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

The renal regulation of sodium is intertwined with the extracellular fluid volume (ECFV). Most adjustments in sodium elimination in man are accomplished via alterations in tubular reabsorption. The latter is sensitive to change in ECFV. An expanded ECFV results in less reabsorption and more excretion of sodium, and a contracted ECFV has the converse effect. There are direct and indirect mechanisms whereby ECFV influences sodium reabsorption. Patients with nephrotic syndrome, heart failure, and cirrhosis "behave" physiologically as normal individuals with a contracted ECFV. Water balance is normally determined by intake and losses in sweat which is always hypoosmotic to plasma, by evaporation from skin and lungs, and through renal excretion. The major factors that determine the ability to concentrate the urine are (1) the establishment of a concentrated environment around the collecting ducts, and (2) the elaboration and effects on the kidney of antidiuretic hormone. The evaluation of a patient with abnormalities of sodium and water rests initially and largely on clinical information. The clinical setting provides clues to anticipating, preventing, and interpreting distortions of body sodium and water. The laboratory can detect an abnormality, confirm or refute clinical assessment, and assist in the quantitative aspects of treatment and its efficacy.
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PMID:Sodium and water: an overview. 96 14

Pulmonary extravascular volume or lung water (PEV), arterial blood gases, and cardiac hemodynamics were measured in 88 patients with acute myocardial infarction. A progressive increase in PEV and a decrease in arterial oxygen tension (PaO2) were observed from Class I (uncomplicated) patients to Class III (frank pulmonary edema) patients. Heart rate and pulmonary wedge pressure (Pw) rose and cardiac index declined with increasing severity of heart failure by clinical classification. There was a significant correlation between PEV and Pw independent of clinical class (r = 0.47, p less than 0.01). PaO2 had a negative correlation with Pw (r = -0.28, p less than 0.01) as well as PEV (r = -0.26, p less than 0.02). We conclude therefore that increased pulmonary hydrostatic pressure secondary to pulmonary venous hypertension in patients with acute myocardial infarction is a major determinant of interstitial edema. At higher values of PEV, PaO2 was lower. The mechanism of hypoxemia in the presence of excessive lung water may be due to multiple factors, including small airway dysfunction and intrapulmonary shunting.
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PMID:Hypoxemia and lung water in acute myocardial infarction. 99 75

The peculiarities of water and electrolytes elimination prior to and following therapy with diuretics were studied in 92 patients with Stage II-III cardiac insufficiency. The control group was comprised of 23 patients with Stage 0-I insufficiency and 12 normal volunteers. A progressing cardiac insufficiency was found to be accompanied by a reduction in sodium and water excretion. The results of the study permit to suggest the localization of enhanced reabsorption of sodium in cases of cardiac insufficiency, to evaluate the proportion of the participation of the antidiuretic hormone and aldosterone in the pathogenesis of sodium retention in the kidney, and to assess the diuretics as means of pathogenetic treatment of cardiac insufficiency, which proves rational on early stages of the disease without accompanying severe circulatory disorders.
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PMID:[Characteristics of sodium and water elimination in chronic cardiac insufficiency]. 101 5

The study was conducted in 58 patients with congenital heart diseases. Preoperative cardiac insufficiency in patients with congenital heart diseases was shown to favour a complicated postoperative course which, in turn, is accompanied by alterations in the water-electrolyte metabolism. The development of cellular hyperhydration in patients with congenital heart diseases depends on the severity of the postoperative course and is its characteristic reflection. Distinct changes in the content of the electrolytes develop at this stage: potassium concentration reduction in the cells and sodium concentration increase in them.
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PMID:[Acute cardiac insufficiency and water-electrolyte metabolism in the postoperative period in congenital heart defects]. 101 6

Dobutamine (dobutamin hydrochloride, Lilly) is a new inotropic catecholamine; it is presented in lyophilized ampoules for I.V. use, each containing 250 mg of dobutamine to be reconstituted with 5 per cent glucose or sterile water for injection. In the first part of this study, animal pharmacology is reported as described in medical literature: inotropic activity with minimal chronotropic effects, direct action, no vasconstriction, minimal arrhythmogenic activity and minimal diversion of blood flow to skeletal muscles are the main experimental features. The authors report afterwards their own experience with dobutamine in 8 patients (cranial traumas) without cardiac failure, and in 9 patients presenting with a cardio-circulatory failure in a toxi-infectious condition. In all patients tested, hemodynamics parameters (heart rate, mean A.P., central venous pressure) and cardiac output measurement (dye dilution method) were performed. Cardiac index and systolic index, total systemic resistances, left ventricular performance were also calculated. Dobutamine dosage ranged from 2.5 to 10 mcg/kg/mn except in patients with low output syndrom (2.5 and 5 mcg/kg/mn). Dobutamine offers new possibilities by its constant and indisputable inotropic activity contrasting with its minimal chronotropic effect.
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PMID:[A comparative study of the cardiovascular effect of dobutamine. Preliminary results obtained in a surgical resuscitation unit]. 101 59

