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Query: UMLS:C0018801 (heart failure)
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Heart overloading due to pressure as a result of 8 periodic full aortic constriction in heart failure (HF) caused by 10-day toxic-allergic myocarditis (TAM) leads to deterioration of heart contractility (pupm function). This is explained by additional decline in functional activity of all three systems of cardiomyocyte responsible for contraction-relaxation. In particular, by a sharp fall of ATP and CP content in the myocardium, a 400% decrease in myofibril power, 200% reduction in efficiency of contraction and marked deterioration of calcium transport. The resultant exhaustion of myocardial reserve brought 70% lethality among the animals. Under the above conditions coordination between the systolic and diastolic cardiac functions, correlation between myocardial functional activity and subcellular systems of cardiomyocyte are impaired. In pressure heart overloading refracterin initiates profound metabolic rearrangements improving metabolism, remodelling of the system of energy supply, reestablishment of systemic homeostasis, normalization of cardiomyocyte and cardiac reserves.
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PMID:[In Process Citation] 1059 56

Heart overloading due to pressure as a result of 8 periodic full aortic constriction in heart failure (HF) caused by 10-day toxic-allergic myocarditis (TAM) leads to deterioration of heart contractility (pump function). This is explained by additional decline in functional activity of all three systems of cardiomyocyte responsible for contraction-relaxation. In particular, by a sharp fall of ATP and CP content in the myocardium, a 400% decrease in myofibril power, 200% reduction in efficiency of contraction and marked deterioration of calcium transport. The resultant exhaustion of myocardial reserve brought 70% lethality among the animals. Under the above conditions coordination between the systolic and diastolic cardiac functions, correlation between myocardial functional activity and subcellular systems of cardiomyocyte are impaired. In pressure heart overloading refracterin initiates profound metabolic rearrangements improving metabolism, remodelling of the system of energy supply, reestablishment of systemic homeostasis, normalization of cardiomyocyte and cardiac reserves.
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PMID:[The positive action of refracterin on the reserve potentials and metabolism of the myocardium during its overload in toxic-allergic myocarditis]. 1063 64

Conventional pharmacotherapy of severe asthma and status asthmaticus includes beta2-sympathomimetics, theophylline, corticosteroids and occasionally topical anticholinergics (ipratropium bromide). Since hypoxemia is the most severe phenomenon in status asthmaticus the administration of oxygen is mandatory. However, if the bronchodilating therapy fails and hypoxemia continues, usually respiratory failure develops due to progressive respiratory muscle failure. An increasing PaCO(2) and respiratory acidosis are indications for mechanical ventilatory support to unload the failing respiratory pump. Nowadays, there is increasing consensus that ventilatory support should be administered primarily as non-invasive ventilation (NIV) via a face mask1. However, in a significant number of patients with severe asthma NIV is either contraindicated or insufficient. In this case usually the patient must be endotracheally intubated and mechanically ventilated "invasively". Intubation and ventilation of patients with severe asthma or status asthmaticus is associated with a high incidence of complications compared to patients ventilated for other causes of respiratory failure2,3. Therefore the risks of invasive mechanical ventilation have to be weighted carefully to ongoing conservative therapy and NIV. Cardiopulmonary arrest and severe hypoxemia in spite of O2 supplement and NIV are absolute criteria for intubation and ventilation. Mostly deterioration in mental status and exhaustion are the clinical findings leading to mechanical ventilation. Decision is guided rather by the course of the deterioration (how fast the patient's condition is worsening) than by pathological values alone. An increased PaCO(2) with moderate respiratory acidosis alone is not per se an indication for mechanical ventilation. However, a continuously rising PaCO(2) or the development of a severe metabolic acidosis after 1 hour of NIV is a strong argument for invasive mechanical ventilation. Other criteria are evidence of cardiac failure with fall in pulse volume and dysrhythmias, pneumomediastinum or pneumothorax (which has to be drained before mechanical ventilation!).
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PMID:Ventilating the patient with severe asthma: nonconventional therapy. 1276 62

