cardiovascular-agents and Dyspnea

Hypertrophic cardiomyopathy is the most common inherited cardiovascular disease. It is characterized by increased ventricular wall thickness and is highly complex due to its heterogeneous clinical presentation, several phenotypes, large number of associated causal mutations and broad spectrum of complications. It is caused by mutations in sarcomeric proteins, which are identified in up to 60% of cases of the disease. Clinical manifestations of Hypertrophic Cardiomyopathy include shortness of breath, chest pain, palpitations and syncope, which are related to the onset of diastolic dysfunction, left ventricular outflow tract obstruction, ischemia, atrial fibrillation and abnormal vascular responses. It is associated with an increased risk of sudden cardiac death, heart failure and thromboembolic events. In this article, we discuss the diagnostic and therapeutic aspects of this disease.

Topics: Animals; Atrial Fibrillation; Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Clinical Trials as Topic; Death, Sudden, Cardiac; Diagnostic Techniques, Cardiovascular; Drug Evaluation, Preclinical; Dyspnea; Genetic Association Studies; Heart; Heart Failure; Heart Septum; Heart Ventricles; Humans; Muscle Proteins; Pacemaker, Artificial; Penetrance; Risk Assessment; Sarcomeres; Syncope

Heart failure (HF) is a clinical syndrome of diverse etiologies and can be associated with preserved, reduced, or mid-range ejection fraction (EF). In the community, heart failure with preserved ejection fraction (HFpEF) is emerging as the most common form of HF. There remains considerable uncertainty regarding its pathogenesis, diagnosis, and optimal therapeutic approach. Hypotheses have been advanced to explain the underlying pathophysiology responsible for HFpEF, but to date, no specific therapy based on these hypotheses has been proven to improve outcomes in HFpEF. We provide a clinically focused review of the epidemiology, clinical presentation, diagnostic approach, pathophysiology, and treatment of HFpEF.

Topics: Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Dyspnea; Exercise Tolerance; Heart Failure; Hospitalization; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Hypertension; Incidence; Inflammation; Ivabradine; Mineralocorticoid Receptor Antagonists; Mortality; Nitrates; Phosphodiesterase 4 Inhibitors; Risk Factors; Stroke Volume

The increasing rate of cardiovascular diseases, the improved survival after the acute phase, the aging of the population and the implementation of primary prevention caused an exponential increase in outpatient cardiac performance, thereby making it difficult to maintain a balance between the citizen-patient request and the economic sustainability of the healthcare system. On the other side, the prescription of many diagnostic tests with a view to defensive medicine and the related growth of patients' expectations, has led several scientific societies to educational campaigns highlighting the concept that "less is more".The present document is aimed at providing the general practitioner with practical information about a prompt diagnosis of signs/symptoms (angina, dyspnea, palpitations, syncope) of the major cardiovascular diseases. It will also provide an overview about appropriate use of diagnostic exams (echocardiogram, stress test), about the appropriate timing of their execution, in order to ensure effectiveness, efficiency, and equity of the health system.

Topics: Algorithms; Ambulatory Care; Cardiovascular Agents; Clinical Decision-Making; Diagnostic Techniques, Cardiovascular; Disease Management; Dyspnea; Follow-Up Studies; Health Priorities; Heart Diseases; Humans; Hypertension; Outpatients; Practice Guidelines as Topic; Symptom Assessment; Time Factors

Congestion is a major reason for hospitalization in acute heart failure (HF). Therapeutic strategies to manage congestion include diuretics, vasodilators, ultrafiltration, vasopressin antagonists, mineralocorticoid receptor antagonists, and potentially also novel therapies such as gut sequesterants and serelaxin. Uncertainty exists with respect to the appropriate decongestion strategy for an individual patient. In this review, we summarize the benefit and risk profiles for these decongestion strategies and provide guidance on selecting an appropriate approach for different patients. An evidence-based initial approach to congestion management involves high-dose i.v. diuretics with addition of vasodilators for dyspnoea relief if blood pressure allows. To enhance diuresis or overcome diuretic resistance, options include dual nephron blockade with thiazide diuretics or natriuretic doses of mineralocorticoid receptor antagonists. Vasopressin antagonists may improve aquaresis and relieve dyspnoea. If diuretic strategies are unsuccessful, then ultrafiltration may be considered. Ultrafiltration should be used with caution in the setting of worsening renal function. This review is based on discussions among scientists, clinical trialists, and regulatory representatives at the 9th Global Cardio Vascular Clinical Trialists Forum in Paris, France, from 30 November to 1 December 2012.

Topics: Acute Disease; Cardiovascular Agents; Disease Management; Dyspnea; Evidence-Based Practice; Heart Failure; Humans; Outcome Assessment, Health Care; Patient Selection; Practice Guidelines as Topic; Risk Assessment

Muscular fatigue and dyspnoea on exertion are among the most common symptoms in chronic heart failure; however their origin is still poorly understood. Several studies have shown that cardiac dysfunction alone cannot fully explain their origin, but the contribution of the multiorgan failure present in this syndrome must be highlighted. We aimed to summarize the existing evidence and the most controversial aspects of the complex interplay of different factors involved in the symptom generation. In the first part of the review, six key factors were revised (the heart, the lung, the skeletal muscle, the hormonal changes, the O2 delivery to the periphery, the endothelium). In this second part, the role of the excitatory reflexes and the cardiac cachexia are presented. Finally, potential therapeutic implications are discussed here. We believe that a better knowledge of the pathophysiology of this syndrome may contribute to the management of the patients and to the improvement in their stress tolerance and quality of life.

Topics: Cachexia; Cardiac Resynchronization Therapy; Cardiovascular Agents; Chronic Disease; Dyspnea; Exercise Tolerance; Heart Failure; Humans; Multiple Organ Failure; Muscle Fatigue; Reflex; Treatment Outcome

Topics: Arrhythmias, Cardiac; Cardiomyopathy, Hypertrophic, Familial; Cardiovascular Agents; Death, Sudden, Cardiac; Dyspnea; Heart Septum; Humans; Hypertrophy, Left Ventricular; Pacemaker, Artificial; Prevalence

