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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 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.
J Pediatr 1975 Sep
PMID:Acute renal failure: an important complication of cardiac surgery in infants. 116 17

A 10-month-old infant, the youngest patient thus far reported to have undergone successful correction of the developmental complex known as "parachute mitral valve," is presented. Severe mitral incompetence and aortic coarctation led to recurrent cardiac failure. Both anomalies were corrected in a one-stage procedure wherein the coarctation was resected under normothermia and the mitral valve replaced thereafter by a prosthesis employing deep hypothermia and total circulatory arrest. He made an uneventful recovery. Forty-two reported cases in the literature are reviewed and the pathologic and clinical features, diagnosis, natural history, and management briefly summarized.
J Thorac Cardiovasc Surg 1975 Sep
PMID:The parachute mitral valve complex. Case report and review of the literature. 116 37

Chronic left ventricular-atrial regurgitation (LVAR) was created in 8 dogs by means of an external conduit so that the effects of acute correction of regurgitation on the mechanics of left ventricular performance could be studied in detail. LVAR of 46 to 77 per cent of the total left ventricular (LV) output was associated with a depression of the LV inotropic state (downward displacement of the stress-velocity relationship, reduction in V max), reduced forward flow, and signs of cardiac failure. Acute occlusion of the shunt (analogous to return of mitral valvular competence) in the anesthetized, open-chest animal resulted in a statistically significant increase in the integrated LV systolic wall stress (afterload), which averaged 18 per cent. In the dog with greatest depression of the LV inotropic state, the increase in afterload was associated with a decrease in forward flow. Occlusion of the shunt had no significant effect on the inotropic state. This model of mitral regurgitation appears to be useful in assessing the effect of chronic LVAR on cardiac performance and may explain the hemodynamic deterioration observed in some patients with severe mitral regurgitation following valve replacement.
J Thorac Cardiovasc Surg 1975 Sep
PMID:Experimental mitral regurgitation: effects on left ventricular function before and after elimination of chronic regurgitation in the dog. 116 39

So-called nonocclusive or spastic mesenteric infarction is a well-known complication of severe circulatory failure with low cardiac output and hypotension. In recent years, acute mesenteric insufficiency has been described in connection with certain drugs. Clinical and experimental evidence suggests a relationship between digitalis therapy, especially overdigitalization, and nonocclusive mesenteric infarction. Two cases are presented in support of this hypothesis. Both patients had digitalis intoxication and died from nonocclusive mesenteric infarction proven by surgery, autopsy and, in one case, arteriography. No cause other than digitalis intoxication (shock, severe cardiac failure or other drugs) could be found. Despite the frequent occurrence of digitalis intoxication, nonocclusive mesenteric infarction is a rare event. Interruption of digitalis therapy does not alter the usually fatal outcome. Experimental data with glucagon and phenoxybenzamine suggest that a therapeutic trial with these drugs might be worth while. Digitalis should be used with caution in shocked patients, since in these the splanchnic circulation is usually critical.
Schweiz Med Wochenschr 1975 Sep 27
PMID:[Mesenteric infarct during digitalis poisoning]. 116 97

Striking variability has been observed in the presenting features in infancy of patients subsequently shown to have tetralogy of Fallot. Some patients presented with severe cyanosis in the neonatal period while others had a systolic murmur and cyanosis only on crying. In these latter patients cyanosis became present at rest over the subsequent months. Yet others presented with episodic attacks of unconsciousness, and a final group presented with dyspnoea and heart failure, accompanying a left-to-right shunt. Angiography demonstrates corresponding variations in the anatomy of the ventricular outflow tracts. In the severely cyanosed patients, the conus septum was deviated so as to obstruct the pulmonary outflow tract, and was best visualized in the lateral projection. In the patients with increasing cyanosis or episodic attacks of unconsciousness, the conus septum again obstructed the pulmonary infundibulum, but was obliquely orientated, not being seen clearly on either lateral or frontal projections. The episodic attacks were considered to be related to infundibular spasm, as previously shown to occur in Fallot's tetralogy. In contrast, increasing cyanosis was believed to be related to hypertrophy of infundibular musculature. In the patients with an initial left-to-right shunt, the arteries were orientated side-by-side so that the conus septum was observed in the frontal projection. Again, subsequent cyanosis was related to ventricular hypertrophy producing outflow tract obstruction. These findings are interpreted in the setting of a recent study, indicating that Fallot's tetralogy is produced by rotation of the embryonic conus together with sinistro-anterior deviation of the conus septum.
Br Heart J 1975 Sep
PMID:Variations in clinical presentation of Fallot's tetralogy in infancy. Angiographic and pathogenetic implications. 119 55

