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

In a study designed to investigate potential non-parenteral treatment for chronic heart failure, hydrallazine, 225 to 300 mg per day, was given orally to 9 patients. There was no significant change in heart rate or mean arterial pressure as cardiac output increased. Left ventricular stroke work increased significantly and pulmonary artery wedge pressure fell. Systemic and pulmonary vascular resistances fell. With the addition of 2 per cent glyceryl trinitrate paste, there was a further decline in mean pulmonary arterial and wedge pressures, without a significant change in heart rate, arterial pressures, cardiac output, or systemic or pulmonary vascular resistance. There were no untoward effects from either form of treatment. All patients reported relief of shortness of breath and other symptoms related to ventricular dysfunction. This study supports the suggestion that oral hydrallazine is effective in increasing cardiac output and decreasing pulmonary congestion. Furthermore, the addition of topical glyceryl trinitrate provides a greater reduction of pulmonary pressures, probably through its predominant venodilator action. In some selected patients with heart failure, oral hydrallazine and topical glyceryl trinitrate in combination produce beneficial clinical and haemodynamic effects, probably through afterload and preload reduction, respectively.
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PMID:Haemodynamic effects of hydrallazine and of hydrallazine plus glyceryl trinitrate paste in heart failure. 9 55

It has been shown that hydralazine is beneficial in chronic heart failure by virtue of its afterload reducing effect. Nitroglycerin paste results in venodilation and fall in left ventricular filling pressure (LVFP). Thirteen patients with chronic heart failure were given a combination of oral hydralazine and nitroglycerin paste. With oral hydralazine (75 to 100 mg every 8 h), left ventricular stroke work increased and LVFP slightly fell. Following addition of 2% nitroglycerin paste, an additional decline in mean pulmonary artery and LVFP was observed without significant changes in heart rate and arterial pressure. There were no untoward side effects from either therapy. Eight patients followed for three to eight months (mean five months) reported subjective improvement in shortness of breath and other symptoms related to ventricular dysfunction. This study shows that in certain patients with chronic heart failure, hydralazine and nitroglycerin paste combination produces salutary clinical effects on long term probably through afterload and preload reduction, respectively.
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PMID:Non-parenteral combined afterload and preload reduction therapy in congestive heart failure. 11 91

Chronic heart failure is a common clinical condition with a high mortality and morbidity. Patients with the condition suffer from shortness of breath and fatigue on exercise. This article reviews the recent advances made in the understanding of the pathophysiology of chronic heart failure and explores further possible research options.
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PMID:The mechanisms underlying the increased ventilatory response to exercise in chronic stable heart failure. 128 2

A case of peripartum cardiac failure is reported in a 20-year-old gravida 3, para 3 black female. The patient was 6 weeks postpartum. Graves' disease had been diagnosed in the first trimester of her pregnancy. The patient presented to the emergency department with complaints of fever, abdominal pain, shortness of breath, and chest pain. Physical examination revealed signs of congestive heart failure and anasarca. Chest x-ray revealed bilateral pleural effusions, and an abdominal series was consistent with ascites. Bedside electrocardiogram revealed pan-hypokinesis of all four cardiac chambers. The authors believe that this is the first case reported in the literature of peripartum cardiac failure occurring in a patient with Graves' disease.
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PMID:Peripartum cardiac failure in a woman with Graves' disease. 173 15

A 66-year-old man with an ECG finding of an elevation of R in leads V5-6 and a calcified space occupying lesion in the apex of the left ventricle on echocardiography admitted for the evaluation of recent onset of shortness of breath and palpitation on exertion. Cineangiography showed an obliteration and accumulation of RI activity in the apex of the left ventricle on TI-201 scintigraphy and a neoplasm of the heart was suspected. Resection of a tumor from apical incision followed by the left atrial approach necessitated the replacement of mitral valve and confirmed the diagnosis of endomyocardial fibrosis. Heart failure persisted and the expired 2 years after surgery due to the gastrointestinal infection. An experience suggested the resection of a mass from the left atrial approach is possible and recommended to prevent the occurrence and persistence of heart failure in case the diagnosis is established preoperatively.
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PMID:[The surgical treatment of endomyocardial fibrosis of the left ventricle--the first surgical case report in Japan]. 237 98

