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Search Results: 1 - 10 of 9948 matches for " heart failure "
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Is There a Crisis in Heart Transplantation? Reflection over 10 Years  [PDF]
Karin Purshouse, Stephen Large, Henry Dargie, John Dunning, James Neuberger
Open Journal of Organ Transplant Surgery (OJOTS) , 2012, DOI: 10.4236/ojots.2012.21001
Abstract: Heart transplantation is without doubt a very effective treatment for patients’ whose lives and well-being are threatened by their failing heart. We previously categorized our concerns into four areas or Ds: Donor availability, Disorganization, Disillusionment (of clinicians) and Disaffection (of tomorrow’s clinicians). After a decade, this is a timely reflection on this crisis of cardiac transplantation. It is also appropriate to set this in the context of a fifth D, the Demand for heart transplantation. In this reflective analysis, we use the 5 Ds to explore the current climate in heart transplantation, with particular reference to the situation in the UK.
Impact of chemical elements on heart failure progression in coronary heart disease patients  [PDF]
Karaskov Alexander, Kamenskaya Oksana, Levicheva Elena, Loginova Irina, Okuneva Galina, Cherniavsky Aleksander, Kliver Evgeni, Volkov Alexander
Health (Health) , 2011, DOI: 10.4236/health.2011.35047
Abstract: Background. The high prevalence, poor prog-nosis of patients with coronary heart disease with chronic heart failure determine the relevance of the study pathophysiological and molecular mechanisms of this pathology. Researches of the trace element metabolism in the myocardium are scarce. With this in mind, an attempt was made to analyze the relationship of macro and trace elements metabolism with the functional state of the myocardium in coronary heart disease patients against the background of chronic heart failure progression. Methods and Results. To study the content of the chemical elements (S, K, Ca, Cr, Fe, Ni, Cu, Zn, Se, Rb, Sr) in the myocardium of 43 patients with coronary heart disease, use was made of X-ray fluorescence with synchrotron radiation. While doing autopsy, 43 samples of left ventricle myocardium were taken off the cardiac callosity. Myocardium samples were subjected to histological examination. Dynamics of macro and trace elements content in the myocardium reflects the development of energy deficiency and disorders of myocardial microcirculation with a decrease of systolic myocardial function. Structural/functional disorders in the myocardium of the left ventricle of patients with coronary heart disease that accompany the progression of chronic heart failure are associated with profound changes of metabolic processes in heart muscle. Conclusions. The structural/ functional changes accompanying chronic heart failure progression are associated with wide variations of metabolic processes in the myocardium, which could be evaluated by the content of chemical elements in tissue.
Value of Orthostatic Hypotension as a Prognostic Bed-Side Test in Heart Failure  [PDF]
Tarek M. Abdel Rahman
World Journal of Cardiovascular Surgery (WJCS) , 2012, DOI: 10.4236/wjcs.2012.24022

Background: Neurohumoral compensatory mechanisms play an important role in stabilizing the functional activity of patients with heart failure using the arms of autonomic nervous system. Orthostatic Hypotension (OH) is one of the most incapacitating symptoms of Cardiac Autonomic Dysfunction (CAD). OH can include sympathetic withdrawal which in turn leads to marked disability and deterioration of heart failure symptoms. Progressive Autonomic Dysfunction (AD) associated with progressive deterioration and impact on mortality of many diseases as hypertension, diabetes and other chronic diseases. The idea of using (OH) as a bed-side simple test expecting the risk of deterioration of cardiac function and furthermore on mortality open a gateway for preventive medicine and care to these group of patients. For more confidential prove, studying subjective and objective factors in heart failure patients became necessary to support these idea. Methods and Results: Sixty-Four patients with known history of heart failure were collected. All patients taking the fixed regiment of 4 drugs (diuretic, ACE inhibitor, Digitalis and B-blocker) in appropriate tolerated doses for two weeks prior to the study. History taking and all routine investigations were done for all patients. Grouping is based upon wither they have (OH) or not. Group-A found to have normal Bp response to standing; they were 24 patients (18 male and 6 female) of mean Age (45 ± 8 years). Group-B discovered to have significant (OH) and was 22 patients (16 males and 6 females) of mean Age (43 ± 4 years). The first Clinical and Echocardiographic examination was done and considered as a base-line characteristic. Then, a Call-back after 6 months for follow-up and second visit examination is recorded. Furthermore, every patient was advised to report

Diabetic cardiomyopathy—What do we know about it?  [PDF]
Muhammad Asrar ul Haq, Vivek Mutha, Nima Rudd, Chiew Wong
World Journal of Cardiovascular Diseases (WJCD) , 2013, DOI: 10.4236/wjcd.2013.35A005
Abstract: Diabetic cardiomyopathy is defined as the presence of myocardial dysfunction in patients with diabetes in the absence of coronary artery disease, hypertension, or other known cardiac disease. Diabetes has been shown to affect the heart through various cellular mechanisms leading to enhanced myocardial fibrosis, left ventricular hypertrophy, systolic and diastolic dysfunction. With increasing incidence of type II diabetes mellitus, it has continuously rising health and financial implications in both developed and developing countries. Hyperglycaemia seems to be the main deriving force, and careful glycaemic control as well as early administration of neurohormonal antagonists currently remains the mainstay of therapy. Many newer treatment targets are currently being explored. Here we present a brief review of its pathophysiology, association with heart failure symptoms, and management strategies.

