Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Deviation of systolic time intervals (STI) from the regression lines obtained from 122 normal subjects was studied in 22 healthy adults (Group 1), 18 N.Y. functional class I cardiac patients (Group II) with ischemic (IHD) or primary myocardial disease (PMD), and 15 similar patients (pts) but N.Y. functional class II with prior heart failure (Group III). STIc (corrected for heart rate) were normal in Groups I and II. Supine exercise caused shortening of pre-ejection period PEPc and prolongation of left ventricular ejection time ETc in both groups. Group III pts had a significantly longer PEPc and shorter ETc at rest. Supine exercise caused further prolongation of PEPc and a slight prolongation of ETc in this group. In 8 mongrel dogs, the effect of controlled changes of hemodynamic variables on STI was studied with intact hearts and repeated after myocardial impairment has been induced by pentobarbital. Doubling of venous return while the heart was intact produced changes in STI similar to the effects of supine exercise in Groups I and II human subjects. With myocardial impairment, comparable increase in venous return had an effect on STI similar to the effect of supine exercise Group III patients. Controlled increase in each of heart rate or blood pressure, with other hemodynamic variables kept constant, produced changes in STI different from the effect of supine exercise on human subjects. The study suggests that the value of supine exercise induced changes in STI in reflecting left ventricular performance is attributable primarily to increased volume load. In this resepct supine exercise is probably superior to other forms of exercise in disclosing impaired left ventricular performance.
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PMID:Relationships of left ventricular systolic time intervals with hemodynamic variables in intact and failing hearts. 115 97

The relationship between changes in cyclosporin (CyA) dose or CyA blood concentration and the reciprocal creatinine concentration was investigated by cross-correlation analysis over the first 3 postoperative months in 32 consecutive heart and heart-lung recipients. Exploratory analysis suggested that early changes in renal function, probably attributable to recovery from preoperative cardiac failure, obscured later underlying correlations. Therefore, all data up to the first nadir in plasma creatinine following transplantation were excluded from the analysis. Five-day mean CyA doses or blood concentrations were cross-correlated with 5-day mean reciprocal creatinine concentrations measured either in the same 5-day period or with the creatinine measured up to two 5-day periods later. Although a significant correlation was found between CyA dose and blood concentration (the 95% confidence interval of the population correlation coefficient did not overlap zero), there was no relationship between dose and changes in renal function. The blood CyA concentration, however, correlated significantly with the reciprocal creatinine concentration measured in the same 5-day period and was also predictive of changes in creatinine measured in the subsequent 5-day period. Thus, a major criterion for therapeutic drug monitoring had been fulfilled: CyA dosage adjustment based on blood CyA concentrations, as the intermediate therapeutic end point, is helpful in the management of acute nephrotoxicity in heart and heart-lung transplant recipients because of the lack of a dose-effect relationship. Regular CyA monitoring and appropriate dosage adjustment is essential for the management of acute nephrotoxicity in the first 3 months following heart or heart-lung transplantation.
Ther Drug Monit 1992 Aug
PMID:Blood cyclosporin concentrations but not doses correlate with acute changes in renal function following heart and heart-lung transplantation. 151

During the period from 1984-1991 in the Institute of Clinical and Experimental Medicine 72 orthotopic transplantations of the heart were performed in 71 patients with irreversible cardiac failure. Indication for transplantation in 39 patients was IHD, in 28 cardiomyopathy, in 3 RHD and in one instance a tumour. The mean age of the patients was 41 years, the youngest patient was 17 and the oldest 62 years old. Immunosuppression involved a combination of three preparations Azathioprine, corticoids and Cyclosporine A. Nineteen patients died within one month after operation. The most frequent cause of death was cardiac failure. As to postoperative complications, renal failure was most frequent. Fifty patients were followed-up on a long-term basis. The longest survival period was 8 years and 2 months. The most frequent cause of death in the long-term follow-up was sudden death caused in the majority most probably by rapid development of coronary disease.
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PMID:[Personal experience with heart transplantation]. 152 82