Hypertrophic cardiomyopathy (HCM) is a primary myocardial disorder which frequently leads to symptoms such as dyspnea and exercise intolerance, often due to severe dynamic left ventricular outflow tract obstruction (LVOTO). Current guideline-recommended pharmacotherapies have variable therapeutic responses to relieve LVOTO. In recent phases 2 and 3, clinical trials for symptomatic obstructive HCM (oHCM), mavacamten, a small molecule inhibitor of β-cardiac myosin has been shown to improve symptoms, exercise capacity, health status, reduce LVOTO, along with having a beneficial impact on cardiac structure and function.. VALOR-HCM is designed as a multicenter (approximately 20 centers in United States) phase 3, double-blind, placebo-controlled, randomized study. The study population consists of approximately 100 patients (≥18 years old) with symptomatic oHCM who meet 2011 American College of Cardiology/American Heart Association and/or 2014 European Society of Cardiology HCM-guideline criteria and are eligible and willing to undergo septal reduction therapy (SRT). The study duration will be up to 138 weeks, including an initial 2-week screening period, followed by16 weeks of placebo-controlled treatment, 16 weeks of active blinded treatment, 96 weeks of long-term extension, and an 8-week posttreatment follow-up visit. The primary endpoint will be a composite of the decision to proceed with SRT prior to or at Week 16 or remain guideline eligible for SRT at Week 16. Secondary efficacy endpoints will include change (from baseline to Week 16 in the mavacamten group vs placebo) in postexercise LVOT gradient, New York Heart Association class, Kansas City Cardiomyopathy Questionnaire clinical summary score, NT-proBNP, and cardiac troponin. Exploratory endpoints aim to characterize the effect of mavacamten on multiple aspects of oHCM pathophysiology.. In severely symptomatic drug-refractory oHCM patients meeting guideline criteria of eligibility for SRT, VALOR-HCM will primarily study if a 16-week course of mavacamten reduces or obviates the need for SRT using clinically driven endpoints.

Topics: Adult; Benzylamines; Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Clinical Trials, Phase III as Topic; Double-Blind Method; Dyspnea; Eligibility Determination; Exercise Tolerance; Female; Humans; Male; Randomized Controlled Trials as Topic; Uracil; Ventricular Myosins

The purpose of this pilot study was to determine if a definitive clinical trial of thiamine supplementation was warranted in patients with acute heart failure. We hypothesized that thiamine, when added to standard of care, would improve dyspnea (primary outcome) in hospitalized patients with acute heart failure. Peak expiratory flow rate, type B natriuretic peptide, free fatty acids, glucose, hospital length of stay, as well as 30-day rehospitalization and mortality were pre-planned secondary outcome measures.. This was a blinded experimental study at two urban academic hospitals. Consecutive patients admitted from the Emergency Department with a primary diagnosis of acute heart failure were recruited over 2 years. Patients on a daily dietary supplement were excluded. Randomization was stratified by type B natriuretic peptide and diabetes medication categories. Subjects received study drug (100 mg thiamine or placebo) in the evening of their first and second day. Outcome measures were obtained 8 h after study drug infusion. Dyspnea was measured on a 100-mm visual analog scale sitting up on oxygen, sitting up off oxygen, and lying supine off oxygen with 0 indicating no dyspnea. Data were analyzed using mixed-models as well as linear, negative binomial and logistic regression models to assess the impact of group on outcome measures.. Of 130 subjects randomized, 118 had evaluable data (55 in the control and 63 in the treatment groups), 89% in both groups were adjudicated to have primarily AHF. Thiamine values increased significantly in the treatment group and were unchanged in the control group. One patient had thiamine deficiency. Only dyspnea measured sitting upright on oxygen differed significantly by group over time. No change was found for the other measures of dyspnea and all of the secondary measures.. In mild-moderate acute heart failure patients without thiamine deficiency, a standard dosing regimen of thiamine did not improve dyspnea, biomarkers, or other clinical parameters.. ClinicalTrials.gov: NCT00680706 , May 20, 2008 (retrospectively registered).

Topics: Acute Disease; Aged; Aged, 80 and over; Cardiovascular Agents; Dyspnea; Female; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Thiamine; Treatment Outcome; Visual Analog Scale

Pulmonary arterial hypertension (PAH) affects people of all ages and is associated with poor prognosis. Chronic breathlessness affects almost all people with PAH.. This randomized, placebo-controlled, double-blind, crossover study aimed to evaluate the effects of regular, low-dose, extended-release (ER) morphine for PAH-associated chronic breathlessness.. Participants with PAH-associated chronic breathlessness were randomized to 1) seven days of ER morphine 20 mg, 2) seven-day washout, and 3) seven days of identically looking placebo, or vice versa. Primary end points were breathlessness "right now"-morning and evening-measured with a Visual Analogue Scale. Secondary end points included additional breathlessness measures, quality of life, function, harms, and blinded treatment preference (ACTRN12609000209291).. Within a period of seven years, 50 patients were assessed in detail and 23 (46%) were randomized (despite broad eligibility criteria). Four participants withdrew while taking morphine. Nineteen participants completed the study. Breathlessness "right now" was higher on morphine compared with placebo both for morning [mean (M) ± SD 31.7 ± 25 mm vs. 26.9 ± 22 mm; effect size (80% CI) = -0.22 (-0.6 to 0.2)] and evening [(M ± SD 33.5 ± 28 mm vs. 25.6 ± 21 mm; effect size (80% CI) = -0.33 (-0.8 to 0.1)]. All secondary measures of breathlessness were higher with morphine as were nausea and constipation.. This study does not support a Phase III study of ER morphine for people with PAH-associated chronic breathlessness. Recruiting to the target sample size was difficult, the direction of effect in every measure of breathlessness favored placebo and morphine generated more harms.

Topics: Cardiovascular Agents; Cross-Over Studies; Delayed-Action Preparations; Double-Blind Method; Dyspnea; Female; Humans; Hypertension, Pulmonary; Male; Middle Aged; Morphine; Patient Selection; Quality of Life; Sample Size; Treatment Failure

Atrial fibrillation (AFib) is a common comorbidity in HF and affects patients' outcome. We sought to assess the effects of serelaxin in patients with and without AFib.. In a post hoc analysis of the RELAX-AHF trial, we compared the effects of serelaxin on efficacy end points, safety end points and biomarkers in 1161 patients with and without AFib on admission electrocardiogram.. AFib was present in 41.3% of patients. Serelaxin had a similar effect in patients with and without AFib, including dyspnea relief by visual analog scale through day 5 [mean change in area under the curve, 541.11 (33.79, 1048.44), p = 0.0366 in AFib versus 361.80 (-63.30, 786.90), p = 0.0953 in non-AFib, interaction p = 0.5954] and all-cause death through day 180 [HR = 0.42 (0.23, 0.77), p = 0.0051 in AFib versus 0.90 (0.53, 1.52), p = 0.6888 in non-AFib, interaction p = 0.0643]. Serelaxin was similarly safe in the two groups and induced similar reductions in biomarkers of cardiac, renal and hepatic damage. Stroke occurred more frequently in AFib patients (2.8 vs. 0.8%, p = 0.0116) and there was a trend for lower stroke incidence in the serelaxin arm in AFib patients (odds ratios, 0.31, p = 0.0759 versus 3.88, p = 0.2255 in non-AFib, interaction p = 0.0518).. Serelaxin was similarly safe and efficacious in improving short- and long-term outcomes and inducing organ protection in acute HF patients with and without AFib.

