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

Oral medication with phentolamine SR produced subjective and objective improvement in all 45 patients with refractory chronic heart failure of various aetiologies, who were already receiving digitalis and diuretics. This was shown by an increase in pulse-pressure amplitude and urine volume, a decrease in bodyweight and marked reduction in cardiac size and pulmonary congestion, the latter changes being more pronounced in patients with arteriosclerotic heart disease (ASHD). Exercise tolerance tests in a further 34 patients with less severe chronic heart failure demonstrated that phentolamine SR markedly increased physical capacity. This effect was more pronounced in patients with slightly compromised cardiac status (functional Class 2, NYHA) than in those with moderately compromised cardiac status (Class 3). The improvement in clinical condition was attributed mainly to arterial and venous dilatation, as well as to the positive inotropic effect of the drug. The most important side-effects were diarrhoea and, in the patients with ASHD, increased attacks of angina pectoris; The side-effects were well controlled by the anticholinergic agent oxyphenonium bromide (Antrenyl) and a slight increase in the dose of nitrates. It is concluded that oral phentolamine SR may be a valuable therapeutic adjunct in the management of patients with refractory chronic heart failure.
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PMID:Treatment of chronic heart failure with slow release phentolamine. 35 8

The new phosphodiesterase-III inhibitor (PDI) enoximone is a non-catecholamine, non-glycoside cardiotonic agent with concomitant vasodilating properties. It has proved beneficial in patients with severe chronic heart failure. The influence of enoximone i.v. on hemodynamics was investigated during cardiac surgery under various conditions. METHODS. A randomized series of 60 patients undergoing elective aorto-coronary bypass grafting were studied. The hemodynamic effects of 0.5 mg/kg enoximone given i.v. as a bolus (30 s) were investigated before anesthesia (n = 10), during anesthesia (n = 10), and during extracorporeal circulation (ECC, n = 10) and compared with those observed in corresponding control groups (n = 10 in each control) of patients who had received saline solution as placebo. Anesthesia was maintained with weight-dependent dosages of fentanyl, midazolam and pancuronium bromide. All patients were invasively monitored by means of a pulmonary artery catheter. Additionally, left ventricular pressure (LVP), left ventricular end-diastolic pressure (LVEDP) and dp/dtmax were measured before the initiation of ECC. During ECC direct vascular effects were investigated with measurement of perfusion pressure and the volume of the oxygenator. RESULTS. Before the induction of anesthesia no significant change in MAP and HR could be observed, whereas CI increased (+20%) and TSR decreased (-24%) significantly. During anesthesia, the injection of enoximone was followed by a significant decrease in MAP only in the 1st min (-17%); baseline level was reached again after 6 min; and HR was slightly increased (+8%). TSR (-31%) and LVEDP (-38%) decreased, whereas CI (+17%) and dp/dtmax (+45%) were increased significantly. During ECC perfusion pressure (-37%) and the volume of the oxygenator (-17%) were significantly decreased, demonstrating direct vasodilating effects on both the arteries and the vein. CONCLUSION. Arterial and venous vasodilation with an increase in myocardial performance (dp/dtmax) resulting in an increase in CI were the predominant hemodynamic effects of enoximone i.v. No arrhythmogenic effects or interactions with the anesthetics used were observed in this study.
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PMID:[Hemodynamic effects of the new phosphodiesterase inhibitor enoximone in heart surgery patients]. 252 51

