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

Acute renal insufficiency after cardiopulmonary bypass can lead to a significant morbidity from fluid overload and electrolyte disturbance, impede pulmonary gas exchange, and postpone weaning from mechanical ventilation. The limitations placed on free water intake result in severe restriction of nutrition while diuretic therapy causes electrolyte imbalance. Artificial renal support either in the form of peritoneal dialysis or hemodialysis may be complicated by sepsis and hemodynamic instability. We reviewed our experience with the use of continuous arteriovenous hemofiltration, an extracorporeal technique for removal of solutes, toxins, and water in critically ill patients with cardiac failure complicated by acute renal insufficiency and hemodynamic instability after cardiopulmonary bypass. Ten infants and children with renal insufficiency caused by low cardiac output had continuous arteriovenous hemofiltration instituted for indications including sepsis, volume overload, oliguria for more than 24 hours nonresponsive to diuretic therapy, and the need for hyperalimentation. All were supported by mechanical ventilation and receiving high-dose inotropic support. Arterial and venous vascular access was successfully obtained by cannulation of the femoral artery and vein in nine patients. Anticoagulation of the circuit was achieved with heparin infusion (6 to 20 micrograms/kg/hr) and monitored by measurement of activated clotting time. The continuous arteriovenous hemofiltration circuit was replaced if there was clot formation, or at 3 days after placement. Dialysis solution (Dianeal) 1.5% or 0.5% was infused as prefilter dilution. With the use of continuous arteriovenous hemofiltration, 20 to 100 m/hr of ultrafiltrate was removed, which allowed correction of hypervolemia, and caloric intake increased from 13.5 kcal/kg/day to 79.5 kcal/kg/day. Continuous arteriovenous hemofiltration was maintained between 5 hours and 8 days and was well tolerated in all patients. Serum urea and creatinine levels declined during continuous arteriovenous hemofiltration. We conclude that continuous arteriovenous hemofiltration is a safe and effective method for fluid and electrolyte homeostasis and that it thus allows hyperalimentation in infants and children after cardiac operations.
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PMID:Continuous arteriovenous hemofiltration after cardiac operations in infants and children. 143 99

Extracorporeal membrane oxygenation is still a relatively new technology that has recently achieved recognition after initial clinical disappointment in the late 1970s. At present, it is considered standard therapy for the full-term infant with PPHN who fails CMV and extraordinary, heroic therapy for older children and adults with ARF or cardiac failure, or both. Currently, the emphasis is on developing new technologies for increasing safety and effectiveness. Areas of interest include heparinless circuits, carotid artery reconstruction, improved monitoring, and expanding applications of VV ECMO. As ECMO becomes safer and more effective, it is believed that new and expanding patient populations will emerge to include premature infants, earlier intervention in term infants, and more liberal application to pediatric and adult populations.
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PMID:Extracorporeal membrane oxygenation. 144 93

We have attempted to define a normal range for blood urea and creatinine for elderly inpatients and to determine the relative importance of pre-renal, renal and post-renal pathology in those with renal impairment. A total of 118 admissions to an acute geriatric unit and 67 separate post mortems in patients over 67 years of age were studied prospectively. Up to 123 items of data were coded and analysed including blood urea and creatinine, clinical or pathological changes associated with renal disease, clinical outcome and post mortem findings. We determined our own 'normal' hospital ranges for urea (1.4-13.2 mmol/l) and creatinine (48-141 mumol/l) from plasma values in 76 patients with no evidence of renal impairment, either on admission or in the past. Using these values 41% of post mortem cases and 25% of clinical admissions had a raised blood urea. Pre-renal conditions such as cardiac failure, dehydration and gastrointestinal haemorrhage, either alone or in combination, were present in 56% of these patients. Urea and creatinine values were substantially higher in patients who died in hospital as opposed to those who were discharged or transferred. Creatinine values were greater in those with intrinsic renal disease or post-renal obstruction as compared to patients with pre-renal causes of renal impairment. Patients with histological evidence of extensive glomerulosclerosis or nephrosclerosis had higher urea and creatinine levels than those with only minor ageing changes.
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PMID:Raised blood urea in the elderly: a clinical and pathological study. 158 74