This paper describes work to develop a model-based system to support clinical decision-making. In previous articles, we have developed (from 695 measurement sets obtained from 148 patients) a physiologic state classification based on a set of 11 cardiovascular and metabolic measurements. There is an R or reference state, for stable ICU patients. Patients under (operative, traumatic, or compensated septic) stress, or with (septic or hepatic) metabolic, respiratory, or cardiac insufficiency are in the A, B, C, or D states, respectively. We wished to make the state easier to measure and eventually available continuously, automatically, and noninvasively, as well as reflecting a wider group of bodily systems. The 5 centers define a 4 dimensional affine subspace, designated the cardiovascular state space. Using eigenvector analysis, we have found four new derived physiologic variables CV1, CV2, CV3, and CV4 that span the state space. We have fit sets of linear regression equations that allow the patient's position in the state space, and therefore his state, to be determined from more easily obtainable sets of measurements. Further, we selected 1966 measurement sets from 512 patients at two hospitals. We used the data from 250 of these patients to define 13 prototypical types, namely survivors and deaths from various combinations of sepsis, cardiogenic decompensation, cirrhosis, and pneumonitis, following trauma or general surgery. For any future patient, the statistical theory of Bayesian inference allows one to infer back from the measurements observed to the probability of his being of any of these types and of surviving or dying. We used this method to predict the outcome of the other 262 patients, prospectively. Statistically, the predictions of survival or death were not significantly different from the actual. For individual patients, the method predicts a clinical course that closely follows the actual episodes in their history. These results confirm and explain the validity of the concept of the patient state and make the state easier to compute. The patient state and the probability plot together help to stage, select, and evaluate therapy. They do not replace the clinician's judgement, but rather are tools that help the clinician to exercise judgement.
Int J Clin Monit Comput 1990
PMID:Probability and the patient state space. 209 69

A group of 75 patients with a history of myocardial infarction and repeated myocardial infarction were subjected to treatment involving dry carbon dioxide baths. Its results demonstrated normalization of IHD manifestations, such as coronary and heart failure, functional state of the cardiovascular system, its reserve potentialities and adaptation to physical effort. Under the influence of a course treatment with dry carbon dioxide baths hemodynamic parameters of cardiac output (cardiac and stroke volume) underwent favourable changes, rhythm slowed down, diastole became longer and systolic and diastolic arterial pressure decreased. The data obtained substantiate application of dry carbon dioxide baths in the recovery period to I-III functional classes patients with a history of myocardial infarction.
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PMID:["Dry" carbon dioxide baths in treating patients with myocardial infarction at the sanatorium stage of rehabilitation]. 252 25

Verapamil has been shown to be effective in reducing the frequency of episodes of ischemic pain in patients with unstable angina pectoris, and to be more effective than beta-adrenoceptor antagonists in such patients. However, in many patients ischemic symptoms persist despite verapamil therapy. In a group of 33 consecutive patients admitted to the Coronary Care Unit with unstable angina pectoris and treated with verapamil and nitroglycerin, we prospectively tested the hypothesis that plasma concentrations of verapamil were a direct determinant of resolution of ischemic symptoms over the initial 72-h period of admission. During this period, improvement or resolution of symptoms occurred in 23 of the 33 patients. With patients receiving 240 to 320 mg/day of verapamil, plasma verapamil concentrations varied between 8 and 487 ng/ml, rising significantly with increasing duration of therapy. Mean plasma verapamil concentrations were somewhat greater in patients who improved than in those with ongoing or worsening symptoms, but the differences were not statistically significant. Furthermore, no correlation was found between symptomatic status and plasma concentrations of norverapamil, the active metabolite of verapamil. In one patient cardiac failure worsened, possibly attributable to an elevated plasma verapamil concentration (336 ng/ml). We conclude that in this clinical setting there is little place for routine monitoring of plasma verapamil concentrations.
Ther Drug Monit 1988
PMID:Verapamil in unstable angina pectoris: failure to demonstrate a relationship between efficacy and plasma levels. 337 79

