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Acute Heart Failure (acute + heart_failure)

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Medical Sciences	100%

Selected Abstracts

Acceleration-Dependent Left Bundle Branch Block with Severe Left Ventricular Dyssynchrony Results in Acute Heart Failure: Are There More Patients Who Benefit from Cardiac Resynchronization Therapy?

JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 1 2006
KATJA ZEPPENFELD M.D.
Cardiac resynchronization therapy (CRT) has been proposed to improve hemodynamics in patients with heart failure and left bundle branch block (LBBB) by resynchronization of left ventricular (LV) dyssynchrony. The current report concerns a patient with narrow QRS complex without LV dyssynchrony who experienced an acute exacerbation of heart failure following exercise. Careful analysis revealed that an increase of heart rate induced acceleration-dependent LBBB with severe LV dyssynchrony and mitral regurgitation followed by acute heart failure and hemodynamic collapse. CRT prevented these adverse reactions. Accordingly, optimal evaluation for CRT may include testing for LV dyssynchrony during exercise. [source]

Management Strategies for Stage-D Patients with Acute Heart Failure

CLINICAL CARDIOLOGY, Issue 7 2008
David Feldman M.D., Ph.D.
Abstract Heart Failure (HF) accounted for 3.4 million ambulatory visits in 2000. Current guidelines from the American Heart Association/American College of Cardiology, the Heart Failure Society of America, and the International Society for Heart & Lung Transplantation recommend aggressive pharmacologic interventions for patients with HF. This may include a combination of diuretics, Angiotensin Converting Enzyme inhibitors, ,-blockers, angiotensin receptor blockers, aldosterone antagonists, and digoxin. Nitrates and hydralazine are also indicated as part of standard therapy in addition to ,-blockers and Angiotensin Converting Enzyme inhibitors, especially but not exclusively, for African Americans with left ventricular (LV) systolic dysfunction. For those with acute decompensated HF, additional treatment options include recombinant human B-type natriuretic peptide, and in the future possible newer agents not yet approved for use in the U.S., such as Levosimendan. Medical devices for use in patients with advanced HF include LV assist devices, cardiac resynchronization therapy, and implantable cardioverter defibrillators. For refractory patients, heart transplantation, the gold-standard surgical intervention for the treatment of refractory HF, may be considered. Newer surgical options such as surgical ventricular restoration may be considered in select patients. Copyright © 2007 Wiley Periodicals, Inc. [source]

Acceleration-Dependent Left Bundle Branch Block with Severe Left Ventricular Dyssynchrony Results in Acute Heart Failure: Are There More Patients Who Benefit from Cardiac Resynchronization Therapy?

Acute Myocardial Infarction Complicated by Early Onset of Heart Failure:

JOURNAL OF INTERVENTIONAL CARDIOLOGY, Issue 3 2003
Feasibility of Interhospital Transfer for Coronary Angioplasty., Safety
Objective: The objective of this study is to assess the feasibility and safety of interhospital transfer (within up to 60 minutes) for primary/rescue coronary angioplasty of patients with myocardial infarction (AMI) complicated by an early onset of acute heart failure (AHF) admitted to a community hospital without PCI facilities. Design and patients: From the multicenter randomized PRAGUE-1 study, a subgroup of 66 patients with AMI complicated by AHF on the first presentation to the community hospital were retrospectively analyzed. Group A patients(n = 21)were treated on site in community hospitals using thrombolysis (streptokinase), group B patients(n = 20)were transported with thrombolytic infusion to a PCI center for coronary angioplasty, and group C patients(n = 25)were immediately transported to a PCI center for primary angioplasty without thrombolysis. Results: No patient died during transportation. One group B patient developed ventricular fibrillation during transfer. The time delay from the onset of chest pain to reperfusion was >142 minutes, and 253 and 251 minutes in groups A, B, and C, respectively. Hospital stay (16 vs 11 vs 10 days,P = NS) was shorter in the angioplasty groups. Transported patients (groups B, C) displayed a significant decrease in heart failure progression within the first 24 hours after treatment (48% vs 15% vs 8%,P < 0.05). The combined end point, i.e., mortality + nonfatal reinfarction (43% vs 25% vs 8%,P < 0.05), was significantly less frequent in the coronary angioplasty group. Conclusions: Interhospital transfer for coronary angioplasty of patients with AMI complicated by an early onset of AHF is feasible and safe. Transport for angioplasty may even reduce the risk of heart failure progression and improve clinical outcome compared to immediate thrombolysis in the nearest community hospital. (J Interven Cardiol 2003;16:201,208) [source]

A Prognostic Index Relating 24-Hour Ambulatory Blood Pressure to Cardiac Events in Ischemic Cardiomyopathy Following Defibrillator Implantation

PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 9 2008
LANFRANCO ANTONINI M.D.
Background:We assessed the role of left ventricular ejection fraction and of ambulatory blood pressure monitoring (ABPM) to predict cardiac death and heart failure in patients with defibrillator fulfilling MADIT II criteria. ABPM variables assessed included: mean 24 hours diastolic and systolic blood pressure, mean 24 hours heart rate, and pulse pressure. Methods:We studied 105 consecutive patients (age 67 ± 11), all with a defibrillator and ejection fraction , 30%). Results:At 1-year follow-up, there were 29 events (25%), three cardiac deaths, and 26 hospitalizations for heart failure. Age, creatinine, mean 24 hours diastolic blood pressure, and mean 24 hours systolic blood pressure (but not ejection fraction) were associated with events. A prognostic index (PI) was built by age and ABPM variables, according to the formula (120 , age) + (mean 24 hours diastolic blood pressure + mean 24 hours systolic blood pressure). Receiver operating characteristic curves showed the best cutoff for PI = 220 (sensitivity 81%, specificity 71%, positive predictive value 56%, negative predictive value 88%). Cox regression analysis confirmed the significant association between lower PI (< 220) and clinical events (HR 4.8, 95% CI 1.8,12.3, P = 0.0001 for PI). Overall, 12% of patients with high PI values (, 220 n = 71) had clinical events at 12-month follow-up, compared with 61% of patients with low PI (< 220 n = 34) (P < 0.0001). Conclusion:The PI built by mean 24 hours diastolic and systolic blood pressure and age could be a simple method to stratify risk of cardiac death and acute heart failure in MADIT II patients, in whom ejection fraction, uniformly depressed, is not predictive. [source]

Somatic awareness, uncertainty, and delay in care-seeking in acute heart failure

RESEARCH IN NURSING & HEALTH, Issue 2 2006
Corrine Y. Jurgens
Abstract Symptom monitoring is difficult for heart failure (HF) patients. Difficulties physically sensing and determining symptom meaning may lead to uncertainty and delay treatment. Somatic awareness may provide insight into symptom monitoring ability. A model combining physical and cognitive aspects of the symptom experience was developed to examine factors affecting care-seeking among HF patients. Adults hospitalized with acute HF were interviewed and completed questionnaires measuring somatic awareness and uncertainty. HF symptom duration prior to admission measured delay. HF specific somatic awareness and symptom pattern predicted delay. Uncertainty correlated with somatic awareness, but did not predict delay. Few responded to early HF symptoms delaying until acutely ill. Development of interventions to improve symptom monitoring is needed. © 2006 Wiley Periodicals, Inc. Res Nurs Health 29:74,86, 2006 [source]

Hemodynamic Changes in a Model of Chronic Heart Failure Induced by Multiple Sequential Coronary Microembolization in Sheep

ARTIFICIAL ORGANS, Issue 11 2009
Jan Dieter Schmitto
Abstract Although a large variety of animal models for acute ischemia and acute heart failure exist, valuable models for studies on the effect of ventricular assist devices in chronic heart failure are scarce. We established a stable and reproducible animal model of chronic heart failure in sheep and aimed to investigate the hemodynamic changes of this animal model of chronic heart failure in sheep. In five sheep (n = 5, 77 ± 2 kg), chronic heart failure was induced under flouroscopic guidance by multiple sequential microembolization through bolus injection of polysterol microspheres (90 µm, n = 25.000) into the left main coronary artery. Coronary microembolization (CME) was repeated up to three times in 2 to 3-week intervals until animals started to develop stable signs of heart failure. During each operation, hemodynamic monitoring was performed through implantation of central venous catheter (central venous pressure [CVP]), arterial pressure line (mean arterial pressure [MAP]), implantation of a right heart catheter {Swan-Ganz catheter (mean pulmonary arterial pressure [PAPmean])}, pulmonary capillary wedge pressure (PCWP), and cardiac output [CO]) as well as pre- and postoperative clinical investigations. All animals were followed for 3 months after first microembolization and then sacrificed for histological examination. All animals developed clinical signs of heart failure as indicated by increased heart rate (HR) at rest (68 ± 4 bpm [base] to 93 ± 5 bpm [3 mo][P < 0.05]), increased respiratory rate (RR) at rest (28 ± 5 [base] to 38 ± 7 [3 mo][P < 0.05]), and increased body weight 77 ± 2 kg to 81 ± 2 kg (P < 0.05) due to pleural effusion, peripheral edema, and ascites. Hemodynamic signs of heart failure were revealed as indicated by increase of HR, RR, CVP, PAP, and PCWP as well as a decrease of CO, stroke volume, and MAP 3 months after the first CME. Multiple sequential intracoronary microembolization can effectively induce myocardial dysfunction with clinical and hemodynamic signs of chronic ischemic cardiomyopathy. The present model may be suitable in experimental work on heart failure and left ventricular assist devices, for example, for studying the impact of mechanical unloading, mechanisms of recovery, and reverse remodeling. [source]

