NEJM â Collection Updates for Heart Failure

IMAGES IN CLINICAL MEDICINE: Kinked Carotids

Robert L. Rosenthal, M.D. and Bradley R. Grimsley, M.D. — Thu, 04Â FebÂ 2010 00:00:00 -05:00

An 80-year-old woman presented with congestive heart failure due to aortic insufficiency associated with a markedly dilated ascending aorta. On physical examination, she was noted to have a pulsatile mass...

CLINICAL PRACTICE: Systolic Heart Failure

John J.V. McMurray, M.D. — Thu, 21Â JanÂ 2010 00:00:00 -05:00

Approximately 1 to 2% of the population in developed countries has heart failure, with the prevalence rising to 10% or more among persons 70 years of age or older.1 At...

ORIGINAL ARTICLE: A Sensitive Cardiac Troponin T Assay in Stable Coronary Artery Disease

Thu, 24Â DecÂ 2009 00:00:00 -05:00

Background: In most patients with stable coronary artery disease, plasma cardiac troponin T levels are below the limit of detection for the conventional assay. The distribution and determinants of very...

EDITORIAL: Anemia and Iron Deficiency â New Therapeutic Targets in Heart Failure?

G. William Dec, M.D. — Thu, 17Â DecÂ 2009 00:00:00 -05:00

Anemia ranges in prevalence from below 10% among patients with mild heart failure symptoms to over 40% for patients with advanced disease.1 Its prevalence is similar among patients who have...

ORIGINAL ARTICLE: Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency

Thu, 17Â DecÂ 2009 00:00:00 -05:00

Background: Iron deficiency may impair aerobic performance. This study aimed to determine whether treatment with intravenous iron (ferric carboxymaltose) would improve symptoms in patients who had heart failure, reduced left...

EDITORIAL: Rise of the Machines â Left Ventricular Assist Devices as Permanent Therapy for Advanced Heart Failure

James C. Fang, M.D. — Thu, 03Â DecÂ 2009 00:00:00 -05:00

Traditionally, the only definitive therapy for patients who have advanced, medically refractory heart failure was replacement of the heart with another human heart. However, transplantation is an inadequate option in...

CLINICAL THERAPEUTICS: Mitral-Valve Repair for Mitral-Valve Prolapse

Subodh Verma, M.D., Ph.D., and Thierry G. Mesana, M.D., Ph.D. — Thu, 03Â DecÂ 2009 00:00:00 -05:00

A 55-year-old man with a holosystolic murmur of increasing intensity has been seen regularly by his family physician for the past 3 years. He is referred to a cardiologist. The...

ORIGINAL ARTICLE: Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device

Thu, 03Â DecÂ 2009 00:00:00 -05:00

Background: Patients with advanced heart failure have improved survival rates and quality of life when treated with implanted pulsatile-flow left ventricular assist devices as compared with medical therapy. New continuous-flow...

EDITORIAL: Deleterious Effects of Right Ventricular Pacing

Bruce D. Lindsay, M.D. — Thu, 26Â NovÂ 2009 00:00:00 -05:00

In this issue of the Journal, Yu et al. report results of the Pacing to Avoid Cardiac Enlargement (PACE) study, a prospective, double-blind, multicenter trial designed to determine whether biventricular...

ORIGINAL ARTICLE: Biventricular Pacing in Patients with Bradycardia and Normal Ejection Fraction

Thu, 26Â NovÂ 2009 00:00:00 -05:00

Background: Observational studies suggest that conventional right ventricular apical pacing may have a deleterious effect on left ventricular function. In this study, we examined whether biventricular pacing is superior to...

EDITORIAL: The Confirmatory Trial in Comparative-Effectiveness Research

Alan M. Garber, M.D., Ph.D., and Mark A. Hlatky, M.D. — Thu, 08Â OctÂ 2009 00:00:00 -05:00

Despite the infusion of more than $1 billion through the American Recovery and Reinvestment Act of 2009 and the potential commitment of much more money, there will never be enough...

ORIGINAL ARTICLE: Defibrillator Implantation Early after Myocardial Infarction

Thu, 08Â OctÂ 2009 00:00:00 -05:00

Background: The rate of death, including sudden cardiac death, is highest early after a myocardial infarction. Yet current guidelines do not recommend the use of an implantable cardioverterâdefibrillator (ICD) within...

EDITORIAL: MADIT-CRT â Breathtaking or Time to Catch Our Breath?

Mariell Jessup, M.D. — Thu, 01Â OctÂ 2009 00:00:00 -05:00

Cardiac-resynchronization therapy (CRT) received Food and Drug Administration approval for use in selected patients with left ventricular systolic dysfunction in 2001. Since that time, CRT has been embraced as a...

ORIGINAL ARTICLE: Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events

Thu, 01Â OctÂ 2009 00:00:00 -05:00

Background: This trial was designed to determine whether cardiac-resynchronization therapy (CRT) with biventricular pacing would reduce the risk of death or heart-failure events in patients with mild cardiac symptoms, a...

