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)

In 18 patients who presented in less than 2 years with heart disease characterized by arrhythmias (including atrial fibrillation, ventricular arrhythmias and heart block), atypical chest pain, pericarditis and cardiac failure, extensive investigation revealed no cause for the disease except for evidence of toxoplasmic infection. One patient had acute toxoplasmosis; the other 17 patients had chronically increased titers, higher than the expected level in the community and also higher than in a control series of patients with well defined heart disease. Toxoplasmosis is probably a fairly common cause of heart disease in this community. The source of infection appeared to be cats, uncooked meat and congenital infection. Patients received chemotherapy with either pyrimethamine and sulfadiazine or tetracycline. Serious relapse occurrred in three patients and embolic complications in two. Experimental myocarditis occurs when toxoplasmic cysts rupture within the heart; therefore clinical symptoms may occur sporadically during a chronic infection.
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PMID:Toxoplasmic infection in cardiac disease. 42 23

The introduction of selective coronary arteriography and aorto-to-coronary saphenous vein bypass surgery (a.-c bypass) has fundamentally altered our understanding of ischemic heart disease (IHD). The indications for the effective diagnostic procedure and the results of the new and increasingly important surgical technique are summarized. Selective coronary arteriography should be performed (a) in patients with known IHD in order to furnish the anatomical and functional information necessary to assess the indication for surgery, i.e. in patients below 60 years with intractable stable or unstable (impending infarction) angina. It is rarely indicated in patients with an old myocardial infarction who are free from symptoms. It is debatable in patients during the acute stage of infarction; (b) in patients with questionable IHD, with the aim of ruling out or confirming the condition, i.e. mainly in patients with atypical chest pain or with equivocal ecg findings. The risks of the procedure, if carried out by experienced personnel, are small. Selective arteriography will always be supplemented by a selective left ventricular angiography yielding important information concerning the functional behaviour of the myocardium. In judging the therapeutic value of a.-c. bypass surgery it should be noted that postoperatively 60 to 70 percent of the patients present without symptoms and 80 to 95 percent feel markedly better, and that physical performance is enhanced in about the same proportions. An improvement in left ventricular function under exercise conditions seems to be rare. Hospital mortality of a.-c. bypass operation is small and below 5 percent if patients with stable angina and without myocardial failure, previous infarctions or mitral regurgitation are considered. In the presence of an ischemic cardiomyopathy, on the other hand, the mere surgical risk soon reaches prohibitive limits. The incidence of early complicating myocardial infarctions ranges around 10 percent. Bypass occlusion occurs in some 5 to 15 percent during the early postoperative phase, while in the following months and years the patency rate diminishes but little. If the survival rates of operated and non-operated patients with IHD are compared it becomes evident that a prolongation of life is possible whenever surgery aims at a correction of two- and three-vessel disease (including the prognostically unfavourable isolated stenosis of the left anterior descending branch and stenosis of left main artery) whereas the natural course of isolated lesions of the right coronary artery and the left circumflex branch seems to balance the effect of corresponding surgical interventions. It should be borne in mind, however, that the follow-up periods on which these statements are based do not exceed 3-4 years.
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PMID:[Problems of aortocoronary bypass. Indications for coronary angiography and ventriculography; results of direct bypassing coronary surgery]. 107 91

Clinical characteristics of 60 (41 males, 19 females) patients with echocardiographically proven mitral valve prolapse were analysed, with special interest in the associated thoracic skeletal abnormalities. There was a male preponderance (2.2:1) and 91.7% of patients were symptomatic--atypical chest pain, palpitations, exertional dyspnoea and easy fatiguability being the major symptoms. Sixty seven percent had an asthenic body habitus, and 55% had high-arched palate. Thoracic scoliosis (55%), straight back syndrome (50%), flat chest (46.7%), and pectus excavatum (20%) were seen in association with the condition, with 81.7% having any one or combination of these features. Lateral chest radiography showed pancaking of heart shadow in 48.3%. Isolated non-ejection systolic click(s) was the major cardiac auscultatory finding (61.7%), while 60% showed pansystolic prolapse on echocardiography. Electrocardiographic ST-T-U changes in the inferior and/or lateral chest leads were seen in 46.7%, while 16.7% had cardiac arrhythmias. None had infective endocarditis, heart failure or cerebral embolic events. The findings corroborate the view that thoracic skeletal anomalies may be regarded as non-auscultatory features of this syndrome.
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PMID:Mitral valve prolapse syndrome and associated thoracic skeletal abnormalities. 130 Oct 49

