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

Diurnal cycles of glomerular filtration rate (GFR), effective renal plasma flow (ERPF), and of excretion rates of sodium, potassium, magnesium, chloride and phosphate were measured in a 22 year old man with moderately severe heart failure under standardized conditions. Cycles of GFR, ERPF and excretion of potassium, chloride, and phosphate were indistinguishable from those of normals. The phases of the sodium and probably the magnesium excretory cycles were reversed from normal. The significance of some of the observations is discussed.
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PMID:Diurnal circadian rhythms of renal function and electrolyte excretion in heart failure. 57 67

The hour of day of primary ventricular tachycardia (VT) in the acute phase of myocardial infarction was studied in 63 consecutive patients without cardiac failure or antiarrhythmic therapy, admitted to hospital less than 6 hours after the onset of chest pain. There were 19 women and 44 men, with an average age of 63 years. The site of infarction was anterior in 23 cases, posterior in 34 cases and circumferential in 6 cases. The cardiac rhythm was analysed from the 6th hour following the onset of chest pain for 4 days, using a HP 98220 A computerised analyser CPK levels were measured daily. Ventricular tachycardia occurred in 73% of cases with no significant difference between daytime (18 patients) and night time (28 patients). The patients developing VT did not differ from the remainder with respect to age, sex, or site of ECG changes, but peak CPK levels were significantly higher than in patients without VT. The risk of VT decreased slowly as the interval from the onset of chest pain increased and fell practically to zero after the 40th hour. Diurnal and nocturnal VT were independent of age, sex or site of infarct. However, nocturnal VT correlated independently of the time of onset of chest pain to high values of CPK. There was no difference with respect to age, sex, location of infarct or incidence of ventricular tachycardia between infarcts with pain starting during the day, and infarcts with pain starting at night. However, when the pain started during the day, the peak CPK was significantly higher and there were significantly more attacks of nocturnal ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Time of occurrence of primary ventricular tachycardia in the acute phase of myocardial infarction]. 643 67

Diurnal variation in plasma norepinephrine (PNE) levels is well documented in healthy individuals but not in patients with heart failure. Therefore, we attempted to determine variations in PNE levels over 24 hours, measured hourly, in six patients with an ejection fraction below 40% and a history of heart failure of longer than 3 months. Three controls without a history of heart failure also were evaluated. Both patients and controls had diurnal variations in PNE, with highest levels occurring during the day and lowest at night. When data in patients were evaluated by 6-hour time intervals the mean value for 6:00 A.M.-12:00 noon was approximately twice as high as 12:00 midnight-6:00 A.M. (689+/-329 vs 338+/-166 pg/ml, p<0.05, respectively). Patients also had significant peak to trough variation in PNE levels compared with controls (959+/-396 vs 386+/-84 pg/ml, p<0.02, respectively). These results suggest that significant intrapatient variations in PNE occur over 24 hours in patients with heart failure. These variations may have to be accounted for when evaluating and treating patients with heart failure.
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PMID:Diurnal variation in plasma norepinephrine in patients with heart failure. 1045 70

