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PubMed2006

Congestive heart failure caused by intracardiac tumours in two dogs.

Congestive heart failure is a common presentation in small animal practice. Cardiac tumours are an unusual cause of congestive heart failure and, when they occur, usually cause clinical signs associated with pericardial effusion and cardiac tamponade. This case report outlines the clinical and histological findings in two dogs presented with clinical signs of congestive heart failure caused by obstruction of blood flow by intracavitary cardiac tumours. Case 1 showed signs of left-sided heart failure caused by osteosarcoma within the left atrial lumen, and case 2 presented with clinical signs of right-sided heart failure due to haemangiosarcoma occupying the right atrial and ventricular lumens. This case report provides further evidence for the inclusion of intracardiac neoplasia in the differential diagnosis for dogs with clinical signs of congestive heart failure.

Animals↗

PubMed2004

Management of Chronic Congestive Heart Failure in Children.

The medical management of congestive heart failure involves manipulating myocardial contractility and loading conditions to achieve optimal performance. Medication may be used to counteract potentially deleterious neurohumoral changes that are associated with congestive heart failure. When appropriate, the correction of the underlying cardiac defect by surgery or catheter intervention is usually the most effective treatment for congestive heart failure in children.

Journal Article↗

PubMed1981

Sustained effectiveness of chronic prazosin therapy in severe chronic congestive heart failure.

Twelve patients with severe chronic congestive heart failure (CHF) (NYHA class III and IV) resistant to digitalis and diuretics were treated with the postsynaptic alpha-blocking agent prazosin (PZ) (3 to 20 mg/day). In 11 patients oral PZ treatment was well tolerated; the agent was discontinued in the remaining patient because of orthostatic dizziness. After 4 weeks of PZ, total systemic vascular resistance decreased from 2245 +/- 792 to 1603 +/- 355 dyn sec cm-5, mean blood pressure declined from 100 +/- 15 to 90 +/- 14 mm Hg, and pulmonary capillary wedge pressure decreased from 29 +/- 8 to 25 +/- 9 mm Hg. Cardiac index increased from 1.92 +/- 0.63 to 2.30 +/- 0.41 l/min/m2. The increase of stroke volume index correlated with the fall in peripheral vascular resistance (r = --0.79, p less than 0.01) and the decline in pulmonary capillary wedge pressure (r = --0.75, p less than 0.05). In parallel, exercise tolerance increased significantly. Four patients improved from functional class IV to II, four from class IV to III, and one from class III to II, while two patients were unchanged. In the eight patients followed for 6 months, the beneficial effects of ambulatory PZ were maintained throughout the expansive observation period. Three patients died as their disease process progressed during the study (sudden death, pneumonia, and post-PZ withdrawal pump failure). Prazosin is a valuable vasodilator for long-term treatment of otherwise refractory congestive heart failure with the agent given in sufficient individualized dosage.

Aged↗

PubMedDate not supplied

Do hemodynamic indices correlate with maximum exercise capacity and oxygen consumption in chronic congestive heart failure?

The mechanism of exercise intolerance in chronic congestive heart failure remains unclear. We correlated resting haemodynamic variables with the peak exercise capacity and maximum oxygen consumption (VO2 max) in patients with congestive heart failure in 27 studies on treadmill exercise testing using the modified Bruce protocol. VO2 max was measured using breath by breath expiratory gas analysis. The patients were in severe congestive heart failure (NYHA class II and III, pulmonary artery wedge pressure 23 +/- 2 mmHg, cardiac index 2.4 +/- 0.21 l/min/m2). VO2 max was 23 +/- 2 ml/kg/min. Fatigue was the commonest symptom limiting the exercise. None of the hemodynamic variables correlated well with VO2 max. [right atrial pressure (r = 0.08), pulmonary artery pressure (r = 0.05), pulmonary artery wedge pressure (r = 0.08), aortic pressure (r = -0.3) & cardiac index (r = 0.29)]. Both uni- and multi-variate analysis failed to show any relation between VO2 max and resting hemodynamic variables. We conclude that unlike the acute heart failure syndromes, resting hemodynamic variables do not correlate with exercise capacity in patients with chronic congestive heart failure. The abnormal resting haemodynamics do not limit exercise in these patients. Peripheral mechanisms may thus be more important.