The prerequisite in establishing the indication for coronary arteriography is low mortality and morbidity of the procedure. Mortality is about 1%, major complications are myocardial infarction (1.5 to 2%) and cerebral embolism (less than 1%). These low complication rates are generally achieved only in institutions which perform at least 400 procedures per year. Coronary arteriography is indicated in the following groups of patients: patients with angina pectoris aged below 45; patients over 45 with sudden worsening of angina, angina pectoris uncontrolled by medication (impaired quality of life) and cases where there is objective evidence of severe ischemia on exercise though angina is mild; recurrence of angina or positive stress ECG after myocardial infarction; following an episode of unstable angina; following resuscitation due to ventricular fibrillation; suspected Prinzmetal angina; postinfarction aneurysm with signs of heart failure; candidates for valve surgery aged over 45. Coronary arteriography is also performed to evaluate the result of bypass surgery, in patients with unclear diagnosis exposed to occupational hazards, and in acute myocardial infarction (thrombolysis, ventricular septal rupture, acute mitral regurgitation). The main indications for radioisotope studies (Tl-201 myocardial scintigraphy and radionuclide angiography during dynamic exercise) are detection and localization of ischemic zones and scars in patients with known coronary disease, and evaluation of the result of coronary artery bypass surgery. Less frequent indications are, today, atypical chest pain and uninterpretable ECG, and asymptomatic patients with abnormal stress ECG. 2-d echocardiography is the most widely used noninvasive technique for qualitative assessment of regional wall motion disorders at rest. 3800 coronary arteriographies are performed yearly in the public hospitals of Switzerland.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Indications for coronary angiography and other special studies]. 660 28

This retrospective study concerns six cases of gravido-puerperal cardiomyopathy. These six cases account for 18% of all cases of non-obstructive cardiomyopathy (NOCM) affecting women in general and 67% of NOCM in women of childbearing age. Mean age was 28.5 with a range of 18 to 39. Reported risk factors include poor socio-economic conditions, multiparity, twin pregnancies and anemia. The clinical picture is that of cardiac failure, most often congestive (83.3%), with a systolic murmur of functional mitral incompetence (50%) and atypical chest pain (50%). The ECG is invariably abnormal, without specific signs. The high incidence of repolarisation disturbances is a fairly special feature. Echocardiography is the technique of choice, enabling detection, diagnosis and study of ventricular function, which is an important factor in prognostic evaluation. Medical treatment is based upon a combination of rest, salt-free diet, diuretics, digitalis and vasodilators. The etiology remains unknown and the prognosis is severe despite cases of complete recovery.
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PMID:[Meadows syndrome: puerperal cardiomyopathy]. 808 5

Rupture of the left-ventricular free wall may not always result in immediate irreversible hemodynamic collapse. We report a series of five patients (4 male, 1 female; age 59-79 years) successfully operated for postinfarction free-wall rupture with good long-term results. Two patients presented with syncopy and acute tamponade three days after an acute myocardial infarction. In two patients with atypical chest pain and congestive heart failure, a large pericardial effusion and an extreme localized thinning of a myocardial scar region was seen several weeks after an uncomplicated myocardial infarct. In one patient a pseudoaneurysm was detected, which developed asymptomatically within three weeks after a posterior myocardial infarct. In all cases myocardial rupture was suspected after an echocardiographic examination. At surgery a hemopericardium and a localized rupture site were found. The surgical procedure included closure of the defect by direct suture or patch, CABG in 3 cases, and mitral valve replacement in one patient. The postoperative course was uneventful, only one patient needed IABP for 24 hours. Three patients returned to NYHA functional class I, one patient to class II, and one patient to class III. The latter patient died of heart failure 17 months postoperatively, and the other patients are still alive 4,18,24, and 26 months postoperatively. Thus clinical representation of left-ventricular free-wall rupture after myocardial infarction can be highly variable. But close cooperation between experienced echocardiographers and surgeons may allow successful corrections with good long term-results.
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PMID:Clinical presentation of rupture of the left-ventricular free wall after myocardial infarction: report of five cases with successful surgical repair. 878 31

The objective of this study was to evaluate the safety of myocardial perfusion scintigraphy with Tc-99 m sestamibi during adenosine stress in patients with recent thrombolytically treated myocardial infarction. Eighty-four patients with thrombolytically treated myocardial infarction, 59 males and 25 females, aged 62.9 +/- 8.4, were eligible for myocardial perfusion scintigraphy during adenosine provocation. Exclusion criteria for adenosine stress were hypotension, unstable angina pectoris, cardiac failure, pericarditis and atrioventricular block (AV block) II-III. Adenosine-stress and resting myocardial perfusion scintigraphy was performed 2-5 days after thrombolysis. Scintigraphy at rest was done 24 h after the stress study. Sixty patients (71%) experienced some kind of side-effects during adenosine infusion. The most frequent side-effects were dyspnoea in 43/84 patients (51%) and unspecific chest discomfort in 26/84 patients (31%). During infusion, ST depressions or elevations on ECG were seen in 9 patients (11%), 5 of whom experienced atypical chest discomfort. Five patients (6%) described typical angina but none of them showed electrographic signs of myocardial ischaemia during infusion. Six patients (7%) developed transient AV block I-II. Reversible scintigraphic perfusion defects were seen in 67 patients (79%). No serious complications, such as death, reinfarction or severe arrhythmias, occurred during adenosine infusion or during a 3-day clinical follow-up period. In conclusion, MIBI-SPECT during adenosine stress is a safe diagnostic method that can be performed in most patients early on after thrombolytically treated acute myocardial infarction. Side-effects are common but benign, and not different from those seen in patients with chronic coronary artery disease.
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PMID:Myocardial perfusion scintigraphy (SPECT) during adenosine stress can be performed safely early on after thrombolytic therapy in acute myocardial infarction. 956 47

