Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peak III phosphodiesterase (PDE) inhibitors have combined positive inotropic and vasodilator effects. We studied 10 patients with chronic heart failure during and after infusion of intravenous (i.v.) ICI 153,110, an investigational peak III PDE inhibitor. Maximum hemodynamic response for the group occurred after cessation of infusion at a lower plasma drug concentration. At maximum hemodynamic response, cardiac index (CI) increased (2.4 +/- 0.5 vs. 3.2 +/- 0.37 L/min/m2, p less than 0.05) with a decrease in mean arterial pressure (MAP 91 +/- 5 vs. 80 +/- 3 mm Hg, p less than 0.05), pulmonary capillary wedge pressure (PCWP 25 +/- 2 vs. 17 +/- 3.1 mm Hg, p less than 0.01), systemic vascular resistance (SVR 1,422 +/- 106 vs. 983 +/- 97 dynes.s.cm-5, p less than 0.05) and pulmonary vascular resistance (PVR 227 +/- 39 vs. 16 +/- 31 dynes.s.cm-5, p less than 0.05). During the infusion, plasma renin activity (PRA) decreased from 6.34 +/- 2.53 to 3.6 +/- 3 ng/ml/h (NS). The five patients with high baseline PRA had a significant decrease (11.2 +/- 2.5 vs. 5.4 +/- 1.67 ng/ml/h, p less than 0.01) that preceded changes in CI and SVR by 1-2 h. These data suggest that reduction in PRA may have contributed to the hemodynamic effects of this peak III PDE inhibitor.
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PMID:Acute neurohormonal and hemodynamic response to a new peak III phosphodiesterase inhibitor (ICI 153,110) in patients with chronic heart failure. 170 Feb 5

ARDS occurs in patients with no underlying pulmonary diseases, induced by stresses, such as lung injury, acute pancreatitis or infections. It is an acute respiratory disorder which manifests as acute dyspnea, hypoxemia and lowered pulmonary compliance. Greene et al, used balloon pulmonary angiogram (BOPA) as diagnostic tool to morphologically observe the pulmonary disorder. To study the dynamic pulmonary circulation and morphology of the peripheral pulmonary artery of ARDS, we performed this method for acute cardiac failure and ARDS patients. Pulmonary hemodynamic changes in ARDS revealed mild pulmonary hypertension and increased PVR, while C.I. and PCWP remained within a normal range. The findings of BOPA in ARDS showed that the frequency of PAFD correlated with the the presence of an elevated PVR and DIC, and pulmonary vasoconstriction was detected by measurement of PA diameter (B/A2).
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PMID:[ARDS: circulatory factors and their evaluation]. 203 88

Hemodynamics during 24-h dobutamine (dob) and subsequent 24-h milrinone (mil) infusion were studied in 20 patients (pts) with severe heart failure (NYHA III: 4 pts, NYHA IV: 16 pts). Three of 20 patients showed a heart-rate increase to 140 bpm and more during dob; five patients were non-responders to dob. Heart rate rose (p less than or equal to 0.001) during dob from 88.8 to 105.6 bpm (+1 hr) and then decreased to 93.0 bpm after 24 h; stroke volume index increased (p less than or equal to 0.001) from 19.3 to 28.9 ml.m-2 (+49.6%) after 1 h and then decreased to 25.2 ml.m-2 after 12 h as did heart rate. During mil heart rate did not change; stroke volume index increased from 18.8 to 31.2 (+66.0%, p less than or equal to 0.001) after 1 h and showed no development of tolerance during the rest of the infusion period. PCWP decreased (p less than or equal to 0.001) during mil from 26.5 to 16.2 mm Hg after 30 min, tending upward again to 20.1 mm Hg after 24 h; during dob the decrease (p less than or equal to 0.01) of PCWP from 27.8 to 19.0 mm Hg after 6 h was delayed, also tending upward during the rest of the infusion period to 22.7 mm Hg after 24 h. There was no sustained decrease of PVR during dob, but after the start of mil infusion PVR decreased (p less than or equal to 0.001) from 312.7 to 172.1 dynes/s/cm-5 (+15 min), remaining on this level during the rest of mil infusion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hemodynamics with dobutamine and milrinone in patients with severe heart failure in an intra-individual comparison]. 205 47

