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Treatment of cardiac decompensation

Bishop LFJ

Malayan Medical Journal, 1937;12:141-2.

Matched MeSH terms: Heart Failure
Ischaemic heart disease

HARRIS CH

Med J Malaya, 1962 Sep;17:55-61.
PMID: 13952910
Matched MeSH terms: Heart Failure*
Partial exchange transfusion in the treatment of severe anaemia in late pregnancy

Ong HC, Chan WF, Hussein N

Med J Malaysia, 1975 Sep;30(1):63-65.
PMID: 1207535
Matched MeSH terms: Heart Failure/therapy
Patent ductus arteriosus in Malaysia

Singham KT, Wong HO

Aust N Z J Med, 1979 Apr;9(2):174-6.
PMID: 287460 DOI: 10.1111/j.1445-5994.1979.tb04323.x

Findings are reviewed of isolated Patent Ductus Arteriosus after infancy as seen in 181 patients studied at the University Hospital, Kuala Lumpur, during the period 1967 to 1975. The ages of patients ranged from nine months to 54 years. Eighty-two patients underwent cardiac catheterization. More than 50% of patients were above ten years of age; the sex ratio was 1 male: 2.93 females. Thirty-two per cent of the patients had significant effort dyspnoea or were in heart failure. The complications noted were elevated pulmonary vascular resistance, Eisenmenger syndrome, bacterial endocarditis and cardiac failure.

Matched MeSH terms: Heart Failure/etiology
Fulltext Mortality in the early phase of acute myocardial infarction: a 3 year experience in the coronary care unit

Ng WH

Med J Malaysia, 1982 Mar;37(1):66-9.
PMID: 7121350

Mortality in the early phase of acute myocardial infarction occurs both during the pre-hospital period and after admission to the Coronary Care Unit. This report is an analysis of deaths that occurred in the Coronary Care Unit within a 3 year period. Forty percent of 304 patients (13 percent) unth. acute myocardial infarction died in the Coronary Care Unit, Fifty percent of the deaths were due to cardiac arrhythmias and 45 percent attributable to myocardial pump failure. Mean delay in hospital admission from onset of symptoms was 15 hours. Factors affecting early mortality and their prevention are discussed.

Matched MeSH terms: Heart Failure/etiology; Heart Failure/mortality
Fulltext Indications of temporary transvenous pacing

Chin K, Singham KT, Masduki A

Med J Malaysia, 1984 Jun;39(2):139-42.
PMID: 6513853

A retrospective study of the indications for temporary transvenous pacing in the University Hospital, Kuala Lumpur, from 1971 to 1979 is reviewed. There were 111 patients. The main indications for temporary transvenous pacing were, namely,complete heart block (57%), sick sinus syndrome (24%), Mobitz type 11 block (5%) and bifascicularblock (3%).

Matched MeSH terms: Heart Failure/therapy*
Tolerability with special reference to cough, of captopril in patients with congestive cardiac failure

Quek DKL, Alfred E, Ong SBL

Family Physician, 1991;3:34-38.

Cough associated with angiotensin converting-enzyme (ACE) inhibitor therapy has been reported in Western communities, where its incidence is disputed. We, therefore, reviewed our patients who were treated with captopril primarily for congestive cardiac failure. 19 of 61 patients (31.1%) receiving an ACE inhibitor had volunteered cough as an important adverse effect, compared with only one of 59 patients who recieved other treatment. In 3 patients, the cough was intolerably severe to require discontinuation of treatment. Another 7 patients were withdrawn from ACE inhibitor treatment because of other adverse effects including deteriorating renal function, insomnia, dizzy spells, ageusia and proteinuria, and skin rash. We suggest that although ACE inhibitors are very beneficial in improving the clinical status of congestive heart failure, intolerable adverse effects are not uncommon and might mandate withdrawal in a sizeable minority (16.4%).

