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Query: UMLS:C0018801 (heart failure)
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Eighteen men with myocardial infarction in their history and without signs of heart failure were investigated at rest and during standard supine exercise. In nine patients aneurysma or diskinesis of the left ventricular wall were found. The left ventricular end-diastolic volume was determined from the wash-out of 133Xe injected into the left ventricle by means of precordial scintillation counting. During exercise the cardiac index rose owing to acceleration of the heart rate, whereas the stroke index remained unchanged, and the left ventricular work and stroke indices increased. The left ventricular end-diastolic pressure, elevated at rest, reached high values during exercise. The left ventricular end-diastolic and residual volumes decreased during exercise in most patients, and simultaneously the systolic ejection fraction increased. In patients with aneurysma or diskinesis the end-diastolic volume both at rest and during exercise does not differ from EDV of other patients. Six patients developed angina pectoris during exercise, but their haemodynamics did not differ significantly. It is concluded that the left ventricle in patients with advanced coronary heart disease and previous myocardial infarction shows the signs rather of diminished compliance than of heart failure during adequate exercise and still possesses some functional reserves.
Cor Vasa 1977
PMID:Left ventricular end-diastolic volume during supine exercise in patients with healed myocardial infarction. 90 91

Fifty patients with acute extensive myocardial infarction, with unfavourable course, were continuously survelled from the beginning of the disease till the terminal stage with the aim to study the interdependences between changes in the sympatho-adrenal and kallikrein-kinin systems in blood. The blood levels of adrenaline and noradrenaline were determined fluorometrically. The activity of the kallikrein-kinin system was estimated on the basis of three components: spontaneous esterase activity, prekallikrein activity, and kallikrein inhibitor activity in blood. Within the first six hours all patients had significantly elevated adrenaline and increased activity of the kallikrein-kinin system in blood. At 24h before death and during the terminal stage, in patients with acute heart failure and those with cardiogenic shock the adrenaline level gradually rose, and in patients with myocardial rupture the noradrenaline level increased. The activity of the kallikrein-kinin system remained elevated throughout the follow-up period. The application of findings as diagnostic and prognostic criteria in myocardial infarction is suggested.
Cor Vasa 1977
PMID:Changes in sympatho-adrenal and kallikrein-kinin systems in the terminal stage of extensive myocardial infarction. 92 53

Possibilities of involution of changes in lesser circulation after closure of experimental aortopulmonary anastomosis were studied. 37 observations at various intervals after closure of anastomosis (several minutes to 13.5 months) in 25 dogs were analyzed. Before closure the anastomosis had functioned for 1-7 months. The results of histological examinations of lungs, pressure measurements in lesser circulation, heart weight, electrocardiographic and spirographic examinations were analyzed. It was found that complete involution of changes in lesser circulation was possible only in first month of existence of anastomosis, in this case with changes of both "early" and "late" types. "Late"-type changes after four months function of anastomosis had both reversible and irreversible character, whereas "early"-type changes became irreversible already after three-month duration of anastomosis. With the "late"-type changes, the operation itself (closure of anastomosis) was accompanied by symptoms of pulmonary vasomotor paresis and heart failure, whereas in the presence of "early"-type changes the operation elicited no morphological or functional changes.
Cor Vasa 1977
PMID:Involution of changes in lesser circulation after closure of prolonged aortopulmonary anastomosis. 92 59

Mortality during the hospitalization period was analyzed in a sample of 786 patients with acute myocardial infarction [AMI], admitted to the coronary care unit within a five-year period from a catchment area of 200 000 urban inhabitants. The total mortality during the hospitalization period amounted to 19.2%. The prognostic significance of certain clinically meaningful phenomena was appraised on the basis of their association to the mortality. It was demonstrated that the factors decisive for the prognosis of a patient with AMI are age, previous myocardial infarction, extent and localization of the ischaemic lesion apparent from the ECG tracing, and, in addition, presence of the atrioventricular and intraventricular conduction defects, especially if combined with anterior myocardial infarction. Patients with a high cumulation of these prognostic factors exhibited severe signs of mechanical heart failure, which is the mechanism of death in practically all of the deceased patients under the present possibilities of treatment.
Cor Vasa 1976
PMID:Hospital mortality in patients with acute myocardial infarction: five-year experience. 102 1

Coagulability of arterial and venous blood was studied in 50 healthy subjects and in 179 patients with circulation disturbances caused by coronary atherosclerosis and rheumatic cardiopathies. All indicators characterizing the individual haemocoagulation phases were respected. In the healthy subjects the coagulative and fibrinolytic activities of venous blood were higher than those of arterial blood. In the patients with heart failure the coagulability of venous blood decreased and that of arterial blood increased. These phenomena were accompanied by fibrinogenaemia, appearance of fibrinogen B in the blood, elevation of free heparin, and inhibition, but occasional activation, of fibrinolysis in both vascular systems. The findings seem to signalize enhanced intravascular blood coagulability in patients with circulation disturbances, which phenomenon has to be taken into account in the treatment of such patients.
Cor Vasa 1976
PMID:Coagulability of arterial and venous blood in healthy subjects, patients with coronary atherosclerosis, and patients with rheumatic cardiopathies. 102 2

