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)

Sodium nitroprusside (SNP) is rarely used in cardiology. It is reserved traditionally for severe episodes of arterial hypertension. Certain states of refractory heart failure represent new indications for use, which implies a double haemodynamic monitoring system: continuous control of systemic blood pressure by intra-arterial catheterization; control of pulmonary pressure and repeated measurements of cardiac output. Prolonged treatment requires continuous biological monitoring of toxicity and careful control of kidney function. As a moderator of blood pressure, SNP is remarkably effective. The hypotensive effect is immediate, readily reversible and generally tachyphylaxis is not observed. The effect of SNP on cardiac work is one of double load reduction: mainly a reduction in afterload or pressure and systemic resistance and a reduction in preload or pressure of ventricular filling. In this respect, SNP can be used effectively for severe cases of heart failure intractable to traditional cardio-stimulatory and diuretic treatments and stemming from diverse causes: acute stage of myocardial infarction, ventricular dilatation, mitral papillary syndrome, heart failure, either subacute or chronic, of various causes. As a rule, the immediate results are positive. Taking the patient off the drug can be difficult and may cause a return to the previous haemodynamic situation.
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PMID:[Use of sodium nitroprusside in cardiology]. 1 64

Since 1972, UK in moderate doses have been used in the treatment of severe or massive pulmonary emboli (PE) and of myocardial infarction (MI) present for less than 24 hours. The standard dose is 2,700,000 CTA units per 24 hours administered as a continuous infusion, in association with appropriate heparin therapy and a platelet anti-aggregant agent in order to palliate the hyperagregant effects of thrombolytic drugs. Laboratory surveillance has now been greatly simplified and is limited to that of the associated heparin therapy. In the acute phase of myocardial infarction, a personal randomised study of 120 cases consisting of 60 treated with heparin + UK and 60 with heparin alone showed that UK decreased mortality, cardiac arrhythmias and cardiac failure. Comparative studies at lower doses have failed to show any significant difference between the two groups of patients treated and the authors feel that the use of UK should be reserved for very recent infarctions in young subjects. In PE, the effectiveness of UK was assessed in 180 severe cases. It depended upon the length of time for which the thrombus had been present. Before the 5th day, there was early average revascularisation of 40 p. 100 of the avascular territory. Mortality was reduced to 15 p. 100 and at the 3rd week 32 p. 100 of the survivors had complete revascularisation, and 68 p. 100 partial but adequate revascularisation. Adjuvant therapy such as a combination of Lysil Plasminogen and/or defibrinating agent currently make it possible to reinforce therapeutic thrombolysis.
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PMID:[Moderate doses of urokinase (UK) in the treatment of myocardial infarct and pulmonary embolism]. 3 Nov 18

The outcome of 67 patients operated on between 1963 and 1971 for pure mitral regurgitation due to dilatation of the mitral ring (group I: 25 cases), papillary muscle dysfunction (group II: 11 cases) and valvular and/or subvalvular lesions (group III: 31 cases) was analysed with an average follow up of 9.1 years (range 4 to 12 years). Eleven patients (16 p. 100) died in the late post-operative period (average 4 years). The main cause of death was cardiac failure related to the valvulopathy (8 cases). 11 patients were reoperated (16 p. 100) (on average 5 years after operation). The opeartive findings, besides early technical errors (2 cases), showed deterioration to be less often related to secondary dilatation of the mitral ring (1 case) than to progression of the valvular and subvalvular disease (7 cases). The patients followed up at present have shown symptomatic improvement (39 out of 40 cases) although the cardiothoracic ratio has generally remained unchanged. Average pulmonary capillary and arterial pressures were lower than the preoperative findings in 9 control cardiac catheterisations. Thromboembolism (2.6 p. 100), infection (2.6 p. 100) and haemolysis (0 p. 100) were less frequent than in patients with prosthetic valves. The survival curve is also better in patients having undergone reconstructive surgery. This study showed the best results in the group with pure mitral regurgitation secondary to mitral ring dilatation. The results were less favourable in groups II and III. This surgical technique would seem best reserved for young people, when anticoagulant therapy carries unacceptable risks, and when the following anatomical conditions are respected: pure mitral regurgitation with a normal valvular and subvalvular apparatus.
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PMID:[Treatment of mitral insufficiency by Wooler-Reed annuloplasty. Remote results]. 10 99

