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

End-stage renal disease (ESRD) patients have a high cardiovascular mortality rate. Precise estimates of the prevalence, risk factors and prognosis of different manifestations of cardiac disease are unavailable. In this study a prospective cohort of 433 ESRD patients was followed from the start of ESRD therapy for a mean of 41 months. Baseline clinical assessment and echocardiography were performed on all patients. The major outcome measure was death while on dialysis therapy. Clinical manifestations of cardiovascular disease were highly prevalent at the start of ESRD therapy: 14% had coronary artery disease, 19% angina pectoris, 31% cardiac failure, 7% dysrhythmia and 8% peripheral vascular disease. On echocardiography 15% had systolic dysfunction, 32% left ventricular dilatation and 74% left ventricular hypertrophy. The overall median survival time was 50 months. Age, diabetes mellitus, cardiac failure, peripheral vascular disease and systolic dysfunction independently predicted death in all time frames. Coronary artery disease was associated with a worse prognosis in patients with cardiac failure at baseline. High left ventricular cavity volume and mass index were independently associated with death after two years. The independent associations of the different echocardiographic abnormalities were: systolic dysfunction-older age and coronary artery disease; left ventricular dilatation-male gender, anemia, hypocalcemia and hyperphosphatemia; left ventricular hypertrophy-older age, female gender, wide arterial pulse pressure, low blood urea and hypoalbuminemia. We conclude that clinical and echocardiographic cardiovascular disease are already present in a very high proportion of patients starting ESRD therapy and are independent mortality factors.
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PMID:Clinical and echocardiographic disease in patients starting end-stage renal disease therapy. 773 Nov 45

To investigate systemic oxygen (O2) transport, we calculated the oxygen delivery index (Do2I), oxygen consumption index (Vo2I) and oxygen extraction ratio (ER) in dogs with heartworm (HW) disease. The Do2I was 770 +/- 331 ml/min/kg in dogs mildly affected with pulmonary HW disease showing respiratory signs, mild anemia and mild cardiac insufficiency (n = 34); 238 +/- 155 ml/min/kg in dogs with ascitic pulmonary HW disease (n = 7); and 577 +/- 320 ml/min/kg in dogs with caval syndrome (CS) which survived (n = 15) or died (n = 7) after surgical HW removal. The Do2I was lower (P < 0.01) in all HW-infected groups, especially in ascites and CS-non-surviving dogs, than in HW-free dogs (n = 11, 1041 +/- 264 ml/min/kg). The Vo2I was higher in some mildly affected dogs (161 +/- 88 ml/min/kg), and lower (P < 0.01) in ascitic dogs (45 +/- 53 ml/min/kg) than in HW-free dogs (123 +/- 44 ml/min/kg). The ER was higher (P < 0.01) in all HW-infected groups than in HW-free dogs. The Do2I correlated significantly with Vo2I (r = 0.84, P < 0.01), and the Vo2I correlated significantly with ER (r = 0.48, P < 0.01). The Do2I correlated significantly with arterial O2 tension (r = 0.33), serum LDH (r = -0.46) and CK (r = -0.46) activities, serum urea nitrogen (UN, r = -0.32) and lactic acid (LA, r = -0.39) concentrations and cardiac index (r = 0.64).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Systemic oxygen delivery and consumption in dogs with heartworm disease. 775 21

Although numerous studies indicate that women have a higher early mortality from acute myocardial infarction (AMI) than men, reasons for the difference are largely unexplained. We studied the role of sex in the prognosis of 1,600 patients with AMI aged 30 to 74 years in the population-based Minnesota Heart Survey. A 50% random sample was taken of all AMI patients hospitalized in 1980 and 1985 in the Twin Cities of Minnesota (Minneapolis-St. Paul) (1,168 men, 432 women). A multiple logistic regression model was used for predicting early death (within 28 days) and included baseline characteristics: sex, age, chest pain on admission, history of previous AMI, angina pectoris, coronary artery bypass surgery or hypertension, presence of heart failure, cardiac arrhythmias requiring direct-current shock, diabetes mellitus, valvular disease, cardiomyopathy, and levels of serum enzymes and blood urea nitrogen. Age-adjusted early mortality rate was significantly higher in women than men, but only in those aged < 65 years (12.5% of women vs 6.5% of men, p < 0.01) versus those aged > or = 65 years (19.5% vs 21.6%, p > 0.05). Multivariate analysis also showed that among those < 65 years, female sex was a strong and independent predictor of early death (odds ratio 2.0, 95% confidence interval 1.2 to 3.5, p < 0.01). Rates of coronary angiography, coronary artery bypass surgery, percutaneous transluminal coronary angioplasty, and thrombolysis performed during hospital stay were higher in men, but after adjustment for age, congestive heart failure, and diabetes mellitus, a statistically significant difference persisted only in the frequency of coronary angiography (26% in men vs 17% in women, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Sex differences in early mortality after acute myocardial infarction (the Minnesota Heart Survey). 776 92

