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

The cytostatic anthracycline antibiotic daunomycin hydrochloride led to the development of plastic myocardial insufficiency characterized by impaired intracellular regeneration of cardiomyocytes and progressive involution of cytoplasmic structures. Morphological signs of plastic myocardial insufficiency included fragmentation, annulation, or collapse of nucleoli in cardiomyocyte nuclei, lysis of myofilaments, sarcomeres, or myofibrils, focal degradation of the cytoplasm, and intensive autophagy. Fatal anthracycline-induced cardiac insufficiency was associated with massive cardiomyocyte loss due to their non-necrotic death and elimination. Our findings indicate that anthracycline-induced cardiomyopathy in laboratory animals is a convenient model for studying general mechanisms underlying the pathogenesis of regenerative and plastic cardiac insufficiency in humans.
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PMID:Anthracycline-induced cardiomyopathy is manifested in decreased protein synthesis, impaired intracellular regeneration, and non-necrotic death of cardiomyocytes. 1155 68

The role of apoptosis in cardiac disease remains controversial. Much of the apoptosis detected, by chemical or molecular means, reflects inflammatory reaction and responding blood cells rather than myocytes, though their apoptosis in situ may exacerbate a bad situation, and their direct action against myocytes has not been excluded definitely. Myocyte apoptosis may reflect end-stage cardiac failure rather than causing it. If this is the case, then preventing apoptosis so that the cells can undergo necrosis does not accomplish much. Apoptosis is a consistent and important finding in many forms of cardiovascular disease. As determined by ultra-structure, apoptosis is common in cardiomyocytes, fibroblasts, vascular endothelial cells, and smooth muscle cells in cardiovascular disease of many origins. (62) Even though smooth muscle cells in atheromatous plaques appear to be necrotic,l it is likely that this is an evolved situation of apoptotic cells that were not removed. Given the prevalence of apoptotic processes in diseased heart and the very limited capacity of this organ to repair itself, (56) it is appropriate and justified to continue to explore the significance of apoptosis in cardiac disease and, above all, to explore the use of antiapoptotic agents in acute situations. Researchers must pay explicit attention to how they document cell death and in what tissues or cells it occurs. Otherwise, clinicians risk being deluded by preservation of morphology in nonfunctional cells and by confusion of what happened and where death occurred in the sequence of causality. Cell death in the heart is a matter of substantial theoretical and practical concern. A major problem in analyzing it is that, although apoptosis may be demonstrated easily in myocytes, particularly embryonic myocytes, under conditions of culture, interpretation is much more complex in an intact organ. The first issue is one of timing. In situations of severe, acute loss of cells, such as in an infarct, apoptotic cells may not be cleared rapidly and may progress to a more oncotic or necrotic morphology. Second, in situations of inflammation, biochemical or molecular techniques may confound apoptosis of inflammatory cells with apoptosis of myocytes. Third, priorities in the sequence of apoptosis differ between large, generally nonmitotic cells with massive cytoplasm (as differentiated myocytes) and small mitotic cells in culture, which usually are studied. The appearance and many markers of physiological cell death may differ from the most widely recognized forms of apoptosis, including late collapse of the nucleus and primacy of lysosomal or other proteases as opposed to caspases. Investigators should always strive to establish multiple criteria for apoptosis, with good documentation of timing and cell type. When these factors are taken into consideration, it seems that aggressive action against apoptosis may be of value in acute situations, such as infarct, in which buying short increments of time may reduce damage. In more chronic situations, much of the apoptosis detected derives from invading lymphocytes, mast cells, or other cells relating to inflammation. The apoptosis of these cells may exacerbate an already difficult situation, and intervention may prove of value. Otherwise, apoptosis of myocytes is more typically an end-stage situation, and it is more fruitful to alleviate the problem before this stage is reached.
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PMID:Cell death in the heart. 1178 4

It is difficult to assemble data from an out-of-hospital cardiac arrest since there is often lack of objective information. The true incidence of sudden cardiac death out-of-hospital is not known since far from all of these patients are attended by emergency medical services. The incidence of out-of-hospital cardiac arrest increases with age and is more common among men. Among patients who die, the probability of having a fatal event outside hospital decreases with age; i. e. younger patients tend to more often die unexpectedly and outside hospital. Among the different initial arrhythmias, ventricular fibrillation is the most common among patients with cardiac aetiology. The true distribution of initial arrhythmias is not known since several minutes most often elapse between collapse and rhythm assessment. Most patients with out-of-hospital cardiac arrest have a cardiac aetiology. Out-of-hospital cardiac arrests most frequently occur in the patient's home, but the prognosis is shown to be better when they occur in a public place. Witnessed arrest, ventricular fibrillation as initial arrhythmia and cardiopulmonary resuscitation are important predictors for immediate survival. In the long-term perspective, cardiac arrest in connection with acute myocardial infarction, high left ventricular ejection fraction, moderate age, absence of other heart failure signs and no history of myocardial infarction promotes better prognosis. Still there is much to learn about time trends, the influence of patient characteristics, comorbidity and hospital treatment among patients with prehospital cardiac arrest.
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PMID:The epidemiology of out-of-hospital 'sudden' cardiac arrest. 1188 28

