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

Verapamil, a calcium antagonist, has been used extensively for treatment of cardiac arrhythmias. Concern persists, however, that it may seriously depress myocardial function in cardiac patients. To investigate this possibility, 20 patients with coronary artery disease (CAD) but no heart failure were given intravenous verapamil (0.1 mg/kg bolus, followed by 0.005 mg/kg/min infusion), and studied hemodynamically and angiographically. Verapamil markedly lowered mean aortic pressure (94 +/- 17 to 82 +/- 13 mm Hg, p less than 0.0005) and systemic vascular resistance (1413 +/- 429 to 1069 +/- 235 dyn-sec-cm5, p less than 0.0005). Simultaneously, all indices of left ventricular (LV) performance greatly improved: cardiac index rose from 2.8 +/- 0.6 to 3.1 +/- 0.7 1/min/m2 (p less than 0.0005), mean velocity of circumferential fiber shortening increased from 0.85 +/- 0.39 to 0.97 +/- 0.46 circ/sec (p less than 0.01), and ejection fraction improved from 55 +/- 16 to 61 +/- 18% (p less than 0.01). No significant changes were noted in the heart rate before and after verapamil administration, and verapamil did not worsen the extent of LV asynergy in the majority of patients. In patients with CAD, the intrinsic negative inotropic effect of verapamil is of negligible importance because its potent vasodilatory properties more than compensate for any intrinsic decrease in LV contractility, and thereby improve the overall cardiac function.
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PMID:Effects of verapamil on myocardial performance in coronary disease. 36 90

The widespread use of cardiac ventriculography has focused interest on the frequency with which asynergy accompanies coronary heart disease as well as on its clinical and prognostic implications and dynamic nature. Recently, "intervention ventriculography" using nitroglycerin or postextrasystolic potentiation has indicated that asynergic zones may be more accurately classified as reversible (implying viable myocardium) or irreversible (nonviable or scarred myocardium), and thus the ventriculographic definition of aneurysm must reflect not only the severity of asynergy but its contractile reserve. Surface electrocardiogram Q waves, the severity of asynergy, and degree of coronary occlusion all adversely affect the potential for reversibility, whereas coronary collaterals enhance it. Important clinical applications include assessment of the potential utility of coronary bypass surgery in improving asynergy and of vasodilators in the treatment of patients with left ventricular failure. With refractory sequelae of aneurysms (heart failure, ventricular tachyarrhythmias, and systemic emboli) and a discrete aneurysm, surgical resection has been increasingly used with generally good results.
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PMID:Asynergy in coronary heart disease. Evolving clinical and pathophysiologic concepts. 41 Mar 36

The results of serial echocardiographic examination of 51 patients with primary myocardial infarction are discussed. Echocardiography was performed on the 1st, 3rd, 5th, 7th, 10th, and 20th days of the disease and before discharge. Thirty patients had infarct of the anterior wall and 21 of the posterior wall. The dynamics of left ventricular asynergy, end diastolic index, and volume/pressure coefficient suggested by Corya et al. were studied. The findings were compared with the indices of 20 healthy persons. The indices of regional and general contractile function of the left ventricle grew worse beginning with the first hours of the disease, the changes were most marked on the 3rd day while in cases with a fatal outcome they progressed or did not change. In cases with a fatal outcome they progressed or did not change. In cases with a favourable outcome, the indices improved gradually, first the volume/pressure coefficient and later the end diastolic index. The zones of asynergy disappeared before discharge in only 5 patients. Differences were found depending on the presence and severity of cardiac insufficiency and the localization of the myocardial infarction.
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PMID:[Serial echocardiographic studies of the function of the left ventricle in acute myocardial infarct]. 45 36

A comparison was performed between the echocardiographic (EchoC) indices for the pump and contraction function of left ventricle and the stage of left-ventricle insufficiency, determined according to clinical criteria of 82 patients with ischemic heart disease (IHD)--old myocardial infarction and (or stable angina pectoris without left-ventricle infarction and for stable angina pectoris without left-ventricle aneurysm. With IHD, regardless of the considerable asynergy of left ventricle, some of the functional EchoC-indices were established to preserve their diagnostic values and definitely to differentiate the majority of the cases with, from those without, cardiac insufficiency, objectivizing the determination of initial left-ventricle insufficiency. The most significant diagnostic value of EchoC-assessment of left-ventricle function in IHD has the following complex of EchoC-indices: diastolic extent, left ventricle index resp, expulsion fraction (EF), shortening fraction (FS), average velocity of circumferential fibres (VCF), distance between point E of mitral echogram and interventricular septum (S-E distance), telediastolic interval A-C of mitral echogram and extent, index of left auricle, resp.
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PMID:[Echocardiographic evaluation of left ventricular function in ischemic heart disease (IHD)]. 52 71

