Symptoms and signs of heart failure in patients with myocardial infarction: Reproducibility and relationship to chest X-ray, radionuclide ventriculography and right heart catheterization

Gadsbøll, Niels; Høilund-Carlsen, Poul Fl.; Nielsen, Gert; Berning, J; Brunn, N. E.; Stage, P; Hein, Ebbe; Marving, J.; Løngborg-Jensen, H.; Svensmark, Bo

doi:10.1093/oxfordjournals.eurheartj.a059414

Cited by 79 publications

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“…29,30 Chronic sustained hypoxemia may affect liver function, as in the case of severe right-sided heart failure resulting in ischemia and congestive hepatomegaly. [31][32][33] In our experiments, no evidence was seen of hepatic congestion after exposure to CIH (Fig. 2, Table 1) and no other evidence of right-sided heart failure.…”

Section: Discussionmentioning

confidence: 40%

Chronic intermittent hypoxia predisposes to liver injury†

et al. 2007

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Obstructive sleep apnea (OSA) is characterized by chronic intermittent hypoxia (CIH). OSA is associated with nonalcoholic steatohepatitis (NASH) in obese subjects. The aim of this study was to investigate the effects of CIH on the liver in the absence of obesity. Lean C57BL/6J mice (n ‫؍‬ 15) on a regular chow diet were exposed to CIH for 12 weeks and compared with pair-fed mice exposed to intermittent air (IA, n ‫؍‬ 15). CIH caused liver injury with an increase in serum ALT (224 ؎ 39 U/l versus 118 ؎ 22 U/l in the IA group, P < 0.05), whereas AST and alkaline phosphatase were unchanged. CIH also induced hyperglycemia, a decrease in fasting serum insulin levels, and mild elevation of fasting serum total cholesterol and triglycerides (TG). Liver TG content was unchanged, whereas cholesterol content was decreased. Histology showed swelling of hepatocytes, no evidence of hepatic steatosis, and marked accumulation of glycogen in hepatocytes. CIH led to lipid peroxidation of liver tissue with a malondialdehyde ( O bstructive sleep apnea (OSA) is characterized by recurrent collapse of the upper airway during sleep, leading to chronic intermittent hypoxia (CIH). 1 OSA is a common disease, present in 2% of women and 4% of men in the general U.S. population; however, the prevalence rises to 40% to 60% in obese individuals. 2,3 CIH of OSA has been associated with an increased risk of hypertension, type 2 diabetes, dyslipidemia, and atherosclerosis, independent of underlying obesity. 2,4-9 Moreover, studies in rodent models of intermittent hypoxia (IH) demonstrated that CIH can cause hypertension, 10 insulin resistance, 11 and dyslipidemia. 12,13 Thus, CIH of OSA has been implicated in causality of cardiovascular and metabolic disorders, independent of obesity.An emerging body of evidence indicates that OSA is associated with non-alcoholic steatohepatitis (NASH) and chronic liver injury in obese individuals. 14,15 Whether OSA can confer risk of NASH, independent of obesity, remains unclear. Two major mechanisms have been implicated in NASH: (1) hepatic steatosis, which is linked to insulin resistance; and (2) increased levels of oxidative stress with liver injury and subsequent inflammation. 16,17 We previously showed that CIH leads to progression of hepatic steatosis and insulin resistance in leptin-deficient obese mice. 12 However, the effects of CIH on hepatic lipids in the absence of obesity have not been examined. Whereas OSA and CIH induce oxidative stress and inflammation in multiple organs and tissues, 18-21 the impact

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Section: Discussionmentioning

confidence: 40%

Chronic intermittent hypoxia predisposes to liver injury†

et al. 2007

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“…Finally, despite the importance of crackles for diagnosing acute heart failure decompensation, 2,6 there is often considerable disagreement among physicians about the actual presence of crackles in individual patients. 20 In our population (n = 65), there was 83% agreement on interpretation of the presence or absence of crackles.…”

Section: Discussionmentioning

confidence: 59%

“…Many previous studies, except several, 16,20,21 lacked defi nite criteria for diagnosing the presence of crackles related to heart failure, and the mere presence or absence of the crackles was often expressed as the defi nition. The nature of the age-related crackles in our study, ie, restriction to the lower quadrant of the lung fi eld, would partly support the notion of Stevenson et al 16 that physical evidence of pulmonary congestion might be specifi c for grade 2 or 4 crackles, not for grade 1, but such strict criteria resulted in low sensitivity for diagnosing congestive heart failure.…”

Section: Discussionmentioning

confidence: 99%

Age-Related Pulmonary Crackles (Rales) in Asymptomatic Cardiovascular Patients

Kataoka¹,

Matsuno²

2008

The Annals of Family Medicine

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PURPOSEThe presence of age-related pulmonary crackles (rales) might interfere with a physician's clinical management of patients with suspected heart failure. We examined the characteristics of pulmonary crackles among patients with stage A cardiovascular disease (American College of Cardiology/American Heart Association heart failure staging criteria), stratifi ed by decade, because little is known about these issues in such patients at high risk for congestive heart failure who have no structural heart disease or acute heart failure symptoms.METHODS After exclusion of comorbid pulmonary and other critical diseases, 274 participants, in whom the heart was structurally (based on Doppler echocardiography) and functionally (B-type natriuretic peptide <80 pg/mL) normal and the lung (X-ray evaluation) was normal, were eligible for the analysis. RESULTSThere was a signifi cant difference in the prevalence of crackles among patients in the low (45-64 years; n = 97; 11%; 95% CI, 5%-18%), medium (65-79 years; n = 121; 34%; 95% CI, 27%-40%), and high (80-95 years; n = 56; 70%; 95% CI, 58%-82%) age-groups (P <.001). The risk for audible crackles increased approximately threefold every 10 years after 45 years of age. During a mean follow-up of 11 ± 2.3 months (n = 255), the short-term (≤3 months) reproducibility of crackles was 87%. The occurrence of cardiopulmonary disease during follow-up included cardiovascular disease in 5 patients and pulmonary disease in 6.CONCLUSIONS Recognition of age-related pulmonary crackles (rales) is important because such clinically unimportant crackles are so common among elderly patients that, without knowledge of this phenomenon, their existence might interfere with the physician's management of cardiopulmonary patients.

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“…Though chest x-ray signs of interstitial/alveolar pulmonary edema and pleural effusion are important markers of fluid retention, the diagnostic accuracy of these x-ray signs of pulmonary congestion in chronic heart failure is not very high (Chakko et al, 1991;Collins et al, 2006;Gadsbøll et al, 1989;Mahdyoon et al, 1989), presumably due to increased lymphatic drainage clearing of the flooded interstitium/alveoli (Szidon et al, 1972). Also, as described above (see section "3.2"), chest x-ray identification of pleural effusion is not sensitive and only detects moderate to large amounts of accumulation.…”

Section: Reappraisal Of Chest X-ray For Evaluation Of Heart Failure Pmentioning

confidence: 99%

Clinical Utility of Ultrasonographic Detection of Pleural Effusion for Evaluation of Heart Failure Patients

Kataoka¹

2012

Sonography

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Symptoms and signs of heart failure in patients with myocardial infarction: Reproducibility and relationship to chest X-ray, radionuclide ventriculography and right heart catheterization

Cited by 79 publications

References 0 publications

Chronic intermittent hypoxia predisposes to liver injury†

Chronic intermittent hypoxia predisposes to liver injury†

Age-Related Pulmonary Crackles (Rales) in Asymptomatic Cardiovascular Patients

Clinical Utility of Ultrasonographic Detection of Pleural Effusion for Evaluation of Heart Failure Patients

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