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

The role of aldosterone-antagonists in the treatment of congestive heart failure. Despite the advances of the treatment of congestive heart failure, nearly half of the patients diagnosed with this disease five years ago are alive today. Experimental and human studies have demonstrated, that under special pathologic condition, the heart extracts aldosterone, and aldosterone extraction in the heart stimulates increased collagen turnover culminating in ventricular remodeling. Aldosterone blockade has been shown to be effective in reducing total mortality and hospitalization for heart failure in patients with systolic left ventricular dysfunction due to chronic heart failure (RALES study with spironolactone) and in patients with systolic left ventricular dysfunction post acute myocardial infarction (EPHESUS study with eplerenone). These clinical studies have shown that mineralocorticoid receptor activation remains important despite the use of angiotensin converting enzyme inhibitor or angiotensin receptor blocking agent and a beta blocker. In the ACC/AHA (and in the European and Hungarian) guidelines for the evolution and management of chronic heart failure, the indication of spironolactone was defined of Class Ila, Level of Evidence: B in CHF of stage C. The eplerenone (in US: INSPRA) was approved for the management of CHF patients after myocardial infarction with ejection fraction < 40%. Eplerenone, compared with spironolactone, is associated with a lower incidence of gynecomastia and other sex hormone-related adverse effect (breast pain, menstrual abnormalities). The spironolactone should not be used in patients with a creatinine above 220 mikromol/l. Despite the guidelines recommendation, spironolactone has been widely used in patients without consideration of their functional class or ejection fraction, without optimization of background treatment with ACE inhibitors and beta-blockers.
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PMID:[The role of aldosterone-antagonists in the treatment of congestive heart failure]. 1588 38

The incidence of heart failure is increasing and its prevalence is high, ranging from 1% to 2% in middle aged patients to more than 10% in older patients. Several pharmacologic approaches developed during the past 15 years, have had at least in clinical trials a significant impact on progression of heart failure mortality. The effect of ACE-inhibitors has been documented extensively during the last 15 years. They offered 15% decrease in hospitalization for moderate heart failure and, depending on the severity of the disease, produced a 16% to 31% reduction in mortality. Angiotensin receptor blockers provide unique pharmacological mechanism, and have demonstrated high tolerability in large trials. According to the new ACC/AHA guidelines for the evaluation and management of heart failure, the results of evidence based studies using ACE-inhibitor and angiotensin blocker therapies were analyzed by the author.
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PMID:[The role of ACE inhibitors and angiotensin receptor blockers in the treatment and prevention of chronic heart failure]. 1592 27

Hypertrophic cardiomyopathy (HCM) counts as one of primary diseases emanating from the myocardium. In approximately 60% of the cases a familial autosomal dominant trait of disease inheritance was determined. In the majority of the cases a mutation in one of the known 14 disease-causing genes could be proven. With a prevalence of 0.2% HCM is one of the most common genetic heart diseases. The genetic causes, the clinical manifestations as well as the clinical progression are heterogeneous. At present, echocardiography is the most important diagnostic tool. It remains to be seen how the results from magnetic resonance imaging and molecular genetic diagnosis will have impact on the disease management in the future. The prognosis varies according to the localization, the degree of hypertrophy and, in some cases, on the underlying genetic mutation. Sudden death (SD) is a significant risk of the disease in young people. A systematic stratification of patients at a higher risk of SD is desperately needed. The implantation of an AICD is the most effective preventive measure against SD. The basis medication therapy of symptomatic patients uses calcium antagonists or beta-blockers. In high-degree heart failure the typical therapy is applied mainly in combination with beta-blockers and, if indicated, also with antiarrhythmics. When a high degree of outflow obstruction is present, transcoronary ablation of septum hypertrophy (TASH; synonym: percutaneous transluminal septal myocardial ablation [PTSMA]) or myectomy Ercan be performed. Heart transplantion is performed only in very few patients with terminal heart failure. Even though HCM is one of the best-documented genetically based heart diseases, only a few prospective studies and registries have been established, which have produced guidelines and recommendations for diagnostics and therapy. The ACC/ESC Expert Consensus Document is very helpful in this respect. Therefore, there is still a great need for systematic prospective analyses in large patient populations.
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PMID:[Hypertrophic cardiomyopathy]. 1617 Jun 88

