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

Cardiovascular infections due to Salmonella enterica are infrequently reported, so their clinical features, prognosis, and optimal treatment are not completely known. Mortality associated with aortitis and endocarditis caused by nontyphoidal Salmonella remains exceedingly high. In this review of cases of cardiovascular infections due to Salmonella enterica studied in 2 hospitals in Madrid, we tried to assess the clinical manifestations and the procedures leading to diagnosis in addition to treatment and outcome. To complete the spectrum of infections related to cardiovascular surgery, cases of postoperative mediastinitis, pericarditis, and infections associated with cardiac devices were also included.Twenty-three patients were reviewed: 11 had mycotic aneurysms; 7 had endocarditis; 2 had device-related infections; and 3 had pericarditis, mediastinitis, and infection of an arteriovenous fistula, respectively. The risk of endovascular infection in patients older than 60 years with bacteremia due to nontyphoidal Salmonella was 23%. Most patients with aortitis had risk factors for atherosclerosis, and 6 had preexisting atherosclerotic aortic aneurysms. All except 1 patient with endocarditis had underlying cardiac disorders. Acquired immunodeficiency disease (AIDS) was a major risk factor for salmonella bacteremia in 1 patient with aortitis and 1 with endocarditis. Fever, unremitting sepsis, "breakthrough" and relapsing bacteremia were the most common clinical findings. In addition, abdominal or thoracic pain and cardiac failure and pericarditis were common features in patients with aortitis and endocarditis respectively. Computed tomography (CT) scan, arteriography, and echocardiography were the main diagnostic tools. Mortality associated with mycotic aneurysms and endocarditis due to S. enterica was 45% and 28%, respectively. Thoracic aneurysms, rupture, and shock at the time of diagnosis were associated with increased mortality in patients with aortitis. In situ bypass grafting was successfully performed in most cases. After surgery, antimicrobial therapy was continued for 4-9 weeks. No relapses were observed after a mean follow-up of 64 months. Antimicrobial therapy alone or combined with valve replacement or excision of a ventricular aneurysm was successful treatment for most patients with salmonella endocarditis. Combined medical and surgical treatment was required for patients with mediastinitis and pericarditis, and patients with device-related infections needed removal of the complete device. Diagnosis of aortitis due to nontyphoidal Salmonella should be established as early as possible to reduce mortality. Patients older than 60 years who have positive blood cultures for Salmonella along with fever and back, abdominal, or chest pain should have an extensive workup for infective aortitis. Immediate bactericidal antimicrobial therapy should be started and a CT scan should be performed on an emergency basis. If a mycotic aneurysm is found, surgical resection should follow as soon as possible. Resection of the aneurysm with in situ bypass grafting is the procedure of choice. Postoperative antimicrobial therapy for 6-8 weeks seems enough to avoid relapses. Optimal treatment of patients with endocarditis occurring on ventricular aneurysms must include resection of the aneurysmal sac. Salmonella endocarditis can be successfully treated with antimicrobials alone. Valve replacement should be reserved for patients with cardiac failure or persisting sepsis, and for those who relapse after discontinuation of antimicrobial therapy.
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PMID:The spectrum of cardiovascular infections due to Salmonella enterica: a review of clinical features and factors determining outcome. 1502 66

Optimal pharmacological therapy for heart failure improves patients' prognosis and symptoms. Despite this, the long-term prognosis for these patients is very poor and symptoms are debilitating. Biventricular pacing, or resynchronization therapy, should be considered for patients who remain symptomatic despite optimal therapy and have evidence of dyssynchrony.
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PMID:Biventricular pacing in heart failure. 1505 5

Cardiac resynchronization therapy (CRT) is potentially an important new treatment for patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. There is growing evidence that CRT can improve symptoms although it is possible that similar benefits could be obtained by skillful manipulation of pharmacological therapy. There is also preliminary but inconclusive evidence to suggest that CRT alone or in synergy with an implantable cardiac defibrillator (ICD) may reduce morbidity and mortality. However, fashion is in danger of overtaking facts and it is important to ensure that benefits are not only statistically proven but clinically meaningful and cost-effective. Optimal timing of intervention and patient selection will be essential to ensure that treatment is deployed efficiently. If CRT with or without ICD becomes part of mainstream therapy for heart failure this will have far-reaching consequences for heart failure management. Implantation is a skilled and often time-consuming procedure. Long-term management of both CRT and ICD is likely to provide challenges in terms of lead technology, pacing thresholds and device management. Heart failure physicians will have to learn new skills and collaborate more closely with electrophysiologists. Such developments, in addition to the need for complex pharmacological interventions will accelerate the move away from general practice and towards specialist care for this most common of malignant diseases. If CRT does reduce mortality, it will graduate from an adjunctive therapy which could be used to an essential one that should be used as part of routine therapy for appropriate patients. Currently, CRT is a symptomatic therapy for patients with severe heart failure resistant to intensive pharmacological therapy delivered by a heart failure specialist.
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PMID:Cardiac resynchronization therapy with or without an implantable defibrillator: only indicated when everything else has failed? 1507 Dec 68