Myocardial blood flow was estimated using the technique of selective xenon-133 solution injection into the coronary artery, in 20 patients with mitral stenosis, 8 patients with mitral insufficiency, 8 patients with primary cardiomyopathy, and in 7 healthy subjects. The mean value of myocardial blood flow in mitral stenosis (60.9 +/- 10.5 ml/min/100 g) and in mitral insufficiency (58.5 +/- 7.7) did not differ from the mean value obtained in the control group (66.0 +/- 9.1). On the other hand, myocardial blood flow in primary congestive cardiomyopathy was significantly diminished (54.1 +/- 8.6). Myocardial blood flow was also lowered in patients with class IV of heart failure (48.3 +/- 7.6), as compared to healthy subjects. A positive correlation was found between myocardial blood flow and the left ventricular work index (r = 0.48, p less than 0.05), as well as between myocardial blood flow and the right ventricular work index (r = 0.47, p less than 0.05). A weak correlation was noticed between myocardial blood flow and left ventricular end-diastolic pressure (r = 0.38, p less than 0.05), as well as between myocardial blood flow and right ventricular end-diastolic pressure (r = 0.34, p less than 0.05).
Cor Vasa 1976
PMID:Myocardial blood flow in mitral valve disease and in primary congestive cardiomyopathy, and its relation to some haemodynamic indices. 126 Dec 75

The purpose of the study was to evaluate the effect of enalapril on the frequency of ventricular premature beats in patients with congestive heart failure. The study group consisted of 30 patients with a mean age of 47 +/- 0.6 years with chronic congestive heart failure (NYHA classes III and IV) due to primary dilated cardiomyopathy and cardiomyopathy in the course of ischaemic heart disease. Initial therapy with digitalis and diuretics was supplemented with enalapril at a dose of 5-20 mg daily. Initially and at three months after enalapril, the following parameters were evaluated: NYHA functional class, the presence of premature ventricular beats in 24-hour ECG recording and left ventricular function by echocardiography. The scheduled therapy was completed by 23 patients; in 5 patients, the intake was discontinued because of hypotension, one patient died after 14 days due to worsening heart failure, and one patient was submitted for pacemaker implantation. Clinical improvement manifesting itself by a shift to lower NYHA classes was found in 20 patients. A reduced number of premature ventricular beats was observed in 52% of the patients. Termination of cardiac arrhythmias, especially of complex beats, was parallel to the circulatory improvement.
Cor Vasa 1992
PMID:The effect of enalapril on cardiac arrhythmias in patients with congestive heart failure. 128 55

The prognosis of patients with advanced left heart failure is fairly dismal. It was not until recently that studies were conducted demonstrating the poor prognosis can be modulated by drug therapy. Of the many vasodilators tested, positive data have emerged only from trials of high-dose nitrates with hydralazine and, most importantly, angiotensin-converting enzyme inhibitors believed to constitute the biggest step forward in the treatment of chronic heart failure. The agents included in this group improve the symptomatology, increase exercise tolerance and improve the prognosis. At present, they are indicated in cases of severe heart failure, and the potential of their use in the more severe forms as well as in patients after myocardial infarction is being intensively investigated. Still, diuretic remain the mainstay of drug therapy. The role of digitalis in the treatment of heart failure is being currently reviewed; its administration is unnecessary in most patients, especially those with maintained sinus rhythm. A number of other positive inotropic drugs, both catecholamine-based agents and phosphodiesterase inhibitors (amrinone, milrinone, xamoterol, enoximone) have been tested. Their effect in the chronic form, unlike acute failure, is controversial, and there is no evidence documenting improved prognosis; some studies even show an adverse trend. As almost 50% of patients with heart failure die suddenly, it would have been only logical to administer antiarrhythmics to them. However, no data demonstrating an improved prognosis are available either. Results of studies conducted to date have proved to be rather disappointing, and a study with the most promising antiarrhythmic drug--amiodarone--is still under way.
Cor Vasa 1992
PMID:Can pharmacological therapy influence the mortality of chronic congestive heart failure? 128 41

It has been proven that treatment of chronic heart failure (CHF) with some modern drugs is able to reduce mortality in groups of patients with the severest grades of this disease. The risk of sudden death has been unchanged, however. Out of 49 patients on long-term follow-up, 28 patients are surviving (group A) and 21 died (group B). 52.3% of the dead patients died suddenly. Eight patients in NYHA classes I-II died, all of them suddenly. Contrary to this, sudden death was the cause of death only in three of 13 patients in NYHA classes III-IV (p < 0.001). More severe heart failure was present in group B (NYHA class 2.95 +/- 0.96 vs. 2.18 +/- 0.48 in group A--p < 0.1). Antiarrhythmic drugs were given more frequently in group B (in 47.6% of pts vs. 17.9% in group A--p < 0.05). It is concluded that the occurrence of sudden death is higher in patients with less severe forms of CHF and has not been reduced by the means employed. Use of antiarrhythmic drugs may be dangerous and their indication should be based on results of a comprehensive examination. Use of the implantable cardioverter-defibrillator seems to be the most promising approach in indicated cases.
Cor Vasa 1992
PMID:Cardiac arrhythmias in chronic heart failure. 128 43

In chronic heart failure, dysregulation of sympathetic nerve system activity and of release of several neurohormones is present. Increased plasma levels of circulating hormones together with other factors have a negative influence on myocardial beta adrenergic receptors and induce cardiac hypertrophy with myocardial fibrosis. ACE inhibitors possess an ability to reverse these phenomena. An endogenous factor with an ACE inhibitory ability was isolated from the bovine left ventricular myocardium.
Cor Vasa 1992
PMID:Humoral factors in chronic heart failure. A review. 133 31


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