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

Opiate receptor inhibition causes adrenergic receptor-mediated increases in aortic pressure, cardiac output, and left ventricular contractile function in right heart failure. To study whether the effects of opiate receptor inhibition are mediated by means of an action on the central opiate system, we administered equimolar doses of naloxone hydrochloride and naloxone methobromide (MeBr) and normal saline to heart failure dogs. Chronic stable right heart failure was produced by progressive pulmonary artery constriction and tricuspid valve avulsion. Naloxone hydrochloride caused an increase in mean aortic pressure, cardiac output, left ventricular dP/dt and dP/dt/P, plasma catecholamines, and regional blood flows to the myocardium, quadriceps muscle, kidneys, and splanchnic beds. Plasma beta-endorphin and adrenocorticotropin also increased. In contrast, neither normal saline nor naloxone MeBr (which does not cross the blood-brain barrier) affected the systemic or regional hemodynamics or neurohormones. Naloxone hydrochloride was also administered to anesthetized heart failure dogs. Pentobarbital anesthesia removed cortical perception of nociceptive stimulation, reduced the increase in plasma epinephrine, and abolished vasodilation in skeletal muscle that occurred in conscious dogs after naloxone hydrochloride administration but had no major effects on responses of plasma norepinephrine, systemic hemodynamics, or other regional blood flows to opiate receptor inhibition. Naloxone hydrochloride had no effect in sham-operated dogs. The results indicate that the hemodynamic effects of naloxone are mediated by an action within the central nervous system. Furthermore, since pentobarbital anesthesia did not markedly alter the hemodynamic responses to naloxone hydrochloride, the acute salutary effects of opiate receptor inhibition probably are not caused by removal of the antinociceptive effect of endogenous opioids in heart failure.
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PMID:Opiate receptor antagonism in right-sided congestive heart failure. Naloxone exerts salutary hemodynamic effects through its action on the central nervous system. 254 17

Sixty-one cases of severe heart diseases were treated between Jan. 1977 and Dec. 1986, accounting for 18.37% of the heart diseases in pregnancy. Of these 61 cases, 39 (63.93%) underwent cesarean section under continuous lumbar epidural anesthesia. The systolic/diastolic blood pressure and mean arterial pressure (MAP) values decreased from the beginning of anesthesia to the end of delivery, and then the values gradually went up to the preoperative level. During the operation, no heart failure occurred. In 22 cases (36.07%), when labor began, the systolic/diastolic pressure and MAP increased and attained the peak value during parturition. After the fetus was delivered, the blood pressure decreased immediately. In 10 cases, heart failure occurred during labor. The adjusted mortality was 4.92%. Two patients died after vaginal delivery. Of these, one had heart failure during labor and underwent cesarean section, but she died after the operation. It was noted that hemodynamic change during cesarean section was smaller than that during vaginal delivery. If an appropriate time is selected for termination of pregnancy or cesarean section is only performed in the early stage of labor, heart failure and fatal outcome may be avoided.
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PMID:[Indications of cesarean section for severe heart diseases in pregnancy--an analysis of 61 cases]. 259 39

A 19-year-old man was diagnosed with a rapidly enlarging arteriovenous malformation of the scalp and a mild degree of cardiomegaly. Operation to excise the large fistula took place under general anesthesia. Both external carotid arteries and their branches were controlled to prevent intraoperative hemorrhage, and dissection took place down to the periosteum. A split skin graft from the thigh was applied to the scalp defect. The patient recovered well with no further evidence of dyspnea or high output cardiac failure.
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PMID:Congenital arteriovenous malformation of the scalp with high output cardiac failure: a case report. 259 24

Cardiovascular complications of surgery--myocardial infarction (MI), chest pain, stroke, heart failure, and rhythm disturbances--are a major cause of post-operative a major cause of post-operative morbidity and mortality. Numerous studies have been conducted on postoperative MI in diverse populations, including patients with previous MI and others with coronary artery disease (CAD) who have or have not undergone coronary artery bypass graft (CABG) surgery. This review presents data from a number of these studies, which attempted to identify predictive tools and contributing factors to postoperative MI and other ischemic events. These potentially predictive methods and factors include previous MI, hemodynamic aberrations and monitoring, drug regimens, presence of CAD, CABG surgery, preoperative and intraoperative ischemia, congestive heart failure, thallium scintigraphy, and anesthesia.
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PMID:Perioperative cardiac problems. 265 71

The fundamental principles of pheochromocytoma management are reviewed. These are a high index of clinical suspicion; biochemical confirmation of the diagnosis; preoperative localization and pharmacologic treatment with alpha-adrenergic blockers (and occasionally with beta-adrenergic blockers and/or alpha-methylparatyrosine); meticulous anesthesia and intraoperative cardiovascular monitoring; and attention to the surgical principles of wide exposure, careful dissection and complete exploration, early interruption of tumor vasculature, and delivery of the tumor with the capsule intact. For malignant lesions, the roles of pharmacologic management (alpha- and beta-adrenergic blockade, alpha-methylparatyrosine, and drugs for heart failure, diabetes, and pain), teleradiotherapy, radiopharmaceutical treatment with I-131 MIBG and chemotherapy (with cyclophosphamide, vincristine, and dacarbazine) are discussed.
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PMID:Management of pheochromocytoma. 266 82

We describe the anaesthetic management of a 20 years old female with a Friedreich's ataxia for curettage of the uterus. After the premedication with thalamonal, diazepam and atropine the anaesthesia was induced with thiopental. Isoflurane and nitrous oxide were used for maintenance. We review the literature about this disease and its implications in anaesthesia. Anesthetic hazards to the patient with Friedreich's ataxia include potential risk of cardiac dysrhythmias and heart failure and also marked sensitivity to muscle relaxants. Respiratory complications and diabetes mellitus are other main problems in postoperative period. We conclude that this patients should be careful monitored specially cardiovascular function and neuromuscular transmission during and after anaesthesia.
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PMID:[Anesthetic management in a case of Friedreich's ataxia]. 268 72

