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

We report a case of a large, B-cell lymphoma of the atria in a 65-year-old man who presented with obstructive right-heart failure, shortness of breath, cirrhosis, and ascites. A computed tomographic scan revealed a large cardiac tumor occupying both atria. The patient underwent debulking of the tumor and postoperative chemotherapy. Six months postoperatively he was alive and his symptoms of obstructive right-heart failure had improved; however, he had developed brain metastasis.
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PMID:Large B-cell lymphoma of the atria. 1263 78

Asthma is common in the elderly population and the differences between younger and older asthmatics should be appreciated (Table 2). Asthma is frequently overlooked in the geriatric population. Objective measures of pulmonary function can aid in a prompt diagnosis and lead to effective treatment and improved quality of life. Because smoking is an important risk factor for asthma-like symptoms of wheezing, cough, and sputum production, asthma is frequently confused with COPD. When airflow obstruction is found, attempts to demonstrate reversibility can uncover an asthmatic component to the disease. In patients who have asthma symptoms and no airflow obstruction, methacholine testing is helpful. When a normal methacholine challenge is present, a diagnosis of asthma can be excluded and the physician can pursue other diagnostic considerations such as heart failure, chronic aspiration syndrome, pulmonary embolic disease, and carcinoma of the lung. The onset of wheezing, shortness of breath, and cough in an elderly patient is likely to cause concern. Although the adage "all that wheezes is not asthma" is true at any age, it is especially true in the elderly. Diagnosis based on objective measures is essential.
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PMID:Asthma in the elderly. 1273 15

Increasing evidence suggests that neurohumoral manifestations of heart failure may lead to insulin resistance, predisposing patients with heart failure to the development of glucose intolerance or worsening of existing diabetes. Theoretically, insulin-sensitizing thiazolidinediones (TZDs) should be beneficial in this patient population. A 74-year-old man with well-compensated systolic dysfunction and longstanding type 2 diabetes mellitus treated with glyburide began therapy with rosiglitazone 4 mg/day, which was increased to 8 mg/day after 1 month. Two weeks later he was seen with a 5-kg weight gain, shortness of breath, bibasilar rales, +S3 gallop, and increased jugular venous distention. Twelve days later symptoms worsened, with pulmonary edema on chest radiograph, continued weight gain, and +4 pitting edema resistant to oral diuretics. The patient was admitted to the hospital for exacerbation of heart failure. Five days after discharge he was readmitted for similar symptoms, including an 11.8-kg weight gain. He reported adherence to drug therapy and diet. Rosiglitazone was immediately discontinued and 11 days later the man's weight stabilized to 79 kg and remained between 79 and 80 kg 2 and 3 months after discharge. This case demonstrates that TZDs may precipitate weight gain and pulmonary and peripheral edema in patients with stable heart failure. Earlier reports documented similar symptoms in patients without a history of heart failure. Although current recommendations state that TZDs should not be administered to patients with New York Heart Association class III or IV disease, practitioners should be aware that these adverse effects also may occur in patients with milder forms heart failure as well as those without heart failure.
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PMID:Possible heart failure exacerbation associated with rosiglitazone: case report and literature review. 1288 8

In order to assess practicability and safety of simple autonomic tests in survivors of acute phase of myocardial infarction (MI) attempts to carry out active orthostatic test, tests with controlled breathing (6 and 15 breaths per min), and Valsalva maneuver were performed in 210 patients on days 4-11 of MI. All patients had no signs of severe heart failure, were in sinus rhythm and did not interrupt standard therapy which included beta blockers. Tests were not completed in 14 patients (4.8%): orthostatic test in 6 due to hypotension, Valsalva maneuver in 3 because they did not reach required pressure in respiratory airways, and controlled breathing in 6 because of shortness of breath and substernal pain. All symptoms disappeared spontaneously and none of them was accompanied by ECG changes. All other tests were successfully completed without complications. Thus simple autonomic tests used in this study can be safely carried out in most stable patients on days 4-11 of MI.
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PMID:[Autonomic tests in survivors of acute phase of myocardial infarction. Feasibility, tolerance, and safety]. 1289 Dec 94

A patient with a two-year history of worsening asthma presented with chest pain and shortness of breath. She developed cardiogenic shock. Analysis of blood chemistry detected increased troponin I concentration. Her electrocardiographic changes were consistent with a diagnosis of anteroseptal myocardial infarction. However, angiography showed normal coronary arteries. Left ventriculography showed severe mitral regurgitation and global hypokinesis. Peripheral eosinophilia was detected. Subsequent endomyocardial biopsy showed myocarditis with prominent eosinophil and plasma cell components. Churg-Strauss syndrome was diagnosed based on her history of asthma, evidence of peripheral eosinophilia and results of endomycardial biopsy. Treatment with a high dose of corticosteroids was initiated. As symptoms of heart failure improved - without recurrence of cardiac and respiratory symptoms - the dose of corticosteroids was gradually reduced. Eight months after her original presentation, she developed urticarial lesions on her abdomen and legs, with muscle soreness but no other associated symptoms. She was treated with a combination of prednisone and dapsone. After the diagnosis of Churg-Strauss syndrome, the patient remained symptom free with a normal ejection fraction for 15 months while taking prednisone.
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PMID:Churg-Strauss syndrome with myocarditis manifesting as acute myocardial infarction with cardiogenic shock: case report and review of the literature. 1453 45

