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PubMed2001

Impact of pharmacotherapy on lymphocyte volumes and activity of the Na+/H+ exchanger in patients with congestive heart failure.

Previous studies in patients with congestive heart failure (CHF) have revealed abnormalities of cellular volume that might have an impact on the dysregulation of peripheral vascular resistance. Human mononuclear leukocytes (HML) represent a model for the study of cellular volume regulation. We investigated the impact of enalapril and carvedilol on HML volume and on the activity of the Na+/H+ exchanger in 26 patients with CHF and 20 volunteers. Over a period of 4 weeks, 18 patients received enalapril in addition to the previous therapy while 8 patients additionally received carvedilol. HML diameters and the activity of the Na+/H+ exchanger were measured by a Coulter Counter. Both patient groups showed abnormally increased initial volumes of HML compared to the volunteer group at baseline. Four weeks of therapy with enalapril in addition to therapy with diuretics and digoxin did not result in a statistically significant reduction of lymphocyte volume, whereas add-on therapy with carvedilol to therapy with ACE inhibitors, diuretics and digoxin reduced the volume significantly. Alterations could not be found in the activity of the Na+/H+ exchanger in either patient group compared to volunteers. Supplementary drug therapy with carvedilol in patients with CHF leads to a reduction of the increased lymphocytic volume, possibly reflecting the beneficial effect of beta-blockade.

Aged↗

PubMed2002

Exudative effusions in congestive heart failure.

OBJECTIVES: Pleural effusions due to congestive heart failure (CHF) typically are transudates, but an occasional patient with CHF is found to have an exudate in the absence of an apparent cause other than CHF. We sought to determine the incidence and clinical significance of such exudative effusions. DESIGN: Patients with CHF and effusions seen during the 7-year period from January 1994 through December 2000 were identified from their hospital discharge diagnoses and radiographs, while those who had undergone thoracentesis were identified from a review of the laboratory logs. The presenting symptoms and clinical course were determined from a review of the medical records. The effect of RBC contamination on pleural fluid lactate dehydrogenase (LDH) levels was determined by measuring the LDH activity of mock pleural fluid containing known amounts of RBC. RESULTS: Seven hundred seventy patients had CHF with an effusion, but only 175 patients underwent a thoracentesis. In this select group, 86 patients had transudates and 89 had exudates. A noncardiac cause for the exudate was readily identified in 59 patients by hospital discharge, and 7 more patients had an etiology found during follow-up. Eleven of the remaining 23 patients had undergone coronary artery bypass graft (CABG) surgery > or = 1 year prior to presentation, and 50% of the effusions in patients who had undergone CABG surgery were exudates. Thus, CHF-related exudates were identified in only 12 patients, and in 4 of these patients the exudates could be explained by RBC contamination of the pleural fluid. The clinical presentation of patients with CHF-associated exudates was similar to that of CHF patients with transudates. CONCLUSION: In most patients who have CHF and an exudative effusion, there is a noncardiac cause for the pleural effusion. The high frequency of exudates in patients with a history of CABG indicates a persistent impairment in lymphatic clearance from the pleural cavity. Exudative effusions due solely to CHF are rare.

Aged↗

PubMed1997

Causes of congestive heart failure. Prompt diagnosis may affect prognosis.

Congestive heart failure (CHF) is a progressive disease with multiple possible causes. Systolic heart failure, defined as contractile failure of the myocardium leading to a reduced ejection fraction, is the most common type. Systolic heart failure may result from coronary artery disease, hypertension, a metabolic disorder, infection, or an infiltrative or other disease, or it may be idiopathic. Recognition of CHF can be difficult, especially in elderly patients with several medical conditions. An early clinical sign may be dyspnea on exertion. The extent of workup needed is often indicated by findings on history taking and physical examination. In all patients suspected of having new-onset CHF, a chest film, an electrocardiogram, and left ventricular ejection fraction should be obtained and a search for complicating and causative factors undertaken. Early treatment may halt the otherwise inevitable decline in cardiac function and improve prognosis.

Heart Failure↗

PubMed1992

Self-care teaching for congestive heart failure patients.