PGE1 has a beneficial effect on cardiac failure with mitral valve regurgitation by decreasing the "after load". An 82-year-old female had a total cystectomy of a bladder tumor. The preoperative standard 12 lead electrocardiogram showed atrial fibrillation and incomplete right bundle branch block. The preoperative echocardiogram showed regurgitation of both mitral valve and tricuspid valve. Under heavy premedication, we intubated with fentanyl and pancuronium bromide, maintained anesthesia with enflurane. After incision, both pulmonary artery pressure and pulmonary capillary wedge pressure increased, and cardiac index decreased. Continuous injection of 100ng.kg-1.min-1 PGE1 made pulmonary artery pressure and pulmonary capillary wedge pressure to decrease, and cardiac index to increase. PaO2, however, decreased apparently. PGE1 was effective for cardiac failure with mitral valve regurgitation associated with pulmonary hypertension. But attention must be given to the decrease in PaO2.
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PMID:[The use of PGE1 in an elderly patient with mitral valve regurgitation during general anesthesia]. 270 14

Seventy-seven patients with drug-refractory sustained ventricular tachycardia (VT) (28 patients) or ventricular fibrillation (VF) (49 patients) underwent implantation of an automatic cardioverter defibrillator (AICD). The 67 men and 10 women, with a mean age of 60 +/- 12 years (range 18 to 79), had coronary artery disease (60 patients), idiopathic cardiomyopathy (eight patients), mitral valve prolapse (four patients), hypertensive heart disease (one patient), Ebstein's anomaly (one patient), long QT syndrome (one patient), and primary electrical disease (two patients). The mean left ventricular ejection fraction was 35 +/- 16% (range 10% to 75%). Sustained VT/VF was induced in 64 patients (83%) at baseline electrophysiologic testing. A mean of 4.1 +/- 1.3 antiarrhythmic drugs failed to control the arrhythmia. Associated surgery at AICD implantation included coronary artery bypass in 19 patients, coronary bypass with aneurysmectomy in six patients, and aneurysmectomy alone in one patient. Five patients had only prophylactic patches implanted during aneurysmectomy or coronary bypass and the AICD device was subsequently implanted under local anesthesia to prevent arrhythmia recurrence or to control persistently inducible VT. Operative mortality was 2.6% with two deaths from intractable VF. Fifty-two patients (69%) continued receiving antiarrhythmic drugs to suppress spontaneous VT. During a mean follow-up of 15 +/- 13 months (range 1 to 63), six patients died: two suddenly due to probable pulse generator failure (greater than 2 years old), one of acute myocardial infarction, two of heart failure, and one of respiratory failure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Clinical experience in seventy-seven patients with the automatic implantable cardioverter defibrillator. 277 68

A new surgical approach for implantation of the automatic implantable cardioverter defibrillator without thoracotomy was used in 12 patients, aged 46 to 72 years. Preimplantation arrhythmia was ventricular tachycardia in 7 patients and ventricular fibrillation in 5 patients. The mean ejection fraction was 19%. Six patients were at high risk for general anesthesia for a variety of medical problems, and 2 patients had had a previous cardiac operation. Epidural anesthesia was used in 8 patients without intubation. The surgical approach used a longitudinal epigastric extraperitoneal incision with access to the heart through an incision made in the central tendon of the diaphragm. Two patches and two epicardial sensing leads were placed in all patients. All patients but one could be defibrillated with 20 J or less. There was no operative mortality and minimal morbidity. There were two late deaths due to heart failure. Thus, the transdiaphragmatic approach provides an excellent exposure for automatic implantable cardioverter defibrillator implantation, avoids general anesthesia and thoracotomy, and can be used after a previous cardiac operation.
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PMID:Transdiaphragmatic implantation of the automatic implantable cardioverter defibrillator. 277 21

A case of anesthesia for a heart-transplant operation on a patient on mono-amine oxidase inhibitors (M.A.O.I.) is reported. This 63-year-old farmer was in end-stage cardiac failure due to familial cardiomyopathy. For 24 hours before surgery, he was on a dobutamine infusion (3 mcg/kg/min). He had been taking nialamide (100 mg/day) for 8 years for reactional depression and had not stopped it, despite advice. Anesthesia was induced with etomidate and succinylcholine, and maintained with fentanyl (25 mcg/kg/min) and pancuronium. Cardio-vascular stability was maintained during induction and first stage of surgery, up to cardectomy. Graft ischemia was 188 minutes. Successful defibrillation occurred after verapamil 3 mg. Weaning from C.P.B. was easy with dopamine (5 mcg/kg/min) and isoprenaline (0.01 mcg/kg/min). Post-operatively, on day 1, hypertension appeared and needed a nitroprusside infusion. On day 3, the patient needed another anesthetic for removal of pericardial clots, without problems. He remained very confused and disorientated during all his stay in hospital, but improved greatly with a neuroleptic. He left the hospital on day 28 in a good shape, with an anxiolytic, captopril and immunosuppressors. One month later, he was back on nialamide. The pharmacology of the M.A.O.I. is reviewed and their interactions with anesthesia are discussed as well as the use of inotropes. In this case, the denervated heart-graft, free from M.A.O. inhibition, behaved normally when transplanted in a chronically M.A.O.I. treated recipient.
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PMID:Heart-transplant and mono-amine oxidase inhibitors. 280 Sep 99


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