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37. Essentials of the Diagnosis of Heart Failure - March 1, 2000 - American Academy of Family Physicians
- www.aafp.org
- Essentials of the Diagnosis of Heart Failure.
- Although heart failure is a common clinical syndrome, especially in the elderly, its diagnosis is often missed. A detailed clinical history is crucial and should address not only current signs and symptoms of heart failure but also signs and symptoms that point to a specific cause of the syndrome, such as coronary artery disease, hypertension or valvular heart disease. ... The physical examination should include Valsalva's maneuver, a test that is highly specific and sensitive for the detection of left ventricular systolic and diastolic dysfunction in patients with heart failure. ... Coronary angiography is indicated in patients with heart failure and anginal chest pain and should be strongly considered in patients with an electrocardiogram suggestive of ischemia or myocardial infarction. ...
- Heart failure affects an estimated 4. ... 2 Each year, about 400,000 new cases of heart failure are diagnosed in the United States. ... 1 Heart failure causes or contributes to approximately 250,000 deaths every year. ...
- The clinical syndrome of heart failure manifests when cellular respiration becomes impaired because the heart cannot pump enough blood to support the metabolic demands of the body, or when normal cellular respiration can only be maintained with an elevated left ventricular filling pressure. ...
- Boston Criteria for Diagnosing Heart Failure .
- The diagnosis of heart failure is classified as "definite" at a score of 8 to 12 points, "possible" at a score of 5 to 7 points, and "unlikely" at a score of 4 points or less.
- The relationship between left ventricular systolic function and congestive heart failure diagnosed by clinical criteria. ...
- The three sets of criteria were designed to assist in the diagnosis of heart failure. ... All of these criteria are most helpful in diagnosing advanced or severe heart failure, a condition that occurs in 20 to 40 percent of patients with a decreased ejection fraction. ...
- Early diagnosis of heart failure is essential for successfully addressing underlying diseases or causes and, in some patients, preventing further myocardial dysfunction and clinical deterioration. However, initial diagnosis may be difficult because the presentations of heart failure can change from no symptoms to pulmonary edema with cardiogenic shock. It is estimated that heart failure is correctly diagnosed initially in only 50 percent of affected patients. ...
38. Heart failure in 10 years time: focus on pharmacological treatment -- McMurray 88 (Supplement 2): 40 -- Heart
- heart.bmjjournals.com
- Heart Failure .
- Heart failure in 10 years time: focus on pharmacological treatment .
- Keywords: heart failure; drug treatment; angiotensin converting enzyme inhibitors; ß blockers.
- Abbreviations: ACE, angiotensin converting enzyme; ANP, atrial natriuretic peptide; BNP brain natriuretic peptide; CHF, chronic heart failure; ET-1, endothelin-1; ICD, implantable cardioverter-defibrillator; NEP neutral endopeptidase; NYHA, New York Heart Association.
- Though the last decade has seen three major breakthroughs in chronic heart failure (CHF) treatment (with angiotensin converting enzyme (ACE) inhibitors,1,2 ß blockers,35 and spironolactone6), the outlook of patients with this condition remains very poor. ... 8 In one part of the UK, 45% of patients died within one year of discharge from their first ever hospital admission with heart failure. 8 The case fatality rate reached 77% within five years and the medial survival of a man discharged after his first heart failure hospitalisation was only 1. ...
- Where should we look for new treatments? To date, the best framework we have for understanding heart failure is what has become known as the "neurohumoral hypothesis", first developed in the early 1980s and much modified since (fig 1). 9 Essentially, this paradigm identifies a key contributing role for neurohumoral factors in the pathophysiological progression of heart failure. ... According to the neurohumoral model of heart failure, inhibition of the actions of these detrimental mediators should break into the neurohumoral "vicious cycle" of heart failure, thereby slowing down the relentless clinical progression that characterises the syndrome. ... 17 Consequently, the identification and antagonism of the effects of other potentially detrimental "humoral" factors is one timely avenue to future therapeutic success in heart failure. More recently, we have also come to recognise that there are neurohumoral factors with potentially beneficial effects in heart failure, and augmentation of the action of these might also represent a useful therapeutic strategy in CHF. ...
- Figure 1 The "neurohumoral" model of heart failure. ...
- 11,12 These effects, not surprisingly, are of potential benefit in heart failure. Early studies with NEP inhibitors in heart failure were encouraging, demonstrating favourable haemodynamic and neurohumoral effects and improvements in exercise tolerance. ... This, plus the unexpected toxicity related to ecadotril,16 were factors stopping further development of NEP inhibitors in heart failure. More recently, molecules that inhibit both ACE and NEP have started to undergo investigation in heart failure. ... A number of studies with omapatrilat have shown favourable haemodynamic and neurohumoral effects in heart failure. ...
