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

Between 1982 and 1988, we observed 312 patients who were affected by syncope or presyncope and whose spontaneous symptoms could be reproduced by means of carotid sinus massage (CSH); no other definite cause of syncope could be identified. The clinical outcome during a 2- to 8-year follow-up period (mean 44 +/- 24 months) was assessed in 262 of them (mean age, 71 +/- 11 years; 183 men) and was compared with that of a group of 55 patients who were affected by unexplained syncope (control patients) who were matched 4:1 for age and sex with CSH patients. CSH patients had an overall mortality rate of 7.3 per 100 person-years (cardiovascular, 66%; sudden death, 9%); overall predicted cumulative survival rates at 1, 3, 5, and 7 years were 92%, 80%, 66% and 53%. Survival was similar in control patients; mortality rate was 5.8 per 100 person-years (cardiovascular, 82%; sudden death, 18%); cumulative survival rates at 1, 3, 5, and 7 years were 85%, 80%, 73%, and 69%. Standardized mortality rate of the general population with similar age and sex distribution, as calculated by means of Italian Istituto Centrale di Statistica death-rate data (1987 edition) was 8 per 100 person-years. Of 13 clinical variables, age, sex, abnormal electrocardiogram, and heart failure (but not CSH type or related arrhythmias) were independently linked to mortality in CSH patients (Cox model). In the vasodepressor form of CSH, patients were younger than those with other forms of CSH and the percentage of women was higher.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Long-term outcome in symptomatic carotid sinus hypersensitivity. 153 20

The causes, clinical indications and diagnosis and differential diagnosis of cardiac disorders which may lead to cerebral symptoms are illustrated on the basis of a review of the present day level of scientific research. Principally involved are cerebral ischaemias arising from cerebral embolisms or from reduction of cardiac output in cardiovalvular and myocardial disorders. The incidence of all embolisms of cardiac origin makes up 10% of all ischaemic cerebral infarcts, with auricular fibrillation, irrespective of its origin, mitral stenosis, myocardial infarct, mitral insufficiency and combined mitral valve defects, and, in younger patients, mitral valve prolapse, being, in this order of frequency, of primary clinical significance. The other cardiovalvular and myocardial disorders have, in comparison, a relatively low incidence of cerebral embolisms. Haemodynamically induced cerebral ischaemias frequently occur in the form of complications following acute cardiac arrest, in myocarditis and in case of primary cardiomyopathies resulting from cardiac insufficiency or complicating bradyarrhythmia. They are clinically apparent in the form of syncope, and other impairments of consciousness of various levels of seriousness with and without indications of cerebral origin, extending up to coma. In view of the high incidence of 25% of acute cerebral ischaemias in cases of cardiac disease, not only neurological but also detailed cardiological investigation is vital in all cases for a correct diagnosis and for the selection of a suitable course of treatment. Cerebral complications in bradyarrhythmia and endocarditis are discussed in the context of a review of the relevant literature together with consideration of their epidemiology, aetiology, pathophysiology and clinical profile. Pathological sinus-bradycardia, bradyarrhythmia absoluta, sinu-atrial and atrio-ventricular blockages, carotid-sinus and sick-sinus node syndrome, paroxysmal atrial tachycardia, AV-node tachycardias, and auricular fibrillation and flutter, taken as a whole, lead to cerebral complications affected patients in 5 to 10% of afflictions of the central nervous system occur in 50% of patients suffering from complete AV blockage and, at a not precisely definable frequency, in patients suffering from other bradyarrhythmias. In addition to transitory, uncharacteristic symptoms such as dizziness, vertigo, impairment of vision and balance, presyncope, syncope and Adams-Stokes syndrome dominate the clinical profile. Endocarditis, with an incidence of 0.01 to 0.05% in the overall population, results in central nervous system complications in 12 to 25% of cases on average.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:[Heart diseases as a cause of cerebral symptoms and syndromes]. 222 59

We have described six centenarians who have benefited from permanent pacemakers. In all of these patients, their initial symptoms of syncope, presyncope, dyspnea, and transient cerebral ischemic attacks resolved promptly after pacemaker implantation. In most of these patients quality of life, as measured by lifestyle and independence, improved after pacemaker implantation. None of these patients exhibited evidence of ischemic heart disease or cardiac failure. Because of increasing longevity and age-related degenerative and destructive changes in the conduction system and the sinus node, we expect that the number of patients requiring pacemakers in this age group will continue to grow. Ischemic heart disease as an underlying pathology necessitating pacemaker implantation appears to be rare in this age group.
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PMID:Permanent pacemakers in centenarians. 275 61