The effect of intravenous nisoldipine (0.12 microgram/kg/min) on diastolic left ventricular (LV) dysfunction was studied from simultaneous hemodynamic and radionuclide measurements in 12 patients with New York Heart Association class II to IV cardiac failure. The initial LV filling fraction was low, the peak LV filling rate normalized for end-diastolic volume was decreased, and the pulmonary capillary wedge pressure (PCWP) was high and associated with clinical shortness of breath. Nisoldipine produced an increase in LV filling fraction from 36 +/- 17% to 43 +/- 20% (p = 0.003). The increase in filling took place in both early and late diastole: peak early filling rate (PFR) increased in 11 of the 12 patients (p = 0.02) and late diastolic filling rate (atrial [A] wave in eight of them (NS). When the determinants of these changes, were examined further, it was found that in the control state PFR was inversely related to LV end-systolic volume (r = 0.77), whereas the A wave was related in exponential fashion to PCWP (preload) (r = 0.79). Nisoldipine did not change the slope of these relationships, and it did not alter the end-diastolic pressure-volume relationship, implying that inherent myocardial relaxation and distensibility were unaltered by the drug. In summary, nisoldipine improved measurements of diastolic LV dysfunction in patients with cardiac failure. This study illustrates the importance of considering ventricular loading conditions when analyzing and interpreting measurements of diastolic ventricular dysfunction. The measured changes in diastolic LV function during infusion of nisoldipine appear to be due to alterations in ventricular loading conditions rather than to a direct myocardial effect of the drug.
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PMID:Effect of the second-generation calcium channel blocking drug nisoldipine on diastolic left ventricular dysfunction in heart failure. 277 71

Central venous catheter (CVC) vascular erosions are difficult to diagnose, and they cause serious complications. From 1985 to 1987, ten patients receiving the surgical services at the University of Florida suffered CVC vascular erosions. By chest roentgenogram, nine CVC tips were in the superior vena cava (SVC), although three catheter tips abutted the lateral wall of the SVC. One catheter tip was in the right atrium. All patients had sudden onset of symptoms, the most common of which was shortness of breath. Initial diagnosis was respiratory insufficiency in five patients, cardiac failure in three patients, pulmonary embolism in one, and sepsis in one. Four patients required intensive care. Two patients suffered pericardial tamponade, and pleural effusions developed in eight patients. One patient died of cardiac arrest. The average time interval from CVC placement to onset of symptoms was 60.2 hours, and from the onset of symptoms to the time of diagnosis, the interval was 16.7 hours. The mean volume obtained at thoracentesis was 1324 ml and at pericardiocentesis was 250 ml.
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PMID:Central venous catheter vascular erosions. Diagnosis and clinical course. 293 Feb 92

Severe shortness of breath is a prominent symptom in acute heart failure (pulmonary oedema) and is related to left atrial pressure. A reduction of this pressure almost always leads to an improvement in symptoms. Patients with chronic heart failure complain of both shortness of breath and tiredness even when fluid overload has been corrected by the appropriate use of diuretics. Shortness of breath under these circumstances is not related simply to central haemodynamics but is determined more by the interaction of changes in respiratory pattern and the metabolic consequences of reduced perfusion of exercising skeletal muscle. An important clinical consequence is that when such patients are optimally treated with diuretics, further improvement of symptoms would not be expected from drugs which merely alter central haemodynamics without influencing other factors such as skeletal muscle blood flow on exercise, or lung perfusion.
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PMID:The origin of symptoms in patients with chronic heart failure. 304 95

The most common symptoms of patients with heart failure are shortness of breath and fatigue. The causes of these symptoms may be different in various entities encompassed by the general term heart failure, such as acute pulmonary edema, circulatory collapse and chronic heart failure. In patients with acute heart failure, shortness of breath is closely related to left atrial pressure. In patients with chronic heart failure, optimally treated with diuretics, the body fluid compartments are usually of normal size. Recent work strongly suggests that, in such patients, central hemodynamic abnormalities are not the sole determinants of symptoms. Impaired vasodilation and altered metabolism in skeletal muscle, circulating metabolites and pulmonary ventilation-perfusion mismatch with consequent increased physiologic dead space may all contribute to the genesis of symptoms. Consequently, it may be possible to alleviate symptoms by treatments that are not aimed directly at improving central hemodynamics. Whether such an approach could also modify prognosis is unknown.
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PMID:Causes of symptoms in chronic congestive heart failure and implications for treatment. 329 93

Patients with heart failure should stop smoking, maintain an optimal weight and limit their intake of salt. Alcohol abuse should be avoided. The detection and early treatment of hypertension appears to have had a major impact in preventing heart failure. Diuretics revolutionized the treatment of congestive heart failure and their proper and appropriate use can alleviate peripheral and pulmonary oedema. Diuretics should not be overused and care should be taken to avoid hypokalaemia. Controversy surrounds the use of digoxin in patients in sinus rhythm; the drug should be used in patients in atrial fibrillation. The use of an inotropic drug may be harmful in the presence of coronary artery disease. A reduction in the current use of digoxin might be of benefit to many patients with heart failure. When the drug is prescribed it should be used in a therapeutic and not homeopathic dose. Recent interest has been directed toward the use of vasodilators and the angiotensin-converting enzyme inhibitors in patients with heart failure. In my opinion, these drugs should be used after patients have been treated with thiazide and loop diuretics. Vasodilators are particularly beneficial in acute heart failure or in patients with chronic heart failure when the symptoms are related to fluid overload and volume expansion. The cause of symptoms in patients with chronic heart failure optimally treated with diuretics is controversial. Shortness of breath may not be simply related to the left atrial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Changing ideas in the treatment of heart failure--an overview. 330 Sep 78


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