39. THE MERCK MANUAL, Sec. 16, Ch. 203, Heart Failure
- www.merck.com
- Heart Failure .
- Heart failure (congestive heart failure): Symptomatic myocardial dysfunction resulting in a characteristic pattern of hemodynamic, renal, and neurohormonal responses.
- (For heart failure in children, see Ch. ...
- No definition of heart failure (HF) is entirely satisfactory. Congestive heart failure (CHF) develops when plasma volume increases and fluid accumulates in the lungs, abdominal organs (especially the liver), and peripheral tissues.
- Left ventricular (LV) failure characteristically develops in coronary artery disease, hypertension, and most forms of cardiomyopathy and with congenital defects (eg, ventricular septal defect, patent ductus arteriosus with large shunts).
- Right ventricular (RV) failure is most commonly caused by prior LV failure (which increases pulmonary venous pressure and leads to pulmonary arterial hypertension) and tricuspid regurgitation. ... Volume overload and increased systemic venous pressure may also occur in polycythemia or overtransfusion, acute renal failure with overhydration, and obstruction of either vena cava simulating HF. ...
- High output failure is HF associated with a persistent high CO that eventually results in ventricular dysfunction. ...
- In LV failure, CO declines and pulmonary venous pressure increases. ... Pulmonary venous hypertension and edema resulting from LV failure significantly alter pulmonary mechanics and, thereby, ventilation/perfusion relationships. ... A combination of alveolar hyperventilation due to increased lung stiffness and reduced PAO2 is characteristic of LV failure. ... A PaCO2 above normal signifies alveolar hypoventilation possibly due to respiratory muscle failure and requires urgent ventilatory support.
- In RV failure, systemic venous congestive symptoms develop. Moderate hepatic dysfunction commonly occurs in CHF secondary to RV failure, with usually modest increases in conjugated and unconjugated bilirubin, prothrombin time, and hepatic enzymes (eg, alkaline phosphatase, AST, ALT). However, in severely compromised circulatory states with markedly reduced splanchnic blood flow and hypotension, increases due to central necrosis around the hepatic veins may be severe enough to suggest hepatitis with acute liver failure. ...
40. Upregulation of Aquaporin-2 Water Channel Expression in Chronic Heart Failure Rat -- Xu et al. 99 (7): 1500 -- Journal of Clinical Investigation
- www.jci.org
- Upregulation of Aquaporin-2 Water Channel Expression in Chronic Heart Failure Rat .
- Chronic heart failure (CHF) is characterized by abnormal renal water retention. ...
- Vasopressin antagonism: a future treatment option in heart failure.
- Neuroendocrine and renal effects of intravascular volume expansion in compensated heart failure.
- Water retention and aquaporins in heart failure, liver disease and pregnancy.
- Hormones and Hemodynamics in Heart Failure.
- Selective V2-Receptor Vasopressin Antagonism Decreases Urinary Aquaporin-2 Excretion in Patients with Chronic Heart Failure.
- Decreased Abundance of Collecting Duct Aquaporins in Post-Ischemic Renal Failure in Rats.
41. Heart Failure: The frequent, forgotten, and often fatal complication of diabetes -- Bell 26 (8): 2433 -- Diabetes Care
- care.diabetesjournals.org
- Heart Failure .
- There is a high frequency of heart failure (HF) accompanied by an increased mortality risk for patients with diabetes. ...
- Abbreviations: ANG-II, angiotensin-II ANP, atrial natriuretic peptide ATLAS, Assessment of Treatment with Lisinopril and Survival BNP, brain natriuretic peptide CHF, chronic heart failure CPT-1, carnitine palmityl transferase 1 DIGAMI, Diabetes Insulin Glucose in Acute Myocardial Infarction FFA, free fatty acid HF, heart failure MHC, myosin heavy chain MI, myocardial infarction RAS renin-angiotensin system RESOLVD, Randomized Evaluation for Strategies of Left Ventricular Dysfunction SERCA-2, sarcoplasmic reticular Ca2+ ATPase SNS, sympathetic nervous system SOLVD, Studies of Left Ventricular Dysfunction TZD, thiazolidinedione.
- Heart failure (HF) is a common and serious comorbidity of diabetes. ...
- However, only those patients with incident chronic heart failure (CHF) were more likely to have had follow-up HbA1c tests than those free of CHF (2). ...