Cardiac Output, Low↗

PubMed2006

Incidence and predictors of development of acute renal failure related to treatment of congestive heart failure with ACE inhibitors.

BACKGROUND/AIMS: Recent studies have shown high rates of morbimortality associated with hyperkalemia in congestive heart failure (CHF) patients treated with angiotensin-converting enzyme inhibitors (ACEI) plus spironolactone and the best predictor of this electrolytic disorder was a decrease in renal function. We aim to identify the incidence and predictors of acute renal failure (ARF) related to treatment with ACEI associated or not with spironolactone. METHODS: We conducted a cohort study and followed 114 consecutive cases of CHF patients treated with ACEI at admission to a University Hospital. We performed measurements of serum creatinine and potassium levels three times a week, and systolic and diastolic blood pressures every 8 h, daily. RESULTS: Among 114 patients, 25% developed ARF, 15% hyperkalemia and 3% severe hyperkalemia. Predictors of ARF were a decrease in average blood pressure 25 mm Hg (OR 18.2; 95% CI: 6.2, 53.5); class IV CHF (OR 4.7; 95% CI: 1.7, 12.7), diabetes (OR 2.6; 95% CI: 1.1, 6.4) and hypertension (OR 3.0; 95% CI: 1.2, 7.4). CONCLUSIONS: ARF and hyperkalemia are common complications in CHF patients after treatment with ACEI. Diabetic, hypertensive and class IV CHF patients who experienced a decrease in average blood pressure 25 mm Hg were more susceptible to ARF.

Acute Kidney Injury↗

PubMed1998

[Intra- and extravascular volumes in congestive heart failure and their redistribution following extracorporeal ultrafiltration].

In advanced congestive heart failure with fluid retention, extracorporeal ultrafiltration (UF) causes persistent relief of edema or anasarca through hemodynamic and humoral changes that interrupt refractoriness to diuretics. The intra and extravascular fluid partition in congestive heart failure, as well as changes occurring in the two compartments following fluid withdrawal with UF, are unknown. In 8 congestive heart failure patients with severe fluid retention undergoing UF, we measured total (TBV), intrathoracic (ITBV) and pulmonary blood volumes (PBV), and extravascular lung water (EVLW). The intra and extravascular volumes were evaluated by a fiberoptic thermal dye dilution monitoring system, before, at the end of UF (3697 +/- 699 ml) and 24 hours later. Baseline data were compared with those of 10 subjects without heart failure undergoing coronary bypass surgery. In congestive heart failure patients, as compared with controls, TBV was normal, the intrathoracic blood content (ITBV, PBV and PBV/TBV ratio) was increased and EVLW was normal. UF did not induce significant changes in TBV and in EVLW, and reduced ITBV, PBV and PBV/TBV ratio, suggesting that a shift of fluid from the intra to the extrathoracic intravascular compartment occurred. Because both TBV and EVLW were not affected by the procedure, the largest proportion of fluid removed by UF derived from the systemic extravascular space. Both pulmonary wedge and right atrial pressures significantly decreased after UF, and cardiac output increased. In conclusion, congestive heart failure is associated with normal TBV and EVLW content and with intravascular intrathoracic hypervolemia and extrathoracic hypovolemia. UF induces hemodynamic improvement through a selective fluid removal from the extravascular systemic space without changes in both TBV and EVLW.

Aged↗

PubMed1988

Short-term hemodynamic effects of vasopressin V1-receptor inhibition in chronic right-sided congestive heart failure.