In recent years cardiology has opened new chapters in the treatment of acute coronary syndrome (ACS). The acute therapeutic procedures include antianginal, anticoagulant and revascularization therapy. Optimal therapeutic procedure in ACS has two objectives: 1) quick removal of the factors causing ischemia, and 2) prevention of death or myocardial infarction, i.e. reinfarction. Nitrates have been present in pharmacotherapy for more than 150 years. They are used exclusively to efficiently suppress the symptoms, but there is no proof of their positive effect on the disease prognosis. The effect of nitrates is manifested as vasodilatation in the arterial, and particularly in the venous vascular basin (central and peripheral effects) thus increasing the capacity of venous blood. Besides the peripheral effect, nitrates have an important central effect, i.e. they dilate epicardial coronary arteries, both the healthy ones and those damaged by atherosclerosis, in this way increasing the collateral blood circulation. Organic nitrates, although the oldest antianginal drug, play one of the leading roels in the treatment of ACS even today. Beta-adrenergic blocking agents have been used since 1960 in the treatment of arterial hypertension, coronary disease and cardiac arrhythmias, and later their efficacy in the prevention of secondary myocardial infarction was noted. Beta blockers (BB) reduce heart rate, systemic blood pressure and myocardial oxygen requirements, reduce myocardial contractility, thus alleviating precordial pain in ACS, decreasing the rate of threatening infarction, and reducing ventricular arrhythmias. Numerous clinical studies have shown that BB in ACS improve the disease prognosis and play an important role in long-term secondary prevention after myocardial infarction. Antagonists of calcium channel blockers are a group of therapeutic agents successfully used in numerous cardiac and noncardiac indications. Potential benefits of calcium antagonists in ACS are the result of various combinations, such as dilation of coronary arteries and arterioles, reduction of heart rate and myocardial oxygen requirements, and beneficial effect on left ventricular function and elasticity. The use of calcium channel blockers in ACS reduces or prevents the symptoms and accompanying ischemia, but there is no evidence that these agents prolong survival in patients with heart failure. In recent years the treatment of an ACS has significantly changed owing to better understanding of the pathogenesis of the disease as well as progress in medicinal and interventional treatment. Antianginal therapy, which includes nitrates analgesics, calcium channel blockers and antiadrenergic therapy using beta-blockers in treatment of ACS, takes a significant place.
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PMID:[Antianginal and antiadrenergic therapy in acute coronary syndrome]. 1520 97

The renin-angiotensin system (RAS) plays an important role in the pathogenesis and worsening of heart failure (HF). Blocking this system with angiotensin converting enzyme (ACE) inhibitors in patients with HF and left ventricular dysfunction reduces mortality and morbidity and these drugs are currently recommended as standard therapy. A more recently developed class of drug, angiotensin receptor blockers (ARBs) block the RAS at the receptor level, and may therefore provide more complete blockade. ARBs, either singly or in combination with ACE inhibitors, are currently being compared to either ACE inhibitor therapy alone or to placebo in randomized trials of patients with or at high risk of developing HF. With respect to large trials published to date directly comparing ARB versus ACE inhibitor therapy, neither the Losartan Heart Failure Survival Study (ELITE II) nor the Optimal Trial in Myocardial Infarction with the Angiotensin II Antagonist Losartan (OPTIMAAL) found differences in mortality or morbidity between the treatment groups. As regards combination ARB/ACE inhibitor therapy versus ACE inhibitor therapy alone, one completed study, the Valsartan Heart Failure Trial (Val-HeFT), found no differences in mortality but a decrease in HF-related hospitalizations in the combined therapy group. Four additional long-term trials (VALIANT, CHARM, ONTARGET, and TRANSCEND) should complete the totality of evidence regarding the role of ARBs in the treatment of HF. Since genetic polymorphisms affecting drug metabolizing enzymes or drug receptors are known to influence responses to drugs, exploration of these effects on treatment responses to ARBs and ACE inhibitors may provide for more targeted treatment of HF.
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PMID:The renin-angiotensin system: the role of inhibitors, blockers, and genetic polymorphisms in the treatment and prevention of heart failure. 1532 Aug 51

The concept of heart failure has undergone several paradigm shifts in the past few decades. Therapeutic targets directed at the heart pump have shifted to circulatory haemodynamics to the current neurohormonal model. Consequently, therapeutic modalities have similarly evolved alongside clinical trials. Successive trials have tested newer drugs in addition to established therapies, resulting in evidence-based treatments necessitating polypharmacy. Optimal heart failure therapy has therefore become increasingly complex. It is only after understanding the precise modes of drug action, as well as the relevance of the design of clinical trials, will physicians hopefully be able to tailor the medical therapy optimally towards the individual patient with heart failure.
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PMID:Medical therapy in heart failure--is polypharmacy necessary? 1532 55