I give some recommendations concerning methodology and interpretation of cardiopulmonary exercise tests. The recommendations are based on our comprehensive data bank of exercise tests (282 tests and about 200 single parameters assessed during each test). When I expect an exercise capacity lower than 100 W I perform a ramp test; concerning expected higher exercise capacity steps of 25 W every 2 min are preferred. In order to achieve an optimal assessment of exercise capacity an exhaustion or symptom limited test should be performed. The achieved maximum oxygen consumption does not allow differing between cardiac or pulmonary causes of exercise limitation. It is only a marker of cardiopulmonary exercise capacity. A lot of algorithms to assess the maximum oxygen consumption are available, yet the results of calculating oxygen consumption with these algorithms differ considerably. Therefore it is mandatory to mention the used algorithm when referring to a calculated predicted oxygen consumption value. There are also several methods to assess the ventilatory and metabolic anaerobic threshold. For clinical purposes assessing lactate values is not necessary. The so called 4 mmol x l(-1) threshold accords primarily to the threshold assessed with the V-slope method. The Hf-slope may be used as an index for classification of heart failure stages analogous to the NYHA classification. Changes in dead space ventilation are mainly an expression of changed ventilation perfusion relationships and do not give evidence for any specific cardiac or pulmonary disorder. The slope of the equivalent for CO(2) is a relevant parameter of prognosis in cardiac failure. The value of the breathing reserve is not indicative of pathologic ventilatory limitation of exercise. You may find a reduced breathing reserve of about 0 also in healthy volunteers who are driven to exhaustion limited exercise. The value of the breathing reserve depends strongly on the kind of calculation or measuring mode and depending on the mode you can get normal or extremely reduced values in the same test person. The analysis of the flow volume curve during exercise provides some criteria of ventilatory exercise limitation. Pulse oxymetry is relevant only as a safety parameter. Because of its inaccuracy it should not be used to prove desaturation during exercise. The assessment of the alveolar-arterial pO (2) difference is of diagnostic relevance. The Borg scale, the course of the oxygen equivalent of O(2), the respiratory exchange ratio, and the aerobic capacity are of no major relevance for differential diagnosis.
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PMID:[Cardiopulmonary exercise tests -- proposals for standardization and interpretation]. 1529 69

Assessment of exercise capacity has been widely used in the evaluation of chronic heart failure (CHF), both to define the severity of the syndrome and to assess the changes induced by therapy. Various exercise tests and protocols can be used. The simple stress test using the exercise bicycle or the treadmill can give useful indications only in patients with severe or lower functional reductions. Maximum exercise duration usually depends on the patient's and the physician's motivation. The addition of respiratory gas exchange measurements, maximum oxygen consumption (VO(2)) or anaerobic threshold, increases the exactness of the assessment of the exercise limitation in CHF. VO(2) maximum provides an objective marker of aerobic capacity and it is biased by neither the patient nor the physician. This technique, however, requires the patient to exercise to exhaustion, and it is somewhat subjective and not indicative of normal daily exercise routine. The anaerobic threshold is a useful way of evaluating adaptability to submaximal efforts and the impact of the therapy on the daily performance. Nevertheless, it is significantly influenced by the fitness level and it has a reduced prognostic capability compared to VO(2) maximum. Submaximal exercise tests discriminate particularly between patients with severe CHF. The major limits are the influence of the patient's motivation and its limited validation in terms of reproducibility and prediction in controlled surveys.
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PMID:Indications and limits of the exercise test in chronic heart failure. 1537 49

Chronic heart failure (CHF) is a common condition and is associated with excess morbidity and mortality, in spite of the many advances in its treatment. Chronic stable heart failure is also associated with an increased incidence of sleep-related breathing disorders, such as central sleep apnoea (CSA) and Cheyne Stokes respiration (CSR). Continuous positive airways pressure (CPAP) has been shown to alleviate the symptoms of CHF, improve left ventricular function and oxygenation. To a certain extent, CPAP also abolishes sleep-related breathing disorders in patients with chronic heart failure. In patients with acute pulmonary oedema, the use of positive pressure ventilation improves cardiac haemodynamic indices, as well as symptoms and oxygenation, and is associated with a lower need for intubation. However, some studies have cast doubts about its safety and suggest a higher rate of myocardial infarction associated with its use. In our opinion, non-invasive positive pressure ventilation and CPAP offers an adjunctive mode of therapy in patients with acute pulmonary oedema and chronic heart failure, who may not be suitable for intubation and in those not responsive to conventional therapies. Non-invasive ventilation also helps to improve oxygenation in those patients with exhaustion and respiratory acidosis. Many trials are still ongoing and the results of these studies would throw more light on the present role of non-invasive ventilation in the management of CHF.
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PMID:Positive pressure ventilation in the management of acute and chronic cardiac failure: a systematic review and meta-analysis. 1638 32

