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

A simplified cannulation system was developed without thoracotomy for a ventricular assist system (VAS) that will be applicable even in an emergency. This system consists of an air driven and diaphragm type pump, cannulae, and devices for insertion. The inlet cannula was inserted into the left atrium through the femoral vein using a modified brockenbrough transseptal method. This system was installed without thoracotomy in a chronic experiment in two goats and was removed without any trouble after 14 days of pumping. In a 40 day experiment with this system implanted between the left atrium and the aorta, bypass flow was maintained at 2.7 to 3.3 L/min, and plasma free hemoglobin levels were below 7 mg/dl. When this system was implanted between the left atrium and the aorta, and activated in an induced heart failure goat, output through the pump was 3.0 +/- 0.4 L/min, and mean aortic pressure was increased to 91.7 +/- 15.9 mmHg from 55.8 +/- 15.4 mmHg. This system takes a middle position between an IABP and VAS with thoracotomy in capability of circulatory support and convenience.
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PMID:Left ventricular assist system with a simplified cannulation technique. 259 47

The present study was undertaken to determine whether near-infrared spectroscopy can be used to noninvasively assess skeletal muscle oxygenation in patients with heart failure. The difference between light absorption at 760 and 800 nm was used to assess hemoglobin-myoglobin oxygenation. Initial studies conducted in isolated canine gracilis muscle demonstrated that 760-800-nm absorption correlated closely (r = -0.97 +/- 0.01) with venous hemoglobin O2 saturation when the muscle was stimulated to contract at 0.25-5.0 Hz. In normal subjects (n = 6) and patients with heart failure (n = 8), 760-800-nm absorption changes from the vastus lateralis muscle were monitored at rest, during progressive maximal bicycle exercise, and during thigh cuff inflation to suprasystolic pressure, an intervention designed to assess minimal hemoglobin-myoglobin oxygenation. Absorption changes were expressed relative to the full physiologic range noted from rest to thigh cuff inflation. During exercise, normal subjects exhibited an initial increase in hemoglobin-myoglobin oxygenation followed by a progressive decrease in oxygenation to 27 +/- 13% of the physiologic range at the peak exercise workload of 140 +/- 9 W. In contrast, patients exhibited an initial decrease in hemoglobin-myoglobin oxygenation with the first workload, followed by a progressive further decrease to 26 +/- 13% of the physiologic range at a peak exercise workload of 60 +/- 8 W, less than half the peak workload noted in the normal subjects. At all exercise loads, hemoglobin-myoglobin oxygenation was significantly less in the patients than in the normal subjects. These data suggest that near-infrared spectroscopy can detect impaired skeletal muscle O2 delivery in patients with heart failure. This technique could provide a valuable method of assessing muscle O2 delivery in patients, particularly before and after therapeutic interventions.
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PMID:Noninvasive detection of skeletal muscle underperfusion with near-infrared spectroscopy in patients with heart failure. 259 29

Now that both magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) have reached their decadic majority, appropriate questions may be asked as to their accomplishments and prognostications for the future. This article emphasizes the approach of the metabolic biologists/physiologists to magnetic resonance biochemistry as indicated by the currently available multinuclear localized approaches. The viewpoint is emphasized that MRS is a critical care instrument where precipitious changes of oxidative metabolism lead to the well-known stroke, heart failure, liver failure, kidney failure, etc. Generally, the gradation between the classical metabolic steady state of life and the pathway leading to cell death is a narrow one and magnetic resonance in some cases is too finely tuned to delineate the gradations of stability and instability of cell metabolism. To this point, magnetic resonance can be supplemented by other modalities that sense tissue distress. An example of a most useful and predictive measure of hypoxic stress is optical spectrophotometry which uses time resolved ranging methods to measure optical path lengths to quantitate hemoglobin deoxygenation in tissues. With such a complement, the two methods emerge as one of general importance in diagnostic procedures.
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PMID:What are the goals of magnetic resonance research? 270 5