- Diabetic subjects make up 25% of all patients enrolled in large-scale clinical trials evaluating treatments for HF: 23% in the Cooperative North Scandinavian Enalapril Survival Study, 25% in SOLVD (Studies of Left Ventricular Dysfunction), 20% in the Vasodilation Heart Failure Trial II, 20% in ATLAS (Assessment of Treatment with Lisinopril and Survival), and 27% in RESOLVD (Randomized Evaluation for Strategies of Left Ventricular Dysfunction) (812). ...
- Table 1 Epidemiology of heart failure in diabetic patients.
- Animals with experimental diabetic cardiomyopathy exhibit biochemical and molecular abnormalities resembling those seen in human myocardial failure stemming from hemodynamic overload (26), which potentially contribute to HF. ... Activation of these and other autocrine and paracrine systems leads to the progressive loss of cardiac myocytes because of accelerated apoptosis and necrosis, eventuating in further myocardial dysfunction and the downward spiral of cardiac failure. ...
- Table 2 Etiology of heart failure in diabetic patients.
- Heart failure is associated with the harmful effects of chronic SNS activation. ...
- Carvedilol and Copernicus studies, the mortality and morbidity outcomes for the diabetic subjects were at least as good as those of the nondiabetic subjects, and in the MERIT-HF (Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure), diabetic patients treated with metoprolol CR/XL showed a trend in a similar direction. ... Carvedilol Heart Failure Study, treatment with a ß-blocker decreased overall mortality by 65% (P < 0. ...
- Table 3 Treatment and prevention of heart failure in diabetic patients.
- Nichols GA, Hillier TA, Erbey JR, Brown JB: Congestive heart failure in type 2 diabetes: prevalence, incidence, and risk factors. ...
- Aronow WS, Ahn C: Incidence of heart failure in 2,737 older persons with and without diabetes mellitus. ...
42. Upregulation of Aquaporin-2 Water Channel Expression in Chronic Heart Failure Rat -- Xu et al. 99 (7): 1500 -- Journal of Clinical Investigation
- www.jci.org
- Upregulation of Aquaporin-2 Water Channel Expression in Chronic Heart Failure Rat .
- Chronic heart failure (CHF) is characterized by abnormal renal water retention. ...
- Water retention is characteristic of advanced congestive heart failure (CHF)1 (1). Moreover, hyponatremia is a well-defined predictor of mortality of heart failure (2, 3). ...
- Experimental heart failure .
- Using this method there is a 30-40% mortality within the first 24 h after the operation due to acute heart failure. ...
- Protocol I: AQP2 gene expression in experimental heart failure rats model. ...
- Effects of OPC 31260 on plasma sodium, osmolality, urine volume, and AVP concentration in experimental heart failure rats. ...
- Pretreatment hyponatremia is a common finding in advanced cardiac failure (2, 3). ... Using a sensitive radioimmunoassay for AVP, however, heart failure patients with hypoosmolality of a degree sufficient to suppress AVP to undetectable levels in normal subjects were shown to have inappropriately high plasma concentrations of AVP (4). ... An important role of AVP in the hyponatremia associated with CHF was further suggested by the demonstration of an increased expression of the mRNA for vasopressin in the hypothalamus of cardiac failure but not control animals (6). ...
- (1988) Pathogenesis of sodium and water retention in highoutput and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy (1). ...
- Rector (1984) Plasma norepinephrine as a guide to prognosis in patient with chronic congestive heart failure. ...
- Packer (1986) Pronostic importance of serum concentration and its modification by converting-enzyme inhibition in patients with severe chronic heart failure. ...
- Schrier (1981) Radioimmunoassay of plasma arginine vasopressin in hyponatremic patients with congestive heart failure. ...
- Cowley (1986) Arginine vasopressin and the renal response to water loading in congestive heart failure. ...
43. Prevention and Treatment of Acute Renal Failure in Sepsis -- De Vriese 14 (3): 792 -- Journal of the American Society of Nephrology
- www.jasn.org
- Prevention and Treatment of Acute Renal Failure in Sepsis .
- Acute renal failure (ARF) is a common complication of sepsis and carries an ominous prognosis. ... 5%) than in those whose renal failure did not result from sepsis (45. ...
- However, a randomized trial of 300 trauma or postoperative patients with sepsis found no difference in mortality or incidence of renal failure between patients resuscitated with hydroxyethylstarch or albumin (11). ...
- There were, however, no significant differences in the clinical characteristics, the severity of renal failure, and the mortality rate between spontaneously non-oliguric patients and patients becoming non-oliguric after furosemide (3334). These observations imply that patients responding to loop diuretics are characterized by a less severe form of renal failure, rather than a beneficial effect of therapy. ...
