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

There is evidence of a growing number of cases of intoxication due to white phosphorus (WP) in Ecuador. These cases mainly occur after consuming the so-called 'little devils'. This work involved a retrospective-type observational descriptive analysis of all the cases registered in the country in a time interval of 19 years. A total of 590 cases were described in this period. The age of the intoxication cases ranged from 2 to 70 years, with an average of 18.27 years. With respect to genre, women were the most affected (68%). The aetiology observed was intentional or violent in 98.6% of the cases registered, the onset of the problem being the most commonly cited cause. The quantity consumed varied between 1 and 70 tablets (0.3-21g). WP produces hepatic and renal failure, which leads to secondary cardiac failure, which is the cause of death. The mortality observed exceeds 10% of the intoxicated people. The main reason for the ingestion of WP is for autolitical purposes, due to a high component of depressive affectation in the majority of patients. Supplementary psychiatric studies will be required in the future to determine the main causes. The posterior hepatic damage, which is considered as an after-effect could not be confirmed, as there are no follow-up protocols, although the hepatotoxity of this substance is obvious. The utility of a specific antidote for this type of intoxication has not been demonstrated. However, the importance of an early gastric wash/aspiration and the administration of large doses of activated carbon prove to be very important. A determinant factor in the quality of survival is early and appropriate health care for the intoxicated people.
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PMID:Acute exposure to white phosphorus: a topical problem in Ecuador (South America). 1293 68

In 16 dog heart-lung preparations modified to permit a more accurate measurement of coronary flow, adrenaline or noradrenaline was infused at a rate of 4 mug. base/min. After a 30-min. pause during which the increased oxygen consumption and heart rate, but not the coronary flow, returned to pre-infusion levels, the other sympathomimetic amine was infused for the same length of time. It was found that, mole per mole, noradrenaline is as effective, and probably more so, than adrenaline in raising the oxygen consumption of the heart-lung preparation. The positive chronotropic and coronary dilating action of both amines appear to be equal. It was observed that in any one experiment the second dose of the sympathomimetic amine was slightly more effective than the first dose in raising the oxygen consumption. The level of high-energy phosphorus compounds does not change after adrenaline or noradrenaline administration even at the time when the oxygen consumption rises to as much as 200%. During this period there are no signs of cardiac hypoxia, as can be judged by the good oxygen saturation of coronary venous blood. Single doses of 5 mug. adrenaline or noradrenaline have a consistent positive inotropic effect that lasts about 15 min. when tested on a failing heart. In 12 experiments on non-failing modified heart-lung preparations, a single dose of 5 mug. adrenaline fails to cause a measurable increase in oxygen consumption after 1, 3, 6, or 11 min. in spite of a mild positive chronotropic action. The significance of these findings is discussed and the suggestion made that, when noradrenaline infusions are effective in treating cardiogenic shock in man, part of this effect may be due to its positive inotropic action, thus correcting an element of heart failure that might exist.
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PMID:The effect of adrenaline and noradrenaline on the metabolism and performance of the isolated dog heart. 1369 21

The aim of the present study was to investigate the possibility of phosphorus magnetic resonance spectroscopy (MR spectroscopy) in the diagnosis of metabolic lesions of skeletal musculature in patients with intermittent claudication syndrome, chronic cardiac failure, and varicose diseases of the lower limbs. Studies included 50 males: 20 patients with intermittent claudication, 10 patients with chronic cardiac failure, and 10 patients with varicose veins. The control group consisted of 10 healthy volunteers. The following measures were determined: the phosphocreatinine index, the intracellular pH in the gastrocnemius muscle, and the half-recovery time for the phosphocreatinine index. The phosphocreatinine index and the pH at rest did not differ between study groups. Isotonic exercise produced no change in the phosphocreatinine index in the control group; patients with intermittent claudication showed a 26.1% decrease, patients with chronic cardiac failure showed an 8% decrease, and patients with varicose veins showed a 25.6% decrease. The only group showing a significant decrease in pH during exercise was the group of patients with intermittent claudication. This group also showed an inverse correlation between the pressure index and the extent of the decrease in the phosphocreatinine index. Thus, MR spectroscopy provides a non-invasive diagnostic method for lesions of energy metabolism in skeletal musculature in patients with deranged peripheral hemodynamics.
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PMID:Potential of phosphorus nuclear magnetic resonance spectroscopy in studies of the energy metabolism of skeletal muscles. 1455 42

