Clinical Features Of Heart Failure Research Articles

Graves' Disease Affecting one Thyroid lobe (Unilateral Graves' Disease): Case Report

We report a 63-year-old male who was referred to nuclear medicine unit for thyroid scanning with provisional diagnosis of Graves' disease. The patient presented to endocrinology clinic few days before referral with clinical features of heart failure and bilateral exophthalmos, with no history of previous thyroid surgery or anti-thyroid medication. Clinically there awas diffuse enlargement of the right thyroid lobe with no definite nodules and no palpable left lobe. His thyroid hormonal profile revealed evidently elevated free T3 and free T4 [12.9 pmol/L (N: 3.1-6.8) and 38.4 pmol/L (N:12-22) respectively] associated with markedly suppressed serum TSH level (< 0.005mIu/ml). Antimicrosomal antibodies (thyroid peroxidase antibodies) were positive with negative antithyroglobulin antibodies. Tc99m pertechnetate thyroid scan revealed diffuse enlargement of the right lobe with intense homogenous tracer uptake pattern, and more intense tracer uptake in its mid substance due to thicker thyroid tissue rather than true nodule. The upper and lower poles showed intense uptake, more than would be expected for such thinner parts of the lobe. On the other hand the left lob was not functionally suppressed. It is of average size with evidently less tracer uptake in a homogenous pattern, again it harbors no nodules (Fig1). The total thyroid uptake level was 11.5%, the right lobe uptake was 9.9 % while left lobe uptake was 1.6% (Fig1). High resolution thyroid ultrasound (Fig2) revealed average size of the left lobe (14x12x34mm) with decreased echogenicity and no increase in vascularity. On the other hand, the right lobe is enlarged (22x24x46) with coarse texture and no nodules. The combined scintigraphic and sonographic data exclude the presence of toxic nodule occupying the whole right thyroid lobe. The patient was diagnosed as Graves' disease affecting only the right thyroid lobe (unilateral Graves' disease).

Echocardiographic Assessment of Diastolic Heart Failure

A normal ejection fraction (EF) is present in &gt;50% of patients with clinical features of heart failure (HF). This entity has been referred to as HF with normal EF (HFNEF), or diastolic HF. The underlying pathophysiology of HFNEF is still under debate and this is reflected in the unsatisfactory results of pharmacological treatment and in the high mortality and morbidity rates, which are similar to those for systolic HF. By providing evidence of left ventricular (LV) diastolic dysfunction in patients with clinical features of HF and normal LVEF, echocardiography, the most practical and widely available diagnostic modality, can offer two of the three current diagnostic criteria for HFNEF. Moreover, abnormalities in LV myocardial deformation and torsional dynamics at rest and during exercise were recently demonstrated in HFNEF patients by echocardiography. Newer echocardiographic parameters may improve the understanding of this complex entity, but further studies are needed before using them in clinical practice for the diagnostic and therapeutic approach of patients with HFNEF. This article discusses the current echocardiographic approach to the diagnosis of diastolic HF, as well as the potential role of newer echo indices and modalities.

The Central Role of the Kidney in the Pathogenesis of Heart Failure

Cardiac dysfunction is an essential part of the definition of heart failure but renal dysfunction may also cause most of the clinical features of heart failure. Altered renal physiology due to cardiac dysfunction plays a central role in the salt and water retention and neuro-endocrine activation characteristic of heart failure. Reno-vascular disease is also common in heart failure. The ASTRAL study, which included many such patients, failed to show that renal angioplasty reduced mortality or end-stage renal disease but suggested a reduction in heart failure hospitalisation.

