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)

Hemodynamic monitoring has moved in the last few years from being the holy grail of evaluating patients with acute heart failure to being all but extinct. Recent studies have not demonstrated any sustained benefits from right heart catheterization, and some studies have even suggested harm due to adverse events related to this invasive procedure. It is possible that this lack of efficacy is related to multiple inherent deficiencies in the design of these studies, including the inclusion of patients with chronic heart failure or mild acute heart failure, use of the reduction in pulmonary artery occlusion pressure as the main hemodynamic target for intervention, choice of treatment algorithms, and selection of ambitious long-term efficacy and safety end points. This review discusses the role of hemodynamic monitoring in patients with acute heart failure. We suggest that right heart catheterization should be reserved for patients with acute heart failure and impending respiratory or circulatory failure especially in the presence of a diagnostic or therapeutic dilemma or when encountering acute heart failure or hemodynamic lability refractory to conventional therapy. Therapeutic algorithms emphasizing modern variables for cardiovascular performance and using safer and more efficacious individualized therapies and possibly noninvasive measurement of certain hemodynamic variables may enhance the likelihood of a beneficial effect for hemodynamic guided therapy.
 ...
PMID:Hemodynamic monitoring in acute heart failure. 1815 76

The same drugs are used to treat hemorrhagic rectocolitis (HRC) and Crohn's disease (CD), although the aims are very different. Aminosalicylates are highly beneficial in HRC but virtually ineffective in CD, a disease in which immunosuppressants are more useful. Aminosalicylates exert their antiinflammatory effect directly on the lesions. Various oral and rectal preparations have been developed in order to deliver the active molecule to the intestinal target segment. These drugs are now known to act by stimulating the nuclear receptor PPAR-gamma, and this knowledge should help with the development of new agents. Chronic aminosalicylate treatment appears to diminish the risk of malignant transformation. Systemic steroids are still the mainstay of treatment for exacerbations of HRC and CD, yielding remissions in 60 to 90% of cases. In contrast, systemic steroids should not be used for maintenance therapy. Budesonide is a preparation that selectively releases steroids in the ileocolonic region, thereby reducing systemic adverse effects. Immunosuppressants such as azathioprine and 6-mercaptopurine, and also methotrexate in some cases, are used for maintenance therapy of steroid-dependent and highly recurrent forms. These drugs stabilize the disease in about half the patients who receive them. Treatment typically lasts several years and necessitates regular monitoring, especially of hematological status. Cyclosporine is used intravenously in severe HRC. Infliximab (RemicadeR), a chimeric monoclonal antibody targeting TNF is effective in acute forms and as maintenance therapy for CD. It was also recently shown to be effective in HRC. Infliximab is indicated in steroid-resistant forms and contraindicated in patients with latent systemic infections (tuberculosis, hepatitis B) and heart failure. Artificial nutrition is now only used in children with acute forms, in order to avoid the need for steroids. Probiotics might have a place in maintenance treatment of HRC. Surgical treatment of HRC consists of colectomy or, more radically, ileoprotectomy followed by ileoanal anastomosis with resection: however, the likely benefits and potential complications (especially nocturnal diarrhea) must be carefully weighed up. Surgical treatment of CD consists of resecting the worst-affected segments. As available medical and surgical treatments can only control these diseases, without curing them, patient management must be planned on a long-term basis. Control of exacerbations is judged on the basis of clinical parameters and biological markers of inflammation, rather than on lesion healing. The choice of maintenance therapy depends on the nature of the disease (HRC or CD) and its progressive nature. Surgery is reserved for patients with complicated and drug-resistant forms.
 ...
PMID:[Treatment of chronic inflammatory bowel diseases]. 1840 68

Heart disease during pregnancy necessitating cardiac surgery is potentially increasing maternal and fetal morbidity and mortality. Most patients know about their heart disease long before conception however the relation between the deteriorating cardiac function and the perinatal complications is not emphasized. Best possible results can be achieved by providing preconception counseling for cardiac patients. Consequently, heart-surgery can be performed before pregnancy thereby the maternal risk is lower and fetal loss or induced abortion can be avoided. The pregnant state is not optimal for cardiac surgery as the principal interest of the mother and the fetus is different. Cardiac surgery should be reserved only for saving the patient's life when medical therapy proves insufficient or when conservative management leads to acute heart failure. The multidisciplinary approach, correct risk assessment, diagnosis, operative indication, timing along with appropriate anaesthesia, extracorporeal circulation and alert monitoring of the uterine activity and fetal heart rate patterns make the intervention technically safe. Fetal monitoring is inevitable for prompt correction of operative conditions in case of impending hypoxemia. The perioperative fetal risk can be reduced by applying normothermia, high mean arterial pressure and cardiac index during the intentionally shortest intervention. Cardiac operation with cardiopulmonary bypass during pregnancy has become a relatively safe procedure for the mother but not for the baby.
 ...
PMID:[Pregnancy and cardiac surgery with cardiopulmonary bypass]. 1850 32

