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

A 46-year-old man was admitted for further evaluation of exertional chest discomfort. One family member had experienced sudden death, and 2 others had died of heart failure, including 1 known to have had Fabry's disease. The patient was also diagnosed with Fabry's disease, based on reduced leukocyte alpha-galactosidase A activity, 2.0 nmol/mg protein/hour, as well as endomyocardial biopsy findings of marked sarcoplasmic vacuolization of cardiac muscle cells by light microscopy and lamellated "zebra bodies'' in the cytoplasm shown by electron microscopy. Echocardiography disclosed marked left ventricular hypertrophy and systolic anterior motion of the mitral leaflets. On cardiac catheterization, a left ventricular peak systolic outflow gradient of 50 mm Hg was noted; this decreased to 10 mm Hg following intravenous administration of 100 mg of cibenzoline. It is imperative to recognize the existence of cases with Fabry's disease associated with left ventricular outflow obstruction.
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PMID:Relief of left ventricular outflow obstruction by cibenzoline in a patient with Fabry's disease--a case report. 1651 35

Vomiting and abdominal pain are common pediatric complaints encountered by emergency physicians. The differential diagnosis of abdominal pain is extensive. Herein, we report 2 cases with fatal myocarditis who initially presented with abdominal pain and vomiting. Both cases were presented with abdominal pain, vomiting, and loose stools. On arrival at our emergency department, hypotension, tachycardia, and cyanotic extremities were found. Their serum troponin-I levels were elevated. The echocardiogram demonstrated poor left ventricular performance and a decreased ejection fraction. In both cases, an arrhythmia and a coma developed within hours and were shortly followed by death. The clinical presentations of acute myocarditis are variable, ranging from an initial mild discomfort to acute progressive heart failure, and at times, even death. Abdominal pain may be a manifestation of systemic disease, an extra-abdominal lesion, or myocarditis. Although myocarditis associated with abdominal pain or vomiting remains a diagnostic challenge to physicians, it should be considered in the differential diagnosis of children with gastritis and hypotension or who are refractory to rehydration therapy.
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PMID:Myocarditis presenting as gastritis in children. 1680 47

Dyspnoea is the most common symptom of patients with cardio-respiratory diseases. It is a generic term related to different pathophysiological abnormalities that may result in different qualities of respiratory discomfort, defined by specific verbal descriptors for a specific diagnosis. Often it is difficult to distinguish the underlying pathology of dyspnoea, eg, either from chronic heart failure (CHF) or from other respiratory causes. The discovery of the endocrine function of the heart, as well as the development of accurate and feasible assay methods allow the use of cardiac natriuretic hormones in the assessment of cardiovascular diseases, namely acute coronary syndromes and heart failure. It is advisable to measure cardiac natriuretic hormones in order to exclude or suggest the diagnosis of CHF in patients with a suspicious diagnosis, but with ambiguous signs and symptoms or manifestations that can be confused with other pathologies (like chronic obstructive pulmonary disease). The most common symptom of patients with cardio-respiratory diseases is dyspnoea, a 'difficult, laboured, uncomfortable breathing'. Dyspnoea has been defined as 'a term used to characterize a subjective experience of breathing discomfort that consists of qualitatively distinct sensations that vary in intensity. The experience derives from interactions among multiple physiological, psychological, social and environmental factors, and may induce secondary physiological and behavioural responses'. Breathlessness is characterized by measurable intensity and qualitative dimensions, which may vary depending on the individual, the underlying disease, and other circumstances.3 The neurophysiological basis of dyspnoea relies on receptors in the airways lung parenchyma, respiratory muscles together with chemoreceptors providing sensory feedback via vagal, phrenic and intercostal nerves to the spinal cord, medulla and higher centres. Breathlessness is based on different pathophysiolagical abnormalities that may result in different qualities of respiratory discomfort, which are defined by specific verbal descriptors related to a specific diagnosis. Nevertheless different diseases may share the same descriptors. There is no clear relationship between the qualitative descriptors of dyspnoea and the quantitative intensity among the patient groups: different diseases may be distinguished by quality but not intensity of the sensation. Differences in languages, in races, cultures, gender, and in the manner in which concepts or symptoms are held can all influence the idea, quality and intensity of dyspnoea.
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PMID:Determining the cause of dyspnoea: linguistic and biological descriptors. 1691 5

Persons with chronic disease experience multiple symptoms. Understanding the association between these symptoms and health outcomes would facilitate a targeted approach to symptom assessment and treatment. Our objectives were to determine the association of a range of symptoms with quality of life, self-rated health, and functional status among chronically ill adults, and to assess methods for evaluating the independent associations of symptoms that may be interrelated. We consecutively enrolled 226 cognitively intact, community-dwelling adults, aged 60 years or older with chronic obstructive pulmonary disease, heart failure, or cancer. Seven symptoms (physical discomfort, pain, fatigue, problems with appetite, feelings of depression, anxiety, and shortness of breath) assessed using the Edmonton Symptom Assessment Scale were examined for their association with self-rated quality of life, self-rated health, and functional status. Principal component analysis and logistic regression revealed similar results. The latter demonstrated that physical discomfort was associated with lower self-rated health (adjusted odds ratio [OR] 1.9; 95% confidence interval 1.2-2.9) and functional disability (adjusted OR 1.8; 95% confidence interval 1.2-2.7). Feelings of depression were associated with poorer quality of life (adjusted OR 1.7; 95% confidence interval 1.1-2.6), and shortness of breath was associated with lower self-rated health (adjusted OR 1.5; 95% confidence interval 1.1-2.0). The association between a range of symptoms and quality of life, self-rated health, and functional status differed across outcomes, but only three symptoms-physical discomfort, feelings of depression, and shortness of breath-maintained their associations when multiple symptoms were examined concurrently. These findings suggest that interventions targeting these symptoms could improve several health-related outcomes.
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PMID:The association of symptoms with health outcomes in chronically ill adults. 1719 7