The aim of this study was to investigate the role of the renin-angiotensin-aldosterone system during anti-heart failure treatment with additional enalapril versus conventional vasodilator therapy (hydralazine + sorbitrate) and to assess whether or not enalapril can be suggested as the preferential vasodilator therapy in patients with chronic congestive heart failure. Over a 2.5-year period, 120 patients (New York Heart Association II-IV, creatinine less than or equal to 2.0 mg/dl) were enrolled in the study and randomly assigned to receive enalapril or hydralazine and sorbitrate therapy in addition to optimal digitalis and diuretics administration. At the end of a one-year followup, there was a tendency for mortality to be lower in the enalapril[correction of enlapril] group (4 cases) compared to the conventional group (9 cases), but the difference was not significant (p = 0.21). Both groups showed similar increases in plasma renin activity. The plasma aldosterone level decreased significantly in the enalapril group (p less than 0.005); whereas it rose significantly in the conventional group (p less than 0.005). The plasma norepinephrine level of the enalapril group fell significantly when compared with the conventional group. Thus, enalapril therapy achieved better reduction in the activating sympathetic system (p less than 0.0001). Reduction in the anti-diuretic hormone level was also found to be highly significant in the enalapril group, whereas no difference was seen in the conventional group. Furthermore, the serum creatinine level and blood urea nitrogen remained unchanged in the conventional group; whereas both were demonstrated to be reduced significantly in the enalapril group at a 1-year follow up.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of enalapril and conventional vasodilator therapy in patients with chronic congestive heart failure. 168 Sep 82

A total of 127 patients with chronic heart failure referred to our exercise laboratory were studied retrospectively to identify parameters predictive of prognosis. Patients were followed for a mean of 14.6 months. The group as a whole had severe ventricular dysfunction with a median ejection fraction of 17% and a median peak rate of oxygen consumption of 13.7 ml/kg/min. During the follow-up period 23 patients (18%) died and 18 (14%) underwent cardiac transplantation. The effect of the following variables on outcome (death or transplantation) were examined: age, cause of heart failure, cardiothoracic ratio on chest radiography, left ventricular end-systolic dimension on echocardiography, left ventricular ejection fraction on radionuclide ventriculography, mean dose of diuretic, plasma sodium and urea concentrations, and peak oxygen consumption during exercise. Although all variables except cause of heart failure affected outcome on univariate analysis, multivariate analysis identified three variables that were statistically significant and independent predictors of outcome. In order of importance these were plasma sodium level, left ventricular ejection fraction and peak oxygen consumption. Even in this group of patients with severe heart failure, these variables were predictive of outcome.
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PMID:Predictors of prognosis in severe chronic heart failure. 173 80

Haemodynamic studies performed in patients with cardiac failure have shown that perindopril decreases right and left ventricular filling pressures, systemic blood pressure and peripheral resistances, slightly reduces the heart rate and increases cardiac output. Flammang showed that these haemodynamic changes are sustained after 12 months' treatment. A randomised double blind multicenter trial versus placebo was carried out over 3 months following a 15 days pre-inclusion period in 125 patients with NYHA Stage II and III cardiac failure stabilised by digitalis and diuretic therapy. Perindopril was administered at a dosage of 2 or 4 mg according to initial systolic blood pressure and efficacy was evaluated at 1 and 3 months according to the NYHA classification, a score of clinical severity, the duration of two exercise stress tests on a bicycle ergometer or treadmill and the cardiothoracic ratio. There were no cases of cardiac decompensation (NYHA Stage IV) in the group of perindopril whilst 3 cases were observed in the placebo group. Significant improvements in the clinical scores and effort capacity were observed in the perindopril group. The duration of exercise on the treadmill was 778 seconds with perindopril compared to 544 seconds in the placebo group. Systolic blood pressure did not change and there was a slight decrease in standing diastolic pressures. No significant increases in blood urea or creatinine levels were observed. To study the effects on blood pressure, a major factor in the management of a patient with cardiac failure, McFadyen compared the changes in blood pressure after a single dose of perindopril, enalapril, captopril and placebo.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Perindopril and chronic heart failure]. 179 31

An analysis of 4 cases of the thrombotic thrombocytopenia in children of 4 to 10 years of age is performed. The disease was characterized by fever, purpura, headache and abdominal pains, arterial hypertension, microangiopathic haemolytic anemia, thrombocytopenia, increase of blood urea and serum creatinine, micro-haematuria and proteinuria. The duration of the disease was from 4 days to 7 months. Anuria, gangrene of the ears, scrotum, penis and soft tissues of legs and feet were registered in a 5-year-old patient with a fulminant disease. The cause of death of other patients was heart failure with acute lung oedema, brain haemorrhages and haemorrhagic pancreonecrosis. The diagnosis of the thrombotic thrombocytopenia was confirmed by the finding in the autopsy material of thrombotic microangiopathy of small arteries, veins, arterioles, venules and capillaries in kidneys and other organs and tissues. Kidney damage in fulminant disease is complicated by segmentary cortical necrosis, in a more prolonged disease--by glomerulosclerosis or mesangio-capillary glomerulonephritis.
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PMID:[Thrombotic thrombocytopenic purpura in children]. 180 69