To evaluate whether or not coronary microvascular dysfunction is associated with exercise-induced myocardial ischemia in left ventricular dysfunction of unknown cause, both the treadmill exercise test (TET) and coronary hemodynamics were studied in 20 patients with impaired left ventricular ejection fraction (<50% by radionuclide ventriculogram), normal cardiac size, normal coronary angiogram and no evidence of clinical heart failure. Ten subjects with atypical chest pain were studied as the control. Coronary hemodynamics were studied both at baseline and after dipyridamole infusion (0.56mg/kg, i.v. for 4'). There was no difference in age, gender, blood pressure, baseline great cardiac venous flow (GCVF) and coronary vascular resistance between ten patients with a positive TET and the other ten with a negative TET. At baseline, coronary sinus oxygen concentration was increased and myocardial oxygen consumption reduced in patients with a positive TET compared with those with negative a TET. After dipyridamole infusion, maximum GCVF (102+/-47 vs. 144+/-31 ml/min, P=0.027) and coronary flow reserve (2.31+/-0.49 vs. 3.00+/-0.61, P=0.012) were significantly reduced and minimum coronary vascular resistance was higher (1.00+/-0.42 vs. 0.63+/-0.12 mmHg/ml/min, P=0.016) in patients with a positive TET than in those with a negative TET. At follow-up, 40% of patients with a positive TET and 10% of those with a negative TET developed clinical heart failure with a dilated left ventricle during a period of 45 months. Thus, coronary microvascular function is heterogeneous in patients with left ventricular dysfunction of unknown cause. In some of them, coronary microvascular dysfunction could be related to the presence of exercise-induced myocardial ischemia, suggesting that similar pathophysiology underlies the early stage of dilated cardiomyopathy and syndrome X.
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PMID:Differential coronary microvascular function in patients with left ventricular dysfunction of unknown cause--implication for possible mechanism of myocardial ischemia in early stage of cardiomyopathy. 1040 8

Recent advances in Medical Science and the thechnological improvements in the field of myocardial revascularisation, in surgical procedures and in percutaneous interventions, made attractive the initial option for invasive strategies in the management of coronary heart disease. For this reason, coronary arteriography is nowadays more often indicated. Some concepts in coronary heart disease have been reviewed, specially those related to acute coronary syndromes. Non-ST-segment elevation myocardial infarction (previously called non-Q wave myocardial infarction) and unstable angina are now considered "unstable acute coronary syndromes" and both have the same guidelines for management. The main indications for coronary arteriography as the first diagnostic tool are: 1) incapacitating angina, even in stable patients; 2) high-risk patients with unstable coronary syndromes (refractory angina, troponin elevation, new ST- segment deviations, cardiac failure and serious arrythmias); 3) patients with acute ST-elevation myocardial infarction that will be submitted to primary angioplasty or with hemodynamic instability or persistent ischemia. Low-risk patients (angina that promptly subsides after medication, no electrocardiographic or laboratorial changes or atypical chest pain) may be submitted to non-invasive testing for further risk stratification; if no ischemia is detected, coronary arteriography is not indicated and optimized medical treatment is perfectly admitted for a great number of patients. The indications of coronary arteriography for the diagnosis and prognosis of coronary heart disease are not well delimited in clinical practice, and this method is frequently used as the first tool in the investigation of chest pain, even when the characteristics of pain are not exactly those of angina. In this review, the authors discuss the main indications of coronary arteriography in the multiple clinical aspects of coronary heart disease and in the differential diagnosis of chest pain.
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PMID:[Indications of coronary cineangiography in coronary heart disease]. 1288 1

A 78-year-old man presented with dyspnoea and a 57-year-old with chest pain. Both had a history of coronary atherosclerosis and were now found to have a cardiac murmur. They proved to have a ventricular septal rupture (VSR) that had not been recognized as such. In the older man, the myocardial infarction that caused the VSR had initially not been recognized and in both men the clinical course was erroneously attributed to heart failure caused by myocardial infarction alone. Both underwent surgical correction of the VSR; the older man died due to postoperative intestinal necrosis, the younger man recovered. Patients with a high cardiac-risk profile, atypical chest pain, symptoms ofdyspnoea and a new specific murmur should be suspected of having a VSR. Early recognition and treatment of VSR may reduce mortality significantly.
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PMID:[A patient with heart failure and a new murmur: not always a valvular problem]. 1607 75


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