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

A salt-free diet is usually useless or dangerous in the elderly subject. It has at present only rare indications, such as after acute pulmonary oedema or congestive heart failure during initial treatment. In all other cases, it may be replaced by a reasonable diet; sodium intake remains permitted, but naturally one should not fall in the opposite extreme. As in younger subjects, and provided one takes into consideration the subjacent renal condition, properly prescribed diuretics have transformed the situation in the treatment of heart failure as in essential hypertension. Naturally the patient still requires regular clinical supervision and laboratory tests which may in practice be limited to periodical estimation of blood urea and serum potassium, less regularly, blood sugar and uric acid.
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PMID:[Salt-free diet and diuretics in the elderly (author's transl)]. 21 98

Five hundred and eighty-eight patients with mitral valve disease were studied. The incidence of systemic emboli was found to be higher in patients with pure mitral stenosis (16.6%) and mixed mitral stenosis and incompetence (19.4%) than in patients with mitral incompetence (3.1%). The patients with mitral stenosis who had episodes of systemic emboli tended to be older than 40 years, with moderate or severe valve lesions, atrial fibrillation and moderate or gross enlargement of the left atrial appendage or left atrium. The following factors were found to be unrelated to systemic embolism---associated aortic valve disease, sex, smoking habit, history of rheumatism, parity, haemoglobin, blood urea, pulmonary hypertension, duration of antifailure treatment, presence of heart failure, and cardiothoracic ratio.
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PMID:Thromboembolic complications of mitral valve disease. 28 50

The concentrations of urea, urate, phosphate and creatinine were measured in the plasma of 30 consecutive patients admitted acutely with heart failure. On admission, 20 had a raised plasma urea, 21 had a raised plasma urate, but only 6 had a raised plasma phosphate and only 6 had a raised plasma creatinine. A further 9 of the patients developed a raised plasma urea after admission. The increase in plasma urea present on admission was greater than expected for the fall in GFR (as indicated by the increase in plasma creatinine). The results for plasma and urine taken together suggest that a major cause of the raised plasma urea was an increased urea production rather than a reduced glomerular filtration rate. There was no obvious relationship between plasma urea and clinical features, or diuretic therapy.
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PMID:The cause of the raised plasma urea of acute heart failure. 43 64

From February 1975 until July 1976 12 patients who elective surgery and 15 trauma victims received intraoperative autotransfusion. The effects of this method on these patients were controlled by monitoring the behaviour of circulation and of important laboratory parameters. The procedure was well tolerated: 1. Only three of 29 patients showed evidence of cardiac insufficiency (lowering of ST. elevated T-peak, low blood pressure, high central venous pressure) which disappeared after reducing the rate of infusion. --2. Blood pressure, pulse rate and central venous pressure were stable at the end of the operation. --3. There was no renal insufficiency under dopamine (210 microgram/min) and 15% manitol (250 ml i.v.). --4. Serum creatine showed only minor changes from the initial level during the time of observation. --5. The same was true for beta2-microglobulin. --6. Serum urea rose slightly during 7 days. --7. There were minor changes of electrolytes without hypocalcaemia or high potassium. --8. The observed changes showed no relation to the method of anticoagulation and to time or volume of autotransfusion.
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PMID:[Intraoperative autotransfusion, technical management and its influence on blood circulation, on kidney and electrolytes (author's transl)]. 59 7

The clinical and laboratory features of 18 adult pellagrins are reviewed. Only four patients (22%) had the full trial of dermatitis, diarrhea and dementia. Dermatitis alone occurred in six(33%), dementia in five(28%) and dermatitis and diarrhea in three(17%). In one patient, dermentia was the initial sign of a relapse. Steatorrhea was found in six patients and was usually associated with marked alopecia. Edema without evidence of cardiac failure was present in seven patients. A diffuse increase in slow wave activity on the electroencephalogram was characteristic in patients with dementia. Fever occurred in 14 patients, and an infection was documented in 10 of these. Common laboratory abnormalities included a normochromic, normocytic anemia, lymphopenia, eosinopenia hyperuricemia, and low serum levels of albumin, urea, cholesterol, carotene, potassium, calcium, and magnesium. Adrenal and thyroid function were normal, but a low serum T4, high serum free T4, and an elevated T3 resin uptake were frequently observed. These abnormalities were corrected with treatment of the underlying nutritional disorder. In two patients initially treated with thiamine alone, and in one who received inadequate amounts of niacin and protein, there was marked deterioration of mental function, which responded to administration of niacin and proper diet.
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PMID:Pellagra: an analysis of 18 patients and a review of the literature. 86 2

Acute renal failure occurred in association with cardiac surgery in 20 of 248 infants (8%). Hypotension, poor tissue perfusion, and hypoglycemia were the most important factors recognized in the pathogenesis and outcome of the ARF. However, many infants were extremely ill preoperatively. The most frequent operative procedures performed in the 20 patients were open-heart surgery with total correction under deep hypothermia and repair of coarctation of the aorta. Thirteen of the 20 infants with ARF died. The combination of a major operative procedure, cardiac failure, hypoglycemia, hypotension, and compromised renal function imposes important constraints in the treatment of hyperkalemia, hypoglycemia, correction of acid-base distrubances, and the administration of fluids.
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PMID:Acute renal failure: an important complication of cardiac surgery in infants. 116 17