Tests conducted with adult (8--10 months) and old (26--28 months) rats brought evidence that in ageing the cardiac ejection, dp/dt max, contractility index, the ATP concentration, that of creatinophosphate, glycogen, pyruvate decline, the phosphorylation coefficient, the lactate content increase, while the level of water-soluble proteins and collagen diminishes and that of water-insoluble ones decreases. In adult rats hemodynamics and myocardial contractility change but unsignificantly on the 4--6th day after coarctation of the aorta, whereas in the old ones there occur functional and metabolic alterations in the heart that are indicative of a developing cardiac insufficiency. The age-specific differences persist also on the 14--16th day following coarctation of the aorta. During these periods the weight of the heart, the content of the myofribrillary proteins and collagen are on the rise, whereas in the old ones the weight of the heart remains unchanged and the level of water-soluble protein drops. Changes in the properties of the actomyosin complex, disruption of the calcium pump, shifts in the system of the energy generation, limitation of potential possibilities incident to the systems of protein biosynthesis in the myocardial cell, all this leads to the development of cardiac incompetence following loading in old age.
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PMID:[Mechanisms of development of cardiac insufficiency in old age]. 102 32

The effects of low protein diet on cardiac metabolic and structural changes subsequent to an extremely high pressure load were investigated. Spontaneously hypertensive rats(SHR) were divided into four groups, and fed the following diets for four weeks: 1) Group A: regular diet (23% protein) and water, 2) Group B: regular diet and 1% saline, 3) Group C: low protein diet (10% protein) and water, and 4) Group D: low protein diet and 1% saline. Two weeks after the start of feeding, there was no significant difference in the left ventricular ultrastructures between the corresponding regular and low protein diet groups. Four weeks after, degenerative findings such as streaming of Z lines, dilatations of smooth endoplasmic reticulum, and disarrangements of myofilaments appeared Group D, while in Group B electron microscopic findings indicated hypertrophy. Incorporation of [14C] leucine into the myocardial myosin B in Group D was significantly low, with a resulting fall of the LVdP/dtmax per integrated isometric pressure (IIP) and a rise of the left ventricular end-diastolic pressure (LVEDP), as compared to that in Group C at four weeks after the start of feeding. These observations suggest that, in the heart with an extremely high pressure load, low protein diet hinders the development of hypertrophy to the load with resulting heart failure.
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PMID:Effect of low protein diet on cardiac function and ultrastructure of spontaneously hypertensive rats loaded with sodium chloride. 103 68

There was no correlation of blood volume measurements with central venous pressure (CVP) or hematocrit determinations and only minimal suggestive trends with wedge pressure in a large series of postoperative patients; the lack of correlations emphasize the unreliability of venous pressure and hematocrit determinations to predict blood volume alterations. To evaluate the physiological problems, to define optimal therapeutic goals, and to measure therapeutic effectiveness of volume loading with an oncotically active agent, we measured the hemodynamic and oxygen transport responses to 500 ml. of 5 percent albumin given over 1 hour in 22 patients with CVP greater than 15 cm. H2O. The patients were separated into two groups according to the CVP response to volume therapy. The CVP decreased in 14 (64 percent) of these patients (Group 1), but it increased slightly but not significantly in eight (36 percent) patients (Group 2). In Group 1 patients, there was increased flow, improvement of tissue perfusion as reflected by increased oxygen consumption, and augmentation of the ventricular function. In Group 2 there were slight increases in mean flow, mean pulmonary arterial pressure, and mean transit time and slightly decreased pulmonary vascular resistance; there was appreciable improvement in left ventricular function without significant deterioration of right ventricular function. The high initial central venous pressure is not a reliable index of either hypervolemia or cardiac failure in critically ill patients. It is concluded that a trial of volume loading with an oncotically active agent with frequent auscultation of the chest and careful observation of the CVP trends will give the maximum diagnostic as well as therapeutic information.
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PMID:Plasma expansion in surgical patients with high central venous pressure (CVP); the relationship of blood volume to hematocrit, CVP, pulmonary wedge pressure, and cardiorespiratory changes. 108 Feb 99

Traumaticed tissue or organs show different reactions to oral and parenteral application of watery solutions. Tissue traumaticed or not does incline to edema. 2. In its central position in blood circulation, its capability of water storage and distribution as well in its regulatory function of the cardiac output, the lung is very suitable for transportation of fluid. 3. If physiologic transportation exceeds a maximum (renal and cardiac insufficiency, high temperature, infusion) and if lymphatics are blocked, edema results in the interstitial and intraalveolare space. 4. Fatal edema is prevented during the first 48 h by applicating proteinase inhibitor drug; Trasylol immediatly after trauma. 5. Edema is significantly diminished applicating Benzopyrone (Venalot), as proven biochemically and electromicroscopically. 6. Taking the findings, it is necessary to considerate a new concept of fluid therapy.
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PMID:[Experimental pulmonary edema: pathophysiological mechanism (author's transl)]. 108 14

Dogs with experimental high-output heart failure (HOF) exhibit marked retention of salt and water secondary to hypersecretion of both renin and aldosterone. The present study was undertaken to evaluate the systemic and intrarenal arteriolar action of angiotensin II (AII) in dogs with HOF and to provide additional information about the role of AII in low-output states. The intravenous infusion of a specific AII antagonist, [Sar1, Ala8]AII (6 mug/kg min-1), into conscious dogs with HOF decreased the mean arterial pressure (AP) from 101 +/- 7 to 83 +/- 7 mmHg (P less than 0.01) after 45 min of infusion. Intrarenal arterial infusion of the AII antagonist (0.2 and 2.0 mug/kg min-1) into anesthetized dogs with HOF also decreased AP and produced a marked increase in renal blood flow (RBF) with no changes in either creatinine clearance or sodium excretion. Similar results were obtained during the intrarenal infusion of the antagonist into sodium-depleted dogs and dogs with thoracic vena caval constriction, but not in normal dogs. The data demonstrate an important role for AII in the regulation of AP and RBF in high- and low-output states.
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PMID:High-output heart failure in the dog: systemic and intrarenal role of angiotensin II. 116 74


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