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

The article describes experiments in animals with laser revascularization of the myocardium and first operations of laser transmyocardial revascularization of the myocardium in man without a combination with operations on the coronary vessels. Operations were performed on 15 IHD patients with the III-IV functional class of cardiac insufficiency. The operations were favourable in all the patients. Immediate and long-term results suggest that this operation can be an alternative to direct interventions on coronary arteries and seems to be the only possibility in patients for whom operations on the heart vessels are not indicated or contraindicated.
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PMID:[Laser transmyocardial revascularization of the myocardium in ischemic heart disease]. 949 May 42

The main problem of treatment of hypertension in this country as well as abroad is the fact that only less than one quarter of hypertensive patients are treated effectively and have thus normal blood pressure readings. More effective treatment of hypertension is thus one of the main tasks of health care systems in different countries. The objective of treatment of hypertension is to achieve a normal blood pressure. Evidence has been provided that diuretics and beta-blockers markedly reduce cerebrovascular and cardiovascular mortality, in particular in the elderly. ACE inhibitors are the drugs of choice in patients with heart failure or asymptomatic left ventricular dysfunction and in patients with diabetic nephropathy. Unsuitable for treatment of hypertension are short acting calcium channel blockers, in particular nifedipine. On the other hand, long-acting calcium channel blockers reduce the cerebrovascular mortality in elderly hypertensive patients. A number of questions still remain the subject of research: a) should diastolic pressure be reduced to values lower than 90 mm Hg; so far it is necessary only in hypertensive subjects with diabetes mellitus and in juvenile hypertensives; b) is the influence of new groups of antihypertensive drugs, in particular calcium channel blockers, similar, better or worse than that of diuretics and beta-blockers in the prevention of cardiovascular and cerebrovascular morbidity and mortality?; c) is it wise to recommend acetylsalicylic acid also to hypertensive patients without clinical signs of IHD or atherosclerotic affection of other vessels?; d) what is the value of combined antihypertensive and hypolipidaemic pharmacological treatment? Will this combination be not much more valuable in the prevention of IHD?; e) is the prognosis of hypertensive subjects with left ventricular hypertrophy better when ACE inhibitors are used as compared with other antihypertensive drugs?; f) do ACE inhibitors influence the prognosis of diabetic patients more favourably than beta-blockers?
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PMID:[Modern trends in the treatment of hypertension]. 953 30

Spirapril, an ACE-inhibitor without the SH group was tested in a randomized double-blind multicentric study in patients with chronic symptomatic heart failure (NYHA II-IV). After a 1-4-week initial stage with placebo the patients were randomized into five groups: the first was given placebo, the second one spirapril 1.5 mg, the third one spirapril 3 mg, the fourth one spirapril 6 mg and the fifth one 5 and later 10 mg for a period of 12 weeks. The number of patients in different groups was in the following order: 48, 48, 53, 51 and 48. The condition for admission into the study was chronic heart failure not responding adequately to treatment with digoxin and diuretics, IHD or dilatation cardiomyopathy with the left ventricular ejection fraction (% tolerating a basic ergometric load for two minutes. The primary criterium was an increment during the period of the load, secondary criteria comprised objective and subjective cardiac symptoms, changes in the left ventricular ejection fraction, cardiothoracic index/heart size and quality of life. The load tolerance increased in all groups, however, no significant differences between groups were found. The authors also found regression of signs of pulmonary congestion during active spirapril treatment and diminution of the cardiac shadow. Moreover the authors proved a significant reduction of the mortality in the actively treated patients as compared with those receiving placebo, a lower frequency of hospital admissions and reduction of serious undesirable cardiovascular symptoms during active treatment. In patients with medium severe and severe cardiac failure with IHD, combination with short acting calcium channel blockers had an unfavourable effect on the load tolerance and clinical parameters. Sprirapril, combined with diuretics and digoxin is a suitable drug also in chronic cardiac failure. Questionable remains the importance of loading tests when verifying the effectiveness of ACE-inhibitors. Treatment with short-time acting calcium antagonists cannot be recommended in symptomatic chronic cardiac failure.
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PMID:[A Czech and Slovak interventional study of spirapril (the CASSIS study). A randomized, double-blind, multicenter, placebo-controlled study in chronic heart failure]. 960 63

