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

Doctors must regularly adjust their patients' care according to recent relevant publications. The chief residents from the Department of Internal Medicine of a university hospital present some major themes of internal medicine treated during the year 2008, such as heart failure, diabetes, COPD, and thromboembolic disease. Emphasis will be placed primarily on changes in the daily hospital practice induced by these recent studies. This variety of topics illustrates both the broad spectrum of the current internal medicine, and the many uncertainties associated with modem medical practice based on evidence.
 ...
PMID:[Highlights 2008 in a university hospital-based internal medicine: the point of view from the chief residents]. 1926 51

Atrial fibrillation is a frequent complication after CABG. It occurs in 20-50% of patients, most often between the 2nd and 3rd postoperative day. About 40 % of patients experience more than 1 episode. Postoperative AF (POAF) is associated with an increase in adverse events and hospital stay and, therefore, costs of care. The incidence of POAF is not influenced by the technique of CABG with or without cardiopulmonary by-pass Neurohormonal activation, electrolyte imbalance, fluid overload, surgical practices and finally an exaggerated inflammatory response has been proposed to be etiological factor. Advanced age, history of AF or heart failure, COPD, postoperative withdrawal of beta-blockers are independent risk factors of postoperative AF. Conversely, postoperative administration of beta-blockers, ACE inhibitors, potassium supplementation and NSAID were associated with a reduced risk of POAF. Pharmacological strategies for prevention of POAF may be divided in two main groups : the first one encompasses the use of antiarrhythmic drugs (amiodarone, metoprolol, sotalol) before and /or after surgery and has been extensively investigated in the last two decades. Recently an Italian study has shown that PUFA administration during hospitalization in patients undergoing CABG significantly decreased the incidence of POAF and was associated with a shorter hospital stay. Since an exaggerated inflammatory reaction may play a significant role in POAF, treatments directed to antagonize inflammation are presently under investigation. Despite different action mechanisms both hydrocortisone and statins have been shown to decrease post-operative AF risk. These two prophylactic regimens are not mutually exclusive and some data suggest that their association may be useful to further decrease the risk of POAF.
 ...
PMID:Recent developments in pharmacologic prophylaxis of atrial fibrillation in patients undergoing surgical revascularization. 1935 75

Physiological changes in old age: loss of muscle mass; reduction in bone mass; percentage of fat increased; lower amount of body water; lack of thirst; diminishing kidney function (caution: sufficient intake of fluids: 1.5-2 l and moderate intake of protein 8 g/kg body weight); reduced secretion of digestive enzymes, delayed emptying of stomach (which means premature feeling of repletion). Lack of fluids and nutrition is therefore likely. Daily intake of 1,500 kcal and 1.5-2 l fluids is necessary. An indicator for malnutrition is low body weight (defined for persons older than 65 years of age as BMI < 20) and a protein serum concentration < 35 g/l. Malnutrition carries an increased risk of infections, falling and fractures, bed sores, anemia, decompensation of chronic diseases. 10-20% of subjects over 80 years of age show signs of malnutrition, 40-60% of subjects in care institutions or hospitals. There are regressive changes in the locomotor and the nervous system of the elderly which have an effect on physical fitness. These changes reduce strength, endurance, proprioceptive capacity (e.g. coordination, balance) and mobility. Exercise in the old and very old should increase skeletal muscle strength in particular and improve coordination and balance. Regular physical exercise and moderate training has a positive effect on mobility and thereby improves independence and reduces falls. Moreover, it has a positive effect on cardiac output, maximum heart rate, stroke volume and the risk of a cardiovascular event and mortality can be reduced. Moreover, moderate physical exercise is often more effective in treating chronic disease than drug therapy e.g. heart failure, coronary heart disease, asthma/COPD, stroke, diabetes mellitus Type 2, degenerative diseases of the joints, depression and others. Examine cardiovascular risks in persons over the age of 50 before beginning physical exercise. Avoid maximum stress levels.
 ...
PMID:Pharmacotherapy guidelines for the aged by family doctors for the use of family doctors: Part D Basic conditions supporting drug treatment. 1947 91