The natriuretic peptides (NPs), through their diuretic, vasodilatory and anti-mitogenic properties, play an important role in the regulation of cardiovascular, renal and endocrine homeostasis. Recent studies suggest that they have utility in both the diagnosis and management of heart failure. Plasma brain NP (BNP) levels have been used to establish prognosis in patients with heart failure and those at risk for heart failure post-myocardial infarction. They have been used to establish a cardiac etiology for acute shortness of breath, and to guide and assess the efficacy of therapy in patients with established heart failure. BNP is also approved for use in the management of acute decompensated heart failure. Of note, recent studies suggest that cardiac NPs suppress myocyte hypertrophy and interstitial fibrosis in the heart, arguing for an important autocrine-paracrine role of these peptides in controlling the cardiac response during hypertrophy. Therefore, the existing evidence supports a role for BNP as both a marker and a modulator of hypertrophy.
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PMID:Natriuretic peptides: markers or modulators of cardiac hypertrophy? 1458 Jul 60

Heart failure is a chronic disabling problem afflicting a growing number of adults. These individuals experience episodes of exacerbation demonstrated by increasing shortness of breath, fatigue, and fluid retention. The symptoms often develop in a slow and insidious manner making perception of worsening difficult to determine. Theoretically, an increase in body awareness may help individuals recognize symptoms of worsening heart failure earlier, but it is not known whether increased body awareness leads to somatization, an abnormal dwelling on body symptoms. This study was conducted to describe body awareness in 90 persons with heart failure or after transplant. We found that the Body Awareness Quesionnaire was a reliable measure of this concept in this sample. When body awareness was examined for age, gender, and treatment (HF or transplant) group were examined, no significant differences were found. Furthermore, there were no significant relationships between body awarenss and negative moods such as anxiety, depression, or anger. Interventions to enhance body awareness may be a fruitful new direction that will improve symptom recognition without increasing somatization in persons with heart failure.
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PMID:An exploratory study of body awareness in persons with heart failure treated medically or with transplantation. 1499 80

The end of life for patients with end-stage heart failure is often characterized by pain, shortness of breath, and diminished quality of life, indicating a lack of adequate care necessary for patients to experience a good death. The vast majority of those who die from heart failure are 65 or older and potentially eligible for the Medicare Hospice Benefit. Yet, only about 10% of patients with end-stage heart failure actually enroll in hospice programs. Lack of enrollment into hospice has been attributed to a variety of factors including a lack of understanding of the availability of hospice as an option for those with heart failure. While improving models of care for patients with heart failure has been of great interest during the last two decades, little is known about the benefits of hospice as a model for care in patients with end-stage heart failure. Nursing must participate in research that explores options of either improving current models of care or developing new and improved models of care for patients with heart failure.
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PMID:Hospice as an alternative model of care for older patients with end-stage heart failure. 1499 85

Heart failure accounts for more hospitalizations among Medicare beneficiaries than any other condition. Its symptoms, including shortness of breath, fatigue, and edema, can be frightening and diminish quality of life. Although treatment advances have allowed patients to live longer with a better quality of life, heart failure remains a leading cause of death in the United States. Half of heart failure patients die within 5 years of diagnosis, and for many patients, death is sudden. Given the availability of effective treatments, the prevalence of distressing symptoms, and a persistent high risk of death that may occur suddenly, physicians must simultaneously treat the underlying condition while helping patients plan for future needs and complete advance directives. Using the case of Mr R, a 74-year-old man with heart failure, we illustrate ways that physicians can address these issues to improve the care of patients with heart failure, including symptom management and discussing advance directives, prognosis, and hospice care. By combining optimal medical management with palliative care, physicians can best care for heart failure patients and their families.
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PMID:Palliative care for patients with heart failure. 1547 40

Natriuretic peptides have proved useful in the diagnosis of heart failure in patients presenting to the emergency department with shortness of breath. Dyspnea and orthopnea in heart failure are clinical expressions of pulmonary capillary congestion and leakage, which may be assessed by the percentage of pulmonary hemosiderin-laden macrophages (HLM) in induced sputum. We found a significant difference in the percentage of HLM present in sputum among patients with acute heart failure, patients with noncardiac dyspnea with ventricular dysfunction, and patients without heart failure (p = 0.008). N-terminal pro-brain natriuretic peptide (N-BNP) concentrations were also different among these 3 patient groups (p = 0.006). N-BNP concentrations were positively associated with the percentage of HLM in patients with acute dyspnea (r = 0.6; p < 0.0001). N-BNP, in addition to being a ventricular dysfunction marker, may reflect the severity of pulmonary capillary congestion and leakage in patients with acute shortness of breath.
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PMID:N-terminal pro-brain natriuretic peptide reflects pulmonary capillary leakage in patients with acute dyspnea. 1534 7


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