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

This article reviews controversies in cardiac pacing in four areas: methods to prevent unnecessary right ventricular pacing and optimal ventricular pacing sites in the bradycardia population, pacing for prevention of atrial fibrillation (AF), a novel pacing technique for the treatment of heart failure, and pacing for the treatment of sleep apnea. Frequent right ventricular pacing has been reported to increase the incidence of AF and congestive heart failure. However, many patients with pacemakers for bradycardia have intrinsic atrioventricular conduction most of the time. Optimal programming of pacemakers and new algorithms designed to reduce unnecessary ventricular pacing are discussed. Pacing algorithms for prevention of AF have generally been shown to be ineffective. Atrial antitachycardia pacing has been shown to reduce the burden of atrial tachyarrhythmias in selected patients. Cardiac contractility modulation has recently been reported to be a promising new approach to the treatment of heart failure. Some pacing techniques may be effective in the treatment of sleep apnea but larger, long-term clinical trials are required to demonstrate a significant clinical benefit.
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PMID:Controversies in pacing: indications and programming. 1610 88

Atrial fibrillation (AF) is one of the most frequently seen arrhythmia. Optimal strategy of its treatment still remains a serious problem. The goal of the investigation was the evaluation of the efficacy of combined treatment of AF with Cordaron and ACE inhibitor Diroton (lizinopril) (D) in patients with chronic heart failure (CHF). 29 patients (32-78 years old) with persistive AF and CHF (II - III class NYHA) were under observation. The treatment with C 200 - 300 mg/day and D 5 -10mg/day for 12 weeks resulted in improvement of clinical status of the patients, improvement in functional class of CHF, decrease in frequency of recurrences of AF in comparison with patients who were not given ACE inhibitor. Ultrasound study showed that combined therapy increases myocardial contractility corrects left ventricular remodeling, maintains the sinus rhythm and improve prognoses in this category of the patients. The use of ACE inhibitior D in antiarrhythmic (antirecurrent) therapy together with C is optimal in patients with persistive AF CHF.
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PMID:[Optimal approach to the treatment of atrial fibrillation in patients with chronic heart failure]. 1614 76

Atrial fibrillation and heart failure have in common that they mainly occur in older patients and the patients have similar underlying heart diseases. The prevalence of atrial fibrillation in heart failure patients varies from 10% to 30%. There are conflicting data whether the presence of atrial fibrillation is an independent predictor for an increased mortality in heart failure. Optimal medical heart failure therapy can improve outcome and may influence the relationship between atrial fibrillation and survival. Keystones for the management of atrial fibrillation in heart failure patients are the optimal treatment of heart failure, the use of oral anticoagulation, the case-adjusted decision of rhythm or rate control, and the primary prevention of sudden cardiac death. Heart failure patients with atrial fibrillation should receive long-term oral anticoagulation. The two options to treat atrial fibrillation are rhythm control and rate control. Given the findings of randomised trials, rhythm control of atrial fibrillation with the aim to improve survival is not justified in heart failure patients because of uncertainty about the role of atrial fibrillation as a predictor of worse outcomes and the safety of antiarrhythmic drugs. Rhythm control can be attempted, if rate control is chosen and symptoms persist. The indications for rhythm control are to control symptoms, including a deterioration of heart failure related to a loss of atrial contraction. Amiodarone seems to be the drug of choice to maintain sinus rhythm in patients with paroxysmal atrial fibrillation as well as in patients who returned to sinus rhythm after cardioversion. New non pharmacologic approaches for rhythm control such as catheter-based techniques seem to be highly effective. Rate control to prevent rapid atrial fibrillation is an acceptable approach in otherwise asymptomatic heart failure patients. Slowing of the ventricular rate often leads to a moderate improvement in left ventricular function in many patients. Standard therapy for rate control in heart failure patients consists of partial atrioventricular (AV) node blockade with digoxin and a beta-blocker. Amiodarone is also highly effective to reduce ventricular rate in patients with atrial fibrillation. When rate control remains refractory to medical therapy, rate control is achieved with AV node ablation and subsequent pacemaker implantation. Non pharmacological treatments for the primary prevention of sudden cardiac death are the implantation of a defibrillator.
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PMID:Atrial fibrillation and heart failure comorbidity. 1617 74

Cardiac resynchronization therapy (CRT) improves symptoms, exercise performance, ventricular function, and survival in patients with left ventricular dysfunction, prolonged QRS, and drug-refractory moderate to severe CHF. The growing application of CRT has created a large number of patients with complicated devices that need follow-up care from general practitioners, cardiologists, heart failure specialists and electro-physiologists. Optimal care of the CRT patient includes recognition and management of peri-implantation complications, optimal programming of atrio-ventricular and sequential ventricular timing, and troubleshooting device-related problems during long-term follow-up. A basic awareness of fundamental device features, the techniques to maximize the response to CRT, and an understanding of stored device data to track the response to therapy provide clinicians the ability to maximize clinical outcomes in the CHF patient. As evolving technology continues to increase the complexity of device therapies, clinicians must understand these therapies in order to properly treat heart failure patients. This work summarizes many of the issues involving early complications of CRT device implant, the strategies to optimize device function, and suggests a scheme for follow-up care of patients with CRT devices.
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PMID:Cardiac resynchronization therapy: strategies for device programming, troubleshooting and follow-up. 1617 48