The reduction of cardiovascular disease risk in kidney failure involves treatment of modifiable risk factors and provision of proven interventions to patients with established disease. Volume status management is key to blood pressure control. Statins are the agents of choice for the treatment of dyslipidemia. Target hemoglobin levels should be achieved using intravenous iron and erythropoietic agents. Combinations of calcium and noncalcium-containing phosphorus binders and vitamin D and its analogues should be used to attain target parathyroid hormone, phosphorus, and calcium phosphorus product levels. beta Blockers and aspirin are recommended in patients with ischemic heart disease and angiotensin-converting enzyme inhibitors (or angiotensin II receptor blockers), and beta blockers are recommended in patients with heart failure with reduced ejection fraction. In patients who require revascularization, studies suggest a survival benefit of coronary artery bypass graft surgery over percutaneous transluminal coronary angioplasty and coronary artery stenting.
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PMID:Treating the Patient with Kidney Failure to Reduce Cardiovascular Disease Risk. 1521 21

Major causes of death in dialysis patients are heart failure, infection, cerebro-vascular accident, malignancy, myocardial infarction, and cardiovascular disturbance; they are 43.7% of all causes of death. Hyperphosphatemia and increased calcium-phosphorus product aggravate ectopic calcification, and raise mortality rate. According to statistical data from the Japanese Society for Dialysis Therapy, calcium and phosphate levels recently decreased, because of progress of therapeutic agents and increase in aged people. But extreme decreases of them are also the risk factors of mortality, so appropriate control into the recommended range is necessary.
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PMID:[Cause of death in dialysis patient--according to the survey of the Japanese Society for Dialysis Therapy]. 1557 59

Dialysis, in its routine 3 x week manifestation, undoubtedly is life saving. The therapy is limited by a number of factors that persist despite the development of safe machines and highly efficient dialyzers. The turnover of known, and very likely, many unknown uremic toxins, is rapid so that 3 x week dialysis is accompanied by relatively high levels of these substances. Only the lower part of the range of molecular weights of those putative uremic toxins, which are small proteins, are removed by current therapies. For substances such as phosphorus, long dialysis is successful in removing the excess retained dietary phosphorus, perhaps the only proven uremic toxin. The difficulty of achieving a normal extracellular volume is probably a major factor in the progression and poor outcomes of cardiovascular disease despite the potential improvement with management of hyperlipidemia, inflammation, potential arrhythmias, and cardiac failure due to other pathogenetic mechanisms. New developments in understanding of Vitamin D metabolism, Ca receptor inhibitor drugs, and control of hyperphosphatemia may reduce the problems of kidney bone disease and the adverse cardiovascular effect of calcium phosphorus disposition. Dialysis more frequent than 3 x week is already routinely, if only infrequently, used to deal with the very large volume or overhydrated patient. However, daily dialysis--whether short or long-is now beginning as a therapy with a large randomized NIH trial in the offing. Currently, the net growth of dialysis is approximately 4% a year, but it would not be surprising if there were a gradual increase in growth rates as CKD patients live longer due to control of cardiac disease. Eventually, the treatment of early kidney disease should reduce the dialysis population, particularly if diabetes can be better controlled or even prevented. The dialysis aspect of nephrology as a profession for physicians, nurses, and technicians appears to be on a long course with increasing demand and the need for applying what is already known, while awaiting new technical developments. Wearable artificial kidneys, involving the application of technology and use of new materials, are currently being investigated. The presence of nephrologists during the actual dialysis treatment is certainly not as evident as it was in the past. Reimbursement methodology has ensured at least a minimum of documented visits by nephrologists or nurse practitioners to the dialysis patient during treatment. It is controversial as to the value of this, but evidence has been presented that certain outcomes, such as use of appropriate dialysis dose and blood chemistries, are improved by more frequent visits. The present is over.
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PMID:Technology: kidneys--the present of dialysis. 1567 76

Nuclear magnetic resonance (NMR) spectroscopy remains an extremely powerful technique for investigating abnormalities in the failing heart. The nondestructive nature of the technique allows the response to physiological, pathophysiological and pharmacological interventions to be studied within the same heart. Phosphorus-31 NMR has provided a gold standard over the past two decades for assessing the myocardial energy status both in vitro and in vivo. Carbon-13 isotopomer analysis is emerging as a direct way to monitor metabolic pathways and, in particular, investigate adaptations in energy provision in pathophysiological conditions. Using models of cardiac hypertrophy and heart failure, we investigated the sequences of changes in substrate oxidation in relation to function using 13C methods. The changes in metabolism modify the balance between energy provision and utilisation, and thus play a deleterious role in the progression towards decompensated heart failure. The application of NMR spectroscopy (phosphorus-31 and carbon-13) to the study of integrated metabolism is an area of research which is now coming into its own. Together with other new technologies, NMR will contribute to our improved understanding of cardiac metabolism in situ, leading to more rapid advances in targeting new therapeutic end points.
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PMID:Imaging cardiac metabolism in heart failure: the potential of NMR spectroscopy in the era of metabolism revisited. 1635 3

