Pub Date : 2002-05-01DOI: 10.1111/J.1527-5299.2002.00716.X
G. Choudhary, S. Dudley
The balance of reactive oxygen species (ROS) and nitric oxide, the cell redox state, appears to be important in the mechanisms of heart failure. This balance has significant impact on calcium-handling proteins, affecting excitation-contraction coupling. Both ROS and nitric oxide appear to be elevated in heart failure and are accompanied by significant impairments in the number and function of calcium-handling proteins. These proteins contain sulfhydryl groups or disulfide linkages involving cysteine residues, making them susceptible to the action of oxidizing-reducing agents and nitrosylation, thereby altering their properties. Initial increases in nitric oxide may be an adaptive response to myocardial dysfunction, elevated cytokines, and increases in ROS, while a further increase in nitric oxide and overwhelming ROS can be damaging. Abundant nitric oxide and ROS can cause formation of peroxynitrite, a strong oxidant, or nitric oxide can activate alternate pathways aiding the ROS, causing impaired calcium handling contributing to contractile dysfunction.
{"title":"Heart failure, oxidative stress, and ion channel modulation.","authors":"G. Choudhary, S. Dudley","doi":"10.1111/J.1527-5299.2002.00716.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2002.00716.X","url":null,"abstract":"The balance of reactive oxygen species (ROS) and nitric oxide, the cell redox state, appears to be important in the mechanisms of heart failure. This balance has significant impact on calcium-handling proteins, affecting excitation-contraction coupling. Both ROS and nitric oxide appear to be elevated in heart failure and are accompanied by significant impairments in the number and function of calcium-handling proteins. These proteins contain sulfhydryl groups or disulfide linkages involving cysteine residues, making them susceptible to the action of oxidizing-reducing agents and nitrosylation, thereby altering their properties. Initial increases in nitric oxide may be an adaptive response to myocardial dysfunction, elevated cytokines, and increases in ROS, while a further increase in nitric oxide and overwhelming ROS can be damaging. Abundant nitric oxide and ROS can cause formation of peroxynitrite, a strong oxidant, or nitric oxide can activate alternate pathways aiding the ROS, causing impaired calcium handling contributing to contractile dysfunction.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"31 1","pages":"148-55"},"PeriodicalIF":0.0,"publicationDate":"2002-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85119996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-03-01DOI: 10.1111/J.1527-5299.2002.0758.X
Susan L. Ravnan, Marcus C. Ravnan, P. Deedwania
Congestive heart failure is a complex clinical hemodynamic disorder characterized by chronic and progressive pump failure and fluid accumulation. Although the overall impact of diuretic therapy on congestive heart failure mortality remains unknown, diuretics remain a vital component of symptomatic congestive heart failure management. Over time, sodium and water excretion are equalized before adequate fluid elimination occurs. This phenomenon is thought to occur in one out of three patients with congestive heart failure on diuretic therapy and is termed diuretic resistance. In congestive heart failure, both pharmacokinetic and pharmacodynamic alterations are thought to be responsible for diuretic resistance. Due to disease chronicity, symptomatic management is vital to improved quality of life and enhancing diuretic response is therefore pivotal.