Pulmonary embolism (PE) can only be diagnosed with imaging techniques, which in practice is performed using ventilation/perfusion scintigraphy (V/P(SCAN)) or multidetector computed tomography of the pulmonary arteries (MDCT). The epidemiology, natural history, pathophysiology and clinical presentation of PE are briefly reviewed. The primary objective of Part 1 of the Task Group's report was to develop a methodological approach to and interpretation criteria for PE. The basic principle for the diagnosis of PE based upon V/P(SCAN) is to recognize lung segments or subsegments without perfusion but preserved ventilation, i.e. mismatch. Ventilation studies are in general performed after inhalation of Krypton or technetium-labelled aerosol of diethylene triamine pentaacetic acid (DTPA) or Technegas. Perfusion studies are performed after intravenous injection of macroaggregated human albumin. Radiation exposure using documented isotope doses is 1.2-2 mSv. Planar and tomographic techniques (V/P(PLANAR) and V/P(SPECT)) are analysed. V/P(SPECT) has higher sensitivity and specificity than V/P(PLANAR). The interpretation of either V/P(PLANAR) or V/P(SPECT) should follow holistic principles rather than obsolete probabilistic rules. PE should be reported when mismatch of more than one subsegment is found. For the diagnosis of chronic PE, V/P(SCAN) is of value. The additional diagnostic yield from V/P(SCAN) includes chronic obstructive lung disease (COPD), heart failure and pneumonia. Pitfalls in V/P(SCAN) interpretation are considered. V/P(SPECT) is strongly preferred to V/P(PLANAR) as the former permits the accurate diagnosis of PE even in the presence of comorbid diseases such as COPD and pneumonia. Technegas is preferred to DTPA in patients with COPD.
 ...
PMID:EANM guidelines for ventilation/perfusion scintigraphy : Part 1. Pulmonary imaging with ventilation/perfusion single photon emission tomography. 1956 36

The long-term use of inhaled anticholinergic agents has recently been suggested to be associated with an excess risk of adverse cardiovascular (CV) outcomes in patients with COPD. We identified 15 published studies that reported on the association between long-term inhaled anticholinergic use and adverse CV outcomes. Only 3 of the studies were adequately designed randomized controlled trials (RCTs). The first RCT that suggested that anticholinergic agents increased the risk of adverse CV outcomes was the Lung Health Study (LHS). Smokers randomized to inhaled ipratropium had a significantly increased risk of CV death than smokers receiving placebo. The LHS results have been questioned as the statistical tests used in the study were not adjusted for multiple tests and endpoints, a convincing dose-effect relationship between ipratropium use and the adverse CV outcomes was not established, and most of the CV deaths in the ipratropium group occurred in patients who were non-compliant to ipratropium. The Investigating New Standards for Prophylaxis in Reducing Exacerbations (INSPIRE) was a RCT that compared the combination of salmeterol plus fluticasone against tiotropium in patients with COPD. All-cause mortality was significantly lower in the salmeterol plus fluticasone group (3%) compared to the tiotropium group (6%). Fatal CV events occurred in 1% of the salmeterol plus fluticasone group compared to 3% in the tiotropium group. The INSPIRE trial was not designed to be a mortality trial, lacked adequate adjudication of fatal outcomes, and lacked a full intention-to-treat analysis of the data. The Understanding Potential Long-Term Impacts on Function with Tiotropium (UPLIFT) trial was a RCT comparing tiotropium and placebo in patients with COPD. Follow-up in UPLIFT was planned for 1440 days (4 years) plus 30 days (1470 days) of post-treatment follow-up. At 1440 days with 95% of patient outcome accounted for, tiotropium was associated with a significant 13% reduction in all-cause mortality compared to placebo. However, at 1470 days with only 75% of patient outcome accounted for, tiotropium was associated with a non-significant 11% reduction in all-cause mortality compared to placebo. The relative risks for serious CV events, heart failure, and myocardial infarction were all significantly lower with tiotropium than placebo. It is not certain why such a wide disparity in findings exists among the published studies evaluating the CV risks of inhaled anticholinergic agents. Prospective, adequately powered RCTs are needed to provide more evidence for the CV safety of tiotropium.
 ...
PMID:A systematic review of the cardiovascular risk of inhaled anticholinergics in patients with COPD. 1965 99

Mortality and other long-term outcomes of COPD from epidemiological studies of cohorts based on the general population are still rare. In contrast, data from follow-ups of patients from hospitals and general practices are more common and demonstrate often a 5-year mortality of about 50% and even higher. The aim was to study 20-year outcomes, mainly mortality, in a COPD cohort derived from a population study. The Obstructive Lung Disease in Northern Sweden (OLIN) Study's first postal survey was performed in 1985, and 5698 subjects (86%) responded. A stratified sample of symptomatic subjects and controls was invited to clinical examinations including lung function tests in 1986, 1506 (91%) of the invited participated and 266 subjects fulfilled the GOLD criteria of COPD. All alive and possible to trace had participated at least at two follow-up examinations. Of the 266 subjects with COPD 46% were still alive after 20 years. The proportion of survived among subjects with severe and very severe COPD at entry was 19%. Death was significantly related to age, male sex, disease severity and concomitant ischemic heart disease or cardiac failure at entry. Socioeconomic status (manual workers) was significant in the univariate analysis, but failed to reach statistical significance in the multivariate model. The annual decline in FEV(1) among survivors was low to normal. Long-term follow-ups of subjects with COPD derived from population studies provide data reflecting the course of COPD in society better than follow-ups of hospital recruited patients, who represent the top of the iceberg. Surprisingly many with severe COPD were still alive after 20 years.
COPD 2009 Aug
PMID:A 20-year follow-up of a population study-based COPD cohort-report from the obstructive lung disease in Northern Sweden studies. 1981 85