Matched MeSH terms: Heart Failure
Conduction abnormalities in thyrotoxicosis--a report of three cases

Yusoff K, Khalid BA

Ann Acad Med Singap, 1993 Jul;22(4):609-12.
PMID: 8257070

Cardiac arrhythmias are common in patients with thyrotoxicosis. Conduction abnormalities have been seen in a few thyrotoxic patients, but these, in particular high grade atrioventricular (AV) block, often occur in the presence of other conditions. Three thyrotoxic patients with conduction abnormalities are described: two were associated with severe hypokalaemia and the third had congestive cardiac failure. Conditions predisposing to conduction abnormality should be identified when this occurs in a thyrotoxic patient as their correction may help resolve or explain the conduction abnormality.

Matched MeSH terms: Heart Failure/physiopathology
Immigrant Health Study. 9. The chest radiographic changes in an immigrant population - a pilot study. [Abstract]

Basri JJA

JUMMEC, 1998;3:64-64.

With the increasing ease of travel and the passage of peoples between counkies there is a need to ensure that the recipient country is not burdened by the need for care of ilniiiigrant with health problems as well as the increased risk posed to the local population froni exposure to conun~unicabled isease. To assess the chest radiographs of a selected group of inun~igrantsto ascertain the presence of abnormalities especially the presence of tuberculosis. A total of 250 imniigrants were prospectively evaluated by a PA chest radiograph. The chest radiograph was evaluated by two radiologists for the presence of abnormalities of the heart, lungs, mediastinum and bony rib cage. There were 112 Indonesians, 133 Bangladeshis, one Myanmar, three Pakistanis and one others. Males made-up 222 while there were 28 females. The chest radiograph was diagnostic in all cases. There were 13 cases with enlarged hearts but with no evidence of heart failure. There was only a single inlmigrant who had evidence of active TB though there were 6 others who had evidence of old disease. There was evidence of other infections in five. With regard to the mediastinuni there was a single case with enlarged hila probably secondary to increased cardiac output. There were 21 patients with scoliosis of the spine and two with abnormaIities of the ribs. Even though there was a single case with evidence of TB from this pilot study, from unreported data from the UMMC, there were 15,16 and 23 immigrants treated for TB for 1994,1995 and 1996 respectively. This was mainly seen in the Indonesians followed by the Bangladeshis and Myanmar. We attribute this discrepancy to the biased salnpie in this study where probably only the healthy were seen while those who were not well did not want to participate in this study. In addition, this may also be due to the small sample used in this study. We feel that screening of the immigrants out in the field may be able to detect cases of active TB. As for the large hearts we feel that in the absence of any cardiac symptoms and other radiological changes these are probably due to the increased workload on the heart from physical activities. This is a recognised presentation. The changes in the mediastinum and bony rib cage are probably not very significant.

Matched MeSH terms: Heart Failure
Balloon dilatation of congenital mitral stenosis in a critically ill infant

Abdul Aziz B, Alwi M

Catheter Cardiovasc Interv, 1999 Oct;48(2):191-3.
PMID: 10506777

We report a case of a 14-month-old-infant with severe congenital mitral stenosis who presented with pulmonary oedema, acute renal failure and haemodynamic instability. Balloon dilatation was successfully performed under fluoroscopic and transesophageal echocardiographic guidance. Cathet. Cardiovasc. Intervent. 48:191-193, 1999.

Matched MeSH terms: Heart Failure/congenital; Heart Failure/diagnosis; Heart Failure/therapy
First-dose response to angiotensin-converting enzyme inhibition in congestive cardiac failure: a Malaysian experience

