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

Bundle branch reentrant (BBR) tachycardia is an uncommon form of ventricular tachycardia (VT) incorporating both bundle branches into the reentry circuit. The arrhythmia is usually seen in patients with an acquired heart disease and significant conduction system impairment, although patients with structurally normal heart have been described. Surface ECG in sinus rhythm (SR) characteristically shows intraventricular conduction defects. Patients typically present with presyncope, syncope or sudden death because of VT with fast rates frequently above 200 beats per minute. The QRS morphology during VT is a typical bundle branch block pattern, usually left bundle branch block, and may be identical to that in SR. Prolonged His-ventricular (H-V) interval in SR is found in the majority of patients with BBR VT, although some patients may have the H-V interval within normal limits. The diagnosis of BBR VT is based on electrophysiological findings and pacing maneuvers that prove participation of the His- Purkinje system in the tachycardia mechanism. Radiofrequency catheter ablation of a bundle branch can cure BBR VT and is currently regarded as the first line therapy. The technique of choice is ablation of the right bundle. The reported incidence of clinically significant conduction system impairment requiring implantation of a permanent pacemaker varies from 0% to 30%. Long-term outcome depends on the underlying cardiac disease. Patients with poor systolic left ventricular function are at risk of sudden death or death from progressive heart failure despite successful BBR VT ablation and should be considered for an implantable cardiovertor-defibrillator.
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PMID:Bundle branch reentrant ventricular tachycardia. 1694 49

Syncope in patients with advanced heart failure is a sign of poor prognosis. The cause of syncope in patients with dilated cardiomyopathy (DC) is not fully recognized and may remain elusive even after standardized evaluation. The purpose of the present study was to examine the implication of neurally mediated mechanisms in the pathophysiology of syncopal episodes in patients with DC. Twenty-six patients (21 men, 5 women; mean age 59 +/- 2 years, range 38 to 79) with DC and left ventricular ejection fractions <or=40% were included in the study. Thirteen patients with unexplained syncope or presyncope and a control group of 13 patients without unexplained syncope underwent head-up tilt tests with clomipramine challenge. The 2 groups were matched with regard to age, gender, and left ventricular ejection fractions, and there were no major differences in terms of medication. Heart rate variability analysis and plethysmography of forearm flow were performed during the tilt tests. Blood samples were also drawn for catecholamine measurements. In the group with histories of unexplained syncope, the head-up tilt test results were positive in 11 patients (84.6%). Sympathetic and parasympathetic heart rate indexes were markedly stimulated, while catecholamine concentrations and blood flow changes indicated sympathetic withdrawal during tilting. In the control group, the head-up tilt test results were negative in 12 patients (92.3%). In conclusion, neurally mediated mechanisms seem to be implicated in the pathophysiology of syncope in patients with DC and should therefore be considered in the differential diagnosis of syncopal episodes of unexplained origin.
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PMID:Neurocardiogenic mechanisms of unexplained syncope in idiopathic dilated cardiomyopathy. 1729 3

Patients with hypertrophic cardiomyopathy (HC) can experience exacerbation of exertional symptoms after a meal. The present study was designed to determine the prevalence and clinical correlates of postprandial symptom exacerbation (PPSE) in patients with HC. The records of 558 patients with HC and PPSE data who had undergone echocardiography at our institution from 2002 to 2006 were reviewed. Continuous-wave Doppler velocities were used to determine the left ventricular outflow tract gradient. Left ventricular filling was assessed using transmitral velocity curves. The Minnesota Living With Heart Failure questionnaire was administered to measure symptom limitations. A multivariate regression model was developed to determine the independent correlates with PPSE. Of the 558 patients whose records were reviewed, 189 (33.8%) had PPSE. The patients with PPSE were more likely to experience New York Heart Association class III/IV dyspnea or presyncope. PPSE was associated with greater resting outflow gradients and lower perceived quality of life. In conclusion, patients presenting with severe postprandial symptoms and reduced quality of life should be carefully evaluated for the presence of dynamic left ventricular outflow tract obstruction.
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PMID:Significance of postprandial symptom exacerbation in hypertrophic cardiomyopathy. 2034 18

