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

318 consultant physicians in Scotland were sent a questionnaire on their use of angiotensin converting enzyme (ACE) inhibitors to treat chronic heart failure (CHF). 229 (72%) replies were received. Of these 91% used ACE inhibitors for CHF; 22% were geriatricians, 58% general physicians and 20% cardiologists. All groups reserved ACE inhibitors for patients uncontrolled by diuretics alone. Compared to general physicians, cardiologists used ACE inhibitors in preference to other vasodilators and digoxin, used higher doses and commenced treatment more often on a day-patient basis. Cardiologists also commonly started treatment with captopril even if continuing with enalapril. Geriatricians used ACE inhibitors as frequently as cardiologists but at lower doses; they did not report side-effects more frequently. Further investigation of the safety and possible cost savings of supervised day-patient rather than in-patient, introduction of ACE inhibitors for CHF is now merited. To avoid an extended period of patient observation after the first dose of ACE inhibitor, captopril might also be given as the initial therapy, even if continuing with enalapril. This policy would also reduce the risk of any hypotensive response being prolonged.
 ...
PMID:A survey of current use of angiotensin-converting-enzyme inhibitors by Scottish physicians in the treatment of chronic cardiac failure. 274 Aug 88

The combined transplantation of heart and lungs, first done successfully by the Stanford Team (USA) in 1982, at present seems to be superseding lung transplantation alone, and has broadened the indications of heart transplantation to include terminal heart failure with fixed pulmonary arterial hypertension. After reviewing the causes for failure in lung transplants, the authors stress the superiority of heart-lung transplants compared to isolated lung transplantations: healing of the tracheal anastomosis, ease of detection of rejects by endomyocardial biopsy and the lack of inhomogeneity of the ventilation/perfusion ratios. This operation still poses problems of surgical technique as the mediastinal nerves need to be preserved and the risk of haemorrhage linked to the mediastinal dissection or to the eventual pulmonary separation under cardiopulmonary bypass is important. Donor subjects for cardiopulmonary transplantation are rare as they ought to have a thoracic cage of matching size to the recipient and to be free of pulmonary infection and trauma. The post-operative complications are essentially those of immediate haemorrhage, graft rejection, pulmonary oedema and infection. The late complications are coronary atherosclerosis and bronchiolitis obliterans. The indications of such a transplant are currently reserved for primary or secondary pulmonary hypertension and to respiratory failure with a normal thoracic cage and ventilatory mechanics.
 ...
PMID:[Heart-lung transplantation]. 310 71

Digitalization by direct intramuscular injection of the fetus successfully controlled supraventricular tachycardia at 24 weeks' gestation after more traditional intensive trials of transplacental therapy with digoxin, verapamil, and procainamide, either separately or in combination, had failed. The fetal pharmacokinetics were calculated from fetal blood samples obtained by cordocentesis. No clear evidence of placental transfer of digoxin administered to the mother could be found despite a digoxin concentration in the mother that ranged from 1.8 to 2.6 ng/ml for 4 days. After direct fetal digitalization we calculated that the coefficient of elimination for digoxin from the fetus was 0.0463 h-1, and digoxin elimination half-life was 15.9 hours. The latter time span is substantially less than the 50-hour half-life previously reported in newborn infants with low birth weight. The fetal/maternal concentration ratio of procainamide was 0.914. However, maternal clearance of procainamide (9.7 ml/kg-1/min-1) was twice as long as the clearance reported for nonpregnant patients undergoing fast acetylation. We conclude first, that at least in the dose of this ill fetus, little digoxin administered to the mother crossed the placentae; and second, that while direct fetal therapy with digoxin is effective, the necessary frequent number of injections render this therapy impractical. Direct fetal digitalization should probably be reserved for the preterm fetus who has evidence of heart failure and has not responded to maternally administered therapy other than digoxin.
 ...
PMID:Direct treatment of fetal supraventricular tachycardia after failed transplacental therapy. 334 17

The development of new inotropic or vasodilator agents, with different spectra of action makes possible a physiological approach to the treatment of acute cardiac failure. The choice depends on the functional disturbances measured and is then adapted to the response obtained. In the most serious cases, where pharmacological treatment proves insufficient, there need be no hesitation in using invasive methods which were formerly reserved for the treatment of cardiogenic shock. Systematic application of therapeutic formulae gives way to rational selection of the agent best adapted to the particular conditions brought about by a specified cardiopathy in a given patient.
 ...
PMID:[The treatment of acute cardiac insufficiency: toward a physiopathological approach]. 338 Oct 77