Captopril, furosemide, and a sodium-restricted diet were administered to 6 normal dogs and 10 dogs with congestive heart failure. Serum electrolyte concentrations and renal function were monitored in both groups. In the normal dogs, no clinically meaningful changes in serum electrolyte, urea nitrogen, or creatinine concentrations developed during therapy with a sodium-restricted diet and 4 weeks each of furosemide alone, captopril alone, or furosemide plus captopril. Three of 6 normal dogs on furosemide and a sodium-restricted diet had at least one serum potassium concentration above the reference range during the 4 weeks of observation. One normal dog on captopril, furosemide, and a sodium-restricted diet developed azotemia, and 2 dogs had serum potassium concentrations above the reference range during the 4 weeks of observation. Ten dogs with congestive heart failure were treated with captopril, furosemide, a sodium-restricted diet, and digoxin. Etiopathogenesis of the heart failure included valvular insufficiency (n = 6), dilated cardiomyopathy (n = 3), and dilated cardiomyopathy and dirofilariasis (n = 1). Serum electrolyte concentrations and renal function were monitored for 5 consecutive weeks in 7 of the 10 dogs and for 17 weeks or longer in 6. Two dogs were euthanized after 4 weeks because of acute decompensation of heart failure, and one dog developed severe azotemia and uremia. Six of 10 dogs with congestive heart failure had at least one serum potassium concentration above the reference range sometime during the 5 weeks of observation, although the changes in the mean serum potassium concentrations were not statistically significant.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The effect of combined therapy with captopril, furosemide, and a sodium-restricted diet on serum electrolyte concentrations and renal function in normal dogs and dogs with congestive heart failure. 783 9

Two hundred and ten patients who were normotensive during pregnancy and labour but developed hypertension during puerperium have been studied. Two groups were identified with this unexpected postpartum hypertension. Although the patients in group A who had earlier onset hypertension were younger and mainly nulliparas, there was no significant difference between both groups with respect to age, serum creatinine, blood urea, blood pressures and presence of abnormal urine sediment at the onset of illness. The incidence of postpartum hypertension was 3.5. per cent; there was remission of hypertension in 8 patients (3.8%) without treatment, recurrence in 17 (8%) while cardiac failure occurred in (5.4%), cerebrovascular accident in 3 (1.4%) and acute oliguric renal failure in 3 (1.4%). Overall mortality was 0.9 per cent while persistent or chronic hypertension was observed in 52 (23.8%) Postpartum hypertension is a definite clinical entity with significant morbidity and mortality. Frequent monitoring of blood pressure in the puerperium is advocated to avoid or reduce cardiovascular, cerebrovascular and renal complications of postpartum hypertension in susceptible women.
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PMID:Morbidity and mortality from postpartum hypertension in Nigerian women. 783 76

We analyzed the serum anion gap (AG = sodium plus potassium minus chloride plus bicarbonate, N = 11-21 mEq/l), serum uric acid and urea concentrations in hyponatremia of various origins. We found that characteristic chemical patterns emerged in association with different hypotonic states: Low uric acid concentration was typically observed in the SIADH and in hyponatremia related to hypopituitarism. The same observation was also frequently noted in hyponatremia secondary to diuretics or to polydypsia. In the SIADH, we observed a decrease in the AG but to a greater extent (-26%) than one would expect from the simple dilutional effect (-16%). Fifty percent of the patients presented an AG lower than 11 mEq/l. In patients with diuretic-related hyponatremia, one group presented an hypouricemia and a low AG as in SIADH (reflecting volume expansion), in the other group the AG was normal or increased as was uric acid concentration (reflecting volume depletion). In adrenocorticotropin deficiency, hyponatremia was typically associated with a low bicarbonate concentration, a normal AG and hypouricemia. In polydypsic patients with hyponatremia, the AG was usually normal or increased despite sometimes very low sodium levels. Uric acid levels were highly variable, most often decreased. We also noted in these patients that the serum urea levels were correlated with urine osmolality (R = +0.8; p < 0.001), and in 40% of them we observed very low blood urea concentration (0.5-2 mmol/l) at the admission time. In hyponatremia related to cardiac failure or cirrhosis, the AG was usually normal despite mild hypoproteinemia.
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PMID:Uric acid, anion gap and urea concentration in the diagnostic approach to hyponatremia. 852 2