The present study assessed the prognostic value of hyperglycemia--a common feature in the early phase of acute myocardial infarction (AMI)--in 330 nondiabetic patients. Seventy-nine known diabetics and 10 (3%) unknown diabetics--diagnosed before discharge by stable glycosylated hemoglobin greater than 6.9% and by oral glucose tolerance testing--were excluded. Thirty-three (10%) patients died. The mortality rate was higher in women, in patients with anterior AMI, in older patients (greater than 65 years) and in the presence of heart failure. It was highest in patients with cardiogenic shock (24/36 vs 9/294; p less than 0.0001). Admission plasma glucose was significantly higher in nonsurvivors than in survivors (163 +/- 60 vs 114 +/- 36 mg/dl; p less than 0.0001). Mortality rate increased with increasing admission plasma glucose: 3% in normoglycemic patients (less than or equal to 120 mg/dl) versus 15% in patients with borderline plasma glucose (121 to 180 mg/dl) versus 43% in hyperglycemic patients (greater than 180 mg/dl) (p less than 0.0001). Multiple regression (stepwise) analysis identified cardiogenic shock, infarct site and age as the major determinants of mortality, while admission plasma glucose failed to reach full statistical significance (p = 0.067). Hyperglycemia was related to all 3 of these independent prognostic factors; when age and infarct site were accounted for, hyperglycemia was significantly associated with heart failure only and this association was characterized by a remarkable mortality rate. In nondiabetic patients with AMI, hyperglycemia is a correlate of heart failure and, therefore, an important factor of prognosis.
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PMID:Hyperglycemia and prognosis of acute myocardial infarction in patients without diabetes mellitus. 280 56

Berberine, an alkaloid of the protoberberine family, has been shown to have strong positive inotropic and peripheral resistance-lowering effects in dogs with and without heart failure. To determine the acute cardiovascular effects of berberine in humans, 12 patients with refractory congestive heart failure were studied before and during berberine intravenous infusion at rates of 0.02 and 0.2 mg/kg per min for 30 minutes. The lower infusion dose produced no significant circulatory changes, apart from a reduction in heart rate (14%). The 0.2 mg/kg per min dose elicited several significant changes: (a) Decreases in systemic (48%, p less than 0.01) and pulmonary vascular resistance (41%, p less than 0.01), and in right atrium (28%, p less than 0.05) and left ventricular end-diastolic pressures (32%, p less than 0.01). (b) Increases in cardiac index (45%, p less than 0.01), stroke index (45%, p less than 0.01), and LV ejection fraction measured by contrast angiography (56%, p less than 0.01). (c) Increases in hemodynamic and echocardiographic indices of LV performance: peak measured velocity of shortening (45%, p less than 0.01), peak shortening velocity at zero load (41%, p less than 0.01), rate of development of pressure at developed isovolumic pressure of 40 mmHg (20%, p less than 0.01), percent fractional shortening (50%, p less than 0.01), and the mean velocity of circumferential fiber shortening (54%, p less than 0.01). (d) Decrease of arteriovenous oxygen difference (28%, p less than 0.05) with no changes in total body oxygen uptake, arterial oxygen tension, or hemoglobin dissociation properties.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Cardiovascular effects of berberine in patients with severe congestive heart failure. 336 76

A 10-year-old patient with severe autoimmune hemolytic anemia (AIHA) presented with heart failure. Hemoglobin levels remained dangerously low despite multiple blood transfusions and corticosteroid therapy. A two-volume exchange transfusion promptly restored and maintained satisfactory hemoglobin levels. An exchange transfusion should be considered in selected patients with AIHA when severe hemolysis results in life-threatening anemia, and repeated blood transfusions are unsuccessful in maintaining safe hemoglobin levels. Such an approach may be especially applicable in children in whom plasma-pheresis may not be suitable because of technical limitations.
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PMID:Exchange transfusion for severe autoimmune hemolytic anemia. 343 79

Serum erythropoietin levels were measured by radioimmunoassay in 146 children and young adults with congenital heart disease to assess the relationship between erythropoietin and clinical factors (heart failure, anemia, cyanosis) and hemodynamic variables affecting oxygen delivery and utilization. Erythropoietin values were in the normal range (10 to 30 microU/mL) in 73% (58 of 80) of the patients with and 82% (54 of 66) of those without cyanosis. Elevated erythropoietin values in cyanotic patients were associated with lower mixed venous oxygen saturation and tension than in cyanotic patients with normal erythropoietin levels, even though the degree of polycythemia was similar. In contrast, most of the acyanotic patients who had elevated erythropoietin levels were anemic. Of the blood oxygen measurements, mixed venous oxygen saturation and tension had the closest inverse correlation with erythropoietin values. The normal erythropoietin values in most patients are in accord with other observations that show that an elevation in erythropoietin level in response to hypoxia will be transient if it results in a rise in hemoglobin concentration "appropriate" to the degree of hypoxia. Persistent elevation of erythropoietin in patients with congenital heart disease may indicate harmful impairment of hemoglobin production that is potentially correctable.
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PMID:Serum erythropoietin levels in patients with congenital heart disease. 355 1