Tubal ligation was initially proposed to prevent serious and foreseeable accidents related to pregnancy. The techniques and indications for tubal ligation have subsequently multiplied. Physicians must assess their own attitudes toward sterilization seekers, taking into account the moral and legal aspects, the risks of all surgery, and the uncertain prospects for reversal. Surgical sterilization should remain an exceptional procedure, reserved for women who have exhausted other medical resources. No law in France specifically addresses the legality of male or female sterilization, but physicians performing sterilizations have some risk of being charged with assault and battery. Laparotomy and minilaparotomy, except in postpartum sterilization, are usually done in France only when there are contraindications to laparoscopic sterilization. Among laparoscopic techniques, electrocoagulation and thermocoagulation are not often used because of the risk of serious complications. Yoon rings and Hulka-Clemens clips are preferred because of the lessened risk of accidents and improved potential reversibility. Laparoscopic sterilization is the technique of choice except during the postpartum or in very obese women, women who have undergone repeated abdominal surgery, or with cardiorespiratory complications. Vaginal techniques are another alternative in case of contraindications to laparoscopy, but they are contraindicated in case of a large uterus, infection, or endometriosis. The medical indications for surgical sterilization are becoming rare because of progress in preventive medicine, nutrition, and hygiene, and the appearance of new treatments and methods of prenatal surveillance. The principal indication at present is a scarred uterus following several cesareans. Other medical indications are neoplasia, severe cardiac insufficiency, and serious psychiatric disorders. Genetic indications are also exceptional. The greatest demand for sterilization is among women desiring contraceptive convenience, but some 10-20% of women sterilized in the absence of specific medical indications experience regret and 1-5% request reversal. Risk factors for reversal include young age of the woman, marital problems, sterilization during an obstetrical event, low parity, poor information on contraception, no previous contraceptive usage, incomplete information on sterilization and its consequences, and intrusion of the physician in the sterilization decision.
 ...
PMID:[Surgical sterilization in women]. 343 98

In a clinical, radiological and electrocardiographical, follow-up study of the "case control" type performed in Virgem da Lapa, Minas Gerais State, Brazil, 124 chagasic patients were followed during six years. The results of the patients, the majority in the indeterminate form, did not register any change, in 32.2% there was a progress in the disease and in 5.6% the electrocardiogram returned to normal. These results when compared to that achieved by the control group, composed of pairs of non chagasic persons with the same age and sex, was shown to be 27.4% higher than among patients with positive serology. This factor represents the excess risk or exclusively chagasic component in the development of the disease. No differences were observed by sex related to the development of the disease. It was more premature and seven times more frequent however when related to the cardiopathy than to the megaesophagus. Both conditions occurring mainly in slight or moderate degree. In 192 chagasic patients and 188 non chagasic persons observed in that area in the same period, the mortality was 3.6 times higher among the chagasic patients with a letality due to cardiopathy of 8.9% without difference between sexes but more premature among the males. Sudden death was more frequent than that one caused by cardiac insufficiency. The prognostic was good for the patients with indeterminate and digestive forms and reserved for patients with the highest degree of cardiopathy.
 ...
PMID:[Morbidity in Chagas' disease. III. Longitudinal study of 6 years, in Virgem da Lapa, MG, Brazil]. 393 14

An analysis is given for the differential therapeutical drug treatment in the acute phase of myocardial infarction. In first line the correction of hemodynamic disorders is taken into consideration following an exact diagnosis of hemodynamic dysfunction. On that basis different subgroups can be identified. In 5% of the patients exists a hypoperfusion. The therapy of choice is a substitution of volume. 25% of the patients with an acute myocardial infarction develop acute left ventricular failure, with a mortality of 40 to 50%. The treatment of choice in patients with clinical signs of congestion of the lungs but normal cardiac output will be diuretics and vasodilators. In patients with global insufficiency afterload reduction with vasodilators and/or stimulation with positive inotropic substances such as catecholamines has proven successful. Cardiac glycosides have lost their place in the treatment of acute but not of chronic cardiac failure. The use of intraaortic counterpulsation will be reserved for patients with mechanical complications.
 ...
PMID:[Diagnostic possibilities and therapy in the acute phase of myocardial infarct]. 644 63