Vascular access (VA) for dialysis is defined as the 'Achilles heel', but also the 'Cinderella' of dialysis, indicating the poor consideration of the problem whether in the surgical environment, or in incomprehensible way in that nephrologic. It can only aspire to the definition 'Fundamental detail'. However, presupposed effective dialysis is a blood flow rate of 300-350 mL/min. Good VA must be easy to prepare, long lasting, free from complications, and aesthetically acceptable and economical. The arteriovenous fistula (AVF) of Cimino and Brescia, from 1966, represents the gold standard and the model of comparison for other systems, more technologically advanced. It must be programmed with an adapted margin (1-2 months) to allow maturation and access certainty for the first puncture, and never carried out sooner than 14 days from the operation. It is known from hemodynamic studies that the good functional flow of the new fistula can already regain 400-500 ml/min in the first week, with cardiological implications like the increase in cardiac throw, in ejection fraction and in the cardiac index. Health workers, patients and dialysis staff must follow a continuous educational program to protect the VA and avoid 'routine and absent-minded management', a basis for its premature failure. The nephrologist must take the responsibility upon himself not to carry out 'medical malpractice'. In the Dialysis Center of Mantova, the VA 'road map' previews all patients (young and old, affections from mono or pluropathology), first the fistula to the wrist, then the cephalic proximal. It follows the basilic vein transposition, the vascular graft to the arm or to the groin, as an alternative to peritoneal dialysis. The permanent central venous catheter (CVCp) is the last choice in patients with reduced life expectancy, heart failure, neoplastic patients with vascular patrimony destroyed by chemotherapy and ischemic lesions produced by the fistula. There were 180 afferent prevailing patients at the Mantova Dialysis Center . The natural fistula rate was 91%, grafts 7% and CVCps 2%. Between 2000 and 31 March 2004 we prepared 367 VAs. Average patient age was 65 yrs, range 20-90 yrs; 59% male and 41% female. Eighty-eight percent of operations were performed by the nephrologist (distal fistula, rescue and cephalic proximal) and 12% by the vascular surgeon (basilic vein transposition, graft in PTFE stretch to the arm and to the groin and permanent catheter in the jugular vein). The fistula with native veins was the better solution, the graft must be prepared after the exhaustion of natural possibilities, and the CVCp, for serious complications (inadequate flow and infections), must be the last alternative.
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PMID:[A good vascular access allows an effective treatment]. 1578 5

The authors of the article analyze the dynamics of the myocardial pumping ability after surgical repair of congenital and acquired heart valvular diseases. Measurement of the intracardial and central hemodynamics allowed the authors to demonstrate the significance of the diastolic component of heart functioning and the subendocardial circulation condition in the development of preclinical heart failure. The study shows a clear interrelation between myocardial functional load and increase of catecholamine concentration in it. An abrupt fall of norepinephrine concentration in the myocardium suggests an extreme overload of the sympathico-adrenal system and its exhaustion, caused by extremal functioning conditions.
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PMID:[Functional condition of the myocardium after reparative heart surgeries]. 1602 8

Changes of blood insulin content were studied in patients with ischemic heart disease with various functional classes of acute and chronic heart failure and at different disease stages. It was established that latent hyperinsulinemia which became evident at induced myocardial ischemia was present on all stages of development of ischemic heart disease. In acute heart failure due to developed myocardial infarction hyperinsulinemia manifested in 58.3% of patients. Amount of insulin in blood increased almost 3 times. During progression of chronic heart failure insulin content significantly decreased, probably because of exhaustion of insulin producing function and development of its relative or absolute deficit. At terminal stage of congestive heart failure insulin level was < or = 1 microU/ml. The authors believe that severity of clinical signs of acute and chronic heart failure are determined by sensitivity of myocardium to insulin, content of insulin in blood, and also depends on compensatory possibilities of insulin producing function at each stage of development of the disease.
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PMID:[Possible role of hyperinsulinemia in pathogenesis of acute and chronic cardiac failure in patients with ischemic heart disease (data of clinical studies)]. 1688 22

B-type natriuretic peptide (BNP) is a neurohormone produced mainly by ventricular myocytes in response to increased left ventricular end-diastolic pressure. Patients with acute decompensated heart failure often have elevated plasma BNP. However, recent clinical observations have demonstrated that in patients with advanced heart failure, the plasma level of BNP is lower than those with acute heart failure. We hypothesized that a lower circulating BNP level in patients with chronic and advanced heart failure is due to the exhaustion of the biosynthesis mechanisms and is associated with a poor outcome in these patients.
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PMID:Low levels of B-type natriuretic peptide predict poor clinical outcomes in patients with chronic and advanced heart failure. 1689 44


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