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

The cardiovascular continuum describes the way from risk factors to atherosclerosis, acute cardiovascular events (unstable angina and myocardial infarction), and development of terminal heart failure and its complications. Following this way, advances are reported in the prevention of cardiovascular disease, in noninvasive diagnostics and revascularization of coronary artery disease, and in new therapeutic options of acute myocardial infarction. The following issues are reported in detail: (1) significance of statins, inhibition of platelet aggregation and vitamins in primary and secondary prevention of cardiovascular disease, (2) comparison of the angiotensin receptor blocker losartan and the beta-blocker atenolol in hypertension (LIFE study), (3) magnetic resonance angiography for the detection of coronary stenoses, (4) advantages and disadvantages of operative and interventional coronary revascularization considering elderly patients and sirolimus-eluting stents, and (5) efficacy of glycoprotein IIb/IIIa inhibition and low molecular weight heparin in acute myocardial infarction.
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PMID:[From risk factors to symptomatic coronary artery disease. Update cardiology 2001/2002--part I]. 1271 45

Recent large-scale clinical trials have provided credible evidence that angiotensin-converting enzyme inhibitors and beta-blockers can prolong the survival in patients with chronic heart failure. Treatment of asymptomatic left ventricular dysfunction is as important as treatment of symptomatic disease. Addition of aldosterone antagonists to angiotensin-converting enzyme inhibitors and beta-blockers may afford further benefits in patients with severe heart failure. If angiotensin-converting enzyme inhibitors or beta-blockers are not tolerated, angiotensin receptor blockers should be considered as the alternative. The present article will review recent advances in treatment of heart failure based on large-scale clinical trials.
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PMID:[Treatment of heart failure based on large-scale clinical trials: renin-angiotensin system antagonists and beta-blockers]. 1275 6

The cardiovascular continuum describes the way from risk factors to atherosclerosis, acute cardiovascular events (unstable angina and myocardial infarction), and development of terminal heart failure and its complications. Following this way, advances are reported in the therapy of acute coronary syndrome, heart failure, ventricular and supraventricular tachyarrhythmias, and stroke in patients with patent foramen ovale. The following issues are reported in detail: (1) significance of statins and statin withdrawal, glycoprotein IIb/IIIa receptor blocker, acute coronary interventions, aspirin and clopidogrel in unstable coronary syndromes, (2) pathogenesis of acute pulmonary edema associated with hypertension, (3) cardiac regeneration capability after transplantation and myocardial infarction, (4) beta-blocker therapy, efficacy of additional angiotensin receptor blocker therapy and multisite biventricular pacing in symptomatic (advanced) heart failure, (5) prognosis after ablation of the atrioventricular node in patients with atrial fibrillation, (6) primary prevention with an implantable defibrillator and resumption of driving after implantation, and (7) therapeutic options after cryptogenic stroke and patent foramen ovale.
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PMID:[Update cardiology 2001/2002-part II. From unstable coronary syndrome to terminal heart failure]. 1281 17