Navookarasu NT, Rahman AR, Abdullah I

Int J Clin Pract, 1999 Jan-Feb;53(1):25-30.
PMID: 10344062

Despite their proven value in reducing morbidity and mortality in different grades of heart failure, angiotensin converting enzyme (ACE) inhibitors continue to be underused. One reason for this is clinicians' apprehension of first-dose hypotension. We conducted a double-blind, randomised, placebo-controlled parallel group study to investigate the effect of various ACE inhibitors on first-dose hypotension. Eighty unselected patients were randomised into five treatment groups: placebo, captopril 6.25 mg, enalapril 2.5 mg, perindopril 2 mg and lisinopril 2.5 mg. Blood pressure was measured at baseline, half hourly for two hours and hourly for three hours after drug treatment. The maximum drops in mean arterial pressure (in mmHg +/- SD) were placebo 5.89 +/- 2.65, perindopril 5.29 +/- 2.49, enalapril 13.28 +/- 3.31, lisinopril 15.04 +/- 5.74 and captopril 16.76 +/- 5.74 (all p < 0.05 vs placebo except for perindopril). Perindopril, unlike the other ACE inhibitors studied, did not produce first-dose hypotension following its initiation in patients with congestive heart failure.

Matched MeSH terms: Heart Failure/drug therapy*; Heart Failure/physiopathology
ß-blockers in congestive heart failure

Teh BT, Wan Azman WA, Thuraisingham S, Choy AM, Tan KH, Jesudason P, et al.

JUMMEC, 1999;4:26-33.

Activation of the synlpathetic nervous system (SNS) and renin-angiotensin system (RAS) plays a pivotal role in the pathophysiology and progression of the disease in chronic heart failure (CHF). Blocking the activation of the RAS with angiotensin converting enzyme inhibitors not only improves sylnptonls but also prolongs life in symptomatic CHF. Does a similar analogy hold true for the use of ß-blockers in CHF? Evidence from a number of small trials and several recent large prospective trials show that b-blockers may improve ventricular function and symptoms in CHF. In a combination of trials investigating the use of carvedilol (an α, and ß-blocker) in congestive heart failure a mortality benefit appears to be evident. There are still a number of key questions that relnaill unanswered regarding the tolerability, patient type and stage of CHF in which ß-blockers should be advocated. Several large scale trials are in progress to answer some of these questions and also to add further information regarding its efficacy and impact on survival. KEYWORDS: Beta-adrenoreceptor antagonist, congestive heart failure.

Matched MeSH terms: Heart Failure
Trends and ethnic differences in hospital admissions and mortality for congestive heart failure in the elderly in Singapore, 1991 to 1998

Ng TP, Niti M

Heart, 2003 Aug;89(8):865-70.
PMID: 12860859

To describe trends in hospital admissions and mortality from congestive heart failure in the elderly population aged 65 years and over in Singapore, 1991 to 1998.

Matched MeSH terms: Heart Failure/ethnology*; Heart Failure/mortality
Heart failure in a multiethnic population in Kuala Lumpur, Malaysia

Chong AY, Rajaratnam R, Hussein NR, Lip GY

Eur J Heart Fail, 2003 Aug;5(4):569-74.
PMID: 12921820

BACKGROUND: There are established differences in cardiovascular disease in different racial groups. Worldwide, the literature regarding the clinical epidemiology of congestive heart failure (CHF) in non-white populations is scarce.
OBJECTIVES: To document the prevalence of CHF in the multiracial population of Malaysia, and to describe the clinical features and management of these patients.
SETTING: Busy city centre general hospital in Kuala Lumpur, Malaysia.
RESULTS: Of 1435 acute medical admissions to Kuala Lumpur General Hospital over the 4-week study period, 97 patients (6.7%) were admitted with the primary diagnosis of CHF. Coronary artery disease was the main aetiology of CHF, accounting for almost half (49.5%) the patients, followed by hypertension (18.6%). However, there were variations in associated aetiological factors between ethnic groups, with diabetes mellitus affecting the majority of Indians-as well as underutilisation of standard drugs for CHF, such as the angiotensin converting enzyme (ACE) inhibitors, which were only used in 43.3%.
CONCLUSION: Amongst acute medical admissions to a single centre in Malaysia the prevalence of CHF was 6.7%. Coronary artery disease was the major aetiological factor in heart failure accounting for almost half the admissions. The under-prescription of ACE inhibitors was similar to other clinical surveys carried out amongst Caucasian populations in the West.