Pulmonary arterial hypertension is a progressive disease characterized by vascular proliferation and vasoconstriction of the small pulmonary arteries that eventually leads to right-sided heart failure and death. Patients often initially have symptoms such as shortness of breath, fatigue, and edema; later in the disease, presyncope and syncope are common. Patients with progressive pulmonary arterial hypertension despite oral therapy and/or with severe disease typically require treatment with a prostanoid. Inhaled treprostinil (Tyvaso) is a prostacyclin analog indicated for the treatment of pulmonary arterial hypertension to increase walk distance in patients with symptoms classified as New York Heart Association functional class III. Inhaled treprostinil was approved by the Food and Drug Administration in July 2009. This article provides a brief overview of the pathophysiology of pulmonary arterial hypertension and reviews the mechanism of action, key clinical data, and the practical management of inhaled treprostinil in patients with pulmonary arterial hypertension.
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PMID:Inhaled treprostinil for the treatment of pulmonary arterial hypertension. 2213 38

Echinococcus granulosus is a common infestation in sheep and cattle raising countries. Although it is typically encountered in liver and lung, rare cardiac involvement of this infestation has very important clinical complications such as heart failure, valve regurgitation, pericardial effusion-tamponade and arrhythmia. In addition, pericardial infestation is an extremely rare condition of Echinococcus granulosus. Here, we report a case of recurrent pericardial hydatid cyst presenting exertional dyspnea, palpitation and presyncope attacks in a 72-year-old man. The diagnosis of recurrent pericardial hydatid cyst was made by transthoracic echocardiography, computed tomography and surgical history.
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PMID:Extremely rare cardiac involvement: recurrent pericardial hydatid cyst. 2233 75

A 44-year-old male patient with known Becker muscular dystrophy and concomitant non-ischemic dilated cardiomyopathy presented to our department because of worsening heart failure and presyncope. Upon admission, the patient was in New York Heart Association functional class III despite optimal pharmacological treatment; his ECG showed sinus rhythm with left bundle branch block and a wide QRS complex. Non-sustained ventricular tachycardia was recorded during 24-hour Holter monitoring. A complete three-dimensional echocardiographic study was performed and documented the dilatation and concomitant hypertrabeculation of the left ventricle (LV), with severely depressed systolic LV performance (ejection fraction 20%), as well as mechanical dyssynchrony--mainly in terms of intraventricular delay. A biventricular cardioverter-defibrillator (CRT-D) was implanted in this patient, with the LV lead in a lateral vein and the right ventricular defibrillating lead in the apical part of the interventricular septum. Echocardiography-guided device programming was performed in order to achieve the optimal atrio-, inter-, and intraventricular resynchronization. The patient's clinical condition was substantially improved within one month after the implantation.
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PMID:Cardiac resynchronization therapy in becker muscular dystrophy. 2368 62

We report a case of idiopathic nonsustained ventricular tachycardia (VT) originating from the aortic sinus cusp referred for presyncope and LV dysfunction and frequent premature ventricular complex with no response to 3 months anti-arrhythmic medication for heart failure and arrhythmia. She was then referred to us for frequent PVC's and runs of nonsustained VT. ECG recorded during the nonsustained VT showed a left bundle branch block pattern in the precordial leads and an inferior axis and early transition in precordial leads in V3-V4. QS morphology in lead V1 was noticed with notching on the downward deflection. Electrophysiologic study was conducted to map ventricular outflow tract as a classic method, although pace map failed to find any matched QRS with the spontaneous PVCs. The mapping of aortic cusps was also performed. The best potential was recorded in a region located at the commissure of left-right aortic cusps. A single radiofrequency energy was delivered which resulted in immediate elimination of PVCs. The patient was discharged the day after ablation without any PVC recorded on monitor. Left ventricular ejection fraction(LVEF) improved to normal level two months later. There was no PVC detected at serial holter monitoring. It seems logical not to overlook even an isolated or nonsustained ventricular arrhythmia considering the available and effective treatments such as ablation rather than congestive heart failure(CHF) therapy especially in a young patient.
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PMID:Cardiomyopathy due to nonsustained ventricular tachycardia originating from the aortic sinus cusp. 2475 16