{"title":"Pharmacotherapy in congestive heart failure: diuretic resistance and strategies to overcome resistance in patients with congestive heart failure.","authors":"Susan L. Ravnan, Marcus C. Ravnan, P. Deedwania","doi":"10.1111/J.1527-5299.2002.0758.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2002.0758.X","url":null,"abstract":"Congestive heart failure is a complex clinical hemodynamic disorder characterized by chronic and progressive pump failure and fluid accumulation. Although the overall impact of diuretic therapy on congestive heart failure mortality remains unknown, diuretics remain a vital component of symptomatic congestive heart failure management. Over time, sodium and water excretion are equalized before adequate fluid elimination occurs. This phenomenon is thought to occur in one out of three patients with congestive heart failure on diuretic therapy and is termed diuretic resistance. In congestive heart failure, both pharmacokinetic and pharmacodynamic alterations are thought to be responsible for diuretic resistance. Due to disease chronicity, symptomatic management is vital to improved quality of life and enhancing diuretic response is therefore pivotal.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"21 1","pages":"80-5"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72801980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-03-01DOI: 10.1111/J.1527-5299.2002.00279.X
S. Paul, N. Sneed
In an effort to better understand patients' definitions of quality of life (QOL) and to determine which tools would be most appropriate for use in future studies, a descriptive study was done in a university-based congestive heart failure clinic. Participants were asked a series of five open-ended questions regarding their perceptions of QOL during recorded interviews. Most patients equated QOL with the ability to perform physical functions in the same way they did before developing heart failure. They grieved for their former abilities and expressed lower self-esteem due to loss of independence from physical limitations. The Short Form-36 and the Minnesota Living With Heart Failure Questionnaire addressed the QOL issues important to our patients. It is important for health care providers to consider the patient's perception of QOL when using quantitative tools for QOL measurement in clinical practice.
{"title":"Patient perceptions of quality of life and treatment in an outpatient congestive heart failure clinic.","authors":"S. Paul, N. Sneed","doi":"10.1111/J.1527-5299.2002.00279.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2002.00279.X","url":null,"abstract":"In an effort to better understand patients' definitions of quality of life (QOL) and to determine which tools would be most appropriate for use in future studies, a descriptive study was done in a university-based congestive heart failure clinic. Participants were asked a series of five open-ended questions regarding their perceptions of QOL during recorded interviews. Most patients equated QOL with the ability to perform physical functions in the same way they did before developing heart failure. They grieved for their former abilities and expressed lower self-esteem due to loss of independence from physical limitations. The Short Form-36 and the Minnesota Living With Heart Failure Questionnaire addressed the QOL issues important to our patients. It is important for health care providers to consider the patient's perception of QOL when using quantitative tools for QOL measurement in clinical practice.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"21 1","pages":"74-6, 77-9"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88840610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-03-01DOI: 10.1111/J.1527-5299.2002.00756.X
L. Ramunno, L. French, A. O'Brien, Michelle L. Ligor, E. Havranek, Jane P Taylor, D. Ordin
This column is the eighth in a series reporting on the efforts of the Centers for Medicare & Medicaid Services ([CMS], formerly known as the Health Care Financing Administration), to improve care for Medicare beneficiaries with heart failure. Previous columns have focused on the hospital-based National Heart Failure project. An outpatient practice-based project, the Heart Failure Practice Improvement Effort (HF PIE), was described in the fourth and sixth columns. This column reports experience from the HF PIE project at the practice level in three states.
{"title":"Improving Heart Failure Care in Outpatient Practices","authors":"L. Ramunno, L. French, A. O'Brien, Michelle L. Ligor, E. Havranek, Jane P Taylor, D. Ordin","doi":"10.1111/J.1527-5299.2002.00756.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2002.00756.X","url":null,"abstract":"This column is the eighth in a series reporting on the efforts of the Centers for Medicare & Medicaid Services ([CMS], formerly known as the Health Care Financing Administration), to improve care for Medicare beneficiaries with heart failure. Previous columns have focused on the hospital-based National Heart Failure project. An outpatient practice-based project, the Heart Failure Practice Improvement Effort (HF PIE), was described in the fourth and sixth columns. This column reports experience from the HF PIE project at the practice level in three states.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"39 1","pages":"86-89"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77795836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-03-01DOI: 10.1111/J.1527-5299.2002.01519.X
W. Peacock, Erica E. Remer, Josef H. Aponte, D. Moffa, C. Emerman, N. Albert
There is little information on the effectiveness of emergency department (ED) observation unit (OU) heart failure (HF) therapy. The authors' objective was to evaluate outcomes after implementation of an ED-OU treatment protocol for HF exacerbation. Unblinded assessment of the effectiveness of an HF protocol was performed, controlled by outcome for 9 months prior to implementation. This included diagnostic and therapeutic algorithms, cardiology consultation, close monitoring, patient education, and discharge planning. Adverse outcomes were defined as the 90-day rates of ED HF revisits, hospital HF readmissions, or death, as determined by chart review, computer database search, and phone follow-up. One hundred fifty-four patients were enrolled; 50 entered before, and 104 after protocol implementation. Only six (12%) in the preprotocol and one (1%) of the postprotocol group were lost to follow-up. After an OU visit, postprotocol 90-day ED HF revisit rates declined 56% (0.90-0.51; p<0.0000) and the 90-day HF rehospitalization rate decreased 64% (0.77-0.50; p=0.007). The 90-day rates of death and OU HF readmission decreased from 4% to 1% (p=0.096) and 18% to 11% (p=0.099), respectively. An intensive outpatient ED OU HF management protocol safely decreases 90-day rates of emergency department visits and inpatient hospitalizations.