The prognostic value of exercise peak VO2 is still controversial. We therefore prospectively studied 75 patients in New York Heart Association functional class II or III with chronic heart failure stabilized by drug treatment. The patients (mean age of 58 +/- 10 years) were submitted to a clinical examination, a radionuclide determination of left ventricular ejection fraction, and a haemodynamic study at rest (right side catheterization); their plasma sodium, plasma creatinine and blood urea nitrogen levels were measured in addition to exercise peak VO2. An exercise peak VO2 threshold value of 14 ml.kg-1.min-1 was used to define two groups: GI (23 patients), with an exercise peak VO2 < or = 14 ml.kg-1.min-1 and G2 (52 patients) with an exercise peak VO2 > 14 m.kg-1.min-1. G1 and G2 were comparable in terms of age, heart rate, left ventricular ejection fraction, cardiac index and mean arterial pressure. Apart from exercise peak VO2, G1 and G2 also showed differences in right and left ventricular filling pressures, plasma sodium, plasma creatinine, blood urea nitrogen levels and exercise duration (all P < 0.01). Moreover the prognosis was worse in G1 than in G2: nine deaths vs 0, and seven major events--major events being defined as pulmonary oedema, hospitalization for heart failure, or severe ventricular arrhythmias--vs three (P < 0.001). A sub-group analysis (deceased patients, living patients with and without major events) was performed. Out of 20 clinical and paraclinical parameters, exercise peak VO2 proved to have the greatest prognostic value.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Exercise peak VO2 determination in chronic heart failure: is it still of value? 807 Apr 76

1. Our aim was to evaluate the effects of an aortocaval fistula (1 mm) on cardiorenal haemodynamics, cardiac hypertrophy and neurohumoral factors in spontaneously hypertensive rats and to compare the results with those observed in Wistar rats at 2 weeks after fistulae placement. Sham-operated spontaneously hypertensive rats and Wistar rats served as controls. 2. Heart weight was significantly increased in spontaneously hypertensive rats (34%) and in Wistar rats (43%) at 2 weeks after fistula creation. Left ventricular systolic pressure and dp/dtmax. were significantly decreased (both P < 0.01) in spontaneously hypertensive rats with fistulae which had higher left ventricular end-diastolic pressure than Wistar rats with fistulae (P < 0.01). Signs of circulatory congestion (ascites, tachypnoea, prostration) were observed only in the overloaded spontaneously hypertensive rats (45%). Cardiac index was comparably increased in both fistulae groups due to an increase in stroke index, since heart rate was not increased. 3. Fistulae placement decreased renal blood flow and kidney weight, and increased blood urea nitrogen to a greater degree in spontaneously hypertensive rats (all P < 0.05); serum creatinine levels were unaltered. Plasma noradrenaline concentration was increased in spontaneously hypertensive rats with fistulae (P < 0.05), whereas plasma renin activity was not changed. 4. Thus, spontaneously hypertensive rats with fistulae developed overt haemodynamic signs of high-output heart failure with frequent ascites and dyspnoea, whereas most of these findings were milder or absent in Wistar rats. This model provides an opportunity to evaluate the pathophysiological and pharmacological responses in high-output heart failure.
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PMID:Haemodynamic and neurohumoral changes in spontaneously hypertensive rats with aortocaval fistulae. 809 20

The study group included 30 middle-aged patients (mean = 47.0 +/- 0.6 years) with chronic heart failure (NYHA class III and IV) in the course of primary dilated cardiomyopathy and ischemic heart disease. Enalapril in a dose of 5-10 mg/day was added to previous therapy with digitalis and diuretics. The patients were submitted for noninvasive cardiac and biochemical studies initially and at 3 months. Twenty-four patients completed the planned therapy. In 5 patients the drug had been withdrawn due to hypotension, and one patient died on the fourteenth day of observation because of heart failure worsening. After enalapril therapy 18 patients improved in NYHA functional classes. All patients showed left ventricular improvement based upon left ventricular systolic time intervals, 18 patients showed reduced peripheral vascular resistance, and in 9 patients echocardiography revealed a significant improvement of EF, CI and mVCF. Renal function also improved based upon the decrease in urea and uric acid.
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PMID:[Enalapril in treatment of severe heart failure in patients with dilated cardiomyopathy]. 819 Jun 55

We evaluated the effects of lisinopril (1 mg/kg per day) on hemodynamics, cardiac hypertrophy, and neurohumoral factors in Wistar rats with an abdominal aortocaval fistula. After 4 weeks of treatment, the results were compared with values obtained for untreated rats with a fistula and for sham-operated rats. Volume loading induced biventricular hypertrophy, hemodynamic signs of high-output heart failure (increased cardiac output, left ventricular end-diastolic pressure, and pulse pressure), and impaired renal function (decreased renal blood flow and kidney weight; increased blood urea nitrogen). Lisinopril did not affect these cardiorenal hemodynamics, but decreased left ventricular mass and mortality rate (both P < 0.05). Lisinopril attenuated the increase in plasma norepinephrine, and increased plasma renin activity (both P < 0.05). Thus, lisinopril reduced left ventricular mass and mortality in rats with high-output heart failure without changing the cardiorenal hemodynamics. Neurohumoral inhibition may play a role in the beneficial effects of lisinopril.
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PMID:Lisinopril reduces cardiac hypertrophy and mortality in rats with aortocaval fistula. 838 93


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