Asthma is under-recognised and undertreated in older populations. This is not surprising, given that one-third of older people experience significant breathlessness. The differential diagnosis commonly includes asthma, chronic obstructive pulmonary disease (COPD), heart failure, malignancy, aspiration and infections. Because symptoms and signs of several cardiorespiratory diseases are nonspecific in older people and diseases commonly co-exist, investigations are important. A simple strategy for the investigation of breathlessness in older people should include a full blood count, chest radiograph, ECG, peak flow diary and/or spirometry with reversibility as a minimum. If there are major abnormalities on the ECG, an echocardiogram should also be performed. Diurnal variability in peak flow readings >or=20% or >or=15% reversibility in forced expiratory volume in 1 second, spontaneously or with treatment, support a diagnosis of asthma. Distinguishing asthma from COPD is important to allow appropriate management of disease based on aetiology, accurate prediction of treatment response, correct prognosis and appropriate management of the chest condition and co-morbidities. The two conditions are usually readily differentiated by clinical features, particularly age at onset, variability of symptoms and nocturnal symptoms in asthma, supported by the results of reversibility testing. Full lung function tests may not necessarily help in differentiating the two entities, although gas transfer factor is characteristically reduced in COPD and usually normal or high in asthma. Methacholine challenge tests previously mainly used in research are now also used widely and safely to confirm asthma in clinical settings. Interest in exhaled nitric oxide as a biomarker of airways inflammation is increasing as a noninvasive tool in the diagnosis and monitoring of asthma. Regular inhaled corticosteroids (ICS) are the mainstay of treatment of asthma. Even in mild disease in older adults, regular preventive treatment should be considered, given the poor perception of bronchoconstriction by older asthmatic patients. If symptoms persist despite ICS, addition of long-acting beta(2)-adrenoceptor agonists (LABA) should be considered. Addition of LABA to ICS improves asthma control and allows reduction in ICS dose. However, older people have been grossly under-represented in trials of LABA, many trials having excluded those >or=65 years of age. On meta-analysis, beta(2)-adrenoceptor agonists (both short acting and long acting) are associated with increased cardiovascular mortality and morbidity in asthma and COPD. While the evidence for excess cardiovascular mortality is stronger for short-acting beta(2)-adrenoceptor agonists, it would be prudent to exercise particular care in using beta(2)-adrenoceptor agonists (long acting and short acting) in those at risk of adverse cardiovascular outcomes, including older people. Regular review of cardiovascular status (and monitoring of serum potassium concentration) in patients taking beta(2)-adrenoceptor agonists is crucial. The response to LABA should be carefully monitored and alternative 'add-on' therapy such as leukotriene receptor antagonists (LRA) should be considered. LRA have fewer adverse effects and in individual cases may be more effective and appropriate than LABA. Long-term trials evaluating beta(2)-adrenoceptor agonists and other bronchodilator strategies are needed particularly in the elderly and in patients with cardiovascular co-morbidities. There is no evidence that addition of anticholinergics improves control of asthma further, although the role of long-acting anticholinergics in the prevention of disease progression is currently being researched. Older patients need to be taught good inhaler technique to improve delivery of medications to lungs, minimise adverse effects and reduce the need for oral corticosteroids. Nurse-led education programmes that include a written asthma self-management plan have the potential to improve outcomes.
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PMID:Overcoming gaps in the management of asthma in older patients: new insights. 1636 86

The diurnal rhythm of the autonomic function is known to be blunted in heart failure, but the timing of this blunting is not well understood. We examined the time course of the alterations in autonomic function in rats with myocardial infarction (MI) by analyzing heart rate variability (HRV). MI was induced by coronary artery ligation, and HRV was analyzed at 2, 4, 6, and 8 weeks post-MI. Diurnal rhythm in heart rate (HR) was maintained over the study period. However, diurnal rhythm in the standard deviation of averages of normal R-R intervals (SDANN) and the ratio between low and high frequency band powers (LF/HF ratio) were disrupted in MI rats at 2 weeks, which persisted up to 8 weeks, with the exception of 4 weeks. The dark-light differences in the LF/HF ratio changed from negative to positive values between weeks 2 and 4 in the MI rats. We also found decreases in HR, SDANN, and the LF/HF ratio in the dark phase at weeks 6 and 8 and an increase in plasma norepinephrine (NE) level at week 8. Collectively, the results indicate that the timing of the disturbance of diurnal rhythm in SDANN and the LF/HF ratio is different from those in HR and in plasma NE level, suggesting that the mechanisms underlying these changes are different. In addition, there is a transition from the compensatory to the decompensatory phase between 4 and 6 weeks post-MI. These findings may help to understand the progression and pathophysiology of heart failure.
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PMID:Time course of diurnal rhythm disturbances in autonomic function of rats with myocardial infarction. 2385 Mar 85