The objective of this study was to examine the relationship between descriptors of breathlessness and its underlying cause in patients with lung cancer and cardiopulmonary diseases to see whether descriptors might be used to help determine the cause of breathlessness, particularly in patients with lung cancer. We studied 131 patients with primary or secondary lung cancer, whose breathlessness was attributed to tumor mass, pleural effusion, lung collapse, metastases, pleural thickening or lymphangitis carcinomatosis, and 130 patients with breathlessness attributed to asthma, chronic obstructive pulmonary disease (COPD), interstitial lung disease or cardiac failure. Patients selected statements (descriptors) that described the quality of their breathlessness from a 15-item questionnaire and the relationship between the descriptors and the attributed cause of breathlessness was evaluated by cluster analysis. All patient groups were characterized by more than one cluster and several clusters were shared between groups. Specific sets of clusters were associated with breathlessness due to asthma, COPD and cardiac failure, and to cancer causing collapse, metastases or pleural thickening. The association of different sets of clusters with the different diagnostic groups suggests that patients are describing qualitatively different experiences of breathlessness, but the relationship does not appear to be sufficiently robust for the questionnaire to aid differential diagnosis.
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PMID:Descriptors of breathlessness in patients with cancer and other cardiorespiratory diseases. 1188 16

Extracorporeal membrane oxygenation (ECMO) can be set up quickly at the bedside and provides reliable temporary mechanical circulatory support for severe heart failure. We report the case of a 56-year-old female with circulatory collapse due to sustained ventricular tachycardia and ventricular fibrillation (VT/Vf) after coronary artery bypass grafting (CABG) who was successfully resuscitated using ECMO. The sustained VT/Vf might have been secondary to myocardial stunning, ischemia, infarction, or reperfusion. There were 40 cardioversions within the first 5 postoperative days. The patient improved after 8 days of ECMO in addition to use of an intraaortic balloon pump and administration of inotropic agents for profound heart failure. Left ventricular ejection fraction improved from 28% preoperatively to 54.5% on the 20th postoperative day. Cardiogenic shock due to sustained VT/Vf after CABG may be an indication for ECMO support. Immediate establishment of circulatory support using ECMO provides valuable time for spontaneous and interventional correction of reversible causes of sustained VT/Vf.
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PMID:Successful rescue of sustained ventricular tachycardia/ventricular fibrillation after coronary artery bypass grafting by extracorporeal membrane oxygenation. 1210 65

Venoarterial extracorporeal membrane oxygenation (VA ECMO) has become a valuable technique in the critical care of children with congenital heart disease who require mechanical cardiorespiratory support. The use of VA ECMO in cardiac patients has expanded from an extension of intraoperative cardiopulmonary bypass and now includes rescue therapy during cardiopulmonary resuscitation, temporary circulatory support for reversible heart failure, and bridge support preceding heart or heart/lung transplantation. In the majority of clinical applications VA ECMO is used in reaction to impending or ongoing cardiorespiratory failure and not in anticipation of an induced change in clinical status. We describe the anticipatory use of VA ECMO to prepare a patient with complex cyanotic congenital heart disease for a high-risk interventional cardiac catheterization. A 2.5 kg neonate with severe Ebstein's anomaly of the tricuspid valve and recurrent episodes of life-threatening supraventricular tachycardia was electively cannulated for VA ECMO in the cardiac intensive care unit. She underwent successful electrophysiologic mapping and transcatheter radiofrequency ablation of an accessory conduction pathway, resulting in termination of the tachycardia. Following an uncomplicated ECMO course she was decannulated in the cardiac intensive care unit and subsequently discharged home in stable condition. The case illustrates the proactive use of ECMO during a procedure in which severe hemodynamic instability could be predicted. We discuss this concept of ECMO use in the context of accepted indications for ECMO in cardiac patients and encourage an expanded role for its use to prevent cardiorespiratory collapse in planned interventions on compromised patients who are at risk of acute deterioration.
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PMID:Anticipatory use of venoarterial extracorporeal membrane oxygenation for a high-risk interventional cardiac procedure. 1218 35