PGE1 has a beneficial effect on cardiac failure with mitral valve regurgitation by decreasing the "after load". An 82-year-old female had a total cystectomy of a bladder tumor. The preoperative standard 12 lead electrocardiogram showed atrial fibrillation and incomplete right bundle branch block. The preoperative echocardiogram showed regurgitation of both mitral valve and tricuspid valve. Under heavy premedication, we intubated with fentanyl and pancuronium bromide, maintained anesthesia with enflurane. After incision, both pulmonary artery pressure and pulmonary capillary wedge pressure increased, and cardiac index decreased. Continuous injection of 100ng.kg-1.min-1 PGE1 made pulmonary artery pressure and pulmonary capillary wedge pressure to decrease, and cardiac index to increase. PaO2, however, decreased apparently. PGE1 was effective for cardiac failure with mitral valve regurgitation associated with pulmonary hypertension. But attention must be given to the decrease in PaO2.
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PMID:[The use of PGE1 in an elderly patient with mitral valve regurgitation during general anesthesia]. 270 14

Bronchodilating drugs can be divided into three main groups: beta-adrenergic stimulants including specific beta-2 receptor agonists (salbutamol, terbutaline, fenoterol) which are the agents of this group used in everyday practice, theophylline and its derivatives, and atropine-like drugs (ipratropium bromide). Bronchodilators act chiefly upon the spasm observed at the bronchial level in reversible obstructive phenomena (mainly asthma), their effect upon inflammation and hypersecretion being slight or controversial. Beta-stimulants have a relatively specific mode of action at the bronchial level in the setting of use in pneumology; they exhibit cardiac effects only at high doses and when used by oral or parenteral routes. Relative to isoprenaline, they also have the advantage of being active orally and over a longer period of time. They are given in maintenance treatment of asthma, by parenteral or oral routes or as aerosols. Main side effects of adrenergic beta-stimulants are tremor with oral administration, and tachycardia with very high doses by parenteral or oral routes; when given as aerosols these agents may fail to control severe attacks. The bronchodilating properties of theophylline have been known for a long time; late advances concerning this drug result from better knowledge of its pharmacokinetics. Recent studies have discriminated between serum levels correlated with therapeutic effectiveness and those accompanied with mild or severe side effects; in addition, it has been clearly shown that the half life of this alkaloid varies from one person to another and with various physiopathologic (age, dietary habits, liver failure, heart failure...) or pharmacologic (drug interactions with enzyme inductors or inhibitors...) factors; these recent advances have led to improved individual adjustment of theophylline dosage using serum concentration assays if needed. Theophylline is used in acute attacks and in maintenance therapy of asthma. Main side effects are digestive intolerance and, with toxic doses, neurologic disorders. Atropine-like drugs inhibit the effects of the parasympathetic reflex which results from stimulation of receptors by irritation of the respiratory tract, through the action of mediators. In this group, ipratropium is the only drug given in aerosols; this, together with its pharmacologic specificity, contributes to its tolerance. In some instances, the bronchodilating effect of ipratropium bromide is comparable to that of sympathomimetics.
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PMID:[Bronchodilators]. 632 Apr 43

There is almost universal agreement that neither beta 2-agonists, theophyllin nor steroids, given either by inhalation or systemically, have any effect on lung function in acute bronchiolitis of infancy. As ipratropium bromide appears to be a more effective bronchodilator drug than beta 2-stimulants in the first year of life, a study was set up to investigate its possible role in bronchiolitis. Diagnostic requirements for inclusion in the study were tachypnoea, hyperinflation recession, and the presence of fine crepitations on auscultation with a chest X-ray which excluded either heart failure or gross pneumonia. Twenty-five infants were recruited in the preliminary study. A respiratory jacket and water filled oesophageal catheter (feeding tube) were used to measure the work of breathing per minute and per litre of expired gases. After baseline readings the infants received salbutamol (2.5 mg), ipratropium bromide (250 micrograms) or placebo in 2 ml volumes using a standard nebuliser. The salbutamol and water were associated with an increase in the work of breathing of 4% and 22% respectively. The ipratropium therapy led to a fall of 18% with a significant response in 6 of 15 infants studied. Following these encouraging results, a double blind study was set up assessing the effects of nebulised ipratropium bromide (250 micrograms) and nebulised saline given every 6 hours to 66 infants admitted to the ward with acute bronchiolitis. Response to therapy was determined using symptom scores and need for nebulised therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Role of anticholinergic agents in acute bronchiolitis in infants]. 763 57

