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Sample records for congestive heart failure

  1. Bisoprolol for congestive heart failure

    DEFF Research Database (Denmark)

    Rosenberg, J.; Gustafsson, F.

    2008-01-01

    Background: beta-Blockers are a cornerstone in the treatment of systolic heart failure treatment, but not all beta-blockers are effective or in this setting. Objective: To define the role of bisoprolol, a highly selective beta(1)-antagonist in congestive heart failure due to systolic dysfunction....... Methods: Using the keywords 'bisoprolol' and 'heart failure' PubMed and BIOSIS databases were searched for information regarding pharmacology and relevant randomised clinical trials. Supplementary publications were acquired by scrutinising reference lists of relevant papers. Additional information...... was obtained from the FDA website. Conclusion: Bisoprolol is an effective and well-tolerated first-line beta-blocker for patients with systolic heart failure. The knowledge is primarily based on study patients with moderate-to-severe heart failure from the three CIBIS trials Udgivelsesdato: 2008/2...

  2. Focus on renal congestion in heart failure.

    Science.gov (United States)

    Afsar, Baris; Ortiz, Alberto; Covic, Adrian; Solak, Yalcin; Goldsmith, David; Kanbay, Mehmet

    2016-02-01

    Hospitalizations due to heart failure are increasing steadily despite advances in medicine. Patients hospitalized for worsening heart failure have high mortality in hospital and within the months following discharge. Kidney dysfunction is associated with adverse outcomes in heart failure patients. Recent evidence suggests that both deterioration in kidney function and renal congestion are important prognostic factors in heart failure. Kidney congestion in heart failure results from low cardiac output (forward failure), tubuloglomerular feedback, increased intra-abdominal pressure or increased venous pressure. Regardless of the cause, renal congestion is associated with increased morbidity and mortality in heart failure. The impact on outcomes of renal decongestion strategies that do not compromise renal function should be explored in heart failure. These studies require novel diagnostic markers that identify early renal damage and renal congestion and allow monitoring of treatment responses in order to avoid severe worsening of renal function. In addition, there is an unmet need regarding evidence-based therapeutic management of renal congestion and worsening renal function. In the present review, we summarize the mechanisms, diagnosis, outcomes, prognostic markers and treatment options of renal congestion in heart failure.

  3. Bisoprolol for congestive heart failure

    DEFF Research Database (Denmark)

    Rosenberg, J.; Gustafsson, F.

    2008-01-01

    was obtained from the FDA website. Conclusion: Bisoprolol is an effective and well-tolerated first-line beta-blocker for patients with systolic heart failure. The knowledge is primarily based on study patients with moderate-to-severe heart failure from the three CIBIS trials Udgivelsesdato: 2008/2...

  4. Congestive Heart Failure and Central Sleep Apnea.

    Science.gov (United States)

    Sands, Scott A; Owens, Robert L

    2016-03-01

    Congestive heart failure (CHF) is among the most common causes of admission to hospitals in the United States, especially in those over age 65. Few data exist regarding the prevalence CHF of Cheyne-Stokes respiration (CSR) owing to congestive heart failure in the intensive care unit (ICU). Nevertheless, CSR is expected to be highly prevalent among those with CHF. Treatment should focus on the underlying mechanisms by which CHF increases loop gain and promotes unstable breathing. Few data are available to determine prevalence of CSR in the ICU, or how CSR might affect clinical management and weaning from mechanical ventilation. Copyright © 2016 Elsevier Inc. All rights reserved.

  5. Update in cardiomyopathies and congestive heart failure

    Directory of Open Access Journals (Sweden)

    The Heart Hospital, London, UK and Monaldi Hospital, Naples, Italy

    2012-05-01

    Full Text Available This abstract book contains four reports and all abstracts presented to the Joint Meeting: Update in cardiomyopathies and congestive heart failure, 22-23 September 2011 - Naples, Italy, endorsed by the Working Group on Myocardial and Pericardial Diseases (WG 21 of the European Society of Cardiology (ESC.

  6. Can complexity decrease in congestive heart failure?

    Science.gov (United States)

    Mukherjee, Sayan; Palit, Sanjay Kumar; Banerjee, Santo; Ariffin, M. R. K.; Rondoni, Lamberto; Bhattacharya, D. K.

    2015-12-01

    The complexity of a signal can be measured by the Recurrence period density entropy (RPDE) from the reconstructed phase space. We have chosen a window based RPDE method for the classification of signals, as RPDE is an average entropic measure of the whole phase space. We have observed the changes in the complexity in cardiac signals of normal healthy person (NHP) and congestive heart failure patients (CHFP). The results show that the cardiac dynamics of a healthy subject is more complex and random compare to the same for a heart failure patient, whose dynamics is more deterministic. We have constructed a general threshold to distinguish the border line between a healthy and a congestive heart failure dynamics. The results may be useful for wide range for physiological and biomedical analysis.

  7. Xamoterol in severe congestive heart failure

    DEFF Research Database (Denmark)

    Tangø, M; Lyngborg, K; Mehlsen, J

    1992-01-01

    Twelve patients in severe congestive heart failure were given placebo, 100 mg xamoterol (Corwin) twice daily and 200 mg xamoterol twice daily, respectively, in 3 two-week periods in a double-blind randomised study. At the end of each treatment period the patients were evaluated. No differences were...... found between placebo and xamoterol in the following parameters: New York Heart Association function group index, heart volume, body weight, exercise duration on bicycle and treadmill, heart rate and systolic and diastolic blood pressure at rest. However, during exercise we found significantly lower...... heart rate and rate-pressure product during xamoterol treatment. This reduction is probably indicating occupation of beta-adrenoreceptors with concomitant reduced oxygen consumption during exercise....

  8. Management of congestive heart failure (CHF): a case report on ...

    African Journals Online (AJOL)

    A case report on the management of Congestive Heart Failure is presented with emphasis on the use of DIGOXIN. Keywords: Congestive heart failure, Failing heart syndrome, Digoxin, Digoxin Toxicity. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT.

  9. Stem Cell Therapy for Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Gunduz E

    2011-01-01

    Full Text Available IntroductionHeart failure is a major cardiovascular health problem. Coronary artery disease is the leading cause of congestive heart failure (CHF [1]. Cardiac transplantation remains the most effective long-term treatment option, however is limited primarily by donor availability, rejection and infections. Mechanical circulatory support has its own indications and limitations [2]. Therefore, there is a need to develop more effective therapeutic strategies.Recently, regenerative medicine has received considerable scientific attention in the cardiovascular arena. We report here our experience demonstrating the beneficial effects of cardiac stem cell therapy on left ventricular functions in a patient with Hodgkin’s lymphoma (HL who developed CHF due to ischemic heart disease during the course of lymphoma treatment. Case reportA 58-year-old male with relapsed HL was referred to our bone marrow transplantation unit in October 2009. He was given 8 courses of combination chemotherapy with doxorubicin, bleomycin, vincristine, and dacarbazine (ABVD between June 2008 and February 2009 and achieved complete remission. However, his disease relapsed 3 months after completing the last cycle of ABVD and he was decided to be treated with DHAP (cisplatin, cytarabine, dexamethasone followed autologous stem cell transplantation (SCT. After the completion of first course of DHAP regimen, he developed acute myocardial infarction (AMI and coronary artery bypass grafting (CABG was performed. After his cardiac function stabilized, 3 additional courses of DHAP were given and he was referred to our centre for consideration of autologous SCT. Computed tomography scans obtained after chemotherapy confirmed complete remission. Stem cells were collected from peripheral blood after mobilization with 10 µg/kg/day granulocyte colony-stimulating factor (G-CSF subcutaneously. Collection was started on the fifth day of G-CSF and performed for 3 consecutive days. Flow cytometric

  10. A case of congestive heart failure induced by therapeutic irradiation

    International Nuclear Information System (INIS)

    Kushigami, Motohiko; Suruda, Hidetoshi; Mizukoshi, Masato; Umemoto, Masaaki; Fujiwara, Setsuko; Yamamoto, Katsuhiro; Ueno, Yuji; Nishio, Ichiro; Masuyama, Yoshiaki

    1985-01-01

    Valvular insufficiency in radiation-induced heart disease is very rare. We described a patient, 53 years old woman, who developed congestive heart failure 2.5 years later following radiotherapy for esophageal carcinoma. The findings on examinations including cardiac catheterization revealed pericarditis with effusion, mitral and tricuspid valve insufficiency and pulmonary infarction. (author)

  11. Case of congestive heart failure induced by therapeutic irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Kushigami, Motohiko; Suruda, Hidetoshi; Mizukoshi, Masato; Umemoto, Masaaki; Fujiwara, Setsuko; Yamamoto, Katsuhiro; Ueno, Yuji; Nishio, Ichiro; Masuyama, Yoshiaki

    1985-02-01

    Valvular insufficiency in radiation-induced heart disease is very rare. We described a patient, 53 years old woman, who developed congestive heart failure 2.5 years later following radiotherapy for esophageal carcinoma. The findings on examinations including cardiac catheterization revealed pericarditis with effusion, mitral and tricuspid valve insufficiency and pulmonary infarction. (author).

  12. Involvement of systemic venous congestion in heart failure.

    Science.gov (United States)

    Rubio Gracia, J; Sánchez Marteles, M; Pérez Calvo, J I

    2017-04-01

    Systemic venous congestion has gained significant importance in the interpretation of the pathophysiology of acute heart failure, especially in the development of renal function impairment during exacerbations. In this study, we review the concept, clinical characterisation and identification of venous congestion. We update current knowledge on its importance in the pathophysiology of acute heart failure and its involvement in the prognosis. We pay special attention to the relationship between abdominal congestion, the pulmonary interstitium as filtering membrane, inflammatory phenomena and renal function impairment in acute heart failure. Lastly, we review decongestion as a new therapeutic objective and the measures available for its assessment. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  13. Hypopituitarism presenting as congestive heart failure

    Directory of Open Access Journals (Sweden)

    S Giri

    2017-01-01

    Full Text Available Sheehan's syndrome (SS develops as a result of ischemic pituitary necrosis due to severe postpartum hemorrhage and is characterized by various degrees of hypopituitarism. Although the occurrence of SS is now rare, it should still be considered in any woman with a history of peripartum hemorrhage who develops manifestations of pituitary hormone deficiency any time following the event. Appropriate hormone replacement therapy results in marked clinical improvement. We present an unusual case of SS in a young lady who continued to have normal menstruation after the index event, had two spontaneous pregnancies, and was diagnosed only 11 years later when she presented to us with acute heart failure.

  14. Sleep and breathing in congestive heart failure.

    Science.gov (United States)

    Rosen, David; Roux, Francoise Joelle; Shah, Neomi

    2014-09-01

    Heart failure (HF) is one of the most prevalent and costly diseases in the United States. Sleep apnea is now recognized as a common, yet underdiagnosed, comorbidity of HF. This article discusses the unique qualities that sleep apnea has when it occurs in HF and explains the underlying pathophysiology that illuminates why sleep apnea and HF frequently occur together. The authors provide an overview of the treatment options for sleep apnea in HF and discuss the relative efficacies of these treatments. Copyright © 2014 Elsevier Inc. All rights reserved.

  15. When the heart kills the liver: acute liver failure in congestive heart failure

    Directory of Open Access Journals (Sweden)

    Saner FH

    2009-12-01

    Full Text Available Abstract Congestive heart failure as a cause of acute liver failure is rarely documented with only a few cases. Although the pathophysiology is poorly understood, there is rising evidence, that low cardiac output with consecutive reduction in hepatic blood flow is a main causing factor, rather than hypotension. In the setting of acute liver failure due to congestive heart failure, clinical signs of the latter can be absent, which requires an appropriate diagnostic approach. As a reference center for acute liver failure and liver transplantation we recorded from May 2003 to December 2007 202 admissions with the primary diagnoses acute liver failure. 13/202 was due to congestive heart failure, which was associated with a mortality rate of 54%. Leading cause of death was the underlying heart failure. Asparagine transaminase (AST, bilirubin, and international normalized ratio (INR did not differ significantly in surviving and deceased patients at admission. Despite both groups had signs of cardiogenic shock, the cardiac index (CI was significantly higher in the survival group on admission as compared with non-survivors (2.1 L/min/m2 vs. 1.6 L/min/m2, p = 0.04. Central venous - and pulmonary wedge pressure did not differ significantly. Remarkable improvement of liver function was recorded in the group, who recovered from cardiogenic shock. In conclusion, patients with acute liver failure require an appropriate diagnostic approach. Congestive heart failure should always be considered as a possible cause of acute liver failure.

  16. Increased walking variability in elderly persons with congestive heart failure

    Science.gov (United States)

    Hausdorff, J. M.; Forman, D. E.; Ladin, Z.; Goldberger, A. L.; Rigney, D. R.; Wei, J. Y.

    1994-01-01

    OBJECTIVES: To determine the effects of congestive heart failure on a person's ability to walk at a steady pace while ambulating at a self-determined rate. SETTING: Beth Israel Hospital, Boston, a primary and tertiary teaching hospital, and a social activity center for elderly adults living in the community. PARTICIPANTS: Eleven elderly subjects (aged 70-93 years) with well compensated congestive heart failure (NY Heart Association class I or II), seven elderly subjects (aged 70-79 years) without congestive heart failure, and 10 healthy young adult subjects (aged 20-30 years). MEASUREMENTS: Subjects walked for 8 minutes on level ground at their own selected walking rate. Footswitches were used to measure the time between steps. Step rate (steps/minute) and step rate variability were calculated for the entire walking period, for 30 seconds during the first minute of the walk, for 30 seconds during the last minute of the walk, and for the 30-second period when each subject's step rate variability was minimal. Group means and 5% and 95% confidence intervals were computed. MAIN RESULTS: All measures of walking variability were significantly increased in the elderly subjects with congestive heart failure, intermediate in the elderly controls, and lowest in the young subjects. There was no overlap between the three groups using the minimal 30-second variability (elderly CHF vs elderly controls: P young: P < 0.001), and no overlap between elderly subjects with and without congestive heart failure when using the overall variability. For all four measures, there was no overlap in any of the confidence intervals, and all group means were significantly different (P < 0.05).

  17. Atrial natriuretic factor binding sites in experimental congestive heart failure

    International Nuclear Information System (INIS)

    Bianchi, C.; Thibault, G.; Wrobel-Konrad, E.; De Lean, A.; Genest, J.; Cantin, M.

    1989-01-01

    A quantitative in vitro autoradiographic study was performed on the aorta, renal glomeruli, and adrenal cortex of cardiomyopathic hamsters in various stages of heart failure and correlated, in some instances, with in vivo autoradiography. The results indicate virtually no correlation between the degree of congestive heart failure and the density of 125I-labeled atrial natriuretic factor [(Ser99, Tyr126)ANF] binding sites (Bmax) in the tissues examined. Whereas the Bmax was increased in the thoracic aorta in moderate and severe heart failure, there were no significant changes in the zona glomerulosa. The renal glomeruli Bmax was lower in mild and moderate heart failure compared with control and severe heart failure. The proportion of ANF B- and C-receptors was also evaluated in sections of the aorta, adrenal, and kidney of control and cardiomyopathic hamsters with severe heart failure. (Arg102, Cys121)ANF [des-(Gln113, Ser114, Gly115, Leu116, Gly117) NH2] (C-ANF) at 10(-6) M displaced approximately 505 of (Ser99, Tyr126)125I-ANF bound in the aorta and renal glomeruli and approximately 20% in the adrenal zona glomerulosa in both series of animals. These results suggest that ANF may exert a buffering effect on the vasoconstriction of heart failure and to a certain extent may inhibit aldosterone secretion. The impairment of renal sodium excretion does not appear to be related to glomerular ANF binding sites at any stage of the disease

  18. Assessment of congestive heart failure in chest radiographs

    International Nuclear Information System (INIS)

    Henriksson, L.; Sundin, A.; Smedby, Oe.; Albrektsson, P.

    1990-01-01

    The effect of observer variations and film-screen quality on the diagnosis of congestive heart failure based on chest radiographs was studied in 27 patients. For each patient, two films were exposed, one with the Kodak Lanex Medium system and one with the Agfa MR 400 system. The films were presented to three observers who assessed the presence of congestive heart failure on a three-graded scale. The results showed no significant difference between the two systems but large systematic differences between the observers. There were also differences between the two ratings by the same observer that could not be explained by the film-screen factor. It is concluded that the choice between these two systems is of little importance in view of the interobserver and intraobserver variability that can exist within the same department. (orig.)

  19. Prerenal azotemia in congestive heart failure.

    Science.gov (United States)

    Macedo, Etienne; Mehta, Ravindra

    2010-01-01

    Prerenal failure is used to designate a reversible form of acute renal dysfunction. However, the terminology encompasses different conditions that vary considerably. The Acute Kidney Injury Network group has recently standardized the acute kidney injury (AKI) definition and classification system; however, these criteria have not determined specific diagnostic criteria to classify prerenal conditions. The difference in the pathophysiology and manifestations of prerenal failure suggests that our current approach needs to be revaluated. Several mechanisms are recognized as contributory to development of a prerenal state associated with cardiac failure. Because of the broad differences in patients' reserve capacity and functional status, prerenal states may be triggered at different time points during the course of the disease. Prerenal state needs to be classified depending on the underlying capacity for compensation, the nature, timing of the insult and the adaptation to chronic comorbidities. Current diagnosis of prerenal conditions is relatively insensitive and would benefit from additional research to define and classify the condition. Identification of high-risk states and high-risk processes associated with the use of new biomarkers for AKI will provide new tools to distinguish between the prerenal and established AKI. Achieving a consensus definition for prerenal syndrome will allow physicians to describe treatments and interventions as well as conduct and compare epidemiological studies in order to better describe the implications of this syndrome. Copyright 2010 S. Karger AG, Basel.

  20. Nitrendipine binding in congestive heart failure due to myocardial infarction

    International Nuclear Information System (INIS)

    Dixon, I.M.; Lee, S.L.; Dhalla, N.S.

    1990-01-01

    Depressed cardiac pump function is the hallmark of congestive heart failure, and it is suspected that decreased influx of Ca2+ into the cardiac cell is responsible for depressed contractile function. Since Ca2+ channels in the sarcolemmal membrane are considered to be an important route for the entry of Ca2+, we examined the status of Ca2+ receptors/channels in failing rat hearts after myocardial infarction of the left ventricular free wall. For this purpose, the left coronary artery was ligated and hearts were examined 4, 8, and 16 weeks later; sham-operated animals served as controls. Hemodynamic assessment revealed decreased total mechanical energy (left ventricular systolic pressure x heart rate), increased left ventricular diastolic pressure, and decreased positive and negative dP/dt in experimental animals at 4, 8, and 16 weeks. Although accumulation of ascites in the abdominal cavity was evident at 4 weeks, other clinical signs of congestive heart failure in experimental rats were evident from the presence of lung congestion and cardiac dilatation at 8 and 16 weeks after induction of myocardial infarction. The density of Ca2+ receptors/channels in crude membranes, as assessed by [3H]nitrendipine binding assay, was found to be decreased in the uninfarcted experimental left ventricle at 8 and 16 weeks; however, no change in the affinity of nitrendipine was evident. A similar depression in the specific binding of another dihydropyridine compound, [3H]PN200-110, was also evident in failing hearts. Brain and skeletal muscle crude membrane preparations, unlike those of the right ventricle and liver, revealed a decrease in Ca2+ receptors/channels density in experimental animals at 16 weeks

  1. Intravenous Milrinone in Treatment of Advanced Congestive Heart Failure

    Science.gov (United States)

    Zewail, Aly M.; Nawar, Mohammad; Vrtovec, Bojan; Eastwood, Cathy; Kar, Biswajit; Delgado, Reynolds M.

    2003-01-01

    Phosphodiesterase inhibitors such as milrinone can relieve symptoms and improve hemodynamics in patients with advanced congestive heart failure. We retrospectively evaluated the hemodynamic and clinical outcomes of long-term combination therapy with intravenous milrinone and oral β-blockers in 65 patients with severe congestive heart failure (New York Heart Association class IV function and ejection fraction milrinone. Oral medical therapy was maximized when possible. The mean duration of milrinone treatment in this combination-treatment group was 269 days (range, 14–1,026 days). Functional class improved from IV to II–III with milrinone therapy. Twenty-four such patients tolerated β-blocker up-titration and were successfully weaned from milrinone. Sixteen patients (31%) died while receiving combination therapy; one died of sudden cardiac death (on treatment day 116); the other 15 died of progressive heart failure or other complications. Hospital admissions during the previous 6 months and admissions within 6 months after milrinone initiation stayed the same. Meanwhile, the total number of hospital days decreased from 450 to 380 (a 15.6% reduction), and the mean length of stay decreased by 1.4 days (a 14.7% reduction). We conclude that 1) milrinone plus β-blocker combination therapy is an effective treatment for heart failure even with β-blocker up-titration, 2) weaning from milrinone may be possible once medications are maximized, 3) patients' functional status improves on the combination regimen, and 4) treatment-related sudden death is relatively infrequent during the combination regimen. (Tex Heart Inst J 2003;30:109–13) PMID:12809251

  2. Sheehan's Syndrome Presenting with Early Postpartum Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Shu-Yi Wang

    2005-08-01

    Full Text Available We report the case of a young woman with Sheehan's syndrome who presented with ventricular arrhythmia and congestive heart failure. The patient was admitted because of postpartum hemorrhage and hypovolemic shock; a massive blood transfusion was required to restore blood volume. After initial stabilization, the patient developed acute respiratory distress and congestive heart failure accompanied by hemodynamic instability 2 weeks after delivery. Episodes of ventricular tachycardia of the torsade de pointes type and a prolonged QT interval were noted on baseline electrocardiogram. A low cortisol level was found incidentally, which led to the suspicion of hypopituitarism. The diagnosis was later supported by laboratory findings of multiple pituitary hormone deficiencies. After administration of corticosteroids and thyroxine, the patient's clinical condition improved dramatically. A pituitary magnetic resonance imaging scan 32 days after delivery revealed a diminished and flattened pituitary gland with prominent intrasellar cerebrospinal fluid loculation, which was compatible with the clinical diagnosis of empty sella with panhypopituitarism. The syndrome of acute anterior pituitary necrosis secondary to postpartum hemorrhage and shock was first described by Sheehan in 1939. Although the occurrence of Sheehan's syndrome is now rare, it should still be considered in any woman with a history of peripartum hemorrhage who develops manifestations of pituitary hormone deficiency. Appropriate hormone replacement therapy is essential and always results in dramatic clinical improvement.

  3. Mechanisms and management of diuretic resistance in congestive heart failure.

    Science.gov (United States)

    De Bruyne, L K M

    2003-05-01

    Diuretic drugs are used almost universally in patients with congestive heart failure, most frequently the potent loop diuretics. Despite their unproven effect on survival, their indisputable efficacy in relieving congestive symptoms makes them first line therapy for most patients. In the treatment of more advanced stages of heart failure diuretics may fail to control salt and water retention despite the use of appropriate doses. Diuretic resistance may be caused by decreased renal function and reduced and delayed peak concentrations of loop diuretics in the tubular fluid, but it can also be observed in the absence of these pharmacokinetic abnormalities. When the effect of a short acting diuretic has worn off, postdiuretic salt retention will occur during the rest of the day. Chronic treatment with a loop diuretic results in compensatory hypertrophy of epithelial cells downstream from the thick ascending limb and consequently its diuretic effect will be blunted. Strategies to overcome diuretic resistance include restriction of sodium intake, changes in dose, changes in timing, and combination diuretic therapy.

  4. Congestive heart failure in patients with chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Poskurica Mileta

    2014-01-01

    Full Text Available Cardiovascular disorders are the most frequent cause of death (46-60% among patients with advanced chronic renal failure (CRF, and on dialysis treatment. Uremic cardiomyopathy is the basic pathophysiologic substrate, whereas ischemic heart disease (IHD and anemia are the most important contributing factors. Associated with well-know risk factors and specific disorders for terminal kidney failure and dialysis, the aforementioned factors instigate congestive heart failure (CHF. Suspected CHF is based on the anamnesis, clinical examination and ECG, while it is confirmed and defined more precisely on the basis of echocardiography and radiology examination. Biohumoral data (BNP, NT-proBNP are not sufficiently reliable because of specific volemic fluctuation and reduced natural clearance. Therapy approach is similar to the one for the general population: ACEI, ARBs, β-blockers, inotropic drugs and diuretics. Hypervolemia and most of the related symptoms can be kept under control effectively by the isolated or ultrafiltation, in conjunction with dialysis, during the standard bicarbonate hemodialysis or hemodiafiltration. In the same respect peritoneal dialysis is efficient for the control of hypervolemia symptoms, mainly during the first years of its application and in case of the lower NYHA class (II°/III°. In general, heart support therapy, surgical interventions of the myocardium and valve replacement are rarely used in patients on dialysis, whereas revascularization procedures are beneficial for associated IHD. In selected cases the application of cardiac resynchronization and/or implantation of a cardioverter defibrillator are advisable.

  5. Problems of rapid digitalization in severe congestive heart failure.

    Science.gov (United States)

    Haustein, K O; Assmann, I; Fiehring, H

    1980-02-01

    The pharmacodynamic effects (changes of systolic time intervals, STI, reaction of pulmonary arterial pressure) of digitoxin were studied in 7 patients with severe congestive heart failure in comparison with the corresponding plasma level. STI indicated glycoside-dependent changes, i.e. shortening of LVETc and QS2c and normalization of prolonged PEPc, while ICT shortening was less observed. In 2 patients with cor pulmonale a pulmonary oedema occurred accompanied with prolonged LVETc. During the early period of glycoside-dependent recompensation no significant correlation between STI shortening and glycoside plasma level was observed. Because of the retarded normalization of the haemodynamics of the pulmonary circulation and because of possible side-effects, rapid digitalization has to be reconsidered.

  6. Hemostatic biomarkers in dogs with chronic congestive heart failure

    DEFF Research Database (Denmark)

    Tarnow, Inge; Falk, Torkel; Tidholm, Anna

    2007-01-01

    Background: Chronic congestive heart failure (CHF) in humans is associated with abnormal hemostasis, and abnormalities in hemostatic biomarkers carry a poor prognosis. Alterations in hemostatic pathways can be involved in the pathogenesis of CHF in dogs, and microthrombosis in the myocardium could...... contribute to increased mortality. Hypothesis: That plasma concentration or activity of hemostatic biomarkers is altered in dogs with CHF and that these factors predict mortality. Animals: Thirty-four dogs with CHF caused by either dilated cardiomyopathy (DCM, n = 14) or degenerative valvular disease (CDVD......, n = 20) compared with 23 healthy age-matched control dogs were included in this study. Dogs with CHF were recruited from 2 referral cardiology clinics, and control dogs were owned by friends or colleagues of the investigators. Methods: Clinical examination and echocardiography were performed in all...

  7. Congestive heart failure as a determinant of postoperative delirium.

    Science.gov (United States)

    Parente, Daniela; Luís, Clara; Veiga, Dalila; Silva, Hugo; Abelha, Fernando

    2013-09-01

    Postoperative delirium (POD) is a frequent post-surgical complication that is associated with increased mortality and poor patient outcomes. POD is a complex disorder with multiple risk factors such as pre-existing patient comorbidities and perioperative complications. The aim of this study was to evaluate the incidence of POD and to identify risk factors for the development of POD in a post-anesthesia care unit (PACU). We enrolled 97 adult patients admitted to a PACU over a five-day period (start date September 6, 2010). Patient demographics and intraoperative and postoperative data were collected. Patients were followed for the development of delirium using the Intensive Care Delirium Screening Checklist. Descriptive analyses of variables were used to summarize data, and the Mann-Whitney U test was used to compare continuous variables; the chi-square or Fisher's exact test was used for comparisons. Univariate analysis was performed using simple binary logistic regression with odds ratios (OR) and 95% confidence intervals (95% CI). The significance level for multiple comparisons was controlled by applying the Bonferroni correction for multiple comparisons and variables were deemed significant if p≤0.0025. Six percent of patients developed POD. These patients were older and more likely to have higher American Society of Anesthesiologists (ASA) physical status (83 vs. 22% with ASA III/IV, p=0.004) as well as a higher frequency of congestive heart failure (50 vs. 3%, p=0.003) and a higher Revised Cardiac Risk Index (RCRI) score (33 vs. 6% with RCRI ≥2, p=0.039). The duration of anesthesia for patients with POD was also longer and they received a greater volume of crystalloids, colloids, and erythrocytes during surgery. Congestive heart disease was an independent risk factor for POD (OR 29.3, 95% CI 4.1-210.6; p<0.001). In addition, patients who developed POD had higher in-hospital mortality and longer PACU and hospital stays. Patients who developed POD had longer

  8. Chronic congestive heart failure is associated with a phenotypic shift of intramyocardial endothelial cells

    NARCIS (Netherlands)

    Marijianowski, M. M.; van Laar, M.; Bras, J.; Becker, A. E.

    1995-01-01

    There is evidence that patients with chronic congestive heart failure have endothelial cell-related abnormalities of the peripheral circulation and the coronary microvasculature. For that reason, we have studied the phenotypic expression of endothelial cells in hearts of patients with congestive

  9. Measurement of effective renal plasma flow in congestive heart failure

    International Nuclear Information System (INIS)

    Tauxe, W.N.; Dubovsky, E.V.; Mantle, J.A.; Dustan, H.P.; Logic, J.R.

    1981-01-01

    In the management of patients with congestive heart failure (CHF), it is often desirable to have precise knowledge of overall renal function, including the effective renal plasma flow (ERPF). It has long been recognized that ERPF is diminished in CHF. Since glomerular filtration rate is often decreased to a much lesser extent, other noninvasive procedures such as the measurement of creatinine clearances may not be entirely suitable. ERPF determination by the single plasma sampling (SPS) method affords a rapid, simple, noninvasive, and economical technique that is quite accurate and reproducible. A SPS method has been well-tested in patients following renal transplantation plus a wide variety of nephrological disorders. We have been concerned whether the SPS method would be valid in volume expanded patients. In 28 determinations of ERPF in patients with CHF, and in five patients who did not have CHF, we have found the SPS estimation of ERPF to yield results that are not clinically significantly different from those obtained by the detailed compartmental analysis method. The volumes of 131 I-orthoiodohippurate (OIH) distribution were found to be somewhat higher in CHF than in controls, but fractional rate constants were proportionately lower so that intercompartmental flow rates and OIH concentrations were not different from controls. Therefore, the SPS estimation of ERPF is valid in patients with CHF and may be useful in monitoring the renal effects of various hemodynamic and pharmacological interventions. (orig.)

  10. A new casemix adjustment index for hospital mortality among patients with congestive heart failure.

    Science.gov (United States)

    Polanczyk, C A; Rohde, L E; Philbin, E A; Di Salvo, T G

    1998-10-01

    Comparative analysis of hospital outcomes requires reliable adjustment for casemix. Although congestive heart failure is one of the most common indications for hospitalization, congestive heart failure casemix adjustment has not been widely studied. The purposes of this study were (1) to describe and validate a new congestive heart failure-specific casemix adjustment index to predict in-hospital mortality and (2) to compare its performance to the Charlson comorbidity index. Data from all 4,608 admissions to the Massachusetts General Hospital from January 1990 to July 1996 with a principal ICD-9-CM discharge diagnosis of congestive heart failure were evaluated. Massachusetts General Hospital patients were randomly divided in a derivation and a validation set. By logistic regression, odds ratios for in-hospital death were computed and weights were assigned to construct a new predictive index in the derivation set. The performance of the index was tested in an internal Massachusetts General Hospital validation set and in a non-Massachusetts General Hospital external validation set incorporating data from all 1995 New York state hospital discharges with a primary discharge diagnosis of congestive heart failure. Overall in-hospital mortality was 6.4%. Based on the new index, patients were assigned to six categories with incrementally increasing hospital mortality rates ranging from 0.5% to 31%. By logistic regression, "c" statistics of the congestive heart failure-specific index (0.83 and 0.78, derivation and validation set) were significantly superior to the Charlson index (0.66). Similar incrementally increasing hospital mortality rates were observed in the New York database with the congestive heart failure-specific index ("c" statistics 0.75). In an administrative database, this congestive heart failure-specific index may be a more adequate casemix adjustment tool to predict hospital mortality in patients hospitalized for congestive heart failure.

  11. Visibility graph analysis of heart rate time series and bio-marker of congestive heart failure

    Science.gov (United States)

    Bhaduri, Anirban; Bhaduri, Susmita; Ghosh, Dipak

    2017-09-01

    Study of RR interval time series for Congestive Heart Failure had been an area of study with different methods including non-linear methods. In this article the cardiac dynamics of heart beat are explored in the light of complex network analysis, viz. visibility graph method. Heart beat (RR Interval) time series data taken from Physionet database [46, 47] belonging to two groups of subjects, diseased (congestive heart failure) (29 in number) and normal (54 in number) are analyzed with the technique. The overall results show that a quantitative parameter can significantly differentiate between the diseased subjects and the normal subjects as well as different stages of the disease. Further, the data when split into periods of around 1 hour each and analyzed separately, also shows the same consistent differences. This quantitative parameter obtained using the visibility graph analysis thereby can be used as a potential bio-marker as well as a subsequent alarm generation mechanism for predicting the onset of Congestive Heart Failure.

  12. When should we use nitrates in congestive heart failure?

    Science.gov (United States)

    Vizzardi, Enrico; Bonadei, Ivano; Rovetta, Riccardo; D'Aloia, Antonio; Quinzani, Filippo; Curnis, Antonio; Dei Cas, Livio

    2013-02-01

    Organic nitrates remain among the oldest and most commonly employed drugs in cardiology. Although, in most cases, their use in acute and chronic heart failure is based on clinical practice, only a few clinical trials have been conducted to evaluate their use in acute and chronic heart failure, most of which compare them with other drugs to evaluate differing endpoints. The purpose of this review is to examine the various trials that have evaluated the use of nitrates in acute and chronic heart failure. © 2012 Blackwell Publishing Ltd.

  13. CONGESTIVE HEART FAILURE IN DOGS IS ASSOCIATED WITH INCREASED PLATELET LEUKOCYTE AGGREGATION MEASURED BY FLOW CYTOMETRY

    DEFF Research Database (Denmark)

    Tarnow, Inge; Andreasen, Susanne SH; Olsen, Lisbeth Høier

    2010-01-01

    Sciences, Faculty of Life Science, University of Copenhagen, Denmark. Chronic congestive heart failure (CHF) in humans is associated with abnormal hemostasis, and changes in hemostatic biomarkers carry a poor prognosis. CHF in dogs has been associated with plasma markers of hypercoagulability, however......CONGESTIVE HEART FAILURE IN DOGS IS ASSOCIATED WITH ENHANCED PLATELET-LEUKOCYTE AGGREGATES - A MARKER FOR PLATELET ACTIVATION. I Tarnow1, LH Olsen2, SHS Andreasen2, SG Moesgaard2, CE Rasmussen2, AT Kristensen1, T Falk2. 1Departments of Small Animal Clinical Sciences and 2Animal and Veterinary Basic......, platelet activation markers have not been investigated in dogs with clinical signs of heart disease. We hypothesized that platelet surface activation markers are higher in dogs with CHF compared to age-matched controls without clinical signs of heart failure. Dogs with compensated congestive heart failure...

  14. Mammographic and sonographic findings of unilateral breast edema in congestive heart failure : a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eun Kyung; Lee, Seung Koo; Oh, Ki Keun [Yonsei Univ. College of Medicine, Seoul (Korea, Republic of)

    1997-06-01

    Unilateral breast edema has many causes, though among these, congestive heart failure is rare. We report mammographic and sonographic findings of unilateral breast edema due to congestive heart failure. Mammography showed diffuse increase density and skin thickening but no evidence of mass or calcification. Ultrasonography showed skin thickening and increased echogenicity in the subcutaneous fat layer, while in the dermal layer, with tubular and reticular anechoic structures suggestive of dilated lymphatics were seen. After treatment of the heart failure, resolution of the abnormalities seen on mammogram established that these were secondary findings.

  15. Mammographic and sonographic findings of unilateral breast edema in congestive heart failure : a case report

    International Nuclear Information System (INIS)

    Kim, Eun Kyung; Lee, Seung Koo; Oh, Ki Keun

    1997-01-01

    Unilateral breast edema has many causes, though among these, congestive heart failure is rare. We report mammographic and sonographic findings of unilateral breast edema due to congestive heart failure. Mammography showed diffuse increase density and skin thickening but no evidence of mass or calcification. Ultrasonography showed skin thickening and increased echogenicity in the subcutaneous fat layer, while in the dermal layer, with tubular and reticular anechoic structures suggestive of dilated lymphatics were seen. After treatment of the heart failure, resolution of the abnormalities seen on mammogram established that these were secondary findings

  16. Lung congestion in chronic heart failure: haemodynamic, clinical, and prognostic implications

    DEFF Research Database (Denmark)

    Melenovsky, Vojtech; Andersen, Mads Jønsson; Andress, Krystof

    2015-01-01

    AIMS:The goal of the study was to examine the prognostic impact, haemodynamic and clinical features associated with lung congestion in patients with chronic heart failure (HF). METHODS AND RESULTS:HF patients (n = 186) and HF-free controls (n = 21) underwent right heart catheterization...... days (interquartile range 80-875), 59 patients (32%) died. Lung congestion was associated with reduced survival (P renal dysfunction. CONCLUSION:Interstitial lung oedema is associated with pulmonary vascular disease, RV overload...

  17. Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART-1) trial design.

    Science.gov (United States)

    Bartunek, Jozef; Davison, Beth; Sherman, Warren; Povsic, Thomas; Henry, Timothy D; Gersh, Bernard; Metra, Marco; Filippatos, Gerasimos; Hajjar, Roger; Behfar, Atta; Homsy, Christian; Cotter, Gad; Wijns, William; Tendera, Michal; Terzic, Andre

    2016-02-01

    Cardiopoiesis is a conditioning programme that aims to upgrade the cardioregenerative aptitude of patient-derived stem cells through lineage specification. Cardiopoietic stem cells tested initially for feasibility and safety exhibited signs of clinical benefit in patients with ischaemic heart failure (HF) warranting definitive evaluation. Accordingly, CHART-1 is designed as a large randomized, sham-controlled multicentre study aimed to validate cardiopoietic stem cell therapy. Patients (n = 240) with chronic HF secondary to ischaemic heart disease, reduced LVEF (Heart Failure Questionnaire score, 6 min walk test, LV end-systolic volume, and LVEF at 9 months. The secondary efficacy endpoint is the time to cardiovascular death or worsening HF at 12 months. Safety endpoints include mortality, readmissions, aborted sudden deaths, and serious adverse events at 12 and 24 months. The CHART-1 clinical trial is powered to examine the therapeutic impact of lineage-directed stem cells as a strategy to achieve cardiac regeneration in HF populations. On completion, CHART-1 will offer a definitive evaluation of the efficacy and safety of cardiopoietic stem cells in the treatment of chronic ischaemic HF. NCT01768702. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

  18. Correlation of radiological assessment of congestive heart failure with left ventricular end-diastolic pressure

    International Nuclear Information System (INIS)

    Herman, P.G.; Kahn, A.; Kallman, C.E.; Rojas, K.A.; Bodenheimer, M.M.

    1988-01-01

    Left ventricular end-diastolic pressure (LVEDP) has been considered a reliable indicator of left ventricular function. The purpose of this study was to correlate the radiologic assessment of congestive heart failure with LVEDP. The population of the study consisted of 85 consecutive cases in four ranges of LVEDP ( 24). The PA chest radiographs obtained 1 day prior to cardiac catherization were assessed for radiological evidence of congestive heart failure and were graded from normal to abnormal (0-3). The results will be summarized in the authors' presentation. The discordance of radiological assessment of congestive heart failure in patients with elevated LVEDP will be discussed in light of recent advances in pathophysiologic understanding of left ventricular function and the impact of new classes of drugs in the management of these patients

  19. ACE inhibitors and calcium antagonists in the treatment of congestive heart failure

    DEFF Research Database (Denmark)

    Hansen, J F

    1995-01-01

    heart failure in the SOLVD trials. In post-myocardial infarction patients, the calcium antagonist nifedipine did not affect mortality or morbidity; diltiazem improved prognosis in patients without congestive heart failure and in patients with non-Q-wave infarction; and verapamil improved prognosis...... by prevention of reinfarction and sudden death. Combination treatment with both verapamil, which has pronounced antiischemic properties and prevents sudden death and reinfarction, and an ACE inhibitor, which prevents the progression of heart failure, is a possibility for future cardiovascular therapy...

  20. Evaluation of haemodynamic effects in computerized gamma-camera os isossorbide dinitrate in congestive heart failure

    International Nuclear Information System (INIS)

    Lara, P.F.; Miyazato, A.N.P.; Hueb, W.A.; Paulillo, L.F.; Oliveira Filho, R.M. de; Campos Netto, J.S.; Souza Valle, L.B. de.

    1987-01-01

    The cardiac function by radiocargiogram before and after the oral administration of isossorbide dinitrate in 20 patients with congestive heart failure is studied, including the meantime of pulmonary circulation, the meantime of cardiac cycle, cardiac debit and the dejection fraction of left ventricle. (author)

  1. Bed rest and increased diuretic treatment in chronic congestive heart failure

    DEFF Research Database (Denmark)

    Abildgaard, U; Aldershvile, J; Ring-Larsen, H

    1985-01-01

    To elucidate the effect of bed rest used as an adjunct to increased diuretic treatment, twelve patients with chronic congestive heart failure (CHF) had a 50% increase in loop diuretic dosage and were allocated to either continuous bed rest or bed rest during nights only. The 24-hour bed rest group...... is a reasonable adjunct to diuretic treatment in patients with CHF....

  2. Elephantiasis Nostras Verrucosa (ENV): a complication of congestive heart failure and obesity.

    Science.gov (United States)

    Baird, Drew; Bode, David; Akers, Troy; Deyoung, Zachariah

    2010-01-01

    Congestive heart failure (CHF) and obesity are common medical conditions that have many complications and an increasing incidence in the United States. Presented here is a case of a disfiguring skin condition that visually highlights the dermatologic consequences of poorly controlled CHF and obesity. This condition will probably become more common as CHF and obesity increase in the US.

  3. Phlegmonous enteritis in a patient with congestive heart failure and colon cancer

    Energy Technology Data Exchange (ETDEWEB)

    Namkung, Sook; Yoo, Yoon Sik; Hwang, Im Kyung; Kim, Bong Soo; Bae, Sang Hoon; Choi, Young Hee [Hallym University, Chuncheon (Korea, Republic of)

    2001-12-01

    Phlegmonous enteritis is a rare infective inflammatory disease of the intestine, predominantly involving the submucosal layer. It is difficult to diagnose and often fatal. Its association with alcoholism and various liver diseases, although rarely reported, is well documented. We report a case of phlegmonous enteritis in a male patient with congestive heart failure and colon cancer, and describe the ultrasonographic and CT findings.

  4. The Impact of Family Functioning on Caregiver Burden among Caregivers of Veterans with Congestive Heart Failure

    Science.gov (United States)

    Moore, Crystal Dea

    2010-01-01

    A cross-sectional study of 76 family caregivers of older veterans with congestive heart failure utilized the McMaster model of family functioning to examine the impact of family functioning variables (problem solving, communication, roles, affective responsiveness, and affective involvement) on caregiver burden dimensions (relationship burden,…

  5. Vein of Galen Aneurysmal Malformation in Neonates Presenting With Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Andjenie Madhuban MD

    2016-03-01

    Full Text Available The authors report the case of a neonate presenting with signs of a congenital cardiac disease. Echocardiography showed a structural normal heart, right-to-left ductal flow, a dilated superior caval vein, and reversed diastolic flow in the proximal descending aorta. Brain magnetic resonance imaging showed a vein of Galen arteriovenous malformation. This highlights the importance of considering an intracranial cause in the differential diagnosis of neonatal congestive heart failure.

  6. Phantom Tumor of the Lung: Localized Interlobar Effusion in Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Mislav Lozo

    2014-01-01

    Full Text Available Localized interlobar effusions in congestive heart failure (phantom or vanishing lung tumor/s is/are uncommon but well known entities. An 83-year-old man presented with shortness of breath, swollen legs, and dry cough enduring five days. Chest-X-ray (CXR revealed massive sharply demarked round/oval homogeneous dense shadow 10 × 7 cm in size in the right inferior lobe. The treatment with the loop diuretics and fluid intake reduction resulted in complete resolution of the observed round/oval tumor-like image on the control CXR three days later. Radiologic appearance of such a mass-like configuration in patients with congestive heart failure demands correction of the underlying heart condition before further diagnostic investigation is performed to avoid unnecessary, expensive, and possibly harmful diagnostic and treatment errors.

  7. Heart failure - tests

    Science.gov (United States)

    CHF - tests; Congestive heart failure - tests; Cardiomyopathy - tests; HF - tests ... the best test to: Identify which type of heart failure (systolic, diastolic, valvular) Monitor your heart failure and ...

  8. Evaluation of skeletal muscle metabolism in patients with congestive heart failure using phosphorus nuclear magnetic

    International Nuclear Information System (INIS)

    Wilson, J.R.

    1988-01-01

    Patients with congestive heart failure are frequently limited by muscular fatigue due skeletal muscle underperfusion and deconditioning. Muscle underperfusion and deconditioning both produce distinctive changes in metabolic parameters which are readily measured by phosphorus nuclear magnetic resonance (NMR). Therefore, phosphorus NMR should provide a useful noninvasive method of assessing muscle performance in heart failure. This chapter describes a protocol which allows detection of forearm muscle metabolic abnormalities in patients with heart failure, abnormalities that seem to be caused by muscle deconditioning. In the future, it is anticipated that this approach may prove to be an extremely useful method for objectively assessing muscle fatigue in patients with heart failure and for monitoring the effects on therapeutic interventions designed to treat this fatigue

  9. Improved detection of congestive heart failure via probabilistic symbolic pattern recognition and heart rate variability metrics.

    Science.gov (United States)

    Mahajan, Ruhi; Viangteeravat, Teeradache; Akbilgic, Oguz

    2017-12-01

    A timely diagnosis of congestive heart failure (CHF) is crucial to evade a life-threatening event. This paper presents a novel probabilistic symbol pattern recognition (PSPR) approach to detect CHF in subjects from their cardiac interbeat (R-R) intervals. PSPR discretizes each continuous R-R interval time series by mapping them onto an eight-symbol alphabet and then models the pattern transition behavior in the symbolic representation of the series. The PSPR-based analysis of the discretized series from 107 subjects (69 normal and 38 CHF subjects) yielded discernible features to distinguish normal subjects and subjects with CHF. In addition to PSPR features, we also extracted features using the time-domain heart rate variability measures such as average and standard deviation of R-R intervals. An ensemble of bagged decision trees was used to classify two groups resulting in a five-fold cross-validation accuracy, specificity, and sensitivity of 98.1%, 100%, and 94.7%, respectively. However, a 20% holdout validation yielded an accuracy, specificity, and sensitivity of 99.5%, 100%, and 98.57%, respectively. Results from this study suggest that features obtained with the combination of PSPR and long-term heart rate variability measures can be used in developing automated CHF diagnosis tools. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. An endoscopic study of upper-GI mucosal changes in patients with congestive heart failure.

    Science.gov (United States)

    Raja, Kaiser; Kochhar, Rakesh; Sethy, Pradeepta K; Dutta, Usha; Bali, Harinder K; Varma, Jagmohan S

    2004-12-01

    Congestive heart failure results in an increase in systemic venous pressure that is transmitted to the inferior vena cava and to the hepatic veins. This can cause GI vascular and mucosal congestion. The aim of this study was to define upper-GI mucosal changes in patients with congestive heart failure. A total of 57 patients with congestive heart failure presenting with GI symptoms underwent upper endoscopy. Echocardiography was performed in all patients to determine the ejection fraction and the degree of tricuspid regurgitation. Transabdominal US was performed to measure the diameters of the hepatic veins, the inferior vena cava, and the portal vein. The presence and the severity of gastropathy and duodenopathy were compared with the parameters relating to severity of cardiac failure. Of the 57 patients studied, gastric mucosal changes were observed in 50 (88%), duodenal mucosal changes in 31 (54%), and esophageal mucosal changes in none. Gastric mucosal changes were the following: mosaic-like pattern (n = 50), punctate spots (n = 34), thickened folds (n = 5), watermelon stomach (n = 3), and telangiectasia (n = 10). Duodenal mucosal changes were the following: mosaic-like pattern (n = 29), thickened folds (n = 8), and telangiectasia (n = 2). Upper-GI symptoms were associated with gastropathy ( p = 0.027) and duodenopathy ( p = 0.003). The presence and the severity of duodenopathy showed a high degree of positive correlation with the presence and the severity of gastropathy (gamma value 0.690; p value <0.001). Patients with gastropathy and duodenopathy had higher mean inferior vena cava and hepatic vein diameters than those without gastropathy and duodenopathy. The severity of duodenopathy but not that of gastropathy was significantly associated with increasing severity of tricuspid regurgitation ( p = 0.001), larger portal vein diameter ( p = 0.02), and lower ejection fraction ( p = 0.008). Among patients with congestive cardiac failure with GI symptoms, changes

  11. Routine screening for depression and quality of life in outpatients with congestive heart failure.

    Science.gov (United States)

    Holzapfel, Nicole; Zugck, Christian; Müller-Tasch, Thomas; Löwe, Bernd; Wild, Beate; Schellberg, Dieter; Nelles, Manfred; Remppis, Andrew; Katus, Hugo; Herzog, Wolfgang; Jünger, Jana

    2007-01-01

    The influence of depression and perceived quality of life (QoL) on symptom perception and prognosis in congestive heart failure is well known. The authors therefore introduced routine questionnaire screening for these parameters in patients attending their outpatient heart failure clinic (N=320). The authors found QoL to be significantly reduced, and almost every third patient screened positive for a depressive disorder. These patients got a clearly-defined treatment offer. The present study demonstrates that screening for depression and QoL is feasible without being too complex or time-consuming and easily implementable in an interdisciplinary outpatient setting.

  12. Self-management of congestive heart failure among elderly men in Japan.

    Science.gov (United States)

    Sano, Motohiro; Majima, Tomoko

    2018-04-01

    The purpose of this study was to explore the process of self-management in elderly male patients with congestive heart failure among those who have had not needed re-hospitalization for more than 2 years. Semi-structured interviews were conducted with 10 male congestive heart failure patients. Interviews were audio-recorded and transcribed verbatim. Data were analysed using the modified grounded theory approach. As a result of the analysis, the core concept identified was a process of living life such that symptoms do not worsen, while balancing good choices and preferences. By trial and error, the men tried to find the limits of physical capacity and dietary choices that would lead to the worsening of symptoms, while also trying to maintain quality of life to the extent possible. © 2018 John Wiley & Sons Australia, Ltd.

  13. Simple platelet markers: Mean platelet volume and congestive heart failure coexistent with periodontal disease. Pilot studies.

    Science.gov (United States)

    Czerniuk, Maciej R; Bartoszewicz, Zbigniew; Dudzik-Niewiadomska, Iwona; Pilecki, Tomasz; Górska, Renata; Filipiak, Krzysztof J

    2017-07-17

    Conducted pilot study concerning mean platelet volume parameter among patients suffering from congestive heart failure and periodontal disease. Examination of dynamic changes of platelet and periodontal markers in group of 50 patients before and an average of 6 months subsequent to professional periodontal treatment. Both platelet and periodontal parameters decreased after periodontal treatment, what is more, the decrease of mean platelet volume (MPV) value due to periodontal disease/mm improvement was shown to be statistically significant (p = 0.05). Improvement of periodontal status may influence decrease of MPV value andincrease of congestive heart failure treatment efficacy and effect patient comfort. It is a new, not frequently used pattern of chronic disease treatment optimalization.

  14. The Performance of Short-Term Heart Rate Variability in the Detection of Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Fausto Lucena

    2016-01-01

    Full Text Available Congestive heart failure (CHF is a cardiac disease associated with the decreasing capacity of the cardiac output. It has been shown that the CHF is the main cause of the cardiac death around the world. Some works proposed to discriminate CHF subjects from healthy subjects using either electrocardiogram (ECG or heart rate variability (HRV from long-term recordings. In this work, we propose an alternative framework to discriminate CHF from healthy subjects by using HRV short-term intervals based on 256 RR continuous samples. Our framework uses a matching pursuit algorithm based on Gabor functions. From the selected Gabor functions, we derived a set of features that are inputted into a hybrid framework which uses a genetic algorithm and k-nearest neighbour classifier to select a subset of features that has the best classification performance. The performance of the framework is analyzed using both Fantasia and CHF database from Physionet archives which are, respectively, composed of 40 healthy volunteers and 29 subjects. From a set of nonstandard 16 features, the proposed framework reaches an overall accuracy of 100% with five features. Our results suggest that the application of hybrid frameworks whose classifier algorithms are based on genetic algorithms has outperformed well-known classifier methods.

  15. Heart rate variability enhances the prognostic value of established parameters in patients with congestive heart failure.

    Science.gov (United States)

    Krüger, C; Lahm, T; Zugck, C; Kell, R; Schellberg, D; Schweizer, M W F; Kübler, W; Haass, M

    2002-12-01

    This prospective study evaluated whether heart rate variability (HRV) assessed from Holter ECG has prognostic value in addition to established parameters in patients with congestive heart failure (CHF). The study included 222 patients with CHF due to dilated or ischemic cardiomyopathy (left ventricular ejection fraction LVEF 21+/-1%; mean+/-SEM). During a mean follow-up of 15+/-1 months, 38 (17%) patients died and 45 (20%) were hospitalized due to worsening of CHF. The HRV parameter SDNN (standard deviation of all intervals between normal beats) was significantly lower in non-surviving or hospitalized than in event-free patients (118+/-6 vs 142+/-5 ms), as were LVEF (18+/-1 vs 23+/-1%), and peak oxygen uptake during exercise (peak VO(2)) (12.8+/-0.5 vs 15.6+/-0.5 ml/min/kg). While each of these parameters was a risk predictor in univariate analysis, multivariate analysis revealed that HRV provides both independent and additional prognostic information with respect to the risk 'cardiac mortality or deterioration of CHF'. It is concluded that the determination of HRV enhances the prognostic power given by the most widely used parameters LVEF and peak VO(2) in the prediction of mortality or deterioration of CHF and thus enables to improve risk stratification.

  16. Cheyne-Stokes respiration in patients with congestive heart failure: causes and consequences

    OpenAIRE

    Lorenzi-Filho,Geraldo; Genta,Pedro R; Figueiredo,Adelaide C.; Inoue,Daniel

    2005-01-01

    Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac outpu...

  17. RESTRICTIVE CARDIOMYOPATHY AND SECONDARY CONGESTIVE HEART FAILURE IN A MCDOWELL'S CARPET PYTHON (MORELIA SPILOTA MCDOWELLI).

    Science.gov (United States)

    Schilliger, Lionel; Chetboul, Valérie; Damoiseaux, Cécile; Nicolier, Alexandra

    2016-12-01

    Echocardiography is an established and noninvasive diagnostic tool used in herpetologic cardiology. Various cardiac lesions have been previously described in reptiles with the exception of restrictive cardiomyopathy. In this case report, restrictive cardiomyopathy and congestive heart failure associated with left atrial and sinus venosus dilation were diagnosed in a 2-yr-old captive lethargic McDowell's carpet python ( Morelia spilota mcdowelli), based on echocardiographic, Doppler, and histopathologic examinations. This cardiomyopathy was also associated with thrombosis within the sinus venosus.

  18. Bolus versus continuous low dose of enalaprilat in congestive heart failure with acute refractory decompensation.

    Science.gov (United States)

    Podbregar, M; Voga, G; Horvat, M; Zuran, I; Krivec, B; Skale, R; Pareznik, R

    1999-01-01

    The first dose of angiotensin-converting enzyme (ACE) inhibitors may trigger a considerable fall of blood pressure in chronic heart failure. The response may be dose-related. To determine hemodynamic and systemic oxygenation effects of low-dose enalaprilat, we administered intravenous enalaprilat (0.004 mg/kg) as bolus (group B) or continuous 1-hour infusion (group C) in 20 patients with congestive heart failure due to ischemic heart disease with acute decompensation refractory to inotropic, vasodilator and diuretic therapy. Hemodynamic and systemic oxygenation variables were recorded at baseline (+0 min), +30, +60, +120, +180, and +360 min after the start of intervention. Mean arterial pressure (MAP) (p < 0. 001), mean pulmonary artery pressure (MPAP) (p < 0.001), pulmonary artery occlusion pressure (PAOP) (p < 0.001), oxygen extraction ratio (ER) (p < 0.026) decreased regardless of enalaprilat application. Compared to group B, there was in group C prolonged decrease of MAP, MPAP, PAOP, ER and increase of pulmonary artery oxyhemoglobin saturation in regard to baseline values. Cardiac index, heart rate, central venous pressure and oxygen consumption index did not change. A low dose of intravenous enalaprilat (0.004 mg/kg) can be used to safely improve hemodynamics and systemic oxygenation in congestive heart failure due to ischemic heart disease with acute refractory decompensation.

  19. Diuretic treatment in decompensated cirrhosis and congestive heart failure: effect of posture

    DEFF Research Database (Denmark)

    Ring-Larsen, H; Henriksen, Jens Henrik Sahl; Wilken, C

    1986-01-01

    The diuretic effect of the supine position was evaluated in six patients with cirrhosis and ascites and six with congestive cardiac failure. After fasting overnight in bed the patients received bumetanide 1 mg intravenously and were then immediately randomly assigned to either bed rest in the sup......The diuretic effect of the supine position was evaluated in six patients with cirrhosis and ascites and six with congestive cardiac failure. After fasting overnight in bed the patients received bumetanide 1 mg intravenously and were then immediately randomly assigned to either bed rest...... in the supine position or normal daily activity in the upright position for the next six hours. Two days later the procedure was repeated, the patients being assigned to the other posture. The diuretic response was similar in patients with heart failure and cirrhosis, and was significantly greater in the supine...

  20. Heterobilharzia americana infection and congestive heart failure in a llama (Lama glama).

    Science.gov (United States)

    Corapi, W V; Eden, K B; Edwards, J F; Snowden, K F

    2015-05-01

    The schistosome Heterobilharzia americana infects several mammalian species in the southeastern United States, including horses, but infections have not been reported in camelids. This is a report of H. americana infection in a 6-year-old llama with extensive cardiac pathology and congestive heart failure. Parasite-induced granulomas were widely disseminated and included overwhelming involvement of the lungs and liver. Microscopic lesions in the heart included myofiber degeneration and necrosis, with extensive replacement fibrosis. Polymerase chain reaction amplification and sequencing confirmed the presence of H. americana in the lungs. © The Author(s) 2014.

  1. Importance of congestive heart failure and interaction of congestive heart failure and left ventricular systolic function on prognosis in patients with acute myocardial infarction

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Pedersen, O D

    1996-01-01

    or persistent. Wall motion index and CHF are correlated. Furthermore, there is an interaction between wall motion index and CHF. The prognostic importance of wall motion index depends on whether patients have CHF or not: the risk ratio associated with decreasing 1 wall motion index unit is 3.0 (2.6 to 3......Left ventricular (LV) systolic function and congestive heart failure (CHF) are important predictors of long-term mortality after acute myocardial infarction. The importance of transient CHF and the interaction of CHF and LV function on prognosis has not been studied in detail previously....... In the TRAndolapril Cardiac Evaluation Study, 6,676 consecutive patients with acute myocardial infarction 1 to 6 days earlier had LV systolic function quantified as wall motion index (echocardiography), which is closely correlated to LV ejection fraction. To study the interaction of CHF and wall motion index on long...

  2. Detection of intra-cardiac thrombi and congestive heart failure in cats using computed tomographic angiography.

    Science.gov (United States)

    Vititoe, Kyle P; Fries, Ryan C; Joslyn, Stephen; Selmic, Laura E; Howes, Mark; Vitt, Jordan P; O'Brien, Robert T

    2018-04-16

    Arterial thromboembolism is a life-threatening condition in cats most commonly secondary to cardiac disease. Echocardiography is the reference standard to evaluate for presence of a thrombus. In humans, computed tomographic (CT) angiography is becoming widely used to detect left atrial thrombi precluding the use of sedation. The purpose of this prospective, controlled, methods comparison pilot study was threefold: (1) describe new CT angiography protocol used in awake cats with cardiac disease and congestive heart failure; (2) determine accuracy of continuous and dynamic acquisition CT angiography to identify and characterize cardiac thrombi from spontaneous echocardiographic contrast using transthoracic echocardiography as our reference standard; (3) identify known negative prognostic factors and comorbidities of the thorax that CT angiography may provide that complement or supersede echocardiographic examination. Fourteen cats with heart disease were recruited; 7 with thrombi and 7 with spontaneous echocardiographic contrast. Echocardiography and awake CT angiography were performed using a microdose of contrast. Six of 7 thrombi were identified on CT angiography as filling defects by at least one reviewer within the left auricle (n = 6) and right heart (n = 1). Highest sensitivity (71.4%) was in continuous phase and highest specificity (85.7%) was in dynamic studies with fair to moderate interobserver agreement (0.38 and 0.44). CT angiography identified prognostic cardiac information (left atrial enlargement, congestive heart failure, arterial thromboembolism) and comorbidities (suspected idiopathic pulmonary fibrosis, asthma). This study indicates CT angiography can readily identify cardiac thrombi, important prognostic information and comorbidities, and can be safely performed in cats with cardiac disease and congestive heart failure. © 2018 American College of Veterinary Radiology.

  3. Visceral Congestion in Heart Failure: Right Ventricular Dysfunction, Splanchnic Hemodynamics, and the Intestinal Microenvironment.

    Science.gov (United States)

    Polsinelli, Vincenzo B; Sinha, Arjun; Shah, Sanjiv J

    2017-12-01

    Visceral venous congestion of the gut may play a key role in the pathogenesis of right-sided heart failure (HF) and cardiorenal syndromes. Here, we review the role of right ventricular (RV) dysfunction, visceral congestion, splanchnic hemodynamics, and the intestinal microenvironment in the setting of right-sided HF. We review recent literature on this topic, outline possible mechanisms of disease pathogenesis, and discuss potential therapeutics. There are several mechanisms linking RV-gut interactions via visceral venous congestion which could result in (1) hypoxia and acidosis in enterocytes, which may lead to enhanced sodium-hydrogen exchanger 3 (NHE3) expression with increased sodium and fluid retention; (2) decreased luminal pH in the intestines, which could lead to alteration of the gut microbiome which could increase gut permeability and inflammation; (3) alteration of renal hemodynamics with triggering of the cardiorenal syndrome; and (4) altered phosphate metabolism resulting in increased pulmonary artery stiffening, thereby increasing RV afterload. A wide variety of therapeutic interventions that act on the RV, pulmonary vasculature, intestinal microenvironment, and the kidney could alter these pathways and should be tested in patients with right-sided HF. The RV-gut axis is an important aspect of HF pathogenesis that deserves more attention. Modulation of the pathways interconnecting the right heart, visceral congestion, and the intestinal microenvironment could be a novel avenue of intervention for right-sided HF.

  4. Relief and Recurrence of Congestion During and After Hospitalization for Acute Heart Failure: Insights From Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARESS-HF).

    Science.gov (United States)

    Lala, Anuradha; McNulty, Steven E; Mentz, Robert J; Dunlay, Shannon M; Vader, Justin M; AbouEzzeddine, Omar F; DeVore, Adam D; Khazanie, Prateeti; Redfield, Margaret M; Goldsmith, Steven R; Bart, Bradley A; Anstrom, Kevin J; Felker, G Michael; Hernandez, Adrian F; Stevenson, Lynne W

    2015-07-01

    Congestion is the most frequent cause for hospitalization in acute decompensated heart failure. Although decongestion is a major goal of acute therapy, it is unclear how the clinical components of congestion (eg, peripheral edema, orthopnea) contribute to outcomes after discharge or how well decongestion is maintained. A post hoc analysis was performed of 496 patients enrolled in the Diuretic Optimization Strategy Evaluation in Acute Decompensated Heart Failure (DOSE-AHF) and Cardiorenal Rescue Study in Acute Decompensated Heart Failure (CARRESS-HF) trials during hospitalization with acute decompensated heart failure and clinical congestion. A simple orthodema congestion score was generated based on symptoms of orthopnea (≥2 pillows=2 points, fails to relieve orthodema during hospitalization or to prevent recurrence after discharge. URL: http://www.clinicaltrials.gov. Unique identifiers: NCT00608491, NCT00577135. © 2015 American Heart Association, Inc.

  5. Angiotensin-converting enzyme inhibition improves cardiac fatty acid metabolism in patients with congestive heart failure.

    Science.gov (United States)

    Yamauchi, S; Takeishi, Y; Minamihaba, O; Arimoto, T; Hirono, O; Takahashi, H; Miyamoto, T; Nitobe, J; Nozaki, N; Tachibana, H; Watanabe, T; Fukui, A; Kubota, I

    2003-08-01

    This study aimed to examine whether angiotensin-converting enzyme (ACE) inhibition improved cardiac fatty acid metabolism in patients with congestive heart failure (CHF). Myocardial 123I-beta-methyl-iodophenylpentadecanoic acid (123I-BMIPP) imaging was performed in 25 patients with CHF and in 10 control subjects. Myocardial 123I-BMIPP images were obtained 30 min and 4 h after tracer injection. The heart-to-mediastinum (H/M) ratio of 123I-BMIPP uptake and the washout rate of 123I-BMIPP from the myocardium were calculated. Patients were given enalapril for 6 months, and 123I-BMIPP imaging was repeated. H/M ratios on early and delayed images were lower in CHF patients than in normal controls (Pacid metabolism by ACE inhibition may represent a new mechanism for the beneficial effect of this therapy in heart failure.

  6. 123I-meta-iodo-benzyl-guanidine myocardial scintigraphy and congestive heart failure: current data and perspective

    International Nuclear Information System (INIS)

    Agostini, D.; Darlas, Y.; Quennelle, F.; Bouvard, G.; Scanu, P.; Grollier, G.; Potier, J.C.; Babatasi, G.; Belin, A.

    1997-01-01

    Congestive heart failure is often associated with an impairment of the sympathetic nervous system, i.e., global hyperactivity and regional impairment of the adrenergic system. Cardiac 123 I-MIBG scintigraphy is a radionuclide technique which can explore the presynaptic adrenergic function. Myocardial MIBG fixation is decreased in congestive heart failure, reflecting a reduction of norepinephrine uptake by the myocardial presynaptic nerve endings. The impairment of presynaptic function occurs early in the disease and is actually involved in the pathogenesis of cardiac failure. Cardiac MIBG scintigraphy is a useful tool to explore the myocardial adrenergic stores in patients with congestive heart failure. It could be proposed in patients with severe ventricular dysfunction in order to assist physicians in setting-up the timing of heart transplantation. (authors)

  7. The economic impact of Medicare Part D on congestive heart failure.

    Science.gov (United States)

    Dall, Timothy M; Blanchard, Tericke D; Gallo, Paul D; Semilla, April P

    2013-05-01

    Medicare Part D has had important implications for patient outcomes and treatment costs among beneficiaries with congestive heart failure (CHF). This study finds that improved medication adherence associated with expansion of drug coverage under Part D led to nearly $2.6 billion in reductions in medical expenditures annually among beneficiaries diagnosed with CHF and without prior comprehensive drug coverage, of which over $2.3 billion was savings to Medicare. Further improvements in adherence could potentially save Medicare another $1.9 billion annually, generating upwards of $22.4 billion in federal savings over 10 years.

