Nihon rinsho. Japanese journal of clinical medicine
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Development of heart failure complicating acute myocardial infarction is directly related to the extent of myocardial infarction and complex architectural changes defined as infarct expansion and remodeling. ACE inhibitors are an exciting class of agents that have the potentiality to prevent left ventricular dilatation, evolution of heart failure and death in the acute myocardial infarction setting. Besides, reperfusion is a important intervention that prevents infarct expansion in the early period after myocardial infarction. ⋯ Therefore, reperfusion therapy decreases the incidence of congestive heart failure and significantly improves the prognosis of heart failure. On the other hand, the in-hospital mortality rate of cardiogenic shock, resulting from acute myocardial infarction, remains high, although primary PTCA has apparently resulted in substantial improvement in mortality of myocardial infarction shock. Thus, reperfusion treatment may be more effective in preventing rather than treating cardiogenic shock.
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About 40% of cardiac death in patients with congestive heart failure (CHF) has been reported to be due to ventricular tachyarrhythmia. Therefore, it is important to know how to treat ventricular arrhythmia associated with CHF. Recently, proarrhythmic effect and negative inotropic effect of antiarrhythmic drugs (class I agents), have been noted and class III agents, especially amiodarone is expected to have preventing effects for sudden death. Furthermore, drug therapy such as beta blocker and ACE inhibitor and implantable cardioverter-defibrillator has advanced.
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Several endocrine diseases show the symptoms of cardiac failure. Among them, patients with acromegaly show a specific cardiomyopathy which results in a severe left-sided cardiac failure. Hypoparathyroidism also induces cardiac failure, which is resulted from hypocalcemia and low levels of serum parathyroid hormone. ⋯ In the patients with thyroid crisis (storm), the cardiac failure comes from the great reduction of cardiac output with dehydration. The reduction of circulation volume, observed in the patients with pheochromocytoma easily induces cardiac failure (shock) just after the removal of adrenal tumor. In patients with malignant carcinoid syndrome, right-sided ventricular failure which may be occurred through the actions of biogenic amines is observed.