Cardiac failure remains a serious complication of myocardial infarction. In addition to therapeutic interventions to limit the infarct size, it would seem possible to influence the progressive changes in geometry and size of the left ventricle, known as remodeling. Experimental and clinical studies have shown beneficial effects of angiotensin converting enzyme inhibitors and the SAVE trial evaluated the prognostic consequences of this therapy, reporting a significant reduction in mortality after 10 months' treatment. Many questions remain which require further research in this field, mainly concerning the optimal time of introduction the treatment, the importance of the chemical molecule used, the most appropriate dosage and the influence of associated drug therapy. ACE inhibitors are now part of the therapeutic arsenal of myocardial infarction but their prescription should be strictly reserved for the population concerned by these trials, that is to say patients with a recent, extensive infarct with left ventricular dysfunction but without clinical signs of cardiac failure.
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PMID:[Prevention of postinfarction cardiac insufficiency: role of angiotensin converting enzyme inhibitors]. 130 44

Angiotensin converting enzyme (ACE) inhibition and digoxin may be used in the management of heart failure. Digoxin increases myocardial contractility in vitro, and has a modest but durable beneficial effect in congestive heart failure due to impaired left ventricular systolic function. ACE inhibitors have clear beneficial effects in all grades of heart failure and, in addition, modify the natural history and reduce mortality. Comparative studies in mild to moderate heart failure reveal a tendency towards greater benefits and tolerability of ACE inhibitors over digoxin. ACE inhibition is indicated, in conjunction with diuretic therapy, for all grades of heart failure. Digoxin is best reserved for patients with atrial fibrillation and a rapid ventricular response, and for those whose heart failure is not controlled with an ACE inhibitor plus a diuretic. In patients with heart failure following myocardial infarction, digoxin is of modest benefit. Digoxin should be administered slowly and carefully to avoid acute vasoconstriction and toxicity. Provisional data suggest ACE inhibitors are also beneficial in these patients. However, the results of clinical trials presently in progress are required to clarify their role following myocardial infarction.
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PMID:Angiotensin converting enzyme inhibitors versus digoxin for the treatment of congestive heart failure. 137 44

Inadequate anticoagulation in patients with mechanical prosthetic heart valves can result in a significant incidence of thromboembolic complications. An even more life-threatening complication is massive thrombosis of the valve itself. Thrombolytic therapy was given to a moribund 22-year-old woman with intractable heart failure caused by a thrombosed St. Jude prosthetic mitral valve (St. Jude Medical, Inc., St. Paul, Minn.). Although this form of therapy has been used before, this is the first report of a case in which transesophageal echocardiography was performed during thrombolytic therapy to continually record successful thrombolysis of the clotted prosthetic valve. Serial imaging during thrombolysis displayed progressive dissolution of the thrombus and progressive improvement in valve function. Transesophageal echocardiography is helpful in the diagnosis of prosthetic valve thrombosis and has the ability to monitor continually the effect of treatment with thrombolysis. Although thrombolytic therapy with recombinant tissue plasminogen activator is effective in treating prosthetic valve thrombosis, it carries a high risk for serious thromboembolic complications and thus should be reserved for critically ill patients who are too sick to undergo immediate surgery.
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PMID:Use of transesophageal echocardiography during thrombolysis with tissue plasminogen activator of a thrombosed prosthetic mitral valve. 157 Nov 69