Topics: Aged; Aged, 80 and over; Atrial Fibrillation; Biomarkers; Cardiovascular Agents; Dyspnea; Electrocardiography; Female; Heart Failure; Humans; Male; Middle Aged; Recombinant Proteins; Relaxin; Stroke; Treatment Outcome

The aim of this study was to evaluate whether Global Initiative for Chronic Obstructive Lung Disease (GOLD) classification could predict mortality risk factors and whether baseline treatment intensity would relate to mortality within each group, using data from TIOSPIR(®), the largest randomized clinical trial in COPD performed to date.. A total of 17,135 patients from TIOSPIR(®) were pooled and grouped by GOLD grading (A-D) according to baseline Medical Research Council breathlessness score, exacerbation history, and spirometry. All-cause mortality and adjudicated cardiovascular (CV) and respiratory mortality were assessed.. Of the 16,326 patients classified, 1,248 died on treatment. Group B patients received proportionally more CV treatment at baseline. CV mortality risk, but not all-cause mortality risk, was significantly higher in Group B than Group C patients (CV mortality - hazard ratio [HR] =1.74, P=0.004; all-cause mortality - HR =1.18, P=0.11). Group D patients had a higher incidence of all-cause mortality than Group B patients (10.9% vs 6.6%). Similar trends were observed regardless of respiratory or CV medication at baseline. In contrast, respiratory deaths increased consistently from Groups A-D (0.3%, 0.8%, 1.6%, and 4.2% of patients, respectively).. The data obtained from the TIOSPIR(®) trial, supporting earlier studies, suggest that proportionally more CV medication and CV deaths occur in GOLD Group B COPD patients, although deaths attributed to respiratory causes are more prevalent in Groups C and D.

Topics: Aged; Cardiovascular Agents; Cardiovascular Diseases; Comorbidity; Disease Progression; Dyspnea; Female; Humans; Incidence; Male; Middle Aged; Patient Outcome Assessment; Proportional Hazards Models; Pulmonary Disease, Chronic Obstructive; Respiratory System Agents; Risk Assessment; Risk Factors; Severity of Illness Index; Spirometry; Symptom Flare Up

Serelaxin, a recombinant form of human relaxin-2, is in development for treating acute heart failure (AHF) and a Phase II study in Japanese AHF patients was conducted.. A randomized, double-blind, placebo-controlled study of serelaxin at 10 and 30 µg·kg(-1)·day(-1)continuous intravenous infusion for up to 48 h, added to standard care for Japanese AHF patients. Primary endpoints were adverse events (AEs) through Day 5, serious AEs (SAEs) through Day 14, and serelaxin pharmacokinetics. Secondary endpoints included changes in systolic blood pressure (SBP) and cardiorenal biomarkers. A total of 46 patients received the study drug and were followed for 60 days. The observed AE profile was comparable between the groups, with no AEs of concern. Dose-dependent increase in the serum concentration of serelaxin was observed across the 2 dose rates of serelaxin. A greater reduction in SBP was observed with serelaxin 30 µg·kg(-1)·day(-1)vs. placebo (-7.7 [-16.4, 1.0] mmHg). A greater reduction in NT-proBNP was noted with serelaxin (-50.8% and -54.9% for 10 and 30 µg·kg(-1)·day(-1), respectively at Day 2).. Serelaxin was well tolerated in this study with Japanese AHF patients, with no AEs of concern and favorable beneficial trends on efficacy. These findings support further evaluation of serelaxin 30 µg·kg(-1)·day(-1)in this patient population.

Topics: Acute Disease; Aged; Aged, 80 and over; Asian People; Biomarkers; Blood Pressure; Cardiovascular Agents; Comorbidity; Double-Blind Method; Drug Therapy, Combination; Dyspnea; Female; Heart Failure; Humans; Infusions, Intravenous; Japan; Male; Metabolic Clearance Rate; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Recombinant Proteins; Relaxin; Treatment Outcome

Most patients with heart failure are diagnosed and managed in primary care, however, underdiagnosis and undertreatment are common. We assessed whether implementation of a diagnostic-therapeutic strategy improves functionality, health-related quality of life, and uptake of heart failure medication in primary care.. A selective screening study followed by a single-blind cluster randomized trial in primary care. The study population consists of patients aged 65 years or over who presented themselves to the general practitioner in the previous 12 months with shortness of breath on exertion. Patients already known with established heart failure, confirmed by echocardiography, are excluded. Diagnostic investigations include history taking, physical examination, electrocardiography, and serum N-terminal pro B-type natriuretic peptide levels. Only participants with an abnormal electrocardiogram or an N-terminal pro B-type natriuretic peptide level exceeding the exclusionary cutpoint for non-acute onset heart failure (> 15 pmol/L (≈ 125 pg/ml)) will undergo open-access echocardiography. The diagnosis of heart failure (with reduced or preserved ejection fraction) is established by an expert panel consisting of two cardiologists and a general practitioner, according to the criteria of the European Society of Cardiology guidelines.Patients with newly established heart failure are allocated to either the 'care as usual' group or the 'intervention' group. Randomization is at the level of the general practitioner. In the intervention group general practitioners receive a single half-day training in heart failure management and the use of a structured up-titration scheme. All participants fill out quality of life questionnaires at baseline and after six months of follow-up. A six-minute walking test will be performed in patients with heart failure. Information on medication and hospitalization rates is extracted from the electronic medical files of the general practitioners.. This study will provide information on the prevalence of unrecognized heart failure in elderly with shortness of breath on exertion, and the randomized comparison will reveal whether management based on a half-day training of general practitioners in the practical application of an up-titration scheme results in improvements in functionality, health-related quality of life, and uptake of heart failure medication in heart failure patients compared to care as usual.. ClinicalTrials.gov NCT01202006.