The carcinoid syndrome is usually evident when enterochromaffin (EC) cell-derived neuroendocrine tumors (carcinoids) metastasize to the liver. In addition to carcinoid symptomatology, about 40% of patients exhibit carcinoid heart disease (CHD) with fibrotic endocardial plaques and associated heart valve dysfunction. The mechanism behind CHD development is not fully understood, but serotonin (5-HT) is considered to be a major initiator of the fibrotic process. Most patients present with right-sided heart valve dysfunction since pulmonary and tricuspid valves lesions are the most common (>95%) cardiac pathology. Left-sided valvular involvement, and angina associated with coronary vasospasm occur in ~10% of subjects with CHD. Pathognomonic echocardiograpic features include immobility of valve leaflets and thickening and retraction of the cusps most commonly resulting in tricuspid valve regurgitation and pulmonary stenosis. Therapeutic options include cardioactive pharmacotherapy for heart failure and, in selected individuals, cardiac valve replacement. Previously valve replacement was reserved for advanced disease due to a perioperative mortality of >20% however in the last decade, technical advances as well as an earlier diagnosis have decreased surgical mortality to <10% and valve replacements are undertaken more frequently. A recent analysis of 200 cases demonstrated an increase in median survival from 1.5 years to 4.4 years in the last two decades. Although the improved prognosis might also reflect the increased use of surgical cytoreduction, hepatic metastatic ablative therapies and somatostatin analogs a robust correlation between diminution of circulating tumor products and an increased long-term survival in CHD has not been rigorously demonstrated.
 ...
PMID:Carcinoid heart disease. 1857 Dec 50

Heart failure (HF) is a major public health problem in the United States, and its prevalence is likely to increase with the aging U.S. population. Mechanical circulatory support (MCS) utilizing bladder-based blood pumps generating pulsatile flow has been reserved for patients with severe HF failing medical therapy. As MCS technology has advanced to include rotary blood pumps, so has our understanding of the biological and clinical responses to MCS, which in turn has altered the risk/benefit profile of this therapy. This may lead to paradigm shifts in device usage from support of end-stage HF to temporary support for recovery of cardiac function and earlier usage, to, ultimately, prevention of disease progression. This review serves to explore the current state and future opportunities of MCS within our larger understanding of the epidemiology, pathophysiology, and treatment options for HF.
 ...
PMID:Current and future considerations in the use of mechanical circulatory support devices. 1864 12

The presence or absence of pulsus paradoxus (PP), defined as an inspiratory decrease greater than 10 mmHg in systolic blood pressure, can have significant diagnostic and therapeutic implications for many clinical conditions including acute asthma, pericardial tamponade, heart failure, hypovolemia, shock states, and the like. However, PP may be difficult to measure in children. Indwelling arterial catheters facilitate the measurement of PP, but this invasive technique generally is reserved for critically ill patients. This study aimed to assess the use of the pulse oximetry plethysmographic waveform (POPW) for the detection of PP in pediatric patients after cardiac surgery. The study enrolled 40 pediatric patients 18 years of age and younger who had invasive blood pressure monitoring with an intraarterial cannula. Systolic pressure variability (SPV) and changes in POPW amplitude (DeltaPOPW%), calculated using five consecutive snapshots from every patient's monitor, were compared using linear regression, Pearson product-moment correlation, the Spearman rank method, and receiver operating characteristic (ROC) curve analysis. A strong correlation existed between respiratory SPV and DeltaPOPW% for the detection of PP (r = 0.682; p < 0.0001). A respiratory variation in DeltaPOPW% exceeding 25.44% (about one-fourth the amplitude of the tallest POP waveform) allowed detection of PP with a sensitivity of 86.7% and a specificity of 88%. Pulse oximetry is a readily available and easily performed noninvasive means for detecting PP in children.
 ...
PMID:Detection of pulsus paradoxus by pulse oximetry in pediatric patients after cardiac surgery. 1866 17

During pregnancy, the changes of cardiovascular physiology can impose additional load and risk on the cardiovascular system of women with heart disease. Care of women with heart disease and childbearing potential should include preconception risk stratification and counselling. Risk stratification rests on a carefully obtained history and examination, electrocardiography and echocardiography. Exercise capacity is an important predictor of maternal cardiovascular events. High-risk conditions include severe pulmonary hypertension, cyanotic lesions, severe left ventricular obstruction and aortic disease in Marfan-Syndrome. High-risk patients should be referred to and cared for by tertiary centres. A multidisciplinary team approach with cardiologists, obstetricians and anaesthetists during pregnancy, delivery and the postpartum period is recommended. Meticulous attention should be paid to effective anticoagulation for prosthetic heart valves. Risks and benefits of the anticoagulation strategy should be fully discussed with the patient. Peripartal cardiomyopathy is a disease that occurs during he late stages of pregnancy and the peripartum period and is associated with congestive heart failure, thrombembolism, cardiac death and recurrence in subsequent pregnancies. Dilated cardiomyopathy with impaired functional reserve or markedly impaired left ventricular function constitutes a high risk for the pregnant women. In addition to sodium restriction, treatment of heart failure consists of loop diuretics, vasodilators, digoxin and beta-blockers, if appropriate. Coronary heart disease and myocardial infarction are rare during pregnancy but should be considered in women with chest pain. Pharmacological therapy of rhythm disorders should be reserved for arrhythmias resulting in maternal or fetal hemodynamic compromise and for arrhythmias with intolerable symptoms.
 ...
PMID:[Heart disease in pregnancy]. 1868 10

