Congestive heart failure Subject

Expert opinion is a source, frequently elicited by survey, that is used to obtain information where no or few data are available. For example, in our experience with a multicountry evaluation of health care resource utilization in atrial fibrillation, very few country-specific published data were available on this subject. Thus the decision-analytic model was supplemented with data from a physician expert panel survey to determine initial management approach (rate control vs. cardioversion) first-, second-, and third-line agents doses and durations of therapy type and frequency of studies that would be performed to initiate and monitor therapy type and frequency of adverse events, by body system and the resources used to manage them place of treatment and adverse consequences of lack of atrial fibrillation control and cost of these consequences, for example, stroke, congestive heart failure. This method may also be used in testing the robustness of the analysis [30]. 

Variants of the P -adrenergic receptor, especially the Thrl64Ile polymorphism, have been associated with increased severity of congestive heart failure. Heart failure subjects with the Thrl64Ile mutation have a 1-year survival rate of 42%, as compared with 76% for a control group with the wild-type P -adrenergic receptor (154,156). Carriers of the Ile polymorphism therefore may be candidates for... 

Congestive heart failure In myocardial insufficiency, the heart depends on a tonic sympathetic drive to maintain adequate cardiac output. Sympathetic activation gives rise to an increase in heart rate and systolic muscle tension, enabling cardiac output to be restored to a level comparable to that in a healthy subject. When sympathetic drive is eliminated during p-receptor blockade, stroke volume and cardiac rate decline, a latent myocardial insufficiency is unmasked, and overt insufficiency is exacerbated (A). 

Absorption/Distribution - Oral absorption is nearly complete. Peak plasma levels are attained at approximately 3 hours. The plasma half-life ranges from 12 to 27 hours after multiple oral doses. Steady-state levels are approached in 3 to 5 days once at steady-state, no accumulation occurs during chronic therapy. Plasma levels are approximately proportional to dose. In patients with congestive heart failure (CHF NYHA class III), the rate of flecainide elimination from plasma is moderately slower than for healthy subjects. Plasma protein binding is about 40% and is independent of plasma drug level over the range of 0.015 to about 3.4 mcg/mL. 

Hysteria after exposure reported, particularly among individuals with slight tendencies toward neurosis." 1 physician reported cases of congestive heart failure in elderly subjects all responded to treatment. 

Half-life. Plasma half-life, about 1 to 3 hours, increased in subjects with renal failure, congestive heart failure, liver disease, and in neonates (up to about 20 hours). 

Therapeutic Concentration. In plasma, usually in the range 2 to 6 pg/ml there is, however, considerable intersubject variation. Concentrations appear to be higher in subjects with congestive heart failure. 

Volume of Distribution. About 2 to 3 litres/kg, decreased in subjects with congestive heart failure. 

The actual risk of NSAID-associated acute renal dysfunction also continues to be the subject of controversy. There is adequate evidence that underlying renal insufficiency, congestive heart failure, or hepatic cirrhosis are conditions that carry a high risk of NSAID-related renal functional impairment. It is still not known whether old age is a risk factor, whether the risk of renal impairment varies with different NSAIDs, or whether renal function continues to deteriorate, stabilize, or even improve in affected patients with continued use of NSAIDs. Three cases of renal insufficiency caused by topical NSAIDs have been described (SEDA-18,100). 

Persons at greatest risk for NSAID hemodynamic nephropathy generally have pre-existing renal insufficiency, medical problems associated with high plasma renin activity (hepatic disease with ascites, decompensated congestive heart failure, or intravascular volume depletion), or systemic lupus erythematosus. Additional risk factors include atherosclerotic cardiovascular disease and diuretic therapy. The elderly are also at higher risk due to interaction of prevalent medical problems, multiple drug therapies, and reduced renal hemodynamics. Advanced age, however, has not been shown to be an independent risk factor for toxicity in limited trials in otherwise healthy elderly subjects. Combined NSAID and ACEl or ARB therapy is also a concern and should be avoided. 

Olivari, M. T., Carlyle, P. F., Levine, B., and Cohn, J. N. (1983). Hemodynamic and hormonal response to transdermal nitroglycerin in normal subjects and in patients with congestive heart failure. J. Am. Coll. Cardiol. 2, 872-878. 

It is a relatively weak diuretic which has been employed in the control of oedema in subjects having mild congestive heart failure. It is rarely used now. 

Thus, the nitrile and methyl moieties in milirone enhances its therapeutic potency significantly than amrinone. It has been observed that it improves cardiac index by 34% and lowers systemic vascular resistance by almost 31% in subjects having congestive heart failure. It is proved to be much superior to amrinone because it is not only orally active but also fails to cause either fever or thrombocytopenia. ... 

Hemodialysis removes about 1% of a dose as unchanged drug. Total apparent plasma clearance of flecainide, by healthy subjects, following oral administration, has been reported to be in the range of 4-20 ml/kg. Renai clearance of the drug is 25-40% of total plasma clearance. Total apparent plasma clearance is decreased in arrhythmias, congestive heart failure and renal... 

Quinapril is also reported not to alter the steady-state levels of digoxin in healthy subjects, and patients with congestive heart failure. ... 

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