Résumé
Heart failure with high prevalence is the endpoint of many cardiovascular diseases. Once diagnosed， patients usually need lifelong medication， which seriously affects their quality of life. The drugs commonly used to treat heart failure include angiotensin-converting enzyme inhibitors， beta-blockers， aldosterone receptor antagonists， and diuretics. However， the long-term use of those drugs can lead to side effects such as hypotension， depletion of body fluid， and electrolyte imbalance and even increase mortality. According to the theory of traditional Chinese medicine （TCM）， Qi deficiency and blood stagnation is the major cause of heart failure and when Qi is not moving， blood is not flowing. Therefore， the TCM clinical treatment of heart failure uses the Chinese medicinal materials which replenish Qi， activate blood， and dispell stasis to treat both internal cause and external symptoms. Recent studies have demonstrated that Chinese herbal medicines such as Astragali Radix， Ginseng Radix et Rhizoma， Notoginseng Radix et Rhizoma， Salviae Miltiorrhizae Radix et Rhizoma， Angelicae Sinensis Radix， as well as the compound formulas such as Buyang Huanwutang， Simiao Yongantang， Qili Qiangxin capsules， and Qishen Yiqi drops， play a significant role in the prevention and treatment of heart failure via replenishing Qi， activating blood， and dispelling stasis. Inhibition of oxidative stress and inflammatory responses， mitigation of myocardial fibrosis， improvement of calcium cycling， and protection of mitochondrial function represent the key mechanisms for the treatment of heart failure with Chinese medicinal materials. Focusing on the pathogenic mechanisms and signaling pathways of heart failure， this paper systematically describes the pharmacological effects， molecular mechanisms， and research progress in the clinical application of Chinese medicinal herbs with effects of replenishing Qi， activating blood， and dispelling stasis and their compound formulas in the prevention and treatment of heart failure， aiming to provide scientific evidence for the development and clinical use of anti-heart failure Chinese medicinal materials.
Résumé
Background: The incidence and prevalence rates of heart failure (HF) are increasing worldwide. The prevalence of HF rises exponentially with increasing age and affects 4% to 8% of people older than 65. The leading causes of HF in India include coronary artery disease (CAD), diabetes, hypertension, rheumatic valvular heart diseases and primary cardiac muscle diseases. Rheumatic heart disease (RHD) is still a common cause of HF in India. Epidemiological studies have estimated that 1.5% to 2% population experience HF and it is the main reason for hospital admission of elderly patients. The objective of this study was to establish the etiological factors of heart failureMethods: A cross sectional study of 150 patients above the age of 18 years presented with heart failure diagnosed clinically on the basis of Framingham heart failure criteria and echocardiography, done over a period of one year in department of medicine in BRD medical college Gorakhpur Uttar Pradesh.Results: A total of 150 patients were include in this analysis the majority of patients were male (57.3%). Age of patients ranged from 18 - 70 years and 84% patients were above the age of 40 years.Conclusions: Heart failure was more prevalent in elderly male above 40 years of age. Myocardial infarction, DCMP, rheumatic heart disease and hypertensive heart failure are the common etiology leading to heart failure.
Résumé
Background: Heart diseases are the most important non obstetrical causes of maternal deaths during pregnancy, accounting for almost 10% of maternal deaths. They complicate 1-3% of all pregnancies.Methods: The study was conducted at Cheluvamba Hospital from January 2015 till July 2016. All pregnant women with cardiac disease were included in the study. Pregnant women with cardiac disease were followed up during antenatal period, evaluated and maternal and foetal outcome was studied.Results: Total number of deliveries in the one and half year study period was 18,803 cases and the total number of women with cardiac disease was 90. Most of the subjects belonged to NYHA grade I and II (95.5%), whereas NYHA grade III and IV constituted only 4.4% of cases. Rheumatic heart disease was the principal cardiac lesion (62.22%) among the pregnancies, while congenital heart disease (33.33%) was the second most common cause. 16.7% had cardiac complications and there were 2(2.22%) maternal mortality. 91.86% were live births with 5.88% IUDs and 2.35% neonatal deaths. 15.29% of the babies were Preterm, 8.14% were IUGR babies and 2.35% had congenital anomalies. It was noted NYHA grade III/IV cases had more preterm babies compared to NYHA grade I/II. NICU admissions were also more with NYHA grade III/IV.Conclusions: The results suggest the need for pre-pregnancy counselling, early diagnosis, correction of cardiac lesions where indicated, close surveillance during pregnancy and a team approach comprising of obstetricians, cardiologists, neonatologists and nursing personnel for a successful pregnancy outcome.
Résumé
Introducción: Hasta 60% de los casos tratados con intervención coronaria percutánea (ICP) o cirugía (CRVC) tienen enfermedad coronaria de múltiples vasos (ECMV). Objetivo: Comparar la evolución clínica de estos pacientes después de su comparativo, de una cohorte tratada por ECMV con CRVC o ICP más stents farmacoactivos o bioactivos entre enero de 2004 a julio de 2011. Se utilizó expediente clínico, consignando eventos cardiovasculares adversos. Resultados: Ingresaron 134 pacientes, predominando varones con enfermedad trivascular y angina estable con un seguimiento de 35.7 ± 20.4 meses. El grupo quirúrgico tuvo más dislipidemia (41.9 vs 36.7%), diabetes (59.5 vs 38.3%), hipertensión arterial (67.6 vs 60%), infarto del miocardio antiguo (37.8 vs 23.3%) y lesión tipo C en la arteria descendente anterior (63.9 vs 30.4%), p < 0.05 para todas. Los tratados con ICP tuvieron más necesidad de revascularización repetida (30.50 vs 2.73%) p < 0.01, recurrencia de angina (44 vs 20%), ergometrías positivas (39 vs 18%), hospitalizaciones (25 vs 9%) y deterioro funcional según la New York Heart Association III o IV (22 vs 11%), p < 0.05 para todos. Conclusión: En pacientes de un hospital comunitario con ECMV, la ICP presenta una recurrencia superior de isquemia y revascularización repetida comparada con la CRVC.
Introduction: 60% of the patients treated with coronary artery bypass grafting (CABG) or percutaneous coronary intervention (PCI) suffer from multivessel coronary artery disease. Objective: Our objective was to compare the clinical course of patients with this diagnosis after revascularization. Methods: We consulted and compared the clinical records of a multivessel coronary artery disease cohort treated with either coronary artery bypass grafting or angioplasty with drug eluting stents or bioactive stents between January 2004 and July 2011, consigning adverse cardiovascular events. Results: 134 patients, mostly male, with 3-vessel disease and stable angina, were followed up for 35.7 ± 20.4 months. Dyslipidemia (41.9 vs 36.7%), diabetes mellitus type 2 (59.5 vs 38.3%), hypertension (67.6 vs 60%), old myocardial infarction (37.8 vs 23.3%) and type C lesion in left anterior descendent artery (63.9 vs 30.4%) were all more frequent in the surgery group (p < 0.05). On the other hand, the angioplasty treated patients needed more frequently revascularization (30.50 vs 2.73%; p < 0.01) and hospitalization (25 vs 9%) and had more often angina (44 vs 20%), positive ergometry (39 vs 18%), and functional impairment type New York Heart Association III/IV (22 vs 11%) (p < 0.05). Conclusion: In patients at a community hospital with multivessel coronary artery disease, PCI has a higher recurrence of ischemia and repeated revascularization compared to CABG.