BOOK REVIEW:

Thu, 07Â MayÂ 2009 00:00:00 -05:00

Patients with the clinical syndrome of heart failure are often placed into one of two categories â those with a reduced left ventricular ejection fraction (systolic heart failure) and those...

EDITORIAL: Surgical Ventricular Reconstruction for Heart Failure

Howard J. Eisen, M.D. — Thu, 23Â AprÂ 2009 00:00:00 -05:00

Congestive heart failure is one of the leading causes of death and complications in the developed world, and coronary artery disease is the major cause of heart failure. Efforts to...

ORIGINAL ARTICLE: Coronary Bypass Surgery with or without Surgical Ventricular Reconstruction

Thu, 23Â AprÂ 2009 00:00:00 -05:00

Background: Surgical ventricular reconstruction is a specific procedure designed to reduce left ventricular volume in patients with heart failure caused by coronary artery disease. We conducted a trial to address...

IMAGES IN CLINICAL MEDICINE: Kerley's A, B, and C Lines

Takeharu Koga, M.D., Ph.D. and Kiminori Fujimoto, M.D., Ph.D. — Thu, 09Â AprÂ 2009 00:00:00 -05:00

A 59-year-old woman with hypertension and diabetic nephropathy presented with a sudden onset of dyspnea after discontinuing her medications. Physical examination revealed hypertension (blood pressure, 225/122 mm Hg), tachycardia (heart...

ORIGINAL ARTICLE: Racial Differences in Incident Heart Failure among Young Adults

Thu, 19Â MarÂ 2009 00:00:00 -05:00

Background: The antecedents and epidemiology of heart failure in young adults are poorly understood.

Methods: We prospectively assessed the incidence of heart failure over a 20-year period among 5115 blacks and...

ORIGINAL ARTICLE: Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction

Thu, 04Â DecÂ 2008 00:00:00 -05:00

Background: Approximately 50% of patients with heart failure have a left ventricular ejection fraction of at least 45%, but no therapies have been shown to improve the outcome of these...

BOOK REVIEW:

Thu, 11Â SepÂ 2008 00:00:00 -05:00

Acute heart failure is a major health issue, accounting for a large proportion of patients admitted to hospitals. Patients with recent hospitalizations for acute heart failure are at high risk...

ORIGINAL ARTICLE: Quality of Life with Defibrillator Therapy or Amiodarone in Heart Failure

Thu, 04Â SepÂ 2008 00:00:00 -05:00

Background: Implantable cardioverterâdefibrillator (ICD) therapy significantly prolongs life in patients at increased risk for sudden death from depressed left ventricular function. However, whether this increased longevity is accompanied by deterioration...

EDITORIAL: Life and Death after ICD Implantation

Jeff Healey, M.D., and Stuart Connolly, M.D. — Thu, 04Â SepÂ 2008 00:00:00 -05:00

Randomized trials have established that the prophylactic use of implantable cardioverterâdefibrillators (ICDs) prolongs survival in patients with left ventricular dysfunction that is due to myocardial infarction1 or associated with heart...

ORIGINAL ARTICLE: Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure

Thu, 04Â SepÂ 2008 00:00:00 -05:00

Background: Patients with heart failure who receive an implantable cardioverterâdefibrillator (ICD) for primary prevention (i.e., prevention of a first life-threatening arrhythmic event) may later receive therapeutic shocks from the ICD....

BOOK REVIEW:

Thu, 03Â JulÂ 2008 00:00:00 -05:00

Heart failure caused predominantly by diastolic dysfunction, or diastolic heart failure, accounts for one third to one half of all cases of heart failure. Its prevalence and the rate of...

IMAGES IN CLINICAL MEDICINE: Spontaneous Thrombolysis of an Obstructed Mechanical Aortic Valve

Nicole Wake, B.A. and Akshay S. Desai, M.D. — Thu, 26Â JunÂ 2008 00:00:00 -05:00

A 28-year-old man with idiopathic dilated cardiomyopathy who had had St. Jude aortic- and mitral-valve replacements 3 years earlier presented with decompensated heart failure. The examination was notable for marked...

EDITORIAL: Rhythm Control in Atrial Fibrillation â One Setback after Another

Michael E. Cain, M.D., and Anne B. Curtis, M.D. — Thu, 19Â JunÂ 2008 00:00:00 -05:00

Atrial fibrillation, the most common sustained arrhythmia observed in hospitalized patients, is associated with substantial morbidity, and its occurrence approximately doubles the rate of death as compared with that of...

ORIGINAL ARTICLE: Increased Mortality after Dronedarone Therapy for Severe Heart Failure

Thu, 19Â JunÂ 2008 00:00:00 -05:00

Background: Dronedarone is a novel antiarrhythmic drug with electrophysiological properties that are similar to those of amiodarone, but it does not contain iodine and thus does not cause iodine-related adverse...

ORIGINAL ARTICLE: Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure

Thu, 19Â JunÂ 2008 00:00:00 -05:00

Background: It is common practice to restore and maintain sinus rhythm in patients with atrial fibrillation and heart failure. This approach is based in part on data indicating that atrial...

