硝酸甘油静脉滴注对充血性心力衰竭患者血浆内皮素浓度的影响

目的：评价硝酸甘油（ＮＧ）对充血性心力衰竭患者血浆内皮素的影响。方法：应用放射免疫法测定３２例充血性心力衰竭患者和１７例健康人血浆内皮素浓度。充血性心力衰竭组含１７例冠心病和１５例非冠心病患者。观测ＮＧ静脉滴注前后内皮素、心率和血压的动态变化。结果：充血性心力衰竭组内皮素浓度为９３．８６±１３．４８ｐｇ／ｍｌ，较对照组（３８．１７±１７．２４ｐｇ／ｍｌ）显著升高（Ｐ＜０．００１）。内皮素升高的程度与充血性心力衰竭的严重程度平行；与充血性心力衰竭的病因无关。ＮＧ静脉滴注后充血性心力衰竭患者内皮素浓度（６６．１８±１１．１３ｐｇ／ｍｌ）显著降低（Ｐ＜０．００１）；心功能Ⅱ级、Ⅲ级、Ⅳ级者分别降低２６％、２９％、３４％。血压和心率无明显变化。结论：ＮＧ不仅能改善充血性心力衰竭患者血液动力学紊乱，而且能显著降低内皮素的血浆浓度。     

内皮素与充血性心力衰竭

内皮素(ET)是1988年3月日本Yanagisawa等从猪主动脉内皮细胞培养上清液中分离出的一种新的血管收缩肽,其由21个氨基酸组成。具有强烈而持久的收缩血管作用,并抑制心功能,参与血管张力调节。近年来,对ET的研究进展迅速。本文综述其与充血性心力衰竭(CHF)的关系。 1 ET的分泌与代谢内皮素是前内皮素原第53～74位肽链片断,其N端是胱氨酸、C端为色氨酸,链内两对双硫键,分子量2492道尔顿。水解过程如下:     

苯那普利对充血性心力衰竭患者血浆内皮素的影响

用放射免疫法测定了36例充血性心力衰竭患者的血浆内皮素（ET）浓度，并观察了经苯那普利治疗后血浆ET的变化。结果显示：心力衰竭患者血浆ET明显高于正常组（P＜0．001），经苯那普利干扰后，较非干扰组（对照组）血浆ET下降更为显著（P＜0．01）。提示苯那普利在治疗充血性心力衰竭时，可改善内皮素的代谢紊乱状态。     

充血性心力衰竭患者的血浆一氧化氮及内皮素的临床研究

目的探讨充血性心力衰竭（CHF）患者的血浆一氧化氮（NO）及内皮素（ET）含量及其在CHF发生发展中所起的作用。方法分别采用比色分析法及放射免疫分析法测定了42例CHF患者的血浆NO及ET。结果CHF患者的血浆NO及ET（64．47±21．42μmol／L及59．71±17．26pg／ml）显著高于正常对照组（51．62±13．62μmol／L及50．83±7．50pg／ml），且心功能Ⅲ－Ⅳ级患者的血浆NO及ET显著高于心功能Ⅱ级者。结论CHF患者的血浆NO及ET含量增高，且与病情严重程度相关。     

慢性充血性心力衰竭患者血浆内皮素与心钠素间的关系

分析了40例慢性充血性心力衰竭患者治疗前后及不同心功能状态下内皮素及心钠素的变化。结果表明：治疗前内皮素明显增高为对照组2倍，内皮素的含量与心力衰竭的严重程度有明显的一致性，充血性心力衰竭时心钠素增高，血浆心钠素与内皮素呈显著正相关。     

内皮素与充血性心力衰竭的研究进展

在心力衰竭的发生发展过程中，血浆、血管壁和心肌组织内的内皮素及其受体含量发生了明显的变化，它们从对心脏的变时性，变力性影响及心脏的重塑等多方面参与心衰过程。近年对这一机制的认识不断取得进展，通过拮抗抗内皮素等治疗心衰的尝试，可能为心衰治疗带来突破性进展。     

阿托伐他汀钙对慢性充血性心力衰竭患者血浆内皮素及血清尿酸水平的影响

最近研究表明，慢性充血性心衰(CCHF)患者血浆B型钠尿肽、内皮素(ET-1)水平与心功能恶化程度相平行。研究证明，血清尿酸(UA)水平是心血管疾病及其病死率增高的一个危险因素。另有资料表明，高尿酸血症可能是协同其他危险因素导致冠心病的重要因素。本文分析了60例心力衰竭患者血浆ET和血清UA浓度，旨在观察血浆ET和血清UA浓度的变化与CCHF的关系，探讨他汀类药物对CCHF患者血浆ET和UA水平的影响及其作用机制。     