Left ventricular systolic dysfunction (LVSD) and clinical heart failure are common complications of acute myocardial infarction (AMI) and result in substantially increased mortality and morbidity. Evidence-based cardiovascular protective therapies, including angiotensin-converting enzyme inhibitors, beta blockers, antiplatelet agents, and lipid-lowering medications, improve outcomes for these patients. However, this population is significantly undertreated with these guideline-recommended agents. Critical pathways have been demonstrated to improve the quality and consistency of treatment; as such, the new American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of patients with ST-elevation myocardial infarction (STEMI) recommend that critical pathways be implemented for the management of these patients. The recent Eplerenone Post-acute Myocardial Infarction Heart Failure Efficacy and Survival Study (EPHESUS) demonstrates that eplerenone, a selective aldosterone blocker, has incremental benefit in decreasing mortality and morbidity when used with standard care therapies in patients post AMI with heart failure and LVSD. The clinical trial evidence coupled with the national guidelines provides a strong rationale for routine incorporation of aldosterone blockade into new or already established critical pathways for AMI complicated by LVSD and heart failure.
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PMID:Hospital protocols and evidence-based therapies: the importance of integrating aldosterone blockade into the management of patients with post-acute myocardial infarction heart failure. 1647 70

Chronic heart failure (CHF) in the elderly is a significant healthcare problem. Nearly half of CHF in this age group is diastolic heart failure with preserved left ventricular ejection fraction. However there is the limitation of the evidence-based therapy for this important group of patients. In this article, the treatments for the diastolic heart failure recommended in the ACC/AHA guidelines for the CHF (1998, 2001, 2005 versions) are described and common problems regarding the diagnosis and management of CHF in the elderly is also discussed. Furthermore, the recent topics about the treatment of diastolic heart failure are presented.
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PMID:[Characteristics of the chronic heart failure in the elderly]. 1668 84

This is the second of a two-part series on strategies for optimizing the delivery of cardiac resynchronization therapy (CRT). A previous article presented strategies to optimize CRT device functioning. This article focuses on patient-related aspects. The 2005 American College of Cardiology/American Heart Association (ACC/AHA) Guidelines for Managing Adults with Chronic Heart Failure now designate CRT as a class IA recommendation for stage C patients (QRS duration, > or = 120 milliseconds; left ventricular ejection fraction, < or = 35%) who remain symptomatic despite optimal medical therapy. While the evidence from prospective randomized controlled trials demonstrates consistent and concordant support for CRT in patients with symptomatic heart failure and ventricular dyssynchrony, a substantial minority of patients do not experience clinical improvement from CRT. In addition to device optimization, optimizing individual patient responses is essential. This article discusses measures for enhancing the patient's response to a CRT device.
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PMID:Cardiac resynchronization therapy: a practical guide for patient management after device implantation, part II. 1689 81

Several pivotal clinical trials have generated new knowledge regarding drug therapy for heart failure. Thus, the Heart Failure Society of America (HFSA) and the American College of Cardiology-American Heart Association (ACC-AHA) guidelines were updated in 2006 and 2005, respectively. We review the evidence from these trials and summarize the changes to the HFSA and ACC-AHA guidelines. Based on data from these studies, the new guidelines include broader, stronger recommendations for beta-blocker therapy, and strong recommendations for angiotensin II receptor blockers. The aldosterone antagonists, spironolactone and eplerenone, are also included in the guidelines. Pharmacists should have a basic level of familiarity with the new guidelines on heart failure and the evidence from recent clinical studies. They should be able to relate how this information contributes to the evolving understanding of treatment strategies for heart failure.
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PMID:Current guidelines for treatment of heart failure: 2006 update. 1738 70

