Cardiovascular disease is the prime cause of disability and death in the elderly population. This article provides a brief review of cardiac physiology in this group as well as a discussion of the acute presentation of myocardial ischemia and infarction, congestive heart failure, vascular dysfunction, and complications of valve replacement.

Congestive heart failure is one of the most important causes of peripheral edema seen in clinical practice. Edema in congestive heart failure is the result of the activation of a series of humoral and neurohumoral mechanisms that promote sodium and water reabsorption by the kidneys and expansion of the extracellular ...

The Epstein-Barr virus nuclear antigen-leader protein (EBNA-LP) is required for high efficiency B lymphocyte growth transformation by the virus. To test the potential contribution of EBNA-LP to tumorigenesis in vivo, we produced transgenic mice carrying an EBNA-LP cDNA construct, using the widely expressed metallothionein promoter. Expression of EBNA-LP was detected ...

Patients with advanced congestive heart failure are often severely ill and may experience substantial abnormalities in thyroid hormone metabolism. Thus, we examined this patient population to determine the prevalence and prognostic significance of altered thyroid hormone concentrations, the course of thyroid abnormalities in congestive heart failure survivors, and the potential ...

We describe a 62-year-old dilated cardiomyopathy patient in whom congestive heart failure progressed shortly after DDD mode was changed to VOO mode because of battery exhaustion. Emergency battery exchange with restoration of DDD mode improved his functional status to the previous level; pulmonary capillary wedge pressure decreased from 28 to ...

BACKGROUND: The incidence of thromboembolism and the benefit of anticoagulation in congestive heart failure are controversial. METHODS AND RESULTS: The data base provided by the Veterans Affairs Vasodilator-Heart Failure Trials (V-HeFT I and II) was examined retrospectively to address these issues. In V-HeFT I, 642 men with heart failure were ...

BACKGROUND: Echocardiographic indexes of ventricular function have become indispensable in clinical cardiology but have not been tested as prognostic markers or therapeutic monitors in clinical trials. In two Veterans Administration trials on heart failure (Vasodilator-Heart Failure Trials I and II, V-HeFT I and II), echocardiographic variables were analyzed as predictors ...

The objective of this study was to ascertain whether immune abnormalities were present in a group of patients with chronic stable heart failure at a time when sympathetic drive was not excessive. Elevated sympathetic tone not only plays an important role in the pathophysiologic characteristics of congestive heart failure but ...

Patients presenting in acute congestive heart failure demonstrate severe dyspnea, rales, hypoxia, and chest radiograph findings of acute pulmonary vascular congestion. Not all patients, however, have systolic left ventricular dysfunction. While initial stabilization of an acute episode in decompensated heart failure may follow a common pathway, understanding the nature of ...

Hypocalcemia is a relatively uncommon but reversible cause of left ventricular dysfunction in infants and children. A 30-day-old boy with idiopathic hypocalcemia presented with congestive heart failure and convulsive seizures. He had no evidence of underlying cardiac disease. The cardiac failure responded to calcium therapy. It is suggested that hypocalcemia ...

We have investigated the relationship between plasma endothelin (ET) concentrations and several clinical characteristics in 31 patients with acute myocardial infarction (MI). ET levels were also measured in 10 age-matched healthy subjects, 9 patients with unstable angina, and 20 patients with chronic heart disease. In patients with MI, although no ...

Calcium sensitization increases myocardial contractility by improving energy utilization of the myocardium, without an increase in intracellular concentrations of cyclic adenosine monophosphate. The calcium sensitizer most extensively studied up to now is pimobendan (UD-CG 115 BS). Vasodilatation results primarily from phosphodiesterase III inhibition. Orally administered pimobendan appears rapidly in plasma. ...

BACKGROUND: Instantaneous changes in the heart rate, i.e., heart rate variation, traditionally have been quantified by the standard deviation of a series of intervals between successive heart beats. Approximate entropy provides another measure of variability by calculating the logarithmic likelihood that patterns that are similar remain similar on the next ...

Severe anemia in a weanling kitten resulted in volume overload hypertrophy of the heart and signs of congestive heart failure. A 6-week-old moribund kitten was admitted to the hospital with a PCV of 3%. The anemia was determined to have resulted from severe flea infestation and iron deficiency. Supportive therapy ...

Left ventricular function was investigated by two-dimensional and M-mode echocardiography in 35 patients with acute poststreptococcal glomerulonephritis and in 25 healthy controls. Six of these patients were found to have myocardial dysfunction during the acute congestive phase and convalescent phases of APSGN. One of these 6 patients, later, died. No ...

OBJECTIVE: The aim was to determine the pharmacological reactivity of human small resistance arteries in patients with cardiac failure. METHODS: Small arteries (< 300 microns internal diameter) were removed from gluteal skin biopsy specimens and mounted in a double myograph for isometric force recording. RESULTS: Arteries from six patients with ...

Neurohormonal activation is a fundamental component in the pathophysiology of congestive heart failure. In fact it represents a mechanism consecutive to cardiac dysfunction that favours the development of congestion and of further heart failure through vasoconstriction and water and salt retention. The time of onset and the mechanisms responsible for ...