REVIEW ARTICLE: Biomarkers in Heart Failure

Eugene Braunwald, M.D. — Thu, 15Â MayÂ 2008 00:00:00 -05:00

Heart failure, a major and growing public health problem, appears to result not only from cardiac overload or injury but also from a complex interplay among genetic, neurohormonal, inflammatory, and...

ORIGINAL ARTICLE: Cardiac Troponin and Outcome in Acute Heart Failure

Thu, 15Â MayÂ 2008 00:00:00 -05:00

Background: Cardiac troponin provides diagnostic and prognostic information in acute coronary syndromes, but its role in acute decompensated heart failure is unclear. The purpose of our study was to describe...

CLINICAL PROBLEM-SOLVING: A Key Miscommunication â An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting

Thu, 06Â MarÂ 2008 00:00:00 -05:00

An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting. She also reported increasing shortness of breath and fatigue, which had become worse over the...

IMAGES IN CLINICAL MEDICINE: Mapping the Atrioventricular Node

Andrew E. Epstein, M.D. and James K. Kirklin, M.D. — Thu, 27Â DecÂ 2007 00:00:00 -05:00

A 75-year-old woman presented with dyspnea, an awareness of rapid heart action, and permanent atrial fibrillation with a rapid ventricular response that had been resistant to treatment with beta-blockers, calcium-channel...

ORIGINAL ARTICLE: Cardiac-Resynchronization Therapy in Heart Failure with Narrow QRS Complexes

Thu, 13Â DecÂ 2007 00:00:00 -05:00

Background: Indications for cardiac-resynchronization therapy (CRT) in patients with heart failure include a prolonged QRS interval (â¥120 msec), in addition to other functional criteria. Some patients with narrow QRS complexes...

ORIGINAL ARTICLE: Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation

Thu, 30Â AugÂ 2007 00:00:00 -05:00

Background: The use of left ventricular assist devices is an accepted therapy for patients with refractory heart failure, but current pulsatile volume-displacement devices have limitations (including large pump size and...

PERSPECTIVE: Bridge to Life â Cardiac Mechanical Support

Thu, 30Â AugÂ 2007 00:00:00 -05:00

Even with well-managed care, many patients with severe heart failure reach a stage at which medical therapy is insufficient to sustain an acceptable level of cardiac function. It is estimated...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: MicroRNAs and the Failing Heart

Douglas L. Mann, M.D. — Thu, 21Â JunÂ 2007 00:00:00 -05:00

The search for the basic mechanisms responsible for the development and progression of heart failure has been exhaustive. Despite the elucidation of several clinically relevant signal transduction pathways that can...

IMAGES IN CLINICAL MEDICINE: A Complication of Central Venous Catheterization

Sudip Nanda, M.D. and Laurie Strockoz-Scaff, P.A.C. — Thu, 24Â MayÂ 2007 00:00:00 -05:00

A 65-year-old man with a history of hypertension, diabetes mellitus, coronary artery disease with angioplasty and bypass grafting, and deep-vein thrombosis (with placement of an inferior vena cava filter several...

REVIEW ARTICLE: The Failing Heart â An Engine Out of Fuel

Stefan Neubauer, M.D., F.R.C.P. — Thu, 15Â MarÂ 2007 00:00:00 -05:00

Heart failure is an enormous medical and societal burden.12 It is a common disease: more than 2% of the U.S. population, or almost 5 million people, are affected, and 30...

EDITORIAL: When the Failing, End-Stage Heart Is Not End-Stage

Dale G. Renlund, M.D., and Abdallah G. Kfoury, M.D. — Thu, 02Â NovÂ 2006 00:00:00 -05:00

Heart failure is increasing in incidence and prevalence, is expensive to treat, and is associated with substantial morbidity and mortality.1 In the nomenclature of the guidelines of the American Heart...

ORIGINAL ARTICLE: Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure

Thu, 02Â NovÂ 2006 00:00:00 -05:00

Background: In patients with severe heart failure, prolonged unloading of the myocardium with the use of a left ventricular assist device has been reported to lead to myocardial recovery in...

EDITORIAL: Diastolic Heart Failure â A Common and Lethal Condition by Any Name

Gerard P. Aurigemma, M.D. — Thu, 20Â JulÂ 2006 00:00:00 -05:00

This issue of the Journal contains two provocative contributions to the literature on heart failure. Owan et al.1 describe the epidemiologic outcomes and survival rates among patients with heart failure...

CLINICAL THERAPEUTICS: Biventricular Pacing

John A. Jarcho, M.D. — Thu, 20Â JulÂ 2006 00:00:00 -05:00

A 55-year-old man who had had an anterior-wall myocardial infarction six months previously is admitted with an exacerbation of congestive heart failure. An electrocardiogram shows sinus rhythm with a left...

ORIGINAL ARTICLE: Outcome of Heart Failure with Preserved Ejection Fraction in a Population-Based Study

Thu, 20Â JulÂ 2006 00:00:00 -05:00

Background: The importance of heart failure with preserved ejection fraction is increasingly recognized. We conducted a study to evaluate the epidemiologic features and outcomes of patients with heart failure with...