Topics: Aged; Aged, 80 and over; Attitude of Health Personnel; Biomarkers; Cardiovascular Agents; Chronic Disease; Clinical Protocols; Dyspnea; Echocardiography; Education, Medical, Continuing; Electrocardiography; Exercise Test; Female; Heart Failure; Humans; Male; Natriuretic Peptide, Brain; Netherlands; Peptide Fragments; Practice Patterns, Physicians'; Predictive Value of Tests; Prevalence; Primary Health Care; Quality of Life; Recognition, Psychology; Research Design; Single-Blind Method; Stroke Volume; Surveys and Questionnaires; Treatment Outcome; Ventricular Function, Left

Rolofylline, an adenosine A(1) receptor antagonist, facilitates diuresis and preserves renal function in patients with acute heart failure (AHF) with renal impairment. Although not powered around any specific hypothesis, this pilot study was designed to identify an efficacious dose while refining inclusion criteria and end points.. A total of 301 patients hospitalized for AHF with an estimated creatinine clearance of 20 to 80 mL/min and elevated natriuretic peptide levels were enrolled within 24 hours of presentation to placebo or rolofylline 10, 20, or 30 mg administered as 4-hour infusions for 3 days in addition to intravenously administered loop diuretics. Post hoc analyses for end points chosen for subsequent Phase III studies were performed.. Compared with placebo, rolofylline produced trends toward greater proportions of patients with marked or moderately improved dyspnea and fewer patients with worsening heart failure or renal function. Serum creatinine increased in patients receiving placebo and remained stable or tended to decrease in those receiving rolofylline. On day 14 the absolute differences between placebo and rolofylline for change in creatinine increased with increasing rolofylline dose, reflecting the lesser increase in creatinine in rolofylline-treated patients (r = -0.12, P = .030). Treatment with 30 mg, the dose selected for the pivotal trials, was associated with a trend toward reduced 60-day mortality or readmission for cardiovascular or renal cause (hazard ratio, 0.55; 95% confidence interval, 0.28-1.04).. These results demonstrate that adenosine A(1) receptor blockade with rolofylline can prevent renal impairment in patients with AHF and may positively affect acute symptoms and 60-day outcome. A 2000-patient trial of this agent is now under way.

Topics: Acute Disease; Adenosine A1 Receptor Antagonists; Aged; Cardiovascular Agents; Confidence Intervals; Disease Progression; Diuresis; Dyspnea; Female; Heart Failure; Humans; Male; Pilot Projects; Renal Insufficiency; Risk; Risk Factors; Xanthines

To assess the prevalence of heart failure and asymptomatic left ventricular systolic dysfunction in the chronically paced population.. Three hundred and seven patients were identified from attendance at routine pacemaker follow-up clinic. Subjects underwent a medical history and examination, 6-minute walk test and echocardiography. 94 (31%) had a left ventricular ejection fraction (LVEF) <40%, of whom 83 had symptoms of heart failure (70% NYHA II, 26% NYHA III and 4% NYHA IV). Heart failure was more prevalent in patients with single chamber compared to dual chamber pacemakers, (DDD(R) 18% vs 35% VVI(R), p<0.008), and those with chronic atrial fibrillation (AF) compared to those with sinus rhythm (42% vs 21%, p=0.003). Decreasing 6-minute walk distance, history of ischaemic heart disease and years of pacing were independently associated with the presence of heart failure (combined R=0.572, p<0.001).. Heart failure due to left ventricular systolic dysfunction is common in the paced population. Only a minority of these had a pre-existing diagnosis and a smaller proportion were on 'optimal' therapy. Echocardiographic screening of this high-risk population is justified to improve rates of diagnosis and treatment of heart failure.

Topics: Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Blood Flow Velocity; Cardiac Output, Low; Cardiac Pacing, Artificial; Cardiovascular Agents; Diabetic Angiopathies; Double-Blind Method; Dyspnea; Echocardiography; Exercise Tolerance; Fatigue; Female; Humans; Male; Middle Aged; Risk Factors; Stroke Volume; Ventricular Dysfunction, Left

The renin-angiotensin system plays an important part in the pathogenesis of congestive heart failure (CHF). This study evaluated the effect of an angiotensin II type 1 receptor antagonist on exercise tolerance and symptoms of CHF.. In this multicenter, double-blind, parallel-group study, 844 patients with CHF were randomized to 12 weeks' treatment with placebo (n=211) or candesartan cilexetil 4 mg (n=208), 8 mg (n=212), or 16 mg (n=213) after a 4-week placebo run-in period. Changes in exercise time, Dyspnea Fatigue Index score, NYHA functional class, and cardiothoracic ratio were determined. Candesartan cilexetil produced a dose-related improvement in exercise time. For the intention-to-treat population, the increase produced by candesartan cilexetil 16 mg was significantly greater than that produced by placebo (47.2 versus 30.8 seconds, P=0.0463). All doses of candesartan cilexetil significantly improved the Dyspnea Fatigue Index score relative to placebo. NYHA class improved more frequently in the candesartan cilexetil groups; the differences relative to placebo were not significant. The decrease in cardiothoracic ratio with candesartan 4 to 16 mg was small but statistically significant compared with placebo (all P<0.05). In all candesartan cilexetil groups, plasma renin activity and angiotensin II levels increased from baseline and aldosterone levels decreased in the 8- and 16-mg treatment groups. Candesartan cilexetil was well tolerated at all doses.. In summary, treatment with candesartan cilexetil demonstrated significant improvements in exercise tolerance, cardiothoracic ratio, and symptoms and signs of CHF and was well tolerated.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin II; Angiotensin Receptor Antagonists; Antihypertensive Agents; Benzimidazoles; Biphenyl Compounds; Cardiovascular Agents; Dose-Response Relationship, Drug; Double-Blind Method; Drug Interactions; Dyspnea; Exercise Test; Exercise Tolerance; Fatigue; Female; Heart Failure; Humans; Hypotension; Male; Middle Aged; Prospective Studies; Receptor, Angiotensin, Type 1; Receptor, Angiotensin, Type 2; Renin; Severity of Illness Index; Tetrazoles

Coronary artery anomalies can provoke intermittent vasospasm and endothelial dysfunction, which can cause takotsubo cardiomyopathy. However, in takotsubo cardiomyopathy, apical myocardial regions are typically affected, and these do not correlate with a specific epicardial coronary distribution territory. We report the case of a 74-year-old woman who presented with acute respiratory failure and suspected myocardial infarction. She had a left coronary artery anomaly, dominant right coronary artery supply, takotsubo cardiomyopathy, depressed left ventricular ejection fraction, and no atherosclerotic disease. In the absence of exercise ischemia, we considered the anomalous artery to be an incidental finding. After 6 weeks of medical therapy, the patient's ejection fraction was normal; one year later, she remained asymptomatic. The anomalous left coronary artery in the presence of dominant right coronary supply did not explain the diffuse apical regional wall-motion abnormalities in our patient. To our knowledge, this is the first report of coexisting takotsubo cardiomyopathy and anomalous coronary artery in a patient presenting with acute dyspnea.