  8. Renal and cardiac function during alpha1-beta-blockade in congestive heart failure

    DEFF Research Database (Denmark)

    Heitmann, M; Davidsen, U; Stokholm, K H

    2002-01-01

    The kidney and the neurohormonal systems are essential in the pathogenesis of congestive heart failure (CHF) and the physiologic response. Routine treatment of moderate to severe CHF consists of diuretics, angiotensin-converting enzyme (ACE) inhibition and beta-blockade. The need for control...... of renal function during initiation of ACE-inhibition in patients with CHF is well known. The aim of this study was to investigate whether supplementation by a combined alpha1-beta-blockade to diuretics and ACE-inhibition might improve cardiac function without reducing renal function....

  9. Cerebral metabolic abnormalities in congestive heart failure detected by proton magnetic resonance spectroscopy.

    Science.gov (United States)

    Lee, C W; Lee, J H; Kim, J J; Park, S W; Hong, M K; Kim, S T; Lim, T H; Park, S J

    1999-04-01

    Using proton magnetic resonance spectroscopy, we investigated cerebral metabolism and its determinants in congestive heart failure (CHF), and the effects of cardiac transplantation on these measurements. Few data are available about cerebral metabolism in CHF. Fifty patients with CHF (ejection fraction OGM) and parietal white matter (PWM). Absolute levels of the metabolites (N-acetylaspartate, creatine, choline, myo-inositol) were calculated. In PWM only creatine level was significantly lower in CHF than in control subjects, but in OGM all four metabolite levels were decreased in CHF. The creatine level was independently correlated with half-recovery time and duration of heart failure symptoms in PWM (r = -0.56, p OGM (r = 0.58, p < 0.05). Cerebral metabolic abnormalities were improved after successful cardiac transplantation. This study shows that cerebral metabolism is abnormally deranged in advanced CHF and it may serve as a potential marker of the disease severity.

  10. Factors associated with health-related quality of life in stable ambulatory congestive heart failure patients: Systematic review.

    Science.gov (United States)

    Baert, Anneleen; De Smedt, Delphine; De Sutter, Johan; De Bacquer, Dirk; Puddu, Paolo Emilio; Clays, Els; Pardaens, Sofie

    2018-03-01

    Background Since improved treatment of congestive heart failure has resulted in decreased mortality and hospitalisation rates, increasing self-perceived health-related quality of life (HRQoL) has become a major goal of congestive heart failure treatment. However, an overview on predictieve factors of HRQoL is currently lacking in literature. Purpose The aim of this study was to identify key factors associated with HRQoL in stable ambulatory patients with congestive heart failure. Methods A systematic review was performed. MEDLINE, Web of Science and Embase were searched for the following combination of terms: heart failure, quality of life, health perception or functional status between the period 2000 and February 2017. Literature screening was done by two independent reviewers. Results Thirty-five studies out of 8374 titles were included for quality appraisal, of which 29 were selected for further data extraction. Four distinct categories grouping different types of variables were identified: socio-demographic characteristics, clinical characteristics, health and health behaviour, and care provider characteristics. Within the above-mentioned categories the presence of depressive symptoms was most consistently related to a worse HRQoL, followed by a higher New York Heart Association functional class, younger age and female gender. Conclusion Through a systematic literature search, factors associated with HRQoL among congestive heart failure patients were investigated. Age, gender, New York Heart Association functional class and depressive symptoms are the most consistent variables explaining the variance in HRQoL in patients with congestive heart failure. These findings are partly in line with previous research on predictors for hard endpoints in patients with congestive heart failure.

  11. Heart rate variability analysis in healthy subjects, patients suffering from congestive heart failure and heart transplanted patients

    Directory of Open Access Journals (Sweden)

    Argentina Leite

    2013-12-01

    Full Text Available This study aimed to find parameters to characterize heart rate variability (HRV and discriminate healthy subjects and patients with heart diseases. The parameters used for discrimination characterize the different components of HRV memory (short and long and are extracted from HRV recordings using parametric as well as non parametric methods. Thus, the parameters are: spectral components at low frequencies (LH and high frequencies (HF which are associated with the short memory of HRV and the long memory parameter (d obtained from autoregressive fractionally integrated moving average (ARFIMA models. In the non parametric context, short memory (α1 and long memory (α2 parameters are obtained from detrended fluctuation analysis (DFA. The sample used in this study contains 24-hour Holter HRV recordings of 30 subjects: 10 healthy individuals, 10 patients suffering from congestive heart failure and 10 heart transplanted patients from the Noltisalis database. It was found that short memory parameters present higher values for the healthy individuals whereas long memory parameters present higher values for the diseased individuals. Moreover, there is evidence that ARFIMA modeling allows the discrimination between the 3 groups under study, being advantageous over DFA.

  12. Measurement of lung density in congestive heart failure by computed tomography

    International Nuclear Information System (INIS)

    Nomura, Masanori; Miyagi, Yutaka; Tachi, Keiji; Sakabe, Yoshiyuki; Sakai, Yasuhiko; Hishida, Hitoshi; Mizuno, Yasushi; Sasaki, Fumio; Koga, Sukehiko

    1984-01-01

    The computed tomography (CT) number within the region of interest (ROI) was used as a parameter to assess lung density in patients with congestive heart failure. Thirty-eight patients with valvular heart disease (VHD) and 34 patients with ischemic heart disease (IHD) were studied. Based on the New York Heart Association (NYHA) classification, 24 VHD patients were in class I or II (VHD I-II) and the other 14 were in NYHA class III or IV (VHD III-IV). Eighteen patients with IHD were in NYHA class I or II (IHD I-II) and 16 were in class III or IV (IHD III-IV). The CT number was measured bilaterally at the upper, middle and lower levels of the chest and compared with the corresponding value in 21 normal subjects (Group N). In a preliminary study on Group N, the CT numbers were insensitive to the size of the ROI, but were closely related to its location. In clinical applications, the mean values of the CT numbers in all six lung fields increased in the order of IHD I-II, to VHD I-II, IHD III-IV and VHD III-IV. Except for patients in IHD I-II, they were significantly larger than in Group N. The relationship between the CT number and the systolic and mean pulmonary arterial pressures and the pulmonary capillary wedge pressure were evaluated in 36 patients. Significant correlations were obtained in all six lung fields (r=0.65-0.78, p<0.001). The results suggest that measurement of lung density by CT is useful for the quantitative evaluation of the severity of disease in patients with congestive heart failure. (author)

  13. Measurement of lung density in congestive heart failure by computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Nomura, Masanori; Miyagi, Yutaka; Tachi, Keiji; Sakabe, Yoshiyuki; Sakai, Yasuhiko; Hishida, Hitoshi; Mizuno, Yasushi; Sasaki, Fumio; Koga, Sukehiko [Fujita-Gakuen Health Univ., Toyoake, Aichi (Japan)

    1984-11-01

    The computed tomography (CT) number within the region of interest (ROI) was used as a parameter to assess lung density in patients with congestive heart failure. Thirty-eight patients with valvular heart disease (VHD) and 34 patients with ischemic heart disease (IHD) were studied. Based on the New York Heart Association (NYHA) classification, 24 VHD patients were in class I or II (VHD I-II) and the other 14 were in NYHA class III or IV (VHD III-IV). Eighteen patients with IHD were in NYHA class I or II (IHD I-II) and 16 were in class III or IV (IHD III-IV). The CT number was measured bilaterally at the upper, middle and lower levels of the chest and compared with the corresponding value in 21 normal subjects (Group N). In a preliminary study on Group N, the CT numbers were insensitive to the size of the ROI, but were closely related to its location. In clinical applications, the mean values of the CT numbers in all six lung fields increased in the order of IHD I-II, to VHD I-II, IHD III-IV and VHD III-IV. Except for patients in IHD I-II, they were significantly larger than in Group N. The relationship between the CT number and the systolic and mean pulmonary arterial pressures and the pulmonary capillary wedge pressure were evaluated in 36 patients. Significant correlations were obtained in all six lung fields (r=0.65-0.78, p < 0.001). The results suggest that measurement of lung density by CT is useful for the quantitative evaluation of the severity of disease in patients with congestive heart failure.

  14. Heart failure - medicines

    Science.gov (United States)

    CHF - medicines; Congestive heart failure - medicines; Cardiomyopathy - medicines; HF - medicines ... You will need to take most of your heart failure medicines every day. Some medicines are taken ...

  15. Cheyne-Stokes respiration in patients with congestive heart failure: causes and consequences.

    Science.gov (United States)

    Lorenzi-Filho, Geraldo; Genta, Pedro R; Figueiredo, Adelaide C; Inoue, Daniel

    2005-08-01

    Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac output and recurrent hypoxia. The key pathophysiological mechanism triggering Cheyne-Stokes respiration is hyperventilation and low arterial CO2 (PaCO2) that when below the apneic threshold triggers a central apnea. Hyperventilation is associated with pulmonary congestion, and Cheyne-Stokes respiration is more prone to occur during sleep, when the respiratory system is mainly dependent on chemical control. It is associated with recurrent dips in oxygen saturation and arousals from sleep, with oscillations in blood pressure and heart rate, sympathetic activation and increased risk of ventricular tachycardia. Cheyne-Stokes respiration is an independent marker of poor prognosis and may participate in a vicious cycle, further stressing the failing heart.

  16. RENAL AND SYSTEMIC HEMODYNAMIC-EFFECTS OF IBOPAMINE IN PATIENTS WITH MILD-TO-MODERATE CONGESTIVE-HEART-FAILURE

    NARCIS (Netherlands)

    LIEVERSE, AG; VANVELDHUISEN, DJ; SMIT, AJ; ZIJLSTRA, JG; MEIJER, S; REITSMA, WD; LIE, KI; GIRBES, ARJ

    To study the hemodynamic and renal effects of the orally (p.o.) active dopamine (DA) agonist ibopamine, we examined 10 patients with mild to moderate congestive heart failure (CHF), who were stable while treated with digoxin and diuretics. All patients were in New York Heart Association (NYHA)

  17. A history of arterial hypertension does not affect mortality in patients hospitalised with congestive heart failure

    DEFF Research Database (Denmark)

    Gustafsson, F; Torp-Pedersen, C; Seibaek, M

    2006-01-01

    OBJECTIVES: To evaluate the importance of a history of hypertension on long-term mortality in a large cohort of patients hospitalised with congestive heart failure (CHF). DESIGN: Retrospective analysis of 5491 consecutive patients, of whom 24% had a history of hypertension. 60% of the patients had...... non-systolic CHF, and 57% had ischaemic heart disease. SETTING: 38 primary, secondary and tertiary hospitals in Denmark. MAIN OUTCOME MEASURES: Total mortality 5-8 years after inclusion in the registry. RESULTS: Female sex and preserved left ventricular systolic function was more common among patients...... with a history of hypertension. 72% of the patients died during follow up. A hypertension history did not affect mortality risk (hazard ratio (HR) 0.99, 95% confidence interval (CI) 0.92 to 1.07). Correction for differences between the normotensive and hypertensive groups at baseline in a multivariate model did...

  18. Pharmacogenetic Risk Stratification in Angiotensin-Converting Enzyme Inhibitor-Treated Patients with Congestive Heart Failure

    DEFF Research Database (Denmark)

    Nelveg-Kristensen, Karl Emil; Busk Madsen, Majbritt; Torp-Pedersen, Christian

    2015-01-01

    BACKGROUND: Evidence for pharmacogenetic risk stratification of angiotensin-converting enzyme inhibitor (ACEI) treatment is limited. Therefore, in a cohort of ACEI-treated patients with congestive heart failure (CHF), we investigated the predictive value of two pharmacogenetic scores...... SNPs of the angiotensin-converting enzyme gene (rs4343) and ABO blood group genes (rs495828 and rs8176746). METHODS: Danish patients with CHF enrolled in the previously reported Echocardiography and Heart Outcome Study were included. Subjects were genotyped and categorized according to pharmacogenetic.......05 [95% CI 0.79-1.40]), respectively. CONCLUSIONS: We found no association between either of the analyzed pharmacogenetic scores and fatal outcomes in ACEI-treated patients with CHF....

  19. Pericardial and congestive heart failure diagnostic with CT-and MR-imaging

    International Nuclear Information System (INIS)

    Rienmueller, R.; Seiderer, M.; Doliva, R.; Kemkes, B.; Lissner, J.

    1986-01-01

    Angiocardiography is still considered the gold standard in the estimation of functional parameters of the heart. However because of the inferior density resolution and the draw back of superimposition of cardiac structures angiocardiography provides only limited information about non cardiac and some cardiac structures for instance: The perimyo-, endocardium, the valves, the myocardial perfusion and metabolism or coronary blood flow. The present diagnostic and prognostic validity of CT and MR in visualizing the pericardium, the left ventricular myocardium, the heart chambers and the great heart vessels in the clinical work up of patients with pericardial and congestive heart failure is demonstrated. MR is more reliable in the diagnosis of left ventricular myocardial atrophy or fibrosis than CT. Disadvantages of MR include the failure to identify endo-, myo-and pericardial calcifications. The measurable improvement in the visualization of systolic and diastolic myocardial wall thickness using MR is of marked prognostic value in the preoperative exclusion of myocardial atrophy or fibrosis in patients with pericardial constriction

  20. Readability Assessment of Online Patient Education Material on Congestive Heart Failure

    Science.gov (United States)

    2017-01-01

    Background Online health information is being used more ubiquitously by the general population. However, this information typically favors only a small percentage of readers, which can result in suboptimal medical outcomes for patients. Objective The readability of online patient education materials regarding the topic of congestive heart failure was assessed through six readability assessment tools. Methods The search phrase “congestive heart failure” was employed into the search engine Google. Out of the first 100 websites, only 70 were included attending to compliance with selection and exclusion criteria. These were then assessed through six readability assessment tools. Results Only 5 out of 70 websites were within the limits of the recommended sixth-grade readability level. The mean readability scores were as follows: the Flesch-Kincaid Grade Level (9.79), Gunning-Fog Score (11.95), Coleman-Liau Index (15.17), Simple Measure of Gobbledygook (SMOG) index (11.39), and the Flesch Reading Ease (48.87). Conclusion Most of the analyzed websites were found to be above the sixth-grade readability level recommendations. Efforts need to be made to better tailor online patient education materials to the general population. PMID:28656111

  1. Arteriosclerotic changes in the myocardium, lung, and kidney in dogs with chronic congestive heart failure and myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Falk, Bo Torkel; Jönsson, Lennart; Olsen, Lisbeth Høier

    2006-01-01

    Background: The occurrence of small vessel arteriosclerosis in the myocardium, kidney, and lung in dogs with naturally occurring myxomatous mitral valve disease has not been previously investigated systematically. Methods: Twenty-one dogs with naturally occurring congestive heart failure and 21 age......-matched, sex-matched, and weight-matched control dogs underwent extensive pathological and histopathological examination. Morphometry and scoring of tissue sections were used to measure arterial narrowing and fibrosis in the myocardium, kidney, and lung; and intimal thickness and plaque formation in the aorta...... and pulmonary artery. Results: Dogs with congestive heart failure had significantly more arterial narrowing in the left ventricle (Pdogs. However...

  2. A NEW APPROACH TO DETECT CONGESTIVE HEART FAILURE USING DETRENDED FLUCTUATION ANALYSIS OF ELECTROCARDIOGRAM SIGNALS

    Directory of Open Access Journals (Sweden)

    CHANDRAKAR KAMATH

    2015-02-01

    Full Text Available The aim of this study is to evaluate how far the detrended fluctuation analysis (DFA approach helps to characterize the short-term and intermediate-term fractal correlations in the raw electrocardiogram (ECG signals and thereby discriminate between normal and congestive heart failure (CHF subjects. The DFA-1 calculations were performed on normal and CHF short-term ECG segments, of the order of 20 seconds duration. Differences were found in shortterm and intermediate-term correlation properties and the corresponding scaling exponents of the two groups (normal and CHF. The statistical analyses show that short-term fractal scaling exponent alone is sufficient to distinguish between normal and CHF subjects. The receiver operating characteristic curve (ROC analysis confirms the robustness of this new approach and exhibits an average accuracy that exceeds 98.2%, average sensitivity of about 98.4%, positive predictivity of 98.00%, and average specificity of 98.00%.

  3. Severe congestive heart failure patient on amiodarone presenting with myxedemic coma: a case report.

    Science.gov (United States)

    Shaheen, Mazen

    2009-01-01

    This is a case report of myxedema coma secondary to amiodarone-induced hypothyroidism in a patient with severe congestive heart failure (CHF). To our knowledge and after reviewing the literature there is one case report of myxedema coma during long term amiodarone therapy. Myxedema coma is a life threatening condition that carries a mortality reaching as high as 20% with treatment. The condition is treated with intravenous thyroxine (T4) or intravenous tri-iodo-thyronine (T3). Patients with CHF on amiodarone may suffer serious morbidity and mortality from hypothyroidism, and thus may deserve closer follow up for thyroid stimulating hormone (TSH) levels. This case report carries an important clinical application given the frequent usage of amiodarone among CHF patients. The myriad clinical presentation of myxedema coma and its serious morbidity and mortality stresses the need to suspect this clinical syndrome among CHF patients presenting with hypotension, weakness or other unexplained symptoms.

  4. The SMART personalised self-management system for congestive heart failure: results of a realist evaluation.

    Science.gov (United States)

    Bartlett, Yvonne K; Haywood, Annette; Bentley, Claire L; Parker, Jack; Hawley, Mark S; Mountain, Gail A; Mawson, Susan

    2014-11-25

    Technology has the potential to provide support for self-management to people with congestive heart failure (CHF). This paper describes the results of a realist evaluation of the SMART Personalised Self-Management System (PSMS) for CHF. The PSMS was used, at home, by seven people with CHF. Data describing system usage and usability as well as questionnaire and interview data were evaluated in terms of the context, mechanism and outcome hypotheses (CMOs) integral to realist evaluation. The CHF PSMS improved heart failure related knowledge in those with low levels of knowledge at baseline, through providing information and quizzes. Furthermore, participants perceived the self-regulatory aspects of the CHF PSMS as being useful in encouraging daily walking. The CMOs were revised to describe the context of use, and how this influences both the mechanisms and the outcomes. Participants with CHF engaged with the PSMS despite some technological problems. Some positive effects on knowledge were observed as well as the potential to assist with changing physical activity behaviour. Knowledge of CHF and physical activity behaviour change are important self-management targets for CHF, and this study provides evidence to direct the further development of a technology to support these targets.

  5. Prognosis of emergency room stabilization of decompensated congestive heart failure with high dose lasix

    Directory of Open Access Journals (Sweden)

    Mahboob Pouraghaei

    2015-06-01

    Full Text Available Objective: Congestive heart failure (CHF has become one of the most important health care problems in western countries. This article focuses on the outpatient diagnosis and management of heart failure. We want to compare the outcome of patients who were treated with high dose diuretics in the emergency department (ED without admission with patients who were admitted to hospital for standard treatment. Methods: This was a randomized prospective clinical trial study. The patients who came to the ED from March 20, 2008 up to August 20, 2008 were divided into two groups randomly. The length of ED stay in the experimental group was documented. Also, readmission and mortality in 6 months and satisfaction in both groups were taken into consideration. All data were analyzed using SPSS 15.0. Results: In experimental group, the rate of recurrent admission, expiration, discharge, clinic visit, and clinic admission was 8%, 4%, 29%, 18%, and 0% respectively. On the other hand, in control group it was 16%, 40%, 18%, 22%, and 2% respectively. Additionally, there was a significant difference between these groups (P = 0.00. Conclusion: This study is the first regional prospective trial to comprehensively examine the therapeutic management in patients with CHF. This study, comparing the high dose diuretic efficacy in the decreasing of hospital stay and readmission; and decreasing mortality rate with routine therapy, showed that there was a significant difference between these two strategies in the mortality rate, readmission, and length of hospital stay (P = 0.00.

  6. Prolonged signal-averaged P wave duration as a prognostic marker for morbidity and mortality in patients with congestive heart failure

    DEFF Research Database (Denmark)

    Dixen, Ulrik; Wallevik, Laura; Hansen, Maja

    2003-01-01

    To evaluate the prognostic roles of prolonged signal-averaged P wave duration (SAPWD), raised levels of natriuretic peptides, and clinical characteristics in patients with stable congestive heart failure (CHF).......To evaluate the prognostic roles of prolonged signal-averaged P wave duration (SAPWD), raised levels of natriuretic peptides, and clinical characteristics in patients with stable congestive heart failure (CHF)....

  7. Mediastinal lymphadenopathy in congestive heart failure: a sequential CT evaluation with clinical and echocardiographic correlations

    Energy Technology Data Exchange (ETDEWEB)

    Chabbert, Valerie; Canevet, Guillaume; Otal, Philippe; Joffre, Francis [Department of Radiology, University of Toulouse, Avenue Jean-Poulhes, 31403, Toulouse (France); Baixas, Cecile; Galinier, Michel [Department of Cardiology, University of Toulouse, Avenue Jean-Poulhes, 31403, Toulouse (France); Deken, Valerie; Duhamel, Alain [Department of Medical Statistics, University of Lille, Place de Verdun, 59037, Lille Cedex (France); Remy, Jacques; Remy-Jardin, Martine [Department of Radiology, Hospital Calmette, University Center of Lille, Boulevard Jules Leclerc, 59037, Lille Cedex (France)

    2004-05-01

    The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%; type IV: n=12, 39%) to moderate (type I, n=1, 3%; type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22-74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 patients (16%) and hazy mediastinal fat in 1 patient (3%). Significant decrease in the size of lymphadenopathy was observed between T1 and T2 (T1, n=13, 42% vs T2, n=10, 32%; p<0.05) with a concurrent decrease in the severity of dyspnea (grade III-IV dyspnea at T1, n=24, 78% vs grade I-II dyspnea at T2, n=26, 83.5%). Patients with enlarged lymph nodes at T1 showed: (a) a significantly lower ejection fraction at echocardiography than those without lymphadenopathy (mean{+-}SD value: 34{+-}12.9 vs 43{+-}13.8%; p=0.04); (b) a significantly larger diameter of the right superior pulmonary vein (mean{+-}SD value: 17{+-}2.75 vs 14{+-}3.9 mm; p=0.04); and (c) a higher frequency of abnormal peribronchovascular thickening (n=5 vs n=1; p=0.06). Mediastinal lymphadenopathy associated with subacute left heart failure was observed in 13 patients (42%), showing regression after initiation of treatment in 8 of 13 patients (62%). (orig.)

  8. Association between glycated haemoglobin and the risk of congestive heart failure in diabetes mellitus : systematic review and meta-analysis

    NARCIS (Netherlands)

    Erqou, Sebhat; Lee, Chee-Tin Christine; Suffoletto, Matthew; Echouffo-Tcheugui, Justin B.; de Boer, Rudolf A.; van Melle, Joost P.; Adler, Amanda I.

    Clinical trials to date have not provided definitive evidence regarding the effects of glucose lowering on the incidence of congestive heart failure (CHF). We synthesized available prospective epidemiological data on the association between glycaemia measured by haemoglobin A(1c) (HbA(1c)) and

  9. Effects of simvastatin on the development of the atrial fibrillation substrate in dogs with congestive heart failure

    NARCIS (Netherlands)

    Shiroshita-Takeshita, Akiko; Brundel, Blanca J. J. M.; Burstein, Brett; Leung, Tack-Ki; Mitamura, Hideo; Ogawa, Satoshi; Nattel, Stanley

    Background: Congestive heart failure (CHF) is a common cause of atrial fibrillation (AF). Oxidative stress and inflammation (profibrotic) and peroxisome proliferator-activated receptor-alpha (PPAR-alpha, antifibrotic) factors may be involved in CHF-related remodeling. We evaluated the effects of

  10. Pharmacodynamic Impact of Carboxylesterase 1 Gene Variants in Patients with Congestive Heart Failure Treated with Angiotensin-Converting Enzyme Inhibitors

    DEFF Research Database (Denmark)

    Nelveg-Kristensen, Karl Emil; Bie, Peter; Ferrero, Laura

    2016-01-01

    BACKGROUND: Variation in the carboxylesterase 1 gene (CES1) may contribute to the efficacy of ACEIs. Accordingly, we examined the impact of CES1 variants on plasma angiotensin II (ATII)/angiotensin I (ATI) ratio in patients with congestive heart failure (CHF) that underwent ACEI dose titrations. ...

  11. Pertussis toxin treatment of whole blood. A novel approach to assess G protein function in congestive heart failure

    NARCIS (Netherlands)

    Maisel, A. S.; Michel, M. C.; Insel, P. A.; Ennis, C.; Ziegler, M. G.; Phillips, C.

    1990-01-01

    This study was designed to assess G protein function in mononuclear leukocytes (MNL) of patients with congestive heart failure (CHF). MNL membranes were ADP-ribosylated in vitro in the presence of pertussis or cholera toxin. The amount of pertussis toxin substrates did not differ significantly

  12. Use of Wavelet Transform to Detect Compensated and Decompensated Stages in the Congestive Heart Failure Patient

    Directory of Open Access Journals (Sweden)

    Pratibha Sharma

    2017-09-01

    Full Text Available This research work is aimed at improving health care, reducing cost, and the occurrence of emergency hospitalization in patients with Congestive Heart Failure (CHF by analyzing heart and lung sounds to distinguish between the compensated and decompensated states. Compensated state defines stable state of the patient but with lack of retention of fluids in lungs, whereas decompensated state leads to unstable state of the patient with lots of fluid retention in the lungs, where the patient needs medication. Acoustic signals from the heart and the lung were analyzed using wavelet transforms to measure changes in the CHF patient’s status from the decompensated to compensated and vice versa. Measurements were taken on CHF patients diagnosed to be in compensated and decompensated states by using a digital stethoscope and electrocardiogram (ECG in order to monitor their progress in the management of their disease. Analysis of acoustic signals of the heart due to the opening and closing of heart valves as well as the acoustic signals of the lungs due to respiration and the ECG signals are presented. Fourier, short-time Fourier, and wavelet transforms are evaluated to determine the best method to detect shifts in the status of a CHF patient. The power spectra obtained through the Fourier transform produced results that differentiate the signals from healthy people and CHF patients, while the short-time Fourier transform (STFT technique did not provide the desired results. The most promising results were obtained by using wavelet analysis. Wavelet transforms provide better resolution, in time, for higher frequencies, and a better resolution, in frequency, for lower frequencies.

  13. Thyrotropin-secreting pituitary tumor presenting with congestive heart failure and good response to dopaminergic agonist cabergoline

    Directory of Open Access Journals (Sweden)

    Yu-Hsi Kao

    2013-11-01

    Full Text Available Hyperthyroidism is an important inducing factor in patients with atrial fibrillation, and may trigger heart failure. Thyrotropin (thyroid stimulating hormone, TSH-secreting pituitary tumors are rare causes of hyperthyroidism. Here, we report a 66-year-old man with a pituitary TSH-secreting tumor who presented with hyperthyroidism and congestive heart failure. Endonasal trans-sphenoidal pituitary adenomectomy was performed. After the operation, the symptoms of hyperthyroidism and congestive heart failure were relieved, associated with normalization of thyroid function tests. Unfortunately, hand tremor and progressively elevated free T4 and TSH concentrations recurred 5 months after surgery. A dopaminergic agonist, cabergoline was administered and euthyroidism was restored for at least 11 months.

  14. Drug therapy for congestive heart failure:appropriate choices can prolong life

    International Nuclear Information System (INIS)

    Sorrentino, M

    1997-01-01

    Between one purpose of the insufficiency congestive heart is improve and prolong the quality life. A good multidisciplinary health equipment can help to the improving patients with this disease referred to effective handling interned and ambulatory patients groups. The inhibition mechanism compensate that perpetuate heart congestive insufficiency are a way for reach treatment purposes. Between patients with symptomatic cardiac insufficiency and overload volume is indicated digoxin(Lanoxin) and vasodilators. The enzyme inhibition angiotensin converted improve over life range more than an others vasodilators and is preferred for the systole dysfunction patients

  15. Prognostic value of echocardiography in 190 patients with chronic congestive heart failure. A comparison with New York Heart Association functional classes and radionuclide ventriculography

    DEFF Research Database (Denmark)

    Madsen, B K; Videbaek, R; Stokholm, H

    1996-01-01

    Survival in 190 consecutive patients with congestive heart failure, discharged from a general hospital, was studied. Sixteen patients were in New York Heart Association (NYHA) class I, 87 in II, 83 in III and 4 in IV. Median left ventricular ejection fraction (LVEF) from radionuclide...

  16. Interaction of prostaglandins and angiotensin II in the modulation of renal function in congestive heart failure.

    Science.gov (United States)

    Packer, M

    1988-06-01

    Despite a dramatic fall in renal blood flow, glomerular filtration rate is usually preserved in patients with congestive heart failure until the terminal stages of the disease. This maintenance of renal function appears to be achieved in part by the synthesis of two vasoactive factors within the kidney--angiotensin II and prostaglandins--which are rapidly released whenever renal perfusion is compromised or sympathetic nerve traffic to the kidneys is increased. Although these two hormonal systems exert opposite effects on systemic and renal blood flow and sodium and water excretion, both act to preserve glomerular filtration rate: prostaglandins by a vasodilator action exerted primarily on the afferent arteriole and angiotensin II by a vasoconstrictor effect on the efferent arteriole. Consequently, when the synthesis of these hormones is experimentally blocked, renal function deteriorates, especially in subjects with marked renal hypoperfusion and sodium depletion; these two factors interact to determine the importance of intrarenal hormonal release in the modulation of renal function. Clinically, four specific factors have been identified that predispose patients with heart failure to the development of functional renal insufficiency after treatment with converting-enzyme or cyclo-oxygenase inhibitors: (1) marked renal hypoperfusion, (2) vigorous diuretic therapy, (3) diabetes mellitus, and (4) intensity of hormonal inhibition within the kidney. This last risk factor may provide the basis for differentiating among enzyme-inhibitory drugs and suggests that renal insufficiency in low-output states may be minimized by the development of therapeutic agents that block hormonal synthesis selectively at sites that are critical to the disease process but spare the homeostatic tissue-based enzyme systems that exist within the kidney.

  17. Mediastinal lymphadenopathy in congestive heart failure: a sequential CT evaluation with clinical and echocardiographic correlations

    International Nuclear Information System (INIS)

    Chabbert, Valerie; Canevet, Guillaume; Otal, Philippe; Joffre, Francis; Baixas, Cecile; Galinier, Michel; Deken, Valerie; Duhamel, Alain; Remy, Jacques; Remy-Jardin, Martine

    2004-01-01

    The aim of this study was to evaluate the frequency and evolution after treatment of mediastinal lymphadenopathy associated with congestive left heart failure on CT scans in correlation with clinical and echocardiographic findings. Thirty-one consecutive patients with subacute left heart failure underwent a clinical evaluation using the NYHA classification, a CT examination, and transthoracic echocardiography at the time of initial presentation (T1). After initiation of medical treatment (T2), follow-up CT scans were systematically obtained together with a clinical evaluation. At T1, all patients showed severe (type III: n=12, 39%; type IV: n=12, 39%) to moderate (type I, n=1, 3%; type II, n=6, 19%) dyspnea with a mean ejection fraction of 39% (range 22-74%). On initial CT scans, enlarged mediastinal lymph nodes were seen in 13 patients (42%) with blurred contours in 5 patients (16%) and hazy mediastinal fat in 1 patient (3%). Significant decrease in the size of lymphadenopathy was observed between T1 and T2 (T1, n=13, 42% vs T2, n=10, 32%; p<0.05) with a concurrent decrease in the severity of dyspnea (grade III-IV dyspnea at T1, n=24, 78% vs grade I-II dyspnea at T2, n=26, 83.5%). Patients with enlarged lymph nodes at T1 showed: (a) a significantly lower ejection fraction at echocardiography than those without lymphadenopathy (mean±SD value: 34±12.9 vs 43±13.8%; p=0.04); (b) a significantly larger diameter of the right superior pulmonary vein (mean±SD value: 17±2.75 vs 14±3.9 mm; p=0.04); and (c) a higher frequency of abnormal peribronchovascular thickening (n=5 vs n=1; p=0.06). Mediastinal lymphadenopathy associated with subacute left heart failure was observed in 13 patients (42%), showing regression after initiation of treatment in 8 of 13 patients (62%). (orig.)

  18. Mechanical analysis of congestive heart failure caused by bundle branch block based on an electromechanical canine heart model

    Energy Technology Data Exchange (ETDEWEB)

    Dou Jianhong; Xia Ling; Zhang Yu; Shou Guofa [Department of Biomedical Engineering, Zhejiang University, Hangzhou 310027 (China); Wei Qing; Liu Feng; Crozier, Stuart [School of Information Technology and Electrical Engineering, University of Queensland, St Lucia, Brisbane, Queensland 4072 (Australia)], E-mail: xialing@zju.edu.cn

    2009-01-21

    understanding of the mechanical implications of congestive heart failure (CHF) caused by BBB.

  19. Direct and indirect assessment of skeletal muscle blood flow in chronic congestive heart failure

    International Nuclear Information System (INIS)

    LeJemtel, T.H.; Scortichini, D.; Katz, S.

    1988-01-01

    In patients with chronic congestive heart failure (CHF), skeletal muscle blood flow can be measured directly by the continuous thermodilution technique and by the xenon-133 clearance method. The continuous thermodilution technique requires retrograde catheterization of the femoral vein and, thus, cannot be repeated conveniently in patients during evaluation of pharmacologic interventions. The xenon-133 clearance, which requires only an intramuscular injection, allows repeated determination of skeletal muscle blood flow. In patients with severe CHF, a fixed capacity of the skeletal muscle vasculature to dilate appears to limit maximal exercise performance. Moreover, the changes in peak skeletal muscle blood flow noted during long-term administration of captopril, an angiotensin-converting enzyme inhibitor, appears to correlate with the changes in aerobic capacity. In patients with CHF, resting supine deep femoral vein oxygen content can be used as an indirect measurement of resting skeletal muscle blood flow. The absence of a steady state complicates the determination of peak skeletal muscle blood flow reached during graded bicycle or treadmill exercise in patients with chronic CHF. Indirect assessments of skeletal muscle blood flow and metabolism during exercise performed at submaximal work loads are currently developed in patients with chronic CHF

  20. Prognostic significance of hemoglobin level in patients with congestive heart failure and normal ejection fraction.

    Science.gov (United States)

    Varadarajan, Padmini; Gandhi, Siddharth; Sharma, Sanjay; Umakanthan, Branavan; Pai, Ramdas G

    2006-10-01

    Previous studies have shown low hemoglobin (Hb) to have an adverse effect on survival in patients with congestive heart failure (CHF) and reduced left ventricular (LV) ejection fraction (EF); but its effect on survival in patients with CHF and normal EF is not known. This study sought to determine whether low Hb has an effect on survival in patients with both CHF and normal EF. Detailed chart reviews were performed by medical residents on 2,246 patients (48% with normal EF) with a discharge diagnosis of CHF in a large tertiary care hospital from 1990 to 1999. The CHF diagnosis was validated using the Framingham criteria. Mortality data were obtained from the National Death Index. Survival analysis was performed using Kaplan-Meier and Cox regression models. By Kaplan-Meier analysis, low Hb (< 12 gm/dl) compared with normal hemoglobin was associated with a lower 5-year survival in patients with CHF and both normal (38 vs. 50%, p = 0.0008) and reduced (35 vs. 48%, p = 0.0009) EF. Using the Cox regression model, low Hb was an independent predictor of mortality after adjusting for age, gender, renal dysfunction, diabetes mellitus, hypertension, and EF in both groups of patients. Low Hb has an independent adverse effect on survival in patients with CHF and both normal and reduced EF in both groups of patients.

  1. Effects of a System Thinking-Based Simulation Program for Congestive Heart Failure.

    Science.gov (United States)

    Kim, Hyeon-Young; Yun, Eun Kyoung

    2018-03-01

    This study evaluated a system thinking-based simulation program for the care of patients with congestive heart failure. Participants were 67 undergraduate nursing students from a nursing college in Seoul, South Korea. The experimental group was given a 4-hour system-thinking program and a 2-hour simulation program, whereas the control group had a 4-hour case study and a 2-hour simulation program. There were significant improvements in critical thinking in both groups, but no significant group differences between educational methods (F = 3.26, P = .076). Problem-solving ability in the experimental group was significantly higher than in the control group (F = 5.04, P = .028). Clinical competency skills in the experimental group were higher than in the control group (t = 2.12, P = .038). A system thinking-based simulation program is a more effective learning method in terms of problem-solving ability and clinical competency skills compared to the existing simulation program. Further research using a longitudinal study is needed to test the long-term effect of the intervention and apply it to the nursing curriculum.

  2. Associations between ambient air pollution and daily mortality among persons with congestive heart failure

    International Nuclear Information System (INIS)

    Goldberg, Mark S.; Burnett, Richard T.; Valois, M.-F.; Flegel, Kenneth; Bailar III, John C.; Brook, Jeffrey; Vincent Renaud; Radon, Katja

    2003-01-01

    We conducted a mortality time series study to investigate the association between daily mortality for congestive heart failure (CHF), and dail concentrations of particles and gaseous pollutants in the ambient air o Montreal, Quebec, during the period 1984-1993. In addition, using data fro the universal Quebec Health Insurance Plan, we identified individuals ≥6 years of age who, one year before death, had a diagnosis of CHF. Fixed-sit air pollution monitors in Montreal provided daily mean levels of pollutants We regressed the logarithm of daily counts of mortality on the daily mean levels of each pollutant, after accounting for seasonal and subseasonal fluctuations in the mortality time series, non-Poisson dispersion, weather variables, and other gaseous and particle pollutants. Using cause of deat information, we did not find any associations between daily mortality for CH and any air pollutants. The analyses of CHF defined from the medical record showed positive associations with coefficient of haze, the extinction coefficient, SO 2 , and NO 2 . For example, the mean percent increase in dail mortality for an increase in the coefficient of haze across the interquartile range was 4.32% (95% CI: 0.95-7.80%) and for NO 2 it was 4.08% (95% CI 0.59-7.68%). These effects were generally higher in the warm season

  3. Increasing self-knowledge: Utilizing tele-coaching for patients with congestive heart failure.

    Science.gov (United States)

    Rosen, Daniel; Berrios-Thomas, Saskia; Engel, Rafael J

    2016-10-01

    The objective was to assess self-care knowledge changes with dually eligible Medicare and Medicaid patients diagnosed with congestive heart failure (CHF), who received a telecoaching protocol integrating symptom monitoring with face-to-face video chat with a social worker. We recruited 45 patients with CHF from a regional managed care organization. Sessions via a Health Insurance Portability and Accountability Act-compliant tablet-based platform focused on educational information designed to improve patient self-care. Social workers administered the 13-item Member Confidence Measure (MCM) at baseline and at a 30-day follow-up period. Scores were recorded to measure differences in patients' understanding of CHF and related symptoms, their knowledge of the disease, and the behaviors necessary to prevent their symptoms from getting worse. Over the 30-day period, scores significantly (p safety). Gender, race, and age were unrelated to these improvements. In addition, effect sizes for the sub-scales ranged from .54 to 1.08; the effect size of the intervention as expressed by the total scale score was 1.12. Overall, patients increased knowledge over a 30-day period. Tele-coaching by social workers holds promise as a feasible model for health education for high-risk populations.

  4. Depression increasingly predicts mortality in the course of congestive heart failure.

    Science.gov (United States)

    Jünger, Jana; Schellberg, Dieter; Müller-Tasch, Thomas; Raupp, Georg; Zugck, Christian; Haunstetter, Armin; Zipfel, Stephan; Herzog, Wolfgang; Haass, Markus

    2005-03-02

    Congestive heart failure (CHF) is frequently associated with depression. However, the impact of depression on prognosis has not yet been sufficiently established. To prospectively investigate the influence of depression on mortality in patients with CHF. In 209 CHF patients depression was assessed by the Hospital Anxiety and Depression Scale (HADS-D). Compared to survivors (n=164), non-survivors (n=45) were characterized by a higher New York Heart Association (NYHA) functional class (2.8+/-0.7 vs. 2.5+/-0.6), and a lower left ventricular ejection fraction (LVEF) (18+/-8 vs. 23+/-10%) and peakVO(2) (13.1+/-4.5 vs. 15.4+/-5.2 ml/kg/min) at baseline. Furthermore, non-survivors had a higher depression score (7.5+/-4.0 vs. 6.1+/-4.3) (all P<0.05). After a mean follow-up of 24.8 months the depression score was identified as a significant indicator of mortality (P<0.01). In multivariate analysis the depression score predicted mortality independent from NYHA functional class, LVEF and peakVO(2). Combination of depression score, LVEF and peakVO(2) allowed for a better risk stratification than combination of LVEF and peakVO(2) alone. The risk ratio for mortality in patients with an elevated depression score (i.e. above the median) rose over time to 8.2 after 30 months (CI 2.62-25.84). The depression score predicts mortality independent of somatic parameters in CHF patients not treated for depression. Its prognostic power increases over time and should, thus, be accounted for in risk stratification and therapy.

  5. Acromegaly with Normal Insulin-Like Growth Factor-1 Levels and Congestive Heart Failure as the First Clinical Manifestation

    Directory of Open Access Journals (Sweden)

    Hyae Min Lee

    2015-09-01

    Full Text Available The leading cause of morbidity and mortality in patients with acromegaly is cardiovascular complications. Myocardial exposure to excessive growth hormone can cause ventricular hypertrophy, hypertension, arrhythmia, and diastolic dysfunction. However, congestive heart failure as a result of systolic dysfunction is observed only rarely in patients with acromegaly. Most cases of acromegaly exhibit high levels of serum insulin-like growth factor-1 (IGF-1. Acromegaly with normal IGF-1 levels is rare and difficult to diagnose. Here, we report a rare case of an acromegalic patient whose first clinical manifestation was severe congestive heart failure, despite normal IGF-1 levels. We diagnosed acromegaly using a glucose-loading growth hormone suppression test. Cardiac function and myocardial hypertrophy improved 6 months after transsphenoidal resection of a pituitary adenoma.

  6. Associations between cardiac pathology and clinical, echocardiographic and electrocardiographic findings in dogs with chronic congestive heart failure

    DEFF Research Database (Denmark)

    Falk, Bo Torkel; Jönsson, Lennart; Olsen, Lisbeth Høier

    2010-01-01

    The objective of this study was to correlate defined pathological features with clinical findings in dogs with naturally occurring congestive heart failure (CHF). Fifty-eight dogs with CHF were examined clinically and using echocardiography and electrocardiography. Detailed cardiac post...... such as MMVD, myocardial atrophy and fibrosis, and by arteriosclerosis. Further, more extensive research will be required to establish cause-effect relationships between these cardiac lesions and the pathophysiology of CHF in dogs....

  7. Ambient air pollution and hospitalization for congestive heart failure among elderly people in seven large US cities; Pollution atmospherique ambiante et hospitalisations pour insuffisance cardiaque congestive chez les personnes agees dans sept grandes villes des Etats-Unis

    Energy Technology Data Exchange (ETDEWEB)

    Morris, R.D.; Naumova, E.N.; Munasinghe, R.L.M.

    2001-01-01

    The aim of this study is the temporal associations between the urban atmospheric pollution, in particular the carbon monoxide, and the hospitalization for congestive heart failure in elderly people, in seven large US cities. (A.L.B.)

  8. Intravenous Milrinone Infusion Improves Congestive Heart Failure Caused by Diastolic Dysfunction

    Science.gov (United States)

    Albrecht, Carlos A.; Giesler, Gregory M.; Kar, Biswajit; Hariharan, Ramesh; Delgado, Reynolds M.

    2005-01-01

    Although there have been significant advances in the medical treatment of heart failure patients with impaired systolic function, very little is known about the diagnosis and treatment of diastolic dysfunction. We report the cases of 3 patients in New York Heart Association functional class IV who had echocardiographically documented diastolic dysfunction as the main cause of heart failure. All 3 patients received medical therapy with long-term milrinone infusion. PMID:16107121

  9. Congestive heart failure effects on atrial fibroblast phenotype: differences between freshly-isolated and cultured cells.

    Directory of Open Access Journals (Sweden)

    Kristin Dawson

    Full Text Available Fibroblasts are important in the atrial fibrillation (AF substrate resulting from congestive heart failure (CHF. We previously noted changes in in vivo indices of fibroblast function in a CHF dog model, but could not detect changes in isolated cells. This study assessed CHF-induced changes in the phenotype of fibroblasts freshly isolated from control versus CHF dogs, and examined effects of cell culture on these differences.Left-atrial fibroblasts were isolated from control and CHF dogs (ventricular tachypacing 240 bpm × 2 weeks. Freshly-isolated fibroblasts were compared to fibroblasts in primary culture. Extracellular-matrix (ECM gene-expression was assessed by qPCR, protein by Western blot, fibroblast morphology with immunocytochemistry, and K(+-current with patch-clamp. Freshly-isolated CHF fibroblasts had increased expression-levels of collagen-1 (10-fold, collagen-3 (5-fold, and fibronectin-1 (3-fold vs. control, along with increased cell diameter (13.4 ± 0.4 µm vs control 8.4 ± 0.3 µm and cell spreading (shape factor 0.81 ± 0.02 vs. control 0.87 ± 0.02, consistent with an activated phenotype. Freshly-isolated control fibroblasts displayed robust tetraethylammonium (TEA-sensitive K(+-currents that were strongly downregulated in CHF. The TEA-sensitive K(+-current differences between control and CHF fibroblasts were attenuated after 2-day culture and eliminated after 7 days. Similarly, cell-culture eliminated the ECM protein-expression and shape differences between control and CHF fibroblasts.Freshly-isolated CHF and control atrial fibroblasts display distinct ECM-gene and morphological differences consistent with in vivo pathology. Culture for as little as 48 hours activates fibroblasts and obscures the effects of CHF. These results demonstrate potentially-important atrial-fibroblast phenotype changes in CHF and emphasize the need for caution in relating properties of cultured fibroblasts to in vivo systems.

  10. Compromised Global and Regional Cerebral Blood Flow in Congestive Heart Failure

    Energy Technology Data Exchange (ETDEWEB)

    Kim, J. S.; Kim, J. J.; Im, K. C.; Moon, D. H. [College of Medicine, Univ. of Ulsan, Seoul (Korea, Republic of)

    2003-07-01

    It has been known that cerebral perfusion is maintained in patients with congestive heart failure (CHF) by a complex series of compensatory mechanisms. However cognitive impairment is a common problem experienced by patients with CHF and may result from deranged cerebral perfusion. We prospectively investigated the global and regional CBF of patients with CHF and compared the results with that of normal controls. Thirty two patients (M/F: 22/10, 4211 yr) with CHF (LVEF=218.1%) and 10 healthy controls (M/F: 6/4, 398 yr) were prospectively studied. No patients had cerebrovascular disease or other disease affecting cognitive function. All patients and normal controls underwent radionuclide angiography including cerebral hemispheres and aortic arch, and brain perfusion SPECT using Tc-99m ECD. Global CBF was measured non-invasively by the application of Patlak plot graphical analysis. Quantitative rCBF images were obtained from SPECT image using global CBF values, regional/global count ratios, and Lassen's linearization correction algorithm. Difference of regional CBF between CHF and normal control were assessed using a SPM99 without global count normalization (uncorrected p<0.0001, extent threshold>100 voxels). Global CBF (41.54.7 ml/min/100g) of the patients with CHF were significantly lower than those (49.15.7 ml/min/100g) of controls (p<0.001). Regional CBF was significantly decreased in frontal, temporal and parietal neocortex of both cerebral hemispheres compared to normal controls. Regional rCBF of basal ganglia, thalamus, and brain stem were preserved, even though global CBF was variably compromised. Our study show that global CBF is significantly decreased in CHF and regional CBF of frontal, parietal and temporal neocortex is compromised preferentially. Further studies would be needed to investigate the relationship of rCBF change and cognitive impairment in patients with CHF.

  11. Mining telemonitored physiological data and patient-reported outcomes of congestive heart failure patients.

    Science.gov (United States)

    Mlakar, Miha; Puddu, Paolo Emilio; Somrak, Maja; Bonfiglio, Silvio; Luštrek, Mitja

    2018-01-01

    This paper addresses patient-reported outcomes (PROs) and telemonitoring in congestive heart failure (CHF), both increasingly important topics. The interest in CHF trials is shifting from hard end-points such as hospitalization and mortality, to softer end-points such health-related quality of life. However, the relation of these softer end-points to objective parameters is not well studied. Telemonitoring is suitable for collecting both patient-reported outcomes and objective parameters. Most telemonitoring studies, however, do not take full advantage of the available sensor technology and intelligent data analysis. The Chiron clinical observational study was performed among 24 CHF patients (17 men and 7 women, age 62.9 ± 9.4 years, 15 NYHA class II and 9 class III, 10 of ishaemic, aetiology, 6 dilated, 2 valvular, and 6 of multiple aetiologies or cardiomyopathy) in Italy and UK. A large number of physiological and ambient parameters were collected by wearable and other devices, together with PROs describing how well the patients felt, over 1,086 days of observation. The resulting data were mined for relations between the objective parameters and the PROs. The objective parameters (humidity, ambient temperature, blood pressure, SpO2, and sweeting intensity) could predict the PROs with accuracies up to 86% and AUC up to 0.83, making this the first report providing evidence for ambient and physiological parameters to be objectively related to PROs in CHF patients. We also analyzed the relations in the predictive models, gaining some insights into what affects the feeling of health, which was also generally not attempted in previous investigations. The paper strongly points to the possibility of using PROs as primary end-points in future trials.

  12. Respiratory muscle dysfunction in congestive heart failure: clinical correlation and prognostic significance.

    Science.gov (United States)

    Meyer, F J; Borst, M M; Zugck, C; Kirschke, A; Schellberg, D; Kübler, W; Haass, M

    2001-05-01

    In congestive heart failure (CHF), the prognostic significance of impaired respiratory muscle strength has not been established. Maximal inspiratory pressure (Pi(max)) was prospectively determined in 244 consecutive patients (207 men) with CHF (ischemic, n=75; idiopathic dilated cardiomyopathy, n=169; age, 54+/-11 years; left ventricular ejection fraction [LVEF], 22+/-10%). Pi(max) was lower in the 244 patients with CHF than in 25 control subjects (7.6+/-3.3 versus 10.5+/-3.7 kPa; P=0.001). The 57 patients (23%) who died during follow-up (23+/-16 months; range, 1 to 48 months) had an even more reduced Pi(max) (6.3+/-3.2 versus 8.1+/-3.2 kPa in survivors; P=0.001). Kaplan-Meier survival curves differentiated between patients subdivided according to quartiles for Pi(max) (P=0.014). Pi(max) was a strong risk predictor in both univariate (P=0.001) and multivariate Cox proportional hazard analyses (P=0.03); multivariate analyses also included NYHA functional class, LVEF, peak oxygen consumption (peak VO(2)), and norepinephrine plasma concentration. The areas under the receiver-operating characteristic curves for prediction of 1-year survival were comparable for Pi(max) and peak VO(2) (area under the curve [AUC], 0.68 versus 0.73; P=0.28), and they improved with the triple combination of Pi(max), peak VO(2), and LVEF (AUC, 0.82; P=0.004 compared with AUC of Pi(max)). In patients with CHF, inspiratory muscle strength is reduced and emerges as a novel, independent predictor of prognosis. Because testing for Pi(max) is simple in clinical practice, it might serve as an additional factor to improve risk stratification and patient selection for cardiac transplantation.

  13. Congestive heart failure, spouses' support and the couple's sleep situation: a critical incident technique analysis.

    Science.gov (United States)

    Broström, Anders; Strömberg, Anna; Dahlström, Ulf; Fridlund, Bengt

    2003-03-01

    Sleep related breathing disorders are common as well as a poor prognostic sign associated with higher mortality in patients with congestive heart failure (CHF). These patients often have a shorter total duration of sleep, disturbed sleep structure and increased daytime sleepiness, which can negatively affect all dimensions of the life situation. The spouse has an important role in supporting the patient in relation to sleep disorders, but this role may be adversely affected by the sleep situation of the couple. The aim of this study was to describe decisive situations that influence spouses' support to patients with CHF in relation to the couple's sleep situation. A qualitative descriptive design using critical incident technique was employed. Incidents were collected by means of interviews with 25 spouses of patients with CHF, strategically selected from two hospital-based specialist clinics in southern Sweden. Two main areas emerged in the analysis: support stimulating situations and support inhibiting situations. Support stimulating situations described how spouses' support was positively affected by their own adaptation in psychosocial or practical situations, and receiving help from others. Support inhibiting situations described how the spouses' support was negatively affected by sleep disturbances as a result of the patient's symptoms, anxiety in relation to the disease, limitations as a result of the sleeping habits, dissatisfaction with care related to the sleep situation, and being left to cope alone with the problems. An increased understanding of the stimulating and inhibiting situations influencing spouses' support for patients with CHF can guide health care personnel in deciding if an intervention is needed to improve the sleep situation for patient and spouse.

  14. Laparoscopy is safe among patients with congestive heart failure undergoing general surgery procedures.

    Science.gov (United States)

    Speicher, Paul J; Ganapathi, Asvin M; Englum, Brian R; Vaslef, Steven N

    2014-08-01

    Over the past 2 decades, laparoscopy has been established as a superior technique in many general surgery procedures. Few studies, however, have examined the impact of the use of a laparoscopic approach in patients with symptomatic congestive heart failure (CHF). Because pneumoperitoneum has known effects on cardiopulmonary physiology, patients with CHF may be at increased risk. This study examines current trends in approaches to patients with CHF and effects on perioperative outcomes. The 2005-2011 National Surgical Quality Improvement Program Participant User File was used to identify patients who underwent the following general surgery procedures: Appendectomy, segmental colectomy, small bowel resection, ventral hernia repair, and splenectomy. Included for analysis were those with newly diagnosed CHF or chronic CHF with new signs or symptoms. Trends of use of laparoscopy were assessed across procedure types. The primary endpoint was 30-day mortality. The independent effect of laparoscopy in CHF was estimated with a multiple logistic regression model. A total of 265,198 patients were included for analysis, of whom 2,219 were identified as having new or recently worsened CHF. Of these patients, there were 1,300 (58.6%) colectomies, 486 (21.9%) small bowel resections, 216 (9.7%) ventral hernia repairs, 141 (6.4%) appendectomies, and 76 (3.4%) splenectomies. Laparoscopy was used less frequently in patients with CHF compared with their non-CHF counterparts, particularly for nonelective procedures. Baseline characteristics were similar for laparoscopy versus open procedures with the notable exception of urgent/emergent case status (36.4% vs 71.3%; P surgery procedures, particularly in urgent/emergent cases. Despite these patterns and apparent preferences, laparoscopy seems to offer a safe alternative in appropriately selected patients. Because morbidity and mortality were considerable regardless of approach, further understanding of appropriate management in this

  15. Changes and significance of TNF - α, NOS activity and NO in the plasma of patients with chronic congestive heart failure

    International Nuclear Information System (INIS)

    Zhou Yafeng; Cheng Xujie; Liu Zhihua

    2003-01-01

    Objective: To study changes and interrelations of TNF - α, NOS activity and NO in the plasma of patients with chronic congestive heart failure (CHF). Methods: The blood samples were taken from eighty patients and twenty healthy subjects. Plasma TNF - α was measured by RIA. Plasma NOS activity and NO were assessed with colorimetric analysis. Results: The level of plasma TNF - α, NOS activity and NO were significantly higher in CHF patients than that in healthy subjects and were increased with the severity of heart failure. The levels of TNF - α, NOS activity and NO showed significant relation with each other and all of them were closely related to the ejection fraction. Conclusion: TNF - α, NOS activity and NO increase greatly in patients of CHF and they maybe play an important roles in the progress of CHF. They can be used as markers for the severity and prognosis of heart failure

  16. Reversible Congestive Heart Failure after Percutaneous Closure of a Large PDA in a 34-year-old Woman

    Directory of Open Access Journals (Sweden)

    Ramazan Kargın

    2010-08-01

    Full Text Available Patent ductus arteriosus is a congenital heart disease which can cause chronic volume overload leading to congestive heart failure. A 34-year-old woman with rest dyspnea was found to have patent ductus arteriosus and echocardiogram revealed a markedly dilated left ventricle (8.9 cm and severely-compromised left ventricle systolic functions (ejection fraction~24%. The patent ductus arteriosus was successfully closed percutaneously with Amplatzer occluder device. The patient was discharged on optimal dosages of ramipril, metoprolol, furosemide, spiranolactone and aspirin. On the follow-up after 18 months, the symptoms were found to have regressed and echocardiographic parameters improved (ejection fraction~55%.

  17. Prevalence, prognostic significance, and treatment of atrial fibrillation in congestive heart failure with particular reference to the DIAMOND-CHF study

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Brendorp, Bente; Køber, Lars

    2003-01-01

    Atrial fibrillation is a growing health problem and the most common cardiac arrhythmia, affecting 5% of persons above the age of 65 years. The number of hospital discharges for atrial fibrillation has more than doubled in the past decade. It occurs very often in patients with congestive heart...... failure and the prevalence increases with the severity of the disease. These two conditions seem to be linked together, and congestive heart failure may either be the cause or the consequence of atrial fibrillation. The prognosis of atrial fibrillation is controversial, but studies indicate that atrial...... fibrillation is a risk factor in congestive heart failure patients. In the last 10-15 years, significant advances in the treatment of heart failure have improved survival, whereas effective management of atrial fibrillation in heart failure patients still awaits similar progress. Empirically, two strategies...

  18. Blood urea nitrogen to creatinine ratio is associated with congestion and mortality in heart failure patients with renal dysfunction.

    Science.gov (United States)

    Parrinello, Gaspare; Torres, Daniele; Testani, Jeffrey M; Almasio, Piero Luigi; Bellanca, Michele; Pizzo, Giuseppina; Cuttitta, Francesco; Pinto, Antonio; Butler, Javed; Paterna, Salvatore

    2015-12-01

    Renal dysfunction (RD) and venous congestion are related and common in heart failure (HF). Studies suggest that venous congestion may be the primary driver of RD in HF. In this study, we sought to investigate retrospectively the relationship between common measures of renal function with caval congestion and mortality among outpatients with HF and RD. We reviewed data from 103 HF outpatients (45 males, mean age 74 years, ejection fraction 41.8 ± 11.6 %) with estimated glomerular filtration rate (eGFR) of 25.5 (adjusted OR 2.98, p 0.015) and eGFR ≤ 45.8 (adjusted OR 5.38, p 0.002) identify patients at risk for caval congestion; a BUN/Cr > 23.7 was the best predictor of impaired collapsibility (adjusted OR 4.41, p 0.001). a BUN/Cr > 25.5 (HR 2.19, 95 % CI 1.21-3.94, p < 0.001) and NYHA class 3 (HR 2.91, 95 % CI 1.60-5.31, p < 0.0005) were independent risk factors associated with all-cause death during a median follow-up of 31 months. In outpatients with HF and RD, a higher BUN/Cr and lower eGFR are reliable renal biomarkers for caval congestion. The BUN/Cr is associated with long-term mortality and may help to stratify HF severity.

  19. Insomnia Self-Management in Heart Failure

    Science.gov (United States)

    2018-01-05

    Cardiac Failure; Heart Failure; Congestive Heart Failure; Heart Failure, Congestive; Sleep Initiation and Maintenance Disorders; Chronic Insomnia; Disorders of Initiating and Maintaining Sleep; Fatigue; Pain; Depressive Symptoms; Sleep Disorders; Anxiety

  20. Pharmacoeconomic analysis of valsartan for the treatment of chronic congestive heart failure in Italy

    Directory of Open Access Journals (Sweden)

    Sergio Iannazzo

    2008-09-01

    Full Text Available Objective: to evaluate pharmacoeconomic implications of the use of valsartan, an angiotensin II antagonist in addition to standard therapy for the treatment of chronic congestive heart failure (CHF. Methods: the study was conducted performing cost-utility and budget impact (B.I. analyses by means of a cohort simulation based on a probabilistic Markov model and projecting 23-months follow-up results in the Val-HeFT trial study over a 10-years time horizon. The model included four states (class NYHA I, II and III and death, and had a cycle of 1 year. Two probabilistic simulations (varying first patients parameters and after model parameters were performed using WinBUGS, a software for bayesian analysis. The distributions of patients parameters (sex, age, use of ACE inhibitors corresponding to Val-HeFT inclusion criteria in the simulated population were derived from the Italian CHF patients population. Individual mortality was derived from general mortality by adjusting with a NYHA state-specific HR, and the probability of changing NYHA class from Val-HeFT. Costs were calculated in the perspective of the Italian NHS and account for drugs and CHF hospitalizations. Quality of life weights were obtained by elaborating published HRQoL data of CHF patients. A 3.5% annual discount rate was applied; probabilistic sensitivity analysis was performed on each parameter using original-source 95% CI, or a ±10% range where it was unavailable. Results: in the 10 years horizon, patients were estimated to live an average of 4.4 years or 3.2 QALYs, with slight increases in the valsartan group. In this group, hospitalizations are predicted to be sensitively reduced and overall costs decreased by about 500 €/pz. In subgroup analysis, valsartan loses dominance in NYHAII and ACE-using patients, for which ICURs are 17,330 and 27,000 €/QALY, respectively. B.I. analysis predicts a saving of about 172 millions €. Conclusions: valsartan in addition to standard therapy

  1. Occurrence, aetiology and challenges in the management of congestive heart failure in sub-saharan Africa: experience of the Cardiac Centre in Shisong, Cameroon

    Directory of Open Access Journals (Sweden)

    Tantchou Tchoumi Jacques Cabral

    2011-02-01

    Full Text Available INTRODUCTION: The aim of the study was to investigate the occurrence, the aetiology and the management of congestive heart failure in the cardiac centre of the St. Elizabeth catholic general hospital Shisong in Cameroon. METHODS: Between November 2002 and November 2008, a population of 8121 patients was consulted in the referral cardiac centre of St. Elizabeth Catholic General Hospital. Of these patients, 462 were diagnosed with congestive heart failure according to the modified Framingham criteria for the diagnosis of heart failure. Complementary investigations used to confirm and establish the aetiology of the disease were the chest X-ray, electrocardiography, bi-dimensional Doppler echocardiography. RESULTS: The results showed that the occurrence of congestive heart failure in our centre was 5,7%. Congestive heart failure was diagnosed in 198 females and 264 males, aged between 8 and 86 years old (42.5, plus or minus 18 years old. Post rheumatic valvulopathies (14.6% and congenital heart diseases (1.9% were the first aetiologic factor of congestive heart failure in the young, meanwhile cardiomyopathies (8,3% in elderly followed by hypertensive cardiomyopathy (4.4%. Congestive heart failure was also seen in adults with congenital heart diseases in 0.01%. In this zone of Cameroon, we discovered that HIV cardiomyopathy (1.6% and Cor pulmonale (8% were represented, aetiological factors not mentioned in previous studies conducted in urban areas of Cameroon. The mean duration of hospital stay for the compensation treatment was thirteen days, ranging between 7 and 21 days, the mortality being 9.2%. All the medications recommended for the treatment of congestive heart failure are available in our centre but many patients are not compliant to the therapy or cannot afford them. Financial limitation is causing the exacerbation of the disease and premature death. CONCLUSION: Our data show a high incidence of congestive heart failure mainly due to post

  2. Clinical and echocardiographic characteristics and outcomes in congestive heart failure at the Hospital of The State University of Haiti.

    Science.gov (United States)

    Malebranche, Rodolphe; Tabou Moyo, Christian; Morisset, Paul-Henry; Raphael, Nernst-Atwood; Wilentz, James Robert

    2016-08-01

    This study aimed to evaluate the clinical and epidemiologic profile of congestive heart failure at the principal free-care hospital in Haiti. Cardiovascular disease represents the most prevalent cause of admissions to the medical service of the University Hospital of the State of Haiti. No previous study has examined the demographics of congestive heart failure in urban Haiti. Two hundred forty-seven patients presented to the inpatient service between May 2011 and May 2013. Evaluation included history and physical, CBC, renal/metabolic profile, serum glucose, anti-HIV antibody, ECG, chest radiograph and echocardiogram. Treatment included angiotensin converting enzyme inhibitors, furosemide and spironolactone, carvedilol, digoxin and anticoagulation. Women (62.4%) outnumbered men; patients were relatively young (mean age 50.1) and from the lowest socio-economic levels of the population. Nearly all (98.8%) presented with NYHA III-IV status, with correspondingly high mortality (23.3%). Echocardiography showed 73% dilated cardiomyopathy; 83% showed moderate to severe LV systolic dysfunction (mean EF 36.5 +/- 15%) and 17% preserved LV systolic function. The three principal etiologies were dilated cardiomyopathy (29%) hypertensive cardiomyopathy (27%) and peripartum cardiomyopathy (20%). Ischemic cardiomyopathy was rare (3.4%). At 27 months follow-up, 76.7% of the patients were alive and well. Among those who died, mean survival time was 113 days. Readmission carried a poor prognosis. This congestive heart failure study from Haiti shows an unusually high proportion of young women, primarily due to peripartum cardiomyopathy. Ischemic cardiomyopathy is rare, as in Africa. Further study is warranted to address the particular problem of the high frequency of peripartum cardiomyopathy in this population. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Cardiac MRI and Transthoracic Echocardiography of Left Ventricular Myocardial Noncompaction in A Patient with Congestive Heart Failure: A Case Report

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Eui Min; Byun, Joo Nam [Chosun University Hospital College of Medicine, Gwangju (Korea, Republic of); Kim, Dong Hun [Soonchunhyang University Hospital Bucheon College of Medicine, Bucheon (Korea, Republic of)

    2010-11-15

    We report a case of a 38-year-old male presenting with new-onset dyspnea, that was diagnosed as left ventricular noncompaction by transthoracic echocardiographic and cardiac MR. The tests revealed left ventricular systolic dysfunction with prominent trabeculations associated with deep intertrabecular recesses and an enddiastolic noncompacted to compacted ratio of 2.5 in the whole apical wall and mid-ventricular anterolateral and inferolateral walls. Delayed gadolinium contrast-enhanced MRI revealed subepicardial mid-wall hyperenhancement of the midventricular anteroseptal and inferoseptal walls, which suggested myocardial fibrosis. We review the pathophysiology, clinical characteristics, and diagnostic approach of the left ventricular noncompaction associated with congestive heart failure

  4. Evolution of a 90-day model of care for bundled episodic payments for congestive heart failure in home care.

    Science.gov (United States)

    Feld, April; Madden-Baer, Rose; McCorkle, Ruth

    2016-01-01

    The Centers for Medicare and Medicaid Services Innovation Center's Episode-Based Payment initiatives propose a large opportunity to reduce cost from waste and variation and stand to align hospitals, physicians, and postacute providers in the redesign of care that achieves savings and improve quality. Community-based organizations are at the forefront of this care redesign through innovative models of care aimed at bridging gaps in care coordination and reducing hospital readmissions. This article describes a community-based provider's approach to participation under the Bundled Payments for Care Improvement initiative and a 90-day model of care for congestive heart failure in home care.