ORIGINAL ARTICLE: Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction

Thu, 20Â JulÂ 2006 00:00:00 -05:00

Background: The prevalence of heart failure with preserved ejection fraction may be changing as a result of changes in population demographics and in the prevalence and treatment of risk factors...

ORIGINAL ARTICLE: Association of Parental Heart Failure with Risk of Heart Failure in Offspring

Thu, 13Â JulÂ 2006 00:00:00 -05:00

Background: The association between heart failure in parents and the prevalence of left ventricular systolic dysfunction and the risk of heart failure in their offspring has not been investigated in...

ORIGINAL ARTICLE: Continuous Positive Airway Pressure for Central Sleep Apnea and Heart Failure

Thu, 10Â NovÂ 2005 00:00:00 -05:00

Background: The Canadian Continuous Positive Airway Pressure for Patients with Central Sleep Apnea and Heart Failure trial tested the hypothesis that continuous positive airway pressure (CPAP) would improve the survival...

IMAGES IN CLINICAL MEDICINE: Ebstein's Anomaly

Aiden J. O'Loughlin, M.B., B.S. and Chris Hayward, F.R.A.C.P. — Thu, 22Â SepÂ 2005 00:00:00 -05:00

A 44-year-old woman presented with increasing dyspnea. The patient had Ebstein's anomaly, which had first been diagnosed when she was in her early 20s. She had declined heart transplantation three...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2005 â A 48-Year-Old Man with Sudden Loss of Consciousness while Jogging

Thu, 25Â AugÂ 2005 00:00:00 -05:00

An unidentified black man who appeared to be approximately 40 years of age was brought to the emergency department of this hospital after suddenly losing consciousness. Witnesses had seen the...

SPECIAL ARTICLE: Care in U.S. Hospitals â The Hospital Quality Alliance Program

Thu, 21Â JulÂ 2005 00:00:00 -05:00

Background: The Hospital Quality Alliance (HQA) is the first initiative that routinely reports data on hospitals' performance nationally. Heretofore, such data have been unavailable.

Methods: We used data collected by the...

SPECIAL ARTICLE: Quality of Care in U.S. Hospitals as Reflected by Standardized Measures, 2002â2004

Thu, 21Â JulÂ 2005 00:00:00 -05:00

Background: In July 2002, the Joint Commission on Accreditation of Healthcare Organizations implemented standardized performance measures that were designed to track the performance of accredited hospitals and encourage improvement in...

PERSPECTIVE: The Controversy over Guidant's Implantable Defibrillators

Robert Steinbrook, M.D. — Thu, 21Â JulÂ 2005 00:00:00 -05:00

On October 4, 2001, Joshua Oukrop, a Minnesota teenager with hypertrophic cardiomyopathy and a high risk of sudden death from ventricular fibrillation, received an implantable cardioverterâdefibrillator (ICD). The device was...

PERSPECTIVE: Nesiritide â Not Verified

Eric J. Topol, M.D. — Thu, 14Â JulÂ 2005 00:00:00 -05:00

How can a drug that is associated with higher rates of both renal dysfunction and death than placebo â and that costs 50 times as much as standard therapies and...

EDITORIAL: Sudden Death after Myocardial Infarction â Who Needs Prophylaxis, and When?

Alfred E. Buxton, M.D. — Thu, 23Â JunÂ 2005 00:00:00 -05:00

Although the age-adjusted mortality from cardiovascular disease has declined in recent years, the number of sudden deaths has risen.1 According to data from the Centers for Disease Control and Prevention,...

ORIGINAL ARTICLE: Sudden Death in Patients with Myocardial Infarction and Left Ventricular Dysfunction, Heart Failure, or Both

Thu, 23Â JunÂ 2005 00:00:00 -05:00

Background: The risk of sudden death from cardiac causes is increased among survivors of acute myocardial infarction with reduced left ventricular systolic function. We assessed the risk and time course...

EDITORIAL: Resynchronizing Ventricular Contraction in Heart Failure

John A. Jarcho, M.D. — Thu, 14Â AprÂ 2005 00:00:00 -05:00

One quarter to one third of patients with congestive heart failure have some form of intraventricular conduction abnormality that is manifested as an increased QRS duration on the electrocardiogram.12 The...

ORIGINAL ARTICLE: The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure

Thu, 14Â AprÂ 2005 00:00:00 -05:00

Background: Cardiac resynchronization reduces symptoms and improves left ventricular function in many patients with heart failure due to left ventricular systolic dysfunction and cardiac dyssynchrony. We evaluated its effects on...

IMAGES IN CLINICAL MEDICINE: Medical Mystery â 50 Years of Medical Progress

Ralf Ostermaier, M.D. and Marianne Taut, M.D. — Thu, 07Â AprÂ 2005 00:00:00 -05:00

Between 1949 and 2002, a patient underwent four lifesaving procedures that documented medical progress throughout the past 50 years. This plain chest radiograph, which was performed when the patient was...

