Mechanisms and immediate outcome of in-hospital cardiac arrest in patients with advanced heart failure secondary to ischemic or idiopathic dilated cardiomyopathy
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O bjectives : The objective of the study was to examine the changes in vertebral heart scale, and left atrial and ventricular dimensions before and at onset of congestive heart failure in cavalier King Charles spaniels with mitral regurgitation. M ethods : Records and radiographs from 24 cavalier King Charles spaniels with mitral regurgitation were used. Vertebral heart scale (24 dogs), and left atrial dimension and left ventricular end diastolic and end systolic diameters (18 dogs) and their rate of increase were measured at intervals over years to the onset of congestive heart failure. They were plotted against time to onset of congestive heart failure. R esults : Dimensions and rates of change of all parameters were highest at onset of congestive heart failure, the difference between observed and chance outcome being highly significant using a two‐tailed chi‐square test (P<0·001). C linical significance : The left heart chambers increase in size rapidly only in the last year before the onset of congestive heart failure. Increasing left ventricular end systolic dimension is suggestive of myocardial failure before the onset of congestive heart failure. Rate of increase of heart dimensions may be a useful indicator of impending congestive heart failure.
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Manifestations of congestive heart failure are frequently observed in patients with coronary disease. However, they may be predominant in patients who have sustained prior myocardial infarction, in whom left ventricular aneurysm or papillary muscle dysfunction may induce left ventricular dysfunction. A small group of patients can develop severe cardiac insufficiency and pump failure on the basis of diffuse occlusive coronary artery disease. Heart failure can also be induced by congenital coronary abnormalities and in congestive cardiomyopathy some previous studies have suggested a decrease of coronary blood flow per unit of myocardial mass. Moreover, coronary artery disease can be associated and worsened congestive heart failure can result from other causes (e.g. valvular disease). However, congestive heart failure per se can also disturb coronary circulation as a result of changes in subendocardial myocardial perfusion or metabolism.
Coronary circulation
valvular heart disease
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Background There have been no reports that show significant direct relationship between echocardiographic parameters and B‐type natriuretic peptide ( BNP ) level. This could be due to the heterogeneous pathophysiology of heart failure and a lack of appropriate echocardiographic parameters. We sought to determine the best echocardiographic parameter that described elevated BNP level in patients with heart failure with and without systolic dysfunction. Methods and Results We studied 111 consecutive heart failure patients. They were divided into patients with heart failure and preserved ejection fraction ( HFPEF , n = 61) and that with heart failure and reduced ejection fraction ( HFREF , n = 50). Conventional and new echocardiographic parameters including myocardial strains were measured. BNP did not reflect any single echocardiographic parameter in patients with heart failure in total. The ratio of early diastolic transmitral flow velocity and mitral annular velocity had strong positive correlation with BNP level in the HFPEF group but not in the HFREF group. In the group of HFREF , global longitudinal and circumferential strains were positively correlated. Multivariate analysis revealed that predicted factors for BNP value in HFPEF and in HFREF were different. Conclusion High BNP level may indicate high filling pressure when ejection fraction is preserved and may indicate myocardial dysfunction when it is reduced.
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We report the case of a patient with chronic bradycardia and congestive heart failure whose clinical and hemodynamic status improved immediately after the implantation of a VVI pacing system. The role of chronic bradycardia in the development of congestive heart failure is discussed.
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