{"title":"Effective observation unit treatment of decompensated heart failure.","authors":"W. Peacock, Erica E. Remer, Josef H. Aponte, D. Moffa, C. Emerman, N. Albert","doi":"10.1111/J.1527-5299.2002.01519.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2002.01519.X","url":null,"abstract":"There is little information on the effectiveness of emergency department (ED) observation unit (OU) heart failure (HF) therapy. The authors' objective was to evaluate outcomes after implementation of an ED-OU treatment protocol for HF exacerbation. Unblinded assessment of the effectiveness of an HF protocol was performed, controlled by outcome for 9 months prior to implementation. This included diagnostic and therapeutic algorithms, cardiology consultation, close monitoring, patient education, and discharge planning. Adverse outcomes were defined as the 90-day rates of ED HF revisits, hospital HF readmissions, or death, as determined by chart review, computer database search, and phone follow-up. One hundred fifty-four patients were enrolled; 50 entered before, and 104 after protocol implementation. Only six (12%) in the preprotocol and one (1%) of the postprotocol group were lost to follow-up. After an OU visit, postprotocol 90-day ED HF revisit rates declined 56% (0.90-0.51; p<0.0000) and the 90-day HF rehospitalization rate decreased 64% (0.77-0.50; p=0.007). The 90-day rates of death and OU HF readmission decreased from 4% to 1% (p=0.096) and 18% to 11% (p=0.099), respectively. An intensive outpatient ED OU HF management protocol safely decreases 90-day rates of emergency department visits and inpatient hospitalizations.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"32 1","pages":"68-73"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83270582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-03-01DOI: 10.1111/J.1527-5299.2002.00759.X
S. Sangha, P. Uber, M. Mehra
Careful thought must be given to the development of bystander pathology that could mimic worsening of heart failure. Recent trials with patients receiving amiodarone record a low rate of amiodarone pulmonary toxicity of 1.6%. Bronchoalveolar lavage in amiodarone toxicity demonstrates an absolute and relative lymphocytic alveolitis, suggesting hypersensitivity, but this finding is neither sensitive nor specific. Recently, KL-6, a mucin-like high molecular weight glycoprotein secreted by proliferating type II alveolar pneumocytes, has been identified as a potential marker of interstitial pneumonitis. A high index of suspicion combined with rapid exclusion of common confounding mimics can help in establishing the diagnosis of amiodarone lung toxicity.
