Heart failure cardiac catheterization

Ischemic heart disease is the leading cause of death in the United States today (American Heart Association, 2001). In 1998, over 450,000 deaths were attributable to ischemic heart disease. This year over 1.1 million citizens will have a new or recurrent myocardial infarction. One of the consequences of non-fatal myocardial infarction is congestive heart failure (CHF), afflicting 22% of men and 46% of women surviving heart attacks over the subsequent five years. Currently, there are over 4.7 million Americans living with CHF, and these patients have a five year mortality of 50%. The mainstay of therapy for ischemic heart disease is revascularization. Nearly 2,000,000 cardiac catheterizations and 553,000 coronary artery bypass surgical procedures are performed annually (American Heart Association, 2001). 

Fang J, Eisenhauer A, Profiles in cardiomyopathy and congestive heart failure, Textbook Grossman s Cardiac Catheterization, Angiography, and Intervention. Seventh Edition, Lippincott Williams Wilkins, 2005. 

For the appropriate development of covariate distribution models, the pharmaceutical industry has huge amount of data in their clinical databases. In addition, there are also public databases available which can be used, like the Congestive Heart Failure Database (http //www.physionet.org/) derived from patients undergoing cardiac catheterization at Duke Medical Centre during 1990-1996 (about 4000 patients, data on demographics, risk factors histories, cardiac catheterization, EKG, cardiac scores, follow-up data). 

Inhaled NO can be used during cardiac catheterization to evaluate safely and selectively the pulmonary vasodilating capacity of patients with heart failure and infants with congenital heart disease. Inhaled NO also is used to determine the diffusion capacity (Dl) across the alveolar-capillary unit. NO is more effective than CO in this regard because of its greater affinity for hemoglobin and its higher water solubility at body temperature. 

A girl with macrosomia, who was deUvered by cesarean section at 34 weeks, developed seizures and hypoglycemia in the first days of Ufe due to hyperinsuhnemia and was given octreotide and diazoxide. After 10 days she became short of breath with signs of heart failure and had evidence of pulmonary hypertension on echocardiography and cardiac catheterization. There was also neutropenia. Her respiratory... 

A 42-year-old woman suffered an acute anterior myocardial infarction, initially associated with pulmonary edema. After hemodjmamic stabilization she was given lisinopril 10 mg oraUy. Two hours later she developed circulatory failure in conjunction with acute renal insufficiency. Right heart catheterization showed markedly reduced systemic vascular resistance but a normal cardiac index. After the usual causes of cardiogenic shock had been ruled out, repeated fluid challenges and intravenous noradrenaline failed to improve her hemodynamic status. She was therefore given angiotensin II intravenously (5-7.5 pg/minute), which immediately and markedly raised the systematic vascular... 

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