Heart failure is a common disease characterised by poor prognosis and frequent hospitalisations, constituting a major economic burden to society. Mortality and morbidity can be reduced by optimal treatment, requiring objective evaluation of cardiac function and anatomy. The development of symptomatic HF can be prevented by initiating adequate treatment in early stages when LVD is still asymptomatic. Asymptomatic patients can be identified only by screening for LVD among patients at risk of developing HF, such as those with IHD, HT, and diabetes. However, there is a severe lack of resources to assess cardiac function and anatomy in all patients at risk. Consequently, many patients with latent HF will remain undetected, and in patients with symptomatic HF treatment will not be optimal. Simplified echocardiography, a 5-minute echocardiogram based on visual estimation of cardiac function and anatomy, is an inexpensive and accurate method for diagnosis and screening for latent and symptomatic HF. The long axis shortening of the LV is related to LV function and can be measured by AVPD. Determination of left AVPD is a reliable, reproducible, readily mastered, quickly performed and, therefore, inexpensive method that can be used in almost all patients for evaluation of LV function, as well as for prognostication in HF. Left AVPD reflects both systolic and diastolic LV function. Simplified echocardiography is useful for screening of asymptomatic patients at risk of developing HF, and for routine diagnostic purposes in patients with symptoms suggestive of HF. In patients with LVSD, simplified echocardiography may be combined with a determination of left AVPD for prognostication and for optimal detection of changes in LV function over time.
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PMID:Assessment of left ventricular dysfunction and remodeling by determination of atrioventricular plane displacement and simplified echocardiography. 963 69

The objective of this retrospective study was to report on the clinical presentation, etiology, and laboratory tests of both chronic and acute atrial fibrillation (AF) admitted to the cardiology unit of a teaching hospital in southern Saudi Arabia. We studied 219 records; 132 (60.3%) and 87 (39.7%) had documented chronic AF (group 1), and acute AF (group 2) respectively. The mean age (SD) was significantly higher in group 1 (64.6 [SD 19.4] vs 52.9 [SD 15.6]) (P<0.001). Palpitation, dizziness and syncope were the most frequent symptoms in acute AF, while dyspnea was the most common presentation in the chronic type. On the other hand, heart failure and embolic complications were reported significantly in group 1, but the frequency of acute respiratory problems and acute myocardial infarction was similar in both groups. The most common causes of both types of AF were rheumatic valvular diseases (26%), IHD (24.2%), hypertension (23.7%), and lung diseases (13.2%); however, in 28 patients (12.8%) no cause was detected. The echocardiography findings of chamber dilatation, valve lesions, and depressed left ventricular function were significantly frequent in group 1 (P<0.01). Although rheumatic valvular diseases are still common in Saudi Arabia, ischemic heart disease and hypertension are emerging as important causes of AF in this developing nation, and therefore require prevention and control.
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PMID:Patterns of atrial fibrillation at a regional hospital in Saudi Arabia. 992 6

Calcium antagonists continue to have a place in the treatment of hypertension, despite recent concerns regarding their safety and long-term capacity to alter the natural history of cardiovascular disease. Results of a well-designed cohort study concerning a very elderly population suggested that administration of shorft-acting nifedipine is linked to an increase in mortality, particularly when a high dose is administered and when the initiaol blood pressure is below 160/90 mmHg. The risk of using short-acting verapamil, however, was no greater than that of beta-blockade. These differences can be attributed at least in part to the low catecholamine profile of verapamil and to the marked rapid adrenergic activation with short-acting nifedipine. Current evidence sujggests that less catecholamine activation occurs during the chronic use of long-acting dihydropyridine agents. Two recent studies have shown that the combination of verapamil and an angiotensin converting enzyme inhibitor reduces numbers of cardiovascular disease events among postinfarct patients with heart failure, and that the dihydropyridine nitrendipine reduces poor outcome measures, such as stroke incidence, in treating systolic hypertension in the elderly. In my view, apparent hazards such as the precipitation of myocardial infarction and cancer are discounted by the available evidence. While we await further major trials concerning outcomes, general safety can be related to a preference for administering those long-acting agents that do not stimulate and may even inhibit adrenergic responses, and the avoidance of possible adverse effects through the use of combination therapies, such as verapamil plus an angiotensin converting enzyme inhibitor or nifedipine plus a beta-blocker.
Blood Press Monit 1998 Feb
PMID:Ongoing clinical outcome studies of calcium antagonists. 1021 33

