Long-term use of the calcium antagonist nifedipine (corinfar) in the treatment of patients with primary pulmonary hypertension

Sixteen patients on long-term treatment for primary pulmonary hypertension were studied. The results were compared after a single 20 mg dose, a two-week course and long-term (13.9 months on the average) use of the drug (40 mg/day). Pulmonary arterial catheterization, thermodilution and occlusion plethysmography were used. Changes in central and peripheral hemodynamic parameters were unidirectional and similar at all stages of the study. Nifedipine improved hemodynamics, as evidenced by selected criteria, in 80% of patients exposed to acute tests, in 91% after a course of treatment and in 58% after long-term use. Therefore, considering the ability of nifedipine to improve pulmonary hemodynamics as well as stable effect over more than one year of treatment, and the absence of marked side effects, this drug can be regarded as the most effective vasodilating agent for the treatment of primary pulmonary hypertension.     

The clinico-morphological aspects of primary pulmonary hypertension]

The authors relate the results of a clinical and post mortem examination of 12 patients who died for primary pulmonary hypertension (PPH). The clinical, x-ray, echocardiography and electrocardiography data were of the same type in all the patients. Macroscopic studies of the heart also demonstrated similar changes: the heart mass was increased because of hypertrophy of its right parts. At the same time the microscopic picture of small vessels of the lungs turned out fairly diverse. Based on these differences all the cases were divided into 3 groups: veno-occlusive disease, recurrent pulmonary thromboembolism, plexogenic pulmonary arteriopathy. However, certain differences were noted inside the groups either. It is therefore assumed that PPH is a collective notion, uniting different alterations in small pulmonary vessels, that lead to a considerable rise of pressure in the pulmonary artery.     

The role of hypotension as a factor of unfavorable prognosis in patients with chronic heart failure

Despite obvious achievements during last decades in studies of pathogenesis and search for effective ways of treatment of chronic heart failure (CHF) it remains one of most severe and prognostically unfavorable diseases of the cardiovascular system. Thereby determination of predictors of death and detection of high risk patients for more active drug interventions on CHF progression appears to be actual. It has been shown in a number of epidemiological and cohort studies that low arterial pressure (AP) serves as an independent risk factor of prognosis in patients with CHF. In this paper we present short literature review on this theme, consideration of possible mechanisms of negative effect of arterial hypotension on function of vitally important organs in patients with CHF, and summation of data of studies which have demonstrated relationship between low level of AP and worsening of prognosis.     

Prevalence of ECG abnormalities in an international survey of patients with suspected or confirmed heart failure at death or discharge

BACKGROUND: Most patients suspected of having heart failure (HF) will get a 12-lead electrocardiogram (ECG) but its utility for excluding HF or assisting in its management has rarely been investigated. METHODS: The EuroHeart Failure survey identified 11,327 patients hospitalised with a suspected diagnosis of HF from 115 hospitals in 24 countries. ECGs were obtained from 9315 patients, of whom 5934 had cardiac imaging tests. The utility of the ECG was assessed for excluding or diagnosing major structural heart disease (MSHD) or major left ventricular systolic dysfunction (MLVSD) and for therapeutic decision making. FINDINGS: MSHD was present in 70% and MLVSD in 54% of patients overall but in only 21% and 5%, respectively, if the ECG was entirely normal. However, <2% of patients had a normal ECG. No single ECG characteristic identified a probability <25% of MSHD or <20% of MLVSD. Patients with QRS width >or=120 ms or anterior pathological Q-waves had a probability >80% of MSHD and >70% of MLVSD. Diagnostic models suggested that electrocardiographic criteria alone were not accurate for the diagnosis or exclusion of important heart disease in this population. However, 2468 patients (42%) had an electrocardiographic finding that should be used to guide the choice of therapy. CONCLUSIONS: A normal ECG is rare in patients with suspected HF but has limited diagnostic value in this setting. The ECG has an important role in guiding therapy.