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

Digital subtraction angiography (DSA) has been confirmed to be an accurate method for determining left ventricular function. It is a relatively non-invasive technique without inducing premature ventricular complexes. The response of left ventricular function to afterload stress was assessed using DSA for eight patients with old anterior myocardial infarction and ventricular aneurysm including that of the anterior wall (averaging 30.3 months after the acute episodes). Their ages ranged from 36 to 65 years and one patient was a woman. Prior to the investigation, we confirmed that a single DSA procedure did not alter left ventricular function in a pilot study of one patient (No. 8). After initial DSA in the basal state, methoxamine was infused intravenously (1 to 2 mg/min). When aortic systolic blood pressure increased by 30 to 50 mmHg, a second DSA was performed for each patient. Left ventricular volumes and ejection fractions were calculated by the area-length method, and regional wall motion was assessed by the visual method according to the AHA classification and the curvature radius of the apical ventricular aneurysm was calculated. Methoxamine induced neither acute heart failure nor angina pectoris in the present series. The heart rates decreased, and there were a significant increase in end-systolic volumes (p less than 0.05), end-systolic radii (p less than 0.05), and a significant decrease in ejection fractions (p less than 0.02) after methoxamine infusion. In 32 of 40 segments, regional wall motion was unchanged by methoxamine as assessed by the visual method; whereas, in the other eight, there was a deterioration.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Functional reserve of the ischemic left ventricle with ventricular aneurysm to afterload stress: digital subtraction angiographic assessments]. 391 6

In view of the increased prevalence of so-called "ischemic cardiomyopathy" ( Burch ) in Japan, we attempted to clarify the clinical manifestations of this condition and to investigate the medical treatment in comparison with the surgical therapy. Eighteen patients (17 males and one female) were identified as having "ischemic cardiomyopathy" according to the following criteria: These include (i) an ejection fraction of 30% or less with asynergy on all segments of AHA classification, (ii) significant coronary stenosis (75% or more) of one or more major coronary branches, and (iii) no other coexisting lesion, such as primary valvular disease or congenital heart disease. In the history, distinct myocardial infarction or angina pectoris was observed in 10 cases (56%), and in the remaining eight cases (44%) only symptoms of cardiac failure was shown. On the ECG, all cases showed pathologic Q waves. Moreover, 10 cases (56%) of these had Q waves in five leads or more. Cardiomegaly on the chest X-ray film (CTR greater than or equal to 60%) was evident in 10 cases and that on echocardiogram ( LVDd greater than or equal to 60 mm) in 16 cases. Physical examinations demonstrated gallop sounds in 89% and a B-B' step formation on echocardiograms in 50%. The LVEDP was greater than 12 mmHg in 13 cases, and the systolic pressure of the pulmonary artery was higher than 35 mmHg in 13 cases. On the other hand, the reduced cardiac index (less than or equal to 2.21/min/M2) was observed in only one case. Selective CAG revealed multiple vessel disease in 78%. Ten of the 18 cases had mitral regurgitation demonstrated by left ventriculography.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical manifestations, therapeutic methods and prognosis of patients with ischemic cardiomyopathy]. 661 4