Combined phosphodiesterase inhibitors in end-stage heart failure: A case presentation  [PDF]
Javier Reyna, Julio G. Peguero, Esteban Escolar, Orlando Santana, Gervasio A. Lamas
World Journal of Cardiovascular Diseases (WJCD) , 2013, DOI: 10.4236/wjcd.2013.33042

Heart failure (HF) is the leading cause of morbidity and mortality and is evolving to epidemic proportions. Despite pharmacologic advances and device interventions, HF remains a progressive disease. The phosphodiesterase inhibitors-3 (PDE3I), and more recently, the phosphodiesterase inhibitors-5 (PDE5I) have been used as part of the treatment in certain patients, however, such combination has not been studied or reported before.

The pathophysiology of AHF
—New insights from recent studies of novel diuretics and vascular modulating therapies

Gad Cotter, Olga Milo, Beth Davison
World Journal of Cardiovascular Diseases (WJCD) , 2013, DOI: 10.4236/wjcd.2013.31A020
Abstract: Treatment of chronic congestive heart failure (HF) has improved substantially during the past decades, with the introduction of modulators of the renin angiotensin aldosterone system (RAAS) such as angiotensin converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs) and aldosterone antagonists and the introduction of the lifesaving beta-blockers as well as device therapy. Despite the dramatic improvement in the treatment of chronic HF, no such progress was achieved in the treatment of acute heart failure (AHF). Diuretics that were never rigorously examined in well controlled large prospective randomized studies remain the cornerstone and almost exclusively the only intravenous therapeutic option for AHF and no further effective therapy as introduced in more than 30 years. As a result, the short term morbidity and most importantly mortality of AHF remains extremely high with up to 20% of patients dying in the first months after admission for AHF and an additional 20% being readmitted to the hospital. In the current manuscript we will address the practical concerns regarding established and novel diuretic and vascular modulating therapies in patients with AHF, examine their recommended use and seek to determine a path to developing better and more effective therapies for AHF.
Predictors of Early Readmission in Heart Failure Patients in an Inner-City Community Hospital  [PDF]
Fafa Xexemeku, Arti Singh, Yaw Amoateng Adjepong, Stuart Zarich
World Journal of Cardiovascular Diseases (WJCD) , 2014, DOI: 10.4236/wjcd.2014.49057

Heart failure (HF) is the most common hospital discharge diagnosis among the elderly. It accounts for nearly 1.4 million hospitalizations and $21 billion in spending per year in the United States. Readmission rates remain high with estimates ranging from 15-day readmission rates of 13%, 30- day readmission rates of 25%, to 6-month readmission rates of 50%. The Center for Medicare and Medicaid Services (CMS) has started penalizing hospitals with higher than expected readmission rates. Objective: To identify factors associated with increased 30-day readmission among heart failure patients in an inner-city community-based teaching hospital. Methods: A retrospective cohort study of patients with principal discharge diagnosis of acute Heart Failure between 2008 and 2010. Demographic, clinical characteristics, length of stay, discharge medications, disposition and all-cause 30-day readmission were abstracted from the hospital’s administrative database and analyzed. Results: Almost 8 out of 10 patients were 65 years or older (mean age 75.4 ± 14.3) and 51% were female. The in-hospital mortality rate was 2.7% (95% confidence interval [CI], 1.6% - 4.3%) with a median length of stay of 5.0 days (Interquartile range of 3 - 7). The all-cause 30-day readmission rate was 17.7% (95% CI 14.9% - 20.8%). By univariate analysis, readmissions were predicted by black race, prior history of HF, length of stay of more than 7 days and discharge to extended care facility (ECF). By logistic regression analysis, black race (OR 2.4, 95% CI 1.4 - 3.8), prior history of HF (OR 1.7, 95% CI 1.5 - 2.6) and discharge to an ECF (OR 2.4, 95% CI 1.5 - 3.7) were the independent predictors of 30-day readmission. HF accounted for 43.7% of the readmissions. Conclusion: Prior diagnosis of HF, black race, and discharge to an ECF were independent predictors of 30-day readmission in this cohort, and over half of the readmissions were for reasons other than HF.