The apparatus "Artificial Beta-Cell" or "Biostator" was used in treatment of 115 patients with diabetes mellitus and concomitant ischemia of the heart. At the same time 30 patients with diabetes mellitus and ischemia of the heart were treated for diabetes mellitus with the routine methods. Hormones such as ACTH, STH, hydrocortisone, immunoreactive insulin and S-peptide, lipid metabolism and glycosylated hemoglobin were investigated in the time course of the treatment. It was shown that adequate correction of glycemia with the "Biostator" promoted renormalization of the levels of ACTH and hydrocortisone. The results were especially favourable in the group of patients with myocardial infarction and chronic ischemia of the heart with the signs of cardiac insufficiency. Moreover, in the patients of the main group there was a tendency for normalization of lipid metabolism and glycosylated hemoglobin. The results of carbohydrate metabolism compensation in patients of the control group were not always satisfactory and the periods of compensation were longer. The clinico-biochemical indices reflected the favourable effect of the use of the "Biostator" and its advantages over the routine methods in treatment of diabetes mellitus.
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PMID:[Control and correction of the blood sugar in diabetes with concomitant ischemic heart disease using the artificial beta-cell apparatus employing glucose oxidase as the enzyme]. 396 92

The heart, lungs and hemoglobin form the body's gas transport system, which links the atmosphere and its supply of O2 with tissue, while simultaneously providing for the elimination of the metabolic end-product, CO2, into the atmosphere. The transport of these respiratory gases must be in accordance with metabolic need. This is particularly evident during the physiologic stress of isotonic exercise, when the O2 requirements and CO2 production of skeletal muscle are increased. The monitoring of these respiratory gases during exercise, referred to as cardiopulmonary exercise testing (CAR-PET), can be used to assess heart and lung function in patients with cardiovascular or lung disease or both. Chronic cardiac failure (CCF) may be defined in physiologic terms as that circumstance in which the heart fails to provide tissue with O2 at a rate commensurate with aerobic requirements. In patients with CCF, CAR-PET represents a noninvasive means to determine aerobic capacity (that is, maximal O2 uptake) and anaerobic threshold during incremental treadmill exercise. It can also provide an objective measure of the severity of failure, the functional status of the patient and the heart's pump reserve. By using additional measurements of ventilation, arterial O2 saturation and, in selected cases, hemodynamic monitoring, the nature and severity of cardiovascular and pulmonary disease may be evaluated.
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PMID:Cardiopulmonary exercise testing for evaluation of chronic cardiac failure. 396 7

Three metabolic adaptive or compensatory mechanisms of heart failure were discussed: Adaptation of energy production and of energy availability in the myocardial cell. With increased myocardial oxygen demands this is achieved by a progressive displacement of the mass action ratio of the creatine phosphokinase reaction, so that pronounced changes in the creatine phosphate-ratio, related to myocardial oxygen consumption, are accompanied by only small changes in adenosine-5'-triphosphate adenosine-5'-diphosphate and hence in free energy of the adenine-nucleotide system. Adjustment of the oxygen availability by adaptation of the hemoglobin dissociation curve due to an increase in the erythrocyte content of 2, 3-diphosphoglycerate. This is accompanied by a swelling of erythrocytes as a consequence of an increase in the Gibbs-Donnan potential. In patients with congestive heart failure 2,3-diphosphoglycerate-synthesis is augmented due to respiratory alkalosis and increased concentrations of deoxygenated hemoglobin. Increase in the sympathetic drive of the heart due to increased net discharge of the neurotransmitter caused by reduced neuronal reuptake of norepinephrine. The diminished myocardial norepinephrine content in heart failure is due to the diminished neuronal uptake and to insufficient de novo catecholamine synthesis in the heart. Rather than tyrosine-hydroxylase the transformation of dopamine to norepinephrine seems to be the rate limiting step for catecholamine synthesis in heart failure.
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PMID:Metabolic aspects of compensatory mechanisms in cardiac failure. 651 Jun 22


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