Red cell mass and plasma volume were simultaneously measured by Cr51 and J125-albumine, respectively, in 36 patients with chronic obstructive lung disease and cor pulmonale. Additionally, pulmonary function tests and arterial blood gas analyses as well as pulmonary circulatory and right ventricular hemodynamic measurements were performed the same day. Patients were divided into 3 clinical subgroups: 1. a predominantely emphysematous A-type (n =12), 2. a predominantly bronchial B-type (n = 12), and 3. an intermediate type (n = 12) with about equal scores for A and B. With regard to the cardiac state, A-patients were clinically characterized by small ptotic hearts on chest x-ray and the absence of overt cardiac failure during the whole course of illness whereas B-patients generally showed radiological evidence of heart dilatation associated with recurrent episodes of manifest right ventricular failure. Patients of the intermediate type mostly had recovered from cardiac failure. The following results were obtained: 1. Red cell volume, plasma volume, and total blood volume were within normal limits in A-patients and in patients of the intermediate type. A marked hypervolemia in B-patients was almost entirely due to an increased red cell volume. 2. Close correlations of the red cell volume and total blood volume, respectively, to the arterial PO2 as well as to the arterial PCO2 could be established. 3. Total blood volume was significantly correlated to certain hemodynamic parameters, including cardiac output, stroke volume, pulmonary artery pressure, and right ventricular enddiastolic pressure. 4. The quotient body hematocrit/venous hematocrit was lowered to a significant degree as compared to normal subjects. As a consequence, indirect determination of red cell volume and total blood volume from plasma volume and venous hematocrit leads to a consistent overestimation of both parameters, amounting to 28% in the mean for the red cell mass and to 12% for the total blood volume in the present series.
Klin Wochenschr 1975 Sep 01
PMID:[Red cell mass and plasma volume in chronic cor pulmonale (author's transl)]. 119 61

In 70 patients hemodynamic controls were preformed during the first 4 days after acute myocardial infarction. A sufficient regulation of heart function and the circulation at rest was accepted with the following conditions: pulmonary artery wedge pressure less than or equal to 13mm Hg, mean right atrial pressure less than or equal to 6 mm Hg, mean systemic arterial pressure greater than 70 mm Hg, cardiac index greater than 2.51/min/m2 and stroke index greater than 25 ml/m2. In 88% of the patients with acute myocardial infarction a cardiac failure was present at rest. The pressures in the right atrium and left atrium (from wedge pressures) were elevated and cardiac output was reduced. The ratio of stroke work index/mean pulmonary artery wedge pressure allowed a more precise differentiation between a compensated and failing heart (X +/- S = 3.6 +/- 0.7 resp. 1.7 +/- 0.6 g m/m2 mm Hg). In the average, a significant improvement of the hemodynamic alterations, due or not due to therapy, occurred only at the 3rd day or later. In the individual case, this improvement points to a favorable prognosis.
Z Kardiol 1975 Sep
PMID:[Hemodynamic evaluation of cardiac insufficiency in the acute stage of myocardial infarct]. 122 62

The effect of some clinical peculiarities of the disease upon the restoration of the patient's capacity for work was studied along with the factors increasing the risk of repeated disablement after resuming the professional functions. The discussion is based on the results obtained in an out-patient study of 285 males who have been employed before their myocardial infarction in administrative-managerial jobs. Three groups of factors characterizing the functional state of the cardiovascular-system in the pre-infraction, acute and post-infarction periods are distinguished. It was demonstrated that the functional state of the heart when the patients resumed their work was characterized by the degree of chronic coronary and cardiac insufficiency, the scope of every-day physical activity, and was one of the essential criteria for the evaluation of the degree of rehabilitation. The first group of factors (essential hypertension, chronic coronary insufficiency preceeding the development of myocardial infarction) and the second group (clinical and anatomical peculiarities of acute myocardial infarction) are of secondary importance in determining the degree of rehabilitation. At the same time, the functional background of the cardiovascular system teinted prior to the infarction and the depth of the infarction, as well as the reduced level of the heart's functional capacity before resuming the professional functions, belong to the factors that increase the risk of secondary disablement in persons who have resumed working after a sustained myocardial infarction.
Kardiologiia 1975 Sep
PMID:[Factors affecting restoration of work capacity after myocardial infarct]. 123 May 26