Hypertension is a nutritional-hygienic disease. Long-term caloric intake in excess of energy expenditures, chronic supraphysiological intake of dietary sodium, excessive alcohol consumption, and psychosocial stressors all contribute to the development of hypertension throughout the world. Elevated BP, particularly systolic BP, has been linked to multiple adverse clinical outcomes including stroke, heart failure, myocardial infarction, renal insufficiency/failure, peripheral vascular disease, retinopathy, dementia, and premature mortality. These undesirable clinical outcomes are typically, although not invariably, preceded by pressure-related target-organ injury such as left ventricular hypertrophy, renal insufficiency and proteinuria. The relation of BP and CKD and, in turn, the prevention of CKD or forestalling its progression by hypertension treatment, will be the focus of this manuscript. In hypertensive persons with reduced kidney function and/or proteinuria, lowering BP with multidrug therapy that is inclusive of pharmacologic modulators of the renin-angiotensin-aldosterone-kinin system is an effective strategy to forestall the progressive loss of kidney function. The totality of data support low therapeutic BP targets for persons with proteinuria >1 g/d. Nevertheless, in persons with CKD, even those with proteinuria below the dipstick positive level (approximately 300 mg/d or urine protein to creatinine ratio of 0.22), aggressive BP control also may be warranted because of the high risk of nonrenal cardiovascular disease. Multiple antihypertensive drugs will be required in the vast majority of patients with diabetes and/or reduced kidney function to attain BP goal. Renin-angiotensin system (RAS) modulator therapy is indicated among persons with diabetes mellitus and CKD. Available data support the use of angiotensin receptor blockers in persons with type 2 diabetes and overt nephropathy for preservation of kidney function. Among persons with type I diabetes with or without overt nephropathy, type 2 diabetes without overt nephropathy and in nondiabetic CKD, the available clinical data support the use of angiotensin-converting enzyme inhibitors as the RAS modulator of choice. Low therapeutic target BP levels <130/80 mmHg in persons with type 2 diabetes mellitus also appear warranted based on available data mostly for reducing the risk of nonrenal cardiovascular disease and overall mortality.
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PMID:Prevention of hypertension and its complications: theoretical basis and guidelines for treatment. 1281 10

American College of Cardiology/American Heart Association class I recommendations for treating patients with heart failure (HF) and abnormal left ventricular ejection fraction are diuretics in patients with fluid retention, an angiotensin-converting enzyme (ACE) inhibitor unless contraindicated, a beta-blocker unless contraindicated, digoxin for the treatment of symptoms of HF, and withdrawal of drugs known to precipitate or aggravate HF such as nonsteroidal anti-inflammatory drugs, calcium channel blockers, and most antiarrhythmic drugs. Class II(a) recommendations for treating HF with abnormal left ventricular ejection fraction are spironolactone in patients with class IV symptoms, preserved renal function, and normal serum potassium; exercise training as an adjunctive approach to improve clinical status in ambulatory patients; an angiotensin receptor blocker in patients who cannot be given an ACE inhibitor because of cough, rash, altered taste sensation, or angioedema; and hydralazine plus nitrates in patients being treated with diuretics, a beta-blocker, and digoxin who cannot be given an ACE inhibitor or an angiotensin receptor blocker because of hypotension or renal insufficiency. Patients with diastolic HF should be treated with cautious use of diuretics and with a beta-blocker. An ACE inhibitor should be added if HF persists or an angiotensin receptor blocker if the patient cannot tolerate an ACE inhibitor because of cough, angioedema, rash, or altered taste sensation. Isosorbide dinitrate plus hydralazine should be added if HF persists. A calcium channel blocker should be added if HF persists. Digoxin should be avoided in diastolic HF if sinus rhythm is present.
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PMID:Epidemiology, pathophysiology, prognosis, and treatment of systolic and diastolic heart failure in elderly patients. 1287 57

There is a high frequency of heart failure (HF) accompanied by an increased mortality risk for patients with diabetes. The poor prognosis of these patients has been explained by an underlying diabetic cardiomyopathy exacerbated by hypertension and ischemic heart disease. In these patients, activation of the sympathetic nervous system results in increased myocardial utilization of fatty acids and induction of fetal gene programs, decreasing myocardial function. Activation of the renin-angiotensin system results in myocardial remodeling. It is imperative for physicians to intercede early to stop the progression of HF, yet at least half of patients with left ventricular dysfunction remain undiagnosed and untreated until advanced disease causes disability. This delay is largely because of the asymptomatic nature of early HF, which necessitates more aggressive assessment of HF risk factors and early clinical signs. Utilization of beta-blockade, ACE inhibitors, or possibly angiotensin receptor blockers is essential in preventing remodeling with its associated decline in ventricular function. beta-Blockers not only prevent, but may also reverse, cardiac remodeling. Glycemic control may also play an important role in the therapy of diabetic HF. The adverse metabolic side effects that have been associated with beta-adrenergic inhibitors in the diabetic patient may be circumvented by use of a third-generation beta-blocker. Prophylactic utilization of ACE inhibitors and beta-blockers to avoid, rather than await, the need to treat HF should be considered in high-risk diabetic patients.
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PMID:Heart failure: the frequent, forgotten, and often fatal complication of diabetes. 1288 75