Matched MeSH terms: Heart Failure/diagnosis; Heart Failure/drug therapy; Heart Failure/ethnology*; Heart Failure/etiology
Combination of drugs acting on the natriuretic system and the renin-angiotensin system in heart failure

Chee KH, Amudha K, Hussain NA, Haizal HK, Choy AM, Lang CC

J Renin Angiotensin Aldosterone Syst, 2003 Sep;4(3):140-8.
PMID: 14608517

Conventional diuretic agents are very effective agents in relieving volume overload and congestive symptoms in chronic heart failure (CHF). However, they are associated with activation of the renin-angiotensin system (RAS) and the sympathetic nervous system and a reduction in glomerular filtration rate, all of which have been associated with adverse outcomes in CHF. Therefore, there is an increasing interest in drugs that target the natriuretic system without neurohormonal activation and deterioration of renal function. In this review, we will discuss the underlying rationale and evidence behind currently pursued strategies that target the natriuretic system. This includes the administration of natriuretic peptides (NPs) and strategies that potentiate the NP system, such as neutral endopeptidase inhibition. We will also highlight some potentially important interactions of these strategies with drugs that target the RAS.

Matched MeSH terms: Heart Failure/drug therapy*
Admissions with atrial fibrillation in a multiracial population in Kuala Lumpur, Malaysia

Freestone B, Rajaratnam R, Hussain N, Lip GY

Int J Cardiol, 2003 Oct;91(2-3):233-8.
PMID: 14559136

BACKGROUND: There are established differences in cardiovascular disease in different racial groups. Worldwide, the literature regarding the clinical epidemiology of atrial fibrillation in non-white populations is scarce.
OBJECTIVES: To document the prevalence of atrial fibrillation (AF) in the multiracial population of Malaysia, and to describe the clinical features and management of these patients.
SETTING: Busy city centre general hospital in Kuala Lumpur, Malaysia, over a 1-month period.
SUBJECTS: One-thousand four hundred and thirty-five acute medical admissions, of whom 40 patients (2.8%) had AF.
RESULTS: Of 1435 acute medical admissions to Kuala Lumpur General Hospital over the 4-week study period, 40 had AF (21 male, 19 female; mean age 65 years). Of these, 18 were Malay, 16 Chinese and six Indian. Nineteen patients had previously known AF (seven with paroxysmal AF) and 21 were newly diagnosed cases. The principal associated medical conditions were ischaemic heart disease (42.5%), hypertension (40%) and heart failure (40%). Dyspnoea was the commonest presentation, whilst stroke was the cause of presentation in only two patients. Investigations were under-utilised, with chest X-ray and echocardiography in only 62.5% of patients and thyroid function checked in 15%. Only 16% of those with previously diagnosed AF were on warfarin, with a further three on aspirin. Anticoagulant therapy was started in 13.5% of patients previously not on warfarin, and aspirin in 8%. Records of contraindications to warfarin were unreliable, being identified in only 25%. For those with known AF, 58% were on digoxin. For new onset AF, digoxin was again the most common rate-limiting treatment, initiated in 38%, whilst five patients with new onset AF were commenced on amiodarone. DC cardioversion was not used in any of the patients with new onset AF.
CONCLUSION: Amongst acute medical admissions to a single centre in Malaysia the prevalence of AF was 2.8%. Consistent with previous similar surveys in mainly western (caucasian) populations, standard investigations in this Malaysian cohort were also inadequate and there was underuse of anticoagulation, medication for ventricular rate control and cardioversion to sinus rhythm.