Arginine vasopressin is elevated in congestive heart failure. To determine the effect of arginine vasopressin upon systemic hemodynamics and regional blood flows, we administered the specific inhibitor of the vascular action of vasopressin [1-(beta-mercapto-beta,beta-cyclopentamethylenepropionic acid),2-(O-methyl)-tyrosine]-arginine vasopressin [d(CH2)5Tyr(Me)AVP] to 15 dogs with chronic right-heart failure produced by tricuspid avulsion and progressive pulmonary artery constriction. The animals exhibited increased plasma arginine vasopressin and norepinephrine levels. Vasopressin inhibition increased cardiac output and left ventricular dP/dt and dP/dt/P, and it decreased total peripheral vascular resistance, whereas mean aortic pressure did not change significantly. Simultaneously, blood flow increased to skeletal muscle, kidneys, skin, and right and left ventricular myocardium. Plasma catecholamines also increased. Pretreatment with propranolol and prazosin abolished the increases in cardiac output and left ventricular function produced by vasopressin inhibition. Pretreatment also led to a decrease in mean aortic pressure after vasopressor inhibition. In contrast, administration of d(CH)2)5Tyr(Me)AVP to 11 sham-operated animals or administration of normal saline to nine sham-operated and eight heart-failure dogs was without effect either in the absence or in the presence of adrenergic receptor blockade. Thus, arginine vasopressin participates in the control of the circulation in right-sided congestive heart failure, with both a direct constrictor action on blood vessels and an indirect action by inhibition of the sympathetic nervous system.

Animals↗

PubMedDate not supplied

Depression and congestive heart failure.

The prevalence rates of depression in congestive heart failure patients range from 24%-42%. Depression is a graded, independent risk factor for readmission to the hospital, functional decline, and mortality in patients with congestive heart failure. Physicians can assess depression by using the SIG E CAPS + mood mnemonic, or any of a number of easily administered and scored self-report inventories. Cognitive-behavior therapy is the preferred psychological treatment. Cognitive-behavior therapy emphasizes the reciprocal interactions among physiology, environmental events, thoughts, and behaviors, and how these may be altered to produce changes in mood and behavior. Pharmacologically, the selective serotonin reuptake inhibitors are recommended, whereas the tricyclic antidepressants are not recommended for depression in congestive heart failure patients. The combination of a selective serotonin reuptake inhibitor with cognitive-behavior therapy is often the most effective treatment.

Antidepressive Agents↗

PubMed1981

Congestive heart failure due to adriamycin cardiotoxicity: its natural history in children.

The congestive heart failure (CHF) associated with Adriamycin cardiotoxicity is frequently fatal. To investigate the course of Adriamycin-induced congestive heart failure, all Adriamycin-treated children who developed congestive heart failure at the Children's Hospital Medical Center and Sidney Farber Cancer Institute were studied. Criteria for Adriamycin-induced congestive heart failure included clinical evidence of left ventricular (LV) failure and echocardiographic evidence of abnormal left ventricular function. Fifteen children fulfilled these criteria. Eleven patients received between 400 and 500 mg/m2 of Adriamycin; four patients received cumulative doses over 500 mg/m2. Twelve of 15 (80%) children survived their acute episode of congestive heart failure. At follow-up, three patients had normalized their echocardiographic parameters of left ventricular function, three had died of their malignancies with compensated cardiac function until death, and six were clinically asymptomatic despite persistence of abnormal LV function on echocardiogram. Only three patients died of Adriamycin cardiomyopathy. In children treated with aggressive medical therapy, congestive heart failure secondary to Adriamycin cardiotoxicity may be reversible in certain cases.

Adolescent↗

PubMed1986

Intermittent, ambulatory dobutamine infusions in patients with severe congestive heart failure.

Thirteen ambulatory patients with severe congestive heart failure were treated with weekly, outpatient 48-hour infusions of dobutamine. All 13 patients had at least a 25% increase in cardiac output during initial dobutamine titration, with a corresponding improvement in systemic vascular resistance. Improvement in functional class was achieved in only seven patients. Additionally, only three patients survived the 26-week study period. Although no change in ventricular ectopy was noted during the initial dobutamine infusions, six patients experienced sudden death; three other patients died of progressive heart failure and one died from pulmonary embolism. These data suggest that chronic intermittent ambulatory dobutamine infusions are only partly successful in improving symptoms and probably do not prolong survival in patients with severe congestive heart failure. Administration of this form of therapy on a clinical basis should be undertaken cautiously until safety and efficacy are demonstrated in prospective, controlled trials.

Aged↗

PubMed2001

Effects of endothelin receptor A antagonist FR139317 on rats with congestive heart failure.