BACKGROUND: The modern developments in engineering allow one to record the speed at which the blood pressure rises on the advancing pulse wave front. It was possible to obtain this through the conversion of a conventional pulse from a single suprasystolic oscillation to the oscillometric envelope into its first derivative with respect to time. OBJECTIVE: The aim of this study was to report a preliminary comparison between healthy subjects and patients with heart failure as a first step towards the clinical ujse of this first derivative of a time-dependent function (dP/dt).METHODS: For 10 normal healthy subjects (aged 37 +/- 5 yhears) and five subjects with ischaemic cardiomyopathy (aged 41 +/- 7 years), whose ejection fractions (invasively assessed) wee < 40%, we evaluated six sequential oscillometric measurements of blood pressure obtain by using a Dynapulse Ps5000 (Pulse Metric, San Diego, California, USA) device, which simultaneously records blood pressure and analyses every arterial waveform. The mean and SD of (dP/dt)max for each subject were calculated, together with the relative mean distribution and the significance of the differences. RESULTS: The data show that (dP/dt)max of subjects with an impairment of cardiac function is less than normal. The mean (dP/dt)max of normalk subjects was significantly different (P < 0.05) from that of patients with ischaemic cardiomyopathy and lower than normalk ejection fractions. CONCLUSION: These preliminary results allowed us to raise the hypothesis that this parameter, being representative of the cardiac function, because many data are obtained, is extremely useful for monitoring changes during daily activities or to outline the nycthoemeral rhythm. We have to test the hypotheses that the analyses of the correlations between (dP/dt)max and other haemodynamic parameters may be used in the pathphysiological study of cardiomyopathies and that the comparison of differences in (dP/dt)max can be used in the evaluation of the effects of the treatment.
Blood Press Monit 1998 Jun
PMID:The (dP/dt)max derived from arterial pulse waveforms during 24 h blood pressure oscillometric recording. 1021 56

Clinical research into the efficacy and safety of antihypertensives has used non-invasive automated ambulatory blood pressure monitoring (ABPM) for the last two decades. Different national validation requirements have standardized the equip;ment and the clinical use thereof. The European Standardization for Medical Devices (CEN/CENELEC) organization has recently approved requirements for new ABPM devices in most European countries. For the approval process of new antihypertensive drugs, ABPM today has a supportive role to play in the documentation. Increasingly, national regulatory bureaux demand ABPM data. For the US Food and Drug Administration (FDA) ABPM is still not a prerequisite for approval but the value of peak: trough evaluation has recently been debated by major advisory boards. A US-based Cooperative Research and Development Agreement (CRADA) has been established to evaluate ABPM data from controlled trials with versus without placebo controls. In major clinical trials it has been documented that the ABPM technique reduces sample size, reduces the number of placebo-controlled trials, provides detailed information concerning the first-dose effect, documents the duration of action and dose-response relationship and allows documentation of antihypertensive therapy throughout 24 h, including the night-time period. ABPM data are recommended to support the documentation of 24 h efficacy and safety of new antihypertensive dose regimens. ABPM has been discussed for the documentation of new drugs to treat angina pectoris, heart failure and arrhythmia.
Blood Press Monit 1996 Jun
PMID:Is it possible to file and approve a new antihypertensive without ambulatory blood pressure monitoring?. 1022 53

Detection of antimyosin antibodies in non-inflammatory cardiac disease undermines their disease specificity as a sensitive marker of damage in dilated cardiomyopathy (DCM) patients. Antibody subclass specificity could provide a more sensitive marker of disease and possibly discriminate the humoral autoimmune responses in different cardiac diseases. Frequency and reactivity of autoantibodies against alpha- and beta-isoforms of myosin heavy chain (mhc) were evaluated by ELISA for IgG, IgM, and subclasses IgG1, IgG2, and IgG3 in patients with DCM (NYHA III/IV, n = 82), end stage ischemic heart disease (E-IHD: NYHA III/IV, n = 62), mild ischemic heart disease (NYHA I/II, n = 27), and controls (n = 54). Autoantibodies against atrial and ventricular myosin were raised in heart failure patients compared to mild-IHD and controls but with different antigen affinities. Reactivity in E-IHD was significantly raised against (ventricular) beta-mhc compared with only mild-IHD patients, suggesting a relative increase in ventricular specific antibodies in IHD patients with a higher NYHA class. IgG subclass analysis for IgG1, IgG2, and IgG3 against alpha- and beta-mhc showed statistically raised levels of IgG3 only in DCM patients and a significantly higher reactivity of IgG2 in heart failure patients versus controls. The results demonstrate immunological heterogeneity of antimyosin antibodies developed in different clinical entities. Pro-inflammatory characteristics of IgG3 antibodies in a select group of patients with DCM may contribute to autoimmune mechanisms of injury in these patients.
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PMID:Subclass specificity of autoantibodies against myosin in patients with idiopathic dilated cardiomyopathy: pro-inflammatory antibodies in DCM patients. 1036 96

Analysis of heart rate variability (HRV) permits an assessment of sympathetic and parasympathetic activity from EKG recordings. Analysis of HRV may be performed in both the time and frequency domain by the application of mathematical principles of signal processing. HRV demonstrates abnormalities in myocardial infarction, sudden death, heart failure, autonomic neuropathy and hypertension. The technique is useful for assessing prognosis and for evaluating therapeutic interventions.
Blood Press Monit 1999
PMID:Modern evaluation of the hypertensive patient: autonomic tone in cardiovascular disease and the assessment of heart rate variability. 1082 11


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