Apical hypertrophic cardiomyopathy (ApHCM) is a subtype of HCM. This variant is more common in the Asian population when compared to North American patients. Patients may present with arrhythmias, heart failure, myocardial infarction, chest discomfort, fatigue, and presyncope or syncope. Initial evaluation requires electrocardiogram and two-dimensional echocardiogram. T-wave inversion in the precordial leads as well as hypertrophy of the left ventricle is hallmarks of the disease. Cardiac magnetic resonance (CMR) imaging is the most specific and sensitive imaging modality. In patients with contraindications for CMR, myocardial perfusion imaging (MPI) has been described to have diagnostic characteristics for ApHCM. MPI images demonstrating a "solar polar" map pattern and increased apical tracer uptake in single-photon emission computed tomography horizontally and vertical long-axis slices are consistent with the diagnosis of ApHCM. Herein, we present a case of a Caucasian adolescent female who underwent a cardiac screening to rule out hypertrophic obstructive cardiomyopathy. Initially, the patient was unable to undergo CMR, and an MPI was utilized to assist with the diagnosis of ApHCM.
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PMID:An Uncommon Variant of an Uncommon Disease: A Caucasian Adolescent with Apical Hypertrophic Cardiomyopathy Diagnosed with Myocardial Perfusion Imaging. 2867 Jan 88

Patients with valvular heart disease (VHD) should be treated for diabetes, hypertension, and hyperlipidemia. They also should receive therapy for left ventricular dysfunction, undergo interval echocardiography, and participate in aerobic exercise. Valve replacement should be considered for patients with aortic stenosis (AS) and syncope, presyncope, heart failure, angina, or severe AS with left ventricular dysfunction. Valve replacement is performed with open or transcatheter procedures; the latter are preferred for patients with high surgical risk. Patients with chronic aortic regurgitation (AR) should undergo open surgical replacement if they are symptomatic or are asymptomatic but have severe regurgitation and left ventricular dysfunction. No transcatheter procedures currently are approved for AR. Patients with mitral stenosis (MS) should receive drugs for heart rate control and anticoagulation if they have atrial fibrillation. Invasive treatment involves valve replacement or percutaneous commissurotomy. Management of severe chronic mitral regurgitation consists of valve replacement or, for patients with high surgical risk, a percutaneous transcatheter procedure that clips the mitral leaflets together. When severe, tricuspid regurgitation can be managed with valve replacement. Pregnant patients with VHD require special management. Women with severe AS or MS should avoid becoming pregnant until VHD is managed definitively.
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PMID:Valvular Heart Disease in Adults: Management of Native Valve Disease. 2867 5

Coronary sinus thrombosis is a rare and often overlooked diagnosis that can have fatal consequences. We report a case of acute coronary sinus thrombosis in a patient with systolic heart failure who had undergone recent right-heart catheterization. The patient presented with recurrent presyncope, syncope, and shortness of breath. An echogenic focus consistent with a coronary sinus thrombus was visualized on transthoracic echocardiography that had not been seen previously on recent imaging. The patient was managed on oral anticoagulation. Awareness of patients at risk for coronary sinus thrombosis can lead to early detection via bedside echocardiography and early management.
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PMID:Coronary sinus thrombosis: Echocardiographic visualization in a patient with known risk factors. 2943 Jun 59


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