Use of beta-adrenoceptor agonists in long-term treatment of patients with chronic asthma bronchiale or heart failure is of limited value because beta-adrenoceptor desensitization develops. The antiallergic drug ketotifen prevents beta-adrenoceptor agonist-induced desensitization of rat and human pulmonary and lymphocyte beta 2-adrenoceptors. In 10 healthy volunteers in a double-blind, placebo-controlled study, we investigated whether ketotifen also prevents beta-adrenoceptor agonist-induced desensitization of beta 1- and/or beta 2-adrenoceptor-mediated physiologic in vivo effects. beta 1-Adrenoceptor-mediated effects were isoprenaline (ISO) infusion-induced increase in systolic blood pressure (SBP) and bicycle exercise-induced increase in heart rate (HR); beta 2-adrenoceptor-mediated effects were ISO infusion-induced increase in plasma norepinephrine (NE) and decrease in diastolic blood pressure (DBP); ISO infusion-induced increase in HR was assessed as mixed beta 1- and beta 2-adrenoceptor-mediated effect. These parameters were assessed before and after a 14-day treatment with the beta 2-adrenoceptor agonist terbutaline (5 mg three times daily) with or without simultaneous administration of ketotifen (1 mg twice daily). Terbutaline desensitized all in vivo effects involving beta 2-adrenoceptors (ISO-induced decrease in DBP and increase in plasma NE and, to a minor extent, the mixed beta 1- and beta 2-adrenoceptor-mediated increase in HR), but did not affect beta 1-adrenoceptor-mediated in vivo effects; concomitant treatment of the volunteers with ketotifen markedly blunted terbutaline-induced desensitization of beta 2-adrenoceptor in vivo function. We conclude that ketotifen prevents, or at least attenuates, beta-adrenoceptor agonist-induced desensitization of beta 2-adrenoceptor in vivo function.(ABSTRACT TRUNCATED AT 250 WORDS)
J Cardiovasc Pharmacol 1992 Sep
PMID:Terbutaline-induced desensitization of beta 2-adrenoceptor in vivo function in humans: attenuation by ketotifen. 127 89

The present study investigated the effects of celiprolol a novel beta 1-antagonist with partial beta 2-agonist activity on the human failing heart. Experiments were performed on isolated electrically driven atrial and ventricular cardiac preparations and in membrane preparations from the left ventricles of nine patients (four with dilated cardiomyopathy; five with ischemic cardiomyopathy) undergoing cardiac transplantation for terminal heart failure. Celiprolol produced a negative inotropic effect in atrial and ventricular heart muscle. However, in the presence of forskolin--which activates the catalyst of the adenylate cyclase-or the cAMP phosphodiesterase inhibitor milrinone, celiprolol produced concentration-dependent positive inotropic effects and positive lusitropic effects. Experiments with the beta 1-and beta 2-selective antagonists CGP 207.12A and ICI 118.551, respectively, suggest that the positive inotropic response is mediated by beta 2-adrenoceptors. In radioligand binding experiments, a selectivity of 15.7 [-Gpp(NH)p] or 23.9 [+Gpp(NH)p] as judged from the Ki values--of binding to beta 2-adrenoceptors was measured in the failing human ventricular myocardium. Competition curves with celiprolol alone and in the presence of the guanine nucleotide Gpp(NH)p revealed no evidence for agonist activity at beta 1- or beta 2-adrenoceptors. It is concluded that amplification of the cAMP response is able to unmask partial agonist activity of celiprolol in the failing human heart at beta 2-adrenoceptors. The inotropic measurements are a more sensitive approach than radioligand binding studies. Whether the pharmacological profile of celiprolol will be useful in conditions like heart failure is questionable with respect to the potential downregulation of beta 2-adrenoceptors by its partial agonist activity.
J Cardiovasc Pharmacol 1992 Sep
PMID:Positive inotropic effects due to partial agonistic activity of the beta-adrenoceptor antagonist celiprolol following amplification of cAMP formation in failing human myocardium. 127 96


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