A New Approach to Assist Postoperative Heart Failure in an Animal Model: Juxta-Aortic Counterpulsation

ARTIFICIAL ORGANS, Issue 10 2002
Edmundo I. Cabrera Fischer
Abstract: Aortic counterpulsation is a useful technique frequently used in postcardiotomy heart failure. An acute heart failure model in open chest sheep was chosen to evaluate hemodynamic improvement with a counterpulsation balloon pump in juxta-aortic position. This was achieved with a manufactured Dacron prosthesis and a balloon pump placed between the prosthesis and the aorta. Juxta-aortic balloon pump counterpulsation in acute experimental heart failure resulted in a significant improvement of hemodynamic parameters: increase of cardiac output (from 0.86 ± 0.04 to 1.29 ± 0.09 L/min, p < 0.05) and cardiac index (from 0.03 ± 0.01 to 0.04 ± 0.01 L/min per kg, p < 0.05), and decrease of systemic vascular resistance (from 89.76 ± 6.69 to 66.56 ± 6.02 mm Hg/L per min, p < 0.05). The extent of aortic diastolic pressure change evaluated through the diastolic and systolic areas beneath the aortic pressure curve (DABAC/SABAC) index before cardiac failure induction showed a significant increase compared with unassisted values (from 0.81 ± 0.10 to 1.12 ± 0.09, p < 0.05). Assisted values of DABAC/SABAC index after heart failure induction also showed a significant increase compared with unassisted values (from 0.78 ± 0.21 to 1.17 ± 0.38, p < 0.05). Treatment of experimental acute heart failure by juxta-aortic balloon pump counterpulsation allows an effective hemodynamic improvement in open chest sheep. [source]

Assessment and treatment of acute heart failure,Case study: Wet and cold profile

CLINICAL CARDIOLOGY, Issue S5 2004
Richard L. Summers M.D.
No abstract is available for this article. [source]

Assessment and treatment of acute heart failure,Case study: Cold and dry profile

CLINICAL CARDIOLOGY, Issue S5 2004
FACEP, Gerard X. Brogan Jr. M.D.
No abstract is available for this article. [source]

Late potentials and QT dispersion after high-dose chemotherapy in patients with non-Hodgkin lymphoma

CLINICAL PHYSIOLOGY AND FUNCTIONAL IMAGING, Issue 3 2010
Taru Kuittinen
Summary The most common cardiotoxic effects of high-dose cyclophosphamide (CY) are electrocardiographic changes and transient arrhythmias. Therefore, we prospectively assessed serial electrocardiogram (ECG) and signal-averaged electrocardiogram (SAECG) recordings in 30 adult patients with non-Hodgkin lymphoma (NHL) receiving high-dose CY as part of high-dose chemotherapy (HDT) regimen. All patients were treated with anthracyclines earlier. Heart-rate-corrected QT interval and QT dispersion (QTc and QTc dispersion) were measured from ECG. QRS duration and late potentials (LPs) were analysed from SAECG. Both ECG and SAECG were recorded 1 day (d) prior to HDT (d,7) at baseline, and 1 day (d,2), 7 days (d+7), 12 days (+12) and 3 months (m+3) after HDT. Stem cells were infused on day 0 (d0). Cardiac systolic and diastolic function were assessed on (d,7), (d+12) and (m+3) by radionuclide ventriculography. At baseline, four patients presented with LPs. Cardiac systolic function decreased significantly (53 ± 2; 49 ± 2%, P = 0·009 versus baseline), whilst no patient developed acute heart failure. QRS duration prolonged and RMS40 reduced significantly versus baseline (104 ± 3; 107 ± 3 ms, P = 0·003; 41 ± 4; 38 ± 3 ,V, P = 0·03), and six patients (21%) presented with LPs after CY treatment. Both QTc interval and QTc dispersion increased versus baseline (402 ± 5; 423 ± 5 ms, P<0·001; 32 ± 2; 44 ± 3 ms, P = 0·012), and six patients (20%) developed abnormal QT dispersion. In conclusion, high-dose CY causes subclinical and transient electrical instability reflected by occurrence of LPs as well as increased QTc interval and QT dispersion. Thus, longer follow-up is required to confirm the meaning of these adverse effects on cardiac function and quality of life. [source]