restriction is troublesome, but it should probably be reserved for patients without severe right heart failure.
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PMID:Treatment of dilutional hyponatremia in congestive heart failure. 738 23

Medical therapy often fails to control symptoms of severe heart failure. The possibility of modifying to some degree the global ventricular performance with the implantation of a physiological dual chamber pacemaker, set with a short atrioventricular delay (100 msec), has been adopted in two patients with severe heart failure due to coronary artery disease. The baseline clinical condition of both patients was characterized by leg edema, ascites, dyspnea at rest, or even orthopnea with a functional New York Heart Association (NYHA) class III-IV. Acute measurements of hemodynamic and echocardiographic parameters during stepwise shortening of AV interval guided the pacemaker implantation and setting of AV delay in the chronic phase. Within a few days after pacemaker implantation, both patients considerably improved their clinical status as well as their functional NYHA class, improving to class II in one patient and to class II-III in the other patient. In addition, modification of systolic and diastolic parameters paralleled these improvements functional class and clinical condition. Pacemaker therapy in severe heart failure refractory to medical therapy can be of considerable benefit in patients whose quality-of-life is severely compromised when pharmacological therapy is no longer effective. Acute hemodynamic and echocardiographic testing is useful in assessing the most appropriate AV delay and pacing mode.
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PMID:Improvement of cardiac function in patients with severe congestive heart failure and coronary artery disease by dual chamber pacing with shortened AV delay. 751 39

Leg edema is a common problem in older patients, with a wide range of possible causes. The diagnosis can be narrowed by categorizing the edema according to its duration (acute or chronic), distribution (unilateral or bilateral), and accompanying symptoms (such as dyspnea, pain, thickening of skin, and pigmentation). The differential diagnosis includes systemic illnesses such as heart failure, liver disease, malnutrition, and thyroid disorder; local conditions such as pelvic tumors, infection,, trauma, and venous thrombosis; and various medications known to increase the risk of edema of the lower extremities. Appropriate therapy is based on the presentation of edema and its identified cause.
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PMID:Leg edema: clinical clues to the differential diagnosis. 783 20

The patient was a 71-year-old man with dyspnea and bilateral leg edema. He was admitted to our hospital with worsening of dyspnea and had received therapy for chronic heart failure in another hospital. On admission, chest X-ray film revealed dilatation of the cardiac silhouette (CTR: 58%). Electrocardiogram showed atrial fibrillation and negative T wave in II, III, and aVF. Cardiac arteriogram showed no organic lesions, but pulmonary hypertension, pulmonary artery pressure of 60/21/34 mmHg, right ventricular pressure of 40/9/20 mmHg were recognized in pulmonary hemodynamics. The diagnosis of chronic pulmonary thromboembolism was made on the basis of pulmonary arteriogram findings and multiple defects of lung perfusion scintigram. After administration of oral PGI2 analogue for one month, lung perfusion scintigram and right cardiac pressure were markedly improved.
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PMID:[A case of pulmonary thromboembolism with pulmonary hypertension with marked improvement by oral PGI2 analogue]. 796 41

An 82-year-old woman was admitted with severe chest pain and orthopnea on January 17, 1997. Physical examination revealed bilateral leg edema and cyanosis at the periphery of the extremities. The serum CK level was 488 IU/l on admission and increased to a maximum value of 4,866 IU/l 8 hours after admission. An echocardiogram demonstrated diffuse severe hypokinesis in the left ventricle. Serial electrocardiograms showed transient right bundle branch block, left bundle branch block, and normal sinus rhythm. The patient was diagnosed as having congestive heart failure. Artificial ventilation was performed, and furosemide, isosorbide dinitrate and dopamine were administered. A right ventricular endomyocardial biopsy performed on the 13th hospital day demonstrated moderate hypertrophy and disparity of cardiac myocytes and fibrosis around the myocytes, and few inflammatory cells in the specimens. This biopsy finding was not compatible with acute myocarditis but with the chronic stage of myocarditis. The patient was discharged on the 45th hospital day, but returned because of a recurrence of congestive heart failure. After an improvement of the heart failure, a coronary angiography was performed on the 20th hospital day. The coronary angiography revealed significant stenosis in three vessels. This elderly patient had congestive heart failure and triple-vessel coronary artery disease with transient alternating bundle branch blocks on serial electrocardiograms. Alternating bundle branch blocks and diffuse left ventricular dysfunction was considered to be induced by the aging process, postmyocarditic change of myocytes, and triple-vessel coronary artery disease in this case.
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PMID:[An elderly case of triple-vessel coronary artery disease with alternating bundle branch blocks in serial electrocardiograms]. 1061 29

Hereditary hemorrhagic telangiectasia, commonly known as Osler-Weber-Rendu disease, is a systemic autosomal dominant inherited disorder, that occurs in Caucasian populations. We report the case of a 56-year-old housewife who was admitted to the gastrointestinal and cardiovascular ward because she had suffered from recurrent gastrointestinal bleeding and heart failure from 1994 to 1997. Panendoscopy showed vascular ectasia scattered over the tongue, larynx, esophagus, and posterior wall of the gastric body. Colonoscopy showed clusters of telangiectasia over the cecum and ascending colon. Arteriovenous malformations (AVMs) were found in the liver and lungs on computerized tomography. Recurrent gastrointestinal bleeding was controlled by estrogen treatment during the follow-up period. In July 1997, the patient was readmitted to our cardiovascular section due to aggravated dyspnea, orthopnea and bilateral lower leg edema. Cardiac catheterization showed a large fistula from the left pulmonary artery to the left atrium and left ventricle, pulmonary arterial pressure of 37/13 mmHg and cardiac output of 9.61/minute. Other studies excluded the possibility of sepsis, and high-output cardiac failure was suspected. The patient was discharged in a stable condition and scheduled for AVM embolization management. Unfortunately, she died of a suspected heart attack at home two weeks following discharge.
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PMID:Recurrent gastrointestinal bleeding and high output cardiac failure caused by hereditary hemorrhagic telangiectasia. 1082 Sep 15


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