EDITORIAL: Atrial Fibrillation and Heart Failure â Five More Years

William G. Stevenson, M.D., and Lynne W. Stevenson, M.D. — Thu, 02Â DecÂ 2004 00:00:00 -05:00

Heart failure is often complicated by atrial fibrillation, and atrial fibrillation can exacerbate and in some cases cause heart failure. Adverse effects of atrial fibrillation include a loss of atrial...

ORIGINAL ARTICLE: Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure

Thu, 02Â DecÂ 2004 00:00:00 -05:00

Background: Congestive heart failure and atrial fibrillation often coexist, and each adversely affects the other with respect to management and prognosis. We prospectively evaluated the effect of catheter ablation for...

EDITORIAL: NitrosoâRedox Balance in the Cardiovascular System

Joshua M. Hare, M.D. — Thu, 11Â NovÂ 2004 00:00:00 -05:00

In this issue of the Journal, Taylor and colleagues report the results of the African-American Heart Failure Trial (A-HeFT), a double-blind, randomized trial that evaluated the effect of the addition...

ORIGINAL ARTICLE: Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure

Thu, 11Â NovÂ 2004 00:00:00 -05:00

Background: We examined whether a fixed dose of both isosorbide dinitrate and hydralazine provides additional benefit in blacks with advanced heart failure, a subgroup previously noted to have a favorable...

PERSPECTIVE: Race-Based Therapeutics

M. Gregg Bloche, M.D., J.D. — Thu, 11Â NovÂ 2004 00:00:00 -05:00

Are we moving into a new era of race-based therapeutics? The publication, in this issue of the Journal, of the African-American Heart Failure Trial (A-HeFT) (pages 2049â2057), a clinical trial...

CLINICAL PRACTICE: Diastolic Heart Failure

Gerard P. Aurigemma, M.D., and William H. Gaasch, M.D. — Thu, 09Â SepÂ 2004 00:00:00 -05:00

A 78-year-old woman with a history of hypertension is admitted to the hospital with congestive heart failure. Physical examination reveals a blood pressure of 180/90 mm Hg, increased jugular venous...

CLINICAL PROBLEM-SOLVING: Undercover and Overlooked

Andrew Wang, M.D., and Thomas M. Bashore, M.D. — Thu, 02Â SepÂ 2004 00:00:00 -05:00

A 67-year-old overweight man was seen by his physician because of a two-month history of shortness of breath, a nonproductive cough, and bilateral swelling of the lower extremities. He also...

ORIGINAL ARTICLE: Cardiac Replacement with a Total Artificial Heart as a Bridge to Transplantation

Thu, 26Â AugÂ 2004 00:00:00 -05:00

Background: The CardioWest Total Artificial Heart orthotopically replaces both native cardiac ventricles and all cardiac valves, thus eliminating problems commonly seen in the bridge to transplantation with left ventricular and...

PERSPECTIVE: Building a Bridge to Heart Transplantation

Dale G. Renlund, M.D. — Thu, 26Â AugÂ 2004 00:00:00 -05:00

End-stage heart failure, characterized by marked symptoms at rest or with minimal activity despite optimal therapy, is designated as stage D heart failure. Frequent, recurring exacerbations may often be treated...

REVIEW ARTICLE: Managing Hyperkalemia Caused by Inhibitors of the ReninâAngiotensinâAldosterone System

Biff F. Palmer, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

Angiotensin-convertingâenzyme (ACE) inhibitors and angiotensin-receptor blockers are used commonly in clinical practice to treat hypertension and decrease cardiovascular events in high-risk patients. A side effect of such therapy is the...

ORIGINAL ARTICLE: Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study

Thu, 05Â AugÂ 2004 00:00:00 -05:00

Background: The Randomized Aldactone Evaluation Study (RALES) demonstrated that spironolactone significantly improves outcomes in patients with severe heart failure. Use of angiotensin-convertingâenzyme (ACE) inhibitors is also indicated in these patients....

PERSPECTIVE: Treatment of Heart Failure with Spironolactone â Trial and Tribulations

John J.V. McMurray, M.D., and Eileen O'Meara, M.D. — Thu, 05Â AugÂ 2004 00:00:00 -05:00

The application of evidence based on the results of clinical trials is a key aim of modern medical practice. Viewed from that perspective, the findings of Juurlink and colleagues in...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Sparking the Failing Heart

Maryjane A. Farr, M.D., and Craig T. Basson, M.D., Ph.D. — Thu, 08Â JulÂ 2004 00:00:00 -05:00

Despite advances in the management of congestive heart failure (CHF), most patients with advanced forms die within a year after receiving the diagnosis. Half of all deaths from CHF are...

EDITORIAL: Electromechanical Associations

Joseph G. Rogers, M.D., and Michael E. Cain, M.D. — Thu, 20Â MayÂ 2004 00:00:00 -05:00

The left ventricle strives valiantly with each cardiac cycle to maximize contractility and provide protection against lethal ventricular arrhythmias. Heart failure can make this coordination difficult. Heart-rhythm and heart-failure specialists...