- Neutralization of TNF- with a TNF-soluble receptor protected mice against LPS-induced renal failure (43). Mice with a targeted deletion of TNF receptor-1 (TNFR1-/-) were resistant to LPS-induced renal failure (44). ... In addition, TNFR1+/+ kidneys transplanted in TNFR1-/- mice sustained severe renal failure after LPS injection, whereas TNFR1-/- kidneys transplanted in TNFR1+/+ mice were relatively protected. Finally, the fact that TNFR1-/- mice remain sensitive to the lethal effects of LPS (45) but are resistant to LPS-induced renal failure further supports a renal-specific role for TNF-. ...
- Although the BAY 1351 monoclonal anti-TNF- antibody did not improve survival in patients with septic shock, a reduction in the development of renal failure was observed (47). ...
- Despite the apparent success of anti-TNF therapies in animal models with prevention of both mortality and renal failure, the beneficial effects of these strategies in humans are marginal at best. ...
- In agreement, the degree of renal failure after LPS infusion was similar in iNOS knockout mice as compared with wild-type mice (43). ...
- A nonselective ET antagonist increased the risk of contrast nephropathy in patients with chronic renal failure undergoing coronary angiography. ...
- In patients with sepsis, cyclooxygenase inhibition with ibuprofen reduced the synthesis of thromboxane and prostacyclin, but it had no effect on the development of shock or renal failure and did not improve survival (76). ...
- As vasodilatory prostaglandins may be important to maintain RBF by opposing the vasoconstrictive influences, the failure of ibuprofen to improve renal function in sepsis is not surprising. ...
44. Non-invasive ventilation in acute respiratory failure -- 57 (3): 192 -- Thorax
- thorax.bmjjournals.com
- Non-invasive ventilation in acute respiratory failure .
- Keywords: non-invasive ventilation; acute respiratory failure; BTS guideline.
- Abbreviations: AHRF, acute hypercapnic respiratory failure; ARDS, acute respiratory distress syndrome; ASB, assisted spontaneous breathing; BMI, body mass index; CMV, continuous mandatory ventilation; COPD, chronic obstructive pulmonary disease; CPAP, continuous positive airways pressure; EPAP, expiratory positive airways pressure; FiO2, fractionated inspired oxygen concentration; FRC, functional residual capacity; HDU, high dependency unit; ICU, intensive care unit; IE, inspiratory/expiratory; IPAP, inspiratory positive airways pressure; IPPV, intermittent positive pressure ventilation; LTOT, long term oxygen therapy; NIV, non-invasive ventilation; OSA, obstructive sleep apnoea; PaCO2, partial pressure of arterial carbon dioxide; PaO2, partial pressure of arterial oxygen; PAV, proportional assist ventilation; PEEP, positive end expiratory pressure; PEEPi, intrinsic PEEP; PS, pressure support; SpO2, oxygen saturation; SIMV, synchronised intermittent mandatory ventilation; S/T, spontaneous/timed; V/Q, ventilation perfusion.
- Although it might be open to debate as to whether the use of non-invasive CPAP in acute respiratory failure constitutes ventilatory support, it is included in this document because of the confusion which commonly arises between NIV and CPAP in clinical practice. ...
- 1,2 This has proved to be so successful that it has become widely accepted as the standard method of non-invasive ventilation used in patients with chronic hypercapnic respiratory failure caused by chest wall deformity, neuromuscular disease, or impaired central respiratory drive. ...
- Within a few years of its introduction, NIV was starting to be used in acute hypercapnic respiratory failure and in patients with abnormal lungs rather than an impaired respiratory pump. ... Analysis of these trials has shown that NIV is a valuable treatment for acute hypercapnic respiratory failure, as will be discussed under the section on Indications. ...
- Non-invasive ventilation has been shown to be an effective treatment for acute hypercapnic respiratory failure, particularly in chronic obstructive pulmonary disease. ...
- NIV is not suitable for all patients with respiratory failure. ...
- Set standards of care for patients receiving NIV in acute respiratory failure based on the available evidence and define minimum standards for the provision of an acute NIV service .
- Identify which patients with acute respiratory failure should be considered for NIV or CPAP .
- Define minimal monitoring requirements and give guidance on what to do in the event of treatment failure .
- Identify which patients should be referred for long term NIV after initial treatment of their acute respiratory failure .
- Facilitate collection of data on the use of NIV in acute respiratory failure and provide tools for audit .
- Hypercapnic respiratory failure secondary to chest wall deformity (scoliosis, thoracoplasty) or neuromuscular diseases.
- Fewer deaths of patients with acute respiratory failure.
45. Failure Is Impossible: A Member of the Reality-Based Community
- www.failureisimpossible.com
- Failure Is Impossible .
- "Failure is impossible. ...
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