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

The clinical usefulness of cardiac imaging modalities that rely upon the detection of perfusion defects and wall motion disturbances requires conditions that provoke a heterogeneity of coronary flow and a myocardial oxygen imbalance, respectively. Traditionally, this has been achieved by exercise stress testing. Many patients cannot perform dynamic exercise sufficiently for various reasons. Pharmacologic stress has been proven to be an attractive alternative for physical exercise. Currently, several stressing agents are used in conjunction with thallium-201 scintigraphy, 2-D echocardiography and, recently, MRI. The most employed agents include vasodilators, such as dipyridamole and adenosine, and catecholamines, such as dobutamine (Table VI). The predominant rationale of thallium-201 perfusion scintigraphy is based on the creation of a flow maldistribution between territories supplied by normal arteries and those supplied by stenotic arteries that does not necessarily require ischemia. Dipyridamole and adenosine, as rather selective coronary vasodilators, are well suited to provoke such a condition and may be classified as the ideal markers of myocardial perfusion. 2-D echocardiography and MRI have the potential to provide noninvasively derived information of cardiac dynamics and regional myocardial function. To assess the functional significance of coronary artery disease, detection of wall motion abnormalities and alterations in ejection fraction require the presence of myocardial ischemia. Dobutamine, as a widely applied inotropic agent in the management of severely depressed left ventricular contractile function, seems to be an appropriate pharmacologic stressor when heart failure is absent. By increasing contractility, heart rate, and systolic arterial pressure, it is capable of inducing an imbalance between myocardial oxygen demand and supply, leading to ischemia in patients with coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:New developments in pharmacologic stress imaging. 163 90

The efficacy of a new calcium channel blocker, gallopamil, has been tested via a single blind, self-controlled versus placebo protocol in 9 consecutive patients admitted to our Coronary Care Unit because of repeated daily attacks of Prinzmetal variant angina. Exclusion criteria were age (greater than 65 years) bradycardia (less than 50 beats/min), recent myocardial infarction, heart failure, sinoatrial or atrioventricular block. After a 24 hours run-in period on saline drip, gallopamil was administered as 0.03 mg/kg bolus followed by continuous infusion at 0.02 mg/kg/h for the first 24 hours and 0.03 mg/kg/h for the last 48 hours. Treatment was then stopped and the patients were again kept on saline infusion for the next 30 hours. Holter monitoring was recorded during run-in, on third day of treatment and 6 hours after gallopamil withdrawal. Anginal attacks were significantly reduced in number by therapy (-63%, -91%, -84% in the 3 days of treatment). Holter monitoring during gallopamil infusion showed a statistically significant reduction in silent (-98%) and symptomatic (-93%) ischemic episodes (IE). During the last 24 hours of the washout period we observed a statistically significant increase in silent ischemic episodes. While no transient ST segment elevation was recorded in 3 patients, in 1 patient symptomatic IE were increased of 150% with respect to the run-in period. On the whole we observed complete suppression of IE in 7 patients (78%) at the third day of treatment with gallopamil. In 2 patients (22%) a greater than 75% reduction was observed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Gallopamil infusion for treatment of Prinzmetal angina]. 212 41

To clarify the clinical significance of regional myocardial perfusion abnormality of the left ventricle in dilated cardiomyopathy (DCM), 20 patients with DCM underwent dipyridamole Tl-201 emission computed tomography (ECT). The subjects were divided into 2 groups: group 1 had (n = 9) reversible defects and group 2 (n = 11) had persistent defects only. Group 2 patients significantly advanced heart failure and significantly poorer prognoses than group 1 (55% vs 11% in 2 years survival rate, p less than 0.05). The echocardiographic left ventricular end-diastolic dimension was larger in group 2 than group 1 (68.3 +/- 8.2 mm vs 61.9 +/- 4.0 mm, p less than 0.05) and % fractional shortening was smaller in group 2 than group 1 (18.0 +/- 4.5% vs 24.5 +/- 6.9%, p less than 0.05). Moreover, 12 of the 13 segments with reversible defect showed fairly well preserved left ventricular wall motion, whereas 35 of 58 segments with persistent defect had severely impaired wall motion (1/13 vs 35/58, p less than 0.01). Dipyridamole Tl-201 ECT demonstrated conclusively that the two types of defects (reversible and persistent) are useful to evaluate not only the abnormal myocardial perfusion but also myocardial damage and the prognosis in DCM.
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PMID:The clinical and prognostic significance of dipyridamole Tl-201 emission computed tomography in patients with dilated cardiomyopathy. 350 Oct 20