Clinical Characteristics and Outcome of Hospitalized Patients With Congestive Heart Failure

Heart failure (HF) represents a major public health issue in an aging population. Although HF is a leading cause of morbidity and mortality in developed countries, the clinical features of HF in Japan remain unclear. This observational cohort study analyzed data from the Heart Institute of Japan--Department of Cardiology (HIJC)-HF Registry, which is based on a nationwide survey by the HIJC, Tokyo Women's Medical University and its affiliated hospitals. Of 3,578 consecutive patients (average age, 69.8 years; females 40.7%) hospitalized for HF between January 2001 and December 2002, 95.0% were followed up until the end of 2005 (median, 2.8 years). The 1- and 3-year mortality rates were 11.3% and 29.2%, respectively. Multivariate analysis revealed that advanced age (hazard ratio 1.71 [95% confidence interval 1.38-2.12]; p<0.001), symptomatic HF at hospital discharge (3.76 [2.30-6.17]; p<0.001), renal impairment (1.96 [1.50-2.57]; p=0.008), anemia (1.46 [1.18-1.80]; p=0.02) and low pulse pressure (2.88 [1.62-5.13]; p=0.0003) were significantly associated with total death. Although the long-term mortality rate for Japanese patients with HF is lower than in other countries, several markers are modifiable. The data demonstrate that continued improvements in the treatment of Japanese patients with HF are still needed.

RISK FACTORS OF DIASTOLIC HEART FAILURE

Background and objective: Isolated diastolicdysfunction /heart failure is the cause of congestive heart failure in 50% of patients with normal systolic function. Severalfactors have been shown to be predisposing conditions associated with the development of diastolic dysfunction anddiastolic heart failure. This study was designed to study the common and important factors leading to diastolicdysfunction of the heart. Study design: This was a descriptive analytic study. Place &amp; Duration: This study wasconducted at Cardiology Department of Mayo Hospital Lahore from January 1998 to September 1998. Material andmethods: One hundred patients of diastolic heart failure who fulfilled our inclusion criteria were studied when theypresented to echo room for echocardiography. Detailed Echocardiography examination of all patients included in thisstudy was done to measure Doppler parameters of diastolic dysfunction like deceleration time, isovolumic relaxationtime, S &amp; D wave measurements on pulmonary vein. Detailed history was taken and physical examination wasperformed to evaluate the risk factor associated with diastolic dysfunction in each patient. Results Mean age of thestudy population was 511 18 years. Majority of patients 50(50%) had age range from 36 to 55 years. There were62(62%) male and 38(38%) female patients. Majority of patients 34(34%) had NYHA class I symptoms and 30(30%)patients were in NYHA class II. Ejection fraction was normal in 54(54%) of patients while it was less than 40% in 24%of patients. Majority of patients, 28(28%) had Ischemic heart disease while 24(24%) patients had hypertension and14(14%) had diabetes mellitus. Hypertension and Ischemic heart disease were present in 14(14%) patients.Conclusion Approximately 40% - 50% of patients with or without overt clinical features of heart failure have isolateddiastolic dysfunction / DHF with normal systolic function. Coronary artery disease, arterial hypertension and diabetesmellitus are the major factors associated with diastolic dysfunction and DHF. Obesity and aging also contributeindependently to the development of diastolic dysfunction in a reasonable number of patients.

Recurrent Reversible Dilated Cardiomyopathy Secondary to Viral and Streptococcal Pneumonia Vaccine-Associated Myocarditis

Myocarditis is inflammation of cardiac muscle, which may be acute, subacute, or chronic with either focal or diffuse involvement of the myocardium. This leads to a cardiomyopathy with clinical features of heart failure as well as echocardiographic evidence of global dilation of the cardiac chambers. There are numerous reports in the literature of viral myocarditis causing dilated cardiomyopathy; however, there are no reports of recurrent viral myocarditis and vaccine-associated myocarditis in a single patient with complete reversal of the cardiomyopathy and return to normal cardiac function. We present a case of recurrent myocarditis in a female patient caused by a viral upper respiratory infection and streptococcal pneumonia vaccination who presented with recurrent episodes of reversible cardiomyopathy.