A 48-year-old man with symptoms of presyncope and congestive cardiac failure had hypertrophic cardiomyopathy (HCM) without obstruction. Complete heart block (CHB), a rare complication of this disease, was preceded by complete left bundle-branch block. Right ventricular (RV) heart failure was a dominant clinical feature but improved dramatically after temporary transvenous RV pacing prompting the insertion of a permanent RV inhibited pacemaker. Repeated ventricular fibrillation was successfully controlled by amiodarone. This is the seventh case of HCM complicated by CHB reported in the literature, and the first in which RV endomyocardial biopsies were undertaken. Two other patients reported in the literature had RV inhibited permanent pacemakers implanted, and a further 2 had atrioventricular sequential pacemakers.
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PMID:Hypertrophic cardiomyopathy complicated by complete heart block. Case report and review of the literature. 654 53

In 17 patients (aged 78 +/- 9 years) with symptomatic atrial fibrillation and a slow ventricular response not related to drugs, a resting electrocardiogram and 24-hour Holter recording were obtained before and 5 to 6 days after administration of slow-release theophylline (700 mg/day), and successively every 3 months during the long-term phase. Fourteen patients had organic heart disease, and 13 complained of syncope or presyncope, and 4 of asthenia and easy fatigability. At the steady-state evaluation, theophylline significantly increased resting heart rate (HR) by 42%, mean 24-hour HR by 31% and minimal 24-hour HR by 34%. Cardiac pauses > 2,500 ms disappeared or markedly decreased. The daily number of wide QRS complexes increased. Serum theophylline level was 13 +/- 5 ng/ml. During the follow-up period (20 +/- 18 months), the mean daily theophylline dosage was 450 mg and the mean serum theophylline level 9 ng/ml. Seven patients died: 1 because of heart failure, and 6 because of noncardiac death. One patient complained of a syncopal episode during 1 visit. The drug markedly reduced asthenia and easy fatigability. During the long-term phase, HR increased spontaneously in 3 patients, and the treatment was interrupted. In 2 patients, theophylline had to be discontinued because of gastric intolerance. During long-term therapy, HR was similar to that observed at the steady-state evaluation, despite the reduction in daily dosage. The data suggest that theophylline is an effective therapy in most patients with symptomatic atrial fibrillation and a slow ventricular response.
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PMID:Long-term effects of theophylline in atrial fibrillation with a slow ventricular response. 823 3

A retrospective analysis of patients with hypertrophic obstructive cardiomyopathy treated by left ventricular myotomy and myectomy from 1972 to 1994 is reported. There were 158 patients (81 male and 77 female) with a mean age of 50.2(+/-17.2) years (range 12 to 80 years). One hundred nine patients (69%) were 60 years of age or younger, and 49 patients (31%) were older than 60 years. The overall mean follow-up period was 6.1(+/-4.8) years (range 0.1 to 19.3 years) and was 94% complete with a cumulative total of 956 patient-years. Preoperative exertional dyspnea was present in 84%, chest pain in 70%, presyncope in 54%, syncope in 31%, and cardiac arrest in 5% of patients. Preoperative cardiac catheterization was done in 150 patients, with mitral regurgitation detected in 104 patients (67%). The average maximal provocable left ventricular outflow tract gradient was 118 (+/-46) mm Hg (range 25 to 250 mm Hg). The average preoperative echocardiographic gradient at rest was 64 mm Hg, 20 mm Hg in the early postoperative period and 10 mm Hg in the late postoperative period. The mean septal thickness was 2.2 (+/-0.6) cm, 1.9 (+/-0.7) cm in the early postoperative period (p < 0.05 vs preoperative) and 1.7 (+/- 0.5) cm in the late postoperative period (p < 0.05 vs preoperative). The overall 30-day operative mortality rate was 3.2% (5/158), and 0% for 109 patients 60 years of age or younger. Causes of death included myocardial infarction and left ventricular free wall rupture, myocardial failure from septal perforation, sepsis, cerebrovascular accident caused by thromboembolism, and delayed cardiac tamponade in one patient each. Concomitant coronary artery bypass grafting was performed in 22 patients (19.3% of patients > or = to 40 years of age) and mitral valve replacement in 5 patients (3.2%). One hundred nine patients (69%) are alive, 10 patients (6.3%) were lost to follow-up, and 39 patients died (24.7%), including operative deaths). Actuarial survivals at 1, 5, 10, and 15 years were 92.4% +/- 2.2%, 85.4% +/- 3.1%, 71.5 +/- 4.6%, and 46% +/- 9%, respectively. The overall linearized death rate for discharged patients was 1.9%/pt-yr, and for cardiac related deaths it was 1.7%/pt-yr. Thirty-nine (36%) of the 109 survivors received beta-adrenergic blockers, and 30 (28%) received calcium channel blockers. Ninety-four patients had improvement in New York Heart Association functional class, 10 had improvement in symptoms but not in functional class, and 5 had no improvement in functional class or symptoms. Neither preoperative hemodynamic values nor routine echocardiographic measurements significantly correlated with quality of postoperative results. Left ventricular myotomy and myectomy is a safe and reproducibly effective operative treatment for medically refractory hypertrophic obstructive cardiomyopathy, especially for patients 60 years of age or younger. Improvement in functional class and symptoms can be expected in nearly all patients 60 years of age or younger. Improvement in functional class and symptoms can be expected in nearly all patients. The results of myotomy and myectomy serve as a standard for comparison with other interventions for medically refractory cardiomyopathy.
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PMID:Long-term results of left ventricular myotomy and myectomy for obstructive hypertrophic cardiomyopathy. 860 73