Topics: Aged; Cardiovascular Agents; Coronary Vessel Anomalies; Dyspnea; Female; Humans; Takotsubo Cardiomyopathy; Treatment Outcome; Ventricular Function, Left

Endomyocardial fibrosis (EMF) is a rare condition and a major cause of death in tropical countries. The etiology of EMF remains elusive, and no specific treatment has been developed yet, therefore it carries poor prognosis.. An 81-year-old male Chinese patient with a history of long-standing exertional breathlessness, presented with worsening symptoms rapidly evolving to orthopnea. A proper specific treatment was prescribed to the patient in the following days, including diuretics, angiotensin-converting-enzyme inhibitor and beta blockers. The patient died of progressive multiple organ failure.. Echocardiography is technically limited due to the acoustic shadowing as a result of the calcification. Chest computed tomography is a more accurate diagnostic tool to examine the anatomic distribution and extent of endomyocardial calcification in this rare case.

Topics: Aged, 80 and over; Cardiovascular Agents; China; Disease Progression; Dyspnea; Echocardiography; Endomyocardial Fibrosis; Fatal Outcome; Humans; Male; Multiple Organ Failure; Predictive Value of Tests; Tomography, X-Ray Computed; Treatment Outcome

Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) can markedly reduce angina symptom burden, but many patients often remain on multiple antianginal medications (AAMs) after the procedure. It is unclear when, or if, AAMs can be de-escalated to prevent adverse effects or limit polypharmacy. We examined the association of de-escalation of AAMs after CTO PCI with long-term health status.. In a 12-center registry of consecutive CTO PCI patients, health status was assessed at 6 months after successful CTO PCI with the Seattle Angina Questionnaire and the Rose Dyspnea Scale. Among patients with technical CTO PCI success, we examined the association of AAM de-escalation with 6-month health status using multivariable models adjusting for revascularization completeness and predicted risk of post-PCI angina (using a validated risk model). We also examined predictors and variability of AAMs de-escalation.. Of 669 patients with technical success of CTO PCI, AAMs were de-escalated in 276 (35.9%) patients at 1 month. Patients with AAM de-escalation reported similar angina and dyspnea rates at 6 months compared with those whose AAMs were reduced (any angina: 22.5% vs 20%, P = .43; any dyspnea: 51.8% vs 50.1%, P = .40). In a multivariable model adjusting for complete revascularization and predicted risk of post-PCI angina, de-escalation of AAMs at 1 month was not associated with an increased risk of angina, dyspnea, or worse health status at 6 months.. Among patients with successful CTO PCI, de-escalation of AAMs occurred in about one-third of patients at 1 month and was not associated with worse long-term health status.

Topics: Aged; Angina Pectoris; Calcium Channel Blockers; Cardiovascular Agents; Chi-Square Distribution; Chronic Disease; Coronary Occlusion; Dyspnea; Female; Health Status; Health Surveys; Humans; Logistic Models; Male; Myocardial Ischemia; Nitro Compounds; Percutaneous Coronary Intervention; Prospective Studies; Quality of Life; Ranolazine; Registries; Time Factors

Peripartum cardiomyopathy (PPCM) is a left ventricular systolic dysfunction failure emerges during the antepartum or puerperal period, and can result in maternal death. Reported incidences are increasing and differing globally. Echocardiography is the cornerstone for the diagnosis. The immediate goals in acute management are the stabilization of the hemodynamic state, providing symptomatic relief, and ensuring fetal wellbeing. Emergency physicians should be aware of PPCM at the differential diagnosis of dyspnea in pregnancy related emergencies and play role in early diagnosis.

Topics: Adrenergic beta-1 Receptor Antagonists; Adult; Anticoagulants; Cardiomyopathies; Cardiovascular Agents; Chest Pain; Drug Therapy, Combination; Dyspnea; Echocardiography; Emergency Service, Hospital; Female; Hemodynamics; Humans; Metoprolol; Puerperal Disorders; Radiography; Ventricular Dysfunction, Left

A 26-year-old man presented to our syncope service with debilitating daily palpitations, shortness of breath, presyncope and syncope following a severe viral respiratory illness 4 years previously. Mobitz type II block had previously been identified, leading to a permanent pacemaker and no further episodes of frank syncope. Transthoracic echocardiography, electophysiological study and repeated urine metanepherines were normal. His palpitations and presyncope were reproducible on deep inspiration, coughing, isometric hand exercise and passive leg raises. We demonstrated rapid increases in heart rate with no change in morphology on his 12 lead ECG. His symptoms were resistant to fludrocortisone, flecainide, β blockers and ivabradine. Initiation of clonidine in combination with ivabradine led to rapid resolution of his symptoms. We suggest that an excessive respiratory sinus arrhythmia was responsible for his symptoms and achieved an excellent response with the centrally acting sympatholytic clonidine, where previous peripherally acting treatments had failed.

Topics: Adrenergic alpha-2 Receptor Agonists; Adult; Benzazepines; Cardiovascular Agents; Clonidine; Cough; Drug Therapy, Combination; Dyspnea; Echocardiography; Electrocardiography; Humans; Inhalation; Ivabradine; Male; Syncope; Tachycardia; Tachycardia, Sinus; Treatment Outcome

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease which follows a relapsing and remitting course that can manifest in any organ system. While classic manifestations consist of arthralgia, myalgia, frank arthritis, a malar rash and renal failure to name a few, cardiac tamponade, however, is a far less common and far more dangerous presentation. We highlight the case of a 61year-old male with complaints of acute onset shortness of breath and generalized body aches associated with a fever and chills in the ER. A bedside echocardiogram revealed a significant pericardial effusion concerning for pericardial tamponade. An emergent pericardiocentesis performed drained 800mL of serosanguinous fluid. While denying a history of any rash, photosensitivity, oral ulcers, or seizures, his physical examination did reveal metacarpal phalangeal joint swelling along with noted pulsus paradoxus of 15-200mmHg. Subsequent lab work revealed ANA titer of 1:630 and anti-DS DNA antibody level of 256IU/mL consistent with SLE. This case highlights cardiac tamponade as a rare but life-threatening presentation for SLE and raises the need to keep it in the differential when assessing patients presenting with pertinent exam findings.