1. Elderly patients with congestive heart failure (CHF) have a high incidence of mortality, morbidity, and hospital readmission. 2. Descriptive research of 41 patients with chronic CHF found that almost all patients could not correctly define CHF, less than half could correctly identify their medications, and almost three fourths of patients did not weight themselves daily. 3. The self-perceived reasons for hospitalizations included shortness of breath, swelling of limbs, exercise intolerance, and eight other symptoms. 4. Some of these patients were able to follow self-care intervention during their hospital stay, which included daily weigh-ins, taking medications at the bedside, ordering a low-salt diet, and identifying symptoms of CHF.

Aged↗

PubMed1976

Combination vasodilator therapy for severe chronic congestive heart failure.

A patient with severe, chronic congestive heart failure was unresponsive not only to conventional therapy, but also to nonparenteral nitroglycerin and isosorbide dinitrate; he became nitroprusside dependent. Oral minoxidil therapy produced a significant decrease in systemic vascular resistance and an increase in cardiac output, with no tachycardia, hypotension, or decrease in systemic and pulmonary venous pressures. The addition of sublingual isosorbide dinitrate decreased venous pressures and produced a further increase in cardiac output. The combination of oral minoxidil and sublingual isosorbide dinitrate maintained clinical and hemodynamic improvements, and the patient could be weaned off nitroprusside. Deterioration in hemodynamics occurred with the withdrawal of minoxidil. Therapy with oral hydralazine produced hemodynamic effects comparable to those of oral minoxidil. These observations suggest that chronic reduction of impedance to left ventricular ejection with minoxidil or hydralazine is possible in patients with severe intractable heart failure and deserves further clinical trial.

Chronic Disease↗

PubMed2006

Anesthesia and congestive heart failure: pathology, medical, and surgical management.

Congestive heart failure (CHF) is increasingly being recognized as a health problem in the United States. It is estimated that the lifetime risk for CHF is 1 in 5. The clinical anesthesiologist can expect to see several cases involving patients suffering from CHF. Because of the danger associated with surgery in a patient with CHF, a thorough knowledge of the disorder and the potential effects on the delivery of anesthetics must be considered. In addition, knowledge of the disease process and its manifestations is required for smooth guidance of the patient through the perioperative period. The understanding of current pharmacotherapies, surgical procedures and their implications related to interactions with anesthetics are all discussed.

Anesthesia↗

PubMed1991

Risk for postoperative congestive heart failure.

To identify predictors of postoperative congestive heart failure (CHF), a high-risk population, mainly hypertensive and diabetic patients undergoing elective general operations, was studied. Of the 254 patients, 6 per cent had postoperative CHF. Among patients with preoperative cardiac disease (that is, previous myocardial infarction, valvular disease or CHF), 17 per cent had postoperative CHF; in contrast with less than 1 per cent of those without cardiac disease (p less than 0.001). Patients with diabetes were also at high risk (12 versus 2 per cent, p less than 0.005), particularly those with cardiac disease. Patients who had equal to or greater than 40 millimeters of mercury increases or decreases intraoperatively in mean arterial pressure in relation to preoperative baseline had increased postoperative failure rates (p less than 0.02). Of note, postoperative failure rates were highest among patients with less than 500 milliliters per hour of net intake (input and output) (p less than 0.03). Risk for postoperative CHF was restricted to patients with preoperative symptomatic cardiac disease and was especially high if patients also had diabetes. Intraoperative fluctuations in mean arterial pressure increased the probability of postoperative failure, while the intraoperative administration of higher net volumes of fluid was associated with decreased risk.

Aged↗

PubMed1990

Survival in congestive heart failure: have we made a difference?