Multiple linear regression techniques were utilized to determine models for the renal clearance and urinary excretion rate of furosemide. Models for the renal clearance were formulated based on data collected from the literature. The best model predicted that the weight-normalized renal clearance was a function of the weight-normalized creatinine clearance, with coefficient values dependent on the presence or absence of heart, liver, and/or kidney failure. The predictive performance of this model was evaluated using a separate verification data set, and, prospectively, for a group of cardiac patients. The urinary excretion rate of furosemide is the primary determinate of response. Models for the furosemide excretion rate were formulated from data collected prospectively from a group of patients with cardiac disease. The best model predicted that the dose-normalized morning urinary excretion rate was a function of the blood urea nitrogen concentration (BUN), with modifications for the presence of liver failure and/or decompensated heart failure. The oral dosage required to produce a clinically optimal furosemide excretion rate in cardiac patients without liver disease was dose (mg) = 42.1/(0.925-0.0151 BUN).
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PMID:Multiple linear regression modeling of furosemide renal clearance and urinary excretion rate. 181 62

Pre- and postoperative nutritional states were studied in fifty patients undergoing cardiac surgery. Seven of them were cardiac cachectic patients. There was no hospital death except one patient with cardiac cachexia. Preoperative measurements showed decreased %standard body weight (80.7%), %standard AMC (86.1%), and %standard TSF (61.5%) in cachectic patients. Resting energy expenditure (REE) and circulating blood volume were significantly higher in cachectic patients throughout the pre- and postoperative periods, and a significant correlations were admitted between them (p less than 0.05). REE increased to 33.6 kcal/kg/day 1 week after operation. Serum proteins, including rapid turnover proteins (RTP), when expressed in g/dl or mg/dl, did not show any difference between two groups. However by correction with circulating plasma volume and body weight (mg/kg), cardiac cachectic patients had significantly higher protein contents preoperatively and seventh post-operative day (p less than 0.05). There was no difference in urinary excretion of 3-methylhistidine between two groups throughout the study period, but urinary excretion of urea was higher in 1st and 3rd postoperative days in non cachectic patients. Serum cortisol and urinary excretion of vanillymandelic acid were higher, and serum insulin level tended to be lower in cachectic patients postoperatively. These results indicate that, in cardiac cachexia, increased blood volume and hypermetabolic state cause higher energy expenditure, resulting in weight loss and chronic heart failure.
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PMID:[Pre- and postoperative nutritional assessment of cardiac cachexia]. 203 35

We studied, by 48-hour Holter monitoring, 33 patients with chronic stable heart failure (radionuclide ejection fraction less than 35%), complex ventricular arrhythmias and no electrolyte abnormalities, after a period during which they were treated with digoxin and diuretics. Before Holter monitoring blood samples were analyzed for serum concentration of sodium, potassium, magnesium, urea, creatinine, digoxin, aldosterone and for plasmatic renin activity in addition to urinary aldosterone and catecholamines determination. After these investigations in 23 patients, 5-20 mg of enalapril were progressively added to the conventional therapy, while 10 patients continued the previous therapy. After 8 weeks 30 patients were subjected to a second 48-hour Holter monitoring and to the same biochemical and hormonal tests. One patient died and 2 were lost to follow up. Only the enalapril group showed a significant decrease in the number of premature ventricular complexes (PVC) (p less than 0.01), and the frequency of couplets and episodes of ventricular tachycardia (VT) declined significantly (P less than 0.01). In the two groups there were no significant changes in digoxin, sodium, or magnesium, while potassium concentration increased in both groups (p less than 0.01). In the enalapril group heart rate and systolic and diastolic pressure declined significantly (p less than 0.01), and New York Heart Association class (NYHA) improved (p less than 0.001). In the other group there were no significant changes in these parameters. Enalapril caused a significant increase in the plasmatic renin activity (p less than 0.01) and a significant fall of plasma and urinary aldosterone (p less than 0.01; p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Reduction of complex ventricular arrhythmias after enalapril treatment in patients with advanced stable heart failure. 205 78


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