Family relationship quality predicts medical outcomes in various health conditions, including stroke, end stage renal disease, and heart failure. Family relationships also influence the onset and course of depression and anxiety disorders. Family may be particularly important in COPD given the high prevalence of depression and anxiety in COPD patients and the association of depression and anxiety with important clinical features of COPD such as dyspnea. The objective of this study was to test three hypotheses in a sample of individuals with COPD: (1) unsupportive family relationships are associated with psychological distress; (2) psychological distress is associated with dyspnea and impairment in health-related quality of life; and (3) unsupportive family relationships are indirectly associated with dyspnea and health-related quality of life via psychological distress. Cross-sectional data were collected via self-report questionnaires completed by 526 individuals with COPD. Structural equation modeling was used to test the hypotheses. All three hypotheses were supported. Unsupportive family relationships were associated with psychological distress, psychological distress was associated with dyspnea and impairment in health-related quality of life, and unsupportive family relationships were indirectly associated with dyspnea and health-related quality of life via psychological distress. If subsequent longitudinal investigations demonstrate that unsupportive family relationships do indeed lead to psychological distress among individuals with COPD, then interventions to improve family relationships of patients with COPD could lead to reductions in psychological distress and, ultimately, to improvements in dyspnea and quality of life.
COPD 2009 Oct
PMID:Family relationship quality is associated with psychological distress, dyspnea, and quality of life in COPD. 1986 65

Copeptin denominates the C-terminal fragment of the vasopressin (AVP) precursor hormone. Circulating copeptin levels reflect the activity of the AVP system and correlate closely with plasma osmolality. The measurement of stimulated plasma AVP levels is crucial in the differential diagnosis of diabetes insipidus, particularly the characterization of partial forms, and is used to diagnose primary polydipsia. However, determination of AVP levels is technically demanding, and validated assays are not readily available for clinical routine. Recently, a reliable sandwich immunoassay for measurement of serum or plasma copeptin levels has been introduced. Assaying stimulated copeptin levels will be helpful in the differential diagnosis of diabetes insipidus. Recent studies suggest that measurement of copeptin, once the assay is commercially available, might prove useful in the workup of hyponatremic disorders. Moreover, copeptin has been found to be a prognostically relevant biomarker in a variety of illnesses such as sepsis, shock, pneumonia, acute exacerbation of COPD, heart failure, and myocardial infarction.
 ...
PMID:[Copeptin: diagnostic parameter, biomarker, or both?]. 1988 89

Excessive daytime sleepiness (EDS) is a major health concern in geriatric patients. EDS affects quality of life, daytime function, and mortality. The Epworth Sleepiness Scale (ESS) is a standard tool for the assessment daytime sleepiness, but the feasibility of the ESS has never been investigated in elderly subjects. We applied the ESS to a random sample of geriatric in-hospital patients. The aim of the study was to reveal the frequency and the risk factors for processing failure of the ESS in geriatric patients. 458 patients with a mean age of 82+/-8 years were included. One hundred sixty six (36%) completed the ESS, 118 (28%) patients had omissions of items, and 174 (38%) patients were unable to respond to any item. Completion of the ESS correlated significantly with age, disability, dementia, impairment of vision, and hearing. Omitted items were related to mobility and activities outside the house. Logistic regression analysis with completed ESS as a dependent variable revealed that dementia, disability, heart failure, and COPD were independent and significant risk factors for processing failure. The majority of patients of a geriatric unit are unable to complete the ESS. Since EDS is a frequent finding with a negative impact on health, the development of a reliable and valid tool for the assessment of EDS in elderly subjects is needed.
 ...
PMID:Feasibility of the Epworth Sleepiness Scale in a sample of geriatric in-hospital patients. 2013 38

There are many potential pathologies that cause a patient to have a complaint of shortness of breath and it may not always be easy to differentiate between heart failure, COPD/asthma and pneumonia. Misdiagnosis of heart failure is common and inappropriate treatment may be harmful. It has been shown that 25% of patients given furosemide developed significant electrolyte imbalances and hypotension requiring fluid boluses; adding morphine increased mortality by 22% compared to 2% with only nitroglycerin. If you have any question about the diagnosis, it would be appropriate to treat your patient with bronchodilators, nitroglycerin and NIPSV, avoiding morphine and furosemide. Remember that heart failure might be the result of an AMI, so it is important to consider aspirin as well.
 ...
PMID:'F' is for failure. One patient's experiences provide a compelling lesson in cardiac care for EMS providers. 2021 9


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>