Matched MeSH terms: Heart Failure/diagnosis; Heart Failure/ethnology; Heart Failure/therapy
Fulltext A descriptive analysis of exercise tolerance test at seremban hospital : an audit for the year 2001

Mohamed AL, Nee CC, Azzad A

Malays J Med Sci, 2004 Jul;11(2):59-64.
PMID: 22973128

Our purpose is to report on the epidemiological variables and their association with the results of the exercise tolerance test (ETT) in the series of patients referred for standard diagnostic ETT at Seremban Hospital during the year 2001. ETT is widely performed, but, in Malaysia, an analysis of the associations between the epidemiological data and the results of the ETT has not been presented. All patients referred for ETT at Seremban Hospital who underwent exercise treadmill tests for the year 2001 were taken as the study population. Demographic details and patients with established heart disease (i.e. prior coronary bypass surgery, myocardial infarction, or congestive heart failure) were noted. Clinical and ETT variables were collected retrospectively from the hospital records. Testing and data management were performed in a standardized fashion with a computer-assisted protocol. This study showed that there was no significant predictive epidemiological variable on the results of the ETT. However, it was found that there was statistically significant difference between the peak exercise time of males and females undergoing the ETT.

Matched MeSH terms: Heart Failure
Fulltext Spontaneous internal ilio-iliac fistula in an elderly woman presenting as heart failure

Tan G, Abdullah B, Kunanayagam S

Biomed Imaging Interv J, 2006 Apr;2(2):e13.
PMID: 21614225 MyJurnal DOI: 10.2349/biij.2.2.e13

Acquired intra-abdominal arteriovenous fistulas (AVFs) are a rare disorder where the communication most commonly occurs between abdominal aorta and inferior vena cava. Ilio-iliac AVF has been reported previously, but is exceedingly rare. We present a case of spontaneous ilio-iliac AVF in an elderly woman who presented with symptoms of right heart failure where the diagnosis was not considered. The computed tomographic (CT) and angiographic features are described. The current status of management as well as a review of the literature is also presented.

Matched MeSH terms: Heart Failure
Fulltext Managing congestive heart failure in a general hospital in Malaysia. Are we keeping pace with evidence?

Chin SP, Sapari S, How SH, Sim KH

Med J Malaysia, 2006 Aug;61(3):278-83.
PMID: 17240575 MyJurnal

Evidence-based heart failure management now includes beta-blockers and spironolactone in addition to diuretics and angiotensin-converting enzyme inhibitors. We aim to determine if these recommendations had been applied in practice for acute and chronic stable heart failure, and what difficulties there might be. Data from 80 consecutive patients hospitalized for decompensated heart failure ('acute') between May and July 2003 were analyzed at admission, upon discharge and at 12 weeks follow-up; along with 74 cardiology clinic out-patients with stable congestive heart failure ('chronic'- no decompensation or admission in previous six months). Less than half of study patients with prior left ventricular dysfunction were on ACE-inhibitors (47%), diuretics (39%), ATII antagonists, spironolactone or digoxin (5% each). All 'acute' patients were commenced on diuretics and ACE-inhibitors in hospital. Six patients died or transferred to another center. Compliance with clinic appointment at 12 weeks was 85% despite telephone reminders. Drug prescription at 12 weeks was significantly lower for diuretics and ACE-inhibitors compared to prescription at discharge (all p < 0.05) but higher compared to patients with chronic HF. Diuretics and ACE inhibitors remain under-utilized for patients with recurrent heart failure. Use of spironolactone and beta-blocker is slow due to limited medical experience and funding. Clinic non-attendance is significant and due to patient factors.

Matched MeSH terms: Heart Failure/drug therapy*
Fulltext Malignant sertoli cell tumour: an uncommon testicular tumour

Sia, S.F., Dublin, N., Nurul, B., Wong, K.T.

JUMMEC, 2006;9(2):18-21.
MyJurnal

We report a case of an 86 year old Chinese man who presented with a painless right testicular swelling that had persisted for one year. There was no history of maldescend or cryptorchid testes. Clinical and ultrasound examination revealed testicular tumour with two round masses within the right scrotal sac, with minimal fluid seen within the sac. Tumour markers were normal. He subsequently underwent a right inguinal orchidectomy under local anaesthesia as he had an underlying cardiac insufficiency. Histopathological examination revealed malignant Sertoli cell tumour. True Sertoli cell mesenchyme tumours constitute less than 1% of all testicular cancers.Current literature on histopathological and clinical features and treatment options are reviewed.

Matched MeSH terms: Heart Failure

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