A 66-year-old man was referred to our hospital with chest discomfort and shortness of breath. Seven months previously he had undergone a laparoscopic left nephroureterectomy for a left renal pelvic tumor and was given two cycles of adjuvant chemotherapy (methotrexate, epirubicin and cisplatin). Echocardiogram showed an 8-mm sized mass extending from the right atrium into the right ventricle. On computed tomography, multiple lung tumors, as well as the right atrial and ventricular mass, were seen. The patient died of acute heart failure caused by right ventricular outflow obstruction. On autopsy, a right atrial and ventricular metastasis of the initial transitional cell carcinoma was found. The patient's cause of death was acute heart failure as a result of cardiac metastasis of his initial renal pelvic carcinoma.
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PMID:Cardiac metastasis of renal pelvic cancer. 1743 Feb 63

A 64-year-old man presented with chief complaints of exertional dyspnea and palpitation. He had previously undergone left nephrolithotomies twice. A chest roentgenogram showed pleural effusion on both sides with cardiac dilation, and electrocardiography showed a frequent occurrence of ventricular premature contractions. An echocardiogram showed diffuse hypokinesis of the left ventricular wall motion (ejection fraction, 45%) and dilation of the left ventricle (left ventricular end-diastolic dimension, 61 mm). We administered diuretics, ACE inhibitors and a beta-adrenergic blocking agent after making a diagnosis of cardiac insufficiency. Because coronary angiography showed 90% stenosis of the left anterior descending coronary artery (No. 7), we performed coronary angioplasty in this locus. Though both the left ventricular wall motion and ejection fraction improved, and the clinical symptoms disappeared, the left ventricular end-diastolic dimension, and arrhythmia did not improve. Furthermore, the brain natriuretic peptide increased despite these treatments. Thereafter, a left renal artery aneurysm (extrarenal aneurysm measuring 5 cm in diameter and an intrarenal aneurysm measuring 3 cm in diameter) and a left renal arteriovenous fistula were discovered when abdominal echography was performed because of epigastric discomfort. As a result, a left total nephrectomy was performed. Subsequently, the left ventricular end-diastolic dimension and arrhythmia improved, and the brain natriuretic peptide returned to a normal value. We herein report a case that developed cardiac insufficiency due to a renal aneurysm and renal arteriovenous fistula after undergoing left nephrolithotomies twice.
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PMID:Two giant renal aneurysms and renal arteriovenous fistula associated with cardiac insufficiency and a sustained elevation of atrial natriuretic peptide and brain natriuretic peptide. 1750 74

The authors analyzed the medical records of 1414 patients aged 60 +/- 14 years, who were examined in a specialized cardiological clinic within a one-year period. Among the patients, 41.2% complained of dyspnea; the number of women with dyspnea prevailed over the number of men. Dyspnea was caused by chronic heart failure in 42.2% of patients, by transient myocardial ischemia in 12.3% of patients, and by paroxysmal tachyarrhythmia in 6.3% of patients. In 45.6% of the patients, mostly in women, significant non-cardial factors were revealed: obstructive or restrictive respiratory failure (20.6%), obesity (14.7%), thyroid gland dysfunction (3.9%), pulmonary arterial thromboembolism, anemia etc. A combination of two or more etiological factors took place in 22.6% of cases. The reason for respiratory discomfort remained unclear in 21.3% of the patients, mostly women. Symptom-limited load test with gas analysis (ergospirometry) was performed in 70 patients with dyspnea of unclear origin. According to its results, in 75% of elderly patients with essential hypertension and postinfarction cardiosclerosis, who did not have significant systolic dysfunction, restrictive diastolic dysfunction, valvular disorder, or atrial fibrillation, dyspnea was caused by hyperventilation, obesity, and respiratory pathology.
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PMID:[Chronic dyspnea in cardiological patients: prevalence and etiology]. 1768 90

The combination of pioglitazone hydrochloride, a thiazolidinedione, and glimepiride, a sulfonylurea, has been approved in many countries worldwide as an oral agent for the management of type 2 diabetes. Glimepiride stimulates insulin secretion from the pancreas with a decreased risk of hypoglycemia compared to glyburide. Pioglitazone increases glucose uptake in the periphery while decreasing glucose production by the liver. Combined, the two agents increase the body's sensitivity to insulin to reduce hemoglobin A1c levels by 1-2%. Pioglitazone and glimepiride also produce favorable effects on lipid profiles and blood pressure. Additionally, pioglitazone has proven to decrease the risk of certain cardiovascular events, providing evidence for macrovascular benefits. Side effects are minimal with pioglitazone and glimepiride, with weight gain and edema providing the most discomfort and complications. Patients must be monitored for the development of heart failure, though the risk is small. Guidelines are in place to limit patient selection for the use of pioglitazone based on cardiac risk factors. In general, pioglitazone and glimepiride are well tolerated.
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PMID:Pioglitazone hydrochloride/glimepiride. 1772 49

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

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


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