IMAGES IN CLINICAL MEDICINE: Acquired Arteriovenous Fistula

Oren K. Steinmetz, M.D. and L.P. Palerme, M.D. — Thu, 20Â MayÂ 2004 00:00:00 -05:00

A 35-year-old man presented with high-output congestive heart failure. Fourteen years earlier, he had received a shrapnel wound to the left thigh in a car-bomb attack in Lebanon. As a...

ORIGINAL ARTICLE: Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure

Thu, 20Â MayÂ 2004 00:00:00 -05:00

Background: We tested the hypothesis that prophylactic cardiac-resynchronization therapy in the form of biventricular stimulation with a pacemaker with or without a defibrillator would reduce the risk of death and...

PERSPECTIVE: Evidence-Based Use of Cardiac Procedures and Devices

Mark A. Hlatky, M.D. — Thu, 20Â MayÂ 2004 00:00:00 -05:00

The fundamental principle of evidence-based medicine is that clinical practice should rest on a sound scientific foundation established by clinical studies involving human subjects. The level of evidence needed for...

ORIGINAL ARTICLE: Diastolic Heart Failure â Abnormalities in Active Relaxation and Passive Stiffness of the Left Ventricle

Michael R. Zile, M.D., Catalin F. Baicu, Ph.D., and William H. Gaasch, M.D. — Thu, 06Â MayÂ 2004 00:00:00 -05:00

Background: Patients with signs and symptoms of heart failure and a normal left ventricular ejection fraction are said to have diastolic heart failure. It has traditionally been thought that the...

PERSPECTIVE: Understanding âDiastolicâ Heart Failure

Margaret M. Redfield, M.D. — Thu, 06Â MayÂ 2004 00:00:00 -05:00

Heart failure is common and costly, and it primarily affects the elderly. As the elderly population expands, there will be marked increases in the number of persons with heart failure....

IMAGES IN CLINICAL MEDICINE: Eruptive Xanthomas Associated with Hypertriglyceridemia and New-Onset Diabetes Mellitus

Keshav R. Nayak, M.D. and Richard G. Daly, M.D. — Thu, 18Â MarÂ 2004 00:00:00 -05:00

A previously healthy, 38-year-old man with a family history of early cerebrovascular accidents presented with a sudden eruption of pink papules with creamy-colored centers on his arms and upper torso...

ORIGINAL ARTICLE: Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea

Thu, 12Â FebÂ 2004 00:00:00 -05:00

Background: B-type natriuretic peptide levels are higher in patients with congestive heart failure than in patients with dyspnea from other causes.

Methods: We conducted a prospective, randomized, controlled study of 452...

PERSPECTIVE: The Artificial Heart

Sandeep Jauhar, M.D., Ph.D. — Thu, 05Â FebÂ 2004 00:00:00 -05:00

At 10:30 p.m. on December 1, 1982, a retired dentist named Barney Clark was wheeled into an operating room at the University of Utah Medical Center in Salt Lake City....

EDITORIAL: Angiotensin-Receptor Blockade in Acute Myocardial Infarction â A Matter of Dose

Douglas L. Mann, M.D., and Anita Deswal, M.D., M.P.H. — Thu, 13Â NovÂ 2003 00:00:00 -05:00

Beta-blockers, angiotensin-convertingâenzyme (ACE) inhibitors, and aldosterone antagonists have been shown to reduce the overall risk of death as well as the risk of major nonfatal cardiovascular events when they are...

ORIGINAL ARTICLE: Valsartan, Captopril, or Both in Myocardial Infarction Complicated by Heart Failure, Left Ventricular Dysfunction, or Both

Thu, 13Â NovÂ 2003 00:00:00 -05:00

Background: Angiotensin-convertingâenzyme (ACE) inhibitors such as captopril reduce mortality and cardiovascular morbidity among patients with myocardial infarction complicated by left ventricular systolic dysfunction, heart failure, or both. In a double-blind...

IMAGES IN CLINICAL MEDICINE: Cardiac Tamponade in Dressler's Syndrome

Bernard Paelinck, M.D. and Paul A. Dendale, M.D., Ph.D. — Thu, 05Â JunÂ 2003 00:00:00 -05:00

A 57-year-old woman was referred to our clinic because of malaise, dyspnea, and pedal edema four weeks after an extensive myocardial infarction. Physical examination revealed jugular venous distention and pulsus...

REVIEW ARTICLE: Heart Failure

Mariell Jessup, M.D., and Susan Brozena, M.D. — Thu, 15Â MayÂ 2003 00:00:00 -05:00

The clinical syndrome of heart failure is the final pathway for myriad diseases that affect the heart. Since the mid-1990s, when the last review of heart failure appeared in the...

ORIGINAL ARTICLE: Nitroprusside in Critically Ill Patients with Left Ventricular Dysfunction and Aortic Stenosis

Thu, 01Â MayÂ 2003 00:00:00 -05:00

Background: Vasodilators are considered to be contraindicated in patients with severe aortic stenosis because of concern that they may precipitate life-threatening hypotension. However, vasodilators such as nitroprusside may improve myocardial...