充血性心力衰竭患者血浆一氧化氮、内皮素含量变化及其意义

目的 探讨充血性心力衰竭(CHF)患者血浆一氧化氮(NO)和内皮素(ET)含量变化及其关系。方法 检测65例CHF患者血浆NO和ET含量,另选30例健康体检者作为正常对照组。结果 CHF患者血浆NO和ET水平明显高于正常对照组(P<0.01)。且心衰程度越重,NO和ET水平越高。直线相关分析表明:NO与ET呈正相关(r=0.6457,P<0.001)。结论 血浆NO和ET水平增高是CHF病理生理特征之一。NO和ET共同参与CHF的发生发展过程。     

充血性心力衰竭患者血浆内皮素和一氧化氮的测定及其临床意义

内皮素 (ET)和一氧化氮 (NO)是一对具有拮抗效应的血管活性物质 ,两者合成释放作用的协调是维持血管张力的主要因素之一 [1 ]。作者在本研究中通过对充血性心力衰竭(CHF)患者血浆 ET,NO水平的监测 ,以探讨血浆 ET及NO在 CHF发病中的意义。1　对象和方法1.1　对象　根据病史、查体、心电图、X线胸片、二维和彩色多普勒超声心动图及实验室检查确诊的 6 0 (男 41,女 19)例CHF患者 ,其年龄 18～ 6 0岁 ,平均 5 8.8岁。心功能按 NY-HA分级 , 级 18例 , 级 2 3例 , 级 19例 ;其中冠心病 17例 ,风心病 10例 ,先心病 6例 ,扩张性心肌病 1…     

Magnesium in congestive heart failure

Magnesium deficit and other electrolyte abnormalities is a frequent disorder in patients with congestive heart failure. Overstimulation of the renin-angiotensin-aldosterone system, long-term administration of diuretics, digoxin, poor oral intake and impaired absorption contribute to these electrolytes abnormalities. Hypomagnesaemia and depletion of intracellular magnesium stores have been held responsible for a variety of cardiovascular and other functional abnormalities, including various arrhythmias, impairment of cardiac contractility, and vasoconstriction. Because sudden death is prevalent in congestive heart failure, a causal relationship between arrhythmias and magnesium deficiency has been proposed. Reportedly, administration of magnesium can suppress ventricular arrhythmias;however, it remains to be elucidated whether administration of magnesium prevents sudden death and improves prognosis of the patients with congestive heart failure. Nevertheless, since magnesium depletion may be prevalent in congestive heart failure and magnesium has anti-arrhythmic and beneficial cardiovascular effects, magnesium should be supplemented to the patients suspected to have its deficiency.     

Treatment of the african-american patient with congestive heart failure

Opinion statement African Americans have a higher burden of cardiovascular disease than white Americans, including a higher prevalence of heart failure. In addition, heart failure in African Americans conforms to a more malignant natural history. Hypertension is most often cited as the sole etiology of heart failure in African Americans. Most of the major trials of pharmacotherapy for the management of chronic heart failure have failed to include significant numbers of African-American patients. Based on the available evidence, there is no reason to withhold standard evidence-based medical therapy for heart failure. Even though there is much controversy as to the efficacy of angiotensin-converting enzyme (ACE) inhibitors and β blockers in African Americans, in the absence of definitive data they should be used. Recently, the combination of isosorbide dinitrate and hydralazine has been demonstrated to improve survival in African Americans with New York Heart Association class III and IV heart failure, and represents an adjunctive treatment option when added to standard medical therapy consisting of ACE inhibitors, β blockers, digoxin, diuretics, and aldosterone antagonists. Emerging evidence suggests that this therapy may be targeting a novel mechanism of heart failure progression (ie, nitric oxide bioavailability) found in African Americans.     

Exercise in the geriatric patient with congestive heart failure

The benefits of exercise in the elderly patient with heart failure have been well documented, but the studies have been limited by restrictive inclusion criteria. Most studies have involved patients who are younger and healthier than those normally seen in clinical practice. Improvements in neurohormonal, metabolic, and vascular status have been well documented in the relatively young patients who have been evaluated. Consequently, peak exercise time, oxygen consumption, submaximal exercise, and quality of life have also improved. Studies suggest that older, more severely limited patients may also benefit from exercise. However, they are less likely to tolerate an exercise program and may not improve their quality of life if the exercise is excessive. Caution is warranted when exercise is prescribed to elderly patients with heart failure.     