There has recently been an increasing interest in beneficial effects of cardiac pacing in patients with myocardial diseases, especially in Obstructive Hypertrophic and Dilated Cardiomyopathy. The experience with dual-chamber pacing for obstructive hypertrophic cardiomyopathy is now important. DDD pacing for sinus rhythm patients and VVI pacing in patients with atrial fibrillation have shown considerable symptomatic improvement, with a significant decrease of angina, dyspnea, presyncope and frank syncope. It has been suggested that DDD pacing may prevent sudden death and improve survival rates in these patients, but this has not yet been established. The experience with DDD pacing in dilated cardiomyopathy is more limited, but in specially chosen patients, DDD pacing with short AV delay has shown symptomatic improvement and a decrease in the need for further hospitalization due to worsening of heart failure. There is no current evidence of higher survival rates with this treatment, but DDD pacing may be used in patients with end-stage dilated and isquemic cardiomyopathy who are waiting for a heart transplantation.
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PMID:[Impact of electric cardiac stimulation on ventricular function and the natural history of patients with myocardiopathy]. 875 4

An update of studies on the natural history of congenital complete AV block is presented. A risk for heart failure, syncope, and sudden death is present at any age including fetal life. Unfavorable prognostic signs in utero are low and decreasing ventricular rate (VR), hydrops, AV valve regurgitation, and low aortic flow velocity. Indications for pacing in infancy are congestive heart failure, ventricular rate < 55 beats/min in isolated block and < 65 beats/min with associated disease, prolonged OTc, syncope attacks, frequent ventricular ectopic beats, and alternating ventricular pacemakers. Indications for immediate pacing in childhood and adult life are syncope, presyncope, VR rates lower than median for age, periods of junctional exit block, prolongation of QTc and mitral regurgitation, and change of ventricular pacemaker. Pacing is recommended to all patients older than 15 years.
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PMID:Natural history of congenital complete atrioventricular block. 927 17

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heart muscle disease of unknown cause. It can cause both cardiac arrhythmia and heart failure or sudden death. As such patients typically will present to one of three groups depending upon the symptoms at presentation: the pathologist, the physician or the arrhythmologist. Typically a young patient who presents with presyncope or syncope may be investigated by an electrophysiologist and have ventricular tachyarrhythmias. Sadly some young individuals with ARVC may present to a pathologist with sudden cardiac death. Those that survive repeated bouts off arrhythmia and/or some individuals with primary heart failure may initially present to general physicians/cardiologists. With the introduction of molecular genetic studies a wider spectrum of disease manifestation has become apparent for Hypertrophic cardiomyopathy (HCM). Different clinical forms of ARVC have been described as having different genetic loci possibly reflecting phenotypic and genetic heterogeneity. Genetic studies have highlighted the difficulties of variable and age-related penetrance for HCM this appears to also be true of ARVC. From the various perspectives it can be seen that ARVC encompasses a complex and variable disease. Over the last decade ongoing research has allowed a much greater understanding of ARVC. Initially arrhythmia was highlighted as the primary disease manifestation, but it has been shown ARVC is a progressive disease, which may present with heart failure or sudden death. As research continues to unravel the complexities of both genetic and environmental factors responsible for variable disease presentation and modification, improvements should also be possible in terms of diagnostic specificity and therapy.
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PMID:Arrhythmogenic right ventricular cardiomyopathy: perspectives on disease. 1050 90

Two men aged 47 and 56 and one woman aged 21 presented at our cardiology department with presyncope, heart failure and exercise induced palpitations, respectively. Using the criteria of McKenna et al., a diagnosis of arrhythmogenic right-ventricular cardiomyopathy (ARVC) was made. Following implantation of a defibrillator, one of the men experienced seven appropriate interventions within six months and also developed psychological problems. The other man was problem-free and the woman recovered reasonably well, having only one appropriate intervention from the defibrillator one year after implantation. Indications of ARVC were also found in her mother but not in any other family members. Because ARVC manifests itself in various different ways it is difficult to diagnose. It is important to consider ARVC in patients with exercise-induced palpitations, presyncope, and unexplained cardiomyopathies or arrhythmias, especially if there is a family history of unexpected deaths. ARVC is a potentially life-threatening disease, that may require implantation of a cardioverter defibrillator. Furthermore, since genetics play an important role and ARVC can be asymptomatic, evaluation of close relatives for preclinical symptoms is important.
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PMID:[Arrhythmogenic right-ventricular cardiomyopathy: different manifestations as precursors of sudden death which might be prevented]. 1561 76


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