We sought to determine the rate of spontaneous closure of the ductus arteriosus (DA) in very-low-birth-weight infants. This prospective observational study included 65 infants whose birth weight (BW) < 1500 g. Echocardiograms were done on day of life (DOL) 3 and 7, weekly for the first month, and bimonthly until ligation, discharge, or death. Treatment was reserved for infants with heart failure, acute renal impairment, or those with significant persistent or escalating respiratory support. Chi-square tests, Student T tests, and logistic regression models were used to identify possible associations between spontaneous ductal closure by DOL 7 and predictor variables. Patterns of spontaneous DA closure over time were examined using Kaplan-Meier survival analysis. The DA closed spontaneously in 49% infants by DOL 7. Rates of spontaneous closure by DOL 7 differed significantly by BW strata: 67% for BW > 1000 g, 31% for BW <or= 1000 g ( P < 0.01). Ninety-seven percent of infants > 1000 g did not require intervention, and the DA closed spontaneously prior to discharge in 94%. In a logistic regression model, only BW > 1000 g and male gender were significantly associated with spontaneous closure by 1 week of life. The median time to spontaneous closure differed significantly between infants in the two BW strata: 7 days for > 1000 g versus 56 days for <or= 1000 g ( P < 0.001). Intervention for the patent DA in infants > 1000 g BW is rarely indicated. In infants <or= 1000 g BW, deferring treatment decisions until at least 1 week of life may avoid unnecessary treatment exposure.
 ...
PMID:The ductus arteriosus rarely requires treatment in infants > 1000 grams. 1885 May 14

This review examines pharmacotherapy of rhythm management for atrial fibrillation (AF) in the elderly. There is little research specifically focused on this topic in the elderly but five of the seven randomized controlled trials comparing pharmacologic rate control to pharmacologic rhythm control enrolled patients who can be considered "elderly". Collectively, these studies showed that the rate control approach was favored for the outcomes of mortality, hospitalization and cost. With respect to stroke and systemic thromboembolism, no clear advantage accrues to either approach and the major therapeutic intervention for stroke prevention is anticoagulation. Rhythm control may be better for relief of symptoms in those who are highly symptomatic but symptoms are usually less problematic in the elderly. Little comparative information is available about use of specific drugs in the elderly but beta blockers are probably the preferred initial therapy for rate control when possible. Although amiodarone is the most effective rhythm control agent, its adverse effect profile suggests it should be reserved for use when other antiarrhythmic drugs fail or are contraindicated. To date, "upstream" or preventive therapies have not been specifically evaluated in the elderly but nebivolol (a beta blocker) does not prevent emergence of AF in elderly patients with heart failure, although it does provide the other salutary benefits of beta blocker therapy seen in younger heart failure patients.
 ...
PMID:Pharmacotherapy for rhythm management in elderly patients with atrial fibrillation. 1914 33

Heart disease is the primary cause of nonobstetric mortality in pregnancy, occurring in 1%-3% of pregnancies and accounting for 10%-15% of maternal deaths. Congenital heart disease has become more prevalent in women of childbearing age, representing an increasing percentage (up to 75%) of heart disease in pregnancy. Untreated maternal heart disease also places the fetus at risk. Independent predictors of neonatal complications include a maternal New York Heart Association heart failure classification >2, anticoagulation use during pregnancy, smoking, multiple gestation, and left heart obstruction. Because cardiac surgical morbidity and mortality in the parturient is higher than nonpregnant patients, most parturients with cardiac disease are first managed medically, with cardiac surgery being reserved when medical management fails. Risk factors for maternal mortality during cardiac surgery include the use of vasoactive drugs, age, type of surgery, reoperation, and maternal functional class. Risk factors for fetal mortality include maternal age >35 yr, functional class, reoperation, emergency surgery, type of myocardial protection, and anoxic time. Nonetheless, acceptable maternal and fetal perioperative mortality rates may be achieved through such measures as early preoperative detection of maternal cardiovascular decompensation, use of fetal monitoring, delivery of a viable fetus before the operation and scheduling surgery on an elective basis during the second trimester. Additionally, fetal morbidity may be reduced during cardiopulmonary bypass by optimizing maternal oxygen-carrying capacity and uterine blood flow. Current maternal bypass recommendations include: 1) maintaining the pump flow rate >2.5 L x min(-1) x m(-2) and perfusion pressure >70 mm Hg; 2) maintaining the hematocrit > 28%; 3) using normothermic perfusion when feasible; 4) using pulsatile flow; and 5) using alpha-stat pH management.
 ...
PMID:Cardiac surgery in the parturient. 1922 82


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