Clinical and hemodynamic studies were carried out for the purpose of evaluating the effects of enalapril in the treatment of chronic heart failure. Enalapril 10-20 mg was given once to 10 patients with moderate to severe congestive heart failure (coronary 6, hypertensive heart disease 2 and idiopathic congestive cardiomyopathy). Hemodynamic studies were done on the first day after drug administration and the same dose was maintained for 2 weeks. The results showed a decrease of mean BP of 18.29% (P less than 0.01), CVP 40.4% mPAP 23.9%, PCWP 41.2%, SVR 39.9% and PVR 41.3% respectively (P less than 0.001). Cardiac index increased 44.16% (P less than 0.001). The therapeutic action lasted more than 24 hours after a single dose. No further drop of BP was found weeks later, 6 patients in NYHA class III and 2 in class IV improved to class II. No severe side effects were found. The results showed that enalapril is well tolerated after a single dose and its therapeutic action lasts 2 weeks with improvement both in hemodynamics and subjective symptoms.
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PMID:[Hemodynamic study of a single oral dose of enalapril in patients with heart failure]. 256 Jul 2

The hemodynamic effects of IS-5-MN were studied in 18 patients with acute myocardial infarction (AMI) complicated with left ventricular failure. Before treatment, 13 patients were in Forrester's hemodynamic class II and 5 in class IV. Hemodynamic monitoring was performed for 3 days, and the following parameters were measured: heart rate (HR), blood pressures (BP), right atrial (RAP), pulmonary artery and pulmonary capillary (PCP) pressures, cardiac index (CI), systemic (SVR) and pulmonary (PVR) vascular resistances, and coronary perfusion pressure (CPP). Patients with clinical symptoms of acute pulmonary edema or systolic BP (BPs) less than 90 mmHg were not included. Twenty mg of 5-IS-MN per os were administered every 8 h. Hemodynamic measurements and IS-5-MN plasma levels were obtained in basal conditions and 1/2, 1, 2, 6 and 8 h after the first and seventh dose of IS-5-MN. A significant decrease of systolic and diastolic BPs, RAP, PCP, SVR and PVR was observed after 1/2 of IS-5-MN administration and was maintained through the study, while CI and CPP increased and HR remained unchanged. The hemodynamic effect was maintained after the seventh dose, with a further decrease of the following parameters: BP, RAC, PCP and PVR. However, 2 patients were withdrawn from the study due to severe symptoms of heart failure. One patient presented headache. IS-5-MN plasma levels were identified after 1/2 h, with a peak level after 1 h, and were similar after the seventh dose. A significant correlation was found between the IS-5-MN levels and the delta RAP and delta PCP after the seventh dose.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Hemodynamic effect of isosorbide-5-mononitrate in acute cardiac insufficiency secondary to myocardial infarct]. 281 84

To study the relationship between the hemodynamic characteristics and prognosis in PPH, we analyzed the data on patients whose prognosis was well documented from the time of hemodynamic monitoring. Our subjects were 87 patients obtained from a nationwide survey in Japan. PCWPs were obtained in 44 patients and COs were measured in 59 patients. The average age was 33 years (range 14 to 69). Patients were followed prospectively for up to 100 months and were categorized based on the survival period from the time of catheterization. Hemodynamic variables that showed significant differences or prognostic trends were RVedp, pulmonary artery diastolic pressure, PCWP, CI, PVR, and PVR/SVR ratio. The CI correlated with the number of survival months (r = 0.583; p less than 0.01). The hemodynamic state of patients who died suddenly within 1 year from the time of catheterization was no different from those who died of clinical right-sided heart failure. The partial pressure of oxygen of arterial blood was the only variable discriminating sudden deaths from right-sided heart failure deaths (54 +/- 2 vs 66 +/- 4 mm Hg; p less than 0.05). The results of this study indicate that the major determinant of prognosis is right ventricular function and that the CI might be used as a prognostic indicator. In addition, sudden death is more likely to occur in patients with severe hypoxia.
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PMID:Natural history of pulmonary hemodynamics in primary pulmonary hypertension. 360 99

Despite recent advances in antimicrobial therapy infective endocarditis (IE) still remains a major surgical problem. All patients undergoing surgical treatment for IE at our Institution since 1970 were reviewed; among these in 40 IE was considered to be active at time of operation. Thirty patients were males and 10 females, ranging in age from 11 to 66 years (average 41); indications for operation were heart failure in 31, mycotic emboli in 5, and sepsis in 4. Nine were in NYHA functional class 11, 18 in NYHA class III, and 13 in class IV. Aortic valve replacement (AVR) was performed in 24 cases, mitral valve replacement (MVR) in 5 and multiple valve replacement (PVR) in 11. Overall hospital mortality was 15% (4.2% in the AVR group, 40% in the MVR group, and 27% in the PVR group). Postoperative follow-up was available in all survivors. Four patients died in the late postoperative period for not infective causes. Almost long-term survivors show, from 7 months to 10 years (average 58 months) postoperatively, a significant improvement. No complications related to the initial infective process were recorded. According to the results of the present study the following conclusions can be drawn: 1) active IE does not represent a contraindication to open heart surgery and prosthetic valve replacement; 2) the surgical results depend not only on the degree of cardiac failure, but mainly on its duration; 3) early surgical intervention affects favourably the prognosis, especially in cases of isolated aortic valve involvement; 4) the surgical management of IE removes the focus of infection.
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PMID:[Surgical treatment of infectious endocarditis in the active phase. Experience in 40 cases]. 689 99