A 6-month-old female infant was seen with heart failure secondary to severe aortic and mitral regurgitation. As a neonate the infant had undergone an aortic valvotomy for congenital aortic stenosis. Subsequently the infant had aortic and mitral regurgitation with an infarcted papillary muscle. Double valve replacement was carried out with the St. Jude valve. The first approach was by the Manouguian procedure with extension of the aortotomy out between the left coronary cusp and the noncoronary cusp. The posterior mitral apparatus was resected, and a 19-mm St. Jude aortic valve was sewn into the mitral position. Because the enlarged aortic valve annulus was still inadequate to accommodate a 19-mm St. Jude valve, a Konno procedure was carried out to enlarge the aortic ring anteriorly. Atrial, septal, and aortic repair and right ventricular outflow tract reconstruction were carried out with bovine pericardium. Bypass was carried out with standard techniques of hypothermia, aortic cross-clamping, and cardioplegia. Postoperative anticoagulation therapy was initially with aspirin and dipyridamole (Persantine); however, clotting of the mitral prosthesis necessitated treatment with urokinase and heparin, which completely resolved the clot. Sodium warfarin (Coumadin) therapy was then begun. One year postoperatively, the child is developing normally.
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PMID:Combined techniques for double valve replacement in the infant. 388 67

Verapamil in a 400 mg daily dose was used in 64 coronary patients with the unstable angina syndrome, their condition being assessed by means of coronarography (40) and the cold test (24). Anginal attacks subsided in more than 60% of the patients treated with verapamil alone or in combination with long-acting nitrates, and their treatment was continued on an out-patient basis. In 24 patients, the drug had no effect and was discontinued. Typically, all the three major coronary arteries were affected in these patients, and they were refractory to other antianginal drugs. Myocardial infarction developed during hospital stay in 7 (11%) patients. The cold test has no predictive value with respect to the efficiency of verapamil in these patients, as the rate of positive tests is rather low. The drug taken in a 400 mg dose is easily tolerated by patients over long periods of treatment (up to 1.5 pears), however, their circulatory status should be closely monitored because of a risk of heart failure and arterial hypotension.
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PMID:[Use of verapamil for treating patients with unstable stenocardia]. 402 Dec 96

This study was designed to analyze the effects of carbocromene and dipyridamole on the haemodynamic and electrocardiographic side-effects resulting from imipramine infusion in anaesthetised rats and dogs. Imipramine was infused at 1 mg/kg/min until cardiac failure and vascular collapse terminated the experiment at 21 +/- 2.3 min in rats and at 29.5 +/- 2.1 min in dogs. This was characterized by hypotension, bradycardia, intraventricular conduction delay, cardiac tachyarrhythmia and A-V block. Carbocromene (4 mg/kg i.v., followed by 80 micrograms/kg/min) protected the animals against heart failure. This was associated with delayed hypotension and negative inotropy, and lower incidence of heart block. Survival time increased to 37 +/- 1.5 min (P less than 0.05), and 54.2 +/- 2.6 min (P less than 0.02) in rats and dogs, respectively. Dipyridamole (0.5 mg/kg i.v., followed by 80 micrograms/kg/min) failed to decrease imipramine toxicity as judged by the haemodynamic and electrocardiographic parameters and did not alter survival time of imipramine controls. These results suggest that carbocromene is an effective treatment for imipramine-induced cardiovascular collapse and cardiac arrhythmias, the beneficial effects being largely due to metabolic and membrane stabilizing effects. Carbocromene has both therapeutic and prophylactic value and appears to be superior to dipyridamole therapy.
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PMID:Treatment of haemodynamic and electrocardiographic side-effects resulting from imipramine toxicity in rats and dogs. 404 78