Congestive heart failure with preserved left ventricular systolic function has emerged as a growing epidemic medical syndrome in developed countries, which is characterized by high morbidity and mortality rates. Rapid and accurate diagnosis of this condition is essential for optimizing the therapeutic management. The diagnosis of congestive heart failure is challenging in patients presenting without obvious left ventricular systolic dysfunction and additional diagnostic information is most commonly required in this setting. Comprehensive Doppler echocardiography is the single most useful diagnostic test recommended by the ESC and ACC/AHA guidelines for assessing left ventricular ejection fraction and cardiac abnormalities in patients with suspected congestive heart failure, and non-invasively determined basal or exercise-induced pulmonary capillary hypertension is likely to become a hallmark of congestive heart failure in symptomatic patients with preserved left ventricular systolic function. The present review will focus on the current clinical applications of spectral tissue Doppler echocardiography used as a reliable noninvasive surrogate for left ventricular diastolic pressures at rest as well as during exercise in the diagnosis of heart failure with preserved left ventricular systolic function. Chronic congestive heart failure, a disease of exercise, and acute heart failure syndromes are characterized by specific pathophysiologic and diagnostic issues, and these two clinical presentations will be discussed separately.
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PMID:Current clinical applications of spectral tissue Doppler echocardiography (E/E' ratio) as a noninvasive surrogate for left ventricular diastolic pressures in the diagnosis of heart failure with preserved left ventricular systolic function. 1738 87

Patients with end-stage renal disease (ESRD) are at high risk for cardiovascular disease (CVD) and therefore should be treated according to ACC/AHA Guidelines. Scant data are available concerning the actual use of cardioprotective drugs in this population. The use of angiotensin-converting enzyme inhibitors (ACE-I), beta-blockers, aspirin, and statins was assessed in 271 (72% males, 66% Caucasians) high-risk ESRD patients on hemodialysis. The study population comprised 27% smokers, 95% with hypertension, 38% with diabetes, and 44% with dyslipidemia; 44% of patients had overt CVD at baseline, including 9% with heart failure, 9% with prior myocardial infarction, and 3% with previous myocardial revascularization. One-third of all patients were not receiving any cardioprotective drugs; among those patients who were, 42% were on one drug, 21% were on two, 3.7% were on three, and 1.5% were on four. The most prescribed agent was ACE-I (35.8%), followed by aspirin (30.6%), and beta-blockers (28.0%). The use of statins was remarkably and significantly low (4.1%) (p < 0.001), even in the higher risk subgroups (patients with diabetes or macrovascular disease). ACE-I plus aspirin was the most prescribed combination (8.5%). Cardioprotective agents recommended for risk-factor modification by the ACC/AHA Guidelines for their well-established efficacy in the general population were underutilized in this cohort of high-risk hypertensive hemodialysis patients, despite an elevated prevalence of clinically evident CVD. Speculatively, this fact may be relevant to better understand the known increased cardiovascular morbidity-mortality associated with chronic renal disease.
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PMID:Underuse of American College of Cardiology/American Heart Association Guidelines in hemodialysis patients. 1765 18

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the optimal treatment strategy for acute prosthetic valve thrombosis (PVT) is surgical management or thrombolytic therapy. Using the reported search 96 papers were identified. Twelve papers represented the best evidence on the subject, and the author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study comments and weaknesses were tabulated for these. Recent AHA/ACC guidelines were also included, as were two large case series of surgical management for comparison. We conclude that the management of obstructive PVT remains widely debated due to a lack of randomised controlled trials. Surgery has been the traditional management of choice, but thrombolysis has recently been proposed as a first-line therapy. Both surgery and thrombolysis can be used with high rates of success and relatively low complication rates, though NYHA class at presentation has a significant bearing on surgical mortality and thrombus size affects complication rates with thrombolysis. Thrombolysis appears particularly favoured when the thrombus area as assessed by transoesophageal echocardiography is small (<0.8 cm(2)), as high success rates and low complication rates have been reported, and thrombolysis does not preclude the patient from proceeding to surgery if it fails. Presentation in a high NYHA class of heart failure or cardiogenic shock is the most difficult patient to decide between surgery and thrombolysis. Surgery for these patients may remain the mainstay of treatment unless the clot burden is particularly small or the patient's co-morbidities make surgery unacceptably high-risk.
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PMID:Is thrombolysis or surgery the best option for acute prosthetic valve thrombosis? 1803 1


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