The "Society of Cardiology and Angiology of the German Democratic Republic (GDR)" was the substitute for the "German Cardiac Society" between 1965 and 1992 in Eastern Germany, when the closed borders (since 1961) pevented free private and official communications. The society experienced 12 elections for the board, it had 792 members in 1989, several working groups and organized 14 cardiovascular congresses and hundreds of meetings. The society was very active in education of physicians and assistance personnel and developed an educational program for specialists in cardiology and angiology in 1977. The society supported the foundation of heart centers and the centralized long-term care of patients with heart failure, arrhythmias, congenital defects, pacemakers or peripheral arterial disease. Scientific results as transvasal closure of the ductus arteriosus Botalli, investigations of the energy metabolism of myocardial fibers, endomyocardial biopsy and several drugs, as ajmaline, talinolol, trapidil, PAMBA and hirudin are used up to these days. The tasks of the society ended with the collapse of the GDR in 1989 and therefore the society was liquidated in 1992, when its functions were taken over again by the German Cardiac Society.
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PMID:The Cardiovascular Society in the GDR (German Democratic Republic). 1243 47

Bronchoscopy is a highly versatile technique in the context of intensive care and has many potentially valuable indications. Safety is of paramount importance and the risks in critically unstable patients are correspondingly greater than in more stable children. The main contraindication to bronchoscopy is if it will provide no useful information. The procedure is obviously more risky in children with severe hypoxia, uncontrolled bleeding diathesis, cardiac failure or severe pulmonary hypertension. Monitoring should include at least oxygen saturation, blood pressure (ideally by continuous, invasive monitoring) and preferably capnography. Indications for bronchoscopy in paediatric intensive care include endobronchial toilet, sometimes instilling recombinant human DNAase even in children who do not have cystic fibrosis; checking tube patency and position; assisting in a difficult intubation or tube change; achieving the selective intubation of a main bronchus; the diagnosis and management of ventilator-associated pneumonia or the ventilated, immunocompromised host; the assessment of lobar collapse or focal hyperinflation; airway stent assessment; assessment of stridor on extubation and the diagnosis of any associated disease. New iatrogenic complications are also likely to be discovered. The procedure is very safe if performed by experienced operators with back-up from doctors skilled in airway management and the monitoring of sick children.
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PMID:Bronchoscopy in paediatric intensive care. 1261 34

Overtly healthy Doberman pinschers, having moderate to severe myocardial failure secondary to dilated cardiomyopathy, which experienced ventricular tachycardia, syncope or collapse, and sudden death were studied to determine the effect of antiarrhythmic medication on their clinical outcome. Antiarrhythmia drug therapy may have retarded sudden death in 13 treated dogs compared to the six dogs not administered antiarrhythmia drugs.
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PMID:Influence of antiarrhythmia therapy on survival times of 19 clinically healthy Doberman pinschers with dilated cardiomyopathy that experienced syncope, ventricular tachycardia, and sudden death (1985-1998). 1473 2

Sleep apnea syndrome (SAS) in patients with chronic heart failure (CHF) increases the risk of death. SAS was divided into 4 types: obstructive sleep apnea-hypopnea syndrome (OSAHS), upper airways resistance syndrome (UARS), central sleep apnea syndrome (CSAS), and sleep hypoventilation syndrome (SHVS). CSAS is caused by temporary cessation of central drive to respiratory muscles, OSAHS results from partial or complete collapse of the pharynx, UARS have typical symptoms of OSAHS and no changes on polysomnography, whereas SHVS results from pathological PCO2 increase with subsequent hypoxemia. Increase in sympathetic activity, renin-angiotensin-aldosterone activation, impaired baroreflex and tonic vagal heart rate control are markers of increased risk of sudden death. CSAS is frequent in patients with CHF. Decreased cardiac output causes delayed transmission of changes in arterial blood gas tensions from the lungs to the chemoreceptors. Increase chemoreceptor sensitivity results from hypoxia and pulmonary congestion. Both types of apneas (OSAHS and CSAS) may occur in the same patient. Periodic cessation in central drive to respiratory muscles (CSAS) causes obstructive apneas/hypopneas by decreased tone of pharyngeal muscles and their collapse. Obstructive apneas (OSAHS) may lead to central apneas by frequent arousals, decreased left ventricular function and prolongation of circulation. Treatment of SAS is based on improvement of cardiovascular function, nocturnal supplementation of O2 and various forms of noninvasive positive airway pressure (i.e. CPAP).
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PMID:[Sleep apnea syndrome in patients with chronic heart failure]. 1530 26


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