Topics: Antihypertensive Agents; Cardiac Tamponade; Cardiovascular Agents; Chills; Diltiazem; Dyspnea; Echocardiography; Fever; Humans; Lupus Erythematosus, Systemic; Male; Metoprolol; Middle Aged; Pericardial Effusion; Pericardiocentesis; Treatment Outcome

Episodic breathlessness is a relevant aspect in patients with advanced cancer.. The aim of this study was to assess the different aspects of this clinical phenomenon.. A consecutive sample of patients with advanced cancer admitted to different settings for a period of six months was surveyed. The presence of background breathlessness and episodic breathlessness, their intensity (numerical scale 0-10), and drugs used for treatment were collected. Factors inducing episodic breathlessness and its influence on daily activities were investigated.. Of 921 patients, 29.3% (n = 269) had breathlessness and 134 patients (49.8%) were receiving drugs for background breathlessness. In the multivariate analysis, the risk of breathlessness increased with chronic obstructive pulmonary disease, although it decreased in patients receiving disease-oriented therapy and patients with gastrointestinal tumors. The prevalence of episodic breathlessness was 70.9% (n = 188), and its mean intensity was 7.1 (SD 1.6). The mean duration of untreated episodic breathlessness was 19.9 minutes (SD 35.3); 41% of these patients were receiving drugs for episodic breathlessness. The majority of episodic breathlessness events (88.2%) were triggered by activity. In the multivariate analysis, higher Karnofsky Performance Status levels were significantly related to episodic breathlessness, although patients receiving disease-oriented therapy were less likely to have episodic breathlessness.. This study showed that episodic breathlessness frequently occurs in patients with breathlessness in the advanced stage of disease, has a severe intensity, and is characterized by rapid onset and short duration, which require rapid measures.

Topics: Activities of Daily Living; Aged; Cardiovascular Agents; Comorbidity; Dyspnea; Female; Humans; Karnofsky Performance Status; Male; Middle Aged; Multivariate Analysis; Neoplasms; Palliative Care; Prevalence; Pulmonary Disease, Chronic Obstructive; Time Factors

Breathlessness is common in patients with advanced cancer. Using a multidisciplinary approach for relieving this challenging symptom was believed to be just a theory. The "SOB Program" was implemented in our institution in March 2013.. An audit of medical records before and after implementation of the "SOB Program" was performed to identify any changes in practice after implementation, specifically in the use of nonpharmacologic interventions.. The "SOB Program" is a multidisciplinary service in our department, using both pharmacologic and nonpharmacologic interventions for all patients with advanced cancer who have dyspnea.. There was a marked increase in the use of nonpharmacologic interventions after the "SOB Program" (26.86% preimplementation vs. 89.35% postimplementation). Patients joining the program also had satisfactory improvement in breathlessness.. A multidisciplinary approach for breathlessness control is both feasible and practical. Similar services can be promoted in other palliative care centers.

Topics: Cardiovascular Agents; Dyspnea; Feasibility Studies; Follow-Up Studies; Hong Kong; Humans; Neoplasms; Palliative Care; Retrospective Studies

Patient-reported outcome (PRO) measures can be used to support label claims if they adhere to US Food & Drug Administration guidance. The process of developing a new PRO measure is expensive and time-consuming. We report the results of qualitative studies to develop new PRO measures for use in clinical trials of omecamtiv mecarbil (a selective, small molecule activator of cardiac myosin) for patients with heart failure (HF), as well as the lessons learned from the development process.. Concept elicitation focus groups and individual interviews were conducted with patients with HF to identify concepts for the instrument. Cognitive interviews with HF patients were used to confirm that no essential concepts were missing and to assess patient comprehension of the instrument and items.. During concept elicitation, the most frequently reported HF symptoms were shortness of breath, tiredness, fluid retention, fatigue, dizziness/light-headedness, swelling, weight fluctuation, and trouble sleeping. Two measures were developed based on the concepts: the Heart Failure Symptom Diary (HF-SD) and the Heart Failure Impact Scale (HFIS). Findings from cognitive interviews suggested that the items in the HF-SD and HFIS were relevant and well understood by patients. Multiple iterations of concept elicitation and cognitive interviews were needed based on FDA request for a broader patient population in the qualitative study. Lessons learned from the omecamtiv mecarbil PRO/clinical development program are discussed, including challenges of qualitative studies, patient recruitment, expected and actual timelines, cost, and engagement with various stakeholders.. Development of a new PRO measure to support a label claim requires significant investment and early planning, as demonstrated by the omecamtiv mecarbil program.

Topics: Aged; Aged, 80 and over; Cardiac Myosins; Cardiovascular Agents; Clinical Trials as Topic; Dizziness; Dyspnea; Edema; Fatigue; Female; Focus Groups; Heart Failure; Humans; Male; Middle Aged; Patient Reported Outcome Measures; Qualitative Research; Quality of Life; Sleep Initiation and Maintenance Disorders; United States; United States Food and Drug Administration; Urea

Topics: Aged; Angina Pectoris; Cardiomyopathy, Hypertrophic; Cardiovascular Agents; Dyspnea; Female; Humans; Male; Middle Aged; Pilot Projects; Ranolazine

Many assume that most patients hospitalized with heart failure (HF) are short of breath at rest (SOBAR). The National HF Audit for England and Wales suggests that this assumption is false, which has profound implications for management. A retrospective case-note review was carried out of patients hospitalized with HF to determine how many present with shortness of breath at rest or are comfortable at rest but breathless on slight exertion (CARBOSE). Vital signs were tracked for 24 h and mortality for 180 days. Of 311 patients, those who were SOBAR (42%) had higher median heart rate (HR) (100 vs. 85 b.p.m.; P < 0.001), systolic blood pressure (SBP) (141 vs. 122 mmHg; P < 0.001), and respiratory rate (RR) (24 vs. 18 breaths/min; P < 0.001) compared with those who were CARBOSE (56%). Vital signs changed little in those who were CARBOSE over the first 4-6 h, but SBP (141-128 mmHg; P < 0.001), HR (100-90 b.p.m.; P = 0.002), and RR (24-20 breaths/min; P < 0.001) fell in those who were SOBAR. At presentation, SBP was >125 mmHg in 73% of patients who were SOBAR and in 46% who were CARBOSE, dropping to 52% and 37%, respectively, by 4-6 h. Mortality amongst those who were SOBAR and those who were CARBOSE was, respectively, 19% and 34% (odds ratio 2.29; P = 0.005, 95% confidence interval 1.29-4.06).. Many patients admitted with HF are CARBOSE. Shortness of breath at rest may be more alarming, but those who are CARBOSE have a worse prognosis, perhaps reflecting more severe right heart dysfunction. Clinical trials of hospitalized HF may inappropriately exclude patients if they focus on shortness of breath at rest rather than peripheral congestion.