The phosphodiesterase inhibitors have been recognised as potent inotropic and vasodilating drugs. In acute congestive heart failure they increase cardiac output, decrease left pulmonary capillary wedge pressure, and reduce total peripheral resistance with an improvement in loading conditions of the failing heart. Their potency in reversal of symptoms of acute ...

OBJECTIVES: The aim of this study was to evaluate the immediate and long-term systemic and coronary hemodynamic, metabolic and neurohormonal effects of flosequinan in patients with congestive heart failure. BACKGROUND: Preliminary studies have shown that this new long-acting oral systemic vasodilator may have beneficial effects in patients with heart failure. ...

Rapid ventricular pacing (RVP) is used as an experimental model of congestive heart failure (CHF). The purpose of this study was to determine the energy status of the dog myocardium after the development of CHF via chronic RVP. The myocardium had a significantly lower (P < 0.05) energy charge (EC) ...

Dopamine is an effective drug in the management of acute congestive heart failure. Its beneficial action is due to both cardiovascular--peripheral vasodilation and positive inotropy--and renal effects. Dopexamine is one of the newer dopamine agonists. Like dopamine, however, it can only be administered intravenously, and its value in the chronic ...

Prolonged exposure to organic nitrates has been shown to lead to the rapid development of tolerance to the peripheral and coronary vasodilatory effects of these drugs. As a result of this phenomenon, the hemodynamic and anti-ischemic effects of nitrates may be rapidly attenuated in patients with ischemic heart disease, congestive ...

A rapidly growing body of data supports the concept of in situ regulation of vascular tone: the ability of vasoactive substances to regulate vascular tone at their site of production within the wall of the vasculature. Sufficient data exist to suggest that ineffective production or response to endothelium-dependent vasodilator substances, ...

A patient with a phaeochromocytoma and severe left ventricular heart failure caused by a catecholamine-induced cardiomyopathy is described. The clinical signs of congestive heart failure resolved rapidly on treatment with captopril and myocardial performance became normal within two weeks of medical treatment with captopril for one week and with captopril ...

This article reviews the main contraindications of vasoconstrictors in cardiac patients, notably unstable angina, recent myocardial infarction, recent coronary artery bypass surgery, refractory arrhythmias, untreated or uncontrolled hypertension, and untreated or uncontrolled congestive heart failure. Extensive survey of the literature has been completed, giving specific guidelines for a rational use ...

The purpose of this study was to investigate the therapeutic effect of an alpha 1-blocker, bunazosin, using an experimental murine model of congestive heart failure induced by viral myocarditis. This model is characterized by a high incidence of severe myocarditis and subsequent congestive heart failure, and is suitable for the ...

Natural history of myocardial dysfunction due to chronic contractile deficit consists of physiological and pathophysiological adaptations culminating in congestive heart failure. Among the mechanisms considered is the combination of compensatory as well as the harmful overcompensatory role of the adrenergic system during the genesis of a congestive heart failure "spiral" ...

In a randomized, placebo-controlled, double-blind, crossover comparison, 12 patients with congestive heart failure (New York Heart Association class II) and dyspeptic complaints were treated orally for 1 week each with placebo, 40 mg omeprazole daily, and 40 mg famotidine daily. Non-invasive haemodynamic measurements were taken on the last day of ...

Cardiomyoplasty and skeletal muscle ventricle procedures have shown increasing promise in the treatment of cardiomyopathy with associated chronic congestive heart failure. More than 100 patients have now received such procedures worldwide. The clinical results to date have been mostly anecdotal with subjective improvement but without firm objective data to collaborate ...

Intracerebral arteriovenous malformations (AVM) are a complex medical emergency in neonates. AVMs are congenital communications between the arterial and venous circulation. Occurring early in gestation, they may enlarge over time, promulgating a left-to-right shunt. This volume overload can present as severe congestive heart failure or as pronounced shock. This article ...

Population characteristics, risk factors, and survival characteristics were evaluated in 74 cats with hypertrophic cardiomyopathy (HC) seen at North Carolina State University veterinary teaching hospital from 1985 to 1989, and compared with 82 clinically normal cats. The mean (+/- SD) age of cats with HC was 6.5 (4.0) years. Neutered ...

A three week old girl was admitted to hospital with severe congestive heart failure and cyanosis. Cross sectional and Doppler echocardiography and cardiac catheterisation showed a unique variant of truncus arteriosus with an intact ventricular septum. The trunk rose only from the left ventricle and was associated with a hypoplastic ...

Many patients with thyrotoxicosis have clinical features that reflect the effects of excess thyroid hormone on the cardiovascular system. Thyrotoxicosis can aggravate preexisting cardiac disease and can also lead to atrial fibrillation, congestive heart failure, or worsening of angina pectoris. In elderly patients, these cardiac manifestations may dominate the clinical ...

Limited clinical data suggest that in particular types of congestive heart failure, the cautious use of low-dose à -blockers may be beneficial, despite the well-known cardiodepressant effect of these drugs. Downregulation of cardiac à -adrenoceptors has been demonstrated repeatedly in various forms of congestive heart failure. This phenomenon is caused ...