A case of single ventricle with pulmonary stenosis operated at 20 years of age by direct atrio-pulmonary anastamosis is presented. This procedure in contrast to classical techniques does not use an intraventricular patch or a valved ventriculo-pulmonary conduit. It is an adaptation of the Fontan technique initially proposed for tricuspid atresia. The operation consisted of closing the right atrioventricular orifice with a piece of Dacron, suturing the pulmonary valves (which were stenosed) and connecting the right atrium and pulmonary artery by a direct anastamosis using the auricle. The clinical result remains satisfactory one year after surgery: the cyanosis has regressed, the functional tolerance is perfect, there is no hepatomegaly and the patient is in sinus rhythm. The technique is very simple and involves less risk to the His bundle than intraventricular septalisation. It should be reserved to cases of single ventricle with low pulmonary pressures and resistance without cardiac failure. The long-term prognosis depends on the tolerance of the right atrium and is, at present, unknown.
 ...
PMID:[Treatment of single ventricle by direct atriopulmonary anastomosis without tube or valve. Apropos of a case operated on]. 681 Jul 87

Due to fundamental considerations and especially after Braunwald's et al. (1962 (4)) examinations of 5 patients with severe hypertrophic obstructive cardiomyopathy (HOCM) with 0.5-0.75 mg of Ouabain, cardiac glycosides in cases of this disease are to be regarded as contraindicated. Own examinations (right and left-heart catheterizations, monoplane cineangiography of the left ventricle, determination of the cardiac output, and the ejection fraction (EF) were performed in 10 patients with HOCM of different stages. Applying the usual dosage of 0.25-0.375 mg of strophanthin, different hemodynamic effects were observed in discrete forms. In cases with a higher severity, the observations of Braunwald et al. could actually be confirmed. The left ventricular systolic pressure gradients were increased, but cardiac output, left ventricular enddiastolic pressure, pulmonary pressure and resistance, and also arterial pressure and peripheral resistance behaved differently. EF increased slightly. The right infundibular gradients were decreased with one exception, or resp., they were unchanged. Obviously, HOCM reacts especially unfavourably with so-called left-ventricular cavity obliteration. The main importance might belong to the behaviour of the free lumen of the left ventricle. In regard of the principally reserved attitude towards the cardiac glycoside therapy in HOCM, no change has occurred. Only in patients with atrial fibrillation and a rapid heart rate, a therapy trial could be considered, if necessary in combination with beta-blocking agents or calcium antagonists under hemodynamic control. In cases of HOCM with serious obstruction and signs of cardiac failure and inadequate affecting by calcium antagonists, an early surgical intervention should be executed.
 ...
PMID:[Hemodynamic examinations concerning the effects of cardiac glycosides in hypertrophic obstructive cardiomyopathy (HOCM)]. 689 Feb 76

In 14 elderly male residents of a veterans' care complex who were receiving diuretic therapy for cardiac failure, oral potassium (K) supplements were withdrawn. Plasma and erythrocyte K levels were measured immediately before and six weeks after withdrawal of the supplements (38 mEq K daily). The controls comprised 19 elderly residents without disease and not taking drugs likely to influence K status. Study subjects and controls were receiving the same diet (average daily K content 100 mEq). After withdrawal of K supplements, the mean plasma K level fell significantly but the mean erythrocyte K level remained unchanged and did not differ from the control values. For a further six weeks after the withdrawal period, 7 subjects were treated with Aldactazide (diuretic hydrochlorothiazide plus K-sparing spironolactone). The plasma K level increased significantly but the erythrocyte K level remained unchanged. It was concluded that, in this setting, diuretic-induced hypokalemia is not necessarily accompanied by intracellular K depletion and that routine prophylaxis with K supplements or K-sparing agents is unnecessary and not without risk. Such therapy should be reserved for patients considered at special risk of K depletion because of known poor dietary intake, advanced liver disease, secondary hyperaldosteronism with renovascular hypertension, gastrointestinal losses, or nondiuretic medication known to affect K status adversely.
 ...
PMID:Diuretics and the institutional elderly: a case against routine potassium prescribing. 720 9


<< Previous 1 2 3 4 5 6 7 8 9 10 Next >>