Heart transplantation of Middle Eastern patients in the United States: A brief report from the UNOS database
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"Heart failure may be defined as the pathophysiologic state in which an abnormality of cardiac function is responsible for failure of the heart to pump blood at a rate commensurate with the requirements of the metabolizing tissues. Heart failure occurs as the consequence of many forms of heart disease afflicting at least 4 million Americans of all ages."1 Heart failure also occurs with the failure of compensatory mechanisms such as myocardial hypertrophy, which may accompany dilatation of the ventricular chambers. Heart failure can be divided into left and right heart failure, although if the heart failure becomes chronic then left heart failure can result in right heart failure, so that both can occur concomitantly. Heart failure may be due to failure of myocardial contraction or it may be due to an excessive hemodynamic burden. The heart will compensate for this physiologically, but also pathologically with myocyte hypertrophy with or without ventricular dilatation. The rate of onset of heart failure also will in fluence the clinical and pathological manifestations.
Hypertensive heart disease
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Congestive heart failure is associated with increased levels of several inflammatory mediators, and animal studies have shown that infusion of a number of cytokines can induce heart failure. However, several drugs with proven efficacy in heart failure have failed to affect inflammatory mediators, and anti-inflammatory therapy in heart failure patients has thus far been disappointing. Hence, to what extent heart failure is caused by or responsible for the increased inflammatory burden in the patient is still unclear. Over the past couple of decades, resynchronization therapy with a biventricular pacemaker has emerged as an effective treatment in a subset of heart failure patients, reducing both morbidity and mortality. Such treatment has also been shown to affect the inflammation associated with heart failure. In this study, we review recent data on the association between heart failure and inflammation, and in particular how resynchronization therapy can affect the inflammatory process.
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What is heart failure? what causes heart failure? the public health problem of heart failure pathophysiology of the heart failure syndrome the symptoms and signs of heart failure investigation of the patient with heart failure treatment of heart failure - diuretics treatment for heart failure - ace inhibitors treatment of heart failure - digoxin management of heart failure - non-pharmacological therapy management of concomitant problems in patients with heart failure patients who do not respond to treatment preventions of heart failure.
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Heart transplantation is in its third decade as a widely accepted treatment for advanced heart failure. What is its prognosis? In the early era of heart transplantation, the perceived alternative to transplantation was imminent death. In 1968, at the beginning of heart transplantation, Peter Medawar, the eminent zoologist and Nobel laureate whose work on tolerance set the scene for successful transplantation, correctly predicted: “The transplantation of human organs will be assimilated into ordinary clinical practice … and there is no need to be philosophical about it. This will come about for the single and sufficient reason that people are so constituted that they would rather be alive than dead.”1
Heart transplantation has a high early mortality—15-20% of recipients die within a year of the operation. 2 3 Thereafter the death rate is constant, at about 4% a year for the next 18 years, so that 50% of patients can expect to be alive after 10 years and 15% after 20 years. Application of heart transplantation has been based almost entirely on doctors' …
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Organ transplantation has kindled the human imagination since the beginning of time. Prehistorically, transplantation appeared as mythological stories: from creatures with body parts from different species, the heart transplant between two Chinese soldiers by Pien Ch’iao, to the leg transplant by physician Saints Cosmas and Damian. By 19th century, the transplantation concept become possible by extensive contributions from scientists and clinicians whose works had taken generations. Although Alexis Carrel is known as the founding father of experimental organ transplantation, many legendary names had contributed to the experimental works of heart transplantation, including Guthrie, Mann, and Demikhov. The major contribution to experimental heart transplantation before the clinical era were made by a team lead by Richard Lower and Norman Shumway at Stanford University in the early 1960s. They played the vital role in developing experimental and clinical heart transplantation as it is known today. Using Shumway biatrial technique Christiaan Barnard started a new era of clinical heart transplantation, by performing the first in man human-to-human heart transplantation in 1967. The techniques of heart transplant have evolved since the first heart transplant. This chapter will summarize the techniques that have been used in clinical heart transplantation.