Patients with chronic heart failure (CHF) have a resting restrictive ventilatory defect. Any type of exercise requires patients with CHF to markedly increase their minute ventilation. Patients with chronic obstructive pulmonary disease (COPD) have airflow obstruction that leads to dynamic lung hyperinflation and reduced ventilatory response to exercise. Because exercise is associated with abnormally high minute ventilation in patients with CHF and with a limited minute ventilation increase in patients with COPD, functional capacity is severely impaired in patients with coexistent CHF and COPD. Optimal treatment of both conditions is a prerequisite to maximally improve functional capacity in patients with CHF and COPD. Unfortunately, beta-adrenergic blockade, the current cornerstone of CHF therapy, is frequently omitted in patients with CHF and COPD for fear of inducing bronchoconstriction. Furthermore, when prescribed, beta-adrenergic blockade is often attempted with a moderate dose of metoprolol tartrate, a beta-1-blocker that results in lesser clinical benefits than combined non-selective beta-blockade with carvedilol at the maximally recommended dose. Recent experience indicates that combined non-selective beta- and alpha-blockade with carvedilol is well tolerated in patients with COPD who do not have reversible airway obstruction. Alpha-adrenergic blockade may promote mild bronchodilation that offsets non-selective beta blockade-induced bronchoconstriction in patients with obstructive airway disease.
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PMID:Therapeutic update: non-selective beta- and alpha-adrenergic blockade in patients with coexistent chronic obstructive pulmonary disease and chronic heart failure. 1535 10

Optimal outpatient treatment of systolic heart failure has three goals that should be pursued simultaneously: (1) control of risk factors for the development and progression of heart failure, (2) treatment of heart failure, and (3) education of patients. Control of risk factors includes treating hypertension, diabetes, and coronary artery disease, and eliminating the use of alcohol and tobacco. All patients with heart failure should be taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin-receptor blocker. In the absence of contraindications, an ACE inhibitor is preferred. In most patients, physicians should consider adding a beta blocker to ACE-inhibitor therapy. In patients with severe heart failure, spironolactone is a useful addition to baseline drug therapy, as is carvedilol (substitute carvedilol if patient is already taking a beta blocker). Patients with stable heart failure should be encouraged to begin and maintain a regular aerobic exercise program. Digoxin therapy may reduce the likelihood of hospitalization but does not reduce mortality. It must be monitored closely, with a target dosage level of 0.5 to 1.1 ng per mL. Symptoms may be controlled with the use of diuretics and restricted dietary sodium. Finally, patient education, with the patient's active participation in the care, is a key strategy in the management of heart failure. Periodic follow-up between scheduled office visits, which is essential in the long-term management of heart failure, may include telephone calls from the office nurse, maintenance of a daily symptom and weight diary, and participation in a disease-management program.
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PMID:Outpatient treatment of systolic heart failure. 1622 19

Effect of cardiac pacing on clinical course of ischemic heart disease was assessed in 154 patients with class II-IV angina pectoris with implanted pacemakers. Improvement of symptoms (decrease of number of anginal attacks, increase of exercise tolerance, reduction of number and doses of antianginal drugs) occurred in 72 patients (46.8%). In 30 patients (19.5%) increase of frequency of angina was accompanied with changed character, localization and duration of attacks as well as response to nitroglycerin. This was believed to be caused by augmented myocardial oxygen consumption due to 1.5-2 fold heart rate elevation during pacing and psychocardial syndrome. In 52 patients (33.8%) pacing was not associated with any changes of character of angina. It was shown that reprogramming of pacing parameters aimed at optimization of coronary reserve should be performed with consideration of angina class and presence of chronic heart failure. Optimal pacing rate was supposed to be 55-65 and 75-85 per min in patients with low coronary reserve and heart failure, respectively.
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PMID:[Effect of pacemaker implantation on clinical course of ischemic heart disease and choice of optimal pacing parameters]. 1579 97

Non-medical approaches to end-stage heart failure (ESHF) include heart transplantation, but also implantable cardioverter-defibrillators, cardiac resynchronization therapy and ventricular assist devices. These techniques might be used as a bridge to transplant, as a bridge to recovery or as destination therapy. Optimal medical therapy of ESHF should include an angiotensin-converting enzyme inhibitor, a beta-blocker and spironolactone. Risk stratification in ESHF allows to determine the individual prognosis of each patient with parameters such as echocardiographic criteria, peak exercise oxygen consumption, or plasma BNP levels. Heart transplantation is to be considered if the individual prognosis obtained after stratification is worse than the expected survival of transplant recipients.
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PMID:[Management of end-stage heart failure]. 1594 Oct 88


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