Clinical Profile and Treatment Management of Heart Failure with Preserved Systolic Function in Rural Setting of India  [PDF]
Tom Devasia, Sunil Datta Nandibandi, Rama Bhat, Hashir Kareem, Ashok Thakkar
International Journal of Clinical Medicine (IJCM) , 2014, DOI: 10.4236/ijcm.2014.55030

Background: In recent decades, the hospital admission due to heart failure with normal ejection fraction (HFnEF) or diastolic heart failure has increased particularly in elderly patients. However, sufficient data regarding prevalence, etiologies and treatment of diastolic heart failure are not available for Indian population. So, we carried out an observational study to determine clinical profile and medical therapy for patients experiencing diastolic heart failure. Methods: This was prospective observational study carried out in rural area of India for the period of 12 months. All the patients diagnosed with heart failure with normal ejection fraction were included in the study. If the patient was having severe anemia (hemoglobin < 8.00 g/dl), hemodynamically significant valvular disease, prosthetic valve replacement, and ventricular pacemaker, they were excluded. Results: A total of 53 patients diagnosed with HFnEF were included in the study. There were 24 male patients. Hypertension, CAD and diabetes mellitus were present in 33, 24 and 16 patients respectively. 18 patients developed severe diastolic dysfunction and more common in female as compared to male (37.9% vs. 33.3%). Most frequently observed clinical feature was tachycardia (96% cases) followed by pedal edema (86%). The patients were treated according to underlying cause. Conclusions: Diastolic heart failure is more common in elderly patients. In Indian population, diastolic heart failure has been associated with hypertension, diabetes mellitus and coronary artery diseases in most of the

How the community pharmacist contributes to the multidisciplinary management of heart failure  [PDF]
E. Chauvelot, V. Nerich, S. Limat, M. F. Seronde, M. C. Woronoff-Lemsi
Health (Health) , 2010, DOI: 10.4236/health.2010.29160
Abstract: Objective: To define how the community pharmacist contributes to the management of heart failure by exploring the type of service he provides to patients and by assessing what patients expect from him. Setting: Pharmacists of the Franche-Comte region (France) and patients of the Franche-Comté Heart Association. Method: Two questionnaires were drawn up and sent to pharmacists and patients. Results: The 118 pharmacists participating in this survey (36.9%) felt that they had a role to play in dispensing drugs (100.0%), educating patients about their treatment (83.1%), informing patients about the importance of observance (81.4%) and over- the-counter drugs (58.5%), distributing heart failure brochures (51.7%) and providing medical equipment (44.9%). On the other hand, only a third of them thought that they should inform patients about their illness and give advice by phone. On the whole, knowledge level is good for disease, drug therapy, contraindicated drugs, medical supervision and hygieno-dietetic management, but intermediate or poor for alert signs of decompensation, essential vaccinations and patient associations. University training in this area during formal pharmacy studies is considered either “insufficient” or “very insufficient” in 56.9% of cases. Although more than 99% of the pharmacists think that additional training is needed, only 33.1% had actually benefited from such training. Of the 96 patients (48.0%) who completed the questionnaire, 92.6% are faithful to their pharmacist. They contact him more about drug therapy than about their disease, or information related to treatments. Roles attributed to their pharmacist are mainly related to drug therapy explanation and information concerning over-the-counter drugs. Therapeutic education is known to 40.6% of interrogated patients. Among these patients, two-thirds depend on their pharmacist and feel that he is capable of providing the necessary education. Moreover, 46.2% of patients had received some form of therapeutic education from their pharmacist. Pharmacists believe that they are able to assume this role in 67.8% of cases. Conclusion: In spite of biases, this study allowed us to assess the expectations of heart failure patients with regard to the pharmaceutical management of their disease, thus clarifying the indispensable contribution that pharmacists make in the management of this disease.
Gender Effects on Acute Heart Failure  [PDF]
Arnon Blum, Rizak Sirchan, Lital Keinan-Boker
International Journal of Clinical Medicine (IJCM) , 2011, DOI: 10.4236/ijcm.2011.23040
Abstract: Background: Congestive heart failure is the leading cause of hospitalization in the elderly. Little is known about gender effect on baseline characteristics and in-hospital outcome in patients admitted with acute heart failure. Our purpose was to study the gender effect on in-hospital mortality in acute heart failure patients. Methods and Results: A prospective study [143 patients, 67 men (73.9 ± 13.8 years old) and 76 women (77.8 ± 10.1 years old) (p = 0.059)] followed in-hospital outcome of patients with acute heart failure admitted to the hospital. Clinical parameters included body mass index (BMI), ankle brachial index (ABI), left ventricular ejection fraction (LVEF), re-admissions within 1 year, and in-hospital mortality. The gender effects that were studied included height, BMI, smoking, coronary artery disease, LVEF and mortality: in total, 9 (6.3%) patients died, of them 8 (10.5%) women and 1 (1.5%) man. Women were shorter (p < 0.001), had a higher BMI (p = 0.053), reported less frequently on current smoking (p < 0.001), had lower prevalence of coronary artery disease (p = 0.016), had a better LVEF (p = 0.02), but still, had a higher mortality rate (p = 0.026). The only variables independently affecting in-hospital mortality in women were height and recurrent admissions. When we tested for the effect of height and recurrent admissions on mortality only among females by a multivariate analysis height inversely and independently affected in-hospital mortality (p = 0.024), as well as recurrent admissions (p = 0.031). Conclusions: In-hospital mortality was significantly higher in women compared with men admitted with acute heart failure. Among females, the only independent variables that affected mortality were low stature and recurrent admissions.
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