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Congestive Heart Failure: Trends in Epidemiology and Therapy Heart Failure and Sudden Cardiac Death Resuscitation Issues in Patients with Severe Congestive Heart Failure Pulmonary Abnormalities in Congestive Heart Failure: A Therapeutic Opportunity? Exercise Gas Exchange in Heart Failure: A Brief Review Exercise Capacity and Prognosis in Congestive Heart Failure Assessment of Physical Activity in the Patient with Heart Failure Pharmacological Enhancement of the Exercise Performance of Patients with Heart Failure Evaluating Quality of Life in Congestive Heart Failure: Issues, Progress and Recommendations Social Support and Congestive Heart Failure Patients Depression in Heart Failure Patients Sexual Functioning in Congestive Heart Failure Patients Clinical Practice Guidelines for Outpatient Management of Patients with Left Ventricular Systolic Dysfunction
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Abstract Background Heart failure hospitalizations in adult patients with congenital heart disease (ACHD) are increasing and are associated with higher healthcare-related costs. We aimed to evaluate factors that are associated with repeated heart failure hospitalizations and whether heart failure hospitalizations are related to adverse outcome in ACHD patients with heart failure (ACHD-HF). Methods Out of 3995 patients under active follow-up in our institution (last visit >2010), 256 patients (mean age 49.5±16.7 years) had ACHD-HF and were included in the study. Medical records were reviewed, including heart failure hospitalization prior and after study inclusion. A combined endpoint of death, ventricular assist device and transplantation was defined. Results Overall, 136 ACHD-HF patients (53%) had a prior heart failure hospitalization. Over a mean follow-up of 2.5±2.3 years, 44 patients (17%) had repeated heart failure hospitalizations. Of these, 31 patients (12%) had 1; 9 patients (4%) 2 and 4 patients (2%) 3 repeated heart failure hospitalizations. Patients with repeated heart failure hospitalizations had higher NYHA class (p=0.031), were more likely to have end-organ dysfunction (p=0.025) and more likely to have a prior heart failure hospitalization (p<0.001). In multivariable Cox regression analysis, only end-organ dysfunction (HR 2.431 95% CI 1.516–43.896 p<0.001) was related to repeated hospitalization. Seventy patients (27%) reached the combined endpoint of death, VAD or transplantation (event-rate 11% per year). Repeated heart failure hospitalizations was not related to the combined endpoint in Cox regression analysis. Conclusions Heart failure hospitalizations are frequent in ACHD-HF. End-organ dysfunction appears to be a strong determinant of repeated heart failure hospitalizations. Event-rate is high in patients with ACHD-HF, but repeated heart failure hospitalizations were not related to outcome in this short-term follow-up study. Funding Acknowledgement Type of funding sources: None. Table 1.1Table 1.2
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Objective To discuss the clinical effect of heart failure mixture in congestive heart failure.Methods Retrospective analysed clinical data of 30 cases patients with congestive heart failure accepted the treatment of heart failure mixture,and evaluated its efficacy.Results The original Western Medicine following the service on 21 cases of heart failure count not control,plus service with heart failure mixture,all effective;Nine cases with Western,the simple used of heart failure mixture,effective 7 cases,invalid 2 cases.Conclusion Heart failure mixture in congestive heart failure has significant clinical effect,without obvious adverse reaction.
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In 1905, Carrel and Guthrie reported the heterotopic heart transplantation on dogs for the first time. In the same year, Shone advanced the transplantation immunity theory which provided a basis for organ transplantation. In 1964, Hardy and his colleagues performed the first human chimpanzee heart transplantation. In 1967, Barnard performed the first human-to-human orthotopic heart transplantation in the world. In 1968 - 1971, 56 hospitals performed 180 heart transplantations world-wide. But because of the poor survival rate after operation, heart transplantations became less frequent. In 1972, Castaneda and Reitz summed up the experiences of heart-lung experimental transplantation, which laid a foundation for human heart-lung transplantation. In 1973, Caves invented myocardium biopsy for rejection surveillance after heart transplantation, which solved the problem of diagnosis for early rejection. In 1981, Stanford University first took cyclosporin A into clinical practice. The acute rejection after heart transplantation was effectively controlled and the long-term survival rate was significantly increased. Heart transplantation entered the second peak period. The launching of Asian heart transplantation began in 1968. Juro·Wada with his medical team performed the first heart transplantation in Japan. In 1978, Zhang Shize in Shanghai performed the first heart transplantation in China.
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