AIM: To study the effects of a selective endothelin receptor A (ETA) antagonist FR139317 on rats with congestive heart failure. METHODS: A congestive heart failure model was established via left coronary artery ligation in adult male Wistar rats. The rats with congestive heart failure were treated with FR139317 at two doses (1 and 5 mg . kg-1 . d-1 respectively for 6 weeks) or with vehicle. Hemodynamics, plasma level of endothelin-1 (ET-1), and mortality rate of rats were measured. RESULTS: Both groups treated with FR139317 (high and low dose) have lower mortality rate (25.0 % and 28.6 % vs 50.0 %) and lower plasma level of ET-1 than that of vehicle [(3.6 +/- 1.2) ng/L and (4.9 +/- 1.5) ng/L vs (5.8 +/- 1.3) ng/L]. Comparing to vehicle group, left ventricular end-diastolic pressures of the FR139317-treated groups were improved significantly [(12 +/- 6) mmHg and (14 +/- 7) mmHg vs (22 +/- 9) mmHg]. FR139317 at a higher dose reduced the mean arterial pressure of the rats with congestive heart failure and decreased the plasma concentration of endothelin to a closer level of rats with normal heart function than lower dose. CONCLUSION: Selective ETA antagonist FR139317 improved the hemodynamics and reduced the plasma ET-1 level and the mortality of rats with congestive heart failure

Animals↗

PubMed1990

Portal blood flow in congestive heart failure: pulsed duplex sonographic findings.

Twenty-one patients with congestive heart failure were examined with duplex sonographic scanning of the portal vein. The Doppler sonographic findings were compared with those of healthy subjects, patients with chronic liver disease, and patients with Budd-Chiari syndrome. Increasing pulsatility of the Doppler signals was demonstrated in 11 patients with severe congestive heart failure. Two patients with severe congestive heart failure showed decreasing pulsatility of portal Doppler signals in response to therapeutic procedures. Portal flow patterns suggestive of severe congestive heart failure include a monophasic forward flow with peak velocity in ventricular diastole and gradual diminution of velocity throughout ventricular systole (n = 5), a reversed flow velocity in ventricular systole (n = 3), and vena cava-like biphasic forward velocity peaks during each cardiac cycle (n = 2). The time-velocity waveform shape of portal flow is, to a large degree, influenced by the mechanical events in the right side of the heart in severe congestive heart failure.

Blood Flow Velocity↗

PubMed2005

Effects of angiotensin-converting enzyme inhibitor plus irbesartan on maximal and submaximal exercise capacity and neurohumoral activation in patients with congestive heart failure.

BACKGROUND: In patients with symptomatic congestive heart failure receiving optimal therapy with an angiotensin-converting enzyme (ACE) inhibitor and a beta-blocker, the impact of using an angiotensin receptor blocker on submaximal exercise capacity and on neurohumoral activation at rest and during stress has not been investigated. METHODS: Thirty-three patients with congestive heart failure, New York Heart Association II or III symptoms, and left ventricular ejection fraction 25.5% +/- 7.2% treated with an ACE inhibitor and a beta-blocker were recruited. Patients were randomly assigned to receive irbesartan 150 mg per day (n = 22) or a placebo (n = 11) for 6 months. Maximal exercise capacity was assessed using a ramp protocol. Submaximal exercise duration was assessed using a constant load protocol, and plasma norepinephrine and angiotensin II (A-II) were measured in resting state, at 6 minutes, and at peak exercise. RESULTS: Patients treated with irbesartan presented a 26% increase in submaximal exercise time (+281 seconds, P = .08) whereas exercise duration increased by only 7% in patients treated with a placebo (+128 seconds, P = NS irbesartan vs placebo). Norepinephrine levels increased to a similar extent in both groups, whereas A-II levels did not increase or change in response to therapy. CONCLUSIONS: Dual A-II suppression with an ACE inhibitor plus irbesartan provides a small but a significant increase in submaximal exercise capacity. This beneficial effect is observed despite no significant changes in maximal exercise capacity, and in resting or exercise-induced increase in neurohumoral activation.

Adrenergic beta-Antagonists↗

PubMedDate not supplied

The relationship of quality of life, depression, and caregiver burden in outpatients with congestive heart failure.