  5. Norepinephrine, {beta}-adrenoceptor and {sup 123}I-MIBG myocardial scintigram in patients with congestive heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Kenichi; Miyajima, Seiichi; Kusano, Yoriko; Tanabe, Naohito [Tsubame Rosai Hospital, Niigata (Japan); Nagatomo, Takafumi

    1997-06-01

    Authors studied the relationships of norepinephrine (NE), {beta}-adrenoceptor and {sup 123}I-MIBG (meta-iodo-benzylguanidine) uptake in 26 patients with dilated cardiomyopathy or valvulitis. Blood NE concentrations were determined by high performance liquid chromatography in those patients and 10 healthy volunteers, and myocardial NE, in 7 patients and 5 cases without the congestive heart failure. The amounts of beta-receptors in lymphocytes of 21 patients and 7 volunteers and in myocardium obtained at autopsy of 3 patients and 3 other cases were estimated by the radioligand binding assay. Planar and SPECT images were taken at 15 min and 3 hr post intravenous administration of 111 MBq of {sup 123}I-MIBG. In the planar and SPECT images, the ratio heart/mediastinum (H/M) and MIBG uptake were computed respectively. Blood flow was evaluated by {sup 201}Tl scintigraphy. In patients with congestive heart failure, blood NE concentration was elevated and the number of lymphocytic and myocardial receptors was decreased. The H/M ratio was low. Low MIBG uptake was seen at the posterior to lateral wall. (K.H.)

  6. Effect of mibefradil on left ventricular diastolic function in patients with congestive heart failure

    NARCIS (Netherlands)

    Muntinga, HJ; vanderVring, JAFM; Niemeyer, MG; vandenBerg, F; Knol, HR; Bernink, PJLM; vanderWall, EE; Blanksma, PK; Lie, KI

    Calcium antagonists have antihypertensive and antianginal properties. In heart failure, however, their use can be hazardous, as systolic function can deteriorate. This may nor be true of the new calcium antagonist mibefradil, which has a new chemical structure. Calcium antagonists may also be

  7. Prognostic importance of a short deceleration time in symptomatic congestive heart failure

    DEFF Research Database (Denmark)

    Akkan, Dilek; Kjaergaard, Jesper; Møller, Jacob Eifer

    2008-01-01

    AIMS: A restrictive transmitral filling (RF) pattern predicts increased mortality in heart failure (HF) with reduced left ventricular (LV) systolic function. We performed a combined evaluation of LV function and RF for prognosis in patients with HF with and without systolic dysfunction. METHODS...

  8. Rapid recovery from congestive heart failure following successful radiofrequency catheter ablation in a patient with late onset of Wolff-Parkinson-White syndrome.

    Science.gov (United States)

    Yodogawa, Kenji; Ono, Norihiko; Seino, Yoshihiko

    2012-01-01

    A 56-year-old man was admitted because of palpitations and dyspnea. A 12-lead electrocardiogram showed irregular wide QRS complex tachycardia with a slur at the initial portion of the QRS complex. He had preexisting long-standing persistent atrial fibrillation, but early excitation syndrome had never been noted. Chest X-ray showed heart enlargement and pulmonary congestion. He was diagnosed with late onset of Wolff-Parkinson-White syndrome, and congestive heart failure was probably caused by rapid ventricular response of atrial fibrillation through the accessory pathway. Emergency catheter ablation for the accessory pathway was undertaken, and heart failure was dramatically improved.

  9. Disease management 360 degrees: a scorecard approach to evaluating TRICARE's programs for asthma, congestive heart failure, and diabetes.

    Science.gov (United States)

    Yang, Wenya; Dall, Timothy M; Zhang, Yiduo; Hogan, Paul F; Arday, David R; Gantt, Cynthia J

    2010-08-01

    To assess the effect of TRICARE's asthma, congestive heart failure, and diabetes disease management programs using a scorecard approach. EVALUATION MEASURES: Patient healthcare utilization, financial, clinical, and humanistic outcomes. Absolute measures were translated into effect size and incorporated into a scorecard. Actual outcomes for program participants were compared with outcomes predicted in the absence of disease management. The predictive equations were established from regression models based on historical control groups (n = 39,217). Z scores were calculated for the humanistic measures obtained through a mailed survey. Administrative records containing medical claims, patient demographics and characteristics, and program participation status were linked using an encrypted patient identifier (n = 57,489). The study time frame is 1 year prior to program inception through 2 years afterward (October 2005-September 2008). A historical control group was identified with the baseline year starting October 2003 and a 1-year follow-up period starting October 2004. A survey was administered to a subset of participants 6 months after baseline assessment (39% response rate). Within the observation window--24 months for asthma and congestive heart failure, and 15 months for the diabetes program--we observed modest reductions in hospital days and healthcare cost for all 3 programs and reductions in emergency visits for 2 programs. Most clinical outcomes moved in the direction anticipated. The scorecard provided a useful tool to track performance of 3 regional contractors for each of 3 diseases and over time.

  10. Investigation of iron deficiency in patients with congestive heart failure: A medical practice that requires greater attention.

    Science.gov (United States)

    Belmar Vega, Lara; de Francisco, Alm; Albines Fiestas, Zoila; Serrano Soto, Mara; Kislikova, María; Seras Mozas, Miguel; Unzueta, Mayte García; Arias Rodríguez, Manuel

    2016-01-01

    Iron deficiency in congestive heart failure (CHF), with or without concomitant anaemia, is associated with health-related quality of life, NYHA functional class, and exercise capacity. Prospective, randomised studies have demonstrated that correcting iron deficiency improves the quality of life and functional status of patients with CHF, including those who do not have anaemia. The aim of this study was to analyse how frequently these iron parameters are tested and thus determine the extent to which this quality improvement tool has been implemented in patients admitted with CHF. Retrospective observational study of patients from a university hospital diagnosed with CHF on admission between 01/01/2012 and 11/06/2013. Iron parameters were tested in 39% (324) of the 824 patients analysed. There was no significant difference in age between the patients whose iron was tested and those whose iron was not tested, but the difference in terms of gender was significant (P=.007). Glomerular filtration rate and haemoglobin, were significantly lower in the group of patients whose iron was tested (Prenal failure or both was significantly higher in the group of patients who had iron tests (Prenal failure (79 vs. 66%, respectively, P=.013), but not in terms of haemoglobin concentration. Congestive heart failure is very frequently associated with anaemia, iron deficiency and renal failure. Despite the fact that correcting iron deficiency is known to improve symptoms, testing of iron parameters in patients admitted with CHF is not performed as often as it should be. Copyright © 2016 Sociedad Española de Nefrología. Published by Elsevier España, S.L.U. All rights reserved.

  11. Beneficial effects of metoprolol on myocardial sympathetic function: Evidence from a randomized, placebo-controlled study in patients with congestive heart failure

    NARCIS (Netherlands)

    de Milliano, Paul A. R.; de Groot, Andre C.; Tijssen, Jan G. P.; van Eck-Smit, Berthe L. F.; van Zwieten, Pieter A.; Lie, Kong I.

    2002-01-01

    BACKGROUND: We sought to investigate whether beta-blockers exert a presynaptic effect in the myocardium as measured by 123I-metaiodobenzylguanidine. METHODS: The study comprised 59 patients with congestive heart failure, New York Heart Association class II or III, and left ventricular ejection

  12. Impact of beta-blocker treatment on the prognostic value of currently used risk predictors in congestive heart failure.

    Science.gov (United States)

    Zugck, Christian; Haunstetter, Armin; Krüger, Carsten; Kell, Robert; Schellberg, Dieter; Kübler, Wolfgang; Haass, Markus

    2002-05-15

    This prospective study tested the impact of beta-blocker treatment on currently used risk predictors in congestive heart failure (CHF). Given the survival benefit obtained by beta-blockade, risk stratification by factors established in the "pre-beta-blocker era" may be questioned. The study included 408 patients who had CHF with left ventricular ejection fraction (LVEF) 2.24 nmol/l (18% vs. 40%) and NT-proBNP >364 pmol/l (27% vs. 45%), although patients with beta-blocker treatment received only 37 +/- 21% of the maximal recommended beta-blocker dosages. The prognostic value of variables used for risk stratification of patients with CHF is markedly influenced by beta-blocker treatment. Therefore, in the beta-blocker era, a re-evaluation of the selection criteria for heart transplantation is warranted.

  13. Comparison of the Effects of Cross-validation Methods on Determining Performances of Classifiers Used in Diagnosing Congestive Heart Failure

    Directory of Open Access Journals (Sweden)

    Isler Yalcin

    2015-08-01

    Full Text Available Congestive heart failure (CHF occurs when the heart is unable to provide sufficient pump action to maintain blood flow to meet the needs of the body. Early diagnosis is important since the mortality rate of the patients with CHF is very high. There are different validation methods to measure performances of classifier algorithms designed for this purpose. In this study, k-fold and leave-one-out cross-validation methods were tested for performance measures of five distinct classifiers in the diagnosis of the patients with CHF. Each algorithm was run 100 times and the average and the standard deviation of classifier performances were recorded. As a result, it was observed that average performance was enhanced and the variability of performances was decreased when the number of data sections used in the cross-validation method was increased.

  14. Elderly women's experiences of support when living with congestive heart failure.

    Science.gov (United States)

    Sundin, Karin; Bruce, Elisabeth; Barremo, Ann-Sofi

    2010-03-04

    Heart failure is a chronic syndrome that has physiological, psychological and social effects. The aim of the study was to illuminate the meanings of support as experienced by elderly women with chronic heart failure. Narrative interviews were conducted with five elderly women with chronic heart failure. A phenomenological hermeneutic method of interpretation was used. The meanings of support were experienced by the women out of two perspectives, that is, when support is present and when there is a lack of support. The findings were revealed in two themes: "Feeling confident means support" and "Feeling abandoned". The women do not wish to be a burden. They want to be independent as much as possible to defend their dignity. An important support to the women is that they are understood and confirmed in their illness. Supportive relations are most valuable, that is, a relationship that supports the women's independence. If there is no supportive relationship, they feel like a burden to others and they feel lonely; this loneliness creates suffering and counteracts wellbeing and health.

  15. Chronic congestive heart failure. Description and survival of 190 consecutive patients with a diagnosis of chronic congestive heart failure based on clinical signs and symptoms

    DEFF Research Database (Denmark)

    Madsen, B K; Hansen, J F; Stokholm, K H

    1994-01-01

    with independent, significant prognostic information, (hazard ratios for death in brackets): ln (natural logarithm) (LVEF) (3.19), NYHA class III+IV (2.72), plasma urea > 7.6 mmol.l-1 (2.22), serum creatinine > 121 mumol.l-1 (2.05), serum sodium ....86), and age > 65 years (1.86). Multivariate analysis, including exercise testing, showed the following variables to contain independent, significant prognostic information: increase in heart rate during maximal exercise creatinine > 121 mumol.l-1 (2.9), maximal...... exercise time 7.6 mmol.l-1 (1.9). In conclusion, patients with CHF have a high risk of death despite intensive medical treatment. LVEF is a strong predictor of mortality. Both NYHA class and exercise...

  16. Risk stratification in middle-aged patients with congestive heart failure: prospective comparison of the Heart Failure Survival Score (HFSS) and a simplified two-variable model.

    Science.gov (United States)

    Zugck, C; Krüger, C; Kell, R; Körber, S; Schellberg, D; Kübler, W; Haass, M

    2001-10-01

    The performance of a US-American scoring system (Heart Failure Survival Score, HFSS) was prospectively evaluated in a sample of ambulatory patients with congestive heart failure (CHF). Additionally, it was investigated whether the HFSS might be simplified by assessment of the distance ambulated during a 6-min walk test (6'WT) instead of determination of peak oxygen uptake (peak VO(2)). In 208 middle-aged CHF patients (age 54+/-10 years, 82% male, NYHA class 2.3+/-0.7; follow-up 28+/-14 months) the seven variables of the HFSS: CHF aetiology; heart rate; mean arterial pressure; serum sodium concentration; intraventricular conduction time; left ventricular ejection fraction (LVEF); and peak VO(2), were determined. Additionally, a 6'WT was performed. The HFSS allowed discrimination between patients at low, medium and high risk, with mortality rates of 16, 39 and 50%, respectively. However, the prognostic power of the HFSS was not superior to a two-variable model consisting only of LVEF and peak VO(2). The areas under the receiver operating curves (AUC) for prediction of 1-year survival were even higher for the two-variable model (0.84 vs. 0.74, P<0.05). Replacing peak VO(2) with 6'WT resulted in a similar AUC (0.83). The HFSS continued to predict survival when applied to this patient sample. However, the HFSS was inferior to a two-variable model containing only LVEF and either peak VO(2) or 6'WT. As the 6'WT requires no sophisticated equipment, a simplified two-variable model containing only LVEF and 6'WT may be more widely applicable, and is therefore recommended.

  17. Chronic heart failure

    OpenAIRE

    Hopper, Ingrid; Easton, Kellie

    2017-01-01

    1. The common symptoms and signs of chronic heart failure are dyspnoea, ankle swelling, raised jugular venous pressure and basal crepitations. Other conditions may be confused with chronic heart failure, including dependent oedema or oedema due to renal or hepatic disease. Shortness of breath may be due to respiratory disease or severe anaemia. Heart failure secondary to lung disease (cor pulmonale) should be distinguished from congestive cardiac failure. Heart failure may also present with l...

  18. Impact of congestive heart failure and left ventricular systolic function on the prognostic significance of atrial fibrillation and atrial flutter following acute myocardial infarction

    DEFF Research Database (Denmark)

    Pedersen, Ole Dyg; Bagger, Henning; Køber, Lars

    2005-01-01

    fibrillation in acute myocardial infarction patients that might explain previous discrepancies. METHODS: The study population was 6676 patients consecutively admitted to hospital with acute myocardial infarction. Information on the presence of atrial fibrillation/flutter, left ventricular systolic function......BACKGROUND: Reports on the prognostic importance of atrial fibrillation following myocardial infarction have provided considerable variation in results. Thus, this study examined the impact of left ventricular systolic function and congestive heart failure on the prognostic importance of atrial...... and congestive heart failure were prospectively collected. Mortality was followed for 5 years. RESULTS: In patients with left ventricular ejection fraction

  19. Levosimendan treatment of severe acute congestive heart failure refractory to dobutamine/milrinone in children

    Directory of Open Access Journals (Sweden)

    Prijić Sergej

    2011-01-01

    Full Text Available Introduction. Levosimendan is a novel positive inotropic agent which, improves myocardial contractility through its calcium-sensitizing action, without causing an increase in myocardial oxygen demand. Also, by opening ATP-sensitive potassium channels, it causes vasodilatation with the reduction in both afterload and preload. Because of the long halflife, its effects last for up 7 to 9 days after 24-hour infusion. Case report. We presented three patients 2, 15 and 17 years old. All the patients had severe acute deterioration of the previously diagnosed chronic heart failure (dilatative cardiomyopathy; univentricular heart with bidirectional Glenn anastomosis and restrictive bulboventricular foramen; bacterial endocarditis on artificial aortic valve with severe stenosis and regurgitation. Signs and symptoms of severe heart failure, cardiomegaly (cardio-thoracic index 0.65 and left ventricular dilatation (end-diastolic diameter z-score 2.6; 4.1 and 4.0 were confirmed on admission. Also, myocardial contractility was poor with ejection fraction (EF - 27%, 25%, 35%, fractional shortening (FS - 13%, 11%, 15% and stroke volume (SV - 40, 60, 72 mL/m2. The treatment with standard intravenous inotropic agents resulted in no improvement but in clinical deterioration. Thus, standard intravenous inotropic support was stopped and levosimendan treatment was introduced. All the patients received a continuous 24-h infusion 0.1 μg/kg/min of levosimendan. In a single patient an initial loading dose of 11 μg/kg over 10 min was administrated, too. Levosimendan treatment resulted in both clinical and echocardiography improvement with the improved EF (42%, 34%, 44%, FS (21%, 16%, 22% and SV (59, 82, 93 mL/m2. Hemodynamic improvement was registered too, with the reduction in heart rate in all the treated patients from 134-138 bpm before, to less than 120 bpm after the treatment. These parameters were followed by the normalization of lactate levels. Nevertheless, left

  20. Dofetilide in patients with congestive heart failure and left ventricular dysfunction. Danish Investigations of Arrhythmia and Mortality on Dofetilide Study Group

    DEFF Research Database (Denmark)

    Torp-Pedersen, C; Møller, M; Bloch-Thomsen, P E

    1999-01-01

    patients with symptomatic congestive heart failure and severe left ventricular dysfunction at 34 Danish hospitals. We randomly assigned 762 patients to receive dofetilide, a novel class III antiarrhythmic agent, and 756 to receive placebo in a double-blind study. Treatment was initiated in the hospital...... and reduced left ventricular function, dofetilide was effective in converting atrial fibrillation, preventing its recurrence, and reducing the risk of hospitalization for worsening heart failure. Dofetilide had no effect on mortality....

  1. Study on plasma levels of brain natriuretic peptide, angiotensin and aldosterone in patients with congestive heart failure

    International Nuclear Information System (INIS)

    Cheng Yu; Hong Liquan; Chen Zhaojun

    2009-01-01

    Objective: To investigate the relationship between brain natriuretic peptide (BNP), angiotensin (AT-II), and aldosterone (ALD) levels in patients with congestive heart failure (CHF). Methods: Plasma levels of BNP (with CLIA) and Angiotensin II (AT-II), aldosterone (ALD) (with RIA) were measured in 98 patients with CHF, 76 cardiac patients without heart faclure, and 86 controls. Results: The plasma levels of BNP, AT-II and ALD in patients (with RIA) CHF were significantly higher than those in the controls. The levels of BNP, AT-II and ALD, CHF patients after therapy were markedly dropped and were significantly lower than those patients before therapy (P<0.01). BNP levels were positively correlated with AT-II and ALD in levels CHF (P<0.05). Conclusion: The over activity of RAA systems may be one of the mechanisms of heart failure. Dynamic observation of changes of BNP, AT-II and ALD may be very useful in assessment of severity and prognosis of patients with CHF. (authors)

  2. Increased serum C-reactive protein concentrations in dogs with congestive heart failure due to myxomatous mitral valve disease

    DEFF Research Database (Denmark)

    Reimann, M. J.; Ljungvall, I.; Hillstrom, A.

    2016-01-01

    Cardiovascular disease in humans and dogs is associated with mildly increased circulating concentrations of C-reactive protein (CRP). Few studies have evaluated associations between circulating CRP and canine myxomatous mitral valve disease (MMVD) and the results reported have been divergent....... The aim of this study was to investigate whether serum concentrations of CRP, determined using a novel automated canine-specific high -sensitivity CRP assay (Gentian hsCRP), were associated with severity of MMVD and selected clinical variables in dogs. The study included 188 client-owned dogs...... with different severities of MMVD. Dogs were classified based on ACVIM consensus statement guidelines (group A, n = 58; group BI, n = 56; group B2, n = 38; group C, n = 36). Data were analysed using descriptive statistics and multiple regression analysis. Dogs with congestive heart failure (CHF; group C) had...

  3. Intestinal congestion and right ventricular dysfunction: a link with appetite loss, inflammation, and cachexia in chronic heart failure.

    Science.gov (United States)

    Valentova, Miroslava; von Haehling, Stephan; Bauditz, Juergen; Doehner, Wolfram; Ebner, Nicole; Bekfani, Tarek; Elsner, Sebastian; Sliziuk, Veronika; Scherbakov, Nadja; Murín, Ján; Anker, Stefan D; Sandek, Anja

    2016-06-01

    Mechanisms leading to cachexia in heart failure (HF) are not fully understood. We evaluated signs of intestinal congestion in patients with chronic HF and their relationship with cachexia. Of the 165 prospectively enrolled outpatients with left ventricular ejection fraction ≤40%, 29 (18%) were cachectic. Among echocardiographic parameters, the combination of right ventricular dysfunction and elevated right atrial pressure (RAP) provided the best discrimination between cachectic and non-cachectic patients [area under the curve 0.892, 95% confidence interval (CI): 0.832-0.936]. Cachectic patients, compared with non-cachectic, had higher prevalence of postprandial fullness, appetite loss, and abdominal discomfort. Abdominal ultrasound showed a larger bowel wall thickness (BWT) in the entire colon and terminal ileum in cachectic than in non-cachectic patients. Bowel wall thickness correlated positively with gastrointestinal symptoms, high-sensitivity C-reactive protein, RAP, and truncal fat-free mass, the latter serving as a marker of the fluid content. Logistic regression analysis showed that BWT was associated with cachexia, even after adjusting for cardiac function, inflammation, and stages of HF (odds ratio 1.4, 95% CI: 1.0-1.8; P-value = 0.03). Among the cardiac parameters, only RAP remained significantly associated with cachexia after multivariable adjustment. Cardiac cachexia was associated with intestinal congestion irrespective of HF stage and cardiac function. Gastrointestinal discomfort, appetite loss, and pro-inflammatory activation provide probable mechanisms, by which intestinal congestion may trigger cardiac cachexia. However, our results are preliminary and larger studies are needed to clarify the intrinsic nature of this relationship. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

  4. PROGNOSTIC FACTORS FOR SURVIVAL AT 6-MONTH FOLLOW-UP OF HOSPITALIZED PATIENTS WITH DECOMPENSATED CONGESTIVE HEART FAILURE

    Directory of Open Access Journals (Sweden)

    Mostafa Cheraghi

    2010-12-01

    Full Text Available Abstract:BACKGROUND: The prevalence of Congestive Heart Failure (CHF is increasing in recent years. Factors associated with mortality in CHF patients are important to be determined in order to select therapeutic modality by physicians. The purpose of the current study was to declare predictors of 6-months survival in patients hospitalized for decompensated CHF in Isfahan.METHODS: A cohort of 301 hospitalized patients with decompensated CHF were recruited in this study. The diagnosis of CHF was based on previous hospitalizations and Framingham criteria for heart failure (HF. Information regarding past history, accompanying diseases such as cerebrovascular accidents (CVA, chronic obstructive pulmonary diseases (COPD, clinical data, medications and echocardiography were obtained by a cardiologist. Patients were followed for their survival for 6 months by telephone calls. Kaplan-Meier method was used for uni variate survival analysis and Cox proportional hazard model was used for multivariate analysis.RESULTS: Mean age of patients was 71.9 ± 12.2 years and 59.8% was male. During 6-months follow-up 138 (45.8% patients died. Mean survival was 119.2 ± 4.4 days (Mean ± SEM. Significant prognostic factors for 6 months survival were high education level (HR = 0.74, CI 95% 0.59—0.93, COPD (HR = 1.91, CI 95% 1.2—3.04, CVA (HR = 1.69, CI 95% 1.03—2.78, Angiotensin Converting enzyme (ACE inhibitors use (HR = 0.44, CI 95% 0.3—0.66 and Diuretics (HR = 0.63, CI 95% 0.41-0.96.CONCLUSION: Six-month survival of hospitalized decompensated CHF patients in Iran is not favorable. Many factors particularly accompanying diseases and medications affected the patient’s 6-months survival.Keywords: Heart failure, Survival,  Mortality.

  5. Short-term assessment of left ventricular function, coronary hemodynamics, and catecholamine balance in severe congestive heart failure after a single oral dose of milrinone

    NARCIS (Netherlands)

    F. Piscione; B.E. Jaski; P.W.J.C. Serruys (Patrick)

    1988-01-01

    textabstractSystemic and coronary hemodynamics were measured before and every 10 min after oral milrinone (10 mg) administration for 50 min, together with the drug plasma level in 14 patients with congestive heart failure. Left ventricular pressure (tip manometry), volume (angiography), and derived

  6. Influence of age on the prognostic importance of left ventricular dysfunction and congestive heart failure on long-term survival after acute myocardial infarction. TRACE Study Group

    DEFF Research Database (Denmark)

    Køber, L; Torp-Pedersen, C; Ottesen, M

    1996-01-01

    for entry into the TRAndolapril Cardiac Evaluation (TRACE) study. Medical history, echocardiographic estimation of LV systolic function determined as wall motion index, infarct complications, and survival were documented for all patients. To study the importance of congestive heart failure and wall motion...... dysfunction was more pronounced in the elderly than in the young....

  7. Hemodynamic effect and safety of intermittent sequential pneumatic compression leg sleeves in patients with congestive heart failure.

    Science.gov (United States)

    Bickel, Amitai; Shturman, Alexander; Sergeiev, Michael; Ivry, Shimon; Eitan, Arieh; Atar, Shaul

    2014-10-01

    Pneumatic leg sleeves are widely used after prolonged operations for prevention of venous stasis. In healthy volunteers they increase cardiac function. We evaluated the hemodynamic effects and safety of intermittent sequential pneumatic compression (ISPC) leg sleeves in patients with chronic congestive heart failure (CHF). We studied 19 patients with systolic left ventricular dysfunction and CHF. ISPC leg sleeves, each with 10 air cells, were operated by a computerized compressor, exerting 2 cycles/min. Hemodynamic and echocardiographic parameters were measured before, during, and after ISPC activation. The baseline mean left ventricular ejection fraction was 29 ± 9.2%, median 32%, range 10%-40%. Cardiac output (from 4.26 to 4.83 L/min; P = .008) and stroke volume (from 56.1 to 63.5 mL; P = .029) increased significantly after ISPC activation, without a reciprocal increase in heart rate, and declined after sleeve deactivation. Systemic vascular resistance (SVR) decreased significantly (from 1,520 to 1,216 dyne-s/cm5; P = .0005), and remained lower than the baseline level throughout the study. There was no detrimental effect on diastolic function and no adverse clinical events, despite increased pulmonary venous return. ISPC leg sleeves in patients with chronic CHF do not exacerbate symptoms and transiently improve cardiac output through an increase in stroke volume and a reduction in SVR. Copyright © 2014 Elsevier Inc. All rights reserved.

  8. Surgery of congestive heart failure - the role of computed tomography in the pre- and postsurgical diagnostic evaluation

    International Nuclear Information System (INIS)

    Lembcke, A.; Kivelitz, D.E.; Rogalla, P.; Dewey, M.; Klessen, C.; Hamm, B.; Enzweiler, C.N.H.; Dohmen, P.M.; Konertz, W.F.; Wiese, T.H.

    2005-01-01

    The treatment of advanced, drug resistant congestive heart failure gains in importance in the field of cardiac surgery. Cardiac imaging for preoperative assessment and follow-up focuses on the determination of ventricular volumes and function as well as on the detection of postoperative complications. Computed tomography (CT) is highly accurate irrespective of the individual patient's anatomic situation, has a low examiner dependence and short examination time, does not require an arterial vascular access and can be performed in patients with metal implants. CT is the modality of choice in the follow-up of heart transplants to detect extracardiac and cardiac complications including coronary calcifications as an early sign of transplant vasculopathy. In addition, CT visualizes the elements of mechanical assist devices and can identify their possible local cardiac and mediastinal complications CT can detect fibrolipomatous involution of the mobilized muscle flap in dynamic cardiomyoplasty and can depict fibrous reactions along the epicardial mesh implant in passive cardiac containment. Further indications include assessment of typical local postoperative complications, such as intrathoracic infection and mediastinal bleeding, intracardiac thrombus formation or pericardial effusion. CT is routinely used for evaluating bypass patency but is limited in assessing associated valve defects since it does not visualize flow. (orig.)

  9. Clinical usefulness of 123I-MIBG myocardial scintigraphy as a marker of the severity and prognosis of congestive heart failure

    International Nuclear Information System (INIS)

    Shiga, Koji

    1999-01-01

    To evaluate the clinical usefulness of 123 I-MIBG myocardial scintigraphy in patients with congestive heart failure. Myocardial dynamic imaging was performed immediately after 123 I-MIBG administration at 1 frame/sec for 500 sec in 52 patients with or without congestive heart failure. The %uptake/ROI, dynamic heart to mediastinum uptake ratio (H/M) and dynamic washout rate (WR) were calculated from their time activity curves to assess the relationship between the NYHA functional class and these values. In 52 other patients with heart failure, the initial and delayed MIBG anterior planar images were obtained, and H/M in delayed images and WR between initial and delayed images were measured. The patients were followed up for 31.8±16.8 months, and their survival rates were compared among three groups, H/M 123 I-MIBG myocardial scintigraphy is very useful to diagnose the severity and prognosis in patients with congestive heart failure. (K.H.)

  10. Prognostic value of myocardial 123I-BMIPP imaging in patients with congestive heart failure without coronary artery disease

    International Nuclear Information System (INIS)

    Narita, Michihiro; Kurihara, Tadashi; Sindoh, Takashi; Sawada, Yoshihiro; Honda, Minoru

    1998-01-01

    We performed 123 I-BMIPP (BMIPP) imaging in order to clarify the characteristics of fatty acid metabolism and its effect on prognosis in patients with congestive heart failure (CHF) without coronary artery disease. We studied 15 normal subjects and 42 patients with CHF (idiopathic dilated cardiomyopathy; 24, hypertensive heart disease; 12, valvular heart disease; 6). We obtained cardiac imaging with BMIPP and 201 Tl at rest on separate days before discharge. Using whole body imaging, the ratio of cardiac uptake of the isotope to total injected dose was calculated (%Uptake). We calculated the cardiac uptake ratio of BMIPP (%Uptake of BMIPP divided by %Uptake of 201 Tl), percent washout of BMIPP from the heart over 3 hours and unhomogeneity of myocardial distribution of BMIPP (coefficient of variation of BMIPP, CV) as scintigraphic parameters. Cardiac events were defined as cardiac death or deterioration of CHF which requiring readmission. Uptake ratio (CHF; 0.91±0.17, normal; 1.10±0.09, p=0.0000) and CV (CHF; 20±5, normal; 16±5, p=0.0385) were different significantly between CHF and normal subjects. During the follow-up period of 27.2±14.4 months (4.5-53.5 months) cardiac events developed in 15 patients (cardiac death; 8, deterioration of CHF; 7). In univariate analysis, % uptake of 201 Tl, uptake ratio, % FS, serum norepinephrine level and serum renin activity were different significantly between event and event-free groups. Cox proportional hazard analysis showed that the uptake ratio (p=0.0000) and age (p=0.018) were independent predictors of cardiac events. In patients with uptake ratio less than 0.88, relative risks of cardiac events was 23.7 times greater than in patients with uptake ratio more than 0.89. These data suggested that in patients with CHF fatty acid metabolism was deteriorated and cardiac uptake of BMIPP was a strong and independent predictor of long-term prognosis in patients with heart failure. (author)

  11. Prognostic value of myocardial {sup 123}I-BMIPP imaging in patients with congestive heart failure without coronary artery disease

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Michihiro; Kurihara, Tadashi; Sindoh, Takashi; Sawada, Yoshihiro; Honda, Minoru [Sumitomo Hospital, Osaka (Japan)

    1998-04-01

    We performed {sup 123}I-BMIPP (BMIPP) imaging in order to clarify the characteristics of fatty acid metabolism and its effect on prognosis in patients with congestive heart failure (CHF) without coronary artery disease. We studied 15 normal subjects and 42 patients with CHF (idiopathic dilated cardiomyopathy; 24, hypertensive heart disease; 12, valvular heart disease; 6). We obtained cardiac imaging with BMIPP and {sup 201}Tl at rest on separate days before discharge. Using whole body imaging, the ratio of cardiac uptake of the isotope to total injected dose was calculated (%Uptake). We calculated the cardiac uptake ratio of BMIPP (%Uptake of BMIPP divided by %Uptake of {sup 201}Tl), percent washout of BMIPP from the heart over 3 hours and unhomogeneity of myocardial distribution of BMIPP (coefficient of variation of BMIPP, CV) as scintigraphic parameters. Cardiac events were defined as cardiac death or deterioration of CHF which requiring readmission. Uptake ratio (CHF; 0.91{+-}0.17, normal; 1.10{+-}0.09, p=0.0000) and CV (CHF; 20{+-}5, normal; 16{+-}5, p=0.0385) were different significantly between CHF and normal subjects. During the follow-up period of 27.2{+-}14.4 months (4.5-53.5 months) cardiac events developed in 15 patients (cardiac death; 8, deterioration of CHF; 7). In univariate analysis, % uptake of {sup 201}Tl, uptake ratio, % FS, serum norepinephrine level and serum renin activity were different significantly between event and event-free groups. Cox proportional hazard analysis showed that the uptake ratio (p=0.0000) and age (p=0.018) were independent predictors of cardiac events. In patients with uptake ratio less than 0.88, relative risks of cardiac events was 23.7 times greater than in patients with uptake ratio more than 0.89. These data suggested that in patients with CHF fatty acid metabolism was deteriorated and cardiac uptake of BMIPP was a strong and independent predictor of long-term prognosis in patients with heart failure. (author)

  12. Prevalence and prognosis of congestive heart failure in Saudi patients admitted with acute coronary syndrome (from SPACE registry).

    Science.gov (United States)

    Albackr, Hanan B; Alhabib, Khalid F; Ullah, Anhar; Alfaleh, Hussam; Hersi, Ahmad; Alshaer, Fayez; Alnemer, Khalid; Al Saif, Shukri; Taraben, Amir; Kashour, Tarek

    2013-11-01

    The aim of this study was to assess the prevalence, clinical features, and in-hospital outcomes of heart failure in patients with acute coronary syndrome (ACS). The Saudi Project for Assessment of Coronary Events recruited patients admitted with ACS from 17 hospitals in Saudi Arabia from 2005 to 2007. The outcomes of ACS patients with congestive heart failure (CHF) compared with those without CHF were analyzed. A total of 4523 patients with ACS were identified, of whom 905 (20%) had CHF. Compared with no CHF, patients with CHF were older (62±13.1 vs. 57±12.9 years; P=0.001), less likely to be men (70 vs. 79%; P=0.001), likely to present with non-ST-segment elevation myocardial infarction (48 vs. 36%; P=0.001), likely to have diabetes (71 vs. 54%; P=0.001), hypertension (64 vs. 54%; P=0.001) and previous history of coronary artery disease (53 vs. 43%; P=0.001), and likely to have significant left ventricular systolic dysfunction (left ventricular ejection fraction coronary intervention (19 vs. 50%; P=0.001). Adjusted in-hospital mortality and cardiogenic shock were higher in the CHF group (odds ratio 4.43, 95% confidence interval 2.52-7.78; and odds ratio 3.51, 95% confidence interval 2.23-5.52), respectively. ACS patients with CHF in the Saudi Project for Assessment of Coronary Events were older, more likely to have more cardiac risk factors, and less likely to be treated with optimum medical treatment on admission. These findings were associated with higher incidence of their in-hospital adverse outcomes. More aggressive treatment is warranted to improve prognosis.

  13. Preservation of Skin Integrity in Heart Failure

    OpenAIRE

    DEMİR BARUTCU, Canan

    2018-01-01

    Congestive heart failure is an international health problem with its high incidence, prevalence, morbidity and mortality rates. Congestive heart failure is the most common reason of hospitalization in patients older than 65 and it causes more than a million hospitalizations a year. Patients with congestive heart failure experience a number of complications due to physiopathologic reasons, side effects of drugs, accompanying comorbid diseases and limitations caused by congestive heart failure....

  14. Beneficial hemodynamic effects of nicorandil in a canine model of acute congestive heart failure: comparison with nitroglycerin and cromakalim.

    Science.gov (United States)

    Noguchi, K; Matsuzaki, T; Ojiri, Y; Koyama, T; Nakasone, J; Sakanashi, M

    1998-01-01

    Comparative hemodynamic effects of nicorandil (NCR), nitroglycerin (NTG) and cromakalim (CRM) were examined in a canine model of acute congestive heart failure (CHF). CHF was produced by injections of saponin into coronary arteries of anesthetized dogs followed by volume loading and continuous i.v. infusion of methoxamine. After the treatment, aortic blood flow (AoF), left ventricular dP/dt and myocardial segment shortening (SS) markedly decreased, while the left ventricular end-diastolic pressure (LVEDP), the right atrial pressure (RAP) and the systemic vascular resistance (SVR) increased. NCR (n = 6), NTG (n = 6) and CRM (n = 8), which were administered i.v. after production of CHF, caused a comparable reduction in LVEDP. NCR and CRM profoundly increased AoF and SS but NTG did only slightly. On the other hand, NTG and NCR but not CRM significantly reduced RAP. Intracoronary NCR (n = 8) exerted no or similar effects on SS as well as systemic hemodynamic indices to those observed with i.v. NCR despite distinct coronary vasodilation. These results indicate that NCR may exert beneficial hemodynamic effects in an experimental CHF mainly due to lessening both afterload and preload rather than the coronary vasodilating effect.

  15. TVP1022 attenuates cardiac remodeling and kidney dysfunction in experimental volume overload-induced congestive heart failure.

    Science.gov (United States)

    Abassi, Zaid A; Barac, Yaron D; Kostin, Sawa; Roguin, Ariel; Ovcharenko, Elena; Awad, Hoda; Blank, Ayelet; Bar-Am, Orit; Amit, Tamar; Schaper, Jutta; Youdim, Moussa; Binah, Ofer

    2011-07-01

    Despite the availability of many pharmacological and mechanical therapies, the mortality rate among patients with congestive heart failure (CHF) remains high. We tested the hypothesis that TVP1022 (the S-isomer of rasagiline; Azilect), a neuroprotective and cytoprotective molecule, is also cardioprotective in the settings of experimental CHF in rats. In rats with volume overload-induced CHF, we investigated the therapeutic efficacy of TVP1022 (7.5 mg/kg) on cardiac function, structure, biomarkers, and kidney function. Treatment with TVP1022 for 7 days before CHF induction prevented the increase in left ventricular end-diastolic area and end-systolic area, and the decrease in fractional shortening measured 14 days after CHF induction. Additionally, TVP1022 pretreatment attenuated CHF-induced cardiomyocyte hypertrophy, fibrosis, plasma and ventricular B-type natriuretic peptide levels, and reactive oxygen species expression. Further, in CHF rats, TVP1022 decreased cytochrome c and caspase 3 expression, thereby contributing to the cardioprotective efficacy of the drug. TVP1022 also enhanced the urinary Na(+) excretion and improved the glomerular filtration rate. Similar cardioprotective effects were obtained when TVP1022 was given to rats after CHF induction. TVP1022 attenuated the adverse functional, structural, and molecular alterations in CHF, rendering this drug a promising candidate for improving cardiac and renal function in this disease state.

  16. Quantitative 1H MR spectroscopy of the brain in patients with congestive heart failure before and after cardiac transplantation

    International Nuclear Information System (INIS)

    Lim, Soo Mee; Lee, Ho Kyu; Choi, Choong Gon; Lim, Tae Hwan; Lee, Jung Hee

    1999-01-01

    To evaluate the effects of cardiac transplantation on the brain in patients with congestive heart failure (CHF), using quantitative 1 H MR spectroscopy ( 1 H-MRS). Ten patients with CHF underwent MRI and quantitative 1 H-MRS before and 1-2 and 4-9 months after cardiac transplantation. MR spectra were obtained from parietal white matter (PWM) and occipital gray matter (OGM) using PROBE (PROton Brain Exam). Changes in MR signal intensity were evaluated, and the cerebral metabolic concentrations in PWM and OGM were compared. For comparative purposes, 20 normal volunteers were included. No abnormal MR signal intensity was seen in the brain before or after cardiac transplantation. Changes in cerebral metabolic concentrations were observed on 1 H-MRS; concentrations of creatine (Cr) in PWM, and of N-acetylacepartate (NAA), Cr and myo-Inositol(mI) in OGM were significantly lower before transplantation. After successful transplantation, Cr levels returned to their normal range in PWM and OGM, while a slightly increase choline (Cho) level was observed in PWM. Cerebral hypoperfusion in CHF can be evaluated using 1 H-MRS. MRS may play a substantial role in monitoring the effect of cardiac transplantation

  17. Right ventricular ejection fraction: an indicator of increased mortality in patients with congestive heart failure associated with coronary artery disease

    International Nuclear Information System (INIS)

    Polak, J.F.; Holman, B.L.; Wynne, J.; Colucci, W.S.

    1983-01-01

    The predictive value of radionuclide ventriculography was studied in 34 patients with depressed left ventricular ejection fraction (less than 40%) and clinically evident congestive heart failure secondary to atherosclerotic coronary artery disease. In addition to left ventricular ejection fraction, right ventricular ejection fraction and extent of left ventricular paradox were obtained in an attempt to identify a subgroup at increased risk of mortality during the ensuing months. The 16 patients who were alive after a 2 year follow-up period had a higher right ventricular ejection fraction and less extensive left ventricular dyskinesia. When a right ventricular ejection fraction of less than 35% was used as a discriminant, mortality was significantly greater among the 21 patients with a depressed right ventricular ejection fraction (71 versus 23%), a finding confirmed by a life table analysis. It appears that the multiple factors contributing to the reduction in right ventricular ejection fraction make it a useful index not only for assessing biventricular function, but also for predicting patient outcome

  18. Intensive symptom control of opioid-refractory dyspnea in congestive heart failure: Role of milrinone in the palliative care unit.

    Science.gov (United States)

    Silvestre, Julio; Montoya, Maria; Bruera, Eduardo; Elsayem, Ahmed

    2015-12-01

    We describe an exemplary case of congestive heart failure (CHF) symptoms controlled with milrinone. We also analyze the benefits and risks of milrinone administration in an unmonitored setting. We describe the case of a patient with refractory leukemia and end-stage CHF who developed severe dyspnea after discontinuation of milrinone. At that point, despite starting opioids, she had been severely dyspneic and anxious, requiring admission to the palliative care unit (PCU) for symptom control. After negotiation with hospital administrators, milrinone was administered in an unmonitored setting such as the PCU. A multidisciplinary team approach was also provided. Milrinone produced a dramatic improvement in the patient's symptom scores and performance status. The patient was eventually discharged to home hospice on a milrinone infusion with excellent symptom control. This case suggests that milrinone may be of benefit for short-term inpatient administration for dyspnea management, even in unmonitored settings and consequently during hospice in do-not-resuscitate (DNR) patients. This strategy may reduce costs and readmissions to the hospital related to end-stage CHF.

  19. Study on clinical value of determination of plasma brain natriuretic peptide levels in patients with chronic congestive heart failure

    International Nuclear Information System (INIS)

    Chen Jianxiong; Li Zhuocheng; Tu Hong

    2010-01-01

    Objective: To evaluate the clinical value of determination of plasma brain natriuretic peptide (BNP) levels in patients with chronic congestive heart failure(CHF). Methods: The levels of plasma BNP were measured with fluorescence immunoassay in 341 patients with chronic CHF and 55 controls. Left ventricular ejection fraction (LVEF), left ventricular end systolic diameter (LVESD) and left ventricular end diastolic diameter (LVEDD) were determined with color doppler ultrasonography in CHF patients. Results: Plasma levels of BNP were significantly increased in patients with CHF as compared with those in controls (P<0.01). There were also significant differences in plasma levels of CHF patients of different clinical stages (P<0.01). There was obvious correlation between plasma levels of BNP and the values of LVEF, LVESD and LVEDD (r was-0.62, +0.54 and +0.60 respectively, P<0.01). Conclusion: Plasma level of BNP is a sensitive indicator for assessment of ventricle function in CHF patients. (authors)

  20. Quantitative {sup 1}H MR spectroscopy of the brain in patients with congestive heart failure before and after cardiac transplantation

    Energy Technology Data Exchange (ETDEWEB)

    Lim, Soo Mee; Lee, Ho Kyu; Choi, Choong Gon; Lim, Tae Hwan [Asan Medical Center, Ulsan Univ. College of Medicine, Ulsan (Korea, Republic of); Lee, Jung Hee [Asan Institute for Life Sciences, Seoul (Korea, Republic of)

    1999-12-01

    To evaluate the effects of cardiac transplantation on the brain in patients with congestive heart failure (CHF), using quantitative {sup 1}H MR spectroscopy ({sup 1}H-MRS). Ten patients with CHF underwent MRI and quantitative {sup 1}H-MRS before and 1-2 and 4-9 months after cardiac transplantation. MR spectra were obtained from parietal white matter (PWM) and occipital gray matter (OGM) using PROBE (PROton Brain Exam). Changes in MR signal intensity were evaluated, and the cerebral metabolic concentrations in PWM and OGM were compared. For comparative purposes, 20 normal volunteers were included. No abnormal MR signal intensity was seen in the brain before or after cardiac transplantation. Changes in cerebral metabolic concentrations were observed on {sup 1}H-MRS; concentrations of creatine (Cr) in PWM, and of N-acetylacepartate (NAA), Cr and myo-Inositol(mI) in OGM were significantly lower before transplantation. After successful transplantation, Cr levels returned to their normal range in PWM and OGM, while a slightly increase choline (Cho) level was observed in PWM. Cerebral hypoperfusion in CHF can be evaluated using {sup 1}H-MRS. MRS may play a substantial role in monitoring the effect of cardiac transplantation.

  1. Heart Failure

    Science.gov (United States)

    Heart failure is a condition in which the heart can't pump enough blood to meet the body's needs. Heart failure does not mean that your heart has stopped ... and shortness of breath Common causes of heart failure are coronary artery disease, high blood pressure and ...

  2. Burned out myocardium in biventricular hypertrophic cardiomyopathy presenting with congestive heart failure: Importance of ECG changes

    Directory of Open Access Journals (Sweden)

    Christer Backman

    2014-01-01

    Full Text Available A 60 year old man was found to have a heart murmur and ECG features of ventricular hypertrophy on a medical check up for military recruitment at age of 20, despite having swimming as the only exercise. His mother had 3 survived children out of 9 pregnancies.

  3. Prognostic Significance of Creatinine Increases During an Acute Heart Failure Admission in Patients With and Without Residual Congestion: A Post Hoc Analysis of the PROTECT Data.

    Science.gov (United States)

    Metra, Marco; Cotter, Gad; Senger, Stefanie; Edwards, Christopher; Cleland, John G; Ponikowski, Piotr; Cursack, Guillermo C; Milo, Olga; Teerlink, John R; Givertz, Michael M; O'Connor, Christopher M; Dittrich, Howard C; Bloomfield, Daniel M; Voors, Adriaan A; Davison, Beth A

    2018-05-01

    The importance of a serum creatinine increase, traditionally considered worsening renal function (WRF), during admission for acute heart failure has been recently debated, with data suggesting an interaction between congestion and creatinine changes. In post hoc analyses, we analyzed the association of WRF with length of hospital stay, 30-day death or cardiovascular/renal readmission and 90-day mortality in the PROTECT study (Placebo-Controlled Randomized Study of the Selective A1 Adenosine Receptor Antagonist Rolofylline for Patients Hospitalized With Acute Decompensated Heart Failure and Volume Overload to Assess Treatment Effect on Congestion and Renal Function). Daily creatinine changes from baseline were categorized as WRF (an increase of 0.3 mg/dL or more) or not. Daily congestion scores were computed by summing scores for orthopnea, edema, and jugular venous pressure. Of the 2033 total patients randomized, 1537 patients had both available at study day 14. Length of hospital stay was longer and 30-day cardiovascular/renal readmission or death more common in patients with WRF. However, these were driven by significant associations in patients with concomitant congestion at the time of assessment of renal function. The mean difference in length of hospital stay because of WRF was 3.51 (95% confidence interval, 1.29-5.73) more days ( P =0.0019), and the hazard ratio for WRF on 30-day death or heart failure hospitalization was 1.49 (95% confidence interval, 1.06-2.09) times higher ( P =0.0205), in significantly congested than nonsignificantly congested patients. A similar trend was observed with 90-day mortality although not statistically significant. In patients admitted for acute heart failure, WRF defined as a creatinine increase of ≥0.3 mg/dL was associated with longer length of hospital stay, and worse 30- and 90-day outcomes. However, effects were largely driven by patients who had residual congestion at the time of renal function assessment. URL: https

  4. Sleeping and resting respiratory rates in dogs and cats with medically-controlled left-sided congestive heart failure.

    Science.gov (United States)

    Porciello, F; Rishniw, M; Ljungvall, I; Ferasin, L; Haggstrom, J; Ohad, D G

    2016-01-01

    Sleeping and resting respiratory rates (SRR and RRR, respectively) are commonly used to monitor dogs and cats with left-sided cardiac disease and to identify animals with left-sided congestive heart failure (L-CHF). Dogs and cats with subclinical heart disease have SRRmean values dogs and cats with CHF that is well controlled with medical therapy. In this study, SRR and RRR were measured by the owners of 51 dogs and 22 cats with stable, well-controlled CHF. Median canine SRRmean was 20 breaths/min (7-39 breaths/min); eight dogs were ≥25 breaths/min and one dog only was ≥30 breaths/min. Canine SRRmean was unrelated to pulmonary hypertension or diuretic dose. Median feline SRRmean was 20 breaths/min (13-31 breaths/min); four cats were ≥25 breaths/min and only one cat was ≥30 breaths/min. Feline SRRmean was unrelated to diuretic dose. SRR remained stable during collection in both species with little day-to-day variability. The median canine RRRmean was 24 breaths/min (12-44 breaths/min), 17 were ≥25 breaths/min, seven were ≥30 breaths/min, two were >40 breaths/min. Median feline RRRmean was 24 breaths/min (15-45 breaths/min); five cats had RRRmean ≥25 breaths/min; one had ≥30 breaths/min, and two had ≥40 breaths/min. These data suggest that most dogs and cats with CHF that is medically well-controlled and stable have SRRmean and RRRmean dogs and cats. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Valvular dysplasia and congestive heart failure in a juvenile African penguin (Spheniscus demersus).

    Science.gov (United States)

    McNaughton, Allyson; Frasca, Salvatore; Mishra, Neha; Tuttle, Allison D

    2014-12-01

    Abstract: An aquarium-housed, 6-mo-old African penguin (Spheniscus demersus) presented with acute respiratory distress. Auscultation revealed a grade II-III systolic murmur in the absence of adventitial sounds, and an enlarged heart without pulmonary edema was seen radiographically. Echocardiographic evaluation revealed atrioventricular (AV) valvular dysplasia and ventricular enlargement. The penguin was treated with enalapril, furosemide, and pimobendan but died within 3 wk of detection of the murmur. Congenital dysplasia of the right AV valve with right atrial and ventricular dilation and ventricular hypertrophy were diagnosed on postmortem examination.

  6. Prenatal diagnosis of concurrent facial and cerebral vascular malformation which caused congestive heart failure

    Directory of Open Access Journals (Sweden)

    Behnaz Moradi

    2017-12-01

    Full Text Available Arteriovenous malformations (AVMs are rarely reported antenatally. Most in utero diagnosis of vascular malformation is related to vein of Galen malformation (VGM. We describe a case of simultaneously diagnosed pial arteriovenous fistula (AVF and facial vascular malformation in a 20 weeks old fetus. The dilated intracranial venous pouch appeared as a midline anechoic structure which was misdiagnosed as a VGM in her previous ultrasound exam. Another AVM was diagnosed in the same side of fetal face which fed by a branch of external carotid artery and communicated with the mentioned pial AVF. High output cardiac failure and hydrops were evident. To our knowledge this is the first report of prenatally detected combination of facial and cerebral vascular malformations at such as early pregnancy week.

  7. Effects of perindopril on cardiac sympathetic nerve activity in patients with congestive heart failure: comparison with enalapril

    Energy Technology Data Exchange (ETDEWEB)

    Kasama, Shu; Toyama, Takuji; Suzuki, Tadashi; Kurabayashi, Masahiko [Gunma University School of Medicine, Department of Cardiovascular Medicine, Maebashi, Gunma (Japan); Kumakura, Hisao; Takayama, Yoshiaki; Ichikawa, Shuichi [Cardiovascular Hospital of Central Japan, Department of Internal Medicine, Gunma (Japan)

    2005-08-01

    The production of aldosterone in the heart is suppressed by the angiotensin-converting enzyme (ACE) inhibitor perindopril in patients with congestive heart failure (CHF). Moreover, perindopril has been reported to have more cardioprotective effects than enalapril. Forty patients with CHF [left ventricular ejection fraction (LVEF) <45%; mean 33{+-}7%] were randomly assigned to perindopril (2 mg/day; n=20) or enalapril (5 mg/day; n=20). All patients were also treated with diuretics. The delayed heart/mediastinum count (H/M) ratio, delayed total defect score (TDS) and washout rate (WR) were determined from {sup 123}I-meta-iodobenzylguanidine (MIBG) images, and plasma brain natriuretic peptide (BNP) concentrations were measured before and 6 months after treatment. The left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and LVEF were also determined by echocardiography. After treatment, in patients receiving perindopril, TDS decreased from 39{+-}10 to 34{+-}9 (P<0.01), H/M ratios increased from 1.62{+-}0.27 to 1.76{+-}0.29 (P<0.01), WR decreased from 50{+-}14% to 42{+-}14% (P<0.05) and plasma BNP concentrations decreased from 226{+-}155 to 141{+-}90 pg/ml (P<0.0005). In addition, the LVEDV decreased from 180{+-}30 to 161{+-}30 ml (P<0.05) and the LVESV decreased from 122{+-}35 to 105{+-}36 ml (P<0.05). Although the LVEF tended to increase, the change was not statistically significant (from 33{+-}8% to 36{+-}12%; P=NS). On the other hand, there were no significant changes in these parameters in patients receiving enalapril. Plasma BNP concentrations, {sup 123}I-MIBG scintigraphic and echocardiographic parameters improved after 6 months of perindopril treatment. These findings indicate that perindopril treatment can ameliorate the cardiac sympathetic nerve activity and the left ventricular performance in patients with CHF. (orig.)

  8. Oral administration of eicosapentaenoic acid or docosahexaenoic acid modifies cardiac function and ameliorates congestive heart failure in male rats.

    Science.gov (United States)

    Yamanushi, Tomoko T; Kabuto, Hideaki; Hirakawa, Eiichiro; Janjua, Najma; Takayama, Fusako; Mankura, Mitsumasa

    2014-04-01

    This study assessed the effects of eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) on normal cardiac function (part 1) and congestive heart failure (CHF) (part 2) through electrocardiogram analysis and determination of EPA, DHA, and arachidonic acid (AA) concentrations in rat hearts. In part 2, pathologic assessments were also performed. For part 1 of this study, 4-wk-old male rats were divided into a control group and 2 experimental groups. The rats daily were orally administered (1 g/kg body weight) saline, EPA-ethyl ester (EPA-Et; E group), or DHA-ethyl ester (DHA-Et; D group), respectively, for 28 d. ECGs revealed that QT intervals were significantly shorter for groups E and D compared with the control group (P ≤ 0.05). Relative to the control group, the concentration of EPA was higher in the E group and concentrations of EPA and DHA were higher in the D group, although AA concentrations were lower (P ≤ 0.05). In part 2, CHF was produced by subcutaneous injection of monocrotaline into 5-wk-old rats. At 3 d before monocrotaline injection, rats were administered either saline, EPA-Et, or DHA-Et as mentioned above and then killed at 21 d. The study groups were as follows: normal + saline (control), CHF + saline (H group), CHF + EPA-Et (HE group), and CHF + DHA-Et (HD group). QT intervals were significantly shorter (P ≤ 0.05) in the control and HD groups compared with the H and HE groups. Relative to the H group, concentrations of EPA were higher in the HE group and those of DHA were higher in the control and HD groups (P ≤ 0.05). There was less mononuclear cell infiltration in the myocytes of the HD group than in the H group (P = 0.06). The right ventricles in the H, HE, and HD groups showed significantly increased weights (P ≤ 0.05) compared with controls. The administration of EPA-Et or DHA-Et may affect cardiac function by modification of heart fatty acid composition, and the administration of DHA-Et may ameliorate CHF.

  9. Clinical usefulness of {sup 123}I-MIBG myocardial scintigraphy as a marker of the severity and prognosis of congestive heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Shiga, Koji [Kyoto Prefectural Univ. of Medicine (Japan)

    1999-04-01

    To evaluate the clinical usefulness of {sup 123}I-MIBG myocardial scintigraphy in patients with congestive heart failure. Myocardial dynamic imaging was performed immediately after {sup 123}I-MIBG administration at 1 frame/sec for 500 sec in 52 patients with or without congestive heart failure. The %uptake/ROI, dynamic heart to mediastinum uptake ratio (H/M) and dynamic washout rate (WR) were calculated from their time activity curves to assess the relationship between the NYHA functional class and these values. In 52 other patients with heart failure, the initial and delayed MIBG anterior planar images were obtained, and H/M in delayed images and WR between initial and delayed images were measured. The patients were followed up for 31.8{+-}16.8 months, and their survival rates were compared among three groups, H/M<1.5, 1.5{<=}H/M<2.0 and H/M{>=}2.0, or WR<45, 45{<=}WR<60 and WR{>=}60[%], respectively. The parameter, such as H/M, WR, age, X-ray cardiothoracic ratio (CTR), echocardiographic end-diastolic diameter (Dd), fractional shortening (%FS) or radionuclide left ventricular ejection fraction (LVEF), which was the most important prognostic predictor was analyzed. MIBG showed that the dynamic kinetics immediately after administration which reflected the severity of congestive heart failure, %uptake/ROI and dynamic H/M were significantly lower and dynamic WR was significantly higher in the advanced NYHA functional class. During the follow-up period, 13 patients died of heart failure. The survival rate in the group of H/M<1.5 or WR{>=}60[%] was significantly poorer than the other groups, and the most important predictive indicator for the prognosis was found to be H/M or WR exceeding age, CTR, Dd, %FS and LVEF {sup 123}I-MIBG myocardial scintigraphy is very useful to diagnose the severity and prognosis in patients with congestive heart failure. (K.H.)

  10. Effects and safety of oral tolvaptan in patients with congestive heart failure: A systematic review and network meta-analysis.

    Directory of Open Access Journals (Sweden)

    Mei-Yi Wu

    Full Text Available Several studies reported treatment benefits of tolvaptan in patients with congestive heart failure (CHF. However, the optimal dosage remains unclear. We aimed to compare different dosage of tolvaptan to determine the optimal dosage in terms of the efficacy and safety.We searched MEDLINE, PubMed, EMBASE, Cochrane CENTRAL and ClinicalTrials.gov through Aug 31, 2016. Randomized controlled trials (RCTs comparing tolvaptan of different dosages or to placebo in patients with CHF were included. We used network meta-analysis to look for the optimal dosage in terms of effectiveness and safety. Urine output, body weight change and change in serum sodium were the main outcomes of efficacy. Adverse effects were the secondary outcomes. Quality was assessed by Cochrane risk-of-bias tool.Twelve RCTs reporting 14 articles with 5793 patients (mean age, 65.7 ± 11.9 years; 73.7% man were included. Compared with placebo, the tolvaptan 30 mg had similar effects to tolvaptan 45-90 mg in terms of urine output (mean difference [MD] 2.03 liter; 95% confidence interval [CI] 1.3 to 2.71, body weight change (MD -1.12 kg; 95% CI -1.37 to -0.88 and change in serum sodium (MD 3.06 meq/L; 95% CI 2.43 to 3.68. Compared with placebo, tolvaptan of different dosage showed a non-significant higher risk of adverse effects.These findings suggest that tolvaptan 30 mg and 45 mg may be the optimum dosage for CHF patients, because of its ability to provide favourable clinical results without greater adverse effects. However, tolvaptan is not beneficial for reducing all-cause mortality in CHF patients.

  11. Cognitive Dysfunction and Malnutrition Are Independent Predictor of Dysphagia in Patients with Acute Exacerbation of Congestive Heart Failure.

    Science.gov (United States)

    Yokota, Junichi; Ogawa, Yoshiko; Yamanaka, Shinsuke; Takahashi, Yoshimi; Fujita, Hiroshi; Yamaguchi, Nobuhiro; Onoue, Noriko; Ishizuka, Takeshi; Shinozaki, Tsuyoshi; Kohzuki, Masahiro

    2016-01-01

    Early detection and intervention for dysphagia is important in patients with congestive heart failure (CHF). However, previous studies have focused on how many patients with dysphagia develop CHF. Studies focusing on the comorbidity of dysphagia in patients with CHF are rare. Additionally, risk factors for dysphagia in patients with CHF are unclear. Thus, the aim of this study was to clarify risk factors for dysphagia in patients with acute exacerbation of CHF. A total of 105 patients, who were admitted with acute exacerbation of CHF, were enrolled. Clinical interviews, blood chemistry analysis, electrocardiography, echocardiography, Mini-Mental State Examination (MMSE), exercise tolerance tests, phonatory function tests, and evaluation of activities of daily living (ADL) and nutrition were conducted on admission. After attending physicians permitted the drinking of water, swallowing screening tests were performed. Patients were divided into a dysphagia group (DG) or a non-dysphagia group (non-DG) based on Functional Oral Intake Scale level. Among the 105 patients, 38 had dysphagia. A greater number of patients had history of aspiration pneumonia and dementia, and there was a higher age, N-terminal pro-B-type natriuretic peptide level in the DG compared with the non-DG. MMSE scores, exercise tolerance, phonatory function, status of ADL, nutrition, albumin, and transthyretin were lower in the DG compared with the non-DG. In multivariate analysis, after adjusting for age and sex, MMSE, BI score, and transthyretin was independently associated with dysphagia. Comorbidity of dysphagia was 36.1% in patients with acute exacerbation of CHF, and cognitive dysfunction and malnutrition may be an independent predictor of dysphagia.

  12. Impact of right ventricular distensibility on congestive heart failure with preserved left ventricular ejection fraction in the elderly.

    Science.gov (United States)

    Harada, Daisuke; Aasanoi, Hidetsugu; Ushijima, Ryuichi; Noto, Takahisa; Takagawa, Junya; Ishise, Hisanari; Inoue, Hiroshi

    2018-06-01

    To elucidate involvement of age-related impairments of right ventricular (RV) distensibility in the elderly congestive heart failure (CHF), we examined the prevalence of less-distensible right ventricle in patients with preserved left ventricular ejection fraction (LVEF) over a wide range of ages. In 893 patients aged from 40 to 102 years, we simultaneously recorded electrocardiogram, phonocardiogram, and jugular venous pulse wave. Using signal-processing techniques, the prominent 'Y' descent of jugular pulse waveform was detected as a hemodynamic sign of a less-distensible right ventricle. Prevalence of less-distensible right ventricle and elevated RV systolic pressure increased along with aging from the 50s to the 90s in an exponential fashion from 3.3 and 12% up to 33 and 61%, respectively (p right ventricle (Odds ratio, 1.05 per 1 year, p = 0.003; and 1.03 per 1 mmHg, p = 0.026, respectively). The elderly CHF was associated with high prevalence of the less-distensible right ventricle and higher RV systolic pressure, both of which were independent risk factors for CHF (Odds ratio, 5.27, p = 0.001, and 1.08 per 1 mmHg, p right ventricle and a high RV systolic pressure seems to be related to developing CHF. The less-distensible right ventricle and elevated RV systolic pressure are closely associated with CHF with preserved LVEF in the elderly patients.

  13. Clinical significance of measurement of changes of serum TNF-α, IL-6 levels in patients with chronic congestive heart failure

    International Nuclear Information System (INIS)

    Yang Chun; Gu Ling; Zhang Yanjun; Huang Rongchong; Lu Yan

    2006-01-01

    Objective: To study the clinical significance of the detection of changes of serum TNF-α and IL-6 levels in patients with chronic congestive heart failure. Methods: The serum levels of TNF-α and IL-6 were determined with RIA in 176 patients with chronic heart failure (CHF) and 30 controls. Results: The serum levels of TNF-α and IL-6 in patients with CHF were significantly higher than those in controls (P<0.05). The levels increased along with the increase of severity of cardiac failure. The levels in patients with cardiac function of any grade were significantly different from those in patients with another grade of cardiac function. Conclusion: Immunological activation and myocardial inflammation exist in CHF patients. The increasing levels of TNF-α and IL-6 can trigger the onset and development of CHF. (authors)

  14. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables.

    Science.gov (United States)

    Juenger, J; Schellberg, D; Kraemer, S; Haunstetter, A; Zugck, C; Herzog, W; Haass, M

    2002-03-01

    To assess health related quality of life of patients with congestive heart failure; to compare their quality of life with the previously characterised general population and in those with other chronic diseases; and to correlate the different aspects of quality of life with relevant somatic variables. University hospital. A German version of the generic quality of life measure (SF-36) containing eight dimensions was administered to 205 patients with congestive heart failure and systolic dysfunction. Cardiopulmonary evaluation included assessment of New York Heart Association (NYHA) functional class, left ventricular ejection fraction, peak oxygen uptake, and the distance covered during a standardised six minute walk test. Quality of life significantly decreased with NYHA functional class (linear trend: p < 0.0001). In NYHA class III, the scores of five of the eight quality of life domains were reduced to around one third of those in the general population. The pattern of reduction was different in patients with chronic hepatitis C and major depression, and similar in patients on chronic haemodialysis. Multiple regression analysis showed that only the NYHA functional class was consistently and closely associated with all quality of life scales. The six minute walk test and peak oxygen uptake added to the explanation of the variance in only one of the eight quality of life domains (physical functioning). Left ventricular ejection fraction, duration of disease, and age showed no clear association with quality of life. In congestive heart failure, quality of life decreases as NYHA functional class worsens. Though NYHA functional class was the most dominant predictor among the somatic variables studied, the major determinants of reduced quality of life remain unknown.

  15. Gastric Bypass Surgery Produces a Durable Reduction in Cardiovascular Disease Risk Factors and Reduces the Long-Term Risks of Congestive Heart Failure.

    Science.gov (United States)

    Benotti, Peter N; Wood, G Craig; Carey, David J; Mehra, Vishal C; Mirshahi, Tooraj; Lent, Michelle R; Petrick, Anthony T; Still, Christopher; Gerhard, Glenn S; Hirsch, Annemarie G

    2017-05-23

    Obesity and its association with reduced life expectancy are well established, with cardiovascular disease as one of the major causes of fatality. Metabolic surgery is a powerful intervention for severe obesity, resulting in improvement in comorbid diseases and in cardiovascular risk factors. This study investigates the relationship between metabolic surgery and long-term cardiovascular events. A cohort of Roux-en-Y gastric bypass surgery (RYGB) patients was tightly matched by age, body mass index, sex, Framingham Risk Score, smoking history, use of antihypertension medication, diabetes mellitus status, and calendar year with a concurrent cohort of nonoperated control patients. The primary study end points of major cardiovascular events (myocardial infarction, stroke, and congestive heart failure) were evaluated using Cox regression. Secondary end points of longitudinal cardiovascular risk factors were evaluated using repeated-measures regression. The RYGB and matched controls (N=1724 in each cohort) were followed for up to 12 years after surgery (overall median of 6.3 years). Kaplan-Meier analysis revealed a statistically significant reduction in incident major composite cardiovascular events ( P =0.017) and congestive heart failure (0.0077) for the RYGB cohort. Adjusted Cox regression models confirmed the reductions in severe composite cardiovascular events in the RYGB cohort (hazard ratio=0.58, 95% CI=0.42-0.82). Improvements of cardiovascular risk factors (eg, 10-year cardiovascular risk score, total cholesterol, high-density lipoprotein, systolic blood pressure, and diabetes mellitus) were observed within the RYGB cohort after surgery. Gastric bypass is associated with a reduced risk of major cardiovascular events and the development of congestive heart failure. © 2017 The Authors and Geisinger Clinic. Published on behalf of the American Heart Association, Inc., by Wiley.