Patients with severe heart failure often exhibit signs of an impaired renal function. As judged from serum urea and creatinine concentrations, renal function may deteriorate further after the addition of angiotensin-converting enzyme (ACE) inhibitors to therapy. The beneficial effect of unloading the failing heart by reducing the systemic outflow resistance is opposed by a potentially harmful effect of unloading the kidney by preferentially reducing the outflow resistance of the glomerulus. However, development of functional renal insufficiency is unlikely and is a rare cause for withdrawing ACE inhibitors when certain precautions are considered: (1) The initial dose of the ACE inhibitor has to be reduced with increasing severity of heart failure (the titration period thereafter should be monitored carefully); (2) an increase in serum creatinine not exceeding 30% of the basal value may be taken as evidence for a beneficial action of the drug, which in addition to altering cardiac function alters kidney function (when the increase in serum creatinine is considered to be of clinical significance, it seems wise to reduce the dose of diuretics first--thereby neuroendocrine stimulation can be attenuated and the dependency of renal filtration from angiotensin II-induced efferent vasoconstriction can be reduced); and (3) the coadministration of inhibitors of prostaglandin synthesis (e.g., acetylsalicylic acid) appears to be associated with a higher risk of impairing renal function: the decrease in glomerular filtration rate is more marked and the compensatory increase in renal plasma flow following ACE inhibition is no longer observed.
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PMID:Angiotensin-converting enzyme inhibitors and renal function in heart failure. 132 67

Once-daily lisinopril (5-20 mg) was compared with twice-daily captopril (12.5-50 mg) in a double-blind, randomized, parallel-group study of angiotensin-converting enzyme (ACE) inhibition conducted in 31 centers for 12 weeks in patients with heart failure (New York Heart Association class II-III) who were currently receiving digitalis and/or diuretics. The drugs were compared with regard to their effects on exercise duration, measured with bicycle ergometry, and on ectopic activity, measured using Holter monitoring. Both drugs significantly increased exercise duration after both 6 and 12 weeks of randomized treatment. Neither ACE inhibitor had any significant impact on the hourly rate of either ventricular ectopic counts or couplets, nor was there any difference between treatments with regard to the proportions of patients in whom ventricular ectopic counts were reduced. Both drugs were well tolerated, with no differences observed between treatments. Potassium, urea, and creatinine levels remained stable for both treatments throughout the study.
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PMID:Long-acting angiotensin-converting enzyme inhibition: once-daily lisinopril versus twice-daily captopril in mild-to-moderate heart failure. 132 77

Early clinical experience with lisinopril suggested that it was well tolerated in congestive heart failure (CHF). An analysis of data from greater than 1,000 patients treated with lisinopril has been performed to examine the long-term safety of lisinopril in CHF. Of these, 620 have been studied for up to nearly 4 years, and a further 440 have been studied in comparative trials for 3 months. When patients who received lisinopril or placebo for the same period were compared, the proportion of lisinopril patients reporting an adverse event was 44.1% compared with 39.4% on placebo. Over a 4-year period, 205 patients (33.1%) discontinued treatment. About 33% of these died, 33% withdrew due to clinical adverse events, 21 (3.4%) were withdrawn because of adverse laboratory findings, and 56 (9.0%) withdrew for reasons unrelated to treatment. Sixteen patients (2.6%) withdrew because lisinopril was deemed ineffective. The most frequently reported drug-related adverse laboratory findings were increases in blood urea nitrogen, blood urea, serum creatinine, and plasma potassium. There appeared to be no differences in the pattern of adverse events with respect to the race of the patient. Elderly patients and those with the most severe forms of heart failure appeared to be at greater risk for an adverse event. Evaluation of the safety of lisinopril compared with enalapril, captopril, and digoxin in controlled clinical trials shows all the angiotensin-converting enzyme inhibitors to be equally well tolerated with a closely similar range of adverse events, suggesting that the satisfactory safety profile of lisinopril is shared by other drugs of this class.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Safety of long-term use of lisinopril for congestive heart failure. 132 80

Thirty-three cases of infective endocarditis presenting during a 6.5 year period to a district general hospital were analysed retrospectively. The annual incidence was 22 cases per million population. Twenty-two cases had pre-existing cardiac disease, mainly valvular disease-usually rheumatic (nine cases) and prosthetic valves (10 cases). Recognizable precipitants such as recent surgery were uncommon. Two cases presented after deliberate drug overdose possibly due to depression exacerbated by systemic disease. Symptoms were usually non-specific. All but two cases had murmurs and most were pyrexial. Splinter haemorrhages and clubbing were seen in about 20% of cases. Viridans-type streptococci were the commonest infecting organisms (14 cases). Staphylococcal infection (six cases) was confined to intravenous drug abusers and patients with prosthetic valves. Five cases were culture negative. Cardiac failure was present in 13 cases at presentation and developed in seven others during treatment. Acute valve replacement was necessary in eight cases, and late replacement in three. Renal impairment (plasma urea > 8 mmol/l and/or plasma creatinine > 120 mumol/l) occurred in 19 cases during the course of their illness. Embolic phenomena occurred in 12 patients and mostly involved the central nervous system. In the 8 fatal cases, the cause of death was cardiac failure in six, cerebrovascular accident in one, and myocardial infarction in one. Four of the six patients who subsequently died of cardiac failure had been referred for surgery. Both those who were not referred had coexisting medical problems. Factors associated with increased mortality were age, male sex, cardiac failure (P < 0.01), renal impairment (P < 0.05), and embolic phenomena (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Infective endocarditis in a district general hospital. 143 86


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