Congestive heart failure (CHF) affects approximately 400,000 new patients each year in the United States, resulting in death in more than 50% within five years, with traditional therapy including digitalis and diuretics. The aging of the population will only serve to aggravate this problem. Surgical treatment of CHF is a viable option in a minority of cases; a total of no more than 2,000 heart transplantation procedures were performed in the United States in 1988. Therefore, if survival is to improve in patients with CHF, effective alternative medical therapy may need to be added to or substituted for more traditional therapy. Vasodilator therapy with the angiotensin-converting enzyme inhibitors captopril and enalapril, or the combination of hydralazine and isosorbide dinitrate, improves survival in patients with severe heart failure when added to treatment with digitalis and diuretics. Nevertheless, the mortality rate remains extremely high once this stage of the disease process is reached. The prevention of left ventricular dilatation and remodeling, before the occurrence of overt heart failure, is the focus of much attention. Interventions that limit or interrupt the disease process at an even earlier stage will be necessary to make a major impact on survival.

Heart Failure↗

PubMed1989

[Pharmacodynamics and pharmacokinetics of nifedipine in patients with congestive heart failure].

Twenty-seven cases of congestive heart failure (CHF) were treated with nifedipine (Nif) 20 mg po. Significant improvements in resting hemodynamics were found in 22 cases. The higher the basal systemic vascular resistance (SVR) and pulmonary artery end diastolic pressure (PAEDP) were, the greater the magnitudes of reduction found (r = 0.84 and 0.77, P less than 0.01, respectively). Exercise hemodynamic investigation showed that Nif led to a lowering of SVR, PAEDP and pulmonary vascular resistance (PVR), with increases in SV and concentration of 5-10 ng/ml, with a maximum being observed at the concentration of 20 ng/ml. No further vasodilation was found when the plasma concentration exceeded 20 ng/ml. No remarkable deviations from the normal ranges of Nif pharmacokinetics were found in CHF patients. The plasma norepinephrine level decreased markedly 2 and 7 h after Nif. Thus, it is concluded that oral Nif is beneficial in severe CHF patients having low cardiac output and high SVR.

Adolescent↗

PubMed1994

Vasodilators and inotropic agents in the treatment of congestive heart failure.

The treatment of patients with congestive heart failure is predicated on an underlying knowledge of the pathophysiology of the syndrome. To date, the most effective therapy has been a combination of diuretics and ACE inhibitors. However, there are specific situations where direct-acting vasodilator therapy is helpful as adjunctive or replacement treatment. As of this writing, digitalis remains the sole orally active positive inotropic drug approved by the FDA for the treatment of patients with heart failure. Although the development of orally active positive inotropic drugs has been generally disappointing, research continues in this area. On the surface, progress in development of vasodilators and inotropic agents for heart failure has been successful, but the average improved survival time is only about 9 to 18 months. Given the current scope of the problem of heart failure, development of newer vasodilators and inotropic therapy as well as agents designed specifically to inhibit the neuroendocrine activation in the syndrome of heart failure can be expected.

Cardiotonic Agents↗

PubMed1994

The use of diuretics in congestive heart failure.

Diuretic resistance in patients with congesting heart failure is for the most part due to pharmacodynamic factors related to increased reabsorption of solute at other parts of the nephron. This mechanism explains the rationale for using combinations of diuretic agents affecting solute reabsorption at different nephron sites in such patients in contrast to a strategy of escalation of loop diuretic doses. Understanding the mechanisms by which diuretic resistance occurs in patients with CHF has allowed design of appropriate dosing regimens of these drugs and rational use of combinations of diuretics.

Biological Availability↗

PubMed1993

Pharmacokinetics of digoxin administered to horses with congestive heart failure.

Nine horses with (naturally acquired) congestive heart failure were treated with 2.2 micrograms of digoxin/kg of body weight by the IV route, followed by 11 micrograms/kg administered orally every 12 hours thereafter. Furosemide was administered IV concurrently with IV administered digoxin every 12 hours. Serum concentration of digoxin was measured after the first (IV) and seventh (orally administered) dose. After IV administration, digoxin disposition was described by a 2-compartment model, with a rapid distribution phase (t1/2 alpha = 0.17 hour), followed by a slower elimination phase (beta = 0.096 +/- 0.055 h-1, t1/2 beta = 7.2 hours, where beta is the exponential term from the elimination phase of the concentration vs time curve). Bioavailability after oral administration was 21.2 +/- 10.8%. After the seventh orally administered dose, serum concentration of digoxin peaked 1 to 2 hours later, and was 1.9 +/- 0.7 ng/ml (mean +/- SD). In 4 horses, a second increase in serum digoxin concentration was observed 4 to 8 hours after the initial peak, which possibly was evidence of enterohepatic recycling of the drug. Response to treatment included reduction in heart rate, peripheral edema, and pulmonary edema, but these could not be attributed to the digoxin alone because the horses were treated concurrently with furosemide.