In 20 patients with IHD without clinical symptoms of heart failure, diastolic pulmonary artery blood pressure (DPAP) and cardiac index (CI) were studied at rest and during physical load (bicycle exercise in sitting position). The control group consisted of 15 patients without any symptoms of coronary artery or myocardium damage. The patients with IHD exhibited several types of heart reaction to exercise. In 6 of 20 patients reaction of DPAP and CI corresponded to that in normal subjects: at maximal load DPAP did not exceed 16 mm Hg, and CI increased by more than 250%. The contractile function of the left ventricular myocardium in these patients was not disturbed when there was no angina attack. 7 patients with IHD exhibited disturbance of diastolic myocardium relaxation, and 7 more patients had myocardial disfunction of various degrees. Treatment was carried out according to the determined changes in DPAP and CI during exercise.
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PMID:[Diastolic pressure in the pulmonary artery and cardiac output in patients with ischemic heart disease during physical load]. 342 14

The authors worked out the method and formula of indirect determination of the left ventricular and diastolic pressure (LVEDP) on the basis of the determined direct relationship between the diastolic-systolic coefficient (DSC) of the differential chest rheogram (difTPCR) and the LVEDP value measured by direct method in patients with IHD. LVEDP = 18.4x + 5.5, where x = DSC TPCR. It was determined that difTPCR can help to determine the degree of the heart failure and to find out patients with unfavourable prognosis.
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PMID:[Clinical significance of diastolic-systolic coefficients of the tetrapolar chest rheogram in patients with ischemic heart disease]. 342 18

Pulmonary artery (PA) catheterization has been extensively employed in the care of the critically ill and injured patients. As the clinical experience has increased, so has the list of indications and complications. Doubts have arisen as to the appropriateness of PA catheterization and positive contributions to patients care. Consensus can be reached as to the usefulness of PA catheterization in patients with severe shock syndromes, adult respiratory distress syndrome and refractory cardiac failure. Patients who require large doses of vasoactive agents may benefit from assessment of hemodynamics. Patients with minimal disease or easily correctable hypovolemia can be safely managed without PA catheter. Similarly patients with chronic obstructive pulmonary disease and renal failure requiring dialysis rarely need PA catheterization. Since technical, septic and thromboembolic complications can develop in a significant number of patients, cost benefit oriented analysis in various subsets of patients is needed. Diagnostic information derived from PA catheters should be related to the clinical condition and shortcomings and pitfalls of data clearly understood. Various indications and their relevance to patient care is reviewed.
Int J Clin Monit Comput 1986
PMID:Pulmonary artery catheterization--uses and abuses. 378 18

Forty-three patients with dilated cardiomyopathy (DCMP) and 12 patients with ischaemic heart disease (HD) in different stages of heart failure were examined using ultrasound sector scanning and pulsed Doppler echocardiography. The degree of mitral regurgitation was determined semi-quantitatively, according to the distance at which the turbulent blood stream penetrates into the left atrial cavity. The dimensions of the left atrium and auscultatory manifestations are not always a reliable indicator of the degree of regurgitation. The severity of mitral regurgitation depends on the dilatation and reduced contractility of the left ventricle as well as on the dilatation of the mitral annulus. Segmental contractility of the left ventricle was assessed using computer analysis of two-dimensional EchoCG. A characteristic feature of DCMP is not only a diffuse decrease in left ventricular contractility but also its segmental disturbances. These disturbances are in DCMP the same as in IHD, but in patients with DCMP there is no simultaneous occurrence of normokinetic and dyskinetic segments.
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PMID:The use of two-dimensional and Doppler echocardiography in assessing mitral regurgitation and segmental contractility disturbances in patients with dilated cardiomyopathy and ischaemic heart disease. 382 85


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