Topics: Aged; Aged, 80 and over; Bed Rest; Blood Pressure; Cardiovascular Agents; Dyspnea; Female; Heart Failure; Heart Rate; Hospital Mortality; Hospitalization; Humans; Length of Stay; Male; Oxygen Inhalation Therapy; Respiratory Rate; Retrospective Studies; Ventilators, Mechanical

To determine the prevalence and analyze the most relevant clinical characteristics of three clinical phenotypes of COPD: emphysema (type 1), chronic bronchitis (type 2) or COPD-asthma (type 3).. Observational, multicenter study performed with 331 COPD patients recruited in pulmonology outpatient services. The stratification in three phenotypes was performed with imaging tests, pulmonary function, and a standardized clinical questionnaire.. The 43.2% presented an emphysematous phenotype, 44.7% were chronic bronchitic and the other 12.1% presented a phenotype showing mixed characteristics with asthma. There were no significant differences in the smoking level, in the gasometric values or time of disease evolution. Type 1 patients showed lower FEV1 values in comparison with types 2 and 3, 46.6% (21.1), 55.2% (21.2) and 54.4% (21.8), respectively (p < 0.05), and greater levels of dyspnea (p < 0.05). No significant differences were observed in the percentage of patients who had at least one exacerbation in the last year (68.8%, 63.9%, 64.9%; p = 0.25), in the number of exacerbations (p = 0.56), in the number of visits to the ER (total and due to COPD), or in the number of hospital admittances. Type 2 patients showed a greater prevalence of cardiovascular comorbidities and of sleep apnea syndrome (4.9%, 23.6% and 12.5%, respectively, p < 0.001).. In COPD, emphysematous patients present worse pulmonary function and greater dyspnea, although there were no differences in the use of hospital health care resources. The greater comorbidity in Group 2 patients may require specific strategies in this subgroup of patients.

Topics: Activities of Daily Living; Aged; Asthma; Bronchitis; Cardiovascular Agents; Chronic Disease; Comorbidity; Cross-Sectional Studies; Dyspnea; Female; Forced Expiratory Volume; Health Services; Humans; Male; Middle Aged; Phenotype; Prevalence; Pulmonary Disease, Chronic Obstructive; Pulmonary Emphysema; Quality of Life; Spain

Topics: Cardiovascular Agents; Chest Pain; Dyspnea; Humans; Myocardial Ischemia; Myocardial Revascularization; Prognosis; Quality of Life; Surveys and Questionnaires; Symptom Assessment

Topics: Adult; Asthma; Cardiomyopathy, Dilated; Cardiovascular Agents; Cesarean Section; Diagnosis, Differential; Drug Therapy, Combination; Dyspnea; Echocardiography, Doppler, Color; Female; Humans; Predictive Value of Tests; Pregnancy; Pregnancy Complications, Cardiovascular; Severity of Illness Index; Treatment Outcome

Brain natriuretic peptide (BNP) and N-Terminal pro natriuretic peptide (NT-proBNP) are widely accepted to diagnose congestive heart failure (CHF) in the emergency room. The aim of this study was to evaluate the value of BNP and NT-proBNP to diagnose CHF in primary care.. Clinical and Doppler-echocardiographic assessment of patients referred by their general practitioner (GP) with the diagnosis of CHF. Receiver operating curves were used to evaluate the accuracy of BNP and NT-proBNP for echocardiographically confirmed systolic and/or diastolic heart failure.. Three hundred and eighty four patients (mean age of 65) were included. One hundred and ninety three (50%) patients had systolic heart failure and 31 (8%) had isolated diastolic heart failure. Using currently recommended cut-off values of BNP (less than 100 pg/ml) and NT-proBNP (less than 125 pg/ml) for exclusion of CHF, BNP was false negative in 25% and NT-proBNP in 10% of the patients. The area under the curve was better for NT-proBNP than for BNP (0.742 vs. 0.691).. In this population with a high prevalence of CHF, BNP and NT-proBNP failed to adequately rule out CHF. GP's should be cautious when using BNP and NT-proBNP in primary care. An echocardiography remains compulsory in unexplained dyspnea.

Topics: Aged; Biomarkers; Cardiovascular Agents; Chronic Disease; Dyspnea; Echocardiography, Doppler; Female; Heart Failure, Diastolic; Heart Failure, Systolic; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Peptide Fragments; Predictive Value of Tests; Primary Health Care; Prospective Studies; Referral and Consultation; ROC Curve; Switzerland; Treatment Outcome

The study aimed to compare the clinical picture and treatment differences in elderly patients (aged 75 years or older) and younger patients (aged below 75 years).. The study included 80 consecutive patients with myocardial infarction (MI) treated in the Cardiology Ward of the Specialist Hospital in Radom, Poland, in 2005. Analyses were performed retrospectively. The patients were separated into 2 groups according to age. The group I study group consisted of 40 patients aged 75 or over (aged 75-95; mean 81 years) and the group II control group consisted of 40 patients aged below 75 years (aged 42-67; mean 60 years).. In the elderly, as compared with younger subjects, dyspnea, fatigue, and other heart failure symptoms, were more frequently the first symptoms of MI than typical chest pain (p<0.05). ST-segment elevation myocardial infarction (STEMI) was also more common (p<0.05). Non-ST-segment elevation myocardial infarction (NSTEMI) was more frequently diagnosed in the elderly (p<0.05). In elderly patients there were more women (p<0.05), more patients with previously diagnosed ischemic heart disease (p<0.05), with hypertension (p<0.05), and with diabetes mellitus (p<0.05). Obesity was less frequently diagnosed in the elderly; however the difference was not statistically significant. Dyslipidemia and cigarette smoking were both significantly less common among elderly patients (p<0.05). The elderly were significantly less frequently revascularized (p<0.05). Both fibrinolysis and primary percutaneous coronary intervention (PCI) were less commonly applied to the elderly (p<0.05). Time from symptom onset to hospital admission was significantly longer in the case of elderly patients (p<0.05). The MI complications and side effects of treatment seemed to be more frequent in the elderly, but only post-MI heart failure was observed more frequently in this group of patients (p<0.05).. Our observations confirm the differences in the clinical picture of MI in the elderly as described previously. All patients of advanced age should be considered as having the highest risk of death and complications occurrence.