In order to evaluate the effects of rapid digitalization on LV volumes, ejection fraction, and asynergy, 21 patients without heart failure were studied with a combination of hemodynamic and angiographic techniques before and after administration of intravenous ouabain (0.007 mg./Kg.). Seven patients had no CAD and served as normal (control) subjects (Group I), while 14 patients had extensive coronary disease (Group II). All pre-ouabain parameters were within the normal limits in Group I. After ouabain infusion, all indices of LV contractility: dP/dt, VCF, and ejection fraction rose significantly in the normal group, while LV filling pressure and end-diastolic volume remained unchanged. The baseline hemodynamic and volumetric values for Group II patients corresponded closely to their normal (Group I) counterparts, and exhibited similar changes after ouabain administration. Eight patients in Group II also had regional disorders of LV contractility, delineated by 23 abnormal hemiaxes of shortening. After ouabain, 15 out of 23 asynergic segments (65 per cent) improved, seven remained unchanged, and one worsened. It is therefore concluded that rapid digitalization not only enhances LV performance in normal subjects and in patients with CAD, but can also markedly reduce the extent of LV asynergy.
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PMID:Effects of rapid digitalization on total and regional myocardial performance in patients with coronary artery disease. 68 6

The presented analysis deals with the physiopathological mechanisms of the debelopment of postinfarction cardiac insufficiency and the clinical peculiarities of its manifestations. It is emphasized that the leading cause of cardiac insufficiency consists in a reduction of the contractile function of the left ventricular myocardium due to the development of asynergy in the cicatrical zone. The addition of several accompanying factors, such as heart mitralization, tachysystolic form of ventricular fibrillation, repeated infarction with a growing asynergic zone, aggravate the course of cardiac insufficiency providing for the development of hypertension in the general circulation system.
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PMID:[Cardiac insufficiency in ischemic heart disease]. 78 66

The paper presents the results of an examination of 62 patients with postinfarction cardiosclerosis by means of echocardiography and ultrasonic scanning. The impact of the asynergy zone on the development of cardiac insufficiency was studied with reference to the area of myocardial lesion. Myocardial hyperkinesia is characterized, its compensatory effect in postinfarction cardiosclerosis and arterial hypertension is discussed. The effect of Inderal and Ildomen on both the zones of hyperkinesia, and on the indices of cardiac haemodynamics as a whole is described.
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PMID:[Importance of myocardial asynergy zones in the development of cardiac insufficiency]. 101 9

The relationship was examined between the severity of heart failure, the degree of asynergy and exercise tolerance in 40 males under 60 years with postinfarction cardiosclerosis. Fifteen healthy males were matched for as a control. Echocardiography was performed before and after bicycle ergometer exercise test, allowing the patients to be divided into 4 groups: Groups 1 and 2 without an ischemic response in the absence or presence of akinesia or dyskinesia, respectively; Groups 3 and 4 with an ischemic response in the absence or presence of akinesia or dyskinesia, respectively. The lowest exercise tolerance was observed in Group 4. Echographic findings showed that the overall left ventricular contractility was diminished in all the patients; there was no noticeable quantitative difference in the values between the groups. No differences were found in segmental ejection fractions. The combination of ischemic response to exercise tolerance and akinesia-dyskinesia asynergy indicates a more severe disease of the coronary bed and myocardium.
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PMID:[Cardiac contractility in males with post-infarction cardiac sclerosis as evidenced by ultrasonic scanning]. 180 64

The aim of this study was to assess if in patients with acute myocardial infarction, two-dimensional echocardiographic asynergy index is correlated to hemodynamic parameters. Furthermore, we compared how reliable the 2 methods are to identify patients at a high risk of developing early left ventricular failure. Fifty-four consecutive patients (43 males, 11 females, mean age: 61 +/- 13 years with acute myocardial infarction were studied using hemodynamic monitoring and 2D-echocardiography within 24 hours from admission. The 2D-echo asynergy index, calculated on a 14-segment left ventricular model, was significantly correlated to heart rate (r = 0.49, p less than 0.001), pulmonary capillary wedge pressure (r = 0.47, p less than 0.001), systemic vascular resistance (r = 0.47, p less than 0.001), cardiac index (r = -0.46, p less than 0.001) and left ventricular stroke work index (r = -0.63, p less than 0.001). Both the asynergy index and the hemodynamic parameters were correlated to Killip clinical classification. In the sub-group of 46 patients initially classified as belonging to Killip class I or II, the patients who later developed left ventricular failure or those in whom it worsened showed a higher asynergy index and a greater impairment of left ventricular function when compared to the patients with an uncomplicated clinical course. The sensitivity of an asynergy index greater than or equal to 1 in predicting early cardiac failure was 75%, the specificity was 64%, the positive predictive value was 43% and the negative predictive value was 88%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Comparison of two-dimensional echocardiography and hemodynamic monitoring in acute myocardial infarct]. 208 3

Echocardiography was used to explore regional myocardial contractility in 92 patients with postinfarction cardiosclerosis complicated by heart failure developed in the late postinfarction period. All the patients were shown to display regional myocardial contractile dysfunctions as hypo-, a-, and dyskinesia accompanied with hyperfunction of intact myocardial segments. The most severe asynergy was present in anterior postinfarction scars. Peripheral vasodilators were found to improve contractility in the hypokinetic and intact areas of the myocardium.
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PMID:[Effect of peripheral vasodilators on the local contractile function of the myocardium in patients with post-infarction cardiosclerosis]. 306 64


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