Eight patients with the middle aortic syndrome are described. They were aged 2 months to 14 years at diagnosis; follow up was one to 11 years. Clinical presentations included asymptomatic hypertension (n = 5), severe headache, nose bleed, and chest pain (n = 1), and cardiac failure (n = 1). All had severe hypertension requiring multiple drug treatment. Diminished peripheral pulses were not helpful in the diagnosis, which is made on aortography. Associated clinical findings were Williams' syndrome (n = 3) and appreciable eosinophilia (n = 3). The differential diagnosis includes Takayasu's arteritis, fibromuscular dysplasia, and neurofibromatosis. Blood pressure was adequately controlled by medical treatment in six patients. Surgical angioplasty was performed in two. One patient remained normotensive without drug treatment 21 months after operation; the other died of sepsis and uncontrollable haemorrhage in the postoperative period. Medical treatment is satisfactory in most cases: surgery should be reserved for those in whom blood pressure cannot be controlled without unacceptable side effects of drug treatment. Although rare, the middle aortic syndrome should be considered in the differential diagnosis of hypertension when commoner causes have been excluded. Aortography is necessary for diagnosis.
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PMID:Middle aortic syndrome: clinical and radiological findings. 158 Jun 80

Long-term follow-up (44 +/- 21 months) was studied in 100 patients (pts) (mean age 56 +/- 12 years) who underwent direct current ablation because of drug-resistant supraventricular arrhythmias. In 85 pts (85%) complete atrioventricular (AV) block was initially achieved. During the follow-up period, AV conduction resumed in 15 pts (15%). Thirteen pts underwent another ablation session and complete AV block was achieved in 11/13 pts (85%). After catheter ablation complete AV-block was achieved in 96 pts and the remaining four pts had second-degree AV-block. Complications like pericardial effusion, arterial hypotension or ventricular arrhythmias occurred in 18 pts. Total mortality was 13% (13 pts): one patient died suddenly, and seven pts died from cardiac causes (heart failure in six pts, reinfarction in one patient). Transcatheter direct-current ablation is an effective method to interrupt AV conduction and to treat patients with drug-resistant supraventricular arrhythmias. Although there is a small risk of severe complications, this procedure should be reserved for pts with supraventricular arrhythmias who do not respond to conventional drug treatment.
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PMID:[Long-term follow-up of patients after interruption of the atrioventricular conduction by electrode catheter and DC shock: experiences with 100 patients]. 162 6

Interventional cardiology has become an alternative to surgery in the treatment of coronary artery and stenotic valvular diseases. Percutaneous transluminal coronary angioplasty is a method of treating severe coronary stenoses under simple local anaesthesia with a primary success rate of 90% and a mortality of about 1%--nearly zero in single vessel disease. These results have to be tempered by the relatively common occurrence of restenosis (30 to 40%) which are treatable by repeat angioplasty. Amongst the new techniques under evaluation at present, coronary endoprostheses (stents) seem to be the most effective in reducing the rate of restenosis. Percutaneous mitral valvuloplasty with an inflatable balloon catheter is associated with excellent results in cases of mitral stenosis when the valvular and subvalvular apparatus is not stiff and not calcified. On the other hand, the results of aortic valve dilatation are often inadequate and temporary, and this technique is now reserved for very elderly patients with severe aortic stenosis and irreducible cardiac failure, inoperable, and for patients with symptomatic calcific aortic stenosis who have to undergo urgent extracardiac surgery and who could benefit from valvular replacement at a later date. Interventional cardiology may replace or postpone surgery and allows effective treatment of patients too old or too ill to undergo cardiac surgery.
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PMID:[Interventional cardiology in adults]. 180 82

Acute pulmonary thromboembolism (PTE) is associated with considerable morbidity and mortality and may, if unrecognized, lead to severe chronic heart failure. Most cases are adequately treated with anticoagulants, while thrombolytic agents and other, more risky treatment regimens should still be reserved for the most severe cases. Even so, a definite diagnosis of PTE is prerequisite to any treatment, because of the risk of serious bleeding complications. However, the diagnosis of PTE is often difficult and always depends on confirmation by one or more diagnostic procedures, of which only pulmonary arteriography is of sufficient diagnostic value to be used alone. As pulmonary arteriography is costly and not without risk to the patient, the paper proposes a diagnostic strategy to limit the need for invasive procedures maximally without loss of diagnostic value. In critically ill patients with suspected PTE, bedside haemodynamic evaluation and balloon-occlusion-angiography may be valuable, as illustrated by two cases histories.
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PMID:[Pulmonary embolism]. 185 86


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