Clinical data on 3,479 consecutive patients having coronary bypass surgery were retrospectively analyzed. Perioperative complications, incomplete revascularization, and reduced long-term survival could frequently be correlated with manifestations of myocardial damage. Patients with triple vessel and left main coronary disease had a greater frequency of inotropic requirements than did patients with single or double vessel disease (7.9% and 8.6% vs. 3.8% and 4.2%). Inotropic requirements in the perioperative period were significantly increased for patients with preoperative left ventricular dysfunction; a history of heart failure or multiple infarctions did not significantly increase the incidence of inotropic requirements. Presence of previous myocardial infarction, heart failure, or left ventricular contraction abnormalities significantly decreased the ability to achieve complete revascularization with bypass grafting. Hospital mortality since 1976 has been 0.8% (25/3,040). Hospital mortality was significantly increased by history of myocardial infarction, hypertension, heart failure, extent of anatomic disease, presence of preoperative ST-T wave changes, and severe abnormalities of left ventricular function. Hospital mortality in patients with ejection fraction </=0.35 was 3.4% vs. 1.3% for those >0.35. Anginal pattern, history of hypertension, previous myocardial infarction, preoperative heart failure all significantly affected long-term survival. Occurrence of perioperative myocardial infarction did not adversely influence long-term survival. Patients with normal left ventricular function had excellent 42 month survival regardless of vessel disease (95%, 96%, and 94% for single, double, and triple vessel disease, respectively). Survival was significantly less for such patients with abnormal left ventricular function. Inability to achieve complete revascularization did not adversely affect hospital mortality, but did significantly reduce late survival. The important effect which complete revascularization had on long-term survival appeared to increase with increasing severity of coronary disease. Although bypass grafting improves survival in patients with multivessel disease and left ventricular dysfunction, the benefits appear to be significantly reduced once manifestations of left ventricular damage have occurred.
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PMID:Clinical, anatomic and functional descriptors influencing morbidity, survival and adequacy of revascularization following coronary bypass. 696 82

We retrospectively analyzed the clinical data on 3479 consecutive patients having coronary bypass surgery. Patients with triple vessel and left main coronary disease had a greater frequency of inotropic requirements than did patients with single or double vessel disease (7.9% and 8.6% versus 3.8% and 4.2%; P less than 0.001). Presence of previous myocardial infarction, heart failure, or left ventricular contraction abnormalities significantly decreased the ability to achieve complete revascularization with bypass grafting. Hospital mortality since 1976 has been 0.8% (25/3040). Hospital mortality was significantly increased by history of myocardial infarction (P less than 0.001), hypertension (P less than 0.05), heart failure (P less than 0.01), extent of anatomic disease (P less than 0.005), presence of preoperative ST-T wave changes (P less than 0.001), and severe abnormalities of left ventricular function (P less than 0.001). Anginal pattern, history of hypertension, previous myocardial infarction, preoperative heart failure but not perioperative myocardial infarction significantly affected long-term survival. Patients with normal left ventricular function had excellent 42-month survival regardless of vessel disease. Inability to achieve complete revascularization did not adversely affect hospital mortality, but did significantly reduce late survival. Although bypass grafting improves survival in patients with multivessel disease and left ventricular dysfunction, the benefits appear to be significantly reduced when left ventricular damage has occurred.
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PMID:Clinical factors influencing survival and adequacy of revascularization after coronary bypass operation. 698 39

The effects of dipyridamole, a coronary and peripheral vasodilator drug, on cardiac performance were investigated in nine patients with severe chronic heart failure. Dipyridamole (30 to 80 mg IV) increased cardiac index (1.63 to 2.65 l/min/m2) and decreased systemic vascular resistance (2097 to 1124 dyn/sec/cm-5). Left ventricular filling pressure decreased (23.7 to 20.7 mm Hg) without significant changes in mean right atrial pressure or heart rate. These effects were similar to the hemodynamic responses after 100 mg hydralazine in the same patients, but they were of shorter duration (less than 90 min). In contrast, oral dipyridamole induced only modest responses in three of eight patients despite large single doses of the drug (150 to 300 mg). Dipyridamole is a rapid-acting short-lived vasodilator, which exerts predominantly arterial vasodilator actions similar to those of hydralazine. Due to inconsistent response after oral doses, however, the therapeutic application of dipyridamole in long-term management of chronic heart failure appears to be limited.
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PMID:Central hemodynamic effects of dipyridamole in severe heart failure: comparison with hydralazine. 708 30

A new feature has been encountered in review of a large species of autopsy materials of beta-thalassaemia/Hb E disease. Among 43 patients pulmonary arterial obstructive lesions were found in 19 (44%), of which 17 were splenectomised cases. The pulmonary arterial thromboembolism may have been due to circulating platelet aggregates. This newly discovered pathology may be an additional factor contributing toward dyspnoea and heart failure in thalassaemia besides anaemia and cardiac iron deposition. If it is proven that this pulmonary arterial thromboembolism is indeed due to circulating platelet aggregates, preventive measure by administration of drugs reducing platelet aggregation such as aspirin and Persantin may be indicated, especially after splenectomy.
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PMID:Pulmonary artery obstruction in thalassaemia. 722 95


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