  16. Determination of Sample Entropy and Fuzzy Measure Entropy Parameters for Distinguishing Congestive Heart Failure from Normal Sinus Rhythm Subjects

    Directory of Open Access Journals (Sweden)

    Lina Zhao

    2015-09-01

    Full Text Available Entropy provides a valuable tool for quantifying the regularity of physiological time series and provides important insights for understanding the underlying mechanisms of the cardiovascular system. Before any entropy calculation, certain common parameters need to be initialized: embedding dimension m, tolerance threshold r and time series length N. However, no specific guideline exists on how to determine the appropriate parameter values for distinguishing congestive heart failure (CHF from normal sinus rhythm (NSR subjects in clinical application. In the present study, a thorough analysis on the selection of appropriate values of m, r and N for sample entropy (SampEn and recently proposed fuzzy measure entropy (FuzzyMEn is presented for distinguishing two group subjects. 44 long-term NRS and 29 long-term CHF RR interval recordings from http://www.physionet.org were used as the non-pathological and pathological data respectively. Extreme (>2 s and abnormal heartbeat RR intervals were firstly removed from each RR recording and then the recording was segmented with a non-overlapping segment length N of 300 and 1000, respectively. SampEn and FuzzyMEn were performed for each RR segment under different parameter combinations: m of 1, 2, 3 and 4, and r of 0.10, 0.15, 0.20 and 0.25 respectively. The statistical significance between NSR and CHF groups under each combination of m, r and N was observed. The results demonstrated that the selection of m, r and N plays a critical role in determining the SampEn and FuzzyMEn outputs. Compared with SampEn, FuzzyMEn shows a better regularity when selecting the parameters m and r. In addition, FuzzyMEn shows a better relative consistency for distinguishing the two groups, that is, the results of FuzzyMEn in the NSR group were consistently lower than those in the CHF group while SampEn were not. The selections of m of 2 and 3 and r of 0.10 and 0.15 for SampEn and the selections of m of 1 and 2 whenever r (herein

  17. The five-point Likert scale for dyspnea can properly assess the degree of pulmonary congestion and predict adverse events in heart failure outpatients

    Directory of Open Access Journals (Sweden)

    Cristina K. Weber

    2014-01-01

    Full Text Available OBJECTIVES: Proper assessment of dyspnea is important in patients with heart failure. Our aim was to evaluate the use of the 5-point Likert scale for dyspnea to assess the degree of pulmonary congestion and to determine the prognostic value of this scale for predicting adverse events in heart failure outpatients. METHODS: We undertook a prospective study of outpatients with moderate to severe heart failure. The 5-point Likert scale was applied during regular outpatient visits, along with clinical assessments. Lung ultrasound with ≥15 B-lines and an amino-terminal portion of pro-B-type natriuretic peptide (NT-proBNP level >1000 pg/mL were used as a reference for pulmonary congestion. The patients were then assessed every 30 days during follow-up to identify adverse clinical outcomes. RESULTS: We included 58 patients (65.5% male, age 43.5±11 years with a mean left ventricular ejection fraction of 27±6%. In total, 29.3% of these patients had heart failure with ischemic etiology. Additionally, pulmonary congestion, as diagnosed by lung ultrasound, was present in 58% of patients. A higher degree of dyspnea (3 or 4 points on the 5-point Likert scale was significantly correlated with a higher number of B-lines (p = 0.016. Patients stratified into Likert = 3-4 were at increased risk of admission compared with those in class 1-2 after adjusting for age, left ventricular ejection fraction, New York Heart Association functional class and levels of NT-proBNP >1000 pg/mL (HR = 4.9, 95% CI 1.33-18.64, p = 0.017. CONCLUSION: In our series, higher baseline scores on the 5-point Likert scale were related to pulmonary congestion and were independently associated with adverse events during follow-up. This simple clinical tool can help to identify patients who are more likely to decompensate and whose treatment should be intensified.

  18. Carbon monoxide and hospital admissions for congestive heart failure: evidence of an increased effect at low temperatures; Pollution par le monoxyde de carbone et hospitalisations pour insuffisance cardiaque congestive: mise en evidence d'une augmentation d'effet a basse temperature

    Energy Technology Data Exchange (ETDEWEB)

    Morris, R.D.; Naumova, E.N.

    2001-01-01

    This study presents the combined effect of the low temperatures and the air pollution exposure, especially the carbon monoxide, on the hospital admissions for congestive heart failure in Chicago during 1986-1989. (A.L.B.)

  19. {sup 123}I-meta-iodo-benzyl-guanidine myocardial scintigraphy and congestive heart failure: current data and perspective; Scintigraphie myocardique a la {sup 123}I-meta-iodobenzylguanidine et insuffisance cardiaque congestibe: donnees actuelles et perspectives

    Energy Technology Data Exchange (ETDEWEB)

    Agostini, D.; Darlas, Y.; Quennelle, F.; Bouvard, G.; Scanu, P.; Grollier, G.; Potier, J.C.; Babatasi, G. [Centre Hospitalier Universitaire, 14 - Caen (France); Belin, A. [Hopital de Trouville, Trouville (France)

    1997-12-31

    Congestive heart failure is often associated with an impairment of the sympathetic nervous system, i.e., global hyperactivity and regional impairment of the adrenergic system. Cardiac {sup 123}I-MIBG scintigraphy is a radionuclide technique which can explore the presynaptic adrenergic function. Myocardial MIBG fixation is decreased in congestive heart failure, reflecting a reduction of norepinephrine uptake by the myocardial presynaptic nerve endings. The impairment of presynaptic function occurs early in the disease and is actually involved in the pathogenesis of cardiac failure. Cardiac MIBG scintigraphy is a useful tool to explore the myocardial adrenergic stores in patients with congestive heart failure. It could be proposed in patients with severe ventricular dysfunction in order to assist physicians in setting-up the timing of heart transplantation. (authors). 52 refs.

  20. Effect of obesity and being overweight on long-term mortality in congestive heart failure: influence of left ventricular systolic function

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Kragelund, Charlotte B; Torp-Pedersen, Christian

    2004-01-01

    AIMS: Previous studies have suggested that a high body mass index (BMI) is associated with an improved outcome in congestive heart failure (CHF). However, the studies addressing this problem have not included enough patients with non-systolic heart failure to evaluate how left ventricular systolic...... function interacts with obesity on prognosis in CHF. The aim of this study was to evaluate how BMI influences mortality in patients hospitalized with CHF, and to address in particular whether the effect of BMI is influenced by left ventricular (LV) systolic function. METHODS AND RESULTS: Retrospective...... analysis of baseline and survival data for 4700 hospitalized CHF patients for whom BMI was available. LV systolic function, as assessed by wall motion index was available for 95% of the patients. Follow-up time ranged from 5 to 8 years. In the total population, the risk of death decreased steadily...

  1. Heart Failure

    OpenAIRE

    McMurray, John; Ponikowski, Piotr

    2011-01-01

    Heart failure occurs in 3% to 4% of adults aged over 65 years, usually as a consequence of coronary artery disease or hypertension, and causes breathlessness, effort intolerance, fluid retention, and increased mortality. The 5-year mortality in people with systolic heart failure ranges from 25% to 75%, often owing to sudden death following ventricular arrhythmia. Risks of cardiovascular events are increased in people with left ventricular systolic dysfunction (LVSD) or heart failure.

  2. Utility of brain natriuretic peptide in diagnosis of congestive heart failure and comparison with trans-thoracic echocardiography: a multicenter analysis in south asian and arabian population

    International Nuclear Information System (INIS)

    Ejaz, N.

    2015-01-01

    Objective: To evaluate serum Brain Natriuretic Peptide levels (BNP) as a screening test in the diagnosis of congestive heart failure. Study Design: Comparative cross-sectional study. Place and Duration of Study: Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia between December 2010 to January 2012 and Nishtar Hospital, Multan, Pakistan, from February to August 2006. Methodology: A total of 80 patients with clinical diagnosis of Congestive Heart Failure (CHF) underwent measurement of serum BNP and had a trans-thoracic echocardiography to measure Ejection Fraction (EF). The normal limit for serum BNP levels, provided by the manufacturer of the kit was applied as a cut-off value for BNP. EF of > 45% was considered normal. Results: Forty seven patients (94%) had an EF < 45%. BNP levels were elevated in 36 patients (72%). Sensitivity and specificity of BNP was found to be 80% and 66% respectively and accuracy was 80%. Conclusion: BNP measurements as a screening tool for CHF has good sensitivity and accuracy when compared to echocardiography. (author)

  3. Dynamic 123I-BMIPP single-photon emission computed tomography in patients with congestive heart failure: effect of angiotensin II type-1 receptor blockade.

    Science.gov (United States)

    Takeishi, Yasuchika; Minamihaba, Osamu; Yamauchi, Sou; Arimoto, Takanori; Hirono, Osamu; Takahashi, Hiroki; Akiyama, Hideyuki; Miyamoto, Takuya; Nitobe, Joji; Nozaki, Naoki; Tachibana, Hidetada; Okuyama, Masaki; Fukui, Akio; Kubota, Isao; Okada, Akio; Takahashi, Kazuei

    2004-04-01

    Heart failure is a major and growing public health problem with a high mortality rate. Although recent studies have demonstrated that a variety of metabolic and/or neurohumoral factors are involved in the progression of this syndrome, the precise mechanisms responsible for this complex condition are poorly understood. To examine 123I-beta-methyl-iodophenylpentadecanoic acid (BMIPP) kinetics in the early phase soon after tracer injection in patients with congestive heart failure (CHF), we performed dynamic single-photon emission computed tomography (SPECT). Twenty-six patients with CHF and eight control subjects were examined. The consecutive 15 images of 2-min dynamic SPECT were acquired for 30 min after injection. In the early phase after injection (0-4 min), a significant amount of radioactivity existed in the blood pool. After 6 min, the myocardial 123I-BMIPP image was clear and thus the washout rate of 123I-BMIPP from 6 to 30 min was calculated. The washout rate of 123I-BMIPP from the myocardium was faster in patients with CHF than in the controls (8 +/- 4 vs. -5 +/- 3%, p acid metabolism may represent a new mechanism for beneficial effects of angiotensin II receptor blockade on cardiac function and survival in patients with heart failure. 123I-BMIPP washout in the early phase obtained from dynamic SPECT may be a new marker for evaluating the severity of heart failure and the effects of medical treatment.

  4. Effect of age on short and long-term mortality in patients admitted to hospital with congestive heart failure

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Torp-Pedersen, Christian; Seibaek, Marie

    2004-01-01

    function the RR was 1.57 (1.43-1.72, multivariate analyses). CONCLUSION: The clinical characteristics of CHF patients vary considerably with age. Elderly patients hospitalised with CHF face a very grave prognosis, particularly if their heart failure symptoms are caused by LV systolic dysfunction....... dysfunction, were under treated with ACE-inhibitors and were more often female. The prevalence of hypertension, diabetes and ischaemic heart disease increased with age, until the oldest age group (>80 years). Age was an independent predictor of short-term mortality (risk ratio (RR) per 10-year increase was 1...

  5. Factores determinantes del déficit cognitivo en la insuficiencia cardiaca congestiva Deciding factors of cognitive deficit in congestive heart failure

    Directory of Open Access Journals (Sweden)

    Silvia L Ruiz

    2009-12-01

    Full Text Available La insuficiencia cardiaca congestiva constituye una de las principales causas de hospitalización, morbilidad y mortalidad en los países occidentales. Aunque en Colombia no se conocen con exactitud su incidencia y prevalencia, recientemente se ha planteado que está adquiriendo proporciones epidémicas. Diversos estudios demuestran que los pacientes con esta condición presentan alteraciones cognitivas tales como pérdida de la memoria y déficit de atención, las cuales se relacionan con un peor pronóstico clínico. Los síntomas cognitivos no sólo indican una enfermedad cardiaca más avanzada, sino que también se asocian con pobre adherencia al tratamiento y menor calidad de vida. A pesar de su importancia, los mecanismos fisiopatológicos de esta relación no son claros. Se sugiere que las alteraciones hemodinámicas cerebrales derivadas de la disminución en el gasto cardiaco, así como de la presencia de múltiples microinfartos cerebrales secundarios a microembolismos, podrían relacionarse con alteraciones cognitivas en dichos pacientes. Sin embargo, hasta el momento no existen suficientes datos que permitan confirmar esta hipótesis.Congestive heart failure is a leading cause of hospitalization, morbidity and mortality in the Western countries. Although its incidence and prevalence in Colombia is not fully established, it seems to be acquiring epidemic proportions. Several studies have shown that patients with congestive heart failure present cognitive impairments such as memory loss and attention deficit, which are associated with a worse clinical prognosis. The cognitive symptoms are not only indicative of a more advanced heart disease but are also associated with poor adherence to treatment and lower quality of life. Despite their importance, the pathophysiological mechanisms of this relationship have not been clearly defined. It has been suggested that the cerebral hemodynamic changes resulting from a decrease in cardiac output

  6. Depressed heart rate variability as an independent predictor of death in chronic congestive heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.

    Science.gov (United States)

    Ponikowski, P; Anker, S D; Chua, T P; Szelemej, R; Piepoli, M; Adamopoulos, S; Webb-Peploe, K; Harrington, D; Banasiak, W; Wrabec, K; Coats, A J

    1997-06-15

    After acute myocardial infarction, depressed heart rate variability (HRV) has been proven to be a powerful independent predictor of a poor outcome. Although patients with chronic congestive heart failure (CHF) have also markedly impaired HRV, the prognostic value of HRV analysis in these patients remains unknown. The aim of this study was to investigate whether HRV parameters could predict survival in 102 consecutive patients with moderate to severe CHF (90 men, mean age 58 years, New York Heart Association [NYHA] class II to IV, CHF due to idiopathic dilated cardiomyopathy in 24 patients and ischemic heart disease in 78 patients, ejection fraction [EF], 26%; peak oxygen consumption, 16.9 ml/kg/min) after exclusion of patients in atrial fibrilation with diabetes or with chronic renal failure. In the prognostic analysis (Cox proportional-hazards model, Kaplan-Meier survival analysis), the following factors were investigated: age, CHF etiology, NYHA class, EF, peak oxygen consumption, presence of ventricular tachycardia on Holter monitoring, and HRV measures derived from 24-hour electrocardiography monitoring, calculated in the time (standard deviation of all normal RR intervals [SDNN], standard deviation of 5-minute RR intervals [SDANN], mean of all 5-minute standard deviations of RR intervals [SD], root-mean-square of difference of successive RR intervals [rMSSD], and percentage of adjacent RR intervals >50 ms different [pNN50]) and frequency domain (total power [TP], power within low-frequency band [LF], and power within high-frequency band [HF]). During follow-up of 584 +/- 405 days (365 days in all who survived), 19 patients (19%) died (mean time to death: 307 +/- 315 days, range 3 to 989). Cox's univariate analysis identified the following factors to be predictors of death: NYHA (p = 0.003), peak oxygen consumption (p = 0.01), EF (p = 0.02), ventricular tachycardia on Holter monitoring (p = 0.05), and among HRV measures: SDNN (p = 0.004), SDANN (p = 0.003), SD

  7. Heart Failure

    Science.gov (United States)

    ... Other diseases. Chronic diseases — such as diabetes, HIV, hyperthyroidism, hypothyroidism, or a buildup of iron (hemochromatosis) or ... transplantation or support with a ventricular assist device. Prevention The key to preventing heart failure is to ...

  8. The change of cerebral blood flow after heart transplantation in congestive heart failure: a voxel-based and automatic VOl analysis of Tc-99m ECD SPECT

    Energy Technology Data Exchange (ETDEWEB)

    Hong, I. K.; Kim, J. J.; Lee, C. H.; Lim, K. C.; Moon, D. H.; Rhu, J. S.; Kim, J. S. [Asan Medical Center, Seoul (Korea, Republic of)

    2007-07-01

    To investigate the change of global and regional cerebral blood flow after heart transplantation (HT) in congestive heart failure (CHF) patients. Twenty-one patients with CHF who underwent HT (45{+-}12 yrs, M/F=19/2) and 10 healthy volunteers (39{+-}13 yrs, M/F = 7/3) were prospectively included. All patients underwent echocardiography and radionuclide angiography including brain and aorta with brain SPECT which was performed after iv bolus injection of Tc-99m ECD (740MBq) before (175{+-}253 days) and after (129{+-}82 days) HT. Patients were divided into two groups according to the interval between HT and postoperative SPECT [early follow-up (f/u): <6 mo, n=14; late f/u: >6 mo, n=7]. Global CBF (gCBF) of bilateral hemispheres were calculated by Patlak graphical analysis. Absolute rCBF map was obtained from brain SPECT by Lassen's correction algorithm. Age-corrected voxel-based analysis using SPM2 and automatic VOl analysis were performed to assess the rCBF change. Cardiac ejection fraction of all patients improved after HT (20.8%{yields}64.0%). gCBF was reduced compared to normal before HT (35.7{+-}3.9 vs. 49.1{+-}3.0 ml/100g/min; p<0.001) and improved postoperatively (46.6{+-}5.4, p<0.001). The preoperative gCBFs of early and late f/u group were not different (34.6{+-}3.2 vs. 38.0{+-}4.4, p=0.149) but postoperative gCBF (43.9{+-}3.7) of late f/u group was higher than those (52.0{+-}4.0) of early f/u group (p<0.001). On voxel-based analysis, preoperative rCBF was reduced in entire brain but most severely in bilateral superior and inferior frontal cortex, supplementary motor area, precuneus and anterior cingulum, compared to normals (uncorrected p<0.001). After HT, rCBF of these areas improved more significantly in late f/u group than in early f/u group but still lower than normals. Global CBF was significantly reduced in CHF patients and improved after HT. rCBFs of the frontal cortex, precuneus and cingulum were most severely reduced and slowly improved after

  9. Types of Heart Failure

    Science.gov (United States)

    ... Introduction Types of Heart Failure Classes of Heart Failure Heart Failure in Children Advanced Heart Failure • Causes and ... and procedures related to heart disease and stroke. Heart Failure Questions to Ask Your Doctor Use these questions ...

  10. Effect of pimobendan or benazepril hydrochloride on survival times in dogs with congestive heart failure caused by naturally occurring myxomatous mitral valve disease: the QUEST study.

    Science.gov (United States)

    Häggström, J; Boswood, A; O'Grady, M; Jöns, O; Smith, S; Swift, S; Borgarelli, M; Gavaghan, B; Kresken, J-G; Patteson, M; Ablad, B; Bussadori, C M; Glaus, T; Kovacević, A; Rapp, M; Santilli, R A; Tidholm, A; Eriksson, A; Belanger, M C; Deinert, M; Little, C J L; Kvart, C; French, A; Rønn-Landbo, M; Wess, G; Eggertsdottir, A V; O'Sullivan, M L; Schneider, M; Lombard, C W; Dukes-McEwan, J; Willis, R; Louvet, A; DiFruscia, R

    2008-01-01

    Myxomatous mitral valve disease (MMVD) continues to be an important cause of morbidity and mortality in geriatric dogs despite conventional therapy. Pimobendan in addition to conventional therapy will extend time to sudden cardiac death, euthanasia for cardiac reasons, or treatment failure when compared with conventional therapy plus benazepril in dogs with congestive heart failure (CHF) attributable to MMVD. Two hundred and sixty client-owned dogs in CHF caused by MMVD were recruited from 28 centers in Europe, Canada, and Australia. A prospective single-blinded study with dogs randomized to PO receive pimobendan (0.4-0.6 mg/kg/d) or benazepril hydrochloride (0.25-1.0 mg/kg/d). The primary endpoint was a composite of cardiac death, euthanized for heart failure, or treatment failure. Eight dogs were excluded from analysis. One hundred and twenty-four dogs were randomized to pimobendan and 128 to benazepril. One hundred and ninety dogs reached the primary endpoint; the median time was 188 days (267 days for pimobendan, 140 days for benazepril hazard ratio = 0.688, 95% confidence limits [CL]=0.516-0.916, P= .0099). The benefit of pimobendan persisted after adjusting for all baseline variables. A longer time to reach the endpoint was also associated with being a Cavalier King Charles Spaniel, requiring a lower furosemide dose, and having a higher creatinine concentration. Increases in several indicators of cardiac enlargement (left atrial to aortic root ratio, vertebral heart scale, and percentage increase in left ventricular internal diameter in systole) were associated with a shorter time to endpoint, as was a worse tolerance for exercise. Pimobendan plus conventional therapy prolongs time to sudden death, euthanasia for cardiac reasons, or treatment failure in dogs with CHF caused by MMVD compared with benazepril plus conventional therapy.

  11. A comparative study of a new wireless continuous cardiorespiratory monitor for the diagnosis and management of patients with congestive heart failure at home.

    Science.gov (United States)

    Andrews, D; Gouda, M S; Higgins, S; Johnson, P; Williams, A; Vandenburg, M

    2002-01-01

    Congestive heart failure (CHF) is a major and increasing chronic disease in Western society, with a high mortality, morbidity and cost for unplanned hospital admissions. Continuous cardiorespiratory monitoring is required to detect Cheyne-Stokes respiration (CSR). We have tested a new wireless monitoring system and compared it with polysomnography (PSG) and respiratory inductance plethysmography (RIP) in six CHF patients with CSR in a sleep laboratory. The wireless system compared well with RIP for the detection of CSR but less well with PSG, which had unexpected but significant respiratory sensing errors that led to misclassification of the respiratory disorder present. The wireless system could be used to select CHF patients for better-customized treatment at home as part of a specialist-supported community telemedicine programme.

  12. Assessment of vasodilator therapy in patients with severe congestive heart failure: limitations of measurements of left ventricular ejection fraction and volumes

    International Nuclear Information System (INIS)

    Firth, B.G.; Dehmer, G.J.; Markham, R.V. Jr.; Willerson, J.T.; Hillis, L.D.

    1982-01-01

    Although noninvasive techniques are often used to assess the effect of vasodilator therapy in patients with congestive heart failure, it is unknown whether changes in noninvasively determined left ventricular ejection fraction, volume, or dimension reliably reflect alterations in intracardiac pressure and flow. Accordingly, we compared the acute effect of sodium nitroprusside on left ventricular volume and ejection fraction (determined scintigraphically) with its effect on intracardiac pressure and forward cardiac index (determined by thermodilution) in 12 patients with severe, chronic congestive heart failure and a markedly dilated left ventricle. Nitroprusside (infused at 1.3 +/- 1.1 [mean +/- standard deviation] microgram/kg/min) caused a decrease in mean systemic arterial, mean pulmonary arterial, and mean pulmonary capillary wedge pressure as well as a concomitant increase in forward cardiac index. Simultaneously, left ventricular end-diastolic and end-systolic volume indexes decreased, but the scintigraphically determined cardiac index did not change significantly. Left ventricular ejection fraction averaged 0.19 +/- 0.05 before nitroprusside administration and increased by less than 0.05 units in response to nitroprusside in 11 of 12 patients. The only significant correlation between scintigraphically and invasively determined variables was that between the percent change in end-diastolic volume index and the percent change in pulmonary capillary wedge pressure (r . 0.68, p . 0.01). Although nitroprusside produced changes in scintigraphically determined left ventricular ejection fraction, end-systolic volume index, and cardiac index, these alterations bore no predictable relation to changes in intracardiac pressure, forward cardiac index, or vascular resistance. Furthermore, nitroprusside produced a considerably greater percent change in the invasively measured variables than in the scintigraphically determined ones

  13. Classes of Heart Failure

    Science.gov (United States)

    ... Introduction Types of Heart Failure Classes of Heart Failure Heart Failure in Children Advanced Heart Failure • Causes and ... and Advanced HF • Tools and Resources • Personal Stories Heart Failure Questions to Ask Your Doctor Use these questions ...

  14. Hypertonic Saline in Conjunction with High-Dose Furosemide Improves Dose-Response Curves in Worsening Refractory Congestive Heart Failure.

    Science.gov (United States)

    Paterna, Salvatore; Di Gaudio, Francesca; La Rocca, Vincenzo; Balistreri, Fabio; Greco, Massimiliano; Torres, Daniele; Lupo, Umberto; Rizzo, Giuseppina; di Pasquale, Pietro; Indelicato, Sergio; Cuttitta, Francesco; Butler, Javed; Parrinello, Gaspare

    2015-10-01

    Diuretic responsiveness in patients with chronic heart failure (CHF) is better assessed by urine production per unit diuretic dose than by the absolute urine output or diuretic dose. Diuretic resistance arises over time when the plateau rate of sodium and water excretion is reached prior to optimal fluid elimination and may be overcome when hypertonic saline solution (HSS) is added to high doses of furosemide. Forty-two consecutively hospitalized patients with refractory CHF were randomized in a 1:1:1 ratio to furosemide doses (125 mg, 250 mg, 500 mg) so that all patients received intravenous furosemide diluted in 150 ml of normal saline (0.9%) in the first step (0-24 h) and the same furosemide dose diluted in 150 ml of HSS (1.4%) in the next step (24-48 h) as to obtain 3 groups as follows: Fourteen patients receiving 125 mg (group 1), fourteen patients receiving 250 mg (group 2), and fourteen patients receiving 500 mg (group 3) of furosemide. Urine samples of all patients were collected at 30, 60, and 90 min, and 3, 4, 5, 6, 8, and 24 h after infusion. Diuresis, sodium excretion, osmolality, and furosemide concentration were evaluated for each urine sample. After randomization, 40 patients completed the study. Two patients, one in group 2 and one in group 3 dropped out. Patients in group 1 (125 mg furosemide) had a mean age of 77 ± 17 years, 43% were male, 6 (43%) had heart failure with a preserved ejection fraction (HFpEF), and 64% were in New York Heart Association (NYHA) class IV; the mean age of patients in group 2 (250 mg furosemide) was 80 ± 8.1 years, 15% were male, 5 (38%) had HFpEF, and 84% were in NYHA class IV; and the mean age of patients in group 3 (500 mg furosemide) was 73 ± 12 years, 54% were male, 6 (46%) had HFpEF, and 69% were in NYHA class IV. HSS added to furosemide increased total urine output, sodium excretion, urinary osmolality, and furosemide urine delivery in all patients and at all time points. The percentage increase was 18,14, and

  15. Effects of hope promoting interventions based on religious beliefs on quality of life of patients with congestive heart failure and their families

    Science.gov (United States)

    Binaei, Niloufar; Moeini, Mahin; Sadeghi, Masoumeh; Najafi, Mostafa; Mohagheghian, Zahra

    2016-01-01

    Background: Heart failure is one of the most important and prevalent diseases that may have negative effects on the quality of life (QOL). Today, the promotion of QOL in patients with heart failure is important in nursing care programs. This research aimed to determine the efficacy of hope-promoting interventions based on religious beliefs on the QOL of patients with congestive heart failure (CHF). Materials and Methods: In this randomized clinical trial (IRCT2014100619413N1) conducted in Isfahan, Iran, 46 adult patients with CHF were selected and randomly assigned to study and control groups. Ferrans and Powers Quality of Life Index (QLI) was completed by both groups before, immediately after, and 1 month after the intervention. For the study group participants and their families, 60-min sessions of hope-promoting interventions based on religious beliefs were held twice a week for 3 weeks. Independent t, repeated measures analysis of variance (ANOVA), Chi-square, Mann–Whitney, and Fisher's exact tests were adopted for data analysis. Results: The mean (standard deviation) overall QOL score in the area of satisfaction significantly increased in the study group, compared to the controls, immediately [70.7 (8.5) vs. 59.2 (12.5)] and 1 month after the intervention [75.2 (7.4) vs. 59.4 (12.9)] (P < 0.05). There was also a similar difference between the two groups in the area of importance immediately [73.6 (5.8) vs. 65.7 (7.5)] and 1 month after the intervention [76.3 (8.1) vs. 66.8 (8.5)] (P < 0.05). Conclusions: Hope-promoting intervention based on religious beliefs is a useful method for improving QOL in patients with CHF. PMID:26985226

  16. Evaluation of haemodynamic effects in computerized gamma-camera os isossorbide dinitrate in congestive heart failure. Avaliacao em gama-camara computadorizada dos efeitos hemodinamicos do dinitrato de isossorbida na insuficiencia cardiaca congestiva

    Energy Technology Data Exchange (ETDEWEB)

    Lara, P F; Miyazato, A N.P.; Hueb, W A; Paulillo, L F; Oliveira Filho, R.M. de; Campos Netto, J S; Souza Valle, L.B. de

    1987-02-01

    The cardiac function by radiocargiogram before and after the oral administration of isossorbide dinitrate in 20 patients with congestive heart failure is studied, including the meantime of pulmonary circulation, the meantime of cardiac cycle, cardiac debit and the dejection fraction of left ventricle. (author).

  17. What can a pilot congestive heart failure disease management program tell us about likely return on investment?: A case study from a program offered to federal employees.

    Science.gov (United States)

    vanVonno, Catherine J; Ozminkowski, Ronald J; Smith, Mark W; Thomas, Eileen G; Kelley, Doniece; Goetzel, Ron; Berg, Gregory D; Jain, Susheel K; Walker, David R

    2005-12-01

    In 1999, the Blue Cross and Blue Shield Federal Employee Program (FEP) implemented a pilot disease management program to manage congestive heart failure (CHF) among members. The purpose of this project was to estimate the financial return on investment in the pilot CHF program, prior to a full program rollout. A cohort of 457 participants from the state of Maryland was matched to a cohort of 803 nonparticipants from a neighboring state where the CHF program was not offered. Each cohort was followed for 12 months before the program began and 12 months afterward. The outcome measures of primary interest were the differences over time in medical care expenditures paid by FEP and by all payers. Independent variables included indicators of program participation, type of heart disease, comorbidity measures, and demographics. From the perspective of the funding organization (FEP), the estimated return on investment for the pilot CHF disease management program was a savings of $1.08 in medical expenditure for every dollar spent on the program. Adding savings to other payers as well, the return on investment was a savings of $1.15 in medical expenditures per dollar spent on the program. The amount of savings depended upon CHF risk levels. The value of a pilot initiative and evaluation is that lessons for larger-scale efforts can be learned prior to full-scale rollout.

  18. Prognostic value of repeated {sup 123}I-metaiodobenzylguanidine imaging in patients with dilated cardiomyopathy with congestive heart failure before and after optimized treatments. Comparison with neurohumoral factors

    Energy Technology Data Exchange (ETDEWEB)

    Matsui, Toshiki; Tsutamoto, Takayoshi; Maeda, Keiko; Kusukawa, Junya; Kinoshita, Masahiko [Shiga Univ. of Medical Science, Otsu (Japan)

    2002-06-01

    The present study was undertaken to assess whether repeated measurement of cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) imaging parameters before and after optimized treatments is useful for predicting the prognosis of patients with congestive heart failure (CHF) resulting from dilated cardiomyopathy (DCM). The subjects were 85 consecutive patients with DCM who had a left ventricular ejection fraction (LVEF) of less than 45%. The MIBG and the concentrations of neurohumoral factors were measured at baseline and after 6 months of optimized treatments. Cox proportional hazards analysis was performed to assess the various parameters before and after treatment. Twenty-three patients had a cardiac event (12 died; 11 hospitalized) during a mean follow-up period of 2 years. Although there was no difference between the baseline heart to mediastinum (H/M) ratio measured by MIBG between survivors and nonsurvivors, the H/M ratio was significantly decreased in nonsurvivors after 6 months. Multivariate analysis revealed that a high plasma concentration of brain natriuretic peptide level after 6 months (p=0.0049) and absolute changes in the H/M ratio (p=0.0046) were independent predictors of mortality. Comparison of the H/M ratio on MIBG imaging before and after optimized additional treatment provided useful information for predicting mortality and was independent of clinical and neurohumoral factors previously shown to be associated with poor prognosis in patients with DCM. (author)

  19. Differential number of CD34+, CD133+ and CD34+/CD133+ cells in peripheral blood of patients with congestive heart failure

    Directory of Open Access Journals (Sweden)

    Fritzenwanger M

    2009-03-01

    Full Text Available Abstract Background Endothelial progenitor cells (EPC which are characterised by the simulateous expression of CD34, CD133 and vascular endothelial growth receptor 2 (VEGF 2 are involved in the pathophysiology of congestive heart failure (CHF and their number and function is reduced in CHF. But so far our knowledge about the number of circulating hematopoietic stem/progenitor cells (CPC expressing the early hematopoietic marker CD133 and CD34 in CHF is spares and therefore we determined their number and correlated them with New York Heart Association (NYHA functional class. Methods CD34 and CD133 surface expression was quantified by flow cytometry in the peripheral venous blood of 41 healthy adults and 101 patients with various degrees of CHF. Results CD34+, CD133+ and CD34+/CD133+ cells correlated inversely with age. Both the number of CD34+ and of CD34+/CD133+ cells inversely correlated with NYHA functional class. The number of CD133+ cells was not affected by NYHA class. Furthermore the number of CD133+ cells did not differ between control and CHF patients. Conclusion In CHF the release of CD34+, CD133+ and CD34+/CD133+ cells from the bone marrow seems to be regulated differently. Modulating the releasing process in CHF may be a tool in CHF treatment.

  20. Sympathetic reflex control of skeletal muscle blood flow in patients with congestive heart failure: evidence for beta-adrenergic circulatory control

    International Nuclear Information System (INIS)

    Kassis, E.; Jacobsen, T.N.; Mogensen, F.; Amtorp, O.

    1986-01-01

    Mechanisms controlling forearm muscle vascular resistance (FMVR) during postural changes were investigated in seven patients with severe congestive heart failure (CHF) and in seven control subjects with unimpaired left ventricular function. Relative brachioradial muscle blood flow was determined by the local 133 Xe-washout technique. Unloading of baroreceptors with use of 45 degree upright tilt was comparably obtained in the patients with CHF and control subjects. Control subjects had substantially increased FMVR and heart rate to maintain arterial pressure whereas patients with CHF had decreased FMVR by 51 +/- 11% and had no increase in heart rate despite a fall in arterial pressure during upright tilt. The autoregulatory and local vasoconstrictor reflex responsiveness during postural changes in forearm vascular pressures were intact in both groups. In the patients with CHF, the left axillary nerve plexus was blocked by local anesthesia. No alterations in forearm vascular pressures were observed. This blockade preserved the local regulation of FMVR but reversed the vasodilator response to upright tilt as FMVR increased by 30 +/- 7% (p less than .02). Blockade of central neural impulses to this limb combined with brachial arterial infusions of phentolamine completely abolished the humoral vasoconstriction in the tilted position. Infusions of propranolol to the contralateral brachial artery that did not affect baseline values of heart rate, arterial pressure, or the local reflex regulation of FMVR reversed the abnormal vasodilator response to upright tilt as FMVR increased by 42 +/- 12% (p less than .02). Despite augmented baseline values, forearm venous but not arterial plasma levels of epinephrine increased in the tilted position, as did arteri rather than venous plasma concentrations of norepinephrine in these patients

  1. Drug therapy for congestive heart failure:appropriate choices can prolong life; Tratamiento farmacologico de la insuficiencia cardiaca congestiva:las elecciones adecuadas pueden prolongar la vida

    Energy Technology Data Exchange (ETDEWEB)

    Sorrentino, M

    1997-09-01

    Between one purpose of the insufficiency congestive heart is improve and prolong the quality life. A good multidisciplinary health equipment can help to the improving patients with this disease referred to effective handling interned and ambulatory patients groups. The inhibition mechanism compensate that perpetuate heart congestive insufficiency are a way for reach treatment purposes. Between patients with symptomatic cardiac insufficiency and overload volume is indicated digoxin(Lanoxin) and vasodilators. The enzyme inhibition angiotensin converted improve over life range more than an others vasodilators and is preferred for the systole dysfunction patients.

  2. Childhood heart failure in Ibadan

    African Journals Online (AJOL)

    Childhood heart failure in Ibadan. I. A. Lagunju and S. I. Omokhodion*. Department of Paediatrics. University College Hospital, Ibadan. Summary. One hundred consecutive admissions of children with a diagnosis of congestive cardiac failure to the paediatric department of the University College Hospital, Ibadan were.

  3. Association between ambient carbon monoxide levels and hospitalizations for congestive heart failure in the elderly in 10 canadian cities; Association entre les niveaux atmospheriques de monoxyde de carbone et les hospitalisations pour insuffisance cardiaque congestive des personnes agees dans 10 villes canadiennes

    Energy Technology Data Exchange (ETDEWEB)

    Burnett, R.T.; Dales, R.E.; Brook, J.R.; Raizenne, M.E.; Krewski, D.

    2001-01-01

    In 1995, two studies, realized in the USA, showed the relation between the carbon monoxide content in the urban air and the hospitalization of elderly people for congestive heart failure. This study, realized this time in the Canada, take again the protocol of one of them increasing the period (4 to 11 years) and the number of concerned towns. (A.L.B.)

  4. Heart failure - home monitoring

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000113.htm Heart failure - home monitoring To use the sharing features on ... your high blood pressure Fast food tips Heart failure - discharge Heart failure - fluids and diuretics Heart failure - what to ...

  5. Positive inotropic and vasodilator actions of milrinone in patients with severe congestive heart failure. Dose-response relationships and comparison to nitroprusside.

    Science.gov (United States)

    Jaski, B E; Fifer, M A; Wright, R F; Braunwald, E; Colucci, W S

    1985-01-01

    Milrinone is a potent positive inotropic and vascular smooth muscle-relaxing agent in vitro, and therefore, it is not known to what extent each of these actions contributes to the drug's hemodynamic effects in patients with heart failure. In 11 patients with New York Heart Association class III or IV congestive heart failure, incremental intravenous doses of milrinone were administered to determine the dose-response relationships for heart rate, systemic vascular resistance, and inotropic state, the latter measured by peak positive left ventricular derivative of pressure with respect to time (dP/dt). To clarify further the role of a positive inotropic action, the relative effects of milrinone and nitroprusside on left ventricular stroke work and dP/dt were compared in each patient at doses matched to cause equivalent reductions in mean arterial pressure or systemic vascular resistance, indices of left ventricular afterload. Milrinone caused heart rate, stroke volume, and dP/dt to increase, and systemic vascular resistance to decrease in a concentration-related manner. At the two lowest milrinone doses resulting in serum concentrations of 63 +/- 4 and 156 +/- 5 ng/ml, respectively, milrinone caused significant increases in stroke volume and dP/dt, but no changes in systemic vascular resistance or heart rate. At the maximum milrinone dose administered (mean serum concentration, 427 +/- 11 ng/ml), heart rate increased from 92 +/- 4 to 99 +/- 4 bpm (P less than 0.01), mean aortic pressure fell from 82 +/- 3 to 71 +/- 3 mmHg (P less than 0.01), right atrial pressure fell from 15 +/- 2 to 7 +/- 1 mmHg (P less than 0.005), left ventricular end-diastolic pressure fell from 26 +/- 3 to 18 +/- 3 (P less than 0.005), stroke volume index increased from 20 +/- 2 to 30 +/- 2 ml/m2 (P less than 0.005), stroke work index increased from 14 +/- 2 to 21 +/- 2 g X m/m2 (P less than 0.01), and dP/dt increased from 858 +/- 54 to 1,130 +/- 108 mmHg/s (P less than 0.005). When compared

  6. Somatic-Affective, But Not Cognitive-Depressive Symptoms are Associated With Reduced Health-Related Quality of Life in Patients With Congestive Heart Failure.

    Science.gov (United States)

    Patron, Elisabetta; Messerotti Benvenuti, Simone; Lopriore, Vincenzo; Aratari, Jenny; Palomba, Daniela

    Depression has been associated with poor health-related quality of life (HRQoL) in patients with congestive heart failure (CHF). However, to date, whether somatic-affective and cognitive-depressive symptoms differently contribute to poor HRQoL and behavioral functional capacity in patients with CHF has yet to be investigated. To examine the differential influence of somatic-affective vs cognitive-depressive symptoms on HRQoL and behavioral functional capacity in CHF patients. Overall, 55 patients with CHF completed a psychologic evaluation, including the Minnesota Living with Heart Failure Questionnaire, the Beck Depression Inventory-II, and the Beck Anxiety Inventory for HRQoL, depressive, and anxiety symptoms, respectively. The patients completed the Instrumental Activities of Daily Living Questionnaire and the 6-minute walk test for behavioral functional capacity. Hierarchical regression analyses were used to predict HRQoL and behavioral functional capacity from Beck Depression Inventory-II and Beck Anxiety Inventory scores. Somatic-affective depressive symptoms were associated with physical (β = 0.37, p = 0.005) and emotional (β = 0.39, p = 0.008) Minnesota Living with Heart Failure Questionnaire subscale scores. Likewise, somatic-affective depressive symptoms predicted Instrumental Activities of Daily Livings Scores (β = 0.43, p = 0.004) and distance ambulated during the 6-minute walk test (β = -0.36, p = 0.029). By contrast, cognitive-depressive symptoms and anxiety were unrelated to HRQoL and behavioral functional capacity (all p > 0.05). These findings showed that somatic-affective depressive symptoms, but not cognitive-depressive symptoms and anxiety, are associated with poor HRQoL and behavioral functional capacity independent of age, clinical functional status, and medical comorbidities. This study suggests that patients with CHF with somatic-affective rather than cognitive-depressive symptoms or anxiety may be at greater risk of poor HRQoL and

  7. Effect of post-discharge follow-up care on re-admissions among US veterans with congestive heart failure: a rural-urban comparison.

    Science.gov (United States)

    Muus, Kyle J; Knudson, Alana; Klug, Marilyn G; Gokun, Jane; Sarrazin, Mary; Kaboli, Peter

    2010-01-01

    Hospital re-admissions for patients with congestive heart failure (CHF) are relatively common and costly occurrences within the US health infrastructure, including the Veterans Affairs (VA) healthcare system. Little is known about CHF re-admissions among rural veteran patients, including the effects of socio-demographics and follow-up outpatient visits on these re-admissions. To examine socio-demographics of US veterans with CHF who had 30 day potentially preventable re-admissions and compare the effect of 30 day VA post-discharge service use on these re-admissions for rural- and urban-dwelling veterans. The 2005-2007 VA data were analyzed to examine patient characteristics and hospital admissions for 36 566 veterans with CHF. The CHF patients who were and were not re-admitted to a VA hospital within 30 days of discharge were identified. Logistic regression was used to examine and compare the effect of VA post-acute service use on re-admissions between rural- and urban-dwelling veterans. Re-admitted veterans tended to be older (p=.002), had disability status (p=.024) and had longer hospital stays (precovery and good health among hospitalized veterans with CHF, regardless of their rural or urban residence. Older, rural veterans with CHF are in need of special attention for VA discharge planning and follow up with primary care providers.

  8. Crackle pitch and rate do not vary significantly during a single automated-auscultation session in patients with pneumonia, congestive heart failure, or interstitial pulmonary fibrosis.

    Science.gov (United States)

    Vyshedskiy, Andrey; Ishikawa, Sadamu; Murphy, Raymond L H

    2011-06-01

    To determine the variability of crackle pitch and crackle rate during a single automated-auscultation session with a computerized 16-channel lung-sound analyzer. Forty-nine patients with pneumonia, 52 with congestive heart failure (CHF), and 18 with interstitial pulmonary fibrosis (IPF) performed breathing maneuvers in the following sequence: normal breathing, deep breathing, cough several times; deep breathing, vital-capacity maneuver, and deep breathing. From the auscultation recordings we measured the crackle pitch and crackle rate. Crackle pitch variability, expressed as a percentage of the average crackle pitch, was small in all patients and in all maneuvers: pneumonia 11%, CHF 11%, pulmonary fibrosis 7%. Crackle rate variability was also small: pneumonia 31%, CHF 32%, IPF 24%. Compared to the first deep-breathing maneuver (100%), the average crackle pitch did not significantly change following coughing (pneumonia 100%, CHF 103%, IPF 100%), the vital-capacity maneuver (pneumonia 100%, CHF 92%, IPF 104%), or during quiet breathing (pneumonia 97%, CHF 100%, IPF 104%). Similarly, the average crackle rate did not change significantly following coughing (pneumonia 105%, CHF 110%, IPF 90%) or the vital-capacity maneuver (pneumonia 102%, CHF 101%, IPF 99%). However, during normal breathing the crackle rate was significantly lower in the patients with pneumonia (74%, P auscultation session suggests that crackle rate can be used to follow the course of cardiopulmonary illnesses such as pneumonia, IPF, and CHF.

  9. Evaluation of a fixed-dose combination of benazepril and pimobendan in dogs with congestive heart failure: a randomized non-inferiority clinical trial.

    Science.gov (United States)

    King, Jonathan N; Hirakawa, Atsushi; Sonobe, Junko; Otaki, Hiroshi; Sakakibara, Nobuhiro; Seewald, Wolfgang; Forster, Sophie

    2018-01-31

    A fixed-dose combination tablet of benazepril and pimobendan (Fortekor Plus; Elanco Animal Health) was tested in dogs with congestive heart failure (CHF) caused by myxomatous mitral valve disease (MMVD) in a three-arm, masked, randomized, non-inferiority clinical trial in Japan. The test group (n = 34) received Fortekor Plus twice daily. Two control groups received registered formulations of benazepril (Fortekor; Elanco Animal Health) and pimobendan (Vetmedin; Boehringer Ingelheim Vetmedica) with administration of Vetmedin twice daily and Fortekor twice (Control I, n = 14) or once (Control II, n = 19) daily. Diuretics were used in 22 dogs (32.8%). Global clinical scores decreased significantly from baseline in all groups; there were no significant differences between groups, and non-inferiority of Fortekor Plus compared to Control I, Control II, and combined Control I + II groups was demonstrated. There were no significant differences between groups for relevant clinical chemistry and hematology variables or frequency of all adverse events. Frequency of emesis was significantly ( p = 0.0042) lower in the Fortekor Plus (8.8%) group than in the Control I + II (39.4%) group. In conclusion, Fortekor Plus had non-inferior efficacy and was associated with significantly less emesis compared to Fortekor and Vetmedin in dogs with CHF caused by MMVD.

  10. Increased NT-proANP predicts risk of congestive heart failure in Cavalier King Charles spaniels with mitral regurgitation caused by myxomatous valve disease.

    Science.gov (United States)

    Eriksson, Anders S; Häggström, Jens; Pedersen, Henrik Duelund; Hansson, Kerstin; Järvinen, Anna-Kaisa; Haukka, Jari; Kvart, Clarence

    2014-09-01

    To evaluate the predictive value of plasma N-terminal pro-atrial natriuretic peptide (NT-proANP) and nitric oxide end-products (NOx) as markers for progression of mitral regurgitation caused by myxomatous mitral valve disease. Seventy-eight privately owned Cavalier King Charles spaniels with naturally occurring myxomatous mitral valve disease. Prospective longitudinal study comprising 312 measurements over a 4.5 year period. Clinical values were recorded, NT-proANP concentrations were measured by radioimmunoassay, and NOx were analyzed colorimetrically. To predict congestive heart failure (CHF), Cox proportional hazards models with time-varying covariates were constructed. The hazard ratio for NT-proANP (per 1000 pmol/l increase) to predict future CHF was 6.7 (95% confidence interval, 3.6-12.5; p 1000 pmol/l was 11 months (95% confidence interval, 5.6-12.6 months), compared to 54 months (46 - infinity) for dogs with concentrations ≤ 1000 pmol/l (p 130 beats per minute) and grade of murmur (≥ 3/6). The risk of CHF due to mitral regurgitation is increased in dogs with blood NT-proANP concentrations above 1000 pmol/l. Measurement of NT-proANP can be a valuable tool to identify dogs that may develop CHF within months. Copyright © 2014 Elsevier B.V. All rights reserved.

  11. Patent ductus arteriosus in an adult cat with pulmonary hypertension and right-sided congestive heart failure: hemodynamic evaluation and clinical outcome following ductal closure.

    Science.gov (United States)

    Novo-Matos, José; Hurter, Karin; Bektas, Rima; Grest, Paula; Glaus, Tony

    2014-09-01

    Right-sided congestive heart failure (CHF) developed secondary to severe pulmonary hypertension (PH) in an 8-year-old cat with a left-to-right shunting patent ductus arteriosus (PDA). Vascular reactivity was tested prior to shunt ligation by treatment with oxygen and sildenafil. This treatment was associated with a significant decrease in pulmonary artery pressure as assessed by echocardiography. Subsequently surgical shunt ligation was planned. During thoracotomy, digital occlusion of the PDA was performed for 10 min with simultaneous catheter measurement of right ventricular pressure, which did not increase. Permanent shunt ligation resulted in a complete and sustained clinical recovery. A lung biopsy sample obtained during thoracotomy demonstrated histopathological arterial changes typical of PH. Cats can develop clinically severe PH and right-sided CHF secondary to a left-to-right PDA even at an advanced age. Assuming there is evidence of pulmonary reactivity, PDA occlusion might be tolerated and can potentially produce long-term clinical benefits. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Ambient air pollution and hospitalization for congestive heart failure among elderly people in seven large US cities

    Energy Technology Data Exchange (ETDEWEB)

    Morris, R.D.; Naumova, E.N.; Munasinghe, R.L.

    1996-01-01

    Several recent studies show that the air pollution noxious effects on the cardiovascular system are certainly as more and even more important than those on the respiratory system diseases. The aim of this work is to study the contribution of the air pollution to the aggravation of the pre-existing heart diseases by the elderly persons in USA. More particularly, the co-variations between the daily hospital admissions for heart diseases and the pollution levels series by carbon monoxide, sulfur dioxide, nitrogen dioxide and ozone have been studied in several American towns. The statistical analysis used is a variant of the Poisson regression: a negative binomial distribution modeling. All the regressions are adjusted for the highest temperature, the yearly, seasonal and weekly trends. A time-lag of 0 to 7 days between the pollution and the hospital admissions have been studied. A risk calculation due to heart diseases is achieved for each town from relative risk estimations. The obtained results (mono-pollutant modeling) show that the carbon monoxide is the best correlated pollutant with the heart diseases incidence. The fact that the other pollutants are taken into account (multi-pollutants modeling) do not modify these results. (O.M.).

  13. Diuretics as pathogenetic treatment for heart failure

    Science.gov (United States)

    Guglin, Maya

    2011-01-01

    Increased intracardiac filling pressure or congestion causes symptoms and leads to hospital admissions in patients with heart failure, regardless of their systolic function. A history of hospital admission, in turn, predicts further hospitalizations and morbidity, and a higher number of hospitalizations determine higher mortality. Congestion is therefore the driving force of the natural history of heart failure. Congestion is the syndrome shared by heart failure with preserved and reduced systolic function. These two conditions have almost identical morbidity, mortality, and survival because the outcomes are driven by congestion. A small difference in favor of heart failure with preserved systolic function comes from decreased ejection fraction and left ventricular remodeling which is only present in heart failure with decreased systolic function. The magnitude of this difference reflects the contribution of decreased systolic function and ventricular remodeling to the progression of heart failure. The only treatment available for congestion is fluid removal via diuretics, ultrafiltration, or dialysis. It is the only treatment that works equally well for heart failure with reduced and preserved systolic function because it affects congestion, the main pathogenetic feature of the disease. Diuretics are pathogenetic therapy for heart failure. PMID:21403798

  14. Ivabradine, heart failure and chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Luca Di Lullo

    2015-12-01

    Full Text Available The incidence and prevalence of congestive heart failure are actually increasing worldwide, especially in Western countries. In Europe and the United States, congestive heart failure represents a disabling clinical disease, accountable for increased hospitalization and health care costs. European guidelines have underlined the importance of pharmacological treatment to improve both patients’ outcomes and quality of life. The latest clinical trials to evaluate ivabradine’s efficacy have underlined its usefulness as a stand-alone medication and in combination with conventional congestive heart failure therapy, including in chronic kidney disease patients.

  15. Excluding infection through procalcitonin testing improves outcomes of congestive heart failure patients presenting with acute respiratory symptoms: results from the randomized ProHOSP trial.

    Science.gov (United States)

    Schuetz, Philipp; Kutz, Alexander; Grolimund, Eva; Haubitz, Sebastian; Demann, Désirée; Vögeli, Alaadin; Hitz, Fabienne; Christ-Crain, Mirjam; Thomann, Robert; Falconnier, Claudine; Hoess, Claus; Henzen, Christoph; Marlowe, Robert J; Zimmerli, Werner; Mueller, Beat

    2014-08-20

    We sought to determine whether exclusion of infection and antibiotic stewardship with the infection biomarker procalcitonin improves outcomes in congestive heart failure (CHF) patients presenting to emergency departments with respiratory symptoms and suspicion of respiratory infection. We performed a secondary analysis of patients with a past medical history of CHF formerly included in a Swiss multicenter randomized-controlled trial. The trial compared antibiotic stewardship according to a procalcitonin algorithm or state-of-the-art guidelines (controls). The primary endpoint was a 30-day adverse outcome (death, intensive care unit admission); the secondary endpoints included a 30-day antibiotic exposure. In the 110/233 analyzed patients (47.2%) with low initial procalcitonin (<0.25 μg/L), suggesting the absence of systemic bacterial infection, those randomized to procalcitonin guidance (n=50) had a significantly lower adverse outcome rate compared to controls (n=60): 4% vs. 20% (absolute difference -16.0%, 95% confidence interval (CI) -28.4% to -3.6%, P=0.01), and significantly reduced antibiotic exposure [days] (mean 3.7 ± 4.0 vs. 6.5 ± 4.4, difference -2.8 [95% CI, -4.4 to -1.2], P<0.01). When initial procalcitonin was ≥0.25 μg/L, procalcitonin-guided patients had significantly reduced antibiotic exposure due to early stop of therapy without any difference in adverse outcomes (25.8% vs. 24.6%, difference [95% CI] 1.2% [-14.5% to 16.9%, P=0.88]). CHF patients presenting to the emergency department with respiratory symptoms and suspicion for respiratory infection had decreased antibiotic exposure and improved outcomes when procalcitonin measurement was used to exclude bacterial infection and guide antibiotic treatment. These data provide further evidence for the potential harmful effects of antibiotic / fluid treatment when used instead of diuretics and heart failure medication in clinically symptomatic CHF patients without underlying infection. Copyright

  16. The progression to permanent atrial fibrillation with congestive heart failure is associated with sympathetic nerve abnormality. A study with I-123 metaiodobenzylguanidine scintigraphy

    International Nuclear Information System (INIS)

    Kodama, Yusuke; Akutsu, Yasushi; Li, Hui-Ling; Kinohira, Yukihiko; Yamanaka, Hideyuki; Shinozuka, Akira; Katagiri, Takashi

    2005-01-01

    The aim of this study was to evaluate the relationship between congestive heart failure (CHF) and atrial fibrillation (AF) using iodine-123 metaiodobenzylguanidine (MIBG) scintigraphic imaging. Ninety-two AF patients (47 male and 45 female patients; mean age, 67±13 years) who did not suffer from structural heart disease or myocardial ischemia underwent MIBG scintigraphy. Global MIBG uptake was assessed by measuring the heart-to-mediastinal ratio (H/M) and washout rate (WR) on planar images, and the abnormal score (AS) was calculated on delayed MIBG single photon emission computed tomography images. Echocardiography was performed within a week after MIBG scintigraphy, to measure left ventricular ejection fraction (EF) and deceleration time (DT). The AF patients were divided into four groups: patients with permanent AF with (n=23, group A) or without (n=19, group B) a history of CHF, and patients with paroxysmal AF with (n=19, group C) or without (n=39, group D) a history of CHF. The H/M ratio was significantly lower in group A than in other groups (2.0±0.6 vs. group B: 2.7±0.6, group C: 2.3±0.5, and group D: 2.6±0.8, P<0.05), and in group C than in group D (P<0.05). Similarly, the WR was significantly higher in group A than in groups B and C (45.9±2.0 vs. group B: 38.9±1.9 and group C: 38.4±2.3, P<0.05). The AS was the highest in group A (19.7±8.2 vs. group B: 7.1±6.6, P<0.01; group C: 11.6±10.6 and group D: 13.5±9.0, P<0.05). The DT was significantly longer in group A than in groups B and D (222.0±59.4 vs. group B: 179.5±49.1, P<0.05 and group D: 177.9±37.1, P<0.01), but did not differ between groups A and C (222.0±59.4 vs. 197.4±51.1). There was no difference in EF among the groups. Although CHF with AF is associated with diastolic dysfunction, the progression to permanent AF from paroxysmal AF with CHF might be caused mainly by sympathetic nerve abnormality. (author)

  17. Congestive Heart Failure Leads to Prolongation of the PR Interval and Atrioventricular Junction Enlargement and Ion Channel Remodelling in the Rabbit

    Science.gov (United States)

    Nikolaidou, Theodora; Cai, Xue J.; Stephenson, Robert S.; Yanni, Joseph; Lowe, Tristan; Atkinson, Andrew J.; Jones, Caroline B.; Sardar, Rida; Corno, Antonio F.; Dobrzynski, Halina; Withers, Philip J.; Jarvis, Jonathan C.; Hart, George; Boyett, Mark R.

    2015-01-01

    Heart failure is a major killer worldwide. Atrioventricular conduction block is common in heart failure; it is associated with worse outcomes and can lead to syncope and bradycardic death. We examine the effect of heart failure on anatomical and ion channel remodelling in the rabbit atrioventricular junction (AVJ). Heart failure was induced in New Zealand rabbits by disruption of the aortic valve and banding of the abdominal aorta resulting in volume and pressure overload. Laser micro-dissection and real-time polymerase chain reaction (RT-PCR) were employed to investigate the effects of heart failure on ion channel remodelling in four regions of the rabbit AVJ and in septal tissues. Investigation of the AVJ anatomy was performed using micro-computed tomography (micro-CT). Heart failure animals developed first degree heart block. Heart failure caused ventricular myocardial volume increase with a 35% elongation of the AVJ. There was downregulation of HCN1 and Cx43 mRNA transcripts across all regions and downregulation of Cav1.3 in the transitional tissue. Cx40 mRNA was significantly downregulated in the atrial septum and AVJ tissues but not in the ventricular septum. mRNA abundance for ANP, CLCN2 and Navβ1 was increased with heart failure; Nav1.1 was increased in the inferior nodal extension/compact node area. Heart failure in the rabbit leads to prolongation of the PR interval and this is accompanied by downregulation of HCN1, Cav1.3, Cx40 and Cx43 mRNAs and anatomical enlargement of the entire heart and AVJ. PMID:26509807

  18. Congestive Heart Failure Leads to Prolongation of the PR Interval and Atrioventricular Junction Enlargement and Ion Channel Remodelling in the Rabbit.

    Directory of Open Access Journals (Sweden)

    Theodora Nikolaidou

    Full Text Available Heart failure is a major killer worldwide. Atrioventricular conduction block is common in heart failure; it is associated with worse outcomes and can lead to syncope and bradycardic death. We examine the effect of heart failure on anatomical and ion channel remodelling in the rabbit atrioventricular junction (AVJ. Heart failure was induced in New Zealand rabbits by disruption of the aortic valve and banding of the abdominal aorta resulting in volume and pressure overload. Laser micro-dissection and real-time polymerase chain reaction (RT-PCR were employed to investigate the effects of heart failure on ion channel remodelling in four regions of the rabbit AVJ and in septal tissues. Investigation of the AVJ anatomy was performed using micro-computed tomography (micro-CT. Heart failure animals developed first degree heart block. Heart failure caused ventricular myocardial volume increase with a 35% elongation of the AVJ. There was downregulation of HCN1 and Cx43 mRNA transcripts across all regions and downregulation of Cav1.3 in the transitional tissue. Cx40 mRNA was significantly downregulated in the atrial septum and AVJ tissues but not in the ventricular septum. mRNA abundance for ANP, CLCN2 and Navβ1 was increased with heart failure; Nav1.1 was increased in the inferior nodal extension/compact node area. Heart failure in the rabbit leads to prolongation of the PR interval and this is accompanied by downregulation of HCN1, Cav1.3, Cx40 and Cx43 mRNAs and anatomical enlargement of the entire heart and AVJ.

  19. Usefulness of {sup 123}I-MIBG myocardial scintigraphy for determining the severity and prognosis in chronic hemodialysis patients with congestive heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Tsukamoto, Masaki; Kato, Shuji; Okamoto, Akio; Kawasaki, Tatsuya; Yamamoto, Teruyuki; Yoneyama, Satoshi; Tatsukawa, Hirotaka; Ida, Kazunori [Asahi Univ., Hozumi, Gifu (Japan). Murakami Memorial Hospital; Terada, Koji

    1997-11-01

    The subjects were 32 patients who had undergone hemodialysis treatment for an average of 17 yr. MIBG myocardial scintigraphy was obtained from SPECT and anterior planar images at 15 min and 4 hr after MIBG injection. Myocardial MIBG uptake was quantified by the heart-to-mediastinum uptake ratio on delayed planar images (H/M) and the mean myocardial MIBG washout rate at 4 hr was calculated by using the Bull`s eye map (MC). The mean lung MIBG washout rate at 4 hr was also obtained from planar images (LC). The left ventricular end diastolic dimension (LVDd), percent fractional shortening (%FS), wall thickness and the ratio of peak velocity of early rapid filling to peak velocity of inflow due to the atrial contraction (E/A) were measured by echocardiography. The patients were divided according to the severity of congestive heart failure (CHF): NYHA classification grade I or II vs. grade III or IV. The severe CHF group showed decreased H/M, LC and dilatation of LVDd. Twenty-two patients were clinically followed up for one and a half years. Seven had acute worsening of CHF and required admission to a hospital. The other 15 patients did not require admission. H/M and LC were decreased, and E/A was increased in the former group. Eighteen of the 24 patients with mild CHF were followed up and classified according to the clinical course whether or not they had acute worsening of CHF. In the acute worsening group, H/M and LC were decreased, and E/A was increased compared with the non-acute worsening group. Thus, H/M and LC indicate the severity and the prognosis of chronic hemodialysis patients with CHF. Dilatation of LVDd reflects the severity of CHF, but it cannot predict the clinical course, because LVDd is always reduced by the medication for CHF. Increased E/A was found in the acute worsening CHF group, but many factors influence the E/A value and increased E/A alone cannot be prognostic for the clinical course of CHF. (K.H.)

  20. Effect of repeated intracoronary injection of bone marrow cells in patients with ischaemic heart failure the Danish stem cell study--congestive heart failure trial (DanCell-CHF)

    DEFF Research Database (Denmark)

    Diederichsen, Axel Cosmus Pyndt; Møller, Jacob E; Thayssen, Per

    2008-01-01

    BACKGROUND: It has been suggested that myocardial regeneration may be achieved by a single intracoronary bone marrow derived stem cell infusion in selected patients with ischaemic heart disease. The effect is uncertain in patients with chronic ischaemic heart failure and it is not known whether r...

  1. Secondary Hyperparathyroidism in Heart Failure.

    Science.gov (United States)

    Morsy, Mohamed S; Dishmon, Dwight A; Garg, Nadish; Weber, Karl T

    2017-10-01

    Secondary hyperparathyroidism (SHPT) is a well-known pathophysiologic feature of chronic renal failure. In recent years, SHPT has become recognized as a complication of the aldosteronism associated with congestive heart failure and where excretory Ca 2+ and Mg 2+ wasting results in plasma-ionized hypocalcemia and hypomagnesemia. Elevations in plasma parathyroid hormone have adverse systemic consequences, including intracellular Ca 2+ overloading of myocytes and vascular smooth muscle with the induction of oxidative stress. Herein, we briefly review the presence and adverse outcomes of SHPT in persons with heart failure. Copyright © 2017 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

  2. Randomised trial of low-dose amiodarone in severe congestive heart failure. Grupo de Estudio de la Sobrevida en la Insuficiencia Cardiaca en Argentina (GESICA)

    Science.gov (United States)

    Doval, H C; Nul, D R; Grancelli, H O; Perrone, S V; Bortman, G R; Curiel, R

    1994-08-20

    In severe heart failure many deaths are sudden and are presumed to be due to ventricular arrhythmias. The GESICA trial evaluated the effect of low-dose amiodarone on two-year mortality in patients with severe heart failure. Our prospective multicentre trial included 516 patients on optimal standard treatment for heart failure. Patients were randomised to 300 mg/day amiodarone (260) or to standard treatment (256). Intention-to-treat analysis showed 87 deaths in the amiodarone group (33.5%) compared with 106 in the control group (41.4%) (risk reduction 28%; 95% CI 4%-45%; log rank test p = 0.024). There were reductions in both sudden death (risk reduction 27%; p = 0.16) and death due to progressive heart failure (risk reduction 23%; p = 0.16). Fewer patients in the amiodarone group died or were admitted to hospital due to worsening heart failure (119 versus 149 in the control group; risk reduction 31%; 95% CI 13-46%; p = 0.0024). The decrease in mortality and hospital admission was present in all subgroups examined and independent of the presence of non-sustained ventricular tachycardia. Side-effects were reported in 17 patients (6.1%); amiodarone was withdrawn in 12. Low-dose amiodarone proved to be an effective and reliable treatment, reducing mortality and hospital admission in patients with severe heart failure independently of the presence of complex ventricular arrhythmias.

  3. Diuretics for heart failure.

    Science.gov (United States)

    Faris, Rajaa F; Flather, Marcus; Purcell, Henry; Poole-Wilson, Philip A; Coats, Andrew J S

    2012-02-15

    Chronic heart failure is a major cause of morbidity and mortality worldwide. Diuretics are regarded as the first-line treatment for patients with congestive heart failure since they provide symptomatic relief. The effects of diuretics on disease progression and survival remain unclear. To assess the harms and benefits of diuretics for chronic heart failure Updated searches were run in the Cochrane Central Register of Controlled Trials in The Cochrane Library (CENTRAL Issue 1 of 4, 2011), MEDLINE (1966 to 22 February 2011), EMBASE (1980 to 2011 Week 07) and HERDIN database (1990 to February 2011). We hand searched pertinent journals and reference lists of papers were inspected. We also contacted manufacturers and researchers in the field. No language restrictions were applied. Double-blinded randomised controlled trials of diuretic therapy comparing one diuretic with placebo, or one diuretic with another active agent (e.g. ACE inhibitors, digoxin) in patients with chronic heart failure. Two authors independently abstracted the data and assessed the eligibility and methodological quality of each trial. Extracted data were analysed by determining the odds ratio for dichotomous data, and difference in means for continuous data, of the treated group compared with controls. The likelihood of heterogeneity of the study population was assessed by the Chi-square test. If there was no evidence of statistical heterogeneity and pooling of results was clinically appropriate, a combined estimate was obtained using the fixed-effects model. This update has not identified any new studies for inclusion. The review includes 14 trials (525 participants), 7 were placebo-controlled, and 7 compared diuretics against other agents such as ACE inhibitors or digoxin. We analysed the data for mortality and for worsening heart failure. Mortality data were available in 3 of the placebo-controlled trials (202 participants). Mortality was lower for participants treated with diuretics than for

  4. Heart failure - surgeries and devices

    Science.gov (United States)

    ... surgery; HF - surgery; Intra-aortic balloon pumps - heart failure; IABP - heart failure; Catheter based assist devices - heart failure ... problem may cause heart failure or make heart failure worse. Heart valve surgery may be needed to repair or ...