Cardiac involvement is a not uncommon complication in patients with antiphospholipid syndrome (APS). Herein, the case is reported of cardiac failure in a female patient with Libman-Sacks endocarditis and with primary APS diagnosed eight years previously. Aggressive anticoagulation therapy and medical treatment for the cardiac failure over a 12-month period resulted in a partial regression of the severe mitral regurgitation. Close clinical and echocardiographic surveillance during the follow up of patients with APS and heart valve disease is mandatory. Optimal treatment, including adequate aggressive anticoagulation therapy and specific treatment for heart failure, may play a pivotal role in reducing the severity of valve dysfunction in these patients.
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PMID:Libman-sacks endocarditis and primary antiphospholipid syndrome. 1624 13

Optimal management of patients with heart failure (HF) should be guided by thorough evaluation and use of functional classification and disease staging systems. Though the understanding of precise underlying pathophysiological mechanisms has increased dramatically in recent years, it is essential to continue the search for greater efficacy in preventing, controlling, and reversing this pathological state. Recent developments in the diagnosis and treatment of heart failure have improved prognosis in terms of both survival and morbidity due to re-hospitalization. The underutilization of medical and preventive therapies in patients with heart failure is a major public health issue, despite the recommendations of various evidence-based guide lines. Patient education and disease management programs have been shown to optimize HF-management by bridging the gap between evidence-based medicine and clinical practice, thereby, reducing hospitalization rate. This paper, the first in a series of three papers, will identify the pathology, prognosis and prevention of heart failure, while the paper to follow will discuss modern methods of interventional management.
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PMID:Pathology, prognosis, and prevention of heart failure. 1625 1

Optimal use of cardiopulmonary exercise testing (CPET) in clinical practice and chronic heart failure (CHF) requires appropriate data presentation and a flexible interpretative strategy. The greatest potential impact on the decision-making process may rest not on the value of any individual measurement, although some are obviously more important than others, but rather on their integrative use. Such an integrative approach relies on interrelationship, trending phenomena and patterns of key gas exchange variable responses. An multiparametric approach will be discussed in different clinical applications, for exercise prescription and monitoring, functional evaluation of drug therapy or cardiac resynchronisation therapy efficacy, and risk stratification. The role of CPET in the daily clinical decision-making process will be underscored. Future indications of CPET will be addressed, suggesting and promoting an extended candidacy either to all CHF patients, including those at high risk or most vulnerable, such as female, elderly patients, and patients with implantable cardioverter defibrillator or in every clinical setting where objective definition of exercise capacity provides implications for medical, surgical, and social decision making.
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PMID:Statement on cardiopulmonary exercise testing in chronic heart failure due to left ventricular dysfunction: recommendations for performance and interpretation Part III: Interpretation of cardiopulmonary exercise testing in chronic heart failure and future applications. 1687 34

The Treatment of chronic heart failure (CHF) has improved markedly over the last 10-15 years. Mortality and morbidity have been reduced significantly. However, CHF is still associated with a high mortality and is costly due to the need for hospitalization of many patients. The best management of patients with CHF includes correct diagnosis and risk assessment, symptomatic treatment of fluid retention, if present, and a combination of at least two neurohormonal antagonists to improve prognosis. Optimal practice in most organizations needs a structured approach to the management. In order to achieve this optimal management, guidelines are used to harmonize and encourage implementation of treatments. Guidelines from Europe and North America are harmonized as they are based on the same evidence. However, in some important aspects there can be differences in the interpretation of the evidence. A comparison of four major guideline documents was published recently.
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PMID:Diagnostic and therapeutic algorithms in chronic heart failure. 1718 Jun 51

Heart failure constitutes the most frequent and expensive hospital discharge diagnosis in the United States, costing annually over $10 billion. Optimal care requires an understanding of their illness, participating in clinical decisions, and frequent communication. Current surveillance is labor intensive and expensive. Follow-up is often inadequate, incomplete, and inconsistent. To address these problems, we developed an Internet-based telemedicine system, consisting of a secure server and database. Patients send or receive data to or from their care provider via the Internet. The system optimizes function and minimizes cost (all hardware is off the shelf and FDA approved). This paper describes our initial experience with this system. We are currently using this telemedicine system in a prospective, randomized clinical trial, comparing Class III or IV heart failure patients with standard care versus standard care plus telemedicine.
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PMID:Improving heart failure care by using a telemedicine system. 1727 Sep 28

The cardiovascular system incorporates several controlling mechanisms acting as feedback loops over different time horizons. Because of their complex interrelationships, information-based methods such as autonomic information flow (AIF) functions promise to be useful in identifying normal and pathological behavior. Optimal adjustment between those controllers is necessary for healthy global behavior of the organism. We investigated the question as to whether there are typical relationships between short-term and long-term AIF by means of a meta-analysis of several of our own clinical studies of the mortality of patients with multiple organ dysfunction syndrome, heart failure, idiopathic dilated cardiomyopathy, and the length of stay in hospital after abdominal aorta surgery. We found a fundamental association of increased short-term randomness (decreased AIF) and decreased long-term randomness (increased AIF) due to pathology. A systems theoretic validation of this fundamental type of association was done by an appropriate mathematical model using a dissipative system with two feedback loops over different time horizons. The systematic simulation of an increasing collapse of the short feedback loop confirmed the inverse association between short-term and long-term information flow as a fundamental, system inherent type of readjustment that occurs under pathological conditions.
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PMID:Interactions between short-term and long-term cardiovascular control mechanisms. 1741 Dec 67


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