Animals↗

PubMed1997

[The angiotensin-converting enzyme inhibitor perindopril in the treatment of congestive heart failure].

The efficacy of perindopril in congestive heart failure (CHF) class II-III (NYHA) was studied in a trial including 37 patients (35 males and 2 females) aged 39-71 years (mean age 57.9 +/- 1.4) with postinfarction cardiosclerosis. They had CHF class II-III and ejection fraction (EF) < 45%. Perindopril was given in a single daily dose 2-4 mg for 6 months. The treatment resulted in a significant lowering of CHF class (from 2.5 +/- 0.1 to 1.7 +/- 0.1 (p < 0.01). Exercise tolerance increased from 256.2 +/- 18.6 s to 349.8 +/- 27.0 s (p < 0.05). Pump and contractile functions of the myocardium improved: stroke volume increased by 12.7%, ejection fraction by 20.5%, total peripheral vascular resistance fell by 9.7%, circulating blood volume by 9.2%. Parameters of oxygen transport to tissues and tissue respiration also changed for the better. The authors state high efficacy of perindopril in CHF patients.

Adult↗

PubMed1975

The effect of congestive heart failure on quinidine pharmacokinetics.

Quinidine is an effective antiarrhythmic agent whose therapeutic effects and toxicity have been related to its serum concentrations. Many patients with cardiac arrhythmias also suffer from congestive heart failure. It is well documented that congestive heart failure can reduce blood perfusion to many regions of the body, and could conceivably alter drug pharmacokinetics. A pharmacokinetic evaluation of two sets of quinidine data in congestive heart failure patients indicates that congestive heart failure reduced the rate of absorption and volume of distribution following oral or intramuscular administration of quinidine. Furthermore, the amount of quinidine absorbed following oral administration is reduced, but congestive heart failure does not appear to alter the elimination rate of quinidine. The interpretation of the data presented herein strongly suggests that the site of administration, extent of distribution, and rate of absorption must be considered when determining dosage regimens in congestive heart failure patients since normal dosages in these patients result in abnormally high serum quinidine concentrations.

Administration, Oral↗

PubMedDate not supplied

Diuretic therapy in congestive heart failure.

Diuretics are a mainstay of therapy in patients with congestive heart failure. A small number of patients can achieve adequate diuresis with a thiazide diuretic alone, but most require a loop diuretic. Some patients with severe disease require combinations of diuretics. Most patients with congestive heart failure manifest resistance to diuretics by having a diminished natriuresis compared with healthy counterparts. This diminished response even to potent diuretics means that dietary sodium may exceed sodium excretion, resulting in patient decompensation. The pharmacokinetics and pharmacodynamics of loop diuretics have been characterized in patients with congestive heart failure, thereby allowing rational therapeutic strategies in terms of what type of doses should be administered, how often, and when to use diuretic combinations. The purpose of this review is to show how understanding pharmacokinetics and pharmacodynamics results in logical diuretic use. (c)2000 by CHF, Inc.

Journal Article↗

PubMed2003

Effects of carvedilol therapy on QT-interval dispersion in congestive heart failure: is there a difference in the elderly?

