摘要:

Over the past decade, there has been a paradigm shift in the understanding of heart failure pathophysiology. Heart failure is no longer conceptualized as a hemodynamic disorder resulting from changes in renal and hormonal function. Rather, the syndrome of heart failure is more complex and is characterized by abnormal myocyte growth, proliferation of cells in the extracellular matrix, and myocyte cell loss (apoptosis)-all of which culminate in significant structural remodeling of the heart and loss of ventricular function. The loss of ventricle function is preceded by an initiating event such as myocardial infarction, which leads to changes in cell function, activation of specific neurohormones and peptides, which in turn are linked to the remodeling of the ventricle, and progression of heart failure. This article discusses how changes in myocyte and nonmyocyte structure may contribute to the progression of heart failure. Insight into these mechanisms will provide a better understanding of newer pharmacologic approaches in the treatment of heart failure.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The syndrome of congestive heart failure occurring secondary to diastolic dysfunction accounts for the major pathophysiologic mechanism in up to one-third of patients who present with dyspnea on exertion and pulmonary congestion. Diastolic dysfunction is characterized by an alteration in the normal diastolic pressure-volume relationship while systolic function may be normal. It is manifested by impairment in the left ventricle's ability to relax and fill completely during diastole at normal low ventricular pressures. This subset of heart failure is most commonly associated with concentric left ventricular hypertrophy and ischemic states. Symptom presentation is similar to that associated with systolic dysfunction as are rates of rehospitalization. Diagnosis is made based on data obtained from invasive and noninvasive procedures. Unlike in the setting of systolic dysfunction, however, there are no large-scale randomized clinical trials evaluating drug efficacy that could be used to guide treatment for the management of diastolic dysfunction. Treatment recommendations, therefore, are empiric. Identifying and aggressively treating potentially reversible causes is a priority. Many of the same drugs used in the management of heart failure associated with systolic dysfunction are also used in the setting of diastolic impairment; however, dosages and rationale for administration may differ. Nursing interventions too are similar. Monitoring response to medications, especially in the acute setting, and comprehensive patient education are paramount. Much is yet to be learned about the management of diastolic dysfunction.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Chronic heart failure (HF) and sudden cardiac death (SCD) present two major public health problems. The risk of death ranges from 10% to 50% annually in patients with HF, depending on the severity of disease. Approximately 50% of these deaths are sudden and presumed to be caused by dysrhythmias. This article defines the population at risk for SCD, explains the methods used for risk stratification, reviews current research on the pathophysiology of ventricular dysrhythmias in HF, and discusses pertinent clinical trials of therapeutic interventions on SCD in HF. The article also explores the effect of SCD on the patient and family with respect to counseling and education, resuscitative issues, and advanced directives.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Since the publication of the Agency for Health Care Policy and Research Guidelines for treatment of heart failure, a number of new agents have been investigated for this indication. β-blockers have now been shown to improve outcomes in mild to moderate heart failure when added to standard therapy. Angiotensin II receptor antagonists have also been investigated and show promise. In general, calcium channel blockers are second-or third-line agents in patients refractory to other therapy. Investigational agents including spironolactone may also hold promise for future therapy.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

The US Food and Drug Administration (FDA) has approved the use of the parenteral positive inotropes (dobutamine and milrinone) for short-term treatment of patients with acute, decompensated heart failure (HF). Despite the limited approved indication, parenteral, positive inotropes have been used clinically for long-term therapy to support the circulation as a bridge to transplant among patients waiting for an organ donor. The increasing number of patients with HF who are ineligible for transplant and the inadequate supply of donor organs have generated interest in the use of intermittent, parenteral positive inotropes for palliative therapy in patients with end-stage HF. Efforts by some clinicians to provide optimal symptomatic relief while controlling health care costs have produced a number of HF clinics that provide intermittent, parenteral inotropic therapy as a component of HF therapy. This article reviews the evidence for and against intermittent infusion of these agents in the ongoing care of people with end-stage HF who are not candidates for transplant. The available evidence indicates that intermittent positive inotropic infusion is associated with fewer HF symptoms, increased functional status, reduced health care costs, but also with increased mortality.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Heart failure is a major health problem in the United States leading to high rates of mortality and morbidity and impaired quality of life. Assisting patients to improve compliance with their self-care regimen, including medications, dietary sodium restrictions, and self-monitoring (daily weights, edema assessment), may improve these poor outcomes. This article describes the development and initial evaluation of Heart Messages, a theory-based, tailored message intervention to improve compliance with the self-care regimen recommended for patients with heart failure. The project involved four phases, each of which is described in this article. The Heart Messages tailored message intervention program is available in both printed and Web-based formats. In a pilot study and clinical evaluation project, the program was found to be useful for patient education and feasible for implementation. Larger randomized trials are now warranted to evaluate the effectiveness of the intervention in improving compliance with the self-care regimen and thereby improving outcomes among patients with heart failure.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Despite advances in its treatment, the epidemic of heart failure continues unabated in the United States and is escalating worldwide. The extremely high morbidity and mortality seen with heart failure demand creative approaches to this problem. Attention to nontraditional risk factors for rehospitalization and mortality, in addition to traditional medical risk factors, may yield improved outcomes. Psychosocial factors, particularly lack of social support and depression, are associated with poorer outcomes in cardiac patients. However, few studies have been conducted among patients with heart failure. In this article, the evidence relating poor quality of life, social isolation and lack of emotional support, anxiety and depression, and morbidity and mortality in patients with heart failure is discussed. Also explored are possible mechanisms for the association between psychosocial variables and physical outcomes and related clinical and research implications.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

摘要:

Improvement in heart failure outcomes depend on patients' abilities to care for themselves and manage aspects of their condition, and patient self-management has itself become an outcome to be measured. Some behaviors, such as diet and fluid restriction, are prescribed, and self-management is often equated with adherence to the treatment regimen. Self-management has also been defined as cognitive decision making in response to symptoms and conceptualized as a process with stages from novice to expert. Greater understanding and measurement of patient decision making and self-management expertise facilitates the development of effective interventions to improve patient outcomes.

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID

ISSN:0889-4655    

出版商:OVID    

年代:2000

数据来源: OVID