Magnesium orotate in severe congestive heart failure (MACH)

Among many cardiac diseases related to cerebral stroke, left ventricular thrombus formation due to silent myocardial infarction with normal coronary arteries represents a rare cause of cerebral ischemia. We describe an unusual case of cerebral ischemia due to cardiac thrombus formation in a young patient with silent myocardial infarction and normal coronary arteries in which echocardiography and cardiac MR imaging clearly showed the embolic source.     

Cushing's syndrome patient who exhibited congestive heart failure

Cushing's Syndrome (CS) may sometimes lead to dilated cardiomyopathy, even though this condition can be partially or completely reversed after treatment. In this article we report the case of a 28-yr-old woman with CS secondary to adrenal adenoma who exhibited congestive heart failure as an initial symptom. Two weeks before being admitted to our hospital, the patient started complaining of shortness of breath, orthopnea, paroxysmal nocturnal dyspnea and generalized edema. A physical examination did not reveal signs of hypercortisolism. Chest auscultation revealed bilateral diffused crepitation; blood pressure was 180/120 mmHg with heart rate of 90 beats/min. A chest X-ray showed a cardiac shade enlargement due to congestive heart failure. Transthoracic echocardiography demonstrated a dilated left ventricle and an impaired left ventricular systolic function. The patient's urinary cortisol excretion was elevated and circadian rhythm of cortisol was absent. ACTH level was low. In addition, plasma cortisol failed to decrease after administration of dexamethasone. An abdominal magnetic resonance imaging scan showed a 7-cm right adrenal mass. The patient was administered oxygen, spironolactone, ACE-inhibitor and the signs and symptoms of heart failure gradually improved. A laparoscopic right adrenalectomy was performed and pathological examination of the gland showed a benign adrenocortical adenoma. After the adrenalectomy the patient was started on hydrocortisone therapy and 5 months later the wall thickness of the left ventricle was within normal range and the patient's blood pressure was 130/80 mmHg. In conclusion we report the case of heart failure as the main clinical symptom in CS secondary to adrenal adenoma.     

Managing congestive heart failure patient factors in the device era

Device-based care such as implantable cardioverter-defibrillators and cardiac resynchronization therapy extends congestive heart failure (CHF) care into a new era. The purpose of this paper is 2-fold: (1) to review the development of device-based CHF management and the implications from a medical and patient management perspective, and (2) to provide assessment and treatment approaches on how to clinically manage patient outcomes optimally. Quality of life, depression, and anxiety are targeted as concerns for patients with CHF and cardiac resynchronization therapy/implantable cardioverter-defibrillators. Brief clinic-based interview questions and formal assessment tools are reviewed. Furthermore, a cognitive-behavioral paradigm using the "Appropriate Education, Behavioral Support, and Cognitive Coping" (ABC) model is proposed to aid health care professionals in addressing patients' device-specific concerns. Available research suggests the need for future studies assessing the efficacy of cognitive-behavioral treatments in patients with CHF and cardiac resynchronization therapy/implantable cardioverter-defibrillators.     

Endothelin in heart failure

Congestive heart failure is a complex disease that results from pumping failure of the cardiac muscle and adaptational processes of the cardiovascular system to correct for the reduced blood supply to the organism. It is associated with increased vasoconstriction and impaired vasodilation in response to physical activity. The elevated vasoconstrictor tone is caused by the activation of compensatory mechanisms including the sympathic nervous system and stimulation of the release of neurohormones like angiotensin II, catecholamines, and vasopressin. Furthermore, the vascular endothelium is importantly involved in the regulation of vascular tone as it releases a variety of vasoactive substances that act locally and systemically. In congestive heart failure, there is a marked imbalance between the diminished release or the increased inactivation of vasodilators on the one hand, ie, nitric oxide, and the elevated production, release, or reduced inactivation of vasoconstrictors such as endothelin-1 on the other hand. In addition to its very potent vasoconstrictor effects, endothelin-1 possesses antinatriuretic and mitogenic properties that are a common feature of substances that are involved in development of the deleterious consequences that render congestive hear failure a lethal disease. The spectrum of action of the endothelin system and the advent of specific antagonists for its receptors have made this system a very interesting target for clinical research and possibly for future therapeutic approaches.