PERSPECTIVE: Heart Failure in Aortic Stenosis â Improving Diagnosis and Treatment

Michael R. Zile, M.D., and William H. Gaasch, M.D. — Thu, 01Â MayÂ 2003 00:00:00 -05:00

The development of heart failure in patients with aortic stenosis is associated with a high mortality rate â unless aortic-valve replacement is performed. There is an especially high risk of...

EDITORIAL: Aldosterone Blockade and Heart Failure

Mariell Jessup, M.D. — Thu, 03Â AprÂ 2003 00:00:00 -05:00

In the fall of 1999, a multicenter, randomized trial examining the effect of spironolactone on morbidity and mortality among patients with severe heart failure was published in the Journal.1 The...

ORIGINAL ARTICLE: Eplerenone, a Selective Aldosterone Blocker, in Patients with Left Ventricular Dysfunction after Myocardial Infarction

Thu, 03Â AprÂ 2003 00:00:00 -05:00

Background: Aldosterone blockade reduces mortality and morbidity among patients with severe heart failure. 03040329.xml We conducted a double-blind, placebo-controlled study evaluating the effect of eplerenone, a selective aldosterone blocker, on...

ORIGINAL ARTICLE: Cardiovascular Effects of Continuous Positive Airway Pressure in Patients with Heart Failure and Obstructive Sleep Apnea

Thu, 27Â MarÂ 2003 00:00:00 -05:00

Background: 03032727.xml Obstructive sleep apnea subjects the failing heart to adverse hemodynamic and adrenergic loads and may thereby contribute to the progression of heart failure. We hypothesized that treatment of...

ORIGINAL ARTICLE: Effect of Left Ventricular Outflow Tract Obstruction on Clinical Outcome in Hypertrophic Cardiomyopathy

Thu, 23Â JanÂ 2003 00:00:00 -05:00

Background: The influence of left ventricular outflow tract obstruction on the clinical outcome of hypertrophic cardiomyopathy remains unresolved.

Methods: We assessed the effect of outflow tract obstruction on morbidity and mortality...

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2003 â A 60-Year-Old Man with Mild Congestive Heart Failure of Uncertain Cause

Thu, 16Â JanÂ 2003 00:00:00 -05:00

A 60-year-old man was admitted to the hospital because of dyspnea and pulmonary vascular congestion.

The patient had reportedly been well until seven days earlier, when he began to have dyspnea...

EDITORIAL: Heart Failure â An Epidemic of Uncertain Proportions

Thu, 31Â OctÂ 2002 00:00:00 -05:00

We are in the midst of a proclaimed epidemic of heart failure, as evidenced by increases in the number of hospitalizations for heart failure, the number of deaths attributed to...

ORIGINAL ARTICLE: Sex-Based Differences in the Effect of Digoxin for the Treatment of Heart Failure

Saif S. Rathore, M.P.H., Yongfei Wang, M.S., and Harlan M. Krumholz, M.D. — Thu, 31Â OctÂ 2002 00:00:00 -05:00

Background: The Digitalis Investigation Group trial reported that treatment with digoxin did not decrease overall mortality among patients with heart failure and depressed left ventricular systolic function, although it did...

ORIGINAL ARTICLE: Long-Term Trends in the Incidence of and Survival with Heart Failure

Thu, 31Â OctÂ 2002 00:00:00 -05:00

Background: Heart failure is a major public health problem. Long-term trends in the incidence of heart failure and survival after its onset in the community have not been characterized.

Methods: We...

PERSPECTIVE: Digoxin â New Perspective on an Old Drug

Thu, 31Â OctÂ 2002 00:00:00 -05:00

Since 1785, when Sir William Withering published his treatise on the use of foxglove (see Figure), our perspective on the use of digitalis has continued to change. Withering believed that...

EDITORIAL: Adrenergic-Receptor Polymorphisms and Heart Failure

Thu, 10Â OctÂ 2002 00:00:00 -05:00

Congestive heart failure is the eventual outcome of diverse myocardial insults, including postischemic remodeling, primary cardiomyopathies, and infections.1 Even for specific forms of myocardial injury, it remains difficult to predict...

ORIGINAL ARTICLE: Synergistic Polymorphisms of Î²- and Î±-Adrenergic Receptors and the Risk of Congestive Heart Failure

Thu, 10Â OctÂ 2002 00:00:00 -05:00

Background: Sustained cardiac adrenergic stimulation has been implicated in the development and progression of heart failure. Release of norepinephrine is controlled by negative feedback from presynaptic Î±2-adrenergic receptors, and the...

EDITORIAL: Obesity and Heart Failure â Risk Factor or Mechanism?

Thu, 01Â AugÂ 2002 00:00:00 -05:00

As has been noted repeatedly by expert panels and the lay press, nearly 60 percent of the adult population of the United States is overweight or obese, with substantial resulting...