  5. Impact of β-blocker selectivity on long-term outcomes in congestive heart failure patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Kubota Y

    2015-03-01

    Full Text Available Yoshiaki Kubota, Kuniya Asai, Erito Furuse, Shunichi Nakamura, Koji Murai, Yayoi Tetsuou Tsukada, Wataru Shimizu Department of Medicine (Division of Cardiology, Nippon Medical School, Bunkyo-ku, Tokyo, Japan Background: Chronic obstructive pulmonary disease (COPD is present in approximately one-third of all congestive heart failure (CHF patients, and is a key cause of underprescription and underdosing of β-blockers, largely owing to concerns about precipitating respiratory deterioration. For these reasons, the aim of this study was to evaluate the impact of β-blockers on the long-term outcomes in CHF patients with COPD. In addition, we compared the effects of two different β-blockers, carvedilol and bisoprolol. Methods: The study was a retrospective, non-randomized, single center trial. Acute decompensated HF patients with COPD were classified according to the oral drug used at discharge into β-blocker (n=86; carvedilol [n=52] or bisoprolol [n=34] and non-β-blocker groups (n=46. The primary endpoint was all-cause mortality between the β-blocker and non-β-blocker groups during a mean clinical follow-up of 33.9 months. The secondary endpoints were the differences in all-cause mortality and the hospitalization rates for CHF and/or COPD exacerbation between patients receiving carvedilol and bisoprolol. Results: The mortality rate was higher in patients without β-blockers compared with those taking β-blockers (log-rank P=0.039, and univariate analyses revealed that the use of β-blockers was the only factor significantly correlated with the mortality rate (hazard ratio: 0.41; 95% confidence interval: 0.17–0.99; P=0.047. Moreover, the rate of CHF and/or COPD exacerbation was higher in patients treated with carvedilol compared with bisoprolol (log-rank P=0.033. In the multivariate analysis, only a past history of COPD exacerbation significantly increased the risk of re-hospitalization due to CHF and/or COPD exacerbation (adjusted hazard

  6. Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

    International Nuclear Information System (INIS)

    Nguyen, Paul L.; Chen, Ming-Hui; Beckman, Joshua A.; Beard, Clair J.; Martin, Neil E.; Choueiri, Toni K.; Hu, Jim C.; Hoffman, Karen E.; Dosoretz, Daniel E.; Moran, Brian J.; Salenius, Sharon A.; Braccioforte, Michelle H.; Kantoff, Philip W.; D’Amico, Anthony V.; Ennis, Ronald D.

    2012-01-01

    Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c–T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32–2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17–5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13–2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96–2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

  7. Adrenergic stimulation promotes T-wave alternans and arrhythmia inducibility in a TNF-alpha genetic mouse model of congestive heart failure.

    Science.gov (United States)

    Shusterman, Vladimir; McTiernan, Charles F; Goldberg, Anna; Saba, Samir; Salama, Guy; London, Barry

    2010-02-01

    T-wave alternans (TWA) is a proarrhythmic repolarization instability that is common in congestive heart failure (CHF). Although transgenic mice are commonly used to study the mechanisms of arrhythmogenesis in CHF, little is known about the dynamics of TWA in these species. We hypothesized that TWA is present in a TNF-alpha model of CHF and can be further promoted by adrenergic stimulation. We studied 16 TNF-alpha mice and 12 FVB controls using 1) in vivo intracardiac electrophysiological testing and 2) ambulatory telemetry during 30 min before and after an intraperitoneal injection of isoproterenol. TWA was examined using both linear and nonlinear filtering applied in the time domain. In addition, changes in the mean amplitude of the T wave and area under the T wave were computed. During intracardiac electrophysiological testing, none of the animals had TWA or inducible arrhythmias before the injection of isoproterenol. After the injection, sustained TWA and inducible ventricular tachyarrhythmias were observed in TNF-alpha mice but not in FVB mice. In ambulatory telemetry, before the isoproterenol injection, the cardiac cycle length (CL) was longer in TNF-alpha mice than in FVB mice (98 +/- 9 and 88 +/- 3 ms, P = 0.04). After the injection of isoproterenol, the CL became 8% and 6% shorter in TNF-alpha and FVB mice (P mice, the magnitude of TWA was 1.5-2 times greater than in FVB mice both before and after the isoproterenol injection. The magnitude of TWA increased significantly after the isoproterenol injection compared with the baseline in TNF-alpha mice (P = 0.003) but not in FVB mice. The mean amplitude of the T wave and area under the T wave increased 60% and 80% in FVB mice (P = 0.006 and 0.009) but not in TNF-alpha mice. In conclusion, TWA is present in a TNF-alpha model of CHF and can be further promoted by adrenergic stimulation, along with the enhanced susceptibility for ventricular arrhythmias.

  8. Influence of Androgen Deprivation Therapy on All-Cause Mortality in Men With High-Risk Prostate Cancer and a History of Congestive Heart Failure or Myocardial Infarction

    Energy Technology Data Exchange (ETDEWEB)

    Nguyen, Paul L., E-mail: pnguyen@LROC.harvard.edu [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Chen, Ming-Hui [Department of Statistics, University of Connecticut, Storrs, CT (United States); Beckman, Joshua A. [Department of Cardiology, Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Beard, Clair J.; Martin, Neil E. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Choueiri, Toni K. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); Hu, Jim C. [Division of Urologic Surgery, Brigham and Women' s/Faulkner Hospital, Harvard Medical School, Boston, MA (United States); Hoffman, Karen E. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Dosoretz, Daniel E. [21st Century Oncology, Fort Myers, FL (United States); Moran, Brian J. [Chicago Prostate Center, Westmont, IL (United States); Salenius, Sharon A. [21st Century Oncology, Fort Myers, FL (United States); Braccioforte, Michelle H. [Chicago Prostate Center, Westmont, IL (United States); Kantoff, Philip W. [Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA (United States); D' Amico, Anthony V. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women' s Hospital, Harvard Medical School, Boston, MA (United States); Ennis, Ronald D. [Department of Radiation Oncology, St. Luke' s-Roosevelt and Beth Israel Hospitals, Continuum Cancer Centers of New York, Albert Einstein College of Medicine, New York, NY (Israel)

    2012-03-15

    Purpose: It is unknown whether the excess risk of all-cause mortality (ACM) observed when androgen deprivation therapy (ADT) is added to radiation for men with prostate cancer and a history of congestive heart failure (CHF) or myocardial infarction (MI) also applies to those with high-risk disease. Methods and Materials: Of 14,594 men with cT1c-T3aN0M0 prostate cancer treated with brachytherapy-based radiation from 1991 through 2006, 1,378 (9.4%) with a history of CHF or MI comprised the study cohort. Of these, 22.6% received supplemental external beam radiation, and 42.9% received a median of 4 months of neoadjuvant ADT. Median age was 71.8 years. Median follow-up was 4.3 years. Cox multivariable analysis tested for an association between ADT use and ACM within risk groups, after adjusting for treatment factors, prognostic factors, and propensity score for ADT. Results: ADT was associated with significantly increased ACM (adjusted hazard ratio [AHR] = 1.76; 95% confidence interval [CI], 1.32-2.34; p = 0.0001), with 5-year estimates of 22.71% with ADT and 11.62% without ADT. The impact of ADT on ACM by risk group was as follows: high-risk AHR = 2.57; 95% CI, 1.17-5.67; p = 0.019; intermediate-risk AHR = 1.75; 95% CI, 1.13-2.73; p = 0.012; low-risk AHR = 1.52; 95% CI, 0.96-2.43; p = 0.075). Conclusions: Among patients with a history of CHF or MI treated with brachytherapy-based radiation, ADT was associated with increased all-cause mortality, even for patients with high-risk disease. Although ADT has been shown in Phase III studies to improve overall survival in high-risk disease, the small subgroup of high-risk patients with a history of CHF or MI, who represented about 9% of the patients, may be harmed by ADT.

  9. Advanced Heart Failure

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Advanced Heart Failure Updated:May 9,2017 When heart failure (HF) ... Making This content was last reviewed May 2017. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  10. Congestive heart failure is associated with lipoprotein components in statin-treated patients with coronary heart disease Insights from the Incremental Decrease in End points Through Aggressive Lipid Lowering Trial (IDEAL)

    DEFF Research Database (Denmark)

    Holme, Ingar; Strandberg, Timo E; Faergeman, Ole

    2009-01-01

    BACKGROUND: Very few, if any, studies have assessed the ability of apolipoproteins to predict new-onset of congestive heart failure (HF) in statin-treated patients with coronary heart disease (CHD). AIMS: To employ the Incremental Decrease in End points Through Aggressive Lipid Lowering Trial...... with the occurrence of new-onset HF. Variables related to low-density lipoprotein cholesterol (LDL-C) carried less predictive information than those related to high-density lipoprotein cholesterol (HDL-C), and apoA-1 was the single variable most strongly associated with HF. LDL-C was less predictive than both non......-HDL-C (total cholesterol minus HDL-C) and apoB. The ratio of apoB to apoA-1 was most strongly related to HF after adjustment for potential confounders, among which diabetes had a stronger correlation with HF than did hypertension. ApoB/apoA-1 carried approximately 2.2 times more of the statistical information...

  11. Dofetilide in patients with congestive heart failure and left ventricular dysfunction: safety aspects and effect on atrial fibrillation. The Danish Investigators of Arrhythmia and Mortality on Dofetilide (DIAMOND) Study Group

    DEFF Research Database (Denmark)

    Møller, M; Torp-Pedersen, C T; Køber, L

    2002-01-01

    to sinus rhythm, 78%/43% of patients in the dofetilide/placebo groups remained in sinus rhythm for at least 1 year. There were 25 instances (3%) of torsade de pointes ventricular tachycardia in the dofetilide group and none in the placebo group. CONCLUSION. In patients with congestive heart failure...... monitored electrocardiographically for the first 3 days of the study. The primary end point was all-cause mortality and follow-up was for at least 1 year. RESULTS. In the dofetilide/placebo groups, 311/317 patients died (41%/42%). The hazard ratio for dofetilide treatment was 0.95 (95% confidence interval...

  12. Patterns of left ventricular geometry and the transition to congestive heart failure with preserved versus depressed ejection fraction (Patrones de geometría ventricular izquierda y la transición a la insuficiencia cardíaca congestiva con fracción de eyección conservada versus deprimida)

    OpenAIRE

    José H. Donis Hernández; Francisco Sanchez; Bárbara das Neves; Carmen A. Mazzei de Dávila, Lisett Aranguibel, Maite González; Lisett Aranguibel; Maite González

    2014-01-01

    Abstract (english) Analysis of cross-sectional and follow up clinical studies, of hypertensive patients with the different left ventricular geometric patterns, provide plausible explanations for the transition from hypertensive heart disease to the two distinct phenotypes of systolic and diastolic congestive heart failure. According to the LIFE study treated-uncomplicated patients, with normal ventricular geometry (12%), concentric remodeling ...

  13. The pathophysiology of heart failure.

    Science.gov (United States)

    Kemp, Clinton D; Conte, John V

    2012-01-01

    Heart failure is a clinical syndrome that results when the heart is unable to provide sufficient blood flow to meet metabolic requirements or accommodate systemic venous return. This common condition affects over 5 million people in the United States at a cost of $10-38 billion per year. Heart failure results from injury to the myocardium from a variety of causes including ischemic heart disease, hypertension, and diabetes. Less common etiologies include cardiomyopathies, valvular disease, myocarditis, infections, systemic toxins, and cardiotoxic drugs. As the heart fails, patients develop symptoms which include dyspnea from pulmonary congestion, and peripheral edema and ascites from impaired venous return. Constitutional symptoms such as nausea, lack of appetite, and fatigue are also common. There are several compensatory mechanisms that occur as the failing heart attempts to maintain adequate function. These include increasing cardiac output via the Frank-Starling mechanism, increasing ventricular volume and wall thickness through ventricular remodeling, and maintaining tissue perfusion with augmented mean arterial pressure through activation of neurohormonal systems. Although initially beneficial in the early stages of heart failure, all of these compensatory mechanisms eventually lead to a vicious cycle of worsening heart failure. Treatment strategies have been developed based upon the understanding of these compensatory mechanisms. Medical therapy includes diuresis, suppression of the overactive neurohormonal systems, and augmentation of contractility. Surgical options include ventricular resynchronization therapy, surgical ventricular remodeling, ventricular assist device implantation, and heart transplantation. Despite significant understanding of the underlying pathophysiological mechanisms in heart failure, this disease causes significant morbidity and carries a 50% 5-year mortality. Copyright © 2012 Elsevier Inc. All rights reserved.

  14. Managing Feelings about Heart Failure

    Science.gov (United States)

    ... About Heart Failure Module 6: Managing Feelings About Heart Failure Download Module Order Hardcopy Heart failure can cause ... professional help for emotional problems. Common Feelings About Heart Failure It is common for people to feel depressed ...

  15. Self-perceived symptoms and care needs of patients with severe to very severe chronic obstructive pulmonary disease, congestive heart failure or chronic renal failure and its consequences for their closest relatives: the research protocol

    Directory of Open Access Journals (Sweden)

    Schols Jos MGA

    2008-05-01

    Full Text Available Abstract Background Recent research shows that the prevalence of patients with very severe chronic obstructive pulmonary disease (COPD, congestive heart failure (CHF and chronic renal failure (CRF continues to rise over the next years. Scientific studies concerning self-perceived symptoms and care needs in patients with severe to very severe COPD, CHF and CRF are scarce. Consequently, it will be difficult to develop an optimal patient-centred palliative care program for patients with end-stage COPD, CHF or CRF. The present study has been designed to assess the symptoms, care needs, end-of-life care treatment preferences and communication needs of patients with severe to very severe COPD, CHF or CRF. Additionally, family distress and care giving burden of relatives of these patients will be assessed. Methods/design A cross-sectional comparative and prospective longitudinal study in patients with end-stage COPD, CHF or CRF has been designed. Patients will be recruited by their treating physician specialist. Patients and their closest relatives will be visited at baseline and every 4 months after baseline for a period of 12 months. The following outcomes will be assessed during home visits: self-perceived symptoms and care needs; daily physical functioning; general health status; end-of-life care treatment preferences; end-of-life care communication and care-giver burden of family caregivers. Additionally, end-of-life care communication and prognosis of survival will be assessed with the physician primarily responsible for the management of the chronic organ failure. Finally, if patients decease during the study period, the baseline preferences with regard to life-sustaining treatments will be compared with the real end-of-life care. Discussion To date, the symptoms, care needs, caregiver burden, end-of-life care treatment preferences and communication needs of patients with very severe COPD, CHF or CRF remain unknown. The present study will

  16. Predictors of sudden death and death from pump failure in congestive heart failure are different. Analysis of 24 h Holter monitoring, clinical variables, blood chemistry, exercise test and radionuclide angiography

    DEFF Research Database (Denmark)

    Madsen, B K; Rasmussen, Verner; Hansen, J F

    1997-01-01

    Association class II and 44% in III. Total mortality after 1 year was 21%, after 2 years 32%. Of 60 deaths, 33% were sudden and 49% due to pump failure. Multivariate analyses identified totally different risk factors for sudden death: ventricular tachycardia, s-sodium ....6 mmol/l, s-potassium sudden death and for death from progressive pump failure........80 mmol/l, s-creatinine > 121 mumol/l, and maximal change in heart rate during exercise death from progressive pump failure: New York Heart Association class III + IV, delta heart rate over 24 h 7...

  17. Determination of the survival rate in patients with congestive heart failure stratified by 123I-MIBG imaging. A meta-analysis from the studies performed in Japan

    International Nuclear Information System (INIS)

    Kuwabara, Yoichi; Tamaki, Nagara; Nakata, Tomoaki; Yamashina, Shohei; Yamazaki, Junichi

    2011-01-01

    The goals of this meta-analysis were to determine survival rates in patients with heart failure (HF) assessed by 123 I-metaiodobenzylguanidine (MIBG) imaging results using recently published studies and to determine the prognostic value of 123 I-MIBG imaging. We reviewed published cohort studies carried out in Japan that compared the prognosis of patients with their 123 I-MIBG activity quantified as late heart-to-mediastinum ratio (H/M) or washout rate by performing a PubMed search for articles in English up to December 2006. Studies were selected if they analyzed a clearly defined lethal outcome (cardiovascular death) using life tables to estimate the odds ratio at 24 months after enrollment. Of 158 articles related to cardiac 123 I-MIBG, seven referred to studies that met the inclusion criteria: 5 evaluated H/M via 123 I-MIBG in a total of 866 patients and 4 calculated washout rate in a total of 491 patients. A low H/M indicated a high risk of cardiac death: pooled odds ratio, 5.2; 95% confidence interval (CI) of 3.1-5.7. A high washout was also associated with lethal events with a pooled odds ratio of 2.8 (CI: 1.6-5.0). The association between washout and cardiac death was heterogeneous (Chi-square=11.0, P 123 I-MIBG studies conducted in Japan indicated that both a decreased cardiac 123 I-MIBG activity (H/M) and an increased washout rate are indicative of a poor prognosis in patients with chronic heart failure. (author)

  18. Creation of a restrictive atrial communication in heart failure with preserved and mid-range ejection fraction: effective palliation of left atrial hypertension and pulmonary congestion.

    Science.gov (United States)

    Bauer, Anna; Khalil, Markus; Lüdemann, Monika; Bauer, Jürgen; Esmaeili, Anoosh; De-Rosa, Roberta; Voelkel, Norbert F; Akintuerk, Hakan; Schranz, Dietmar

    2018-04-16

    Left atrial decompression is considered in patients with symptomatic heart failure with preserved ejection fraction (HFpEF). We aimed to evaluate the feasibility and efficacy of transcatheter generation of a restrictive atrial septum communication to manage HFpEF from infancy to adulthood with cardiomyopathy and congenital heart defect. From June 2009 to December 2016, 24 patients (50% with an age less than 16 years) with HFpEF were palliated; NYHA-/Ross class IV (n = 10); median systemic ventricular ejection fraction 64 (range 35-78) %. Cardiomyopathy was classified as a restrictive (n = 4) or hypertrophic (n = 2). (75% related to congenital heart defects) Three patients had a systemic right ventricle; in the majority of patients, HFpEF was associated to complex congenital heart defects (n = 18). Mean pulmonary arterial pressures (PAP systolic/diastolic) were 56/28 (± 24/13), left atrial pressures (LAP, v-, a-wave, mean) 26/25/20 (± 7/10/6). Trans-septal puncture was used in 22 patients; foramen ovale dilatation in 2 patients. Median balloon size was 12 (range 6-18) mm; procedure time including diagnostic measures 125 (83-221) min. No procedural death or complications were observed. Mean LA-pressures decreased significantly to 19/19/15 ± 6/8/5 mmHg (p = 0.05); median brain natriuretic peptide (BNP) decreased from 392 (range 93-4401) pg/ml median BNP to 314 (range 61-1544) pg/ml (p = 0.05). Three patients died; one patient received orthotopic heart and one patient a heart-lung transplantation. No patient required so far an assist device. Clinical improvement occurred in all patients, in some after additional surgical or interventional approach. Transcatheter LA decompression is an age-independent, effective palliation treating patients with HFpEF.

  19. Heart Failure in Women

    Science.gov (United States)

    Bozkurt, Biykem; Khalaf, Shaden

    2017-01-01

    Heart failure is an important cause of morbidity and mortality in women, and they tend to develop it at an older age compared to men. Heart failure with preserved ejection fraction is more common in women than in men and accounts for at least half the cases of heart failure in women. When comparing men and women who have heart failure and a low left ventricular ejection fraction, the women are more symptomatic and have a similarly poor outcome. Overall recommendations for guideline-directed medical therapies show no differences in treatment approaches between men and women. Overall, women are generally underrepresented in clinical trials for heart failure. Further studies are needed to shed light into different mechanisms, causes, and targeted therapies of heart failure in women. PMID:29744014

  20. [Diuretic therapy in heart failure].

    Science.gov (United States)

    Trullàs, Joan Carles; Morales-Rull, José Luís; Formiga, Francesc

    2014-02-20

    Many of the primary clinical manifestations of heart failure (HF) are due to fluid retention, and treatments targeting congestion play a central role in HF management. Diuretic therapy remains the cornerstone of congestion treatment, and diuretics are prescribed to the majority of HF patients. Despite this ubiquitous use, there is limited evidence from prospective randomized studies to guide the use of diuretics. With the chronic use of diuretic and usually in advanced stages of HF, diuretics may fail to control salt and water retention. This review describes the mechanism of action of available diuretic classes, reviews their clinical use based on scientific evidence and discusses strategies to overcome diuretic resistance. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  1. Nutrition in Heart Failure

    OpenAIRE

    Reci Meseri

    2013-01-01

    Heart failure is defined as decreased ability of heart due to various reasons. It%u2019s seen 2-3% but the prevalence increases sharply after the age of seventy. The objectives of nutrition therapy in heart failure are to prevent from water retention and edema, to avoid from hard digestion and to offer a balanced diet. In order to avoid fluid retention and edema, daily sodium and fluid intake must be monitored carefully. Main dilemma of the heart failure patients is the obesity-cachexia dilem...

  2. Elevated Potassium Levels in Patients With Congestive Heart Failure: Occurrence, Risk Factors, and Clinical Outcomes: A Danish Population-Based Cohort Study.

    Science.gov (United States)

    Thomsen, Reimar Wernich; Nicolaisen, Sia Kromann; Hasvold, Pål; Garcia-Sanchez, Ricardo; Pedersen, Lars; Adelborg, Kasper; Egfjord, Martin; Egstrup, Kenneth; Sørensen, Henrik Toft

    2018-05-22

    Data on the true burden of hyperkalemia in patients with heart failure (HF) in a real-world setting are limited. Incidence rates of hyperkalemia (first blood test with a potassium level >5.0 mmol/L) in primary or hospital care were assessed in a population-based cohort of patients with incident HF diagnoses in northern Denmark from 2000 to 2012. Risk factors and clinical outcomes were compared in patients with HF with versus without hyperkalemia. Of 31 649 patients with HF, 39% experienced hyperkalemia (mean follow-up, 2.2 years). Risks of experiencing a second, third, or fourth event were 43%, 54%, and 60%, respectively. Among patients with HF with stage 3A, 3B, 4, or 5 kidney dysfunction, 26%, 35%, 44%, and 48% experienced hyperkalemia within the first year. Important hyperkalemia risk factors included chronic kidney disease (prevalence ratio, 1.46; 95% confidence interval [CI], 1.43-1.49), diabetes mellitus (prevalence ratio, 1.38; 95% CI, 1.32-1.45), and spironolactone use (prevalence ratio, 1.48; 95% CI, 1.42-1.54). In patients with HF who developed hyperkalemia, 53% had any acute-care hospitalization 6 months before the hyperkalemia event, increasing to 74% 6 months after hyperkalemia (before-after risk ratio, 1.41; 95% CI, 1.38-1.44). Compared with matched patients with HF without hyperkalemia, adjusted 6-month hazard ratios in patients with hyperkalemia were 2.75-fold (95% CI, 2.65-2.85) higher for acute-care hospitalization and 3.39-fold (95% CI, 3.19-3.61) higher for death. Almost 4 in 10 patients with HF develop hyperkalemia, and many patients have recurrent hyperkalemia episodes. Hyperkalemia risk is strongly associated with degree of reduced kidney function and use of spironolactone. Hyperkalemia is associated with severe clinical outcomes and death in HF. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

  3. Surgery of congestive heart failure - the role of computed tomography in the pre- and postsurgical diagnostic evaluation; Chirurgie der Herzinsuffizienz - Stellenwert der Computertomographie in der prae- und postoperativen Diagnostik

    Energy Technology Data Exchange (ETDEWEB)

    Lembcke, A.; Kivelitz, D.E.; Rogalla, P.; Dewey, M.; Klessen, C.; Hamm, B.; Enzweiler, C.N.H. [Inst. fuer Radiologie, Charite - Universitaetsmedizin Berlin, Charite Campus Mitte, Berlin (Germany); Dohmen, P.M.; Konertz, W.F. [Klinik fuer Kardiovaskulaere Chirurgie, Charite - Universitaetsmedizin Berlin, Charite Campus Mitte, Berlin (Germany); Wiese, T.H. [Inst. fuer Radiologie, Augusta-Kranken-Anstalt, Bochum (Germany)

    2005-07-01

    The treatment of advanced, drug resistant congestive heart failure gains in importance in the field of cardiac surgery. Cardiac imaging for preoperative assessment and follow-up focuses on the determination of ventricular volumes and function as well as on the detection of postoperative complications. Computed tomography (CT) is highly accurate irrespective of the individual patient's anatomic situation, has a low examiner dependence and short examination time, does not require an arterial vascular access and can be performed in patients with metal implants. CT is the modality of choice in the follow-up of heart transplants to detect extracardiac and cardiac complications including coronary calcifications as an early sign of transplant vasculopathy. In addition, CT visualizes the elements of mechanical assist devices and can identify their possible local cardiac and mediastinal complications CT can detect fibrolipomatous involution of the mobilized muscle flap in dynamic cardiomyoplasty and can depict fibrous reactions along the epicardial mesh implant in passive cardiac containment. Further indications include assessment of typical local postoperative complications, such as intrathoracic infection and mediastinal bleeding, intracardiac thrombus formation or pericardial effusion. CT is routinely used for evaluating bypass patency but is limited in assessing associated valve defects since it does not visualize flow. (orig.)

  4. Associations between ambient air pollution and daily mortality in a cohort of congestive heart failure: Case-crossover and nested case-control analyses using a distributed lag nonlinear model.

    Science.gov (United States)

    Buteau, Stephane; Goldberg, Mark S; Burnett, Richard T; Gasparrini, Antonio; Valois, Marie-France; Brophy, James M; Crouse, Dan L; Hatzopoulou, Marianne

    2018-04-01

    Persons with congestive heart failure may be at higher risk of the acute effects related to daily fluctuations in ambient air pollution. To meet some of the limitations of previous studies using grouped-analysis, we developed a cohort study of persons with congestive heart failure to estimate whether daily non-accidental mortality were associated with spatially-resolved, daily exposures to ambient nitrogen dioxide (NO 2 ) and ozone (O 3 ), and whether these associations were modified according to a series of indicators potentially reflecting complications or worsening of health. We constructed the cohort from the linkage of administrative health databases. Daily exposure was assigned from different methods we developed previously to predict spatially-resolved, time-dependent concentrations of ambient NO 2 (all year) and O 3 (warm season) at participants' residences. We performed two distinct types of analyses: a case-crossover that contrasts the same person at different times, and a nested case-control that contrasts different persons at similar times. We modelled the effects of air pollution and weather (case-crossover only) on mortality using distributed lag nonlinear models over lags 0 to 3 days. We developed from administrative health data a series of indicators that may reflect the underlying construct of "declining health", and used interactions between these indicators and the cross-basis function for air pollutant to assess potential effect modification. The magnitude of the cumulative as well as the lag-specific estimates of association differed in many instances according to the metric of exposure. Using the back-extrapolation method, which is our preferred exposure model, we found for the case-crossover design a cumulative mean percentage changes (MPC) in daily mortality per interquartile increment in NO 2 (8.8 ppb) of 3.0% (95% CI: -0.9, 6.9%) and for O 3 (16.5 ppb) 3.5% (95% CI: -4.5, 12.1). For O 3 there was strong confounding by weather

  5. Acute heart failure syndrome

    African Journals Online (AJOL)

    and the classical syndrome of chronic persistent heart failure develops. The vast ... Flash pulmonary oedema: This is a severely elevated blood pressure with an .... (CPAP or bilevelNPPV) for cardiogenic pulmonary edema (review). Cochrane.

  6. Comparative Effectiveness of Disease Management With Information Communication Technology for Preventing Hospitalization and Readmission in Adults With Chronic Congestive Heart Failure.

    Science.gov (United States)

    Aronow, Wilbert S; Shamliyan, Tatyana A

    2018-06-01

    Critical appraisal of all available evidence regarding the role of noninvasive communication technology for improving patient survival and reducing hospital admissions in adults with chronic heart failure (HF). Systematic literature review and grading of the quality of evidence according to the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group approach. Four databases were searched in March 2018 to find 2 high-quality meta-analyses and published and unpublished data from 58 randomized controlled trials (RCTs) that compared noninvasive communication technology with usual care in community-dwelling adults with HF. Direct meta-analysis of aggregate data with random effects models. Moderate-quality evidence suggests that there are no differences in all-cause mortality between telemonitoring and usual care, whereas complex telemonitoring that includes transmission of patient parameters and analysis by health care professionals decreases all-cause mortality (relative risk [RR] 0.78, 95% confidence interval [CI] 0.62, 0.99; 2885 people in 12 RCTs). Moderate-quality evidence suggests that telemonitoring prevents HF-related hospitalizations (RR 0.74; 95% CI 0.62, 0.88; 4001 people in 11 RCTs). Moderate-quality evidence suggests that structured telephone support decreases all-cause mortality (RR 0.86; 95% CI 0.77, 0.97; 9535 people in 24 RCTs) and HF-related hospitalizations (RR 0.83; 95% CI 0.73, 0.94; 7030 people in 16 RCTs). Use of a mobile personal digital assistant prevents HF-related hospitalizations (RR 0.58; 95% CI 0.44, 0.77; 674 people in 3 RCTs). The evidence regarding the comparative effectiveness of specific telecommunication devices is insufficient. The results from many completed studies are not available. Clinicians should offer noninvasive monitoring with communication technology applications to all HF patients. Future research should examine comparative effectiveness of technology applications in patient subpopulations

  7. Acute heart failure

    OpenAIRE

    Sénior Sánchez, Juan Manuel; Gándara Ricardo, Jairo Alfonso

    2015-01-01

    We describe the clinical case of a 26 year-old woman who came to Hospital Universitario San Vicente Fundación (Medellín, Colombia) with symptoms and signs of acute heart failure. She had been previously diagnosed with chronic heart failure with reduced ejection fraction without clear origin, pulmonary thromboembolism and ischemic stroke, without optimal neurohormonal modulation. She was admitted with clinical findings of fluid overload and low tissue perfusion, with inotropic support requirem...

  8. Risk calculation for hyperkalaemia in heart failure patients.

    NARCIS (Netherlands)

    Vereijken, T.L.; Bellersen, L.; Groenewoud, J.M.M.; Knubben, L.; Baltussen, L.; Kramers, C.

    2007-01-01

    BACKGROUND: We aimed to develop a model to estimate the risk of hyperkalaemia in patients treated for heart failure in a tertiary reference hospital and to identify precipitating factors. METHODS: 125 congestive heart failure (CHF) patients were studied retrospectively. Thirty of these patients

  9. Nutrition in Heart Failure

    Directory of Open Access Journals (Sweden)

    Reci Meseri

    2013-10-01

    Full Text Available Heart failure is defined as decreased ability of heart due to various reasons. It%u2019s seen 2-3% but the prevalence increases sharply after the age of seventy. The objectives of nutrition therapy in heart failure are to prevent from water retention and edema, to avoid from hard digestion and to offer a balanced diet. In order to avoid fluid retention and edema, daily sodium and fluid intake must be monitored carefully. Main dilemma of the heart failure patients is the obesity-cachexia dilemma. Since one of the main reasons of heart failure is cardiovascular diseases, in first phase, the patient may be obese. In the later phases, cachexia may show up. It was shown that cachexia is associated with mortality. Within this period, patients should not be over-fed and the patient should pass from catabolic state to anabolic state slowly. If the gastrointestinal track is functional oral/enteral feeding must be preferred. Multi vitamin and mineral supportsmay be beneficial, which may replace the increased loss, increase anti-inflammatory response and be anti-oxidants. Large, controlled and well-designed studies must be conducted in order to evaluate the benefits of nutritional practices such as nutritional assessment, enteral feeding and nutrient supports in heart failure patients.

  10. Heart failure - fluids and diuretics

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000112.htm Heart failure - fluids and diuretics To use the sharing features ... to Expect at Home When you have heart failure, your heart does not pump out enough blood. This causes ...

  11. Cheyne-Stokes respiration in patients with congestive heart failure: causes and consequences A respiração de Cheyne-Stokes em pacientes com insuficiência cardíaca congestiva: causas e conseqüências

    Directory of Open Access Journals (Sweden)

    Geraldo Lorenzi-Filho

    2005-08-01

    Full Text Available Cheyne-Stokes respiration is a form of periodic breathing in which central apneas and hypopneas alternate with periods of hyperventilation, producing a waxing and waning pattern of tidal volume. This review focuses on the causes and consequences of Cheyne-Stokes respiration in patients with congestive heart failure, in whom the prevalence is strikingly high and ranges from 30% to 50%. Several factors have been implicated in the genesis of Cheyne-Stokes respiration, including low cardiac output and recurrent hypoxia. The key pathophysiological mechanism triggering Cheyne-Stokes respiration is hyperventilation and low arterial CO2 (PaCO2 that when below the apneic threshold triggers a central apnea. Hyperventilation is associated with pulmonary congestion, and Cheyne-Stokes respiration is more prone to occur during sleep, when the respiratory system is mainly dependent on chemical control. It is associated with recurrent dips in oxygen saturation and arousals from sleep, with oscillations in blood pressure and heart rate, sympathetic activation and increased risk of ventricular tachycardia. Cheyne-Stokes respiration is an independent marker of poor prognosis and may participate in a vicious cycle, further stressing the failing heart.A respiração de Cheyne-Stokes é uma forma de respiração periódica na qual apnéias e hipopnéias se alternam com períodos de hiperpnéias que apresentam um padrão crescendo e decrescendo de volume corrente. Esta revisão enfoca as causa e conseqüências da respiração de Cheyne- Stokes em pacientes com insuficiência cardíaca congestiva na qual a prevalência é extremamente alta e varia entre 30 a 50%. Vários fatores foram implicados na gênese da respiração de Cheyne-Stokes, incluindo baixo debito cardíaco e hipoxia recorrente. Hiperventilacão e baixos níveis de CO2 arterial (PaCO2, que quando abaixo do limiar de apnéia desencadeiam apnéia central são os mecanismos fisiopatológicos chave na g

  12. Vasopressin and Vasopressin Antagonists in Heart Failure

    DEFF Research Database (Denmark)

    Vishram-Nielsen, Julie K; Gustafsson, Finn

    2017-01-01

    Despite the introduction of multiple new pharmacological agents over the past three decades in the field of heart failure (HF), overall prognosis remains poor. Hyponatremia is prevalent in HF patients and has been suggested as a contributor to poor response to standard therapy. Elevated levels...... by the V2 receptors in the renal collecting tubules. The optimal use of VRAs is yet to be determined, especially in patients with congestive HF. Although long-term effects on improvement in mortality have not been shown in the Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study with Tolvaptan...

  13. Metaiodobenzylguanidine and heart rate variability in heart failure

    International Nuclear Information System (INIS)

    Kurata, Chinori; Shouda, Sakae; Mikami, Tadashi; Uehara, Akihiko; Ishikawa, Keiko; Tawarahara, Kei; Nakano, Tomoyasu; Matoh, Fumitaka; Takeuchi, Kazuhiko

    1998-01-01

    It is assumed that the low-frequency power (LF) of heart rate variability (HRV) increases with progress of congestive heart failure (CHF), therefore positively correlating with cardiac 123 I-metaiodobenzylguanidine (MIBG) washout. It is demonstrated here that HRV, including normalized LF, correlated inversely with MIBG washout and positively with the ratio of heart-to-mediastinum MIBG activity in controls and CHF patients, whereas these correlations were not observed within CHF patients. Thus MIBG washout may increase and HRV including normalized LF may decrease with CHF, although the HRV and MIBG measures may not similarly change in proportion to the severity of the cardiac autonomic dysfunction in CHF. (author)

  14. Metaiodobenzylguanidine and heart rate variability in heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Kurata, Chinori; Shouda, Sakae; Mikami, Tadashi; Uehara, Akihiko; Ishikawa, Keiko [Hamamatsu Univ., Shizuoka (Japan). School of Medicine; Tawarahara, Kei; Nakano, Tomoyasu; Matoh, Fumitaka; Takeuchi, Kazuhiko

    1998-10-01

    It is assumed that the low-frequency power (LF) of heart rate variability (HRV) increases with progress of congestive heart failure (CHF), therefore positively correlating with cardiac {sup 123}I-metaiodobenzylguanidine (MIBG) washout. It is demonstrated here that HRV, including normalized LF, correlated inversely with MIBG washout and positively with the ratio of heart-to-mediastinum MIBG activity in controls and CHF patients, whereas these correlations were not observed within CHF patients. Thus MIBG washout may increase and HRV including normalized LF may decrease with CHF, although the HRV and MIBG measures may not similarly change in proportion to the severity of the cardiac autonomic dysfunction in CHF. (author)

  15. Rethinking Heart Failure

    OpenAIRE

    F?rstenwerth, Hauke

    2012-01-01

    An increasing body of clinical observations and experimental evidence suggests that cardiac dysfunction results from autonomic dysregulation of the contractile output of the heart. Excessive activation of the sympathetic nervous system and a decrease in parasympathetic tone are associated with increased mortality. Elevated levels of circulating catecholamines closely correlate with the severity and poor prognosis in heart failure. Sympathetic over-stimulation causes increased levels of catech...

  16. Heart failure due to severe myocardial calcification

    International Nuclear Information System (INIS)

    Takahashi, Shouichi; Maida, Kiyoshi; Yokoyama, Hitoshi; Tanaka, Shigeo

    1993-01-01

    A 28-year-old female who had had irradiation on the chest wall at the age of 5 as a remedy for keloid granulation after burn, recently developed congestive heart failure. Severe tricuspid regurgitation was demonstrated by echocardiography with a certain calcification in the cardiac shadow on chest radiogram. Calcified right ventricle and ventricular septum were noticed operatively, which disturbed ventricular motion and also caused tricuspid valve deformity. These calcified myocardium apparently corresponded with the irradiation field. After tricuspid valve replacement, she regained physical activity satisfactorily without congestive heart failure. Because she had no other known causes of cardiac calcification such as hypercalcemia, myocarditis, myocardial infarction or renal diseases, irradiation on the chest wall could be responsible for the severe myocardial calcification. (author)

  17. Echo and heart failure

    DEFF Research Database (Denmark)

    Modin, Daniel; Andersen, Ditte Madsen; Biering-Sørensen, Tor

    2018-01-01

    Heart failure (HF) is a threat to public health. Heterogeneities in aetiology and phenotype complicate the diagnosis and management of HF. This is especially true when considering HF with preserved ejection fraction (HFpEF), which makes up 50% of HF cases. Natriuretic peptides may aid in establis......Heart failure (HF) is a threat to public health. Heterogeneities in aetiology and phenotype complicate the diagnosis and management of HF. This is especially true when considering HF with preserved ejection fraction (HFpEF), which makes up 50% of HF cases. Natriuretic peptides may aid...

  18. Copeptin in Heart Failure

    DEFF Research Database (Denmark)

    Balling, Louise; Gustafsson, Finn

    2016-01-01

    Heart failure (HF) is one of the most common causes of hospitalization and mortality in the modern Western world and an increasing proportion of the population will be affected by HF in the future. Although HF management has improved quality of life and prognosis, mortality remains very high...

  19. CMR in Heart Failure.

    OpenAIRE

    Sado, D. M.; Hasleton, J. M.; Herrey, A. S.; Moon, J. C.

    2011-01-01

    Heart Failure (HF) is a common syndrome with multiple causes. Cardiovascular magnetic resonance (CMR) is a medical imaging technique with significant advantages, allowing the understanding of aetiology and pathophysiology of HF in the individual patient, permitting specific therapy to be administered and predicting prognosis. This paper discusses the diverse role of CMR in HF.

  20. [The impact of weight management and related diuretic medication intervention based on body weight changes on cardiac function and re-hospitalization rate in patients with chronic congestive heart failure].

    Science.gov (United States)

    Wang, F W; Shi, J; Shi, J; Yang, J W; Wang, Z H; Ye, J H; Ye, Y; Zheng, H Q; Huang, J

    2017-10-24

    Objective: To explore the impact of weight management and related medication intervention based on body weight changes on cardiac function among patients with chronic congestive heart failure (CHF). Methods: Using prospective, randomized, controlled study methods, consecutive CHF patients, who hospitalized in our department from June 2014 to June 2016 ( n =350), were randomly divided into intervention group ( n =175) and control group ( n =175). Patients in the intervention group received weight management guidance and the post discharge diuretic drugs regimen was adjusted based on body weight changes. The control group received routine medical care post discharge. Left ventricular ejection fraction (LVEF), B type natriuretic peptide precursor (NT-proBNP), 6 minutes walk distance and NYHA classification at one day before discharge and after 6 months were compared between the two groups respectively. Results: Follow-up visit data were not available from 6 patients in the control and intervention group respectively. NYHA classification, LVEF, NT-proBNP and 6 minutes walk distance were similar between the two groups at one day before discharge (all P >0.05). After 6 months, the LVEF and 6 minutes walk distance were significantly higher while NT-proBNP level was significantly lower in the intervention group compared to the control group (all P weight remained unchanged in the intervention group, while body weight tended to be higher in the control group compared to one day before discharge. Conclusion: The weight management and diuretic drug regimen adjudgment intervention based on body weight changes can improve cardiac function and reduced re-hospitalization rate in CHF patients.

  1. In-hospital and long-term outcomes of congestive heart failure: Predictive value of B-type and amino-terminal pro-B-type natriuretic peptides and their ratio.

    Science.gov (United States)

    Dai, Yuxiang; Yang, Jun; Takagi, Atsutoshi; Konishi, Hakuoh; Miyazaki, Tetsuro; Masuda, Hiroshi; Shimada, Kazunori; Miyauchi, Katsumi; Daida, Hiroyuki

    2017-08-01

    Relative changes in B-type natriuretic peptide (BNP) and amino terminal pro-BNP (NT-proBNP) levels may help to assess the risk of congestive heart failure (CHF). However, whether these levels at the time of admission enable the prediction of outcomes with acute exacerbation remains unknown. The current study determined the abilities of BNP, NT-proBNP and their ratio to predict in-hospital and long-term outcomes of patients with CHF. Patients who were admitted to the cardiac care unit of Juntendo University Hospital (Tokyo, Japan) with acute CHF onset were consecutively enrolled into the present observational study. Serum levels of BNP and NT-proBNP were immediately measured on admission, and other biomarkers and clinical data were also investigated. Of 195 enrolled patients, 16 (8.2%) succumbed to CHF in hospital and 124 (69.3%) reached the endpoint of mortality or readmission following a median follow-up of 14 months. Multiple linear regression analysis revealed body mass index, low density lipoprotein cholesterol, hemoglobin, estimated glomerular filtration rate and C-reactive protein as independent predictors of the NT-proBNP/BNP ratio. BNP, NT-proBNP and their ratio were significantly higher among those who succumbed to CHF than in those who remained alive in hospital (P<0.05). Logistic regression analysis indicated that the ratio was an independent predictor for in-hospital mortality and long-term outcomes. In conclusion, the ratio of NT-proBNP to BNP more effectively predicts in-hospital outcomes than either factor alone and it may also help to predict outcomes among patients with acute exacerbation of HF.

  2. Valvular Heart Disease in Heart Failure

    Directory of Open Access Journals (Sweden)

    Giuseppe MC Rosano

    2017-01-01

    Full Text Available Structural valvular heart disease may be the cause of heart failure or may worsen the clinical status of patients with heart failure. Heart failure may also develop in patients treated with valve surgery. Patients with heart failure with valvular heart disease are at increased risk of events including sudden cardiac death. Before considering intervention (surgical or percutaneous all patients should receive appropriate medical and device therapy taking into account that vasodilators must be used with caution in patients with severe aortic stenosis. Numerous percutaneous and/or hybrid procedures have been introduced in the past few years and they are changing the management of valvular heart disease. In patients with heart failure and valvular heart disease, either primary or functional, the whole process of decision-making should be staged through a comprehensive evaluation of the risk– benefit ratio of different treatment strategies and should be made by a multidisciplinary ‘heart team’ with a particular expertise in valvular heart disease. The heart team should include heart failure cardiologists, cardiac surgeons/structural valve interventionists, imaging specialists, anaesthetists, geriatricians and intensive care specialists. This article will review recent developments and distill practical guidance in the management of this important heart failure co-morbidity.

  3. A case of peripartum heart failure

    Directory of Open Access Journals (Sweden)

    Annalisa Vinci

    2008-03-01

    Full Text Available A 32-year-old woman was admitted in congestive heart failure (CHF 3 days after delivery. She had no history of cardiovascular disease and impaired left ventricular Ejection Fraction (EF 35%. She underwent complete heart catheterisation, selective coronary angiography and right ventricular endomyocardial biopsy (EMB.Coronary arteries were normal and EMB revealed active virus negative myocarditis. Serum was positive for anti-heart autoantibodies (AHA. Thus myocarditis was classified as autoimmune and the patient was treated with immunosuppressive therapy, with clinical and hemodynamic improvement. At 27 months follow-up EMB showed healed myocarditis. Peripartum cardiomyopathy (PPCM is a rare disorder in which left ventricular dysfunction and heart failure occur in the peripartum period in previously healthy women. The etiology is still unknown but a sizable proportion of patients may have an underlying organ-specific autoimmune myocarditis.

  4. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial) - design, intervention, and population

    DEFF Research Database (Denmark)

    Zwisler, A.D.O.; Schou, O.; Soja, A.M.B.

    2005-01-01

    , or readmissions due to heart disease based on linkage to public registries. The CR was an individually tailored, multidisciplinary program (6 weeks of intensive CR and 12 months of follow-up) including patient education, exercise training, dietary counseling, smoking cessation, psychosocial support, risk factor...... that a large-scale, centrally randomized clinical trial on comprehensive CR can be conducted among a broadly defined patient group, but reaching the stipulated number of 1800 patients was difficult. Although the study included relatively many women and older people, elderly patients and patients with high...

  5. A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial)--design, intervention, and population

    DEFF Research Database (Denmark)

    Zwisler, Ann-Dorthe Olsen; Soja, Anne Merete Boas; Brønnum-Hansen, Henrik

    2005-01-01

    , or readmissions due to heart disease based on linkage to public registries. The CR was an individually tailored, multidisciplinary program (6 weeks of intensive CR and 12 months of follow-up) including patient education, exercise training, dietary counseling, smoking cessation, psychosocial support, risk factor...... that a large-scale, centrally randomized clinical trial on comprehensive CR can be conducted among a broadly defined patient group, but reaching the stipulated number of 1800 patients was difficult. Although the study included relatively many women and older people, elderly patients and patients with high...

  6. Heart Failure Society of America

    Science.gov (United States)

    ... MACRA Resource Portal The Heart Failure Society of America, Inc. (HFSA) represents the first organized effort by heart failure experts from the Americas to provide a forum for all those interested ...

  7. Heart Failure in the Elderly

    NARCIS (Netherlands)

    B. Cost (Bernard)

    2000-01-01

    textabstractHeart failure is a clinical syndrome with various causes for which no universally accepted definition exists. Packer's definition of heart failure "representing a complex clinical syndrome characterised by abnonnalities of left ventricular function and neurohumoral regulation. which are

  8. Your Heart Failure Healthcare Team

    Science.gov (United States)

    ... Artery Disease Venous Thromboembolism Aortic Aneurysm More Your Heart Failure Healthcare Team Updated:May 9,2017 Patients with ... to the Terms and Conditions and Privacy Policy Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  9. Planning Ahead: Advanced Heart Failure

    Science.gov (United States)

    ... Venous Thromboembolism Aortic Aneurysm More Planning Ahead: Advanced Heart Failure Updated:May 9,2017 An important part of ... Care This content was last reviewed May 2017. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  10. Diastolic Heart Failure

    OpenAIRE

    Wake, Ryotaro; Yoshikawa, Junichi; Yoshiyama, Minoru

    2012-01-01

    Primary diastolic failure is typically seen in patients with hypertensive or valvular heart disease as well as in hypertrophic or restrictive cardiomyopathy but can also occur in a variety of clinical disorders, especially tachycardia and ischemia. Diastolic dysfunction has a particularly high prevalence in elderly patients and is generally associated, with low mortality but high morbidity. The pathophysiology of diastolic dysfunction includes delayed relaxation, impaired LV filling and/or in...

  11. Heart failure complicating tetralogy of Fallot | Ogunkunle | West ...

    African Journals Online (AJOL)

    Background: Heart failure is considered to be an unusual complication of uncorrected tetralogy of Fallot. Patients and method: Three adolescents with tetralogy of Fallot, presenting in congestive cardiac failure are presented. Two died. Myocardial infarction was found in the only patient that underwent autopsy, and is thought ...

  12. Combination stem cell therapy for heart failure

    Directory of Open Access Journals (Sweden)

    Ichim Thomas E

    2010-04-01

    Full Text Available Abstract Patients with congestive heart failure (CHF that are not eligible for transplantation have limited therapeutic options. Stem cell therapy such as autologous bone marrow, mobilized peripheral blood, or purified cells thereof has been used clinically since 2001. To date over 1000 patients have received cellular therapy as part of randomized trials, with the general consensus being that a moderate but statistically significant benefit occurs. Therefore, one of the important next steps in the field is optimization. In this paper we discuss three ways to approach this issue: a increasing stem cell migration to the heart; b augmenting stem cell activity; and c combining existing stem cell therapies to recapitulate a "therapeutic niche". We conclude by describing a case report of a heart failure patient treated with a combination stem cell protocol in an attempt to augment beneficial aspects of cord blood CD34 cells and mesenchymal-like stem cells.

  13. Tratamento de insuficiência cardíaca com benazepril em cães com cardiomiopatia dilatada e endocardiose Treatment of congestive heart failure with benazepril in dogs with dilated cardiomyopathy and endocardiosis

    Directory of Open Access Journals (Sweden)

    P.M. Pereira

    2005-09-01

    Full Text Available Foram avaliados os efeitos clínicos do benazepril, um inibidor da enzima de conversão da angiotensina de ação prolongada, em cães com insuficiência cardíaca congestiva (ICC secundária à endocardiose de mitral ou cardiomiopatia dilatada. O medicamento foi administrado na dose de 0,25 a 0,5mg/kg/dia. Diuréticos, digitálicos e f��rmacos antiarrítmicos foram usados de acordo com a necessidade de cada paciente. Exames físico, radiográfico e eletrocardiográfico foram realizados nos dias 0, 7, 28 e 56. A gasometria arterial e a bioquímica sérica foram avaliadas nos dias 0 e 56. Os sinais de dispnéia e o estado geral dos pacientes melhoraram em todos os cães após o início do tratamento. Houve diminuição na freqüência da tosse e não houve alterações no eletrocardiograma, exceto pela diminuição na amplitude e na duração da onda P. Nenhum efeito colateral foi observado. Conclui-se que o benazepril é um inibidor da enzima de conversão da angiotensina, eficaz e bem tolerado no tratamento da ICC no cão.Clinical effects of benazepril, a long acting angiotensin-converting enzyme (ACEi, in dogs with naturally-occurring congestive heart failure (CHF caused by mitral endocardiosis or dilated cardiomyopathy were studied. The drug was given orally at a dose of 0.25 to 0.5mg/kg/day. Diuretics, digitalics, and antiarrhtyhmic drugs were given as needed. Physical, radiographic, and eletrocardiographic examination were performed at days 0, 7, 28, and 56. Serum biochemistry and arterial blood gases were obtained at days 0 and 56. Signs of dyspnea and general condition improved in all dogs. Cough decreased in frequency. The electrocardiogram did not change with benazepril use except for a decrease in P wave amplitude and duration. No adverse effects related to the use of benazepril were observed. Benazepril is an effective and well tolerated ACEi for the treatment of CHF in dogs.

  14. Features of conngestive heart failure development in patients with post infarct cardiosclerosis concomitant with arrhythmias

    International Nuclear Information System (INIS)

    Zharov, E.I.; Martynov, A.I.; Vertkin, A.L.; Sergeeva, L.I.; Sedov, V.P.

    1989-01-01

    Two hundred and seventy seven patients with coronary heart disease, includng 182 with postinfarction cardiosclerosis undewent 24-hour Holter monitoring. A significant correlation was found between the number of coupled ventricular arrhythmias, ventricular tachycardia paroxysms and developmet of congestive heart failure in patients with postinfarct cardiosclerosis. With evolving metabolic deficiency as evidenced by thallium-201 myocardial scintigraphy, the incidence of congestive heart failure and ventricular arrhythmias increased among the patients

  15. Vitamin D and Heart Failure.

    Science.gov (United States)

    Marshall Brinkley, D; Ali, Omair M; Zalawadiya, Sandip K; Wang, Thomas J

    2017-10-01

    Vitamin D is principally known for its role in calcium homeostasis, but preclinical studies implicate multiple pathways through which vitamin D may affect cardiovascular function and influence risk for heart failure. Many adults with cardiovascular disease have low vitamin D status, making it a potential therapeutic target. We review the rationale and potential role of vitamin D supplementation in the prevention and treatment of chronic heart failure. Substantial observational evidence has associated low vitamin D status with the risk of heart failure, ventricular remodeling, and clinical outcomes in heart failure, including mortality. However, trials assessing the influence of vitamin D supplementation on surrogate markers and clinical outcomes in heart failure have generally been small and inconclusive. There are insufficient data to recommend routine assessment or supplementation of vitamin D for the prevention or treatment of chronic heart failure. Prospective trials powered for clinical outcomes are warranted.

  16. Warning Signs of Heart Failure

    Science.gov (United States)

    ... the two terms are used interchangeably. View an animation of heart failure . If you have been diagnosed ... resources here Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium and Salt 3 Heart Attack Symptoms ...

  17. Obesity and Heart Failure as a Mediator of the Cerebrorenal Interaction

    OpenAIRE

    Jindal, Ankur; Whaley-Connell, Adam; Sowers, James R.

    2013-01-01

    The obesity epidemic is contributing substantially to the burden of cardiovascular disease including heart disease and congestive heart failure, in the United States and the rest of the world. Overnutrition as a driver of obesity, promotes alterations in fatty acid, lipid, and glucose metabolism that influence myocardial function and progression of heart failure from diastolic to systolic failure. The association of progressive heart failure and progressive chronic kidney disease is well docu...

  18. Determination of hepatic blood flow through radioactive colloidal gold in congestive heart foilure

    International Nuclear Information System (INIS)

    Papaleo Netto, M.; Carvalho, N.; Carvalho Filho, E.T.; Forti, N.A.; Giannini, S.D.; Diament, J.; Decourt, L.V.; Chiaverini, R.

    1974-01-01

    Hepatic blood flow as derermined by radioactive colloidal gold and its correlation with total blood valume are studied in 13 patients with predominantly right-side congestive heart failure. During the phase of cardiac compensation, the following events occur: 1) significant decrease of the half-life of the clearance of radioactive colloidal gold and of the total blood volume; 2) increase of the clearance constant of the radioactive substance and of hepatic blood flow; 3) significantion correlation between the clearance constant and the total blood volume [pt

  19. Hypertension as a risk factor for heart failure.

    Science.gov (United States)

    Kannan, Arun; Janardhanan, Rajesh

    2014-07-01

    Hypertension remains a significant risk factor for development of congestive heart failure CHF), with various mechanisms contributing to both systolic and diastolic dysfunction. The pathogenesis of myocardial changes includes structural remodeling, left ventricular hypertrophy, and fibrosis. Activation of the sympathetic nervous system and renin-angiotensin system is a key contributing factor of hypertension, and thus interventions that antagonize these systems promote regression of hypertrophy and heart failure. Control of blood pressure is of paramount importance in improving the prognosis of patients with heart failure.

  20. Nuclear cardiology and heart failure

    International Nuclear Information System (INIS)

    Giubbini, Raffaele; Bertagna, Francesco; Milan, Elisa; Mut, Fernando; Dondi, Maurizio; Metra, Marco; Rodella, Carlo

    2009-01-01

    The prevalence of heart failure in the adult population is increasing. It varies between 1% and 2%, although it mainly affects elderly people (6-10% of people over the age of 65 years will develop heart failure). The syndrome of heart failure arises as a consequence of an abnormality in cardiac structure, function, rhythm, or conduction. Coronary artery disease is the leading cause of heart failure and it accounts for this disorder in 60-70% of all patients affected. Nuclear techniques provide unique information on left ventricular function and perfusion by gated-single photon emission tomography (SPECT). Myocardial viability can be assessed by both SPECT and PET imaging. Finally, autonomic dysfunction has been shown to increase the risk of death in patients with heart disease and this may be applicable to all patients with cardiac disease regardless of aetiology. MIBG scanning has a very promising prognostic value in patients with heart failure. (orig.)

  1. Nuclear cardiology and heart failure

    Energy Technology Data Exchange (ETDEWEB)

    Giubbini, Raffaele; Bertagna, Francesco [University of Brescia, Department of Nuclear Medicine, Brescia (Italy); Milan, Elisa [Ospedale Di Castelfranco Veneto, Nuclear Medicine Unit, Castelfranco Veneto (Italy); Mut, Fernando; Dondi, Maurizio [International Atomic Energy Agency, Nuclear Medicine Section, Division of Human Health, Vienna (Austria); Metra, Marco [University of Brescia, Department of Cardiology, Brescia (Italy); Rodella, Carlo [Health Physics Department, Spedali Civili di Brescia, Brescia (Italy)

    2009-12-15

    The prevalence of heart failure in the adult population is increasing. It varies between 1% and 2%, although it mainly affects elderly people (6-10% of people over the age of 65 years will develop heart failure). The syndrome of heart failure arises as a consequence of an abnormality in cardiac structure, function, rhythm, or conduction. Coronary artery disease is the leading cause of heart failure and it accounts for this disorder in 60-70% of all patients affected. Nuclear techniques provide unique information on left ventricular function and perfusion by gated-single photon emission tomography (SPECT). Myocardial viability can be assessed by both SPECT and PET imaging. Finally, autonomic dysfunction has been shown to increase the risk of death in patients with heart disease and this may be applicable to all patients with cardiac disease regardless of aetiology. MIBG scanning has a very promising prognostic value in patients with heart failure. (orig.)

  2. Higher Heart Failure Risk Seen in Some Cancers

    Science.gov (United States)

    Some people treated for breast cancer or lymphoma have a higher risk of developing congestive heart failure than people who haven’t had cancer, a new study shows. As this Cancer Currents blog post reports, the risk persisted for at least 20 years.

  3. Cognitive dysfunction in congestive heart failure: transcranial Doppler evidence of microembolic etiology Disfunção cognitiva na insuficiência cardíaca congestiva: evidência de etiologia microembólica ao Doppler transcraniano

    Directory of Open Access Journals (Sweden)

    Pedro A.P. Jesus

    2006-06-01

    Full Text Available Cognitive symptoms are common in patients with congestive heart failure (CHF and are usually attributed to low cerebral blood flow. In the present study, we aimed to evaluate global cognitive function (Mini Mental State Exam MMSE in relation to both cardiac function (evaluated by echocardiogram and cerebrovascular hemodynamics (evaluated by transcranial Doppler TCD in CHF patients. In 83 patients studied, no correlation was found between echocardiographic parameters and MMSE scores. In contrast, a significant correlation was found between right middle cerebral artery (RMCA mean flow velocity and MMSE score (r=0.231 p=0.039, as well as between RMCA pulsatility index and MMSE score (r s= -0.292 p=0.015. After excluding patients with a previous history of stroke, only RMCA pulsatility index correlated with MMSE score (r s=-0,314 p=0,007. The relationship between high cerebrovascular resistance and worse cognitive scores suggest that microembolism may be responsible for a significant proportion of cognitive symptoms in CHF patients.Sintomas cognitivos são comuns em pacientes com insuficiência cardíaca congestiva (ICC e são geralmente atribuídos a um regime de baixo fluxo sanguíneo cerebral. Neste estudo, objetivamos avaliar a função cognitiva global (Mini Exame do Estado Mental MEEM em pacientes com ICC e sua relação com o grau de disfunção cardíaca (avaliada pelo ecocardiograma e a hemodinâmica cerebral (avaliada pelo Doppler transcraniano DTC. Em 83 pacientes estudados, nenhuma correlação foi encontrada entre a pontuação no MEEM e parâmetros ecocardiográficos. Em contraste, uma correlação significativa foi encontrada entre a velocidade média na artéria cerebral média direita (ACMD e a pontuação no MEEM (r=0,231 p=0,039, assim como entre o índice de pulsatilidade na ACMD e a pontuação no MEEM (r s=-0,292 p=0,015. Após excluir pacientes com histórico prévio de acidente vascular encefálico, somente o índice de

  4. New Medications for Heart Failure

    Science.gov (United States)

    Gordin, Jonathan S.; Fonarow, Gregg C.

    2016-01-01

    Heart failure is common and results in substantial morbidity and mortality. Current guideline-based therapies for heart failure with reduced ejection fraction, including beta-blockers, angiotensin converting enzyme (ACE) inhibitors, and aldosterone antagonists aim to interrupt deleterious neurohormonal pathways and have shown significant success in reducing morbidity and mortality associated with heart failure. Continued efforts to further improve outcomes in patients with heart failure with reduced ejection fraction have led to the first new-in-class medications approved for heart failure since 2005, ivabradine and sacubitril/valsartan. Ivabradine targets the If channels in the sinoatrial node of the heart, decreasing heart rate. Sacubitril/valsartan combines a neprilysin inhibitor that increases levels of beneficial vasodilatory peptides with an angiotensin receptor antagonist. On a background of previously approved, guideline-directed medical therapies for heart failure, these medications have shown improved clinical outcomes ranging from decreased hospitalizations in a select group of patients to a reduction in all-cause mortality across all pre-specified subgroups. In this review, we will discuss the previously established guideline-directed medical therapies for heart failure with reduced ejection fraction, the translational research that led to the development of these new therapies, and the results from the major clinical trials of ivabradine and sacubitril/valsartan. PMID:27038558

  5. Biomarkers in acute heart failure.

    Science.gov (United States)

    Mallick, Aditi; Januzzi, James L

    2015-06-01

    The care of patients with acutely decompensated heart failure is being reshaped by the availability and understanding of several novel and emerging heart failure biomarkers. The gold standard biomarkers in heart failure are B-type natriuretic peptide and N-terminal pro-B-type natriuretic peptide, which play an important role in the diagnosis, prognosis, and management of acute decompensated heart failure. Novel biomarkers that are increasingly involved in the processes of myocardial injury, neurohormonal activation, and ventricular remodeling are showing promise in improving diagnosis and prognosis among patients with acute decompensated heart failure. These include midregional proatrial natriuretic peptide, soluble ST2, galectin-3, highly-sensitive troponin, and midregional proadrenomedullin. There has also been an emergence of biomarkers for evaluation of acute decompensated heart failure that assist in the differential diagnosis of dyspnea, such as procalcitonin (for identification of acute pneumonia), as well as markers that predict complications of acute decompensated heart failure, such as renal injury markers. In this article, we will review the pathophysiology and usefulness of established and emerging biomarkers for the clinical diagnosis, prognosis, and management of acute decompensated heart failure. Copyright © 2015 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  6. Diabetes Mellitus and Heart Failure.

    Science.gov (United States)

    Lehrke, Michael; Marx, Nikolaus

    2017-06-01

    Epidemiologic and clinical data from the last 2 decades have shown that the prevalence of heart failure in diabetes is very high, and the prognosis for patients with heart failure is worse in those with diabetes than in those without diabetes. Experimental data suggest that various mechanisms contribute to the impairment in systolic and diastolic function in patients with diabetes, and there is an increased recognition that these patients develop heart failure independent of the presence of coronary artery disease or its associated risk factors. In addition, current clinical data demonstrated that treatment with the sodium glucose cotransporter 2 inhibitor empagliflozin reduced hospitalization for heart failure in patients with type 2 diabetes mellitus and high cardiovascular risk. This review article summarizes recent data on the prevalence, prognosis, pathophysiology, and therapeutic strategies to treat patients with diabetes and heart failure. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  7. [Diuretic therapy in acute heart failure].

    Science.gov (United States)

    Trullàs, Joan Carles; Morales-Rull, José Luis; Formiga, Francesc

    2014-03-01

    Diuretics are widely recommended in patients with acute heart failure (AHF). Unfortunately, despite their widespread use, limited data are available from randomized clinical trials to guide clinicians on the appropriate management of diuretic therapy. Loop diuretics are considered the first-line diuretic therapy, especially intravenous furosemide, but the best mode of administration (high-dose versus low-dose and continuous infusion versus bolus) is unclear. When diuretic resistance develops, different therapeutic strategies can be adopted, including combined diuretic therapy with thiazide diuretics and/or aldosterone antagonists. Low or "non-diuretic" doses (25-50mg QD) of aldosterone antagonists have been demonstrated to confer a survival benefit in patients with heart failure and reduced ejection fraction and consequently should be prescribed in all such patients, unless contraindicated by potassium and/or renal function values. There is less evidence on the use of aldosterone antagonists at higher or "diuretic" doses (≥ 100mg QD) but these drugs could be useful in relieving congestive symptoms in combination with furosemide. Thiazide diuretics can also be helpful as they have synergic effects with loop diuretics by inhibiting sodium reabsorption in distal parts of the nephron. The effect of diuretic therapy in AHF should be monitored with careful observation of clinical signs and symptoms of congestion. Serum electrolytes and kidney function should also be monitored during the use of intravenous diuretics. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  8. Heart failure report

    Directory of Open Access Journals (Sweden)

    Pamila Dua

    2015-01-01

    Full Text Available Despite advancements in diagnosis and pharmacotherapy, heart failure (HF remains as a major health problem. The prevalence in the general population is estimated to range from 0.3% to 2.0%, increases considerably with age, and approximately doubles with every additional decade of life. In the last two decades, hospital admission rates for HF have increased steadily. The prevalence of HF can be estimated at 1–2% in the Western world and the incidence approaches 5–10/1000 persons/year. Estimates of the occurrence of HF in the developing world are largely absent. In a recent US population-based study, the prevalence of HF was 2.2% (95 confidence interval 1.6–2.8%, increasing from 0.7% in persons aged 45 through 54 years to 8.4% for those aged 75 years or older. In this article, we look at the major papers published in HF in the past 1 year.

  9. Periodontitis in Chronic Heart Failure.

    Science.gov (United States)

    Fröhlich, Hanna; Herrmann, Kristina; Franke, Jennifer; Karimi, Alamara; Täger, Tobias; Cebola, Rita; Katus, Hugo A; Zugck, Christian; Frankenstein, Lutz

    2016-08-01

    Periodontal disease has been associated with an increased risk of cardiovascular events. The purpose of our study was to investigate whether a correlation between periodontitis and chronic heart failure exists, as well as the nature of the underlying cause. We enrolled 71 patients (mean age, 54 ± 13 yr; 56 men) who had stable chronic heart failure; all underwent complete cardiologic and dental evaluations. The periodontal screening index was used to quantify the degree of periodontal disease. We compared the findings to those in the general population with use of data from the 4th German Dental Health Survey. Gingivitis, moderate periodontitis, and severe periodontitis were present in 17 (24%), 17 (24%), and 37 (52%) patients, respectively. Severe periodontitis was more prevalent among chronic heart failure patients than in the general population. In contrast, moderate periodontitis was more prevalent in the general population (P periodontal disease was not associated with the cause of chronic heart failure or the severity of heart failure symptoms. Six-minute walking distance was the only independent predictor of severe periodontitis. Periodontal disease is highly prevalent in chronic heart failure patients regardless of the cause of heart failure. Prospective trials are warranted to clarify the causal relationship between both diseases.

  10. Prueba de esfuerzo cardiopulmonar (PEC en el síndrome de falla cardíaca. Una propuesta basada en la evidencia Cardiopulmonary exercise testing in congestive heart failure. a proposal based on evidence

    Directory of Open Access Journals (Sweden)

    Juan Manuel Sénior Sánchez

    2008-06-01

    ; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:10.0pt; font-family:"Times New Roman"; mso-ansi-language:#0400; mso-fareast-language:#0400; mso-bidi-language:#0400;}

    The purpose of this document is to present recommendations for the clinical utilization of the cardiopulmonary exercise testing in patients with congestive heart failure with special emphasis on the evidence-based medicine, by means of a systematic search of the literature. The cardiopulmonary exercise testing is a useful tool in the evaluation and follow-up of patients with heart failure, but it is infrequently used in the daily practice of specialists in internal medicine and clinical cardiology. It allows differential diagnoses in patients with dyspnea of unexplained cause; to evaluate the tolerance to exercise, the functional capacity and prognosis; to select patients for heart transplantation; to provide parameters for the prescription of exercise, and to monitor the response to training in rehabilitation programs.