In cardiac surgery new developments in the current area are mainly directed towards minimally invasive surgery techniques. New anastomotic devices for CABG are clinically available and will facilitate partial and total endoscopic CABG techniques. In valve surgery percutaneous techniques are already available for AVR and PVR. Single percutaneous mitral valve repair is not a too far away procedure. Tissue engineering will offer biocompatible heart valves. New developments for heart failure therapy are booming. The major drawback for the achievements of this amazing progress is the financial cost. An open debate between all the parties concerned in healthcare is urgently needed in order to maintain the quality of surgical care for the decades to come.
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PMID:New developments in cardiac surgery. 1529 33

Left ventricular assist device (LVAD) implantation and heart transplantation (HTx) are established therapeutic approaches in the treatment of end-stage heart failure. The postoperative humoral responses to the two treatments have not yet been compared. All patients were treated with inhaled nitric oxide (iNO) on weaning from cardiopulmonary bypass as they presented with pulmonary hypertension. We investigated atrial natriuretic peptide (ANP), brain natriuretic peptide (BNP), cGMP, endothelin (ET)-1, big endothelin (big ET), and hemodynamic parameters after LVAD implantation (15 patients; age 51 +/- 8 years) or HTx (10 patients; age 53 +/- 6 years) preoperatively, on cardiopulmonary bypass and postoperatively up to 72 hrs after cessation of iNO. Preoperatively, cardiac index (CI), pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), central venous pressure (CVP), and mean atrial pressure (MAP) were similar for both groups. Similarly, ANP, BNP, cGMP, ET-1, and big ET were comparable before surgery. Seventy-two hours after weaning from iNO, the administered epinephrine dose was higher in the HTx group (P = 0.003); whereas the CVP (P = 0.04) and pulmonary vascular resistance (PVR; P = 0.03) were lower. The following humoral parameters differed markedly: ANP (preoperatively: LVAD, 99 +/- 123 pg/ml; HTx, 197 +/- 199 pg/ml; P = 0.14; vs. 72 hrs after iNO: LVAD, 110 +/- 106 pg/ml; HTx, > 640 +/- 0 pg/ml; P = 0.003) and cGMP (preoperatively: LVAD, 4.4 +/- 5.8 pg/ml; HTx, 5.0 +/- 3.0 pg/ml; P = 0.35; vs. 72 hrs after iNO: LVAD, 8.0 +/- 10.8 pg/ml; HTx, 26.2 +/- 15.8 pg/ml; P = 0.02). Although the hemodynamic effects of both LVAD implantation and HTx in the treatment of end-stage heart failure are comparable, except for the effects on CVP and PVR, the humoral responses with respect to ANP and cGMP were strikingly different. These effects are independent of volume status, iNO, and ETs, suggesting a physiologic response to maintain circulatory homeostasis.
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PMID:Humoral and hemodynamic responses after left ventricular assist device implantation and heart transplantation. 1674 Oct 13

Pulmonary hypertension (PH) unresponsive to pharmacological intervention is considered a contraindication for orthotopic heart transplantation (OHTX) due to risk of postoperative right-heart failure. In this prospective study, we describe our experience with a treatment strategy of improving severe PH in heart transplant candidates by means of ventricular assist device (VAD) implantation and subsequent OHTX. In 11 heart transplantation candidates with severe PH unresponsive to pharmacological intervention we implanted VAD with the aim of achieving PH to values acceptable for OHTX. In all patients we observed significant drop in pulmonary pressures, PVR and TPG (p < 0.001 for all) 3 months after VAD implantation to values sufficient to allow OHTX. Seven patients underwent transplantation (mean duration of support 216 days) while none of patients suffered right-side heart failure in postoperative period. Two patients died after transplantation and five patients are living in very good condition with a mean duration of 286 days after OHTX. In our opinion, severe PH is not a contraindication for orthotopic heart transplantation any more.
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PMID:Is severe pulmonary hypertension a contraindication for orthotopic heart transplantation? Not any more. 2181 20


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