Primary caregivers of patients with congestive heart failure withstand enormous burden, often sacrificing their own quality of life. The relationship between caregiver burden and depression and patient quality of life and depression in this setting is unknown. Fifty outpatients were prospectively administered the Minnesota Living with Heart Failure Questionnaire and Beck Depression Inventory II (BDI-II). Caregivers were administered the Zarit Caregiver Burden Interview and BDI-II. The mean quality of life score was 35, and 26% had a BDI-II score >10. The mean Zarit Caregiver Burden Interview score was 16. Minnesota Living with Heart Failure Questionnaire, BDI-II, and Zarit Caregiver Burden Interview scores were all associated with lower ejection fraction, need for hospitalization, increased number of medications, and comorbidities. Patient Minnesota Living with Heart Failure Questionnaire score correlated with patient BDI-II, caregiver BDI-II, and Zarit Caregiver Burden Interview scores. Caregiver burden score correlated with both caregiver BDI-II and patient BDI-II. Death or hospitalization at 6 months was associated with caregiver burden and depressive symptoms and with patient quality of life and depressive symptoms. Caregivers of patients with congestive heart failure experience high caregiver burden and prevalence of depressive symptoms, which are related to the patient disease burden.

Age Distribution↗

PubMedDate not supplied

Benefits of comprehensive inpatient education and discharge planning combined with outpatient support in elderly patients with congestive heart failure.

Multidisciplinary disease management programs for congestive heart failure have been shown to substantially reduce readmission rates, resulting in a reduction of costs. These interventions, however, have typically included changes in medical management, making it difficult to quantitate the key elements of a successful program involving education, discharge planning, and transitional care in the outpatient setting. The investigators utilized an experienced cardiac nurse educator to coordinate a targeted inpatient congestive heart failure education program coupled with comprehensive discharge planning and immediate outpatient reinforcement through a coordinated nurse-driven home health care program. The comprehensive intervention resulted in a marked reduction in 6-month readmission rates, from 44.2% to 11.4% (p=0.01). The average total cost saving for each subject in the interventional group was $1541, based on the decreased utilization of both skilled nursing services and home health care during outpatient follow-up. The costs to implement an inpatient education program were negligible, at $158 per subject. There was no difference in discharge medications or medical management protocols that would have influenced these results.

Aged↗

PubMed1994

Improved hemodynamic function and mechanical efficiency in congestive heart failure with sodium dichloroacetate.

OBJECTIVES: The purpose of this study was to determine whether sodium dichloroacetate improves hemodynamic performance and mechanical efficiency in congestive heart failure. BACKGROUND: Congestive heart failure is associated with impaired hemodynamic performance and reduced mechanical efficiency. Dichloroacetate stimulates pyruvate dehydrogenase activity by inhibition of pyruvate dehydrogenase kinase, which results in inhibition of free fatty acid metabolism and stimulation of high respiratory quotient glucose and lactate consumption by the heart. Facilitation of glucose and lactate consumption with dichloroacetate should improve mechanical efficiency of the failing ventricle. METHODS: Ten patients with New York Heart Association functional class III to IV congestive heart failure were studied. Dichloroacetate (50 mg/kg body weight) was administered intravenously for 30 min, with measurements of hemodynamic variables, coronary sinus blood flow and blood gas, glucose and lactate levels for 2 h. The same patients were also given dobutamine (5 to 12.5 micrograms/kg per min) for comparison. RESULTS: Therapeutic levels of dichloroacetate were achieved (100 to 160 micrograms/liter of plasma). Myocardial consumption of lactate was stimulated from 29% to 37.4%. Forward stroke volumes increased (+5.3 ml/beat, p < 0.02), as did left ventricular stroke work (+1.8 g-m/m2 per beat, p < 0.02) and left ventricular minute work (from 1.38 to 1.55 kg-m/m2 per min, p < 0.01). Myocardial oxygen consumption decreased (from 19.3 to 16.5 ml/min, p = 0.06) as left ventricular minute work increased. Left ventricular mechanical efficiency thus improved from 15.2% to 20.6% (p = 0.03). Dobutamine administration resulted in the opposite trend with respect to myocardial lactate extraction (from 34% to 15.3%, p < 0.02). Stroke volume increased (+7.4 ml/beat, p = NS vs. dichloroacetate), as did left ventricular minute work (from 1.29 to 1.59 g-m/m2 per min, p < 0.01 vs. dichloroacetate) and myocardial oxygen consumption (from 18.6 to 21.0 ml/min, p = 0.06 vs. dichloroacetate). Left ventricular mechanical efficiency did not change with dobutamine administration (from 16.4% to 15.8%, p = NS). CONCLUSIONS: Dichloroacetate administration stimulates myocardial lactate consumption and improves left ventricular mechanical efficiency. Forward stroke volume and left ventricular minute work increase significantly, with a simultaneous reduction in myocardial oxygen consumption. Dobutamine administration results in similar hemodynamic improvements but with no change in left ventricular mechanical efficiency and with opposite effects on lactate metabolism. The opposing metabolic actions, yet similar hemodynamic responses, of dichloroacetate and dobutamine suggest that these agents may be complementary in the treatment of congestive heart failure.