{"title":"Amiodarone Lung Injury: Another Heart Failure Mimic?","authors":"S. Sangha, P. Uber, M. Mehra","doi":"10.1111/J.1527-5299.2002.00759.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2002.00759.X","url":null,"abstract":"Careful thought must be given to the development of bystander pathology that could mimic worsening of heart failure. Recent trials with patients receiving amiodarone record a low rate of amiodarone pulmonary toxicity of 1.6%. Bronchoalveolar lavage in amiodarone toxicity demonstrates an absolute and relative lymphocytic alveolitis, suggesting hypersensitivity, but this finding is neither sensitive nor specific. Recently, KL-6, a mucin-like high molecular weight glycoprotein secreted by proliferating type II alveolar pneumocytes, has been identified as a potential marker of interstitial pneumonitis. A high index of suspicion combined with rapid exclusion of common confounding mimics can help in establishing the diagnosis of amiodarone lung toxicity.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"57 1","pages":"93-96"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73531994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2002-03-01DOI: 10.1111/J.1527-5299.2002.01169.X
C. Leier, M. Silver, M. Rich, Eric J. Eichhorn, M. Fowler, T. Giles, D. Johnstone, T. L. Le Jemtel, J. Lachmann, T. Levine, P. Armstrong, W. Dec, M. Jessup, J. Howlett, R. E. Hershberger, J. Cohn, K. Adams, W. Colucci, L. Warner-Stevenson, J. Hosenpud, M. Bristow, I. Piña, K. Baughman, P. Binkley, H. Ventura, G. Francis, M. White, L. Miller, B. Berry, E. Missov
{"title":"Nuggets, pearls, and vignettes of master heart failure clinicians. Part 4--treatment.","authors":"C. Leier, M. Silver, M. Rich, Eric J. Eichhorn, M. Fowler, T. Giles, D. Johnstone, T. L. Le Jemtel, J. Lachmann, T. Levine, P. Armstrong, W. Dec, M. Jessup, J. Howlett, R. E. Hershberger, J. Cohn, K. Adams, W. Colucci, L. Warner-Stevenson, J. Hosenpud, M. Bristow, I. Piña, K. Baughman, P. Binkley, H. Ventura, G. Francis, M. White, L. Miller, B. Berry, E. Missov","doi":"10.1111/J.1527-5299.2002.01169.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2002.01169.X","url":null,"abstract":"","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"17 1","pages":"98-124"},"PeriodicalIF":0.0,"publicationDate":"2002-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86005691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-11-01DOI: 10.1111/J.1527-5299.2001.01001.X
M. Aslam, L. Brookfield
The authors describe the challenging case of a 46-year-old patient who presented with a 2-week history of exertional dyspnea, paroxysmal nocturnal dyspnea, and orthopnea. He was found to have left ventricular failure and atrial fibrillation with a rapid ventricular rate. Initial work-up revealed dilated cardiomyopathy with marked left ventricular dysfunction, without any obvious cause. He received standard medical therapy for left ventricular dysfunction and his symptoms improved. Electrical cardioversion to sinus rhythm and maintenance resulted in complete recovery of left ventricular function within 6 months.
{"title":"Reversible Cardiomyopathy Due to Atrial Fibrillation in a 46-Year-Old Patient","authors":"M. Aslam, L. Brookfield","doi":"10.1111/J.1527-5299.2001.01001.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.01001.X","url":null,"abstract":"The authors describe the challenging case of a 46-year-old patient who presented with a 2-week history of exertional dyspnea, paroxysmal nocturnal dyspnea, and orthopnea. He was found to have left ventricular failure and atrial fibrillation with a rapid ventricular rate. Initial work-up revealed dilated cardiomyopathy with marked left ventricular dysfunction, without any obvious cause. He received standard medical therapy for left ventricular dysfunction and his symptoms improved. Electrical cardioversion to sinus rhythm and maintenance resulted in complete recovery of left ventricular function within 6 months.","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"62 1","pages":"331-333"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78741812","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2001-11-01DOI: 10.1111/J.1527-5299.2001.00275.X
D. Tepper
{"title":"Utility of B‐Natriuretic Peptide As a Rapid, Point‐of‐Care Test for Screening Patients Undergoing Echocardiography to Determine Left Ventricular Dysfunction","authors":"D. Tepper","doi":"10.1111/J.1527-5299.2001.00275.X","DOIUrl":"https://doi.org/10.1111/J.1527-5299.2001.00275.X","url":null,"abstract":"","PeriodicalId":10536,"journal":{"name":"Congestive heart failure","volume":"135 1","pages":"329-330"},"PeriodicalIF":0.0,"publicationDate":"2001-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78673406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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