Use of angiotensin-converting enzyme inhibitor in heart failure with left ventricular systolic dysfunction has revolutionized management of heart failure and resulted in several national heart failure guidelines. However, studies have documented underutilization of these life saving drugs. Subsequently, results of other randomized clinical trials revealed the beneficial effects of angiotensin receptor blockers, beta-blockers, and spironolactone in heart failure with systolic dysfunction, which prompted several other guidelines. However, all these guidelines were primarily restricted to systolic dysfunction. Heart failure is as much a geriatric syndrome as it is a cardiac. Most heart failure patients are older adults. About half of the heart failure in older adults is not associated with left ventricular systolic dysfunction. Two recent heart failure guidelines, from the European Society of Cardiology and the American College of Cardiology/American Heart Association, published respectively in September and December 2001 included recommendations for patients with preserved left ventricular systolic function and other special populations, including older adults and those at end of life. The purpose of this article is to review the relevance of these two guidelines to heart failure patients living in long-term care facilities. As our population is aging, more heart failure patients are expected to live in long-term care facilities. Appropriate evaluation and management of these patients are essential to improve quality of heart failure care in the coming decades.
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PMID:Treatment of chronic heart failure in long-term care facilities: implications of recent heart failure guidelines recommendations. 1288 26

When added to antihypertensive treatment in patients with diabetes and nephropathy, neither the angiotensin receptor blocker (ARB) irbesartan nor the calcium channel blocker amlodipine reduced the overall occurrence of cardiovascular events. However, irbesartan decreased the rate of heart failure and amlodipine reduced the rate of acute myocardial infarction.
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PMID:Do irbesartan and amlodipine reduce cardiovascular events in diabetic patients? 1266 24

In 2002, several studies were directed at new developments in the management of heart failure. In the COPERNICUS study, the previously reported benefits of the beta-adrenoreceptor blocker carvedilol regarding morbidity and mortality in patients with mild-to-moderate heart failure were also found in patients with severe heart failure. Carvedilol not only improves survival but when given in addition to conventional therapy, ameliorates the severity of heart failure and reduces the risk of clinical deterioration, hospitalisation and other serious adverse events. The diagnostic value of B-type natriuretic peptide (BNP) in patients with congestive heart failure has been a topic of study for the past five years. Many questions still need to be answered but the results of a study by Maisel et al. show that BNP is not only of diagnostic value but is also important for prognosis and evaluation of therapy. A substudy of the Val-HeFT study focussed on the effects of the angiotensin receptor blocker valsartan on BPN and noradrenaline levels. Valsartan significantly reduced the combined endpoint of mortality and morbidity and improved clinical signs and symptoms in patients with heart failure, if added to prescribed therapy. However, in a post-hoc observation an adverse effect on mortality and morbidity was seen in the subgroup receiving valsartan, an ACE inhibitor and a beta-blocker, which raised concern about the potential safety of this specific combination. And finally, interesting work by Abraham et al. on cardiac resynchronisation through atrial-synchronised biventricular pacing clearly shows that this therapy can produce a significant clinical improvement in patients with moderate-to-severe congestive heart failure and intraventricular conduction delay.
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PMID:New developments in the management of heart failure: a review of the literature in 2002. 1291 46

Heart failure is a common medical condition affecting nearly 5 million people each year in the United States, of whom 500,000 are newly diagnosed. The impact of this disease on society and the health care system is immense. Inpatient and outpatient costs are approximately $40 billion annually, almost $500 million of which is spent on heart failure medications alone. Beyond the problem of financial costs, however, it is imperative for us as health care professionals to improve our ability to prevent disease progression, decrease morbidity and mortality, and optimize patients quality of life. The use of a broad spectrum of treatments is reviewed in the context of a patient case study. Primary data justifying the use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, diuretics, digoxin, as well as beta blockers and spironolactone, is reviewed, with special reference to the stage of heart failure.
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PMID:Congestive heart failure: guidelines for the primary care physician. 1296 98


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