In cases of chronic congestive heart failure, QT-interval dispersion is a strong predictor of death. Carvedilol therapy appears to decrease QT-interval dispersion. We investigated whether carvedilol reduces QT-interval dispersion in congestive heart failure and whether this pharmaceutical agent has additional effects on elderly patients. Seventy-seven ambulatory patients who had chronic congestive heart failure were evaluated for hypertension, diabetes mellitus, smoking, alcohol abuse, concomitant medications, and QT-interval dispersion. Carvedilol therapy was then initiated. Six months later, we re-evaluated the same variables, as well as morbidity and mortality rates, and number of hospitalizations. The patients were divided into 2 groups: Group I, aged < 65 years (n = 42); and Group II, aged > or = 65 years (n = 35). Statistics were analyzed with the Student's t-test chi2 test, and Cox regression model. At 6 months, both groups showed significantly decreased QT-interval dispersion values compared with baseline values (76.9 +/- 29.3 vs 104.3 +/- 41.5 ms, respectively; P < 0.0001). An elevated QT-interval dispersion value at baseline increased morbidity (P = 0.041) but not hospitalization (P > 0.05). Group II had a smaller reduction in QT-interval dispersion than did Group I (24.41 +/- 29.36 and 30.98 +/- 32.70 ms, respectively), but this difference was not significant. We conclude that in ambulatory patients with chronic congestive heart failure, long-term carvedilol therapy significantly decreases QT-interval dispersion, and this effect is uniformly distributed between patients aged < 65 years and those aged 265 years.

Adrenergic beta-Antagonists↗

PubMed2006

A case-crossover study of fine particulate matter air pollution and onset of congestive heart failure symptom exacerbation leading to hospitalization.

Persons with congestive heart failure may be susceptible to ambient air pollution. The authors evaluated the association between exposure to particulate matter with an aerodynamic diameter of <2.5 microm (PM2.5) and onset of symptom exacerbation leading to hospital admission in Baltimore, Maryland. They used a case-crossover design for 135 case events occurring among 125 persons with prevalent congestive heart failure who were admitted to a single hospital through the emergency department during 2002. The case period was assigned using three index times: 8-hour and 24-hour periods of symptom onset and date of hospital admission. Controlling for weather, the authors detected a modest relative increase in risk for cases defined by 8-hour symptom onset for an interquartile-range increase in PM2.5 at a 2-day lag (odds ratio=1.09, 95% confidence interval: 0.91, 1.30). A corresponding increase in risk was not observed when admission date was used to define the case period. A series of simulations based on study data indicated that the study had adequate statistical power to detect odds ratios of 1.2 or higher. Although overall findings were not statistically significant, the identification of case events defined by an 8-hour onset period may be more relevant than either a 24-hour onset period or the admission date for estimating harmful effects of air pollutant exposure on cardiovascular health.

Aged↗

PubMedDate not supplied

The use of gated radionuclide ventriculography as a noninvasive method of evaluating right ventricular function in dogs with experimentally induced congestive heart failure.

Gated radionuclide ventriculography was evaluated as a noninvasive method of quantifying right ventricular function in dogs with experimentally induced congestive heart failure. Gated radionuclide ventriculography measurements of right ventricular function (right ventricular ejection fraction, right ventricular average emptying rate, and right ventricular average filling rate) were related to standard hemodynamic and echocardiographic measurements. Congestive heart failure was induced by rapid ventricular pacing in eight normal dogs. Hemodynamic, echocardiographic, and gated radionuclide ventriculography measurements were obtained before and after development of biventricular failure. Congestive heart failure resulted in significant changes in all hemodynamic, echocardiographic, and gated radionuclide ventriculography measurements with the exception of systemic arterial pressure. Right ventricular ejection fraction was inversely related to pulmonary artery systolic, diastolic, and mean pressure, and right ventricular average emptying rate was inversely related to the pulmonary artery systolic, diastolic, and mean pressure. Right ventricular ejection fraction was inversely related to left ventricular filling pressure, (pulmonary capillary wedge pressure). Neither the echocardiographic measurements of right ventricular size (right ventricular internal diastolic dimension) nor the right ventricular end-diastolic pressure were related to right ventricular ejection fraction and right ventricular average emptying rate. However, echocardiographic measurements of right ventricular dimension were related to right ventricular filling pressure. The gated radionuclide ventriculography indexes of right ventricular function, right ventricular ejection fraction and right ventricular average emptying rate, are affected by afterload but unaffected by preload, whereas the echocardiographic measurement of right ventricular dimension is related to preload. Gated radionuclide ventriculography provides right ventricular data which is unique from that obtained by standard echocardiographic imaging. Also, gated radionuclide ventriculography has potential value as a noninvasive means of estimating a change in pulmonary artery pressure.

Animals↗