Bioelectrical impedance analysis (BIA) is a noninvasive method recently introduced for body fluid evaluation in healthy subjects. The purpose of this paper is to verify the reliability of bioelectrical measurements in extracellular water (ECW) prediction in healthy subjects and in fluid retention states. We studied 40 subjects (19 males and 21 females) aged 21-81 years; 22 were healthy subjects, 12 were affected by chronic heart failure, and 6 by chronic renal failure. In all subjects resistance (R) and reactance (Xc) at 1 and 50 kHz corrected for height were compared with ECW measured by the bromide dilution method. Our results suggested a different behavior of the current in fluid-retention states with respect to healthy subjects. ECW was best predicted by resistance at 1 kHz corrected for height, group (considered as dummy variable), weight and gender (R2 = 0.89, p < 0.001, SEE = 1.7 liters). The bioelectrical impedance analysis at 50 kHz explained the 89% of ECW variability when resistance and reactance corrected for height are considered with gender group and weight (R2 = 0.89, p < 0.001, SEE = 1.7 liters). In conclusion, the bioelectrical method at 1 kHz can be considered sufficiently accurate in ECW prediction in healthy subjects and in fluid retention states. Also, the bioelectrical impedance analysis at 50 kHz is useful for predicting ECW, but his role must be further investigated.
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PMID:Accuracy of bioelectrical impedance analysis in estimation of extracellular space in healthy subjects and in fluid retention states. 797 69

The aim of this study was to test the hypothesis that lung oedema causes an obstructive airway impairment, due to an increase in cholinergic bronchial tone in patients with chronic heart failure (CHF). Ten patients with CHF were tested by inhalation of ipratropium bromide and placebo, given in sequential randomized order, in double-blind fashion, after assessment of baseline lung function, both during acute cardiac decompensation and after 8-10 days of adequate treatment. The decrease in lung oedema was associated with a significant increase in vital capacity (VC) (from 70 +/- 4.4 to 83 +/- 5.4% pred), forced expiratory volume in one second (FEV1) (from 59 +/- 3.6 to 72 +/- 4.6% pred), FEV1/VC (from 61 +/- 2.8 to 64 +/- 2.3%) and residual volume (RV) (from 94 +/- 7.9 to 99 +/- 6.8% pred). Ipratropium bromide produced a far better bronchodilatation during acute decompensation when FEV1 increased from 59 +/- 3.6 to 70 +/- 3.7% pred, than after intensive treatment for heart failure, when FEV1 increased from 72 +/- 4.6 to 76 +/- 4.8% pred. The maximum absolute increase in FEV1 induced by ipratropium bromide was 286 +/- 32 ml at admission and only 111 +/- 15 ml after treatment. In conclusion, in chronic heart failure, airway obstruction is partially reversible after inhalation of an anti-muscarinic drug, when lung oedema is present, supporting the hypothesis that lung oedema increases cholinergic bronchial tone.
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PMID:Bronchodilating effect of ipratropium bromide in heart failure. 811 44