  11. Heart Failure Questions to Ask Your Doctor

    Science.gov (United States)

    ... Peripheral Artery Disease Venous Thromboembolism Aortic Aneurysm More Heart Failure Questions to Ask Your Doctor Updated:May 9, ... you? This content was last reviewed May 2017. Heart Failure • Home • About Heart Failure • Causes and Risks for ...

  12. Neonate With Severe Heart Failure Related to Vein of Galen Malformation

    Directory of Open Access Journals (Sweden)

    Meng-Yu Chen

    2010-08-01

    Full Text Available We report a full-term female neonate who presented with respiratory distress and severe heart failure soon after birth. Heart failure secondary to perinatal infection was initially suspected. Subsequent echocardiography revealed aortic runoff, which led to consideration of an intracranial vascular abnormality. Ultrasound and magnetic resonance imaging of the brain confirmed a diagnosis of vein of Galen aneurismal malformation (VGAM. Endovascular coil embolization of the vascular anomaly was performed, resulting in improvement of heart failure. VGAM should be considered in the differential diagnosis of neonatal congestive heart failure with a structurally normal heart. Urgent endovascular embolization and aggressive medical treatment of heart failure improve prognosis in neonatal VGAM.

  13. Fluid removal in acute heart failure: diuretics versus devices.

    Science.gov (United States)

    Krishnamoorthy, Arun; Felker, G Michael

    2014-10-01

    Fluid removal and relief of congestion are central to treatment of acute heart failure. Diuretics have been the decongestive mainstay but their known limitations have led to the exploration of alternative strategies. This review compares diuretics with ultrafiltration and examines the recent evidence evaluating their use. Relevant recent studies are the Diuretic Optimization Strategies Evaluation trial (of diuretics) and the Cardiorenal Rescue Study in Acute Decompensated Heart Failure (of ultrafiltration). The Diuretic Optimization Strategies Evaluation study evaluated strategies of loop diuretic use during acute heart failure (continuous infusion versus intermittent bolus and high dose versus low dose). After 72  h, there was no significant difference with either comparison for the coprimary end points. Patients treated with a high-dose strategy tended to have greater diuresis and more decongestion compared with low-dose therapy, at the cost of transient changes in renal function. The Cardiorenal Rescue Study in Acute Decompensated Heart Failure study showed that in acute heart failure patients with persistent congestion and worsening renal function, ultrafiltration, as compared with a medical therapy, was associated with similar weight loss but greater increase in serum creatinine and more adverse events. Decongestion remains a major challenge in acute heart failure. Although recent studies provide useful data to guide practice, the relatively poor outcomes point to the continued need to identify better strategies for safe and effective decongestion.

  14. Heart failure etiology impacts survival of patients with heart failure

    DEFF Research Database (Denmark)

    Pecini, Redi; Møller, Daniel Vega; Torp-Pedersen, Christian

    2010-01-01

    BACKGROUND: The impact of heart failure (HF) etiology on prognosis of HF is not well known. METHODS: 3078 patients (median age 75years, 61% male) hospitalized with HF were studied. Patients were classified into six etiology groups: hypertension (HTN, 13.9%), ischemic heart disease (IHD, 42...

  15. Management of Mechanical Ventilation in Decompensated Heart Failure

    Directory of Open Access Journals (Sweden)

    Brooks T. Kuhn

    2016-12-01

    Full Text Available Mechanical ventilation (MV is a life-saving intervention for respiratory failure, including decompensated congestive heart failure. MV can reduce ventricular preload and afterload, decrease extra-vascular lung water, and decrease the work of breathing in heart failure. The advantages of positive pressure ventilation must be balanced with potential harm from MV: volutrauma, hyperoxia-induced injury, and difficulty assessing readiness for liberation. In this review, we will focus on cardiac, pulmonary, and broader effects of MV on patients with decompensated HF, focusing on practical considerations for management and supporting evidence.

  16. Liver failure in total artificial heart therapy.

    Science.gov (United States)

    Dimitriou, Alexandros Merkourios; Dapunt, Otto; Knez, Igor; Wasler, Andrae; Oberwalder, Peter; Koerfer, Reiner; Tenderich, Gero; Spiliopoulos, Sotirios

    2016-07-01

    Congestive hepatopathy (CH) and acute liver failure (ALF) are common among biventricular heart failure patients. We sought to evaluate the impact of total artificial heart (TAH) therapy on hepatic function and associated clinical outcomes. A total of 31 patients received a Syncardia Total Artificial Heart. Preoperatively 17 patients exhibited normal liver function or mild hepatic derangements that were clinically insignificant and did not qualify as acute or chronic liver failure, 5 patients exhibited ALF and 9 various hepatic derangements owing to CH. Liver associated mortality and postoperative course of liver values were prospectively documented and retrospectively analyzed. Liver associated mortality in normal liver function, ALF and CH cases was 0%, 20% (P=0.03) and 44.4% (P=0.0008) respectively. 1/17 (5.8%) patients with a normal liver function developed an ALF, 4/5 (80%) patients with an ALF experienced a markedly improvement of hepatic function and 6/9 (66.6%) patients with CH a significant deterioration. TAH therapy results in recovery of hepatic function in ALF cases. Patients with CH prior to surgery form a high risk group with increased liver associated mortality.

  17. Palliative Care in Heart Failure

    Directory of Open Access Journals (Sweden)

    Hatice Mert

    2012-04-01

    Full Text Available Heart failure is an important health problem since its incidence and prevalence is increasing year by year. Since symptom burden and mortality are high in heart failure, supportive and palliative care should be provided. However, very few patients are referred to palliative care services. In comparison with cancer patients, it is difficult to identify end of life care for patients with heart failure, because these patients are hospitalized when the signs of acute decompensation appear, and their symptoms decrease and functional status improve before they are discharged. Therefore, palliative care, which is a holistic approach aiming to improve patients’ quality of life, to detect and treat the attacks of the disease before they become severe, and to deal with patients’ physical, psychological, social, and mental health altogether during their care, should be integrated into heart failure patients’ care. [TAF Prev Med Bull 2012; 11(2.000: 217-222

  18. Heart Failure in North America

    OpenAIRE

    Blair, John E. A; Huffman, Mark; Shah, Sanjiv J

    2013-01-01

    Heart failure is a major health problem that affects patients and healthcare systems worldwide. Within the continent of North America, differences in economic development, genetic susceptibility, cultural practices, and trends in risk factors and treatment all contribute to both inter-continental and within-continent differences in heart failure. The United States and Canada represent industrialized countries with similar culture, geography, and advanced economies and infrastructure. During t...

  19. A Zebrafish Heart Failure Model for Assessing Therapeutic Agents.

    Science.gov (United States)

    Zhu, Xiao-Yu; Wu, Si-Qi; Guo, Sheng-Ya; Yang, Hua; Xia, Bo; Li, Ping; Li, Chun-Qi

    2018-03-20

    Heart failure is a leading cause of death and the development of effective and safe therapeutic agents for heart failure has been proven challenging. In this study, taking advantage of larval zebrafish, we developed a zebrafish heart failure model for drug screening and efficacy assessment. Zebrafish at 2 dpf (days postfertilization) were treated with verapamil at a concentration of 200 μM for 30 min, which were determined as optimum conditions for model development. Tested drugs were administered into zebrafish either by direct soaking or circulation microinjection. After treatment, zebrafish were randomly selected and subjected to either visual observation and image acquisition or record videos under a Zebralab Blood Flow System. The therapeutic effects of drugs on zebrafish heart failure were quantified by calculating the efficiency of heart dilatation, venous congestion, cardiac output, and blood flow dynamics. All 8 human heart failure therapeutic drugs (LCZ696, digoxin, irbesartan, metoprolol, qiliqiangxin capsule, enalapril, shenmai injection, and hydrochlorothiazide) showed significant preventive and therapeutic effects on zebrafish heart failure (p failure model developed and validated in this study could be used for in vivo heart failure studies and for rapid screening and efficacy assessment of preventive and therapeutic drugs.

  20. Reassessing guidelines for heart failure

    Directory of Open Access Journals (Sweden)

    Helmut Drexler

    2004-03-01

    Full Text Available Significant progress has been made in the last few years in the management of heart failure. In particular several trials have given significant results. It has become apparent that heart failure may be prevented in some patients by treatment of risk factors such as coronary artery disease. Experience with angiotensin-converting enzyme (ACE inhibitors has shown that the survival and symptomatic benefits do last in the long term, and confirm that they are the first-line treatment in heart failure. The results of a number of trials using the angiotensin receptor blockers (ARBs candesartan, valsartan and losartan are presented and discussed. There is also some experience now in the use of candesartan for patients with heart failure and preserved left ventricular systolic function. The COMET trial compared the β-blockers carvedilol and metoprolol tartrate, and suggests that there may be differences in clinical effect between β-blockers. The selective aldosterone receptor blocker eplerenone was evaluated in the EPHESUS trial in post-MI patients with signs of heart failure. Based on these clinical trials, heart failure guidelines are now being updated.

  1. Exercise Intolerance in Heart Failure

    DEFF Research Database (Denmark)

    Brassard, Patrice; Gustafsson, Finn

    2016-01-01

    Exercise tolerance is affected in patients with heart failure (HF). Although the inability of the heart to pump blood to the working muscle has been the conventional mechanism proposed to explain the lowered capacity of patients with HF to exercise, evidence suggests that the pathophysiological...

  2. [Heart failure mortality in Spain: is there an andalusian paradox?].

    Science.gov (United States)

    Jiménez-Navarro, M; Gómez-Doblas, J; Molero, E; Galván, E de Teresa

    2006-06-01

    Congestive heart failure has a high mortality, as reflected in different clinical trials and observational studies. Spain, as other countries around the Mediterranean basin, have a relatively low rate of coronary deaths, attributed to the so-called Mediterranean lifestyle. Andalusia, in the southern most part of Spain, constitutes the paradigm of Mediterranean lifestyle. However, different reports show that the prevalence of ischemic heart disease is higher in Andalusia than in other zones of Spain. Thus the mortality rate due to heart failure in Spain in the year 2000 per 100,000 inhabitants was 27.3 in men and 28.88 in women and each one of the eight Andalusia provinces had greater rates than the national mean in both men and woman. Even in countries with a relatively low prevalence of coronary heart disease as is the case in Spain, heart failure mortality seems to be parallel to local differences in IHD prevalence.

  3. The Danish Heart Failure Registry

    DEFF Research Database (Denmark)

    Schjødt, Inge; Nakano, Anne; Egstrup, Kenneth

    2016-01-01

    AIM OF DATABASE: The aim of the Danish Heart Failure Registry (DHFR) is to monitor and improve the care of patients with incident heart failure (HF) in Denmark. STUDY POPULATION: The DHFR includes inpatients and outpatients (≥18 years) with incident HF. Reporting to the DHFR is mandatory......: The main variables recorded in the DHFR are related to the indicators for quality of care in patients with incident HF: performance of echocardiography, functional capacity (New York Heart Association functional classification), pharmacological therapy (angiotensin converting enzyme/angiotensin II...

  4. Heart failure overview

    Science.gov (United States)

    ... bicycle. Your provider can provide a safe and effective exercise plan for you. DO NOT exercise on days ... changing your lifestyle . Get enough rest, including after exercise, ... as your health care team directed. These medicines: Help the heart ...

  5. Heart failure - palliative care

    Science.gov (United States)

    ... It is available as a pill, liquid, or tablet that dissolves under the tongue. Your provider will ... RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine . 10th ed. Philadelphia, PA: Elsevier ...

  6. Insulin Signaling and Heart Failure

    Science.gov (United States)

    Riehle, Christian; Abel, E. Dale

    2016-01-01

    Heart failure is associated with generalized insulin resistance. Moreover, insulin resistant states such as type 2 diabetes and obesity increases the risk of heart failure even after adjusting for traditional risk factors. Insulin resistance or type 2 diabetes alters the systemic and neurohumoral milieu leading to changes in metabolism and signaling pathways in the heart that may contribute to myocardial dysfunction. In addition, changes in insulin signaling within cardiomyocytes develop in the failing heart. The changes range from activation of proximal insulin signaling pathways that may contribute to adverse left ventricular remodeling and mitochondrial dysfunction to repression of distal elements of insulin signaling pathways such as forkhead (FOXO) transcriptional signaling or glucose transport which may also impair cardiac metabolism, structure and function. This article will review the complexities of insulin signaling within the myocardium and ways in which these pathways are altered in heart failure or in conditions associated with generalized insulin resistance. The implications of these changes for therapeutic approaches to treating or preventing heart failure will be discussed. PMID:27034277

  7. Heart failure - discharge

    Science.gov (United States)

    ... your body. Lots of foods that DO NOT taste salty, or that you DO NOT add salt to, still contain a lot of salt. You may need to take a diuretic, or water pill. DO NOT drink alcohol. Alcohol makes it harder for your heart muscles ...

  8. Renal Denervation to Modify Hypertension and the Heart Failure State.

    Science.gov (United States)

    Zhong, Ming; Kim, Luke K; Swaminathan, Rajesh V; Feldman, Dmitriy N

    2017-07-01

    Sympathetic overactivation of renal afferent and efferent nerves have been implicated in the development and maintenance of several cardiovascular disease states, including resistant hypertension and heart failure with both reduced and preserved systolic function. With the development of minimally invasive catheter-based techniques, percutaneous renal denervation has become a safe and effective method of attenuating sympathetic overactivation. Percutaneous renal denervation, therefore, has the potential to modify and treat hypertension and congestive heart failure. Although future randomized controlled studies are needed to definitively prove its efficacy, renal denervation has the potential to change the way we view and treat cardiovascular disease. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Recurrent infective endocarditis causing heart valve failure: A case report

    Directory of Open Access Journals (Sweden)

    Victoria McIntyre, BASc Chemical Engineering (2018 candidate

    2017-11-01

    Full Text Available Infective endocarditis (IE is an infection that does not usually respond rapidly to treatment, often because its early symptoms are non-specific. The diseased valves (native or bioprosthetic may be calcified and the thrombotic vegetations on them typically friable and embolize easily. Left untreated IE leads to damage to the infected valve and to congestive heart failure (CHF. Its treatment usually requires heart valve replacement. Our 69-year-old patient had IE, and underwent aortic valve replacement (AVR with a bioprosthesis. This case stresses the complications of IE and its tendency to recur in patients with bioprosthetic heart valves (BHV who previously had IE.

  10. [Definition of acute heart failure].

    Science.gov (United States)

    Metra, Marco; Carbone, Giorgio; Lombardi, Carlo; Borghi, Claudio; Vescovo, Giorgio

    2014-02-01

    Acute heart failure (AHF) is a potentially life-threatening condition that may arise as a deterioration of a previous heart failure or may be the first presentation of heart failure. Several causes or precipitating factors have been listed, as well as different mechanisms have been described, thus leading to a broad spectrum of clinical presentations. Symptoms and signs of AHF have a strong clinical and prognostic significance and are kept into consideration to guide disease management. In particular, a higher clinical severity or a worse prognosis are associated with lower blood pressure levels, fluid overload, evidence of myocardial ischemia or renal impairment. Putatively, interventions addressed to restore these factors may play a role in the management of AHF.

  11. Predictors of the first heart failure hospitalization in patients who are stable survivors of myocardial infarction complicated by pulmonary congestion and/or left ventricular dysfunction: a VALIANT study

    DEFF Research Database (Denmark)

    Lewis, Eldrin F; Velazquez, Eric J; Solomon, Scott D

    2008-01-01

    markedly increased the risk of death [HR(hazard ratio) 8.22; 95% CI(confidence interval), 7.49-9.01]. CONCLUSION: HF post high risk-MI occurs in a time-dependent fashion and is usually not directly related to re-infarction. Patients who experience HF beyond the acute phase have increased mortality. Long......AIMS: We sought to assess the incidence of and prognostic factors for heart failure (HF) hospitalization among survivors of high-risk acute myocardial infarction (MI). METHODS AND RESULTS: We assessed the risk of an initial hospitalization for HF in 11 040 stable MI patients (no major non......-term survivors of high-risk MI should be followed closely and treated aggressively beyond the acute MI period....

  12. Predicting survival in heart failure

    DEFF Research Database (Denmark)

    Pocock, Stuart J; Ariti, Cono A; McMurray, John J V

    2012-01-01

    AimsUsing a large international database from multiple cohort studies, the aim is to create a generalizable easily used risk score for mortality in patients with heart failure (HF).Methods and resultsThe MAGGIC meta-analysis includes individual data on 39 372 patients with HF, both reduced...

  13. Ventilatory disorders in heart failure

    NARCIS (Netherlands)

    Güder, G.

    2017-01-01

    Introduction: Chronic obstructive pulmonary disease (COPD), heart failure (HF) or both syndromes are the most common reasons for dyspnea in the elderly. Currently there is no standard to diagnose COPD and multiple definitions (fixed ratio [GOLD], lower limit of normal [LLN]) are discussed. Further,

  14. Prognostic relevance of metabolic approach in patients with heart failure.

    Science.gov (United States)

    Di Napoli, P; Barsotti, A

    2009-01-01

    Progressions in acute cardiac care have improved survival after acute myocardial infarction, but in contraposition with this, there has been an increase in mortality because of heart failure. For this reason congestive heart failure is an increasingly widespread, costly and deadly disease, frequently named as epidemic of the XXI century. Despite advancement in modern treatment, mortality rate in heart failure patients remains high. In these patients more importance was attributed in the management of the left ventricle dysfunction. In fact, the heart failure patients have still a poor prognosis due to the ineluctable progression of contractile dysfunction and ventricular remodeling. The classical management of left ventricle dysfunction includes the pharmacological treatment with beta-blockers, ACE-inhibitors and aldosterone antagonists, and various surgical or electrophysiological interventions. Emerging evidence suggests that myocardium dysfunction is also due to substrate metabolism alterations. In particular, there is evidence that, in the failing heart, shifting metabolism away from a preference for fatty acids towards more carbohydrate oxidation could recover contractile function. Trimetazidine has been shown to improve symptoms and ventricular function and to have a beneficial effect on the inflammatory profile and endothelial function in these patients. Recently, it has been suggested that trimetazidine could also reduce ventricular remodeling, slowing down the progression of pump failure, and improve prognosis. These results suggest that trimetazidine is a useful adjunct to our current armamentarium for the treatment of heart failure patients.

  15. Can NT-proBNP be used as a criterion for heart failure hospitalization in emergency room?

    Directory of Open Access Journals (Sweden)

    Tuba Cimilli Ozturk

    2011-01-01

    Conclusions: NT-proBNP can be used as an easy diagnostic method for congestive heart failure. A certain cut-off value may be determined in further multi-centre controlled trials with larger patient groups.

  16. Resolution of sonographic B-lines as a measure of pulmonary decongestion in acute heart failure.

    Science.gov (United States)

    Martindale, Jennifer L

    2016-06-01

    Objective noninvasive measures of dyspnea in patients with acute heart failure are lacking. In this review, we describe lung ultrasound as a tool to estimate the degree of pulmonary congestion in patients presenting with acute heart failure and to monitor therapeutic efficacy. Serial semiquantitative measures of sonographic B-lines in acute heart failure patients can be converted to pulmonary edema scores obtained at admission and hospital discharge. These scores provide prognostic information for short-term clinical outcomes. Lung ultrasound has the potential to measure changes in pulmonary edema during acute heart failure management and improve risk stratification. Copyright © 2016 Elsevier Inc. All rights reserved.

  17. Total artificial heart implantation for biventricular failure due to eosinophilic myocarditis.

    Science.gov (United States)

    Kawabori, Masashi; Kurihara, Chitaru; Miller, Yair; Heck, Kent A; Bogaev, Roberta C; Civitello, Andrew B; Cohn, William E; Frazier, O H; Morgan, Jeffrey A

    2017-09-01

    Idiopathic hypereosinophilic syndrome is a condition of unknown etiology characterized by proliferation of eosinophils and their infiltration into tissues. Although cardiac involvement is rare, eosinophilic myocarditis can lead to life-threating fulminant congestive heart failure. Treatment of patients with eosinophilic myocarditis is challenging as heart failure can be caused by biventricular dysfunction. To our knowledge, this is the first case reported in the literature describing a patient with acute severe biventricular heart failure caused by eosinophilic myocarditis with mural left ventricular apical thrombus who was successfully treated with implantation of a total artificial heart as a bridge to heart transplant.

  18. Heart failure in patients treated with bisphosphonates

    DEFF Research Database (Denmark)

    Grove, E L; Abrahamsen, B; Vestergaard, P

    2013-01-01

    The aim of this study was to investigate the occurrence of heart failure in patients treated with bisphosphonates.......The aim of this study was to investigate the occurrence of heart failure in patients treated with bisphosphonates....

  19. [Diuretics in heart failure and Karl Popper's turkey].

    Science.gov (United States)

    Cice, Gennaro

    2015-12-01

    Heart failure and renal failure often coexist in the same patient. This condition is commonly referred to as cardiorenal syndrome. When this occurs, patient survival worsens significantly with increasing degree of renal dysfunction. Management of this complex patient poses treatment challenges because of unstable hemodynamics (the problem is to reduce congestion without affecting organ perfusion) and very high mid-term in-hospital mortality. Congestion is a typical feature of this syndrome, and use of diuretics is mandatory. Loop diuretics should be administered first. However, poor attention to pharmacodynamic and pharmacokinetic properties of loop diuretics may contribute to the development of diuretic resistance leading to iatrogenic hyponatremia. Accordingly, emphasis is given to the importance of sequential nephron blockade to reduce the number of non-responder patients to diuretics and to recognize a possible role for acquaretics.

  20. [Refractory heart failure. Models of hospital, ambulatory, and home management].

    Science.gov (United States)

    Oliva, Fabrizio; Alunni, Gianfranco

    2002-08-01

    common symptoms causing hospitalizations are those related to congestion; the distinction between the rising filling pressures and low cardiac output puts the focus on the adjustment of further medical therapy. The persistence of congestion confers a worse prognosis and urgency for the consideration of surgical therapies. It has been repeatedly shown that in case of heart failure, fewer hospitalizations and lower costs are necessary after referral to programs that provide multidisciplinary care. This care includes heart failure physician specialists with specifically trained clinical nurses. Other important components of a comprehensive management program for advanced heart failure are patient education, rehabilitation and the availability of adequate social service. We have entered a difficult era marked by a collision course between increasing scientific discoveries and restricted resources; a better care for heart failure, integrating improved medical practice with the necessity of bearing the financial pressures in mind, constitutes a great opportunity for medicine.

  1. Prognostic value of the physical examination in patients with heart failure and atrial fibrillation: insights from the AF-CHF trial (atrial fibrillation and chronic heart failure).

    Science.gov (United States)

    Caldentey, Guillem; Khairy, Paul; Roy, Denis; Leduc, Hugues; Talajic, Mario; Racine, Normand; White, Michel; O'Meara, Eileen; Guertin, Marie-Claude; Rouleau, Jean L; Ducharme, Anique

    2014-02-01

    This study sought to assess the prognostic value of physical examination in a modern treated heart failure population. The physical examination is the cornerstone of the evaluation and monitoring of patients with heart failure. Yet, the prognostic value of congestive signs (i.e., peripheral edema, jugular venous distension, a third heart sound, and pulmonary rales) has not been assessed in the current era. A post-hoc analysis was conducted on all 1,376 patients, 81% male, mean age 67 ± 11 years, with symptomatic left ventricular systolic dysfunction enrolled in the AF-CHF (Atrial Fibrillation and Congestive Heart Failure) trial. The prognostic value of baseline physical examination findings was assessed in univariate and multivariate Cox regression analyses. Peripheral edema was observed in 425 (30.9%), jugular venous distension in 297 (21.6%), a third heart sound in 207 (15.0%), and pulmonary rales in 178 (12.9%) patients. Death from cardiovascular causes occurred in 357 (25.9%) patients over a mean follow-up of 37 ± 19 months. All 4 physical examination findings were associated with cardiovascular mortality in univariate analyses (all p values examination (i.e., peripheral edema, jugular venous distension, a third heart sound, and pulmonary rales) continue to provide important prognostic information in patients with congestive heart failure. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  2. Parallel paths to improve heart failure outcomes

    DEFF Research Database (Denmark)

    Albert, Nancy M.

    2013-01-01

    -based, heart failure guidelines improves clinical outcomes. Thus, nurses and patients are on parallel paths related to setting the foundation for improved self-care adherence in advanced heart failure. Through research, we found that nurses were not adequately prepared as heart failure educators...... and that patients did not believe they were able to control heart failure. In 2 educational intervention studies that aimed to help patients understand that they could control fluid management and follow a strict daily fluid limit, patients had improved clinical outcomes. Thus, misperceptions about heart failure......Gaps and disparities in delivery of heart failure education by nurses and performance in accomplishing self-care behaviors by patients with advanced heart failure may be factors in clinical decompensation and unplanned consumption of health care. Is nurse-led education effectively delivered before...

  3. The effects of heart failure on renal function.

    Science.gov (United States)

    Udani, Suneel M; Koyner, Jay L

    2010-08-01

    Heart-kidney interactions have been increasingly recognized by clinicians and researchers who study and treat heart failure and kidney disease. A classification system has been developed to categorize the different manifestations of cardiac and renal dysfunction. Work has highlighted the significant negative prognostic effect of worsening renal function on outcomes for individuals with heart failure. The etiology of concomitant cardiac and renal dysfunction remains unclear; however, evidence supports alternatives to the established theory of underfilling, including effects of venous congestion and changes in intra-abdominal pressure. Conventional therapy focuses on blockade of the renin-angiotensin-aldosterone system with expanding use of direct renin and aldosterone antagonists. Novel therapeutic interventions using extracorporeal therapy and antagonists of the adenosine pathway show promise and require further investigation. 2010 Elsevier Inc. All rights reserved.

  4. A Comparison of three diuretic Regimens in Heart Failure

    DEFF Research Database (Denmark)

    Andreasen, F.; Eriksen, U.H.; Guul, S.-J.

    1993-01-01

    Farmakologi, bendroflumethiazide, diuretics, heart failure, bumethanide, ergometry plasma lactate......Farmakologi, bendroflumethiazide, diuretics, heart failure, bumethanide, ergometry plasma lactate...

  5. Adverse cardiovascular effects of drugs in patients with heart failure: Pharmaco-epidemioiogicai studies on ibopamine and NSAIDs

    NARCIS (Netherlands)

    J. Feenstra

    2000-01-01

    textabstractHeart failure is one of the most common cardiovascular disorders in westem countries. Because (congestive) heart failure is a chronic, incapacitating disease with a poor prognosis and a substantial public health impact, the attention paid to this disorder in research and both scientific

  6. Molecular Epidemiology of Heart Failure

    Directory of Open Access Journals (Sweden)

    J. Gustav Smith, MD, PhD

    2017-12-01

    Full Text Available Heart failure (HF is the end-stage of all heart disease and arguably constitutes the greatest unmet therapeutic need in cardiovascular medicine today. Classic epidemiological studies have established clinical risk factors for HF, but the cause remains poorly understood in many cases. Biochemical analyses of small case-control series and animal models have described a plethora of molecular characteristics of HF, but a single unifying pathogenic theory is lacking. Heart failure appears to result not only from cardiac overload or injury but also from a complex interplay among genetic, neurohormonal, metabolic, inflammatory, and other biochemical factors acting on the heart. Recent development of robust, high-throughput tools in molecular biology provides opportunity for deep molecular characterization of population-representative cohorts and HF cases (molecular epidemiology, including genome sequencing, profiling of myocardial gene expression and chromatin modifications, plasma composition of proteins and metabolites, and microbiomes. The integration of such detailed information holds promise for improving understanding of HF pathophysiology in humans, identification of therapeutic targets, and definition of disease subgroups beyond the current classification based on ejection fraction which may benefit from improved individual tailoring of therapy. Challenges include: 1 the need for large cohorts with deep, uniform phenotyping; 2 access to the relevant tissues, ideally with repeated sampling to capture dynamic processes; and 3 analytical issues related to integration and analysis of complex datasets. International research consortia have formed to address these challenges and combine datasets, and cohorts with up to 1 million participants are being collected. This paper describes the molecular epidemiology of HF and provides an overview of methods and tissue types and examples of published and ongoing efforts to systematically evaluate molecular

  7. Decongestion: Diuretics and other therapies for hospitalized heart failure.

    Science.gov (United States)

    Vazir, Ali; Cowie, Martin R

    2016-04-01

    Acute heart failure (AHF) is a potentially life-threatening clinical syndrome, usually requiring hospital admission. Often the syndrome is characterized by congestion, and is associated with long hospital admissions and high risk of readmission and further healthcare expenditure. Despite a limited evidence-base, diuretics remain the first-line treatment for congestion. Loop diuretics are typically the first-line diuretic strategy with some evidence that initial treatment with continuous infusion or boluses of high-dose loop diuretic is superior to an initial lower dose strategy. In patients who have impaired responsiveness to diuretics, the addition of an oral thiazide or thiazide-like diuretic to induce sequential nephron blockade can be beneficial. The use of intravenous low-dose dopamine is no longer supported in heart failure patients with preserved systolic blood pressure and its use to assist diuresis in patients with low systolic blood pressures requires further study. Mechanical ultrafiltration has been used to treat patients with heart failure and fluid retention, but the evidence-base is not robust, and its place in clinical practice is yet to be established. Several novel pharmacological agents remain under investigation. Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.

  8. Congestive Cardiac Failure in a patient with Systemic Sclerosis ...

    African Journals Online (AJOL)

    TNHJOURNALPH

    disease(ILD) and cardiac function ... failure symptoms, in order to avoid a ... were a few blood vessels with thickened wall .... mean left atrial diameter, a smaller LV ejection ... resistance to flow is at the level of the ... 8The finding of mitral valve.

  9. Physical training in patients with heart failure

    Directory of Open Access Journals (Sweden)

    Barbara Fletcher, RN, MN, FAAN

    2012-11-01

    Full Text Available Heart failure is a primary health concern in North and South America, with hospitalizations for heart failure as the primary diagnosis continuing to rise. There is a positive relationship between the prevalence of heart failure and age. However, mortality from heart failure is on the decline due to medical advancements, pharmacotherapy and nonpharmacological interventions. One of these nonpharmacological interventions is physical training or exercise. Physical training or exercise is becoming widely accepted by the medical community as a viable option in the medical management of stable heart failure patients. Both aerobic and resistance type exercise have been shown to be efficacious in stable heart failure patients. Evidence now exists not only supporting exercise to improve or maintain physical function in heart failure patients, but also quality of life. Many studies have shown that utilizing exercise in this population improves mood and overall self-reported well being. While the myocardial benefits from exercise may be minimal in heart failure patients, the peripheral benefits leading to improved physical function and preservation of independence are indispensible. Based on the research that has been conducted in the area of exercise and heart failure to this point, clinicians working with this population have the data necessary to prescribe evidence-based exercise prescriptions that can be utilized as part of a comprehensive medical management approach. Currently, several medical position statements endorse exercise as a safe and effective modality in heart failure patients.

  10. Distribution side of pleural effusion in heart failure

    International Nuclear Information System (INIS)

    Park, Cheol Kyu; Park, Young Ha; Jung, Se Young; Park, Seog Hee; Bahk, Yong Whee

    1988-01-01

    The interrelationship between the etiology of pleural effusion and the side of its occurrence has been a subject of clinical interest for many years. It has often been stated that pleural effusion caused by congestive heart failure tends to occur on the right side. However, some authors contended that such a side proclivity is not reliable. In the present study, the authors investigated the laterally of effusion caused by various cardiovascular diseases complicated by heart failure. We reviewed the chest X-ray films and clinical records of 68 patients with proven pleural effusion resulted from heart failure. 1. There were 34 men and 34 women with the age ranging from 10 to 84 years with the mean of 59. 2. The diagnoses were rheumatic heart disease (2 patients), coronary heart disease (10 patients), hypertensive heart disease (8 patients), mitral valvular disease (18 patients), aortic valvular disease (3 patients), and miscellaneous (27 patients). 3. 34 patients had unilateral pleural effusion, 25 and 9, right and left, respectively. Of the 34 patients with bilateral effusion, 13 patients had predominantly right-sided effusion, 5 patients had predominantly left-sided effusion and 16 patients had evenly distributed bilateral effusion. Thus, 55.8% of effusion was right-sided

  11. Combination decongestion therapy in hospitalized heart failure: loop diuretics, mineralocorticoid receptor antagonists and vasopressin antagonists.

    Science.gov (United States)

    Vaduganathan, Muthiah; Mentz, Robert J; Greene, Stephen J; Senni, Michele; Sato, Naoki; Nodari, Savina; Butler, Javed; Gheorghiade, Mihai

    2015-01-01

    Congestion is the most common reason for admissions and readmissions for heart failure (HF). The vast majority of hospitalized HF patients appear to respond readily to loop diuretics, but available data suggest that a significant proportion are being discharged with persistent evidence of congestion. Although novel therapies targeting congestion should continue to be developed, currently available agents may be utilized more optimally to facilitate complete decongestion. The combination of loop diuretics, natriuretic doses of mineralocorticoid receptor antagonists and vasopressin antagonists represents a regimen of currently available therapies that affects early and persistent decongestion, while limiting the associated risks of electrolyte disturbances, hemodynamic fluctuations, renal dysfunction and mortality.

  12. Psychosocial risk factors and heart failure hospitalization

    DEFF Research Database (Denmark)

    Rod, Naja Hulvej; Andersen, Ingelise; Prescott, Eva

    2011-01-01

    Prospective studies on the role of psychosocial factors in heart failure development are virtually nonexistent. The authors aimed to address the effect of psychosocial factors on the risk of heart failure hospitalization in men and women free of cardiovascular disease. In 1991-1993, the 8......-fourth of the population reported some degree of vital exhaustion. The vital exhaustion score was associated with a higher risk of heart failure in a dose-response manner (P risk of heart failure in both men (hazard ratio = 1.93, 95% confidence...... in the population, even a modestly higher risk of heart failure associated with vital exhaustion may be of importance in the planning of future preventive strategies for heart failure....

  13. Patterns of left ventricular geometry and the transition to congestive heart failure with preserved versus depressed ejection fraction (Patrones de geometría ventricular izquierda y la transición a la insuficiencia cardíaca congestiva con fracción de eyección conservada versus deprimida

    Directory of Open Access Journals (Sweden)

    José H. Donis Hernández

    2014-12-01

    Full Text Available Abstract (english Analysis of cross-sectional and follow up clinical studies, of hypertensive patients with the different left ventricular geometric patterns, provide plausible explanations for the transition from hypertensive heart disease to the two distinct phenotypes of systolic and diastolic congestive heart failure. According to the LIFE study treated-uncomplicated patients, with normal ventricular geometry (12%, concentric remodeling (11 % and concentric hypertrophy (34 %, may evolve to the eccentric hypertrophy pattern. Patients with the eccentric hypertrophy pattern have selective sympathetic activation and progressive enlargement of the left ventricular cavity with thinning of its walls. This pattern goes on to a stage of systolic dysfunction with diminished ejection fraction and enhanced degradation of the collagen matrix. On the other hand, patients with the concentric hypertrophy pattern have predominant activation of the renin-angiotensin-aldosterone system and progressive shrinking of the left ventricular cavity with thickening of its walls. This pattern usually precedes the stage of diastolic heart failure with preserved ejection fraction, impairment of relaxation and increased deposition of collagen in the myocardial interstitium. Thus, ventricular remodeling preceding diastolic heart failure is opposite to that of hypertensive patients who go on to develop systolic heart failure. Resumen (español El análisis de los estudios transversales y longitudinales, de pacientes hipertensos con diferentes patrones de geometría ventricular izquierda, permite postular posibles mecanismos fisiopatológicos para explicar la transición de la cardiopatía hipertensiva hacia los dos fenotipos conocidos de insuficiencia cardiaca. De acuerdo con el estudio LIFE, los pacientes hipertensos no complicados, con patrones de geometría ventricular normal (12 %, remodelado concéntrico (11 % e hipertrofia concéntrica (34 %, pueden evolucionar hacia

  14. Iron deficiency and anemia in heart failure.

    Science.gov (United States)

    Çavuşoğlu, Yüksel; Altay, Hakan; Çetiner, Mustafa; Güvenç, Tolga Sinan; Temizhan, Ahmet; Ural, Dilek; Yeşilbursa, Dilek; Yıldırım, Nesligül; Yılmaz, Mehmet Birhan

    2017-03-01

    Heart failure is an important community health problem. Prevalence and incidence of heart failure have continued to rise over the years. Despite recent advances in heart failure therapy, prognosis is still poor, rehospitalization rate is very high, and quality of life is worse. Co-morbidities in heart failure have negative impact on clinical course of the disease, further impair prognosis, and add difficulties to treatment of clinical picture. Therefore, successful management of co-morbidities is strongly recommended in addition to conventional therapy for heart failure. One of the most common co-morbidities in heart failure is presence of iron deficiency and anemia. Current evidence suggests that iron deficiency and anemia are more prevalent in patients with heart failure and reduced ejection fraction, as well as those with heart failure and preserved ejection fraction. Moreover, iron deficiency and anemia are referred to as independent predictors for poor prognosis in heart failure. There is strong relationship between iron deficiency or anemia and severity of clinical status of heart failure. Over the last two decades, many clinical investigations have been conducted on clinical effectiveness of treatment of iron deficiency or anemia with oral iron, intravenous iron, and erythropoietin therapies. Studies with oral iron and erythropoietin therapies did not provide any clinical benefit and, in fact, these therapies have been shown to be associated with increase in adverse clinical outcomes. However, clinical trials in patients with iron deficiency in the presence or absence of anemia have demonstrated considerable clinical benefits of intravenous iron therapy, and based on these positive outcomes, iron deficiency has become target of therapy in management of heart failure. The present report assesses current approaches to iron deficiency and anemia in heart failure in light of recent evidence.

  15. Sacubitril/Valsartanstive Heart Failure: Cardiogenic Shock

    Directory of Open Access Journals (Sweden)

    H. A. Rawal

    2018-01-01

    Full Text Available Sacubitril/valsartan is a combination drug described as a new class of dual-acting angiotensin receptor-neprilysin inhibitor (ARNi for heart failure. We present a case of a patient with NYHA class IV systolic heart failure who was refractory to all other classes of heart failure medications and was started on this new medication. On sacubitril/valsartan, he developed cardiogenic shock. This led us to reevaluate the use and risks of this medication in the class IV heart failure population.

  16. Sacubitril/Valsartanstive Heart Failure: Cardiogenic Shock

    OpenAIRE

    Rawal, H. A.; Kocheril, A. G.

    2018-01-01

    Sacubitril/valsartan is a combination drug described as a new class of dual-acting angiotensin receptor-neprilysin inhibitor (ARNi) for heart failure. We present a case of a patient with NYHA class IV systolic heart failure who was refractory to all other classes of heart failure medications and was started on this new medication. On sacubitril/valsartan, he developed cardiogenic shock. This led us to reevaluate the use and risks of this medication in the class IV heart failure population.

  17. Heart failure: epidemiology, pathophysiology, and management of heart failure in diabetes mellitus

    OpenAIRE

    Jorsal, Anders; Wiggers, Henrik; McMurray, John J.V.

    2018-01-01

    This article briefly discusses the epidemiology of heart failure and diabetes and summarizes the key findings from the recent cardiovascular outcome trials in patients with type 2 diabetes, with a focus on heart failure as an endpoint.

  18. Vagal stimulation in heart failure.

    Science.gov (United States)

    De Ferrari, Gaetano M

    2014-04-01

    Heart failure (HF) is accompanied by an autonomic imbalance that is almost always characterized by both increased sympathetic activity and withdrawal of vagal activity. Experimentally, vagal stimulation has been shown to exert profound antiarrhythmic activity and to improve cardiac function and survival in HF models. A open-label pilot clinical study in 32 patients with chronic HF has shown safety and tolerability of chronic vagal stimulation associated with subjective (improved quality of life and 6-min walk test) and objective improvements (reduced left ventricular systolic volumes and improved left ventricular ejection fraction). Three larger clinical studies, including a phase III trial are currently ongoing and will evaluate the clinical role of this new approach.

  19. Cheyne-stokes respiration in patients with heart failure.

    Science.gov (United States)

    AlDabal, Laila; BaHammam, Ahmed S

    2010-01-01

    Cheyne-Stokes respiration (CSR) is a form of central sleep-disordered breathing (SDB) in which there are cyclical fluctuations in breathing that lead to periods of central apneas/hypopnea, which alternate with periods of hyperpnea. The crescendo-decrescendo pattern of respiration in CSR is a compensation for the changing levels of blood oxygen and carbon dioxide. Severe congestive heart failure seems to be the most important risk factor for the development of CSR. A number of pathophysiologic changes, such as sleep disruption, arousals, hypoxemia-reoxygenation, hypercapnia/hypocapnia, and changes in intrathoracic pressure have harmful effects on the cardiovascular system, and the presence of CSR is associated with increased mortality and morbidity in subjects with variable degrees of heart failure. The management of CSR involves optimal control of underlying heart failure, oxygen therapy, and positive airway pressure support. In this review, we initially define and describe the epidemiology of central sleep apnea (CSA) and CSR, its pathogenesis, clinical presentation, diagnostic methods, and then discuss the recent developments in the management in patients with heart failure.

  20. The role of exercise testing in heart failure.

    Science.gov (United States)

    Swedberg, K; Gundersen, T

    1993-01-01

    The objectives of exercise testing in congestive heart failure (CHF) may be summarized as follows: (a) detect impaired cardiac performance, (b) grade severity of cardiac failure and classify functional capability, and (c) assess effects of interventions. Several different methods are available to make these assessments, and we have to ask ourselves how well exercise testing achieves these objectives. It has to be kept in mind that the power generated by the exercising muscles is dependent on the oxygen delivery to the skeletal muscles. Oxygen uptake is the result of an integrated performance of the lungs, heart, and peripheral circulation. In patients, as well as in normal subjects, oxygen uptake is related to hemodynamic indices such as cardiac output, stroke volume, or exercise duration when a stepwise regulated maximal exercise protocol is used. However, there are major differences in the concept of a true maximum in normal subjects versus heart failure patients. Fit-normal subjects will achieve a real maximal oxygen uptake, whereas patients may stop testing before a maximum is reached because of symptoms such as dyspnea or leg fatigue. Therefore, it is better if the actual oxygen uptake can be measured. "Peak" rather than true maximal oxygen uptake has been suggested for the classification of the severity of heart failure. Peripheral factors modify the cardiac output through such factors as vascular resistance, organ function, and hormonal release. Maximal exercise will stress the cardiovascular system to a point where the weakest chain will impose a limiting effect.(ABSTRACT TRUNCATED AT 250 WORDS)

  1. Comparison of frequencies of left ventricular systolic and diastolic heart failure in Chinese living in Hong Kong.

    Science.gov (United States)

    Yip, G W; Ho, P P; Woo, K S; Sanderson, J E

    1999-09-01

    There is a wide variation (13% to 74%) in the reported prevalence of heart failure associated with normal left ventricular (LV) systolic function (diastolic heart failure). There is no published information on this condition in China. To ascertain the prevalence of diastolic heart failure in this community, 200 consecutive patients with the typical features of congestive heart failure were studied with standard 2-dimensional Doppler echocardiography. A LV ejection fraction (LVEF) >45% was considered normal. The results showed that 12.5% had significant valvular heart disease. Of the remaining 175 patients, 132 had a LVEF >45% (75%). Therefore, 66% of patients with a clinical diagnosis of heart failure had a normal LVEF. Heart failure with normal LV systolic function was more common than systolic heart failure in those >70 years old (65% vs 47%; p = 0.015). Most (57%) had an abnormal relaxation pattern in diastole and 14% had a restrictive filling pattern. In the systolic heart failure group, a restrictive filling pattern was more common (46%). There were no significant differences in the sex distribution, etiology, or prevalence of LV hypertrophy between these 2 heart failure groups. In conclusion, heart failure with a normal LVEF or diastolic heart failure is more common than systolic heart failure in Chinese patients with the symptoms of heart failure. This may be related to older age at presentation and the high prevalence of hypertension in this community.

  2. Tolvaptan in Patients Hospitalized With Acute Heart Failure: Rationale and Design of the TACTICS and the SECRET of CHF Trials.

    Science.gov (United States)

    Felker, G Michael; Mentz, Robert J; Adams, Kirkwood F; Cole, Robert T; Egnaczyk, Gregory F; Patel, Chetan B; Fiuzat, Mona; Gregory, Douglas; Wedge, Patricia; O'Connor, Christopher M; Udelson, James E; Konstam, Marvin A

    2015-09-01

    Congestion is a primary reason for hospitalization in patients with acute heart failure (AHF). Despite inpatient diuretics and vasodilators targeting decongestion, persistent congestion is present in many AHF patients at discharge and more severe congestion is associated with increased morbidity and mortality. Moreover, hospitalized AHF patients may have renal insufficiency, hyponatremia, or an inadequate response to traditional diuretic therapy despite dose escalation. Current alternative treatment strategies to relieve congestion, such as ultrafiltration, may also result in renal dysfunction to a greater extent than medical therapy in certain AHF populations. Truly novel approaches to volume management would be advantageous to improve dyspnea and clinical outcomes while minimizing the risks of worsening renal function and electrolyte abnormalities. One effective new strategy may be utilization of aquaretic vasopressin antagonists. A member of this class, the oral vasopressin-2 receptor antagonist tolvaptan, provides benefits related to decongestion and symptom relief in AHF patients. Tolvaptan may allow for less intensification of loop diuretic therapy and a lower incidence of worsening renal function during decongestion. In this article, we summarize evidence for decongestion benefits with tolvaptan in AHF and describe the design of the Targeting Acute Congestion With Tolvaptan in Congestive Heart Failure Study (TACTICS) and Study to Evaluate Challenging Responses to Therapy in Congestive Heart Failure (SECRET of CHF) trials. © 2015 American Heart Association, Inc.

  3. CD14CD16 Monocyte Subset Levels in Heart Failure Patients

    Directory of Open Access Journals (Sweden)

    Chiara Barisione

    2010-01-01

    Full Text Available Our aim was to define the distribution of monocyte subsets in a cohort of congestive heart failure (CHF patients, to verify whether increased severity of CHF is linked to the expansion of specific monocyte subsets, and finally to investigate the relationship between monocyte subset relative frequencies, laboratory parameters of inflammation, and monocyte ACE expression.

  4. Concurrent neutral endopeptidase and ACE inhibition in experimental heart failure: renal and hormonal effects

    DEFF Research Database (Denmark)

    Helin, K

    1993-01-01

    Neutral endopeptidase (NEP) inhibitors have been shown to strengthen the effects of endogenous atrial natriuretic peptide (ANP). It has been well documented that angiotensin I-converting enzyme (ACE) inhibitors act beneficially in chronic congestive heart failure (CHF). In the present study, renal...

  5. Renal function in patients with hypertension associated congestive cardiac failure seen in a tertiary hospital.

    Science.gov (United States)

    Osuji, C U; Nwaneli, C U; Onwubere, B J; Onwubuya, E I; Ahaneku, G I

    2012-01-01

    Background. Chronic kidney disease is frequently seen in patients with congestive cardiac failure and is an independent risk factor for morbidity and mortality. The aim of this study was to determine the prevalence of chronic kidney disease in patients with hypertension associated congestive cardiac failure. Method. One hundred and fifty patients with hypertension associated congestive cardiac failure were recruited consecutively from the medical outpatient department and the medical wards of the Nnamdi Azikiwe University Teaching Hospital Nnewi over a one year period, January to December 2010. Patients' biodata and medical history were obtained, detailed physical examination done and each patient had a chest X-ray, 12 lead ECG, urinalysis, serum urea and creatinine assay done. Ethical clearance was obtained from the Ethical Review Board of our institution and data analysed using SPSS-version 16. Results. There were 86 males and 64 females with mean age 62.7 ± 12.5 years. The mean blood pressures were systolic 152.8 ± 28.5 mmHg and diastolic 94.3 ± 18 mmHg. 84.7% had blood pressure ≥140/90 mmHg on presentation. The mean GFR was 70.1 ± 31.3 mls/min. 76% of subjects had GFR <90 mls/min and no statistical significant difference between males and females, P = 0.344. The mean serum urea was 7.2 ± 51 mmol/L while the mean serum creatinine was 194 ± 416.2 mmol/L. Conclusions. This study has demonstrated that majority of patients presenting with hypertension associated congestive cardiac failure have some degree of chronic kidney disease.

  6. Efficacy of carvedilol in pediatric heart failure

    DEFF Research Database (Denmark)

    Christensen, Alex Hørby; Fatkin, Diane

    2013-01-01

    Evaluation of: Huang M, Zhang X, Chen S et al. The effect of carvedilol treatment on chronic heart failure in pediatric patients with dilated cardiomyopathy: a prospective, randomized-controlled study. Pediatr. Cardiol. 34, 680-685 (2013). A role for β-blockers in children with heart failure has...

  7. Obesity and heart failure as a mediator of the cerebrorenal interaction.

    Science.gov (United States)

    Jindal, Ankur; Whaley-Connell, Adam; Sowers, James R

    2013-01-01

    The obesity epidemic is contributing substantially to the burden of cardiovascular disease including heart disease and congestive heart failure, in the United States and the rest of the world. Overnutrition as a driver of obesity, promotes alterations in fatty acid, lipid, and glucose metabolism that influence myocardial function and progression of heart failure from diastolic to systolic failure. The association of progressive heart failure and progressive chronic kidney disease is well documented and often referred to as the cardiorenal syndrome, as well as a prognosticator for cerebrovascular disease (e.g. stroke). Whether the relationship between obesity, heart disease/failure and risk for chronic kidney disease and stroke is direct or a confluence of risk factors is poorly understood. Copyright © 2013 S. Karger AG, Basel.

  8. Heart Failure Management - Evolution Over The Ages

    Directory of Open Access Journals (Sweden)

    KV Sahasranam

    2017-04-01

    Full Text Available The simplest definition of heart failure is "A condition in which the heart fails to discharge its contents adequately". Even though the prevalence is quoted at 4 - 20 / 1000 population, in the elderly above 65 years, the figures may exceed 100/1000. After the age of 45, it is found that the relative incidence of heart failure which is approximately 1 - 5 /1000, double for each decade of life. As modernization increases and healthcare improves over the years, the prevalence of heart failure also increases due to the increase in longevity of individuals.

  9. Biofeedback in the treatment of heart failure.

    Science.gov (United States)

    McKee, Michael G; Moravec, Christine S

    2010-07-01

    Biofeedback training can be used to reduce activation of the sympathetic nervous system (SNS) and increase activation of the parasympathetic nervous system (PNS). It is well established that hyperactivation of the SNS contributes to disease progression in chronic heart failure. It has been postulated that underactivation of the PNS may also play a role in heart failure pathophysiology. In addition to autonomic imbalance, a chronic inflammatory process is now recognized as being involved in heart failure progression, and recent work has established that activation of the inflammatory process may be attenuated by vagal nerve stimulation. By interfering with both autonomic imbalance and the inflammatory process, biofeedback-assisted stress management may be an effective treatment for patients with heart failure by improving clinical status and quality of life. Recent studies have suggested that biofeedback and stress management have a positive impact in patients with chronic heart failure, and patients with higher perceived control over their disease have been shown to have better quality of life. Our ongoing study of biofeedback-assisted stress management in the treatment of end-stage heart failure will also examine biologic end points in treated patients at the time of heart transplant, in order to assess the effects of biofeedback training on the cellular and molecular components of the failing heart. We hypothesize that the effects of biofeedback training will extend to remodeling the failing human heart, in addition to improving quality of life.

  10. Cardiorenal Syndrome in Acute Heart Failure: Revisiting Paradigms.

    Science.gov (United States)

    Núñez, Julio; Miñana, Gema; Santas, Enrique; Bertomeu-González, Vicente

    2015-05-01

    Cardiorenal syndrome has been defined as the simultaneous dysfunction of both the heart and the kidney. Worsening renal function that occurs in patients with acute heart failure has been classified as cardiorenal syndrome type 1. In this setting, worsening renal function is a common finding and is due to complex, multifactorial, and not fully understood processes involving hemodynamic (renal arterial hypoperfusion and renal venous congestion) and nonhemodynamic factors. Traditionally, worsening renal function has been associated with worse outcomes, but recent findings have revealed mixed and heterogeneous results, perhaps suggesting that the same phenotype represents a diversity of pathophysiological and clinical situations. Interpreting the magnitude and chronology of renal changes together with baseline renal function, fluid overload status, and clinical response to therapy might help clinicians to unravel the clinical meaning of renal function changes that occur during an episode of heart failure decompensation. In this article, we critically review the contemporary evidence on the pathophysiology and clinical aspects of worsening renal function in acute heart failure. Copyright © 2014 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

  11. Cognitive Impairment in Heart Failure

    Directory of Open Access Journals (Sweden)

    Efthimios Dardiotis

    2012-01-01

    Full Text Available Cognitive impairment (CI is increasingly recognized as a common adverse consequence of heart failure (HF. Although the exact mechanisms remain unclear, microembolism, chronic or intermittent cerebral hypoperfusion, and/or impaired cerebral vessel reactivity that lead to cerebral hypoxia and ischemic brain damage seem to underlie the development of CI in HF. Cognitive decline in HF is characterized by deficits in one or more cognition domains, including attention, memory, executive function, and psychomotor speed. These deficits may affect patients’ decision-making capacity and interfere with their ability to comply with treatment requirements, recognize and self-manage disease worsening symptoms. CI may have fluctuations in severity over time, improve with effective HF treatment or progress to dementia. CI is independently associated with disability, mortality, and decreased quality of life of HF patients. It is essential therefore for health professionals in their routine evaluations of HF patients to become familiar with assessment of cognitive performance using standardized screening instruments. Future studies should focus on elucidating the mechanisms that underlie CI in HF and establishing preventive strategies and treatment approaches.

  12. CPAP in chronic heart failure

    Directory of Open Access Journals (Sweden)

    F. Lari

    2013-05-01

    Full Text Available BACKGROUND Chronic Heart Failure (CHF represents worldwide a clinical condition with increasing prevalence, high social, economical and epidemiological impact. Even if new pharmacological and non-pharmacological approachs have been recently used, mortality remains high in general population and quality of life is poor in these patients. DISCUSSION The association between CHF and sleep disorders is frequent but still undervalued: sleep apnoeas in CHF produce negative effects on cardiovascular system and an aggravation of prognosis. CPAP (Continuous Positive Airway Pressure is commonly used to treat sleep apnoeas in patients without cardiac involvement and it is also used in first line treatment of acute cardiogenic pulmonary oedema thanks to its hemodynamic and ventilatory effects. The addition of nightly CPAP to standard aggressive medical therapy in patients with CHF and sleep apnoeas reduces the number of apnoeas, reduces the blood pressure, and the respiratory and cardiac rate, reduces the activation of sympathetic nervous system, the left ventricular volume and the hospitalization rate; besides CPAP increases the left ventricular ejection fraction, amd the oxygenation, it improves quality of life, tolerance to exercise and seems to reduce mortality in patients with a higher apnoeas suppression. CONCLUSIONS These implications suggest to investigate sleep apnoeas in patients with CHF in order to consider a possible treatment with CPAP. Further studies need to be developed to confirm the use of CPAP in patients with CHF without sleep disorders.

  13. Exercise training in heart failure.

    Science.gov (United States)

    Abela, Mark

    2018-05-04

    Exercise training (ET) in heart failure (HF) has long been established as an important part of HF care. ET is known to improve quality of life and functional capacity in a number of ways. Despite its proposed benefits, evidence supporting its routine inclusion in standard rehabilitation programme is at times conflicting, partly because of the significant heterogeneity present in available randomised controlled trials. There is lack of evidence with regard to the duration of the overall benefit, the optimal exercise regimen and whether certain types of HF aetiologies benefit more than others. The aim of this review is to provide an update to date literature review of the positive and negative evidence surrounding ET in HF, while proposing an efficient novel in-hospital exercise-based rehabilitation programme for patients with HF in addition to a pre-existing HF clinic. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  14. The dark side of the kidney in cardio-renal syndrome: renal venous hypertension and congestive kidney failure.

    Science.gov (United States)

    Di Nicolò, Pierpaolo

    2018-03-01

    Renal involvement in some forms of acute or chronic diseases, such as heart failure or sepsis, presents with a complex pathophysiological basis that is not always clearly distinguishable. In these clinical settings, kidney failure is traditionally and almost exclusively attributed to renal hypoperfusion and it is commonly accepted that causal elements are pre-renal, such as a reduction in the ejection fraction or absolute or relative hypovolemia acting directly on oxygen transport mechanisms and renal autoregulation systems, causing a reduction of glomerular filtration rate. Nevertheless, the concept emerging from accumulating clinical and experimental evidence is that in complex clinical pictures, kidney failure is strongly linked to the hemodynamic alterations occurring in the renal venous micro and macrocirculation. Accordingly, the transmission of the increased venous pressure to the renal venous compartment and the consequent increasing renal afterload has a pivotal role in determining and sustaining the kidney damage. The aim of this review was to clarify the physiopathological aspects of the link between worsening renal function and renal venous hypertension, analyzing the prognostic and therapeutic implications of the so-called congestive kidney failure in cardio-renal syndrome and in other clinical contexts of its possible onset.

  15. Definition and Classification of Heart Failure

    Directory of Open Access Journals (Sweden)

    Mitja Lainscak

    2017-01-01

    Full Text Available A review of the definition and classification of heart failure, updated since the recent 2016 European Society of Cardiology guidelines for the diagnosis and treatment of acute and chronic heart failure. Heart failure is defined by the European Society of Cardiology (ESC as a clinical syndrome characterised by symptoms such as shortness of breath, persistent coughing or wheezing, ankle swelling and fatigue, that may be accompanied by the following signs: jugular venous pressure, pulmonary crackles, increased heart rate and peripheral oedema. However, these signs may not be present in the early stages and in patients treated with diuretics. When apparent, they are due to a structural and/or functional cardiac abnormality, leading to systolic and/or diastolic ventricular dysfunction, resulting in a reduced cardiac output and/or elevated intra- cardiac pressures at rest or during stress. According to the most recent ESC guidelines the initial evaluation of patients with suspected heart failure should include a clinical history and physical examination, laboratory assessment, chest radiography, and electrocardiography. Echocardiography can confirm the diagnosis. Beyond detecting myocardial abnormality, other impairments such as abnormalities of the valves, pericardium, endocardium, heart rhythm, and conduction may be found. The identification of the underlying aetiology is pivotal for the diagnosis of heart failure and its treatment. The authors review the definitions and classifications of heart failure.

  16. Biomarker Guided Therapy in Chronic Heart Failure

    Science.gov (United States)

    Bektas, Sema

    2015-01-01

    This review article addresses the question of whether biomarker-guided therapy is ready for clinical implementation in chronic heart failure. The most well-known biomarkers in heart failure are natriuretic peptides, namely B-type natriuretic peptide (BNP) and N-terminal pro-BNP. They are well-established in the diagnostic process of acute heart failure and prediction of disease prognosis. They may also be helpful in screening patients at risk of developing heart failure. Although studied by 11 small- to medium-scale trials resulting in several positive meta-analyses, it is less well-established whether natriuretic peptides are also helpful for guiding chronic heart failure therapy. This uncertainty is expressed by differences in European and American guideline recommendations. In addition to reviewing the evidence surrounding the use of natriuretic peptides to guide chronic heart failure therapy, this article gives an overview of the shortcomings of the trials, how the results may be interpreted and the future directions necessary to fill the current gaps in knowledge. Therapy guidance in chronic heart failure using other biomarkers has not been prospectively tested to date. Emerging biomarkers, such as galectin-3 and soluble ST2, might be useful in this regard, as suggested by several post-hoc analyses. PMID:28785440

  17. Heart Failure: From Research to Clinical Practice.

    Science.gov (United States)

    Islam, Md Shahidul

    2018-01-01

    "Heart failure: from research to clinical practice", a collection of selected reviews, which comes out also as a book, covers essentially all important aspects of heart failure, including the pathogenesis, clinical features, biomarkers, imaging techniques, medical treatment and surgical treatments, use of pacemakers and implantable cardioverter defibrillators, and palliative care. The reviews include essential background information, state of the art, critical and in-depth analysis, and directions for future researches for elucidation of the unresolved issues. Everyone interested in heart failure is expected to find this compilation helpful for a deeper understanding of some of the complex issues.

  18. Modern treatment methods for heart failure

    Directory of Open Access Journals (Sweden)

    Bojan Vrtovec

    2011-04-01

    Full Text Available Abstract: Chronic heart failure is a clinical syndrome that can result from many cardiac diseases, the most common being cardiomyopathies and coronary artery disease. According to recent epidemiological data, heart failure is the only cardiologic entity whose prevalence is actually increasing and is present in 2–5 % of general population and in 10 % of people older than 65 years. The scope of this paper includes algorithms of initial heart failure diagnostic work-up , medical management and contemporary non-medical treatment options.

  19. pneumonia complicated by congestive heart failure in nigerian

    African Journals Online (AJOL)

    2012-10-10

    Oct 10, 2012 ... Requests for reprints to: Dr. W. E. Sadoh, Department of Child Health, University of Benin/ University of Benin Teaching ... with the acquired immunodefficicency syndrome .... middle SEC and 25(24.0%) in the high SEC. All the.

  20. Iodine-123 metaiodobenzylguanidine imaging of the heart in idiopathic congestive cardiomyopathy and cardiac transplants

    International Nuclear Information System (INIS)

    Glowniak, J.V.; Turner, F.E.; Gray, L.L.; Palac, R.T.; Lagunas-Solar, M.C.; Woodward, W.R.

    1989-01-01

    Iodine-123 metaiodobenzylguanidine ([ 123 I]MIBG) is a norepinephrine analog which can be used to image the sympathetic innervation of the heart. In this study, cardiac imaging with [ 123 I]MIBG was performed in patients with idiopathic congestive cardiomyopathy and compared to normal controls. Initial uptake, half-time of tracer within the heart, and heart to lung ratios were all significantly reduced in patients compared to normals. Uptake in lungs, liver, salivary glands, and spleen was similar in controls and patients with cardiomyopathy indicating that decreased MIBG uptake was not a generalized abnormality in these patients. Iodine-123 MIBG imaging was also performed in cardiac transplant patients to determine cardiac nonneuronal uptake. Uptake in transplants was less than 10% of normals in the first 2 hr and nearly undetectable after 16 hr. The decreased uptake of MIBG suggests cardiac sympathetic nerve dysfunction while the rapid washout of MIBG from the heart suggests increased cardiac sympathetic nerve activity in idiopathic congestive cardiomyopathy

  1. Pattern of heart failure in a Nigerian teaching hospital

    Directory of Open Access Journals (Sweden)

    Arthur C Onwuchekwa

    2009-09-01

    Full Text Available Arthur C Onwuchekwa, Godspower E AsekomehDepartment of Internal Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, NigeriaBackground: Congestive cardiac failure (CCF has emerged as a major public health problem worldwide and imposes an escalating burden on the health care system. Objective: To determine the causes and mortality rate of CCF in the University of Port Harcourt Teaching Hospital (UPTH, south Nigeria, over a five-year period from January 2001 to December 2005.Methods: A retrospective study of CCF cases were identified from the admission and discharge register of the medical wards of UPTH and the case notes were retrieved from the medical records department and analyzed.Results: There were 423 patients: 242 males and 181 females. Their ages ranged from 18 to 100 years with a mean of 54.4 ± 17.3. The commonest causes of CCF were hypertension (56.3% and cardiomyopathy (12.3%. Chronic renal failure, rheumatic heart disease, and ischemic heart disease accounted for 7.8%, 4.3%, and 0.2% of CCF, respectively. Peripartum heart disease was rare despite being commonly reported in northern Nigerian females. Eighteen patients died from various complications with a mortality rate of 4.3%.Conclusion: The burden of CCF in the Niger Delta is mainly attributed to hypertension. Efforts should be geared towards hypertension awareness, detection, treatment, and prevention in the region.Keywords: pattern, cardiac failure, Nigeria, etiological factors

  2. Heart Failure: Unique to Older Adults

    Science.gov (United States)

    ... to Z › Heart Failure › Unique to Older Adults Font size A A A Print Share Glossary Unique ... will suffer from depression at some point. This type of severe depression is more serious than the ...

  3. ACTIVE CYCLE BREATHING TECHNIQUES IN HEART FAILURE ...

    African Journals Online (AJOL)

    RICHY

    Pulmonary Function Responses to Active Cycle. Breathing ... Key Words: Heart Failure, Active Cycle of Breathing ... cough, fatigue, reduced respiratory muscle mass, and. [5] ... an amount of exercise which is said to lower disease. [9].

  4. Psoriasis and risk of heart failure

    DEFF Research Database (Denmark)

    Khalid, Usman; Ahlehoff, Ole; Gislason, Gunnar Hilmar

    2014-01-01

    AIMS: Psoriasis is a common inflammatory disease that is associated with increased risk of cardiovascular disease, including myocardial infarction. Heart failure (HF) is independently associated with several cardiovascular risk factors and is a major cause of cardiovascular morbidity and mortality...

  5. Mechanical circulatory treatment of advanced heart failure

    DEFF Research Database (Denmark)

    Løgstrup, Brian B; Vase, Henrik; Gjedsted, Jakob

    2016-01-01

    Heart failure is one of the most common causes of morbidity and mortality worldwide. When patients cease to respond adequately to optimal medical therapy mechanical circulatory support has been promising. The advent of mechanical circulatory support devices has allowed significant improvements...... in patient survival and quality of life for those with advanced or end-stage heart failure. We provide a general overview of current mechanical circulatory support devices encompassing options for both short- and long-term ventricular support....