412 Influence of QRS width on the clinical features of heart failure: data from the euroheart failure study

412 Influence of QRS width on the clinical features of heart failure: data from the euroheart failure study

Cardiac effects of exercise rehabilitation in hemodialysis patients

Exercise training has well documented beneficial effects in a variety of cardiac disorders. End stage renal disease patients present many cardiovascular complications and suffer from impaired exercise capacity. No study to date has adequately examined the cardiac responses to exercise training in renal patients on hemodialysis (HD). To determine the effects of an exercise rehabilitation program on the left ventricular function at rest and during submaximal effort, 38 end-stage renal disease patients on maintenance HD were randomised into three groups. Sixteen of them (group A — mean age 46.4 ± 13.9 years), without clinical features of heart failure, participated in a 6-month supervised exercise renal rehabilitation program consisting of three weekly sessions of aerobic training, 10 (group B — mean age 51.4 ± 12.5 years) followed a moderate exercise program at home, and the other 12 (group C — mean age 50.2 ± 7.9 years) were not trained and remained as controls. The level of anemia and the HD prescription remained constant during the study. Fifteen sex- and age-matched sedentary individuals (group D — mean age 46.9 ± 6.4 years) were the healthy controls. All subjects at the start and end of the program underwent physical examination, laboratory tests, treadmill exercise testing, M-mode and 2-D echocardiograms performed at rest and at peak of supine bicycle exercise. Left ventricular volumes (EDV, ESV) and mass (LVM) were measured and ejection fraction (EF), stroke volume index (SVI) and cardiac output index (COI) were calculated by standard formulae. The maximal oxygen consumption increased by 43% ( P < 0.001) and the exercise time by 33% ( P < 0.001) after training in group A, by 17% ( P < 0.001) and 14% ( P < 0.01), respectively, in B, and both remained unchanged in group C. Training in group A was also associated with an increase in LVIDd (from 52.1 ± 6.4 to 54.0 ± 6.1 mm, P < 0.001) and LVM (226 ± 67 to 240 ± 84 g, P < 0.05) at rest with no change noted in groups B and C. Following a 6-month exercise training in group A an increase was also found in the resting EF by 5% ( P < 0.01) and SVI by 14% ( P < 0.001). There was no change found in groups B and C. Supine bicycle exercise after training in group A was associated with an improvement in EF by 14% compared to the pre-training change ( P < 0.001), SVI by 14% ( P < 0.001) and COI by 73% ( P < 0.001). These changes from rest to submaximal exercise were less pronounced in group B following training at home. The untrained patients demonstrated no changes in LV systolic function over the 6-month period. These results demonstrate that intense exercise training improves LV systolic function at rest in HD patients; both intense and moderate physical training leads to enhanced cardiac performance during supine submaximal exercise.

Enalapril for severe heart failure in infancy.

Eight infants aged between 4 days and 12 weeks with severe heart failure that was refractory to optimal conventional treatment with diuretics were treated with enalapril. The starting dose was 0.1 mg/kg/day, increasing according to response to 0.12-0.43 mg/kg/day. One infant with severe myocarditis did not tolerate enalapril because of hypotension and later died of intractable heart failure. Six of the remaining patients had congenital systemic to pulmonary shunts and one had a simple aortic coarctation. Two weeks after starting enalapril the clinical features of heart failure had improved in all the infants, the mean (SEM) plasma sodium concentration had increased from 129 (2.4) to 136 (1.1) mmol/l and plasma urea concentration had fallen from 7.0 (0.85) to 2.9 (0.85) mmol/l. These data suggest that enalapril is a potentially useful treatment for severe heart failure in infancy.

CHARACTER OF CONGESTIVE FAILURE IN CHILDREN WITH ACTIVE RHEUMATIC FEVER

That congestive failure in children with rheumatic heart disease is due to the presence of active rheumatic fever is now commonly recognized. Less well known, however, are the clinical features of heart failure in such patients. It is the purpose of this communication to describe these clinical features. MATERIAL More than 200 children and adults with congestive failure and rheumatic heart disease have been carefully observed and treated at the House of the Good Samaritan between 1920 and 1940. Of particular interest for this report are 44 members of the group who entered the hospital during the period from July 1, 1937 to April 1, 1940, who were subjects of special study. These 44 patients were between the ages of 3 and 15 years (average, 8.8 years). The length of the stay in the hospital varied from less than a month to four years (average, twelve months). CLINICAL OBSERVATIONS It