Bronchoconstriction is seen at rest in patients with chronic heart failure, and may contribute towards exercise limitation. To investigate the effect of bronchodilator agents on exercise capacity, 10 patients (mean age 60 years, range 39-72) in New York Heart Association class II and III heart failure, underwent symptom-limited maximal exercise testing after inhalation of nebulized salbutamol (5 mg), ipratropium bromide (500 micrograms) or placebo delivered on separate days in a randomized, double-blinded study. There was an increase in forced expiratory volume in one second from pre-treatment to after nebulizer, 2.28 +/- 0.20 to 2.38 +/- 0.19 l (P < 0.05) with salbutamol, and 2.27 +/- 0.21 to 2.37 +/- 0.21 l (P < 0.05) with ipratropium bromide. There was an increase in maximal oxygen consumption after salbutamol 17.9 +/- 1.3 ml.kg-1.min-1 (P < 0.05) and ipratropium bromide 17.0 +/- 1.4 ml.kg-1.min-1 (P < 0.05), compared with placebo 16.3 +/- 1.4 ml.kg-1.min +/- 1. Peak minute ventilation during exercise also increased after salbutamol 52.8 +/- 4.5 l.min-1 (P < 0.05), compared with placebo 46.1 +/- 3.1 l.min-1. The small but significant increase in exercise capacity in chronic heart failure following bronchodilator agents implies that a degree of bronchoconstriction is present in these patients and contributes to exercise limitation.
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PMID:Inhaled bronchodilators increase maximum oxygen consumption in chronic left ventricular failure. 832 99

The cytokine modulating effects of inotropic agents on human umbilical vein endothelial cells (HUVEC) were investigated. Confluent HUVEC in 24-well plates were treated with inotropic agents and then stimulated with 10 ng/ml of human interleukin (IL)-1 beta. After 24 h of incubation, the cytokine levels in the culture supernatants were determined by specific enzyme-linked immunosorbent assay (ELISA) kits. Vesnarinone [OPC-8212; 3,4-dihydro-6-(4-(3,4-dimethoxybenzoil)-1-piperazinyl)-2(1H)- quinolinone] at 26 mumol/l significantly suppressed the production of IL-6, granulocyte macrophage colony stimulating factor (GM-CSF) and granulocyte colony stimulating factor (G-CSF) induced by IL-1 beta. Although 8 bromoadenosine 3'5' cyclic monophosphate (8Br-cAMP) at 100 mumol/l also inhibited the production of these cytokines, the inhibitory effect was less marked than that of vesnarinone. Amrinone at 26 mumol/l and NKH477 at 10 nmol/l also had a less marked inhibitory effect against the production of IL-6. Next, the inhibitory effect of inotropic agents against the expression of the adhesion molecules of HUVEC was measured by a cell ELISA method. Vesnarinone at 26 mumol/l and NKH477 at 10 mumol/l, a water soluble forskolin derivative used as a positive control, both significantly inhibited the expression of E-selectin induced by 10 ng/ml of human tumor necrosis factor (TNF)-alpha. Amrinone at 26 mumol/l did not inhibit the expression of E-selectin. The level of HUVEC cAMP induced by vesnarinone at 26 mumol/l was much lower than that induced by NKH477 at 10 mumol/l. Moreover, according to a 3-(4,5-dimethyl-thiazol-2yl)-2,5-diphenyl tetrazolium bromide (MTT) cell viability assay, vesnarinone did not affect the viability of HUVEC. The immunosuppressive effects of vesnarinone described above are not derived from either a cAMP elevating effect or a cytotoxic effect against HUVEC. Although the cytokine network in heart failure has not yet been elucidated, patients with congestive heart failure might benefit from the immunomodulating effects of inotropic agents.
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PMID:Inotropic agent vesnarinone inhibits cytokine production and E-selectin expression in human umbilical vein endothelial cells. 857 41

We describe the anesthetic management of an obese myotonic patient who underwent bilio-pancreatic diversion for severe obesity. A female, 35 years old (weight 137 kg, height 160 cm, excess body weight 120%) suffered from myotonic dystrophy and obesity, complicated by a mild heart failure and restrictive disease. Induction of anesthesia and tracheal intubation were performed after propofol (1 mg/kg). Anesthesia was maintained with isoflurane and fentanyl muscular blockade by vecuronium bromide. Perioperatively extensive hemodynamic monitoring has been performed. The patient was discharged successfully the 12th day postoperatively. One year later she had lost 50 kgs of body weight; oxygen blood tension and pulmonary function tests were greatly improved.
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PMID:Anesthetic management of a patient combining myotonic dystrophy and obesity. 925 74


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