Depressed heart rate variation has been shown to predict a high mortality rate in patients with severe congestive heart failure. To determine whether the degree of altered heart rate correlates with the clinical state, 24-h Holter monitoring was performed in 21 patients (mean ejection fraction: 18 +/- 11%) at baseline ...

Pneumococcal endocarditis characteristically presents as an acute illness, often accompanied by purulent meningitis, rapid destruction of the heart valves, congestive heart failure, and high mortality. We describe two patients with subacute pneumococcal endocarditis without a known primary source of pneumococcal bacteremia, fever, meningitis, or congestive heart failure. Both patients were ...

Myoglobin is known to protect the mechanical function of the heart from hypoxia by acting as a sarcoplasmic oxygen reservoir and shuttle. We postulated a role for myoglobin in the pathogenesis of congestive heart failure. Several models of congestive heart failure were employed to test the hypothesis, including spontaneous inherited ...

Clinicians must remain undaunted when history, physical examination, and chest radiography suggest congestive heart failure but left ventricular systolic function is normal. Many of these patients have diastolic dysfunction, and standard therapy for left ventricular systolic dysfunction is often ineffectual or detrimental. Noninvasive testing is subject to many pitfalls but ...

The manifestations of cardiac mucormycosis may dominate the clinical picture of disseminated mucormycosis. These manifestations include myocardial infarction, congestive heart failure, conduction system disease, valvular imcompetence and pericarditis. The development of such manifestations in a febrile compromised host with one or more predisposing factors should prompt consideration of disseminated mucormycosis ...

Cardiac transplantation can be a highly successful therapeutic option for patients with end-stage congestive heart failure. Successful results, however, depend on the appropriate selection of patients for the procedure. Patients whose survival or quality of life would be compromised without cardiac transplantation and who are likely to benefit from this ...

Heart transplantation is the procedure of choice for patients with severe congestive heart failure, but many patients are not candidates because of associated medical problems and the lack of donor hearts. Since 1988 we have performed 36 heart transplantations. One and 2-year actuarial survival rates have been 82% and 73%. ...

Coronary arteriovenous fistulae are rare, but can be of hemodynamic significance. We report a circumflex-coronary sinus fistula in an elderly man which was associated with a loud continuous murmur and congestive heart failure. Noninvasive evaluation, including transesophageal echocardiography and magnetic resonance imaging, suggested the diagnosis. Angiographic diagnosis of concomitant atherosclerotic ...

Diagnosing cor pulmonale and detecting left ventricular dysfunction in patients with advanced lung disease are difficult challenges. Usually, routine clinical assessment (history, physical examination, chest radiography, and electrocardiography) is inadequate and additional cardiac diagnostic techniques (eg, two-dimensional echocardiography, first-pass radionuclide angiography) are required for definitive documentation. Diagnosis of cor pulmonale ...

The interrelation of different grades of pulmonary congestion evaluated by chest roentgenogram in the coronary care unit, predischarge left ventricular (LV) ejection fraction (EF) and long-term prognosis was studied in 1,850 surviving patients of acute myocardial infarction (AMI). Pulmonary congestion was categorized as: none, mild or moderate, or severe; LVEF ...

Clinical predictors of in-hospital fatality were assessed in 191 persons admitted to the Yale-New Haven Hospital Intensive Care Unit with a diagnosis of congestive heart failure. In the 17 (8.9%) patients who died, the most important individual predictors among the presenting clinical features were absence of dyspnea, presence of anterior ...

A case of life-threatening adverse effects following intravenous administration of a non-ionic contrast medium is reported. The patient, a 68-year-old diabetic hypertensive male with dyspnoea and cough had an abnormal chest radiograph, revealing congestive heart failure and an enlarged right hilum. Computed tomography (CT) of the chest was performed using ...

The postoperative course in two children with extrahepatic biliary atresia and cardiovascular disease was reviewed and the correlation between biliary drainage and cardiac function was analyzed. Both patients obtained satisfactory biliary drainage after Kasai's hepatic portoenterostomy. One patient developed heart failure postoperatively due to severe viral myocarditis. This child's total ...

Because the Na+ pump is considered to modulate the contractile force development by the cardiac muscle and depressed cardiac pump function is the hallmark of congestive heart failure, we characterized the sarcolemmal Na(+)-K(+)-ATPase activity in failing rat hearts after myocardial infarction. For this purpose, the left ventricular coronary artery was ...

Survival in patients paced for high degree AV block has been demonstrated to be influenced by underlying cardiac disease in particular congestive heart failure. One previous study has suggested that dual chamber pacing may improve the vital prognosis for such patients. To investigate this, 74 patients treated with rate adaptive ...

OBJECTIVE: The aim was to investigate the interrelation between pulsatile components (assessed by determination of aortic input impedance) and neurohormonal activation in chronic congestive heart failure. METHODS: Aortic input impedance, plasma noradrenaline, renin, atrial natriuretic factor, and arginine vasopressin were measured in 20 patients with mild to moderate chronic congestive ...