  6. Clinical findings and survival time in dogs with advanced heart failure.

    Science.gov (United States)

    Beaumier, Amelie; Rush, John E; Yang, Vicky K; Freeman, Lisa M

    2018-04-10

    Dogs with advanced heart failure are a clinical challenge for veterinarians but there are no studies reporting clinical features and outcome of this population. To describe clinical findings and outcome of dogs with advanced heart failure caused by degenerative mitral valve disease (DMVD). Fifty-four dogs with advanced heart failure because of DMVD. For study purposes, advanced heart failure was defined as recurrence of congestive heart failure signs despite receiving the initially prescribed dose of pimobendan, angiotensin-converting-enzyme inhibitor (ACEI), and furosemide >4 mg/kg/day. Data were collected for the time of diagnosis of Stage C heart failure and time of diagnosis of advanced heart failure. Date of death was recorded. At the diagnosis of advanced heart failure, doses of pimobendan (n = 30), furosemide (n = 28), ACEI (n = 13), and spironolactone (n = 4) were increased, with ≥1 new medications added in most dogs. After initial diagnosis of advanced heart failure, 38 (70%) dogs had additional medications adjustments (median = 2 [range, 0-27]), with the final total medication number ranging from 2-10 (median = 5). Median survival time after diagnosis of advanced heart failure was 281 days (range, 3-885 days). Dogs receiving a furosemide dose >6.70 mg/kg/day had significantly longer median survival times (402 days [range, 3-885 days] versus 129 days [range 9-853 days]; P = .017). Dogs with advanced heart failure can have relatively long survival times. Higher furosemide dose and non-hospitalization were associated with longer survival. Copyright © 2018 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  7. O impacto do CPAP na reabilitação cardíaca de pacientes com ICC: relato de caso El impacto del CPAP en la rehabilitación cardíaca de pacientes con ICC: caso clínico The impact of continuous positive airway pressure (CPAP on the cardiac rehabilitation of patients with congestive heart failure: case report

    Directory of Open Access Journals (Sweden)

    Murillo Frazão de Lima e Costa

    2010-07-01

    Full Text Available A insuficiência cardíaca congestiva é uma patologia que limita a função física do paciente. Neste estudo foi analisada uma paciente, realizando um programa de reabilitação cardíaca associado à pressão positiva contínua nas vias aéreas, aferindo-se antes do estudo e após 6 semanas, o teste de caminhada de 6 minutos (TC6M, questionário de qualidade de vida e ecocardiograma. A paciente aumentou a distância no TC6M de 152,5 m para 520,44 m. O questionário Minnesota reduziu de 62 para 18. A fração de ejeção subiu de 33% para 36%. Na paciente estudada a conduta melhorou o desempenho físico e a qualidade de vida.La insuficiencia cardíaca congestiva es una patología que limita la función física del paciente. En este estudio fue analizada una paciente, realizando un programa de rehabilitación cardíaca asociado a la presión positiva continua en las vías aéreas, realizando antes del estudio y después de 6 semanas, el test de caminata de 6 minutos (TC6M, cuestionario de calidad de vida y ecocardiograma. La paciente aumentó la distancia en el TC6M de 152,5 m a 520,44 m. El cuestionario Minnesota redujo de 62 a 18. La fracción de eyección subió de 33% a 36%. En la paciente estudiada la conducta mejoró el desempeño físico y la calidad de vida.Congestive heart failure is a pathology that limits the patient's physical function. This study analyzed one patient who was submitted to a cardiac rehabilitation program associated to Continuous Positive Airway Pressure (CPAP, by assessing the results of the six-minute walk test (6MWT and a questionnaire on the quality of life and performing an echocardiographic assessment before the study and after six weeks. The distance walked by the patient increased from 152.5 m to 520.44 m at the 6MWT. The Minnesota questionnaire score decreased from 62 to 18. Ejection fraction increased from 33% to 36%. Therefore, the management chosen for this case improved the patient's physical performance

  8. Evaluation of passive cardiomyoplasty using left- and right-ventricular volume measurements by EBCT and MRI in patients with chronic congestive heart failure; Evaluierung der passiven Kardiomyoplastie mittels links- und rechtsventrikulaerer EBCT- und MRT-Volumetrie bei Patienten mit chronischer Herzinsuffizienz

    Energy Technology Data Exchange (ETDEWEB)

    Lembcke, A.; Enzweiler, C.N.H.; Wiese, T.H.; Kivelitz, D.E.; Rogalla, P.; Hamm, B. [Inst. fuer Radiologie, Universitaetsklinikum Charite, Campus Charite Mitte, Humboldt Univ. zu Berlin (Germany); Hotz, H.; Dushe, S.; Konertz, W. [Klinik fuer Kardiovaskulaere Chirurgie, Universitaetsklinikum Charite, Campus Charite Mitte, Humboldt Univ. zu Berlin (Germany)

    2003-08-01

    Purpose: To evaluate the efficacy of passive cardiomyoplasty with the determination of biventricular volumes, global systolic function as well as left-ventricular muscle mass. Materials and Methods: In 19 patients with congestive heart failure of idiopathic or ischemic origin, a polyester mesh-graft was implanted around both ventricles for stabilization and functional support. Before and three months after surgery, 15 patients underwent EBCT and 4 patients with impaired renal function underwent MRI, for the evaluation of the volume and ejection fraction of both ventricles. Results: EBCT demonstrated a decrease from 385 to 310 ml in LV-EDV, from 312 to 242 ml in LV-ESV, from 209 to 160 ml in RV-EDV and from 149 to 87 ml in RV-ESV, and an increase from 20 to 26% in LV-EF and from 37 to 50% in RV-EF as well as a reduction of LV-MM from 300 to 274 g (p < 0.05 each). Similar results were obtained by MRI. Conclusion: Following passive cardiomyoplasty, EBCT and MRI revealed an improvement of the global systolic function as well as a reduction of biventricular volumes and left-ventricular muscle mass. (orig.) [German] Ziel: Evaluierung des Therapieerfolges der passiven Kardiomyoplastie durch Bestimmung der biventrikulaeren Volumina und global systolischen Funktion sowie der linksventrikulaeren Muskelmasse. Methoden: Bei 19 Patienten mit idiopathisch und ischaemisch bedingter Herzinsuffizienz erfolgte die Implantation eines Polyesternetzes um die Ventrikel zu deren Stabilisierung und funktioneller Unterstuetzung. Praeoperativ sowie drei Monate postoperativ wurden bei 15 Patienten durch EBCT und bei 4 Patienten mit eingeschraenkter Nierenfunktion durch MRT die Volumina und Ejektionsfraktion beider Ventrikel sowie die linksventrikulaere Muskelmasse bestimmt. Ergebnisse: Die EBCT zeigte eine Abnahme des LV-EDV von 385 auf 310 ml, des LV-ESV von 312 auf 242 ml, des RV-EDV von 209 auf 160 ml und des RV-ESV von 149 auf 87 ml, eine Zunahme der LV-EF von 20 auf 26% und der RV

  9. Data and Statistics: Heart Failure

    Science.gov (United States)

    ... Summary Coverdell Program 2012-2015 State Summaries Data & Statistics Fact Sheets Heart Disease and Stroke Fact Sheets ... Roadmap for State Planning Other Data Resources Other Statistic Resources Grantee Information Cross-Program Information Online Tools ...

  10. State-of-the-art implantable cardiac assist device therapy for heart failure: bridge to transplant and destination therapy.

    Science.gov (United States)

    Park, S J; Kushwaha, S S; McGregor, C G A

    2012-01-01

    Congestive heart failure is associated with poor quality of life (QoL) and low survival rates. The development of state-of-the-art cardiac devices holds promise for improved therapy in patients with heart failure. The field of implantable cardiac assist devices is changing rapidly with the emergence of continuous-flow pumps (CFPs). The important developments in this field, including pertinent clinical trials, registry reports, innovative research, and potential future directions are discussed in this paper.

  11. Treatment of chronic heart failure with aldosterone-blocking agents

    NARCIS (Netherlands)

    van Veldhuisen, Dirk J.; Swedberg, Karl

    Three large randomized trials in advanced heart failure (RALES), in heart failure after myocardial infarction (EPHESUS), and most recently mild heart failure (EMPHASIS-HF) have firmly established the place of aldosterone-blocking agents in patients with heart failure. In this paper we will shortly

  12. [Organ damage and cardiorenal syndrome in acute heart failure].

    Science.gov (United States)

    Casado Cerrada, Jesús; Pérez Calvo, Juan Ignacio

    2014-03-01

    Heart failure is a complex syndrome that affects almost all organs and systems of the body. Signs and symptoms of organ dysfunction, in particular kidney dysfunction, may be accentuated or become evident for the first time during acute decompensation of heart failure. Cardiorenal syndrome has been defined as the simultaneous dysfunction of both the heart and the kidney, regardless of which of the two organs may have suffered the initial damage and regardless also of their previous functional status. Research into the mechanisms regulating the complex relationship between the two organs is prompting the search for new biomarkers to help physicians detect renal damage in subclinical stages. Hence, a preventive approach to renal dysfunction may be adopted in the clinical setting in the near future. This article provides a general overview of cardiorenal syndrome and an update of the physiopathological mechanisms involved. Special emphasis is placed on the role of visceral congestion as an emergent mechanism in this syndrome. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  13. HE4 Serum Levels Are Associated with Heart Failure Severity in Patients With Chronic Heart Failure

    NARCIS (Netherlands)

    Piek, Arnold; Meijers, Wouter C.; Schroten, Nicolas F.; Gansevoort, Ron T.; de Boer, Rudolf A.; Sillje, Herman H. W.

    Background: The novel biomarker human epididymis protein 4 (HE4) shows prognostic value in acute heart failure (HF) patients. We measured HE4 levels in patients with chronic heart failure (CHF) and correlated them to HF severity, kidney function, and HF biomarkers, and determined its predictive

  14. Geographic differences in heart failure trials.

    Science.gov (United States)

    Ferreira, João Pedro; Girerd, Nicolas; Rossignol, Patrick; Zannad, Faiez

    2015-09-01

    Randomized controlled trials (RCTs) are essential to develop advances in heart failure (HF). The need for increasing numbers of patients (without substantial cost increase) and generalization of results led to the disappearance of international boundaries in large RCTs. The significant geographic differences in patients' characteristics, outcomes, and, most importantly, treatment effect observed in HF trials have recently been highlighted. Whether the observed regional discrepancies in HF trials are due to trial-specific issues, patient heterogeneity, structural differences in countries, or a complex interaction between factors are the questions we propose to debate in this review. To do so, we will analyse and review data from HF trials conducted in different world regions, from heart failure with preserved ejection fraction (HF-PEF), heart failure with reduced ejection fraction (HF-REF), and acute heart failure (AHF). Finally, we will suggest objective and actionable measures in order to mitigate regional discrepancies in future trials, particularly in HF-PEF where prognostic modifying treatments are urgently needed and in which trials are more prone to selection bias, due to a larger patient heterogeneity. © 2015 The Authors European Journal of Heart Failure © 2015 European Society of Cardiology.

  15. Epidemiology and Prognosis of Heart Failure

    Directory of Open Access Journals (Sweden)

    Ilaria Spoletini

    2017-01-01

    Full Text Available In this article the state of the art of prevalence, incidence and prognosis of heart failure is discussed. Prevalence and incidence are two measures of disease occurrence. Briefly, prevalence is the proportion of the population affected by the disease at a certain point in time. Incidence indicates the number of new cases within a given time period in a population at risk for the disease (for example, elderly people. A related, prognostic measure is mortality, i.e. the incidence of death from the disease occurring in a period of time. In the case of chronic, steady- state disease such as heart failure, disease duration is directly affected by mortality, and prevalence may correspond to the incidence of disease multiplied by the average duration of disease . Prevalence rates of heart failure may, therefore, vary across studies depending on the variability in incidence as well as in survival between population samples. Also, given that heart failure is a complex syndrome with different phenotypes (see article 1, each with specific clinical characteristics and associated risk factors, prevalence and incidence rates may vary according to the definition of the heart failure subtype. Finally, rates may vary on the basis of the method of collecting data and the criterion for defining left ventricular systolic dysfunction that is applied in the study.

  16. [Comorbidities of heart failure: sleep apnea].

    Science.gov (United States)

    Woehrle, H; Oldenburg, O; Stadler, S; Arzt, M

    2018-05-01

    Since sleep apnea often occurs in heart failure, physicians regularly need to decide whether further diagnostic procedures and/or treatment are required. Which types of sleep apnea occur in heart failure patients? When is treatment needed? Which treatments and treatment goals are appropriate? Clinical trials and guidelines as well as their implementation in clinical practice are discussed. At least 40% of patients with heart failure, both with reduced and preserved left ventricular ejection fraction (HFrEF and HFpEF, respectively), suffer from relevant sleep apnea. In heart failure patients both obstructive and central sleep apnea are associated with increased mortality. In HFrEF as well as in HFpEF patients with obstructive sleep apnea, treatment with continuous positive airway pressure (CPAP) achieves symptomatic and functional improvements. In patients with HFpEF, positive airway pressure treatment of central sleep apnea may be beneficial. In patients with HFrEF and left ventricular ejection fraction ≤45%, adaptive servoventilation is contraindicated. Sleep apnea is highly prevalent in heart failure patients and its treatment in specific patient groups can improve symptoms and functional outcomes. Thus, testing for sleep apnea is recommended.

  17. Serum Potassium Levels and Outcome in Acute Heart Failure (Data from the PROTECT and COACH Trials)

    OpenAIRE

    Tromp, Jasper; ter Maaten, Jozine M.; Damman, Kevin; OConnor, Christopher M.; Metra, Marco; Dittrich, Howard C.; Ponikowski, Piot; Teerlink, John R.; Cotter, Gad; Davison, Beth; Cleland, John G. F.; Givertz, Michael M.; Bloomfield, Daniel M.; van der Wal, Martje H. L.; Jaarsma, Tiny

    2017-01-01

    Serum potassium is routinely measured at admission for acute heart failure (AHF), but information on association with clinical variables and prognosis is limited. Potassium measurements at admission were available in 1,867 patients with AHF in the original cohort of 2,033 patients included in the Patients Hospitalized with acute heart failure and Volume Overload to Assess Treatment Effect on Congestion and Renal FuncTion trial. Patients were grouped according to low potassium (amp;lt;3.5 mEq/...

  18. Adults living with heart failure and fatigue

    DEFF Research Database (Denmark)

    Schjødt, Inge; Sommer, Irene; Bjerrum, Merete

    studies have been performed to develop more coherent and effective interventions to support self-care among heart failure patients experiencing fatigue. The findings of qualitative research should be synthesised to optimise nurses' understanding of fatigue and develop recommendations for practice. Aim......Background Fatigue is one of the most common symptoms reported by patients with heart failure (HF). Fatigue negatively impacts on patients’ everyday life, prognosis and quality of life. No specific cure or effective interventions to alleviate fatigue are available. Over the past decade, qualitative...... To synthesise the best available evidence related to the lived experiences and management of fatigue in everyday life in adult patients with stable heart failure to develop effective interventions to support self-care. Specific questions on the patients’ lived experiences included: • How do patients with HF...

  19. [Holistic therapy of chronic heart failure].

    Science.gov (United States)

    Feldmann, C; Ertl, G; Angermann, C E

    2014-06-01

    The rising prevalence and increasing disease-related costs render chronic heart failure a rapidly growing socioeconomic challenge. The concerted action of guideline-adjusted therapy and holistic patient care is essential to achieve improvements in mortality, morbidity, functional status and quality of life of patients with symptomatic heart failure. Holistic care strategies comprise consideration of comorbidities and individual needs, lifestyle recommendations and multidisciplinary management programs for high-risk symptomatic patients in addition to basic medication and surgical therapies. For optimal patient care and coaching, seamless interaction is required between in-hospital treatment and outpatient facilities. Moreover, the palliative needs of heart failure patients need to be considered, a topic that is currently not receiving enough attention.

  20. Lay Consultations in Heart Failure Symptom Evaluation.

    Science.gov (United States)

    Reeder, Katherine M; Sims, Jessica L; Ercole, Patrick M; Shetty, Shivan S; Wallendorf, Michael

    2017-01-01

    Lay consultations can facilitate or impede healthcare. However, little is known about how lay consultations for symptom evaluation affect treatment decision-making. The purpose of this study was to explore the role of lay consultations in symptom evaluation prior to hospitalization among patients with heart failure. Semi-structured interviews were conducted with 60 patients hospitalized for acute decompensated heart failure. Chi-square and Fisher's exact tests, along with logistic regression were used to characterize lay consultations in this sample. A large proportion of patients engaged in lay consultations for symptom evaluation and decision-making before hospitalization. Lay consultants provided attributions and advice and helped make the decision to seek medical care. Men consulted more often with their spouse than women, while women more often consulted with adult children. Findings have implications for optimizing heart failure self-management interventions, improving outcomes, and reducing hospital readmissions.

  1. Recommendations for pacemaker implantation for the treatment of atrial tachyarrhythmias and resynchronisation therapy for heart failure

    Science.gov (United States)

    van Hemel, N.M.; Dijkman, B.; de Voogt, W.G.; Beukema, W.P.; Bosker, H.A.; de Cock, C.C.; Jordaens, L.J.L.M.; van Gelder, I.C.; van Gelder, L.M.; van Mechelen, R.; Ruiter, J.H.; Sedney, M.I.; Slegers, L.C.

    2004-01-01

    Today, new pacing algorithms and stimulation methods for the prevention and interruption of atrial tachyarrhythmias can be applied on patients who need bradycardia pacing for conventional reasons. In addition, biventricular pacing as additive treatment for patients with severe congestive heart failure due to ventricular systolic dysfunction and prolonged intraventricular conduction has shown to improve symptoms and reduce hospital admissions. These new pacing technologies and the optimising of the pacing programmes are complex, expensive and time-consuming. Based on many clinical studies the indications for these devices are beginning to emerge. To support the cardiologist's decision-making and to prevent waste of effort and resources, the 'ad hoc committee' has provided preliminary recommendations for implantable devices to treat atrial tachyarrhythmias and to extend the treatment of congestive heart failure respectively. PMID:25696255

  2. ▼ Sacubitril valsartan for heart failure.

    Science.gov (United States)

    2016-06-01

    ▼ Sacubitril valsartan (Entresto-Novartis) is a new oral drug licensed for the treatment of symptomatic chronic heart failure in adults with reduced ejection fraction.(1) It is described as an angiotensin receptor neprilysin inhibitor and contains the neprilysin inhibitor, sacubitril and the angiotensin II receptor antagonist, valsartan.(1-3) Here, we review the evidence for sacubitril valsartan and consider its place in the management of heart failure. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  3. Diuretics in heart failure: practical considerations.

    Science.gov (United States)

    Basraon, Jagroop; Deedwani, Prakash C

    2012-09-01

    This review discusses the role of diuretics in heart failure by focusing on different classifications and mechanisms of action. Pharmacodynamic and pharmacokinetic properties of diuretics are elucidated. The predominant discussion highlights the use of loop diuretics, which are the most commonly used drugs in heart failure. Different methods of using this therapy in different settings along with a comprehensive review of the side-effect profile are highlighted. Special situations necessitating adjustment and the phenomenon of diuretic resistance are explained. Copyright © 2012. Published by Elsevier Inc.

  4. Renal function assessment in heart failure.

    Science.gov (United States)

    Pérez Calvo, J I; Josa Laorden, C; Giménez López, I

    Renal function is one of the most consistent prognostic determinants in heart failure. The prognostic information it provides is independent of the ejection fraction and functional status. This article reviews the various renal function assessment measures, with special emphasis on the fact that the patient's clinical situation and response to the heart failure treatment should be considered for the correct interpretation of the results. Finally, we review the literature on the performance of tubular damage biomarkers. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  5. Understanding the C-pulse device and its potential to treat heart failure.

    Science.gov (United States)

    Sales, Virna L; McCarthy, Patrick M

    2010-03-01

    The Sunshine Heart C-Pulse (C-Pulse; Sunshine Heart Inc., Tustin, CA) device is an extra-aortic implantable counterpulsation pump designed as a non-blood contacting ambulatory heart assist device, which may provide relief from symptoms for class II-III congestive heart failure patients. It has a comparable hemodynamic augmentation to intra-aortic balloon counterpulsation devices. The C-Pulse cuff is implanted through a median sternotomy, secured around the ascending aorta, and pneumatically driven by an external system controller. Pre-clinical studies in the acute pig model, and initial temporary clinical studies in patients undergoing off-pump coronary bypass surgery have shown substantial increase in diastolic perfusion of the coronary vessels, which translated to a favorable improvement in ventricular function. A U.S. prospective multi-center trial to evaluate the safety and efficacy of the C-Pulse in class III patients with moderate heart failure is now in progress.

  6. Evaluation of pulmonary congestion by computed tomography

    International Nuclear Information System (INIS)

    Morooka, Nobuhiro; Yamamoto, Hironori; Yoshida, Hideo; Watanabe, Shigeru; Nakamura, Mamoru

    1980-01-01

    Pulmonary congestion and pulmonary water distribution of lung fields were evaluated by computed tomography (CT) in 31 patients with congestive heart failure and 19 normal subjects in the supine position. In normal subjects, no difference was noted in the CT value between levels of intercostal spaces as well as between right and left lung fields. CT values were greater in posterior lung fields than in anterior lung fields. A significant increase of CT values at both anterior and posterior lung fields was shown in patients with congestive heart failure compared to normal subjects. In congestive heart failure, pulmonary CT values were correlated with various clinical parameters in the order of chest X-ray findings, NYHA functional classification, venous pressure, right heart catheter findings and circulation time. CT values were decreased with the improvement of parameters by medical treatment. Thus, the increase of pulmonary CT values in patients with congestive heart failure indicated the increase of pulmonary blood content and pulmonary tissue edema in a unit volume. This method was particularly useful for the evaluation of pulmonary congestion and pulmonary water distribution. (author)

  7. Hemodynamic changes as a result of experimental heart failure in sheep as observed with technetium 99m

    International Nuclear Information System (INIS)

    Van Rooyen, J.M.

    1978-01-01

    The aim of this project is to study heart failure in sheep that have gousiekte by using technetium 99m to determine the blood flow. Gousiekte is a congestive cardiomyopathy that occurs in ruminant animals. It is characterised by a latent period of 2-6 weeks followed by a sudden death. It appears that during gousiekte the stroke volume decreases with about 40% and the PFI increases with more than a 100%. The decrease in stroke volume is observed by means of an electromagnetic bloodflow meter. The greater change in PFI than stroke volume during gousiekte is a sign that there is congestive failure of the left ventricle. A decrease in ejection fraction has been observed by a loss of value lower than 30% after the final congestive phase has been reached. Normally 7,4 plus minus 0,3 contractions of a sheep's heart are needed to pump the blood from the right to left side of the heart. Complete congestive failure during gousiekte can decrease the effectiveness of the heart so that 50 contractions are needed, in other words a PFI value of 50. Two phases can be distinguished during the development of gousiekte namely a compensation phase and a decompensation phase. The PFI as criterion is used to establish the influence of certain drugs with an inotropic effect and to establish whether a gousiekte heart can protentiate after administration of the drugs. The findings are positive which shows than energy abnormalities are not primary causes of gousiekte. As a model for heart failure gousiekte can be compared with other well known models of heart failure such a volume overload, pressure overload and coronary ligatures in sheep. The by-product of this research is the development and possible application of the technetium isotope method to diagnose heart failure in sheep

  8. Percutaneous Implantation of A Parachute Device For Treatment of Ischemic Heart Failure

    International Nuclear Information System (INIS)

    Cilingiroglu, Mehmet; Rollefson, William A.; Mego, David

    2013-01-01

    Congestive heart failure (CHF) secondary to ischemic cardiomyopathy is associated with significant morbidity and mortality despite currently available medical therapy. The Parachute TM device is a novel left ventricular partitioning device that is delivered percutaneously in the left ventricle (LV) in patients with anteroapical regional wall motion abnormalities, dilated LV and systolic dysfunction after anterior myocardial infarction with favorable clinical and LV hemodynamic improvements post-implantation. Here, we do review the current literature and present a case of the Parachute device implantation

  9. Nurses' decision making in heart failure management based on heart failure certification status.

    Science.gov (United States)

    Albert, Nancy M; Bena, James F; Buxbaum, Denise; Martensen, Linda; Morrison, Shannon L; Prasun, Marilyn A; Stamp, Kelly D

    Research findings on the value of nurse certification were based on subjective perceptions or biased by correlations of certification status and global clinical factors. In heart failure, the value of certification is unknown. Examine the value of certification based nurses' decision-making. Cross-sectional study of nurses who completed heart failure clinical vignettes that reflected decision-making in clinical heart failure scenarios. Statistical tests included multivariable linear, logistic and proportional odds logistic regression models. Of nurses (N = 605), 29.1% were heart failure certified, 35.0% were certified in another specialty/job role and 35.9% were not certified. In multivariable modeling, nurses certified in heart failure (versus not heart failure certified) had higher clinical vignette scores (p = 0.002), reflecting higher evidence-based decision making; nurses with another specialty/role certification (versus no certification) did not (p = 0.62). Heart failure certification, but not in other specialty/job roles was associated with decisions that reflected delivery of high-quality care. Copyright © 2018 Elsevier Inc. All rights reserved.

  10. Medication adherence and Medicare expenditure among beneficiaries with heart failure.

    Science.gov (United States)

    Lopert, Ruth; Shoemaker, J Samantha; Davidoff, Amy; Shaffer, Thomas; Abdulhalim, Abdulla M; Lloyd, Jennifer; Stuart, Bruce

    2012-09-01

    To (1) measure utilization of and adherence to heart failure medications and (2) assess whether better adherence is associated with lower Medicare spending. Pooled cross-sectional design using six 3-year cohorts of Medicare beneficiaries with congestive heart failure (CHF) from 1997 through 2005 (N = 2204). Adherence to treatment was measured using average daily pill counts. Bivariate and multivariate methods were used to examine the relationship between medication adherence and Medicare spending. Multivariate analyses included extensive variables to control for confounding, including healthy adherer bias. Approximately 58% of the cohort were taking an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), 72% a diuretic, 37% a beta-blocker, and 34% a cardiac glycoside. Unadjusted results showed that a 10% increase in average daily pill count for ACE inhibitors or ARBs, beta-blockers, diuretics, or cardiac glycosides was associated with reductions in Medicare spending of $508 (not significant [NS]), $608 (NS), $250 (NS), and $1244 (P <.05), respectively. Estimated adjusted marginal effects of a 10% increase in daily pill counts for beta-blockers and cardiac glycosides were reductions in cumulative 3-year Medicare spending of $510 to $561 and $750 to $923, respectively (P <.05). Higher levels of medication adherence among Medicare beneficiaries with CHF were associated with lower cumulative Medicare spending over 3 years, with savings generally exceeding the costs of the drugs in question.

  11. Atrial natriuretic peptide in patients with heart failure and chronic atrial fibrillation : Role of duration of at atrial fibrillation

    NARCIS (Netherlands)

    Van Den Berg, MP; Crijns, HJGM; Van Veldhuisen, DJ; Van Gelder, IC; De Kam, PJ; Lie, KI

    The purpose of this study was to analyze the determinants of atrial natriuretic peptide level in patients with congestive heart failure and atrial fibrillation. In particular, the duration of atrial fibrillation was analyzed because atrial fibrillation per se might have a specific effect on atrial

  12. Review Article Heart failure - an inflammatory paradigm

    African Journals Online (AJOL)

    1999-02-01

    Feb 1, 1999 ... Together with the growing clinical problem of heart failure, new information at a .... nificantly raised in the prevention as well as the treatment arms when .... tricular dysfunction and pulmonary oedema in humans; experimentally ... adenine dinucleotide (reduced) and the rate-limiting amino acid (L-arginine).

  13. Selecting heart failure patients for metabolic interventions

    NARCIS (Netherlands)

    Booij, Harmen G.; Koning, Anne M.; van Goor, Harry; de Boer, Rudolf A.; Westenbrink, B. Daan

    2017-01-01

    Introduction: Heart failure (HF) has become the cardiovascular epidemic of the century and now imposes an immense burden on health care systems. While our understanding of the pathophysiology of HF has increased dramatically, the translation of knowledge into clinical practice has been

  14. The management of acute heart failure

    NARCIS (Netherlands)

    Milo-Cotter, O.; Bettari, L.; Kleijn, L.; Bugatti, S.; Lombardi, C.; Rund, M.; Metra, M.; Voors, A. A.; Cotter, G.; Kaluski, E.; Weatherley, B. D.

    Hospitalization for acute heart failure (AHF) is one of the burdensome aspects of 21(st) century medicine, leading to significant debilitating symptoms, high morbidity and mortality and consuming significant portion of the health care budget. Management of AHF is thought-provoking given the

  15. Copeptin as a biomarker in heart failure

    DEFF Research Database (Denmark)

    Balling, Louise; Gustafsson, Finn

    2014-01-01

    Increased neurohormonal activation is a key feature of heart failure (HF). Copeptin is a surrogate marker for proarginine vasopressin and the prognostic value of copeptin has been reported for multiple disease states of both nonvascular and cardiovascular etiology. Elevated plasma copeptin in HF...

  16. Heart failure in children - home care

    Science.gov (United States)

    ... ency/patientinstructions/000940.htm Heart failure in children - home care To use the sharing features on this page, ... to write down the results of your child's home checks so that you can share them with your child's health care provider. You may need to keep a chart, ...

  17. Dopamine in heart failure and critical care

    NARCIS (Netherlands)

    Smit, AJ

    Dopamine is widely used in critical care to prevent renal function loss. Nevertheless sufficient evidence is still lacking of reduction in end points like mortality or renal replacement therapy. Dopaminergic treatment in chronic heart failure (CHF) has provided an example of unexpected adverse

  18. Heart Failure Care in General Practice

    NARCIS (Netherlands)

    Valk, M.J.M.

    2017-01-01

    Heart failure (HF) is an increasing health care problem worldwide, and a multidisciplinary approach with a general practitioner (GP) in the health care team is considered optimal. HF management has improved substantially over the last two decades, mainly for patients with HF with a reduced ejection

  19. Circulating cells in heart and renal failure

    NARCIS (Netherlands)

    Jie, K.E.

    2010-01-01

    The presence of combined chronic heart failure and chronic kidney disease, i.e. the cardiorenal syndrome (CRS), is a rising problem with high cardiovascular morbidity and mortality. In CRS, disease progression in both organs is amplified. In this thesis, we aimed to gain insight into

  20. Right ventricular myxoma with heart failure

    International Nuclear Information System (INIS)

    Nuri, M.M.H.; Naseem, A.; Raza, A.; Ahmad, W.; Raja, M.K.; Ahmad, A.; Rasheed, A.; Gohar, A.

    2005-01-01

    Cardiac myxomas are histologically benign tumors but they may be lethal because of their strategic position. These are mostly located in the left atrium and uncommonly in the right atrium. We report a case of a large right ventricular myxoma presenting with heart failure. (author)

  1. Body mass index in chronic heart failure

    DEFF Research Database (Denmark)

    Christensen, Heidi M.; Schou, Morten; Goetze, Jens P

    2013-01-01

    Low body mass index (BMI) is associated with a poor outcome in chronic heart failure (CHF). An inverse association between BMI and adiponectin and N-terminal pro-B-type natriuretic peptide (NT-proBNP) has been reported. The aim of the present study was to investigate whether novel markers...

  2. Becoming a patient with heart failure.

    Science.gov (United States)

    Stull, D E; Starling, R; Haas, G; Young, J B

    1999-01-01

    The purpose of this study was to gain a better understanding of the process of becoming a patient with heart failure, a process of identity formation. Are there clues in the patients' stories about heart failure that might give us a better idea of how patients adjust to heart failure and what heart failure means to them? Meanings that individuals attach to events or situations are central to development of identity and subsequent behaviors. Qualitative methods involving detailed interviews and grounded theory method were used in an outpatient cardiology department of a large health care facility in northeast Ohio. Twenty-one patients with a diagnosis of heart failure were conveniently selected and interviewed for this research. Patients were selected on the basis of having a left ventricular ejection fraction of 35% or less and New York Heart Association class II, III, or IV. Other possible selection criteria (eg, VO(2Max ), walk test, or dyspnea) were not available for all patients and thus did not constitute consistent selection criteria. A broad net was cast for patients with varying characteristics to see if common processes and experiences existed regardless of the differences in clinical indicators. Patients were interviewed in the examining room as part of a regularly scheduled visit with their cardiologists. All interviews were tape recorded and fully transcribed. Field notes and relevant patient chart data (eg, age, sex, race, marital status, cause of heart failure, comorbidities, history of hospitalization, New York Heart Association functional class, left ventricular ejection fraction) were included in the transcribed interviews. The transcribed interview was read and responses were given initial conceptual codes. These coded passages were categorized according to more abstract categories or concepts and underlying processes that encompass them. This process continues until all relevant passages have been categorized and subsumed under higher-order (more

  3. Effect of percutaneous renal sympathetic nerve radiofrequency ablation in patients with severe heart failure.

    Science.gov (United States)

    Dai, Qiming; Lu, Jing; Wang, Benwen; Ma, Genshan

    2015-01-01

    This study aimed to investigate the clinical feasibility and effects of percutaneous renal sympathetic nerve radiofrequency ablation in patients with heart failure. A total of 20 patients with heart failure were enrolled, aged from 47 to 75 years (63±10 years). They were divided into the standard therapy (n = 10), and renal nerve radiofrequency ablation groups (n = 10). There were 15 males and 5 female patients, including 8 ischemic cardiomyopathy, 8 dilated cardiomyopathy, and 8 hypertensive cardiopathy. All of the patients met the criteria of New York Heart Association classes III-IV cardiac function. Patients with diabetes and renal failure were excluded. Percutaneous renal sympathetic nerve radiofrequency ablation was performed on the renal artery wall under X-ray guidance. Serum electrolytes, neurohormones, and 24 h urine volume were recorded 24 h before and after the operation. Echocardiograms were performed to obtain left ventricular ejection fraction at baseline and 6 months. Heart rate, blood pressure, symptoms of dyspnea and edema were also monitored. After renal nerve ablation, 24 h urine volume was increased, while neurohormone levels were decreased compared with those of pre-operation and standard therapy. No obvious change in heart rate or blood pressure was recorded. Symptoms of heart failure were improved in patients after the operation. No complications were recorded in the study. Percutaneous renal sympathetic nerve radiofrequency ablation may be a feasible, safe, and effective treatment for the patients with severe congestive heart failure.

  4. Heart failure and 1231-M.I.B.G. scintigraphy: comeback; Scintigraphie cardiaque a la 1231-metaiodobenzylguanidine et cardiomyopathies: le retour

    Energy Technology Data Exchange (ETDEWEB)

    Agostini, D.; Hugentobler, A.; Costo, S.; Bouvard, G. [Centre Hospitalier Universitaire Cote de Nacre, Service de Medecine Nucleaire, 14 - Caen (France); Manrique, A. [Centre de Lutte Contre le Cancer Henri-Becquerel, Service de Medecine Nucleaire, 76 - Rouen (France); Sabatier, R.; Grollier, G. [Centre Hospitalier Universitaire Cote de Nacre, Service de Cardiologie, 14 - Caen (France); Belin, A. [Hopital de Trouville, Service de Readaptation Cardiaque, 14 - Trouville (France)

    2007-09-15

    Congestive heart failure is a often associated with an impairment of sympathetic nervous system, i.e., global hyperactivity and regional impairment of adrenergic system. Cardiac {sup 123}I-meta-iodo-benzyl-guanidine (M.I.B.G.) scintigraphy is a radionuclide technique which can explore the presynaptic adrenergic function. Cardiac fixation of M.I.B.G. is decreased in congestive heart failure, reflecting a reduction of norepinephrine uptake by the myocardial presynaptic ending nerves. The impairment of presynaptic function is early and actually involved in the pathogenesis of cardiac failure. Cardiac M.I.B.G. scintigraphy is a useful tool to explore the myocardial adrenergic stores in patients with congestive heart failure. (authors)

  5. STUDY OF PHARMACO THERAPEUTIC CONSIDERATIONS IN THE MANAGEMENT OF HEART FAILURE

    Directory of Open Access Journals (Sweden)

    Souris Kondaveti

    2015-02-01

    Full Text Available BACKGROUND AND OBJECTIVES: Congestive heart failure (CHF continues to be a major clinical and public health problem. Conflicting data exists about its rate of occurrence in general population, relative frequencies of predisposing heart diseases and the prognosis of the patient. In the present study, gender aspects, age wise distribution, drug distribution pattern were assessed in these patients. MATERIALS AND METHODS: A total number of 100 patients from the medical outpatient department of medicine, M.G.M. Hospital Warangal were en rolled into the study. All male and female patients between 30 to 85 years of age, diagnosed with heart failure falling into the category of functional New York Heart Association (NYHA class II or III with left ventricular ejection fraction (LVEF ≤35% we re included in the study. RESULTS: Of the 100 subjects studied 55 (40 - 75 yr were male and 45 (35 - 73 yr were female. 94 patients presented with ischemic heart failure compared to only 6 patients with non - ischemic heart failure. Out of total subjects enrol led, 61 were put on Digoxin, 71 on Diuretics, 47 on ACEI, 20 on Beta Blocker (Carvedilol, 30 on Nitrates, 64 on Anticoagulants, 19 on Statins. CONCLUSION: The incidence of heart failure was more in advanced age groups and slightly more common in males. Is chemic heart disease accounted for heart failure in majority of patients in our study we found that Digoxin, Diuretics, ACEI and Anticoagulants followed by Nitrates, Beta blockers and Statins were the most prescribed medications in the management of heart failure

  6. Pathophysiological relationships between heart failure and depression and anxiety.

    Science.gov (United States)

    Chapa, Deborah W; Akintade, Bimbola; Son, Heesook; Woltz, Patricia; Hunt, Dennis; Friedmann, Erika; Hartung, Mary Kay; Thomas, Sue Ann

    2014-04-01

    Depression and anxiety are common comorbid conditions in patients with heart failure. Patients with heart failure and depression have increased mortality. The association of anxiety with increased mortality in patients with heart failure is not established. The purpose of this article is to illustrate the similarities of the underlying pathophysiology of heart failure, depression, and anxiety by using the Biopsychosocial Holistic Model of Cardiovascular Health. Depression and anxiety affect biological processes of cardiovascular function in patients with heart failure by altering neurohormonal function via activation of the hypothalamic-pituitary-adrenal axis, autonomic dysregulation, and activation of cytokine cascades and platelets. Patients with heart failure and depression or anxiety may exhibit a continued cycle of heart failure progression, increased depression, and increased anxiety. Understanding the underlying pathophysiological relationships in patients with heart failure who experience comorbid depression and/or anxiety is critical in order to implement appropriate treatments, educate patients and caregivers, and educate other health professionals.

  7. Management of atrial fibrillation in the setting of heart failure

    NARCIS (Netherlands)

    Crijns, HJGM; VandenBerg, MP; VanGelder, IC; VanVeldhuisen, DJ

    Heart failure is often complicated by atrial fibrillation. Once atrial fibrillation has started it further enhances heart failure due to uncontrolled rate with shortened filling time and provocation of tachycardiomyopathy. Absent atrial kick and irregularity of the ventricular rhythm also

  8. Structural Bases of Postresuscitative Heart Failure

    Directory of Open Access Journals (Sweden)

    V. T. Dolgikh

    2005-01-01

    Full Text Available An experiment on 106 non-inbred male albino rats undergone 4-minute clinical death from acute blood loss has revealed that the first three days after resuscitation are marked by a concomitance of vascular disorders and cardiomyocytic dystrophic changes, the leading role being played by sludge, stasis, thrombosis, increased vascular permeability, perivascular edema, and hemorrhages. Cardiomyocytic destruction (various contractures, block-like myofibrillolysis, myocytoly-sis is a structural basis of postresuscitative heart failure. Three days later the heart displayed concomitant processes of recovery and damage. Three types of cardiac morphological changes have been identified in relation to the ratio of these processes.

  9. Effect of cardiac resynchronization therapy-defibrillator implantation on health status in patients with mild versus moderate symptoms of heart failure

    DEFF Research Database (Denmark)

    Versteeg, Henneke; van den Broek, Krista C; Theuns, Dominic A M J

    2011-01-01

    Indications for cardiac resynchronization therapy (CRT) have expanded to include patients with mild congestive heart failure (CHF) symptoms (New York Heart Association [NYHA] functional class II) because of a demonstrated morbidity reduction in this subset of patients. However, little is known...

  10. Aldosterone and aldosterone receptor antagonists in patients with chronic heart failure

    Directory of Open Access Journals (Sweden)

    Nappi J

    2011-06-01

    Full Text Available Jean M Nappi, Adam SiegClinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Medical University of South Carolina Campus, Charleston, SC, USAAbstract: Aldosterone is a mineralocorticoid hormone synthesized by the adrenal glands that has several regulatory functions to help the body maintain normal volume status and electrolyte balance. Studies have shown significantly higher levels of aldosterone secretion in patients with congestive heart failure compared with normal patients. Elevated levels of aldosterone have been shown to elevate blood pressure, cause left ventricular hypertrophy, and promote cardiac fibrosis. An appreciation of the true role of aldosterone in patients with chronic heart failure did not become apparent until the publication of the Randomized Aldactone Evaluation Study. Until recently, the use of aldosterone receptor antagonists has been limited to patients with severe heart failure and patients with heart failure following myocardial infarction. The Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure (EMPHASIS-HF study added additional evidence to support the expanded use of aldosterone receptor antagonists in heart failure patients. The results of the EMPHASIS-HF trial showed that patients with mild-to-moderate (New York Heart Association Class II heart failure had reductions in mortality and hospitalizations from the addition of eplerenone to optimal medical therapy. Evidence remains elusive about the exact mechanism by which aldosterone receptor antagonists improve heart failure morbidity and mortality. The benefits of aldosterone receptor antagonist use in heart failure must be weighed against the potential risk of complications, ie, hyperkalemia and, in the case of spironolactone, possible endocrine abnormalities, in particular gynecomastia. With appropriate monitoring, these risks can be minimized. We now have evidence that patients with mild-to-severe symptoms

  11. Treatment of anemia with darbepoetin alfa in systolic heart failure

    DEFF Research Database (Denmark)

    Swedberg, Karl; Young, James B; Anand, Inder S

    2013-01-01

    Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia.......Patients with systolic heart failure and anemia have worse symptoms, functional capacity, and outcomes than those without anemia. We evaluated the effects of darbepoetin alfa on clinical outcomes in patients with systolic heart failure and anemia....

  12. Risk following hospitalization in stable chronic systolic heart failure

    DEFF Research Database (Denmark)

    Abrahamsson, Putte; Swedberg, Karl; Borer, Jeffrey S

    2013-01-01

    We explored the impact of being hospitalized due to worsening heart failure (WHF) or a myocardial infarction (MI) on subsequent mortality in a large contemporary data set of patients with stable chronic systolic heart failure (HF).......We explored the impact of being hospitalized due to worsening heart failure (WHF) or a myocardial infarction (MI) on subsequent mortality in a large contemporary data set of patients with stable chronic systolic heart failure (HF)....

  13. Severe right heart failure in a patient with Grave's disease.

    Science.gov (United States)

    Xenopoulos, N P; Braden, G A; Applegate, R J

    1996-11-01

    This brief report presents a patient with isolated right heart failure and two rare underlying causes, hyperthyroidism and dysplastic tricuspid valve. Repair of the tricuspid valve and treatment of the hyperthyroidism were both essential for successful treatment of the right heart failure. Most important, recrudescence of hyperthyroidism in this patient was associated with reappearance of florid right heart failure. This report provides further information about a potential linkage of hyperthyroidism and severe right heart failure.

  14. Preoperative assessment of congestive liver dysfunction using technetium-99m galactosyl human Serum albumin liver scintigraphy in patients with severe valvular heart disease

    International Nuclear Information System (INIS)

    Nishi, Hiroyuki; Matsumiya, Goro; Takano, Hiroshi; Ichikawa, Hajime; Miyagawa, Shigeru; Sawa, Yoshiki; Takahashi, Toshiki

    2007-01-01

    Severe valvular heart disease is often complicated by congestive liver dysfunction, which greatly compromises the operative results. We evaluated congestive liver dysfunction by a novel approach using technetium-99m galactosyl human serum albumin ( 99m Tc-GSA) with liver scintigraphy. Between 1998 and 2004, we performed scintigraphy accompanied by 99m Tc-GSA in 28 patients who had valvular heart disease with moderate-to-severe tricuspid regurgitation and who showed symptoms of right heart failure. Based on the results, we calculated a receptor index (LHL15) and an index of blood clearance (HH15) and assessed the correlation between these factors and postoperative liver dysfunction, defined as the maximum serum total bilirubin level (max T-bil) as >2.0 mg/dl. Nineteen patients, including four who died in hospital, had postoperative liver dysfunction. The level of HH15 was significantly higher and the level of cholinesterase was significantly lower (P 99m Tc-GSA is a clinically useful predictor of postoperative liver dysfunction in patients with severe valvular disease. (author)

  15. Heart Failure Association of the European Society of Cardiology Specialist Heart Failure Curriculum

    DEFF Research Database (Denmark)

    McDonagh, Theresa A; Gardner, Roy S; Lainscak, Mitja

    2014-01-01

    Training Curricula. In addition, European Society of Cardiology (ESC) subspecialty curricula exist for Interventional Cardiology and Heart Rhythm Management. The purpose of this heart failure curriculum is to provide a framework which can be used as a blueprint for training across Europe. This blueprint...... mirrors other ESC curricula. Each section has three components: the knowledge required, the skills which are necessary, and the professionalism (attitudes and behaviours) which should be attained. The programme is designed to last 2 years. The first year is devoted to the specialist heart failure module...

  16. Myocardial myostatin in spontaneously hypertensive rats with heart failure.

    Science.gov (United States)

    Damatto, R L; Lima, A R R; Martinez, P F; Cezar, M D M; Okoshi, K; Okoshi, M P

    2016-07-15

    Myostatin has been shown to regulate skeletal and cardiac muscle growth. However, its status on long-term hypertrophied myocardium has not been addressed. The purpose of this study was to evaluate the expression of myocardial myostatin and its antagonist follistatin in spontaneously hypertensive rats (SHR) with heart failure. Eighteen-month-old SHR were evaluated to identify clinical features of heart failure such as tachypnea/labored respiration and weight loss. After heart failure was detected, rats were subjected to echocardiogram and euthanized. Age-matched normotensive Wistar-Kyoto (WKY) rats were used as controls. Myostatin and follistatin protein expression was assessed by Western blotting. Statistical analysis was performed by Student's t test. All SHR (n=8) presented right ventricular hypertrophy and five had lung congestion. SHR had left chambers hypertrophy and dilation (left atrial diameter: WKY 5.73±0.59; SHR 7.28±1.17mm; p=0.004; left ventricular (LV) diastolic diameter/body weight ratio: WKY 19.6±3.1; SHR 27.7±4.7mm/kg; p=0.001), and LV systolic dysfunction (midwall fractional shortening: WKY 34.9±3.31; SHR 24.8±3.20%; p=0.003). Myocyte diameter (WKY 23.1±1.50, SHR 25.5±1.33μm; p=0.004) and myocardial interstitial collagen fraction (WKY 4.86±0.01; SHR 8.36±0.02%; pMyostatin (WKY 1.00±0.16; SHR 0.77±0.23 arbitrary units; p=0.035) and follistatin (WKY 1.00±0.35; SHR 0.49±0.18 arbitrary units; p=0.002) expression was lower in SHR. Myostatin and follistatin expression negatively correlated with LV diastolic diameter-to-body weight ratio and LV systolic diameter, and positively correlated with midwall fractional shortening. Myostatin and follistatin protein expression is reduced in the long-term hypertrophied myocardium from spontaneously hypertensive rats with heart failure. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  17. Prognostic indices in childhood heart failure | Omokhodion | West ...

    African Journals Online (AJOL)

    Objectives: To evaluate the short term prognosis of childhood heart failure and highlight the factors that affect outcome among cases of heart failure admitted into the paediatric wards, University College Hospital, Ibadan. Background: Childhood heart failure remains a major cause of morbidity and mortality in the developing ...

  18. Albuminuria in heart failure : what do we really know?

    NARCIS (Netherlands)

    Dobre, Daniela; Nimade, Sandeep; de Zeeuw, Dick

    Purpose of the review To describe the role of albuminuria as a risk marker for heart failure and a predictor for treatment effect on heart failure prognosis. Recent findings The level of albumin in the urine is a predictor of heart failure in the general population and in patients with

  19. Heart failure in sub-Saharan Africa: A clinical approach.

    Science.gov (United States)

    Kraus, S; Ogunbanjo, G; Sliwa, K; Ntusi, N A B

    2016-01-01

    Despite medical advances, heart failure (HF) remains a global health problem and sub-Saharan Africa (SSA) is no exception, with decompensated HF being the most common primary diagnosis for patients admitted to hospital with heart disease. In SSA the in-hospital mortality rate of decompensated HF is up to 8.3%. HF is a clinical syndrome that is caused by a diverse group of aetiologies, each requiring unique management strategies, highlighting the need for diagnostic certainty and a broad understanding of the complex pathophysiology of this condition. While there are a number of advanced medical, device and surgical interventions being tailored for HF internationally, the fundamental basic principles of HF management, such as patient education, effective management of congestion and initiation of disease-modifying medical therapies, remain a challenge on our continent. This review addresses both the epidemiology of HF in SSA and principles of management that focus specifically on symptom relief, prevention of hospitalisation and improving survival in this population.

  20. Cardiovascular mechanisms of SSRI drugs and their benefits and risks in ischemic heart disease and heart failure.

    Science.gov (United States)

    Andrade, Chittaranjan; Kumar, Chethan B; Surya, Sandarsh

    2013-05-01

    Depression and heart disease are commonly comorbid. Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat depression. In March 2011, we carried out a 15-year search of PubMed for preclinical and clinical publications related to SSRIs and ischemic heart disease (IHD) or congestive heart failure (CHF). We identify and discuss a number of mechanisms by which SSRIs may influence cardiovascular functioning and health outcomes in patients with heart disease; many of the mechanisms that we present have received little attention in previous reviews. We examine studies with positive, neutral, and negative outcomes in IHD and CHF patients treated with SSRIs. SSRIs influence cardiovascular functioning and health through several different mechanisms; for example, they inhibit serotonin-mediated and collagen-mediated platelet aggregation, reduce inflammatory mediator levels, and improve endothelial function. SSRIs improve indices of ventricular functioning in IHD and heart failure without adversely affecting electrocardiographic parameters. SSRIs may also be involved in favorable or unfavorable drug interactions with medications that influence cardiovascular functions. The clinical evidence suggests that, in general, SSRIs are safe in patients with IHD and may, in fact, exert a cardioprotective effect. The clinical data are less clear in patients with heart failure, and the evidence for benefits with SSRIs is weak.

  1. Epidemiological Study of Heart Failure in China

    Directory of Open Access Journals (Sweden)

    Yang Guo

    2015-10-01

    Full Text Available Heart failure (HF is a complex clinical syndrome that results from any structural or functional impairment of ventricular filling or ejection of blood. HF is one of the most important and severe end stages of many cardiovascular diseases. Epidemiological studies of HF have focused mainly on the prevalence, incidence, mortality, fatality, and distribution and temporal trends of these indicators among different populations. This review highlights important epidemiological studies of HF in China.

  2. [Alternatives to conventional diuretic therapy in heart failure].

    Science.gov (United States)

    Morales-Rull, José Luis; Trullàs, Joan Carles; Formiga, Francesc

    2014-03-01

    Although treatment of acute heart failure is based primarily on the administration of intravenous loop diuretics, evidence supporting this practice is still scarce and there is uncertainty about the optimal dose. The existence of a considerable percentage of patients refractory to diuretic therapy and worsening of renal failure associated with the use of these drugs, with possible implications for medium-term mortality, have prompted the search for more effective and safer alternatives. Extracorporeal purification techniques, such as ultrafiltration, have demonstrated efficacy, although their superiority is unclear, due to the possible adverse effects associated with the procedure. The use of low-dose dopamine is not superior to conventional diuretic therapy after the first few hours of treatment. Moreover, combination with furosemide and hypertonic saline could be a valid alternative for patients with refractory congestion and depressed ejection fraction and serum creatinine ≤ 2.5mg/dL, but further studies are needed before its widespread use. The use of tolvaptan may be an effective alternative in the short-term but its use may be limited by its price. There is still controversy about whether treatment with loop diuretics is associated with higher mortality in all groups of patients with HF exacerbations. These controversies should be clarified by future clinical trials. Copyright © 2014 Elsevier España, S.L. All rights reserved.

  3. Are there long-term benefits in following stable heart failure patients in a heart failure clinic?

    DEFF Research Database (Denmark)

    Leetmaa, Tina; Villadsen, Henrik; Mikkelsen, Kirsten

    2008-01-01

    Objectives and Design. This study describes the long-term outcome of 163 patients with stable mild to moderate heart failure (NYHA II-III), who already were enrolled in a heart failure clinic and now were randomized to continued follow-up in the heart failure (HF) clinic or else to usual care (UC...

  4. Emerging therapies for the management of decompensated heart failure: from bench to bedside.

    Science.gov (United States)

    deGoma, Emil M; Vagelos, Randall H; Fowler, Michael B; Ashley, Euan A

    2006-12-19

    While pharmaceutical innovation has been highly successful in reducing mortality in chronic heart failure, this has not been matched by similar success in decompensated heart failure syndromes. Despite outstanding issues over definitions and end points, we argue in this paper that an unprecedented wealth of pharmacologic innovation may soon transform the management of these challenging patients. Agents that target contractility, such as cardiac myosin activators and novel adenosine triphosphate-dependent transmembrane sodium-potassium pump inhibitors, provide inotropic support without arrhythmogenic increases in cytosolic calcium or side effects of more traditional agents. Adenosine receptor blockade may improve glomerular filtration and diuresis by exerting a direct beneficial effect on glomerular blood flow while vasopressin antagonists promote free water excretion without compromising renal function and may simultaneously inhibit myocardial remodeling. Urodilatin, the renally synthesized isoform of atrial natriuretic peptide, may improve pulmonary congestion via vasodilation and enhanced diuresis. Finally, metabolic modulators such as perhexiline may optimize myocardial energy utilization by shifting adenosine triphosphate production from free fatty acids to glucose, a unique and conceptually appealing approach to the management of heart failure. These advances allow optimism not only for the advancement of our understanding and management of decompensated heart failure syndromes but for the translational research effort in heart failure biology in general.

  5. German disease management guidelines: surgical therapies for chronic heart failure.

    Science.gov (United States)

    Sindermann, J R; Klotz, S; Rahbar, K; Hoffmeier, A; Drees, G

    2010-02-01

    The German Disease Management Guideline "Chronic Heart Failure" intends to guide physicians working in the field of diagnosis and treatment of heart failure. The guideline provides a tool on the background of evidence based medicine. The following short review wants to give insights into the role of some surgical treatment options to improve heart failure, such as revascularization, ventricular reconstruction and aneurysmectomy, mitral valve reconstruction, ventricular assist devices and heart transplantation. (c) Georg Thieme Verlag KG Stuttgart-New York.

  6. Renal dysfunction prevalence and clinical impact in heart failure

    Directory of Open Access Journals (Sweden)

    Palazzuoli A

    2011-09-01

    Full Text Available Alberto Palazzuoli, Susanna Benincasa, Stefanie Grothgar, Pasquale Di Sipio, Giovanni Paganini, Marco Pellegrini, Ranuccio NutiDepartment of Internal Medicine and Metabolic Diseases, Cardiology Section, Le Scotte Hospital, University of Siena, ItalyAbstract: Chronic kidney disease (CKD is associated with a significant increase in death and cardiovascular mortality. However the exact mechanism by which CKD impairs the cardiovascular outcome is not well established. Some reasons may lie in the association of CKD with several other cardiovascular and noncardiovascular disorders including accelerated systemic atherosclerosis, endothelial dysfunction, increased levels of inflammatory factors, anemic status, bone mineral dysfunction, electrolyte imbalance, and renin–angiotensin–aldosterone system (RAAS activation. Therefore several risk factors such as hypertension, diabetes, lipid disorders, and older age are common in both conditions. In patients affected with heart failure (HF a key role is represented by the neurohormonal activation. This condition causes fluid and sodium retention, peripheral vasoconstriction, as well as increased congestion and cardiac workload. Moreover, HF during the decompensated phases is often associated with a worsening renal function that leads to further RAAS activation, microvascular damage, and intrarenal flow redistribution. In order to clarify the interactions between these factors, several questions need to be answered: the universal definition of “worsening renal function,” the identification of the best laboratory parameters to investigate renal function in terms of sensitivity and specificity, and a better definition of the comorbidities’ role in the determination of the outcome, especially in patients with chronic HF. A clarification of these key points could lead to the individualization of new specific therapeutic targets and to a reduction in mortality and hospitalization in patients with HF and

  7. Aquapheresis Versus Intravenous Diuretics and Hospitalizations for Heart Failure.

    Science.gov (United States)

    Costanzo, Maria Rosa; Negoianu, Daniel; Jaski, Brian E; Bart, Bradley A; Heywood, James T; Anand, Inder S; Smelser, James M; Kaneshige, Alan M; Chomsky, Don B; Adler, Eric D; Haas, Garrie J; Watts, James A; Nabut, Jose L; Schollmeyer, Michael P; Fonarow, Gregg C

    2016-02-01

    The AVOID-HF (Aquapheresis versus Intravenous Diuretics and Hospitalization for Heart Failure) trial tested the hypothesis that patients hospitalized for HF treated with adjustable ultrafiltration (AUF) would have a longer time to first HF event within 90 days after hospital discharge than those receiving adjustable intravenous loop diuretics (ALD). Congestion in hospitalized heart failure (HF) patients portends unfavorable outcomes. The AVOID-HF trial, designed as a multicenter, 1-to-1 randomized study of 810 hospitalized HF patients, was terminated unilaterally and prematurely by the sponsor (Baxter Healthcare, Deerfield, Illinois) after enrollment of 224 patients (27.5%). Aquadex FlexFlow System (Baxter Healthcare) was used for AUF. A Clinical Events Committee, blinded to the randomized treatment, adjudicated whether 90-day events were due to HF. A total of 110 patients were randomized to AUF and 114 to ALD. Baseline characteristics were similar. Estimated days to first HF event for the AUF and ALD group were, respectively, 62 and 34 (p = 0.106). At 30 days, compared with the ALD group, the AUF group had fewer HF and cardiovascular events. Renal function changes were similar. More AUF patients experienced an adverse effect of special interest (p = 0.018) and a serious study product-related adverse event (p = 0.026). The 90-day mortality was similar. Compared with the ALD group, the AUF group trended toward a longer time to first HF event within 90 days and fewer HF and cardiovascular events. More patients in the AUF group experienced special interest or serious product-related adverse event. Due to the trial's untimely termination, additional AUF investigation is warranted. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

  8. GRACE score predicts heart failure admission following acute coronary syndrome.

    Science.gov (United States)

    McAllister, David A; Halbesma, Nynke; Carruthers, Kathryn; Denvir, Martin; Fox, Keith A

    2015-04-01

    Congestive heart failure (CHF) is a common and preventable complication of acute coronary syndrome (ACS). Nevertheless, ACS risk scores have not been shown to predict CHF risk. We investigated whether the at-discharge Global Registry of Acute Coronary Events (GRACE) score predicts heart failure admission following ACS. Five-year mortality and hospitalization data were obtained for patients admitted with ACS from June 1999 to September 2009 to a single centre of the GRACE registry. CHF was defined as any admission assigned WHO International Classification of Diseases 10 diagnostic code I50. The hazard ratio (HR) for CHF according to GRACE score was estimated in Cox models adjusting for age, gender and the presence of CHF on index admission. Among 1,956 patients, CHF was recorded on index admission in 141 patients (7%), and 243 (12%) were admitted with CHF over 3.8 median years of follow-up. Compared to the lowest quintile, patients in the highest GRACE score quintile had more CHF admissions (116 vs 17) and a shorter time to first admission (1.2 vs 2.0 years, HR 9.87, 95% CI 5.93-16.43). Per standard deviation increment in GRACE score, the instantaneous risk was more than two-fold higher (HR 2.28; 95% CI 2.02-2.57), including after adjustment for CHF on index admission, age and gender (HR 2.49; 95% CI 2.06-3.02). The C-statistic for CHF admission at 1-year was 0.74 (95% CI 0.70-0.79). The GRACE score predicts CHF admission, and may therefore be used to target ACS patients at high risk of CHF with clinical monitoring and therapies. © The European Society of Cardiology 2014.

  9. Preoperative Prevention of Heart Failure in Noncardiac Surgery

    Directory of Open Access Journals (Sweden)

    V. V. Likhvantsev

    2016-01-01

    Full Text Available Congestive heart failure is consistently associated with adverse outcomes, and is characterized by a twofold increase in mortality in noncardiac surgery. In this regard, developing the methods aimed to prevent and treatacute heart failure (AHF in the intraoperative period remain a challenging problem.Objective. To evaluate the efficacy of preoperative levosimendan infusion in reduction both mortality and duration of treatment of elderly patients with reduced left ventricular ejection fraction in noncardiac surgery.Material and Methods. Design: Multicenter blind randomized placebocontrolled study. Patients: 81 patients operated on abdominal organs. The main endpoint of the study: The length of stay in the Intensive Care Unit (ICU and at the hospital were chosen as the primary endpoints. The secondary endpoints of the study were 30 day and annual mortality, the rate of acute myocardial infarction and stroke.Results. Levosimendan infusion at a rate of 0,05 μg/kg/min — 0,1 μg/kg/min to patients with low left ven tricular ejection fraction just before the surgery reduced the length of stay in ICU for 2 days and required hospital stay for 3 days. NTproBNP showed the best ratio of sensitivity/specificity in predicting 30day mortality in cumulative group: AUC=0,86 (90,77 to 0,93, P<0,0001. From other indicators the most informative were the Inotropes scoring, no change or decrease of a left ventricular ejection fraction, and cardiac index.Conclusion. To reduce perioperative mortality, the intravenous infusion of levosimendan at a rate of 0,05—0,1 μg/kg/min in elderly patients with low left ventricular ejection fraction is recommened as a preoperative preparation the day before the alleged noncardiac surgery.

  10. Heart failure as an endpoint in heart failure and non-heart failure cardiovascular clinical trials: the need for a consensus definition

    DEFF Research Database (Denmark)

    Zannad, F.; Stough, W.G.; Pitt, B.

    2008-01-01

    Specific criteria have been established to define the occurrence of myocardial infarction (MI) and stroke in cardiovascular clinical trials, but there is not a consistent definition for heart failure. Heart failure events appear to occur at a rate that is similar to stroke and MI in trials...... of hypertension, hyperlipidaemia, diabetes, and coronary heart disease, yet a consistent approach to defining heart failure events has not yet been realized. The wide range of definitions used in clinical trials makes it difficult to interpret new data in the context of existing literature. This inconsistency has...... led to challenges in determining the incidence of heart failure in cardiovascular studies and the effects of interventions on these endpoints. This paper examines issues related to defining heart failure events in cardiovascular clinical trials and presents a definition to formally address this issue...

  11. Highlights from the British Society for Heart Failure 20th Annual Autumn Meeting: three decades of heart failure.

    Science.gov (United States)

    Abel, Alexandra AI

    2018-05-16

    The 20th Annual Autumn Meeting of the British Society for Heart Failure took place on the 23-24 November 2017 at the Queen Elizabeth II Conference Centre, London, UK. Over 800 delegates were in attendance: a multidisciplinary league of professionals who treat patients with heart failure, including specialist nurses, trainees, cardiologists, geriatricians, pharmacists and general practitioners. The theme of the conference was 'three decades of heart failure' and celebrated the success of modern heart failure management. This report highlights the 'three decades' session, the clinical trials update, and the main discussion points from heart failure question time.

  12. Managing patients with heart failure: a qualitative study of multidisciplinary teams with specialist heart failure nurses.

    Science.gov (United States)

    Glogowska, Margaret; Simmonds, Rosemary; McLachlan, Sarah; Cramer, Helen; Sanders, Tom; Johnson, Rachel; Kadam, Umesh T; Lasserson, Daniel S; Purdy, Sarah

    2015-09-01

    The purpose of this study was to explore the perceptions and experiences of health care clinicians working in multidisciplinary teams that include specialist heart failure nurses when caring for the management of heart failure patients. We used a qualitative in-depth interview study nested in a broader ethnographic study of unplanned admissions in heart failure patients (HoldFAST). We interviewed 24 clinicians across primary, secondary, and community care in 3 locations in the Midlands, South Central, and South West of England. Within a framework of the role and contribution of the heart failure specialist nurse, our study identified 2 thematic areas that the clinicians agreed still represent particular challenges when working with heart failure patients. The first was communication with patients, in particular explaining the diagnosis and helping patients to understand the condition. The participants recognized that such communication was most effective when they had a long-term relationship with patients and families and that the specialist nurse played an important part in achieving this relationship. The second was communication within the team. Multidisciplinary input was especially needed because of the complexity of many patients and issues around medications, and the participants believed the specialist nurse may facilitate team communication. The study highlights the role of specialist heart failure nurses in delivering education tailored to patients and facilitating better liaison among all clinicians, particularly when dealing with the management of comorbidities and drug regimens. The way in which specialist nurses were able to be caseworkers for their patients was perceived as a method of ensuring coordination and continuity of care. © 2015 Annals of Family Medicine, Inc.

  13. Validation of the Seattle Heart Failure Model (SHFM) in Heart Failure Population

    International Nuclear Information System (INIS)

    Hussain, S.; Kayani, A.M.; Munir, R.

    2014-01-01

    Objective: To determine the effectiveness of Seattle Heart Failure Model (SHFM) in a Pakistani systolic heart failure cohort in predicting mortality in this population. Study Design: Cohort study. Place and Duration of Study: The Armed Forces Institute of Cardiology - National Institute of Heart Diseases, Rawalpindi, from March 2011 to March 2012. Methodology: One hundred and eighteen patients with heart failure (HF) from the registry were followed for one year. Their 1-year mortality was calculated using the SHFM software on their enrollment into the registry. After 1-year predicted 1-year mortality was compared with the actual 1-year mortality of these patients. Results: The mean age was 41.6 +- 14.9 years (16 - 78 years). There were 73.7% males and 26.3% females. One hundred and fifteen patients were in NYHA class III or IV. Mean ejection fraction in these patients was 23 +- 9.3%. Mean brain natriuretic peptide levels were 1230 A+- 1214 pg/mL. Sensitivity of the model was 89.3% with 71.1% specificity, 49% positive predictive value and 95.5% negative predictive value. The accuracy of the model was 75.4%. In Roc analysis, AUC for the SHFM was 0.802 (p<0.001). conclusion: SHFM was found to be reliable in predicting one year mortality among patients with heart failure in the pakistan patients. (author)

  14. Current strategies for preventing renal dysfunction in patients with heart failure: a heart failure stage approach

    Science.gov (United States)

    Issa, Victor Sarli; Andrade, Lúcia; Bocchi, Edimar Alcides

    2013-01-01

    Renal dysfunction is common during episodes of acute decompensated heart failure, and historical data indicate that the mean creatinine level at admission has risen in recent decades. Different mechanisms underlying this change over time have been proposed, such as demographic changes, hemodynamic and neurohumoral derangements and medical interventions. In this setting, various strategies have been proposed for the prevention of renal dysfunction with heterogeneous results. In the present article, we review and discuss the main aspects of renal dysfunction prevention according to the different stages of heart failure. PMID:23644863

  15. Difficult cases in heart failure: the challenge of neurocognitive dysfunction in severe heart failure.

    Science.gov (United States)

    Sangha, Sumadeep S; Uber, Patricia A; Park, Myung H; Scott, Robert L; Mehra, Mandeep R

    2002-01-01

    Often ignored, neurocognitive dysfunction in chronic heart failure represents a daunting morbidity progressing to loss of self-reliance. Although the precise mechanisms arbitrating the development of this disorder remain elusive, microembolization and cerebral hypoperfusion are implicated. Other causes of cognitive decline may include prior cardiac surgery, chronic hypertension, sleep disordered breathing, hyperhomocysteinemia, dementia of aging, and more traditional causes such as Alzheimer's disease. The discovery of neurocognitive defects in heart failure must prompt a well-constructed diagnostic evaluation to search for the underlying causes since this process may be at least partially reversible in many cases. Copyright 2002 CHF, Inc

  16. Diagnosis and management of acute heart failure

    Science.gov (United States)

    Ural, Dilek; Çavuşoğlu, Yüksel; Eren, Mehmet; Karaüzüm, Kurtuluş; Temizhan, Ahmet; Yılmaz, Mehmet Birhan; Zoghi, Mehdi; Ramassubu, Kumudha; Bozkurt, Biykem

    2016-01-01

    Acute heart failure (AHF) is a life threatening clinical syndrome with a progressively increasing incidence in general population. Turkey is a country with a high cardiovascular mortality and recent national statistics show that the population structure has turned to an ‘aged’ population. As a consequence, AHF has become one of the main reasons of admission to cardiology clinics. This consensus report summarizes clinical and prognostic classification of AHF, its worldwide and national epidemiology, diagnostic work-up, principles of approach in emergency department, intensive care unit and ward, treatment in different clinical scenarios and approach in special conditions and how to plan hospital discharge. PMID:26574757

  17. β-Blocker pharmacogenetics in heart failure

    Science.gov (United States)

    Shin, Jaekyu

    2009-01-01

    β-Blockers (metoprolol, bisoprolol, and carvedilol) are a cornerstone of heart failure (HF) treatment. However, it is well recognized that responses to a β-blocker are variable among patients with HF. Numerous studies now suggest that genetic polymorphisms may contribute to variability in responses to a β-blocker, including left ventricular ejection fraction improvement, survival, and hospitalization due to HF exacerbation. This review summarizes the pharmacogenetic data for β-blockers in patients with HF and discusses the potential implications of β-blocker pharmacogenetics for HF patients. PMID:18437562

  18. Are de novo acute heart failure and acutely worsened chronic heart failure two subgroups of the same syndrome?

    Directory of Open Access Journals (Sweden)

    Banović Marko

    2010-01-01

    Full Text Available Introduction. Acute heart failure (AHF is one of the most common diseases in emergency medicine, associated with poor prognosis and high in-hospital and long-term mortality. Objective. To investigate clinical presentation of patients with de novo AHF and acute worsening of chronic heart failure (CHF and to identify differences in blood levels of biomarkers and echocardiography findings. Methods. This prospective study comprised 64 consecutive patients being grouped according to the onset of the disease into patients with the de novo AHF (45.3%, and patients with acute worsening of CHF (54.7%. Results. Acute congestion (60% was the most common manifestation of de novo AHF, whereas pulmonary oedema (43.1% was the most common manifestation of acutely decompensated CHF. Patients with acutely decompensated CHF had significantly higher blood values of creatinine (147.10 vs 113.16 μmol/l; p<0.05, urea (12.63 vs 7.82 mmol/l; p<0.05, BNP (1440.11 vs 712.24 pg/ml; p<001 and NTproBNP (9097.00 vs 2827.70 pg/ml; p<0.01 on admission, and lower values of M-mode left ventricular ejection fraction (LVEF during hospitalization (49.44% vs 42.94%; p<0.05. The follow-up after one year revealed still significantly higher BNP (365.49 vs 164.02 pg/ ml; p<0.05 and lower average values of both LVEF in patients with acutely worsened CHF (46.62% vs 54.41% and 39.52% vs 47.88%; p<0.05. Conclusion. Considering differences in clinical severity on admission, echocardiography and natriuretic peptide values during hospitalization and after one year follow-up, de novo AHF and acutely worsened CHF are two different subgroups of the same syndrome.