Dichloroacetic Acid↗

PubMed2005

Cognitive functions in severe congestive heart failure before and after an exercise training program.

BACKGROUND: Congestive heart failure is associated with cognitive impairment, particularly of attentional skills. We assessed, in a hypothesis-generating study, the effect of an exercise training program on cognitive functions among patients with severe congestive heart failure. METHODS: Patients with severe congestive heart failure (n=20; New York Heart Association functional class III; left ventricular ejection fraction < or =35%) were evaluated before and following a standardized and supervised exercise training program (x2/week for 18 weeks; exercise group), while 5 additional patients did not undergo an exercise training program (control group). A battery of cognitive tests was used to assess cognitive functions. Physical performance was assessed by the 6-min walk test and the modified Bruce exercise test, cardiac index and systemic vascular resistance using thoracic electrical bioimpedance, and cerebral vasomotor reactivity to hypercapnia by means of the breath-holding index using transcranial Doppler. RESULTS: Time of completion of the trail making A (105+/-116 to 75+/-52; p=0.02) and B (169+/-100 to 119+/-65; p=0.002) tests, and of the Stroop part A (40+/-13 to 37+/-13; p=0.04) was shorter in patients completing the exercise training program, but not in control patients, while the other neuropsychological measures remained unchanged in both groups. Cerebral vasomotor reactivity to hypercapnia remained diminished (breath-holding index 0.64+/-0.27 vs. 0.68+/-0.37) despite significant improvements in exercise capacity (6-min walk test 308+/-87 to 423+/-91 m, p<0.001; modified Bruce exercise test 5.6+/-3.8 to 9.8+/-3.4 min, p<0.001). CONCLUSIONS: Patients with severe congestive heart failure undergoing an exercise training program improve in some measures of cognitive functions that are limited to general attention and psychomotor speed. Based on these preliminary findings, further evaluations are designed within the framework of a larger controlled clinical trial.

Adult↗

PubMed2003

Correlation between negative near-wall shear stress in human aorta and various stages of congestive heart failure.

The critical effect of advanced congestive heart failure is reduced blood flow in descending aorta resulting from mild to severe reduction in cardiac output, usually accompanying low ejection fraction. In these patients the heart tries to compensate by beating faster, but reduced blood flow combined with increased heart rate can lead to retrograde flow and negative shear stress along the vessel walls during each cardiac cycle. Our studies show that near-wall negative shear stress can result from an entire-retrograde flow at normal heart rates or a Womersley-type phase delayed near-wall retrograde flow at high heart rate and low ejection fraction conditions. In our experiments, a compliant aortic loop with appropriate pressure and flow instrumentation was used, running on either various aqueous glycerin solutions or property filtered, anticoagulated diluted bovine blood. The flow field was mapped using a General Electric Vingmed System 5 platform. The resulting images were analyzed with Caltech's digital ultrasound speckle image velocimetry technique. We showed the occurrence of near-wall retrograde flow under certain aortic flow rates and frequencies, charted via an empirical relationship between Reynolds and Womersley numbers. Also, we demonstrated a strong correlation between retrograde flow level and transition from preliminary to advanced congestive heart failure patients.

Animals↗