Topics: Adult; Age Factors; Aged; Aged, 80 and over; Angina Pectoris; Angioplasty, Balloon, Coronary; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Dyspnea; Fatigue; Female; Heart Failure; Humans; Male; Middle Aged; Myocardial Infarction; Poland; Retrospective Studies; Risk Assessment; Risk Factors; Thrombolytic Therapy; Time Factors; Treatment Outcome

The aim of this study was to investigate the long-term prognosis of non-interventionally followed patients with myocardial bridge and angiographic milking of the left anterior descending (LAD) coronary artery.. All of the coronary angiography records from May 2000 to November 2007 were reevaluated and patients who had more than 70% narrowing during systole on LAD were eligible for the present study. Follow-up was carried out by physical examination, echocardiography, and treadmill exercise testing. The clinical situations of the patients, medical treatment at the time of follow-up, and experienced events (death, myocardial infarction, or revascularization) were recorded.. There were 59 eligible patients (44 male, 74.6%). The mean age of the patients was 54 +/- 11 years. The bridges were located in the proximal, mid, and distal portion of the LAD in 17 (28.8%), 20 (33.9%), and 22 (37.3%) patients, respectively. Distributions of the narrowing degree were as follows: between 70% to 89% in 33 (56%) patients and 90% to 100% in 26 (44%) patients. Mean follow-up duration of the group was 37 +/- 13 months (range 15-65 mo). The clinical presentation during follow-up was stable angina in 9 (15.3%) cases, atypical angina in 12 (20.3%), atypical chest pain in 13 (22%), dyspnea in 3 (5.1%), and syncope in 3 (5.1%) cases. There were no experienced events and/or hospitalizations related to cardiac disease. Echocardiographic examination revealed normal systolic ventricular function. Only 17 (28.8%) patients continued to use medication. Most of them were on beta-blocker therapy.. Patients with myocardial bridges and angiographic milking of the LAD coronary artery have a good long-term prognosis.

Topics: Adult; Aged; Angina Pectoris; Cardiovascular Agents; Cineangiography; Coronary Angiography; Coronary Stenosis; Dyspnea; Echocardiography; Exercise Test; Female; Follow-Up Studies; Humans; Male; Middle Aged; Myocardial Bridging; Myocardial Ischemia; Registries; Severity of Illness Index; Syncope; Time Factors; Treatment Outcome

Topics: Aged; Cardiac Catheterization; Cardiovascular Agents; Diagnosis, Differential; Dyspnea; Echocardiography; Edema; Female; Humans; Leg; Myocardial Infarction; Takotsubo Cardiomyopathy

Topics: Aged; Cardiomyopathy, Dilated; Cardiovascular Agents; Chronic Disease; Coronary Disease; Disease Progression; Drug Therapy, Combination; Dyspnea; Fatal Outcome; Heart Failure; Humans; Leukemia, Lymphoid; Male; Myocardial Stunning; Pleural Effusion

To describe a single-center experience of using retrospectively gated multislice computed tomographic (MSCT) coronary angiography for imaging congenital coronary anomalies.. We retrospectively reviewed the clinical information and imaging studies for 9 patients diagnosed as having congenital coronary anomalies on invasive, selective coronary angiography between February 2001 and October 2003 at the Mayo Clinic in Jacksonville, Fla. Two experienced observers classified by consensus the origin and proximal course of the abnormal coronary arteries as seen on MSCT.. In 1 patient, MSCT showed a normal but extremely anterior origin of the right coronary artery from the right aortic sinus of Valsalva. In the other 8 patients, the origin and course of 4 anomalous right coronary arteries, 2 anomalous left circumflex coronary arteries, and 2 single coronary arteries were recognized easily on MSCT.. Similar to electron beam computed tomography and magnetic resonance imaging, widely available MSCT can characterize the proximal course of congenitally abnormal coronary arteries and thus aid in clinical decision making for patients with such anomalies.

Topics: Adult; Aged; Aged, 80 and over; Angina Pectoris; Cardiovascular Agents; Coronary Angiography; Coronary Artery Bypass; Coronary Vessel Anomalies; Dyspnea; Female; Florida; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Observer Variation; Patient Selection; Predictive Value of Tests; Retrospective Studies; Tomography, Spiral Computed

Topics: Arterial Occlusive Diseases; Cardiovascular Agents; Connective Tissue Diseases; Dyspnea; Hemangioma; HIV Infections; Humans; Hypertension, Pulmonary; Risk Factors

The impact of coronary heart disease (CHD) on elderly patients' functional abilities is of growing interest because of the increasing number of people that survive the disease. The aim of our study was, firstly, to describe functional abilities among elderly CHD patients and, secondly, to analyze the relationships between physical disability and the severity of chest pain or dyspnea. The third aim was to assess whether there is an independent association between physical disability and CHD. The study was carried out at the health center of the municipality of Lieto, southwestern Finland. From a population of 1196 community-dwelling persons aged > or = 64 years, 89 men and 73 women with CHD (angina pectoris and/or a past myocardial infarction) were selected along with 178 male and 146 female sex- and age-matched controls without CHD. Physical functioning was assessed by means of interviewer-based questionnaires, compared between patients and controls and described in relation to the severity of chest pain and dyspnea among patients. The associations between dependence or difficulties in mobility, ADL (activities of daily living) and IADL (instrumental activities of daily living) and CHD, age, smoking, comorbidities, drug therapy and clinical characteristics were assessed by logistic regression analyses. On items representing mobility and managing in IADL, patients reported more difficulties or dependence than controls. Among female patients, more severe chest pain was associated with poor managing in IADL and tended to be associated with poor mobility. More severe dyspnea was associated with poor mobility among both male and female patients, and with poor managing in IADL among male patients. Logistic regression analyses failed to show that CHD was associated independently with physical disability among the elderly. However, physical disability was associated with the use of cardiovascular drugs in the models among both genders, which probably indirectly indicated an association between physical disability and CHD. Several confounding factors, such as higher age, depression, cancer and the use of psychotropic drugs, contributed to the decline in functional abilities even among persons with CHD. In conclusion, elderly CHD patients have greater limitations in their functional ability than matched controls, which may depend on the severity of the disease. Especially male patients' limitations in physical abilities may be influenced by the fact that men with C

Topics: Activities of Daily Living; Age Factors; Aged; Aged, 80 and over; Cardiovascular Agents; Case-Control Studies; Chest Pain; Coronary Disease; Disability Evaluation; Dyspnea; Female; Humans; Logistic Models; Male; Middle Aged; Smoking

Topics: Body Fluids; Body Water; Cardiovascular Agents; Dyspnea; Heart; Heart Failure; Humans; Lung; Lung Diseases; Mitral Valve Stenosis; Pleural Effusion; Positive-Pressure Respiration; Pulmonary Edema

Topics: Aminorex; Animals; Cardiovascular Agents; Dogs; Dyspnea; Female; Hemodynamics; Humans; Hypertension, Pulmonary; Male; Monocrotaline; Prognosis; Pyrrolizidine Alkaloids; Rats

Topics: Asthma; Bis-Trimethylammonium Compounds; Cardiovascular Agents; Dyspnea; Dyspnea, Paroxysmal; Muscle Relaxants, Central