  19. Pig models for the human heart failure syndrome

    DEFF Research Database (Denmark)

    Hunter, Ingrid; Terzic, Dijana; Zois, Nora Elisabeth

    2014-01-01

    Human heart failure remains a challenging illness despite advances in the diagnosis and treatment of heart failure patients. There is a need for further improvement of our understanding of the failing myocardium and its molecular deterioration. Porcine models provide an important research tool...... in this respect as molecular changes can be examined in detail, which is simply not feasible in human patients. However, the human heart failure syndrome is based on symptoms and signs, where pig models mostly mimic the myocardial damage, but without decisive data on clinical presentation and, therefore, a heart...... to elucidate the human heart failure syndrome....

  20. Relationship of hemoglobin and hematocrit to systolic function in advanced heart failure.

    Science.gov (United States)

    Guglin, Maya; Darbinyan, Nellie

    2012-01-01

    The dataset from the Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) trial provides a rare opportunity to evaluate the whole spectrum of associations of hemoglobin (HB) and hematocrit (HCT) in heart failure (HF). In that trial, subjective and objective data were recorded at multiple time points when HB and HCT were also measured. We investigated the relationship between anemia and ventricular systolic function. A limited access dataset from the ESCAPE trial, provided by the National Heart, Lung and Blood Institute, was analyzed. Linear regression analysis, correlation coefficients and Student's t test were utilized. Besides the known association of anemia with poor prognosis, more severe symptoms, decreased functional capacity and impaired kidney function, we found a significant and very consistent inverse correlation between HB and HCT and ventricular contractility. Both left ventricular ejection fraction and right ventricular fractional area change improved with a decrease in HB and vice versa. We hypothesize that this effect can result from a change in viscosity, which decreases with a decrease in HCT, and may facilitate adaptation of the heart to a volume overload state accompanied by hemodilution. In HF, anemia is associated with poor prognosis and functional impairment, but also with mildly improved systolic function. It may represent an adaptive reaction to congestion. Copyright © 2012 S. Karger AG, Basel.

  1. Review Paper Heart Failure in Small Animals - Advances in Clinical ...

    African Journals Online (AJOL)

    The rationale for the use of drugs and supportive therapy in the management of heart diseases (HDs) and heart failure (HF), is discussed in the light of contemporary concepts. The in-adequacy of the age-long therapy of heart failure with oxygen supplementation, cardiac glycosides, rest and the withholding of salt in food is ...

  2. Developing New Treatments for Heart Failure: Focus on the Heart.

    Science.gov (United States)

    Gheorghiade, Mihai; Larson, Christopher J; Shah, Sanjiv J; Greene, Stephen J; Cleland, John G F; Colucci, Wilson S; Dunnmon, Preston; Epstein, Stephen E; Kim, Raymond J; Parsey, Ramin V; Stockbridge, Norman; Carr, James; Dinh, Wilfried; Krahn, Thomas; Kramer, Frank; Wahlander, Karin; Deckelbaum, Lawrence I; Crandall, David; Okada, Shunichiro; Senni, Michele; Sikora, Sergey; Sabbah, Hani N; Butler, Javed

    2016-05-01

    Compared with heart failure (HF) care 20 to 30 years ago, there has been tremendous advancement in therapy for ambulatory HF with reduced ejection fraction with the use of agents that block maladaptive neurohormonal pathways. However, during the past decade, with few notable exceptions, the frequency of successful drug development programs has fallen as most novel therapies have failed to offer incremental benefit or raised safety concerns (ie, hypotension). Moreover, no therapy has been approved specifically for HF with preserved ejection fraction or for worsening chronic HF (including acutely decompensated HF). Across the spectrum of HF, preliminary results from many phase II trials have been promising but are frequently followed by unsuccessful phase III studies, highlighting a disconnect in the translational process between basic science discovery, early drug development, and definitive clinical testing in pivotal trials. A major unmet need in HF drug development is the ability to identify homogeneous subsets of patients whose underlying disease is driven by a specific mechanism that can be targeted using a new therapeutic agent. Drug development strategies should increasingly consider therapies that facilitate reverse remodeling by directly targeting the heart itself rather than strictly focusing on agents that unload the heart or target systemic neurohormones. Advancements in cardiac imaging may allow for more focused and direct assessment of drug effects on the heart early in the drug development process. To better understand and address the array of challenges facing current HF drug development, so that future efforts may have a better chance for success, the Food and Drug Administration facilitated a meeting on February 17, 2015, which was attended by clinicians, researchers, regulators, and industry representatives. The following discussion summarizes the key takeaway dialogue from this meeting. © 2016 American Heart Association, Inc.

  3. Transient right-sided heart failure after percutaneous transluminal angioplasty (PTA) of Membranous obstruction of inferior vena cava: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Sung Bin [College of Medicine, University of Ulsan, Ulsan (Korea, Republic of); Lee, Deok hee; Kim, Yeon Suk; Jung, Seung Mun; Ryu, Dae Sik; Park, Man Soo [Kangnung Hospital, Kangnung (Korea, Republic of)

    2000-09-01

    We experienced a case of transient right-sided heart failure after angioplasty of membranous obstruction of the inferior vena cava confirmed by sonography and an inferior vena cavogram. Angioplasty involved the use of a self-expandable metallic stent, but after successful recanalization of the obstruction, the patient became dyspneic. Chest radiography revealed mild cardiomegaly with pulmonary congestion, but this was resolved spontaneously. For the prevention of serious heart failure, we recommend preprocedural evaluation of cardiac function. (author)

  4. Diagnósticos e intervenções de enfermagem para pacientes portadores de insuficiência cardíaca congestiva utilizando a CIPE® Diagnósticos e intervenciones de enfermería para pacientes portadores de insuficiencia cardíaca congestiva utilizando la cipe® Nursing diagnoses and interventions for patients with congestive heart failure using the ICNP ®

    Directory of Open Access Journals (Sweden)

    Angela Amorim de Araújo

    2013-04-01

    enfermería elaboradas puedan colaborar en la evaluación de individuos portadores de ICC y en la construcción de un subconjunto terminológico de la CIPE®.The aim of this descriptive exploratory study was to construct nursing diagnosis and intervention statements for patients with Congestive Heart Failure. To accomplish this aim, 53 terms were identified in the focus axis of the International Classification for Nursing Practice (ICNP®, which guided the construction of these statements using the guidelines of the International Council of Nurses and ISO 18. 104. A total of 92 nursing diagnosis statements were constructed, which resulted in 66 statements after standardization. The standardized statements were separated according to the following pathophysiological models: 13 related to tachycardia, 20 related to dyspnea, 19 related to edema, and 14 related to congestion. A total of 234 interventions were constructed for these statements using the terms from the 7-Axis Model of the ICNP®, the literature in the area and the clinical experience of the authors. The nursing diagnosis and intervention statements designed are expected to facilitate the evaluation of CHF patients and assist in the construction of a terminological subset for the ICNP®.

  5. Effectiveness and adverse events of tolvaptan in octogenarians with heart failure. Interim analyses of Samsca Post-Marketing Surveillance In Heart faiLurE (SMILE study).

    Science.gov (United States)

    Kinugawa, Koichiro; Inomata, Takayuki; Sato, Naoki; Yasuda, Moriyoshi; Shimakawa, Toshiyuki; Bando, Kosuke; Mizuguchi, Kazuki

    2015-01-01

    The vasopressin receptor 2 (V2) receptor antagonist tolvaptan is an aquaretic agent that has been found to improve symptoms in patients with congestive heart failure. In this study (SMILE study), we administered tolvaptan to patients aged ≥ 80 years with heart failure accompanied by congestive symptoms and compared its effectiveness and safety profiles in this group with those in patients effectiveness of tolvaptan in the aged patients was similar to that in U-80 patients. In the safety profile, the incidence rate of thirst was lower in the aged patients than that in U-80 patients (9.6% versus 11.6%, P = 0.0023). Furthermore, the incidence of hypernatremia, defined as ≥ 150 mEq/L in aged patients, was comparable with that in U-80 patients (2.9% versus 3.6%, respectively, P = 0.3657). Based on these findings, tolvaptan has similar effectiveness and safety profiles in aged patients compared with U-80 patients. In addition, we found that a higher starting dose of tolvaptan was markedly associated with the occurrence of hypernatremia exclusively in the aged population; therefore, we recommend that tolvaptan should be started at lower doses in aged patients.

  6. Delivering Chronic Heart Failure Telemanagement via Multiple Interactive Platforms

    Directory of Open Access Journals (Sweden)

    Joseph Finkelstein

    2013-06-01

    Full Text Available Existing telemonitoring systems provide limited support in implementing personalized treatment plans. We developed a Home Automated Telemanagement (HAT system for patients with congestive heart failure (CHF to provide support in following individualized treatment plans as well as to monitor symptoms, weight changes, and quality of life, while educating the patient on their disease. The system was developed for both a laptop computer and a Nintendo Wii. The system is designed to be placed in the patient's home and to communicate all patient data to a central server implementing real-time clinical decision support. The system questions the patient daily on their condition, monitors their weight, and provides the patient with instant feedback on their condition in the form of a 3-zone CHF action plan. Their medication regimen and suggested actions are determined by their care management team and integrated into the system, keeping a personalized approach to disease management while taking advantage of the technology available. The systems are designed to be as simple as possible, making it usable by patients with no prior computer or videogame experience. A feasibility assessment in African American patients with CHF and without prior computer or videogame experience demonstrated high level of acceptance of the CHF HAT laptop and Wii systems. Keywords: telem

  7. Major developments in the 2016 european guidelines for heart failure.

    Science.gov (United States)

    Trullàs, J C; González-Franco, Á

    2017-10-01

    The European Society of Cardiology has recently published new guidelines on the diagnosis and treatment of acute and chronic heart failure (HF). This article aims to review these recommendations and their level of scientific evidence and to present the most innovative aspects. The most significant deviations from the 2012 edition are: 1) the introduction of the concept of HF with midrange LVEF (40-49%); 2) a new diagnostic algorithm for chronic HF, initially considering the clinical probability; 3) recommendations on preventing or delaying the apparition of HF; 4) indications for the use of the new sacubitril-valsartan compound, the first angiotensin receptor blocker and neprilysin inhibitor; 5) modification of indications for cardiac resynchronisation therapy; and 6) a new algorithm for a combined diagnostic and treatment strategy for acute HF based on the presence or absence of congestion and hypoperfusion. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. Reasons for readmission in heart failure : Perspectives of patients, caregivers, cardiologists, and heart failure nurses

    NARCIS (Netherlands)

    Annema, Coby; Luttik, Marie-Louise; Jaarsma, Tiny

    2009-01-01

    OBJECTIVE: Despite efforts to improve outcomes in heart failure (HF), readmission rates remain relatively high. Reasons for readmission from different perspectives (patient, caregiver, health care providers) may help to optimize the future management of patients with HF. The aims of this study are

  9. European Society of Cardiology Heart Failure Association Standards for delivering heart failure care

    NARCIS (Netherlands)

    McDonagh, Theresa A.; Blue, Lynda; Clark, Andrew L.; Dahlstroem, Ulf; Ekman, Inger; Lainscak, Mitja; McDonald, Kenneth; Ryder, Mary; Stroemberg, Anna; Jaarsma, Tiny

    The management of heart failure (HF) is complex. As a consequence, most cardiology society guidelines now state that HF care should be delivered in a multiprofessional manner. The evidence base for this approach now means that the establishment of HF management programmes is a priority. This

  10. Pathophysiologic aspects of the development of cognitive disorders in chronic heart failure in elderly patients

    Directory of Open Access Journals (Sweden)

    M A Pokachalova

    2018-04-01

    Full Text Available The present literature review presents current views on pathophysiologic aspects of the formation and progression of cognitive disorders in chronic heart failure in elderly patients. Advanced age itself is an important predictor of the development of cardiovascular, neurodegenerative and other diseases. Involutive changes of cardiovascular system are known to potentiate the development of chronic heart failure. Heart failure in older people usually develops gradually. Formation of the cognitive deficit in heart disease is associated with chronic cerebral ischemia as well as a cascade of neurochemical processes occurring in the brain, eventually forming a vicious circle. Often the symptoms of cerebral ischemia due to reduced stroke volume occur much earlier than congestion signs in other organs and systems. Chronic cerebral ischemia that occurs due to violation of cerebral hemodynamics, is associated with both extracerebral and intracerebral causes, which in turn contributes to the development of chronic brain hypoxia and aggravation of cognitive dysfunction. Thus, the features of the development and course of disease in people of older age groups indicate that in geriatric practice existing diagnostic schemes are not always applicable. When observing patients of elderly and senile age with chronic heart failure, during the assessment of their condition and running diagnostic tests, special attention should be payed to the earliest detection of cognitive dysfunction signs in order to correct the patient's treatment and improve quality of life.

  11. Heart Failure with Recovered EF and Heart Failure with Mid-Range EF: Current Recommendations and Controversies.

    Science.gov (United States)

    Unkovic, Peter; Basuray, Anupam

    2018-04-03

    This review explores key features and potential management controversies in two emerging populations in heart failure: heart failure with recovered ejection fraction (HF-recovered EF) and heart failure with mid-range ejection fraction (HFmrEF). While HF-recovered EF patients have better outcomes than heart failure with reduced ejection fraction (HFrEF), they continue to have symptoms, persistent biomarker elevations, and abnormal outcomes suggesting a continued disease process. HFmrEF patients appear to have features of HFrEF and heart failure with preserved ejection fraction (HFpEF), but have a high prevalence of ischemic heart disease and may represent a transitory phase between the HFrEF and HFpEF. Management strategies have insufficient data to warrant standardization at this time. HF-recovered EF and HFmrEF represent new populations with unmet needs and expose the pitfalls of an EF basis for heart failure classification.

  12. [Heart failure patterns in Djibouti: epidemiologic transition].

    Science.gov (United States)

    Massoure, P L; Roche, N C; Lamblin, G; Topin, F; Dehan, C; Kaiser, E; Fourcade, L

    2013-05-01

    The features of heart failure (HF) in Djibouti have not been well described. We sought to document the current patterns of HF here. We prospectively included Djiboutian adults hospitalized for HF in the French Military Hospital (Djibouti) from August 2008 through December 2010. Of 1688 adults hospitalized in the medical department, 45 (2.7%) had symptomatic HF: 38 (84%) men, mean age 55.8 years (range 27-75). Twenty-five (56%) patients were initially hospitalized for acute pulmonary edema. The underlying diseases included coronary artery disease (CAD) (62%), hypertensive heart disease (18%), rheumatic valvular disease (13%), and primary dilated cardiomyopathy (7%). Their cardiovascular risk factors included tobacco use (53%), hypertension (69%), diabetes (47%), and hypercholesterolemia (51%). Patients in the CAD group were older, and had diabetes more often (p<0.01). All khat chewers (53%) were males and smokers. Mean left ventricular ejection fraction (LVEF) was 39 ± 14%. During follow-up (14.4 ± 9 months), 8 (18%) patients died, 9 (20%) were again hospitalized for HF, and 3 (7%) had ischemic strokes. One month after discharge, the New York Heart Association (NYHA) class was II for 40%, III for 44%, and IV for 16%. Higher NYHA classes and dilated cardiomyopathy were both associated with poorer outcomes (p<0.03). In hospitalized Djiboutians, most HF patterns are similar to those in industrialized countries. CAD is more prevalent than previously reported in African patients with HF.

  13. Khat Use: History and Heart Failure

    Directory of Open Access Journals (Sweden)

    Ayman El-Menyar

    2015-03-01

    Full Text Available Recent reports suggest that 20 million people worldwide are regularly using khat as a stimulant, even though the habit of chewing khat is known to cause serious health issues. Historical evidence suggests khat use has existed since the 13th century in Ethiopia and the southwestern Arabian regions even before the cultivation and use of coffee. In the past three decades, its availability and use spread all over the world including the United States and Europe. Most of the consumers in the Western world are immigrant groups from Eastern Africa or the Middle East. The global transport and availability of khat has been enhanced by the development of synthetic forms of its active component. The World Health Organization considers khat a drug of abuse since it causes a range of health problems. However, it remains lawful in some countries. Khat use has long been a part of Yemeni culture and is used in virtually every social occasion. The main component of khat is cathinone, which is structurally and functionally similar to amphetamine and cocaine. Several studies have demonstrated that khat chewing has unfavorable cardiovascular effects. The effect on the myocardium could be explained by its effect on the heart rate, blood pressure, its vasomotor effect on the coronary vessels, and its amphetamine–like effects. However, its direct effect on the myocardium needs further elaboration. To date, there are few articles that contribute death among khat chewers to khat-induced heart failure. Further studies are needed to address the risk factors in khat chewers that may explain khat-induced cardiotoxicity, cardiomyopathy, and heart failure.

  14. 2013 update on congenital heart disease, clinical cardiology, heart failure, and heart transplant.

    Science.gov (United States)

    Subirana, M Teresa; Barón-Esquivias, Gonzalo; Manito, Nicolás; Oliver, José M; Ripoll, Tomás; Lambert, Jose Luis; Zunzunegui, José L; Bover, Ramon; García-Pinilla, José Manuel

    2014-03-01

    This article presents the most relevant developments in 2013 in 3 key areas of cardiology: congenital heart disease, clinical cardiology, and heart failure and transplant. Within the area of congenital heart disease, we reviewed contributions related to sudden death in adult congenital heart disease, the importance of specific echocardiographic parameters in assessing the systemic right ventricle, problems in patients with repaired tetralogy of Fallot and indication for pulmonary valve replacement, and confirmation of the role of specific factors in the selection of candidates for Fontan surgery. The most recent publications in clinical cardiology include a study by a European working group on correct diagnostic work-up in cardiomyopathies, studies on the cost-effectiveness of percutaneous aortic valve implantation, a consensus document on the management of type B aortic dissection, and guidelines on aortic valve and ascending aortic disease. The most noteworthy developments in heart failure and transplantation include new American guidelines on heart failure, therapeutic advances in acute heart failure (serelaxin), the management of comorbidities such as iron deficiency, risk assessment using new biomarkers, and advances in ventricular assist devices. Copyright © 2013 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

  15. Pulse pressure as a haemodynamic variable in systolic heart failure

    NARCIS (Netherlands)

    Petrie, Colin James

    2016-01-01

    In patients with heart failure, the heart is unable to pump enough blood to satisfy the requirements of the body. Explanations for this include heart muscle damage after a heart attack. This could be very recently, or in the past, sometimes dating back many years. In other cases the explanation for

  16. The Hriday Card: A checklist for heart failure

    Directory of Open Access Journals (Sweden)

    Sandeep Seth

    2017-01-01

    Full Text Available Use of a simple checklist can drastically lower the likelihood of heart failure patient readmission and improve quality of life. The Hriday Card is a simple 4 page booklet which combines patient education material teaching the patient about heart failure, how to tackle daily emergencies, how to look after their fluid balance with appropriate use of diuretics. It also contains medication and daily weight charts for the patient and a heart failure checklist for the heart failure nurse or doctor which covers points like vaccination, presence of LBBB or Atrial fibrillation and use or lack of use of ACE inhibitors and beta blockers and many other points related to heart failure. This checklist can be filled in less than a minute. It is a simple tool to enhance heart failure care and medication adherence.

  17. Practical guide on home health in heart failure patients

    DEFF Research Database (Denmark)

    Jaarsma, T.; Larsen, Torben; Stromberg, A.

    2013-01-01

    in this population and specialised heart failure care can save costs and improve the quality of care. However, only a few European countries have implemented specialised home care and offered this to a larger number of patients with heart failure. Method: We developed a guide on Home Health in Heart Failure patients...... from a literature review, a survey of heart failure management programs, the opinion of researchers and practitioners, data from clinical trials and a reflection of an international expert meeting. Results: In integrated home care for heart failure patients, it is advised to consider the following...... components: integrated multidisciplinary care, patient and partner participation, care plans with clear goals of care, patient education, self-care management, appropriate access to care and optimised treatment. Discussion: We summarised the state of the art of home-based care for heart failure patients...

  18. Association of heart failure severity with risk of diabetes

    DEFF Research Database (Denmark)

    Demant, Malene N; Gislason, Gunnar H; Køber, Lars

    2014-01-01

    AIMS/HYPOTHESIS: Heart failure has been suggested to increase the risk of developing diabetes. We investigated the relation between heart failure severity, defined by loop-diuretic dosage, and the risk of developing diabetes in a nationwide cohort of patients with heart failure. METHODS: We...... followed all Danish patients discharged from hospitalisation for first-time heart failure in 1997-2010, without prior use of hypoglycaemic agents, until a claimed prescription for hypoglycaemic agents, death or 31 December 2010. The association of loop-diuretic dosage (furosemide equivalents) 90 days after.......32), 2.28 (2.01, 2.59), 2.88 (2.52, 3.30) and 3.02 (2.66, 3.43) without RASi treatment. CONCLUSIONS/INTERPRETATION: In a nationwide cohort of patients with heart failure, severity of heart failure was associated with a stepwise increased risk of developing diabetes. Increased awareness of risk...

  19. Role and Value of Clinical Pharmacy in Heart Failure Management.

    Science.gov (United States)

    Stough, W G; Patterson, J H

    2017-08-01

    Effectively managing heart failure requires a multidisciplinary, holistic approach attuned to many factors: diagnosis of structural and functional cardiac abnormalities; medication, device, or surgical management; concomitant treatment of comorbidities; physical rehabilitation; dietary considerations; and social factors. This practice paper highlights the pharmacist's role in the management of patients with heart failure, the evidence supporting their functions, and steps to ensure the pharmacist resource is available to the broad population of patients with heart failure. © 2017 American Society for Clinical Pharmacology and Therapeutics.

  20. Understand Your Risk for Heart Failure

    Science.gov (United States)

    ... Heart.org Arrhythmia About Arrhythmia Why Arrhythmia Matters Understand Your Risk for Arrhythmia Symptoms, Diagnosis & Monitoring of ... Heart Defects The Impact of Congenital Heart Defects Understand Your Risk for Congenital Heart Defects Symptoms & Diagnosis ...

  1. Management of Sleep Disordered Breathing in Patients with Heart Failure.

    Science.gov (United States)

    Oates, Connor P; Ananthram, Manjula; Gottlieb, Stephen S

    2018-04-03

    This paper reviews treatment options for sleep disordered breathing (SDB) in patients with heart failure. We sought to identify therapies for SDB with the best evidence for long-term use in patients with heart failure and to minimize uncertainties in clinical practice by examining frequently discussed questions: what is the role of continuous positive airway pressure (CPAP) in patients with heart failure? Is adaptive servo-ventilation (ASV) safe in patients with heart failure? To what extent is SDB a modifiable risk factor? Consistent evidence has demonstrated that the development of SDB in patients with heart failure is a poor prognostic indicator and a risk factor for cardiovascular mortality. However, despite numerous available interventions for obstructive sleep apnea and central sleep apnea, it remains unclear what effect these therapies have on patients with heart failure. To date, all major randomized clinical trials have failed to demonstrate a survival benefit with SDB therapy and one major study investigating the use of adaptive servo-ventilation demonstrated harm. Significant questions persist regarding the management of SDB in patients with heart failure. Until appropriately powered trials identify a treatment modality that increases cardiovascular survival in patients with SDB and heart failure, a patient's heart failure management should remain the priority of medical care.

  2. Hemodynamic determinants of dyspnea improvement in acute decompensated heart failure.

    Science.gov (United States)

    Solomonica, Amir; Burger, Andrew J; Aronson, Doron

    2013-01-01

    Dyspnea relief constitutes a major treatment goal and a key measure of treatment efficacy in decompensated heart failure. However, there are no data with regard to the relationship between hemodynamic measurements during treatment and dyspnea improvement. We studied 233 patients assigned to right heart catheterization in the Vasodilation in the Management of Acute Congestive Heart Failure trial. Dyspnea (assessed using a 7-point Likert scale) and hemodynamic parameters were measured simultaneously at 15 and 30 minutes and 1, 2, 3, 6, and 24 hours. Dyspnea relief was defined as moderate or marked improvement. There was a time-dependent association between the reductions in pulmonary capillary wedge pressure (PCWP; 25.4, 24.6, 24.0, 23.5, 23.4, 21.5, and 19.9 mm Hg) and the percentage of patients achieving dyspnea relief (17.7%, 24.6%, 32.2%, 36.2%, 37.8%, 47.4%, and 66.1%, in the respective time points). Multivariable logistic generalized estimating equations modeling demonstrated that reductions of both PCWP and mean pulmonary artery pressure were independently associated with dyspnea relief. Compared with the highest PCWP quartile, the adjusted odds ratios for dyspnea relief were 0.92 (95% confidence interval [CI], 0.67-1.29), 1.07 (95% CI, 0.75-1.55), and 1.80 (95% CI, 1.22-2.65) in the third, second, and first PCWP quartiles, respectively (P(trend)=0.003). Compared with the highest mean pulmonary artery pressure quartile, the adjusted odds ratios for dyspnea relief were 2.0 (95% CI, 1.41-2.82), 2.23 (95% CI, 1.52-3.27), and 2.98 (95% CI, 1.91-4.66) in the third, second, and first mean pulmonary artery pressure quartiles, respectively (P(trend)<0.0001). A clinically significant improvement in dyspnea is associated with a reduction in both PCWP and mean pulmonary artery pressure.

  3. Use of Diuretics in the Treatment of Heart Failure in Older Adults.

    Science.gov (United States)

    Sica, Domenic A; Gehr, Todd W B; Frishman, William H

    2017-07-01

    Diuretics are the most commonly prescribed class of drugs in patients with heart failure, and in the short term they remain the most effective treatment for relief from fluid congestion. This article reviews the mode of action of the various diuretic classes and the physiologic adaptations that follow and sets up the basis for their use in the treatment of volume-retaining states, particularly as applies to the elderly. In addition, the article reviews the common side effects related to diuretics. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Percutaneous Implantation of A Parachute Device For Treatment of Ischemic Heart Failure

    Energy Technology Data Exchange (ETDEWEB)

    Cilingiroglu, Mehmet, E-mail: mcilingiroglu@yahoo.com; Rollefson, William A.; Mego, David

    2013-07-15

    Congestive heart failure (CHF) secondary to ischemic cardiomyopathy is associated with significant morbidity and mortality despite currently available medical therapy. The Parachute{sup TM} device is a novel left ventricular partitioning device that is delivered percutaneously in the left ventricle (LV) in patients with anteroapical regional wall motion abnormalities, dilated LV and systolic dysfunction after anterior myocardial infarction with favorable clinical and LV hemodynamic improvements post-implantation. Here, we do review the current literature and present a case of the Parachute device implantation.

  5. Inverse Relation between Condition of Heart Failure and Intrathoracic Impedance Measured by Implantable Cardioverter Defibrillator—A case report—

    Directory of Open Access Journals (Sweden)

    Kohei Matsushita, MD

    2005-01-01

    Full Text Available The patient was a 78-year-old man with dilated cardiomyopathy. His cardio-thoracic ratio was 60.4% and left ventricular ejection fraction (LVEF was 33%. He had been repeatedly admitted for congestive heart failure. He underwent implantation of an implantable cardioverter-defibrillator (ICD for ventricular fibrillation. We compared the values of BNP and shock impedance stored by the ICD. The correlation coefficient (p-value between BNP and shock impedance was −0.700 (p < 0.0005, increase of BNP and shock impedance was −0.778 (p < 0.0001, percent increase of BNP and shock impedance was −0.767 (p < 0.0005. In conclusion, there is an inverse relation between BNP and shock impedance, and measurements of shock impedance may be useful in the management of congestive heart failure.

  6. Correlation between trans and intra-thoracic impedance and conductance in patients with chronic heart failure.

    Science.gov (United States)

    Malfatto, Gabriella; Villani, Alessandra; Rosa, Francesco Della; Rella, Valeria; Oldani, Matteo; Giglio, Alessia; Facchini, Mario; Parati, Gianfranco

    2016-04-01

    In chronic heart failure, changes of intra-thoracic impedance (Z0IT) may suggest impending pulmonary congestion; a similar result has been found by measuring trans-thoracic conductance (TFCTT = 1/Z0 = 1/kΩ). We assumed that a relationship could exist between Z0IT and TFCTT. We collected 140 measurements from 70 patients carrying an implantable cardioverter-defibrillator/cardiac resynchronization device with the CareLink function (71 ± 9 years, New York Heart Association (NYHA) 2.4 ± 0.9, ejection fraction 31 ± 8%, optimal treatment); they were studied during system alarms and after appropriate treatment (diuretics and/or vasodilators, n = 42) or during clinical stability and at the time of a system alarm (n = 28); correspondent BNP values were obtained. We related Z0IT obtained by the device, with TFCTT obtained with a commercial system. A strong relationship was found between Z0IT and TFCTT. Changes in the variables after treatment or during worsening conditions were of the same direction and order of magnitude, and were related to BNP levels obtained simultaneously. Trans-thoracic conductance, similarly to intra-thoracic impedance, may noninvasively point to pulmonary congestion and be useful in patients not carrying an implanted device. The possibility of remotely obtaining this variable should be evaluated for the telemonitoring of heart failure patients.

  7. Organ protection possibilities in acute heart failure.

    Science.gov (United States)

    Montero-Pérez-Barquero, M; Morales-Rull, J L

    2016-04-01

    Unlike chronic heart failure (HF), the treatment for acute HF has not changed over the last decade. The drugs employed have shown their ability to control symptoms but have not achieved organ protection or managed to reduce medium to long-term morbidity and mortality. Advances in our understanding of the pathophysiology of acute HF suggest that treatment should be directed not only towards correcting the haemodynamic disorders and achieving symptomatic relief but also towards preventing organ damage, thereby counteracting myocardial remodelling and cardiac and extracardiac disorders. Compounds that exert vasodilatory and anti-inflammatory action in the acute phase of HF and can stop cell death, thereby boosting repair mechanisms, could have an essential role in organ protection. Copyright © 2016 Elsevier España, S.L.U. y Sociedad Española de Medicina Interna (SEMI). All rights reserved.

  8. [The heart failure patient: a case report].

    Science.gov (United States)

    Alconero-Camarero, Ana Rosa; Arozamena-Pérez, Jorge; García-Garrido, Lluïsa

    2014-01-01

    Given its prevalence, high mortality rate, morbidity, chronicity and use of resources, heart failure (HF) is a priority issue from a social and health standpoint, due to the ageing population and to lack of adherence to and the complexity of treatment. For these reasons, an individualized care plan needs to be established to meet the real and potential needs of the patient diagnosed with HF. A clinical case is presented of a patient admitted to the Cardiology Critical Care (CCC) unit of a tertiary hospital. A patient care plan was prepared following the steps of the scientific method and relying on the NANDA taxonomy, and the NOC and NIC to design goals and nursing interventions, respectively. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  9. Nutritional Deficiency in Patients with Heart Failure

    Directory of Open Access Journals (Sweden)

    Edoardo Sciatti

    2016-07-01

    Full Text Available Heart failure (HF is the main cause of mortality and morbidity in Western countries. Although evidence-based treatments have substantially improved outcomes, prognosis remains poor with high costs for health care systems. In patients with HF, poor dietary behaviors are associated with unsatisfactory quality of life and adverse outcome. The HF guidelines have not recommended a specific nutritional strategy. Despite the role of micronutrient deficiency, it has been extensively studied, and data about the efficacy of supplementation therapy in HF are not supported by large randomized trials and there is limited evidence regarding the outcomes. The aim of the present review is to analyze the state-of-the-art of nutritional deficiencies in HF, focusing on the physiological role and the prognostic impact of micronutrient supplementation.

  10. Remote patient monitoring in chronic heart failure.

    Science.gov (United States)

    Palaniswamy, Chandrasekar; Mishkin, Aaron; Aronow, Wilbert S; Kalra, Ankur; Frishman, William H

    2013-01-01

    Heart failure (HF) poses a significant economic burden on our health-care resources with very high readmission rates. Remote monitoring has a substantial potential to improve the management and outcome of patients with HF. Readmission for decompensated HF is often preceded by a stage of subclinical hemodynamic decompensation, where therapeutic interventions would prevent subsequent clinical decompensation and hospitalization. Various methods of remote patient monitoring include structured telephone support, advanced telemonitoring technologies, remote monitoring of patients with implanted cardiac devices such as pacemakers and defibrillators, and implantable hemodynamic monitors. Current data examining the efficacy of remote monitoring technologies in improving outcomes have shown inconsistent results. Various medicolegal and financial issues need to be addressed before widespread implementation of this exciting technology can take place.

  11. Renal function and acute heart failure outcome.

    Science.gov (United States)

    Llauger, Lluís; Jacob, Javier; Miró, Òscar

    2018-06-05

    The interaction between acute heart failure (AHF) and renal dysfunction is complex. Several studies have evaluated the prognostic value of this syndrome. The aim of this systematic review, which includes non-selected samples, was to investigate the impact of different renal function variables on the AHF prognosis. The categories included in the studies reviewed included: creatinine, blood urea nitrogen (BUN), the BUN/creatinine quotient, chronic kidney disease, the formula to estimate the glomerular filtration rate, criteria of acute renal injury and new biomarkers of renal damage such as neutrophil gelatinase-associated lipocalin (NGAL and cystatin c). The basal alterations of the renal function, as well as the acute alterations, transient or not, are related to a worse prognosis in AHF, it is therefore necessary to always have baseline, acute and evolutive renal function parameters. Copyright © 2018 Elsevier España, S.L.U. All rights reserved.

  12. Cognitive impairment in heart failure patients

    Science.gov (United States)

    Leto, Laura; Feola, Mauro

    2014-01-01

    Cognitive damage in heart failure (HF) involves different domains thus interfering with the ability for single patient to self-care and to cope with treatment regimens, modifying symptoms and health behaviours. Many cerebral and functional changes were detected in brain imaging, involving areas of both grey and white matter deputed to cognition. Although various instruments are available to explore cognition, no consensus was obtained on better tools to be used in HF population. Reduction in cerebral blood flow, decreased cardiac output, alterations of cerebrovascular reactivity and modification of blood pressure levels are the main features involved in the etiopathogenetic mechanisms of cognitive deficit. Several cardiac variables, laboratory parameters, demographic and clinical elements were studied for their possible relation with cognition and should be properly evaluated to define patients at increased risk of impairment. The present review gathers available data pointing out assured information and discussing possible areas of research development. PMID:25593581

  13. Myocardial remodeling and bioelectric changes in tachycardia-induced heart failure in dogs

    Energy Technology Data Exchange (ETDEWEB)

    Song, B.; Wang, B.N.; Chen, D.N.; Luo, Z.G. [Department of Cardiovascular Medicine, The First Affiliated Hospital, Anhui Medical University, HeFei, Anhui Province (China)

    2013-09-06

    In this study, electrical and structural remodeling of ventricles was examined in tachycardia-induced heart failure (HF). We studied two groups of weight-matched adult male mongrel dogs: a sham-operated control group (n=5) and a pacing group (n=5) that underwent ventricular pacing at 230 bpm for 3 weeks. Clinical symptoms of congestive HF were observed in both groups. Their hemodynamic parameters were determined and the severity of the HF was evaluated by M-mode echocardiography. Changes in heart morphology were observed by scanning electron and light microscopy. Ventricular action potential duration (APD), as well as the 50 and 90% APD were measured in both groups. All dogs exhibited clinical symptoms of congestive HF after rapid right ventricular pacing for 3 weeks. These data indicate that rapid, right ventricular pacing produces a useful experimental model of low-output HF in dogs, characterized by biventricular pump dysfunction, biventricular cardiac dilation, and non-ischemic impairment of left ventricular contractility. Electrical and structural myocardial remodeling play an essential role in congestive HF progression, and should thus be prevented.

  14. Heart Failure as an Aging-Related Phenotype.

    Science.gov (United States)

    Morita, Hiroyuki; Komuro, Issei

    2018-01-27

    The molecular pathophysiology of heart failure, which is one of the leading causes of mortality, is not yet fully understood. Heart failure can be regarded as a systemic syndrome of aging-related phenotypes. Wnt/β-catenin signaling and the p53 pathway, both of which are key regulators of aging, have been demonstrated to play a critical role in the pathogenesis of heart failure. Circulating C1q was identified as a novel activator of Wnt/β-catenin signaling, promoting systemic aging-related phenotypes including sarcopenia and heart failure. On the other hand, p53 induces the apoptosis of cardiomyocytes in the failing heart. In these molecular mechanisms, the cross-talk between cardiomyocytes and non-cardiomyocytes (e,g,. endothelial cells, fibroblasts, smooth muscle cells, macrophages) deserves mentioning. In this review, we summarize recent advances in the understanding of the molecular pathophysiology underlying heart failure, focusing on Wnt/β-catenin signaling and the p53 pathway.

  15. Baseline Hemodynamics and Response to Contrast Media During Diagnostic Cardiac Catheterization Predict Adverse Events in Heart Failure Patients.

    Science.gov (United States)

    Denardo, Scott J; Vock, David M; Schmalfuss, Carsten M; Young, Gregory D; Tcheng, James E; O'Connor, Christopher M

    2016-07-01

    Contrast media administered during cardiac catheterization can affect hemodynamic variables. However, little is documented about the effects of contrast on hemodynamics in heart failure patients or the prognostic value of baseline and changes in hemodynamics for predicting subsequent adverse events. In this prospective study of 150 heart failure patients, we measured hemodynamics at baseline and after administration of iodixanol or iopamidol contrast. One-year Kaplan-Meier estimates of adverse event-free survival (death, heart failure hospitalization, and rehospitalization) were generated, grouping patients by baseline measures of pulmonary capillary wedge pressure (PCWP) and cardiac index (CI), and by changes in those measures after contrast administration. We used Cox proportional hazards modeling to assess sequentially adding baseline PCWP and change in CI to 5 validated risk models (Seattle Heart Failure Score, ESCAPE [Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness], CHARM [Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity], CORONA [Controlled Rosuvastatin Multinational Trial in Heart Failure], and MAGGIC [Meta-Analysis Global Group in Chronic Heart Failure]). Median contrast volume was 109 mL. Both contrast media caused similarly small but statistically significant changes in most hemodynamic variables. There were 39 adverse events (26.0%). Adverse event rates increased using the composite metric of baseline PCWP and change in CI (Pcontrast correlated with the poorest prognosis. Adding both baseline PCWP and change in CI to the 5 risk models universally improved their predictive value (P≤0.02). In heart failure patients, the administration of contrast causes small but significant changes in hemodynamics. Calculating baseline PCWP with change in CI after contrast predicts adverse events and increases the predictive value of existing models. Patients with elevated baseline PCWP and

  16. [Disease management for chronic heart failure patient].

    Science.gov (United States)

    Bläuer, Cornelia; Pfister, Otmar; Bächtold, Christa; Junker, Therese; Spirig, Rebecca

    2011-02-01

    Patients with chronic heart failure (HF) are limited in their quality of life, have a poor prognosis and face frequent hospitalisations. Patient self-management was shown to improve quality of life, reduce rehospitalisations and costs in patients with chronic HF. Comprehensive disease management programmes are critical to foster patient self-management. The chronic care model developed by the WHO serves as the basis of such programmes. In order to develop self-management skills a needs orientated training concept is mandatory, as patients need both knowledge of the illness and the ability to use the information to make appropriate decisions according to their individual situation. Switzerland has no established system for the care of patients with chronic diseases in particular those with HF. For this reason a group of Swiss experts for HF designed a model for disease management for HF patients in Switzerland. Since 2009 the Swiss Heart Foundation offers an education programme based on this model. The aim of this programme is to offer education and support for practitioners, patients and families. An initial pilot evaluation of the program showed mixed acceptance by practitioners, whereas patient assessed the program as supportive and in line with their requirements.

  17. Plasma urocortin in human systolic heart failure.

    Science.gov (United States)

    Ng, Leong L; Loke, Ian W; O'Brien, Russell J; Squire, Iain B; Davies, Joan E

    2004-04-01

    Urocortin (UCN), a member of the corticotrophin-releasing factor family, is expressed in heart, brain and gut. UCN has potent cardiostimulatory, cardioprotective, vasodilator and diuretic/natriuretic effects, and cardiac UCN expression is increased in heart failure (HF). In the present study, we investigated plasma levels of UCN in 119 patients with HF and 212 age- and gender-matched controls to clarify its relationship with gender and disease severity. UCN was elevated in HF [normal males, 19.5 (3.9-68.8) pmol/l and HF males, 50.2 (6.9-108.2) pmol/l, P fall in UCN levels with increasing NYHA class was reinforced by a significant correlation between UCN and ejection fraction ( r(s) = 0.45, P < 0.0005) in HF patients. Although receiver operating characteristic (ROC) curves for diagnosis of all HF cases yielded an area under the curve (AUC) of 0.76, ROC AUCs for patients with early HF (NYHA class I and II) were better (0.91). ROC AUCs for logistic models incorporating N-terminal probrain natriuretic peptide (N-BNP) and UCN were better than either peptide alone. In conclusion, plasma UCN is elevated in HF, especially in its early stages. Its decline with increasing HF severity may expedite disease progression due to diminished cardioprotective/anti-inflammatory effects. UCN measurement may also complement N-BNP in the diagnosis of early HF.

  18. Heart failure in patients with kidney disease.

    Science.gov (United States)

    Tuegel, Courtney; Bansal, Nisha

    2017-12-01

    Heart failure (HF) is a leading cause of morbidity and mortality in patients with chronic kidney disease (CKD), and the population of CKD patients with concurrent HF continues to grow. The accurate diagnosis of HF is challenging in patients with CKD in part due to a lack of validated imaging and biomarkers specifically in this population. The pathophysiology between the heart and the kidneys is complex and bidirectional. Patients with CKD have greater prevalence of traditional HF risk factors as well as unique kidney-specific risk factors including malnutrition, acid-base alterations, uraemic toxins, bone mineral changes, anemia and myocardial stunning. These risk factors also contribute to the decline of kidney function seen in patients with subclinical and clinical HF. More targeted HF therapies may improve outcomes in patients with kidney disease as current HF therapies are underutilised in this population. Further work is also needed to develop novel HF therapies for the CKD population. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  19. Influence of diabetes mellitus on heart failure risk and outcome

    Directory of Open Access Journals (Sweden)

    Van Belle Eric

    2003-01-01

    Full Text Available Abstract Our aim is to summarize and discuss the recent literature linking diabetes mellitus with heart failure, and to address the issue of the optimal treatment for diabetic patients with heart failure. The studies linking diabetes mellitus (DM with heart failure (HF The prevalence of diabetes mellitus in heart failure populations is close to 20% compared with 4 to 6% in control populations. Epidemiological studies have demonstrated an increased risk of heart failure in diabetics; moreover, in diabetic populations, poor glycemic control has been associated with an increased risk of heart failure. Various mechanisms may link diabetes mellitus to heart failure: firstly, associated comorbidities such as hypertension may play a role; secondly, diabetes accelerates the development of coronary atherosclerosis; thirdly, experimental and clinical studies support the existence of a specific diabetic cardiomyopathy related to microangiopathy, metabolic factors or myocardial fibrosis. Subgroup analyses of randomized trials demonstrate that diabetes is also an important prognostic factor in heart failure. In addition, it has been suggested that the deleterious impact of diabetes may be especially marked in patients with ischemic cardiomyopathy. Treatment of heart failure in diabetic patients The knowledge of the diabetic status may help to define the optimal therapeutic strategy for heart failure patients. Cornerstone treatments such as ACE inhibitors or beta-blockers appear to be uniformly beneficial in diabetic and non diabetic populations. However, in ischemic cardiomyopathy, the choice of the revascularization technique may differ according to diabetic status. Finally, clinical studies are needed to determine whether improved metabolic control might favorably influence the outcome of diabetic heart failure patients.

  20. Pathogenic Gut Flora in Patients With Chronic Heart Failure.

    Science.gov (United States)

    Pasini, Evasio; Aquilani, Roberto; Testa, Cristian; Baiardi, Paola; Angioletti, Stefania; Boschi, Federica; Verri, Manuela; Dioguardi, Francesco

    2016-03-01

    The goal of this study was to measure the presence of pathogenic gut flora and intestinal permeability (IP) and their correlations with disease severity, venous blood congestion, and inflammation in patients with chronic heart failure (CHF). Evidence suggests that translocation of gut flora and/or their toxins from the intestine to the bloodstream is a possible trigger of systemic CHF inflammation. However, the relation between pathogenic gut flora and CHF severity, as well as IP, venous blood congestion as right atrial pressure (RAP), and/or systemic inflammation (C-reactive protein [CRP]), is still unknown. This study analyzed 60 well-nourished patients in stable condition with mild CHF (New York Heart Association [NYHA] functional class I to II; n = 30) and moderate to severe CHF (NYHA functional class III to IV; n = 30) and matched healthy control subjects (n = 20). In all subjects, the presence and development in the feces of bacteria and fungi (Candida species) were measured; IP according to cellobiose sugar test results was documented. The study data were then correlated with RAP (echocardiography) and systemic inflammation. Compared with normal control subjects, the entire CHF population had massive quantities of pathogenic bacteria and Candida such as Campylobacter (85.3 ± 3.7 CFU/ml vs. 1.0 ± 0.3 CFU/ml; p < 0.001), Shigella (38.9 ± 12.3 CFU/ml vs. 1.6 ± 0.2 CFU/ml; p < 0.001), Salmonella (31.3 ± 9.1 CFU/ml vs 0 CFU/ml; p < 0.001), Yersinia enterocolitica (22.9 ± 6.3 CFU/ml vs. 0 CFU/ml; p < 0.0001), and Candida species (21.3 ± 1.6 CFU/ml vs. 0.8 ± 0.4 CFU/ml; p < 0.001); altered IP (10.2 ± 1.2 mg vs. 1.5 ± 0.8 mg; p < 0.001); and increased RAP (12.6 ± 0.6 mm Hg) and inflammation (12.5 ± 0.6 mg/dl). These variables were more pronounced in patients with moderate to severe NYHA functional classes than in patients with the mild NYHA functional class. Notably, IP, RAP, and CRP were mutually interrelated (IP vs. RAP, r = 0.55; p < 0.0001; IP vs

  1. Influenza infection and heart failure-vaccination may change heart failure prognosis?

    Science.gov (United States)

    Kadoglou, Nikolaos P E; Bracke, Frank; Simmers, Tim; Tsiodras, Sotirios; Parissis, John

    2017-05-01

    The interaction of influenza infection with the pathogenesis of acute heart failure (AHF) and the worsening of chronic heart failure (CHF) is rather complex. The deleterious effects of influenza infection on AHF/CHF can be attenuated by specific immunization. Our review aimed to summarize the efficacy, effectiveness, safety, and dosage of anti-influenza vaccination in HF. In this literature review, we searched MEDLINE and EMBASE from January 1st 1966 to December 31st, 2016, for studies examining the association between AHF/CHF, influenza infections, and anti-influenza immunizations. We used broad criteria to increase the sensitivity of the search. HF was a prerequisite for our search. The search fields used included "heart failure," "vaccination," "influenza," "immunization" along with variants of these terms. No restrictions on the type of study design were applied. The most common clinical scenario is exacerbation of pre-existing CHF by influenza infection. Scarce evidence supports a potential positive association of influenza infection with AHF. Vaccinated patients with pre-existing CHF have reduced all-cause morbidity and mortality, but effects are not consistently documented. Immunization with higher antigen quantity may confer additional protection, but such aggressive approach has not been generally advocated. Further studies are needed to delineate the role of influenza infection on AHF/CHF pathogenesis and maintenance. Annual anti-influenza vaccination appears to be an effective measure for secondary prevention in HF. Better immunization strategies and more efficacious vaccines are urgently necessary.

  2. Exercise training in older patients with systolic heart failure

    DEFF Research Database (Denmark)

    Prescott, Eva; Hjardem-Hansen, Rasmus; Dela, Flemming

    2009-01-01

    Training improves exercise capacity in patients with heart failure (CHF) but most evidence is on selected younger patients with systolic CHF.......Training improves exercise capacity in patients with heart failure (CHF) but most evidence is on selected younger patients with systolic CHF....

  3. The Significance Mild Renal Dysfunction in Chronic Heart Failure ...

    African Journals Online (AJOL)

    BACKGROUND: Heart failure is a major public health concern. Prediction models in heart failure have employed echocardiography and other advanced laboratory parameters in predicting the risk of mortality.However, most of the patients in the resource poor economies still do not have easy access to these advanced ...

  4. Right ventricular strain in heart failure: Clinical perspective.

    Science.gov (United States)

    Tadic, Marijana; Pieske-Kraigher, Elisabeth; Cuspidi, Cesare; Morris, Daniel A; Burkhardt, Franziska; Baudisch, Ana; Haßfeld, Sabine; Tschöpe, Carsten; Pieske, Burket

    2017-10-01

    The number of studies demonstrating the importance of right ventricular remodelling in a wide range of cardiovascular diseases has increased in the past two decades. Speckle-tracking imaging provides new variables that give comprehensive information about right ventricular function and mechanics. In this review, we summarize current knowledge of right ventricular mechanics in heart failure with reduced ejection fraction and preserved ejection fraction. We searched PubMed, MEDLINE, Ovid and Embase databases for studies published from January 2000 to December 2016 in the English language using the following keywords: "right ventricle"; "strain"; "speckle tracking"; "heart failure with reduced ejection fraction"; and "heart failure with preserved ejection fraction". Investigations showed that right ventricular dysfunction is associated with higher cardiovascular and overall mortality in patients with heart failure, irrespective of ejection fraction. The number of studies investigating right ventricular strain in patients with heart failure with reduced ejection fraction is constantly increasing, whereas data on right ventricular mechanics in patients with heart failure with preserved ejection fraction are limited. Given the high feasibility, accuracy and clinical implications of right ventricular strain in the population with heart failure, it is of great importance to try to include the evaluation of right ventricular strain as a regular part of each echocardiographic examination in patients with heart failure. However, further investigations are necessary to establish right ventricular strain as a standard variable for decision-making. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Epidemiology of childhood heart failure in Port Harcourt, Nigeria ...

    African Journals Online (AJOL)

    Background: Heart failure (HF) is a clinical syndrome that complicates a variety of childhood illnesses. Recent studies in various parts of Nigeria show a prevalence rate of 5.8-15.5%. There is relatively scant data on heart failure in children in the south-south geo-political region of the country, necessitating this study. Aim: To ...

  6. Program Description: Physical Therapy in a Heart Failure Clinic

    OpenAIRE

    Knocke, Ann

    2012-01-01

    Aerobic exercise and resistance training have been proven to be beneficial for patients with heart failure. Current reimbursement guidelines exclude these patients from our traditional cardiac rehabilitation program, so at Newton Wellesley Hospital a clinic model was developed for the disease management and exercise of heart failure patients.

  7. Predicting mortality in patients with heart failure : a pragmatic approach

    NARCIS (Netherlands)

    Bouvy, ML; Heerdink, ER; Leufkens, HGM; Hoes, AW

    Objective: To develop a comprehensive and easily applicable prognostic model predicting mortality risk in patients with moderate to severe heart failure. Design: Prospective follow up study. Setting: Seven general hospitals in the Netherlands. Patients: 152 outpatients with heart failure or patients

  8. The puzzle of kidney dysfunction in heart failure : an introduction

    NARCIS (Netherlands)

    Metra, Marco; Voors, Adriaan A.

    Heart failure and kidney disease often coexist, and each of the two conditions may lead to progression of the other. Kidney dysfunction is an independent prognostic factor in patients with either acute or chronic heart failure. Worsening renal function may be related with poorer outcomes as well.

  9. Anemia in chronic heart failure : etiology and treatment options

    NARCIS (Netherlands)

    Westenbrink, B. Daan; de Boer, Rudolf A.; Voors, Adriaan A.; van Gilst, Wiek H.; van Veldhuisen, Dirk J.

    Purpose of review Anemia is common in patients with chronic heart failure, and is related to increased morbidity and mortality. The etiology of anemia in heart failure is complex and still not fully resolved. The review will describe current advances in the understanding of the pathophysiology of

  10. Creating interatrial shunts in heart failure and pulmonary hypertension

    DEFF Research Database (Denmark)

    Wolsk, Emil; Gustafsson, Finn

    2016-01-01

    Patients with elevated filling pressures are at increased risk of adverse cardiovascular (CV) outcomes. Structural interventions to lower elevated either left or right atrial filling pressures are gaining attention. Studies in heart failure show that lowering left atrial pressure may reduce CV...... interatrial device shunt therapy a part of our armamentarium in patients with heart failure or pulmonary hypertension and increased filling pressure....

  11. High mortality among heart failure patients treated with antidepressants

    DEFF Research Database (Denmark)

    Veien, Karsten Tang; Videbæk, Lars; Schou, Morten

    2011-01-01

    This study was designed to assess whether pharmacologically treated depression was associated with increased mortality risk in systolic heart failure (SHF) patients.......This study was designed to assess whether pharmacologically treated depression was associated with increased mortality risk in systolic heart failure (SHF) patients....

  12. Digoxin affects potassium homeostasis during exercise in patients with heart failure.

    Science.gov (United States)

    Schmidt, T A; Bundgaard, H; Olesen, H L; Secher, N H; Kjeldsen, K

    1995-04-01

    The aim was to evaluate whether digitalisation of heart failure patients affects extrarenal potassium handling during and following exercise, and to assess digoxin receptor occupancy in human skeletal muscle in vivo. In a paired study of before versus after digitalisation, 10 patients with congestive heart failure underwent identical exercise sessions consisting of three bouts of increasing work rates, 41-93 W, on a cycle ergometer. The final bouts were followed by exercise to exhaustion. The femoral vessels and brachial artery were catheterised. Arterial blood pressure, heart rate, leg blood flow, cardiac output, plasma potassium, haemoglobin, pH, and skeletal muscle receptor occupancy with digoxin in biopsies were determined. Occupancy of skeletal muscle Na/K-ATPase with digoxin was 9% (P digitalisation femoral venous plasma potassium increased by 0.2-0.3 mmol.litre-1 (P digitalisation the femoral venoarterial difference in plasma potassium increased by 50-100% (P digitalisation on plasma potassium were not the outcome of changes in haemodynamics, because cardiac output and leg blood flow increased by up to 13% and 19% (P < 0.05), nor was it the outcome of changes in haemoconcentration or pH. Extrarenal potassium handling is altered as a result of digoxin treatment. This is likely to reflect a reduced capacity of skeletal muscle Na/K-ATPase for active potassium uptake because of inhibition by digoxin, adding to the reduction of skeletal muscle Na/K-ATPase concentration induced by heart failure per se. In heart failure patients, improved haemodynamics induced by digoxin may, however, increase the capacity for physical conditioning. Thus the impairment of extrarenal potassium homeostasis by heart failure and digoxin treatment may be counterbalanced by training.

  13. Inhibition of cyclooxygenase-2 reduces hypothalamic excitation in rats with adriamycin-induced heart failure.

    Directory of Open Access Journals (Sweden)

    Min Zheng

    Full Text Available BACKGROUND: The paraventricular nucleus (PVN of the hypothalamus plays an important role in the progression of heart failure (HF. We investigated whether cyclooxygenase-2 (COX-2 inhibition in the PVN attenuates the activities of sympathetic nervous system (SNS and renin-angiotensin system (RAS in rats with adriamycin-induced heart failure. METHODOLOGY/PRINCIPAL FINDING: Heart failure was induced by intraperitoneal injection of adriamycin over a period of 2 weeks (cumulative dose of 15 mg/kg. On day 19, rats received intragastric administration daily with either COX-2 inhibitor celecoxib (CLB or normal saline. Treatment with CLB reduced mortality and attenuated both myocardial atrophy and pulmonary congestion in HF rats. Compared with the HF rats, ventricle to body weight (VW/BW and lung to body weight (LW/BW ratios, heart rate (HR, left ventricular end-diastolic pressure (LVEDP, left ventricular peak systolic pressure (LVPSP and maximum rate of change in left ventricular pressure (LV±dp/dtmax were improved in HF+CLB rats. Angiotensin II (ANG II, norepinephrine (NE, COX-2 and glutamate (Glu in the PVN were increased in HF rats. HF rats had higher levels of ANG II and NE in plasma, higher level of ANG II in myocardium, and lower levels of ANP in plasma and myocardium. Treatment with CLB attenuated these HF-induced changes. HF rats had more COX-2-positive neurons and more corticotropin releasing hormone (CRH positive neurons in the PVN than did control rats. Treatment with CLB decreased COX-2-positive neurons and CRH positive neurons in the PVN of HF rats. CONCLUSIONS: These results suggest that PVN COX-2 may be an intermediary step for PVN neuronal activation and excitatory neurotransmitter release, which further contributes to sympathoexcitation and RAS activation in adriamycin-induced heart failure. Treatment with COX-2 inhibitor attenuates sympathoexcitation and RAS activation in adriamycin-induced heart failure.

  14. Renal Denervation for Chronic Heart Failure: Background and Pathophysiological Rationale.

    Science.gov (United States)

    Böhm, Michael; Ewen, Sebastian; Mahfoud, Felix

    2017-01-01

    The activation of the sympathetic nervous system is associated with cardiovascular hospitalizations and death in heart failure. Renal denervation has been shown to effectively reduce sympathetic overdrive in certain patients with uncontrolled hypertension. Pilot trials investigating renal denervation as a potential treatment approach for heart failure were initiated. Heart failure comorbidities like obstructive sleep apnea, metabolic syndrome and arrhythmias could also be targets for renal denervation, because these occurrences are also mediated by the activation of the sympathetic nervous system. Therefore, renal denervation in heart failure is worthy of further investigation, although its effectiveness still has to be proven. Herein, we describe the pathophysiological rationale and the effect of renal denervation on surrogates of the heart failure syndrome.

  15. Renal Denervation for Chronic Heart Failure: Background and Pathophysiological Rationale

    Science.gov (United States)

    Ewen, Sebastian; Mahfoud, Felix

    2017-01-01

    The activation of the sympathetic nervous system is associated with cardiovascular hospitalizations and death in heart failure. Renal denervation has been shown to effectively reduce sympathetic overdrive in certain patients with uncontrolled hypertension. Pilot trials investigating renal denervation as a potential treatment approach for heart failure were initiated. Heart failure comorbidities like obstructive sleep apnea, metabolic syndrome and arrhythmias could also be targets for renal denervation, because these occurrences are also mediated by the activation of the sympathetic nervous system. Therefore, renal denervation in heart failure is worthy of further investigation, although its effectiveness still has to be proven. Herein, we describe the pathophysiological rationale and the effect of renal denervation on surrogates of the heart failure syndrome. PMID:28154583

  16. Translational aspects of cell therapy for heart failure

    OpenAIRE

    Nasseri, Boris

    2015-01-01

    This cumulative “habilitation” thesis focuses on myocardial regeneration by means of cell therapy and on experimental and clinical approaches. To supplement the articles published by the author the work gives an overview of the pathogenesis of heart failure and remodeling of the heart, taking into account the role of nitric oxide and statins. Further, the treatment of ischemic heart failure including organ transplantation and mechanical circulatory support is discussed. Different approaches t...

  17. Left ventricular heart failure and pulmonary hypertension†

    Science.gov (United States)

    Rosenkranz, Stephan; Gibbs, J. Simon R.; Wachter, Rolf; De Marco, Teresa; Vonk-Noordegraaf, Anton; Vachiéry, Jean-Luc

    2016-01-01

    Abstract In patients with left ventricular heart failure (HF), the development of pulmonary hypertension (PH) and right ventricular (RV) dysfunction are frequent and have important impact on disease progression, morbidity, and mortality, and therefore warrant clinical attention. Pulmonary hypertension related to left heart disease (LHD) by far represents the most common form of PH, accounting for 65–80% of cases. The proper distinction between pulmonary arterial hypertension and PH-LHD may be challenging, yet it has direct therapeutic consequences. Despite recent advances in the pathophysiological understanding and clinical assessment, and adjustments in the haemodynamic definitions and classification of PH-LHD, the haemodynamic interrelations in combined post- and pre-capillary PH are complex, definitions and prognostic significance of haemodynamic variables characterizing the degree of pre-capillary PH in LHD remain suboptimal, and there are currently no evidence-based recommendations for the management of PH-LHD. Here, we highlight the prevalence and significance of PH and RV dysfunction in patients with both HF with reduced ejection fraction (HFrEF) and HF with preserved ejection fraction (HFpEF), and provide insights into the complex pathophysiology of cardiopulmonary interaction in LHD, which may lead to the evolution from a ‘left ventricular phenotype’ to a ‘right ventricular phenotype’ across the natural history of HF. Furthermore, we propose to better define the individual phenotype of PH by integrating the clinical context, non-invasive assessment, and invasive haemodynamic variables in a structured diagnostic work-up. Finally, we challenge current definitions and diagnostic short falls, and discuss gaps in evidence, therapeutic options and the necessity for future developments in this context. PMID:26508169

  18. Heart Failure Virtual Consultation: bridging the gap of heart failure care in the community - A mixed-methods evaluation.

    Science.gov (United States)

    Gallagher, Joseph; James, Stephanie; Keane, Ciara; Fitzgerald, Annie; Travers, Bronagh; Quigley, Etain; Hecht, Christina; Zhou, Shuaiwei; Watson, Chris; Ledwidge, Mark; McDonald, Kenneth

    2017-08-01

    We undertook a mixed-methods evaluation of a Web-based conferencing service (virtual consult) between general practitioners (GPs) and cardiologists in managing patients with heart failure in the community to determine its effect on use of specialist heart failure services and acceptability to GPs. All cases from June 2015 to October 2016 were recorded using a standardized recording template, which recorded patient demographics, medical history, medications, and outcome of the virtual consult for each case. Quantitative surveys and qualitative interviewing of 17 participating GPs were also undertaken. During this time, 142 cases were discussed-68 relating to a new diagnosis of heart failure, 53 relating to emerging deterioration in a known heart failure patient, and 21 relating to therapeutic issues. Only 17% required review in outpatient department following the virtual consultation. GPs reported increased confidence in heart failure management, a broadening of their knowledge base, and a perception of overall better patient outcomes. These data from an initial experience with Heart Failure Virtual Consultation present a very positive impact of this strategy on the provision of heart failure care in the community and acceptability to users. Further research on the implementation and expansion of this strategy is warranted. © 2017 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology.

  19. A holistic approach to managing a patient with heart failure.

    Science.gov (United States)

    Duncan, Alison; Cunnington, Colin

    2013-03-01

    Despite varied and complex therapeutic strategies for managing patients with heart failure, the prognosis may remain poor in certain groups. Recognition that patients with heart failure frequently require input from many care groups formed the basis of The British Society of Heart Failure Annual Autumn Meeting in London (UK), in November 2012, entitled: 'Heart failure: a multidisciplinary approach'. Experts in cardiology, cardiac surgery, general practice, care of the elderly, palliative care and cardiac imaging shared their knowledge and expertise. The 2-day symposium was attended by over 500 participants from the UK, Europe and North America, and hosted physicians, nurses, scientists, trainees and representatives from the industry, as well as patient and community groups. The symposium, accredited by the Royal College of Physicians and the Royal College of Nursing, focused on the multidisciplinary approach to heart failure, in particular, current therapeutic advances, cardiac remodeling, palliative care, atrial fibrillation, heart rate-lowering therapies, management of acute heart failure and the management of patients with mitral regurgitation and heart failure.

  20. A Prognostic Indicator for Patients Hospitalized with Heart Failure.

    Science.gov (United States)

    Snow, Richard; Vogel, Karen; Vanderhoff, Bruce; Kelch, Benjamin P; Ferris, Frank D

    2016-12-01

    Current methods for identifying patients at risk of dying within six months suffer from clinician biases resulting in underestimation of this risk. As a result, patients who are potentially eligible for hospice and palliative care services frequently do not benefit from these services until they are very close to the end of their lives. To develop a prospective prognostic indicator based on actual survival within Centers for Medicare and Medicaid Services (CMS) claims data that identifies patients with congestive heart failure (CHF) who are at risk of six-month mortality. CMS claims data from January 1, 2008 to June 30, 2009 were reviewed to find the first hospitalization for CHF patients with episode of care diagnosis-related groups (DRGs) 291, 292, and 293. Univariate and multivariable analyses were used to determine the associations between demographic and clinical factors and six-month mortality. The resulting model was evaluated for discrimination and calibration. The resulting prospective prognostic model demonstrated fair discrimination with an ROC of 0.71 and good calibration with a Hosmer-Lemshow statistic of 0.98. Across all DRGs, 5% of discharged patients had a six-month mortality risk of greater than 50%. This prospective approach appears to provide a method to identify patients with CHF who would potentially benefit from a clinical evaluation for referral to hospice care or for a palliative care consult due to high predicted risk of dying within 180 days after discharge from a hospital. This approach can provide a model to match at-risk patients with evidenced-based care in a more consistent manner. This method of identifying patients at risk needs further prospective evaluation to see if it has value for clinicians, increases referrals to hospice and palliative care services, and benefits patients and families.