National and international societies have issued guidelines on the management of heart failure: The European Society of Cardiology, WHO, ACC/AHA Task Force Report, US Department of Health and Human Services, German Society of Cardiology. The therapeutic approaches to heart failure have undergone considerable changes during the last few years. The guidelines have to be updated almost yearly due to new results from prospective randomized studies. Although an agreement could be reached with respect to general measures and drug treatment, no agreement on mechanical devices, pacemakers and surgical interventions has been reached. The basis for medical treatment of chronic heart failure depends on diuretics, digitalis, ACE inhibitors, and beta-blockers. Calcium antagonists and other positive inotropic drugs, other than digitalis, should be avoided as far as possible. Thiazides, loop diuretics and aldosterone antagonists are needed for acute and chronic treatment of heart failure, alone or in combination (diuretic resistant heart failure!). Digitalis glycosides are needed in patients with atrial fibrillation with a fast ventricular rate or atrial flutter and in patients with systolic dysfunction, large hearts and symptomatic failure class NYHA III and IV. However, digitalis does not convert atrial fibrillation to sinus rhythm. Today there is no question that ACE inhibitors improve the prognosis of all patients with heart failure in all stages, if ejection fraction is reduced. Therefore, most patients after myocardial infarction or after having experienced pump failure due to myocarditis or cardiomyopathy are treated with ACE inhibitors and diuretics. The beneficial effects of ACE inhibitors seem to be most pronounced the worse the situation is. Relative risk reductions (mortality!) between 10% and 40% have been published depending on the severity of symptomatic left ventricular dysfunction. Those patients with high absolute risk have more to gain than those with low risk for any given "risk reduction", of course. Recent studies also indicate that most high risk cardiac patients profit from ACE inhibitors even if pump function is normal (i.e., patients with coronary heart disease, diabetes mellitus, cerebral vascular disease, hypertension) (15). AT1 antagonists can substitute for ACE inhibitors, if the latter are not tolerated due to cough. Up to now, beta-blocking agents apart from diuretics seem to be the best investigated drugs in heart failure. Large controlled studies with bisoprolol, carvedilol and metoprolol in addition to diuretics, digitalis and ACE inhibitors convincingly yielded positive results in chronic left ventricular failure patients. Reduction of mortality by 35% and even of sudden cardiac deaths by 40% have been proven beyond doubt. Thus, heart failure patients today should also receive beta-blocking agents in all stages of the disease. In the era of controlled prospective studies (evidence-based medicine), physicians are well advised to use only drugs that have been proven beneficial in large controlled studies.
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PMID:The management of heart failure--an overview. 1119 49

ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult are summarized in detail. According to statements of these Guidelines most patients with chronic heart failure as a rule should receive combination of representatives of 4 different drug classes - diuretic, angiotensin converting enzyme inhibitor, beta-adrenoblocker and usually digoxin. Special indications have been formulated for inclusion in complex therapy of aldosterone receptor blockers (first of all spironolactone), angiotensin1 receptor blockers and direct vasodilators (hydralazine, isosorbide dinitrate).
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PMID:[Contemporary approaches to diagnosis and management of chronic heart failure (summary of the American College of Cardiology/American Heart Association Guidelines)]. 1249 35

A review of the most important topics published during 2001 is presented. The Writing Committee of the American College of Cardiology and the American Heart Association decided to take a new approach to the classification of heart failure that emphasizes both the evolution and the progression of the disease, using potential risk factors and structural disorders as criteria to identify the severity of a heart failure syndrome. Similarly, an ACC/AHA Clinical Competence Statement on electrocardiography and ambulatory electrocardiography was published with a special emphasis on the computer interpretation of the electrocardiogram. Since various drugs were shown to induce electrocardiographic abnormalities as e.g. QT prolongation associated with ventricular tachycardias, the FDA decided to introduce higher regulatory requirements on the cardiac safety of novel drugs. In cardiovascular surgery Octopus off-pump bypass was demonstrated to be a safe procedure for carefully selected patients with multivessel coronary heart disease. Because of the extensive progress made in cardiovascular surgery, the management of severe heart failure has to be improved and early effective preventive measures have to be introduced to reduce the risk of intractable heart failure. The "New guidelines for evaluating acute coronary syndrome" stress the importance of early identifying and early treatment, including invasive strategy as PTCA with stenting.
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PMID:[Cardiology 2001]. 1250 6

A review of the revised ACC/AHA heart failure guidelines.
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PMID:What makes the new heart failure guidelines tick? Serving as an adjunct to the NYHA's classification, the ACC/AHA system assesses objective signs of heart disease. 1257 83