The purpose of this study was to evaluate the correlation between the plasma B-type natriuretic peptide (BNP) level and the myocardial phosphocreatine/adenosine triphosphate ratio determined using rapid phosphorus-31 magnetic resonance spectroscopy (31P-MRS) in patients with dilated cardiomyopathy (DCM). Thirteen DCM patients, who had slight or moderate heart failure, were examined. The plasma BNP was measured on a day close to the rapid 31P-MRS study. 31P-MRS measurements were conducted with a 1.5-T MR instrument. The plasma BNP levels tended to be correlated negatively with the myocardial phosphocreatine/adenosine triphosphate, although the correlation did not reach statistical significance (r = -0.54, p = 0.06). By contrast, the log of the plasma BNP levels was correlated negatively with the myocardial phosphocreatine/adenosine triphosphate (r = -0.73, p < 0.01). Our results indicate that the myocardial energy metabolism evaluated using 31P-MRS tends to be correlated with the severity of heart failure and left ventricular dysfunction estimated using the plasma BNP levels in DCM patients. This paper provides additional information regarding the relationship between the BNP and myocardial energy metabolism in DCM patients.
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PMID:The relationship between plasma BNP level and the myocardial phosphocreatine/adenosine triphosphate ratio determined by phosphorus-31 magnetic resonance spectroscopy in patients with dilated cardiomyopathy. 1663 42

A number of cross-sectional analysis studies have been conducted to determine the relationships between serum uric acid and related variables or clinical manifestations. However, few data related to changes in serum uric acid within the same cohort population at two separate periods of time have been reported. In this study, we investigated the changes in serum uric acid in a population from baseline to 1-year follow-up and examined the associations with related parameters and medical conditions. A total of 1,437 eligible male subjects who underwent 2 medical examinations at a health promotion center at an interval of approximately 12 months were enrolled in this study. Data were obtained from routine physical assessments such as blood pressure, height, waist circumference, blood analyses for liver function, renal function, lipid profile, and electrolytes, along with standardized questionnaires including self-reported data. In this population, serum uric acid was significantly increased at 1-year follow-up compared with the baseline level (5.94 +/- 1.20 vs 5.99 +/- 1.22, p = 0.003). Changes of some confounders such as total bilirubin, creatinine, BUN, phosphorus, total cholesterol, and triglyceride were significantly associated with changes in serum uric acid. Among them, serum creatinine may be the most influential in determining the serum uric acid level (odds ratio = 21.691, 95%CI = 5.110-92.086). A change of serum uric acid over 1 year did not seem to affect changes in the clinical status for some medical conditions including hypertension, diabetes mellitus, cardiovascular disease, and metabolic syndrome. This analysis showed that a change in serum creatinine level between baseline and 1-year follow-up might be the most potent factor affecting a change in serum uric acid in healthy, male subjects. Changes of serum uric acid did not show any meaningful impact on the development of hypertension, heart failure, diabetes mellitus, and metabolic syndrome in this 1-year follow-up study.
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PMID:Change in serum uric acid between baseline and 1-year follow-up and its associated factors in male subjects. 1787 70

A multicenter cross-sectional study was performed to evaluate the prevalence of heart failure (HF) and the associated cardiovascular (CV) risk factors in 298 peritoneal dialysis (PD) patients from Argentina and Uruguay, representing almost 30% of the total number of PD patients in the two countries. Bidimensional echocardiography, electrocardiography, and biochemical analysis were performed. Systolic HF was defined as an ejection fraction <50%. According to echocardiography, 84.6% showed left ventricular hypertrophy (LVH), 38.3% valvular heart disease, and 35.4% valvular calcification, whereas 20% showed intraventricular conduction disturbances on the electrocardiogram. The prevalence of CV risk factors was of 73% hypertension, 51% sedentarism, 18% diabetes, 16.8% obesity, 12% smokers, 42.3% phosphorus >5.5 mg per 100 ml, 42.3% parathyroid hormone>300 pg ml(-1), and 29.6% calcium phosphate product >55. The prevalence of systolic HF was 9.9%, being significantly associated with diabetes: odds ratio (OR)=4.11 (P<0.006) and hypoalbuminemia: OR=3.45 (P<0.011). Forty percent of patients with a diagnosis of left ventricular dysfunction at the time of the study were asymptomatic. Variables associated with LVH in the multivariate analysis were anemia (OR=4.06; P<0.001) and previous hemodialysis (OR=1.99; P<0.031). The identification of reversible risk factors associated to HF and the diagnosis of asymptomatic ventricular dysfunction in this PD population will lead our efforts to establish guidelines for prevention and early treatment of congestive HF in patients on PD.
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PMID:Rio de La Plata study: a multicenter, cross-sectional study on cardiovascular risk factors and heart failure prevalence in peritoneal dialysis patients in Argentina and Uruguay. 1837 40


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