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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Congestive heart failure (CHF) is a progressive disease with multiple possible causes. Systolic heart failure, defined as contractile failure of the myocardium leading to a reduced ejection fraction, is the most common type. Systolic heart failure may result from coronary artery disease, hypertension, a metabolic disorder, infection, or an infiltrative or other disease, or it may be idiopathic. Recognition of CHF can be difficult, especially in elderly patients with several medical conditions. An early clinical sign may be dyspnea on exertion. The extent of workup needed is often indicated by findings on history taking and physical examination. In all patients suspected of having new-onset CHF, a chest film, an electrocardiogram, and left ventricular ejection fraction should be obtained and a search for complicating and causative factors undertaken. Early treatment may halt the otherwise inevitable decline in cardiac function and improve prognosis.
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PMID:Causes of congestive heart failure. Prompt diagnosis may affect prognosis. 900 88

The main cardiovascular effect of aging is a rise of the systolic blood pressure due to reduced impedance of the central arteries. The resulting increase of the afterload leads to hypertrophy, increased rigidity and lengthening of the relaxation period in the left ventricle. The manifestations of ischaemia or arrhythmias are often atypical at more advanced ages and may delay diagnosis. Ejection murmur due to stenosis of the aortic valve, to calcification or degeneration, may be difficult to distinguish from a functional murmur. The cause of heart failure is usually coronary sclerosis and, less often, hypertension or a valvular defect. Systolic heart failure is associated with decreased contractility of the left ventricle and compensatory dilation, diastolic heart failure with reduced filling of the ventricles. Both forms respond well to acute treatment with antihypertensive, diuretic and (or) vasodilator drugs; the treatment in isolated diastolic heart failure should also focus on lowering the increased blood pressure and reducing the heart rate to increase the filling phase.
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PMID:[Aging and cardiology; various physiological, pathophysiological and clinical aspects]. 955 Jul 97

Congestive heart failure affects >5% of those aged 65-75 and 10-20% of those aged >80 in the UK, and levels are likely to rise in the wake of improved therapies for hypertension and myocardial infarction. It is often multifactorial in this group. The most common causes are hypertension and coronary heart disease, with valvular heart disease playing an increasing role. The most common precipitant of pre-existing heart failure is non-compliance with medication or diet; non-steroidal anti-inflammatory drugs are particularly likely to exacerbate the condition. Diagnosis may be difficult since typical signs are often absent or masked in older people, but plasma levels of brain natriuretic peptide appear to be a reliable indicator and may provide diagnostic test in the future. Systolic heart failure is managed by conventional therapy (diuretics, angiotensin-converting enzyme inhibitors and beta-blockers). The management of diastolic heart failure is less well defined, but symptoms should be managed, ischaemia prevented and the underlying causes identified and treated. Nurse-directed, multidisciplinary intervention (including education of patient and family, social support, review of medication, dietary modification and weight monitoring) have resulted in improvements in event-free survival and quality of life.
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PMID:Heart failure in older people: causes, diagnosis and treatment. 1254 Mar 61

Heart failure is a substantial cause of increased morbidity and mortality in the African-American population, with poorer prognosis versus white patients. Systolic heart failure is predominantly caused by poorly controlled hypertension in African-Americans. Overall, African-Americans remain underrepresented in morbidity and mortality heart failure trials, and further data are needed to confirm the potential benefit of present therapies and newer approaches to heart failure in African-Americans. Intensive blood pressure control and control of other risk factors, along with the appropriate application of evidence-based therapies including angiotensin converting enzyme (ACE) inhibitors and approved beta-blockers, are required to decrease racial disparities. Although some data suggest that contemporary treatment with ACE inhibitors and beta-blockers may be less effective in African-Americans in terms of reducing heart failure morbidity and mortality, there is not adequate evidence to support a unique strategy for this population. The use of evidence-based therapies should be equally applied to African-Americans as well as to other ethnic groups while awaiting further studies.
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PMID:Contemporary treatment of heart failure: is there adequate evidence to support a unique strategy for African-Americans? Con position. 1211 59

Heart failure is a common clinical syndrome characterized by dyspnea, fatigue, and signs of volume overload, which may include peripheral edema and pulmonary rales. Heart failure has high morbidity and mortality rates, especially in older persons. Many conditions, such as coronary artery disease, hypertension, valvular heart disease, and diabetes mellitus, can cause or lead to decompensation of chronic heart failure. Up to 40 to 50 percent of patients with heart failure have diastolic heart failure with preserved left ventricular function, and the overall mortality is similar to that of systolic heart failure. The initial evaluation includes a history and physical examination, chest radiography, electrocardiography, and laboratory assessment to identify causes or precipitating factors. A displaced cardiac apex, a third heart sound, and chest radiography findings of venous congestion or interstitial edema are useful in identifying heart failure. Systolic heart failure is unlikely when the Framingham criteria are not met or when B-type natriuretic peptide level is normal. Echocardiography is the diagnostic standard to confirm systolic or diastolic heart failure through assessment of left ventricular ejection fraction. Evaluation for ischemic heart disease is warranted in patients with heart failure, especially if angina is present, given that coronary artery disease is the most common cause of heart failure.
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PMID:Diagnosis and evaluation of heart failure. 2296 96