The aim of this study was to evaluate ventricular arrhythmias occurring in recipients of the InSync ICD for the primary and secondary prevention of sudden death. The InSync ICD was implanted in 142 patients (128 men; mean age 65 +/- 10 years) with heart failure (mean NYHA functional Class 3.0 +/- 0.7) and wide QRS (mean 159 +/- 33 ms). The underlying etiology was ischemic in 55%, idiopathic in 33%, and valvular or hypertensive cardiomyopathy in 12% of patients. The numbers of arrhythmic episodes/100 patient-months was computed with their 95% CI, assuming a Poisson distribution. Implants were performed in 48 (34%) patients who did not have an ACC/AHA guidelines Class I indication for ICD therapy. A total of 104 patients were compliant for follow-up visits. During a 9-month median (range 0.1-24) follow-up of 104 compliant patients, 19 experienced a total of 94 ventricular arrhythmias, all successfully interrupted or self-terminated, with a median number of two separate episodes, corresponding to a rate of 10 episodes/100 person-month (95% CI 8-12). A rate of 12 episodes/100 person-months (95% CI 10-15) was measured in the subgroup of patients with ACC/AHA class I indications, versus two episodes/100 person-months (95% CI 1-5) in the remainder of the population. Among 12 deaths, 9 were due to heart failure, 1 to a non-cardiovascular cause, and 2 to unknown causes. The implantation of ICD in heart failure patients has been prominently extended to primary prevention. Patients without standard ICD indications experienced life-threatening arrhythmic events. The impact of ICD combined with cardiac resynchronization therapy on arrhythmic profile, mortality, and costs in this subgroup of patients need to be more precisely studied, with a particular focus on the various types of underlying heart disease.
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PMID:Cardiac resynchronization and implantable cardioverter defibrillator therapy: preliminary results from the InSync Implantable Cardioverter Defibrillator Italian Registry. 1268 1

Acute heart failure is a life-threatening medical emergency and appropriate management can reduce the morbidity and mortality of heart failure. Despite advances in treatments, the number of deaths has increased steadily. Therefore, the guideline was assigned to convey to the physicians the virtue of medical management with recent trends in pharmacological and nonpharmacological treatments. Japanese new guidelines for the management of acute heart failure have been published from the Japanese Circulation Society in October, 2000, which was partially based on ACC/AHA guideline in 1995 but prepared under consideration of medical benefits system and health care system in Japan. We expect that the guideline would be revised to make it more useful with continual advances in the management strategies in the future.
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PMID:[Acute heart failure]. 1275 93

It has been estimated that about 320,000 to 400,000 patients in the USA alone are possible candidates to cardiac resynchronization therapy according to the recently published AHA/ACC/NASPE guidelines for pacing and the results of the COMPANION trial. The selection of the most suitable candidate for CRT/CRTD is a crucial issue, but still a matter of debate. A large variety of clinical, invasive and non-invasive criteria have been proposed for appropriately selecting candidates for CRT. However, in all the studies the parameters have been retrospectively identified and none has reported their results in the form of a multivariate regression model. We have now well characterized the patients in sinus rhythm who most likely benefit from this non-pharmacological approach. The fact that the COMPANION trial was able to single out a specific subgroup of heart failure patients that can be treated better than what was very short time ago best medical therapy validates the large body of research that investigators worldwide have created about this therapy. Finally, the concept that any patients that require ventricular pacing, who have heart failure class II/III or IV may benefit from receiving biventricular rather than right ventricular pacing as much as the other patients with more classical indication for CRT is still open to discussion and needs to be tested in a randomized multicenter trial.
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PMID:The promise of resynchronization therapy. Who (and how many) will benefit? 1276 11

Chronic heart failure (CHF) constitutes a significant clinical issue due to its increasing prevalence in general population and still fatal prognosis. During last twenty years the significance of beta-blockers in the treatment of CHF has changed. It resulted from the hypothesis from 1975 that in the course of CHF it comes to the activation of sympathetic system and renin-angiotensin-aldosterone system. Authors presented the actual views on CHF pathogenesis, mechanisms of favourable action of beta-blockers in CHF and the data from clinical trials on effectiveness of beta-blockers in different stages of CHF (among the others in elderly patients and in comparison with other treatment). Nevertheless, there are still several questions related to beta-blockers treatment in patients with CHF waiting to be resolved. Although the number of patients with CHF treated with beta-blockers is still increasing, the usefulness of conclusions resulting from clinical trials--as it has been shown in IMPROVEMENT-HF--is still insufficient. In contrast, following the recommendations of ESC, AHA and the Section of Heart Failure of Polish Cardiology Association both beta-blockers and ACE inhibitors constitute two main groups of medications that should be undoubtedly used in patients with CHF.
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PMID:[Beta-blockers in chronic heart failure]. 1286 3


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