ORIGINAL ARTICLE: Obesity and the Risk of Heart Failure

Thu, 01Â AugÂ 2002 00:00:00 -05:00

Background: Extreme obesity is recognized to be a risk factor for heart failure. It is unclear whether overweight and lesser degrees of obesity also pose a risk.

Methods: We investigated the...

ORIGINAL ARTICLE: Rapid Measurement of B-Type Natriuretic Peptide in the Emergency Diagnosis of Heart Failure

Thu, 18Â JulÂ 2002 00:00:00 -05:00

Background: 02071822.xml B-type natriuretic peptide is released from the cardiac ventricles in response to increased wall tension.

Methods: We conducted a prospective study of 1586 patients who came to the emergency...

PERSPECTIVE: B-Type Natriuretic Peptide â A Window to the Heart

Thu, 18Â JulÂ 2002 00:00:00 -05:00

Left ventricular dysfunction, regardless of its cause, results in characteristic hemodynamic derangements and a process of neurohormonal activation. Among the neuronal and hormonal pathways activated are the sympathetic nervous system,...

EDITORIAL: Cardiac-Resynchronization Therapy for Heart Failure

Thu, 13Â JunÂ 2002 00:00:00 -05:00

The syndrome of congestive heart failure is responsible for substantial morbidity and mortality.1 Patients with heart failure have shortness of breath and a limited capacity for exercise, have high rates...

ORIGINAL ARTICLE: Ventricular Pacing or Dual-Chamber Pacing for Sinus-Node Dysfunction

Thu, 13Â JunÂ 2002 00:00:00 -05:00

Background: Dual-chamber (atrioventricular) and single-chamber (ventricular) pacing are alternative treatment approaches for sinus-node dysfunction that causes clinically significant bradycardia. However, it is unknown which type of pacing results in the...

ORIGINAL ARTICLE: Cardiac Resynchronization in Chronic Heart Failure

Thu, 13Â JunÂ 2002 00:00:00 -05:00

Background: Previous studies have suggested that cardiac resynchronization achieved through atrial-synchronized biventricular pacing produces clinical benefits in patients with heart failure who have an intraventricular conduction delay. We conducted a...

PERSPECTIVE: Beta-Blockers for Stable Heart Failure

Thu, 02Â MayÂ 2002 00:00:00 -05:00

According to current recommendations, Î²-adrenergicâreceptor blocking agents should be prescribed for all patients who have symptomatic heart failure and are in stable condition, unless these agents are contraindicated. The impetus...

REVIEW ARTICLE: Aldosterone in Congestive Heart Failure

Karl T. Weber, M.D. — Thu, 06Â DecÂ 2001 00:00:00 -05:00

Aldosterone was isolated from blood and urine, its adrenal origin elucidated, and its steroid structure identified nearly 50 years ago. Actions involving the reabsorption of sodium and the release of...

ORIGINAL ARTICLE: A Randomized Trial of the Angiotensin-Receptor Blocker Valsartan in Chronic Heart Failure

Thu, 06Â DecÂ 2001 00:00:00 -05:00

Background: Actions of angiotensin II may contribute to the progression of heart failure despite treatment with currently recommended drugs. We therefore evaluated the long-term effects of the addition of the...

EDITORIAL: Mechanical Cardiac-Support Devices â Dreams and Devilish Details

Thu, 15Â NovÂ 2001 00:00:00 -05:00

Statistics on the human and economic impact of the syndrome of heart failure in the United States have been well described, but they deserve further emphasis.1 The incidence of heart...

ORIGINAL ARTICLE: Long-Term Use of a Left Ventricular Assist Device for End-Stage Heart Failure

Thu, 15Â NovÂ 2001 00:00:00 -05:00

Background: Implantable left ventricular assist devices have benefited patients with end-stage heart failure as a bridge to cardiac transplantation, but their long-term use for the purpose of enhancing survival and...

EDITORIAL: The Jugular Venous Pulse and Third Heart Sound in Patients with Heart Failure

Thu, 23Â AugÂ 2001 00:00:00 -05:00

In my recent book on the cardiovascular physical examination, Braunwald wrote, âIntelligent selection of investigative procedures from the ever-increasing array of tests now available requires far more sophisticated decision-making than...

ORIGINAL ARTICLE: Prognostic Importance of Elevated Jugular Venous Pressure and a Third Heart Sound in Patients with Heart Failure

Thu, 23Â AugÂ 2001 00:00:00 -05:00

Background: The independent prognostic value of elevated jugular venous pressure or a third heart sound in patients with heart failure is not well established.

Methods: We performed a retrospective analysis of...

EDITORIAL: Expanding Indications for Beta-Blockers in Heart Failure

Thu, 31Â MayÂ 2001 00:00:00 -05:00

For more than a century, clinicians have noted that tachycardia, cutaneous vasoconstriction, diaphoresis, and reduced urinary output are cardinal manifestations of severe heart failure and surmised that these findings are...

ORIGINAL ARTICLE: A Trial of the Beta-Blocker Bucindolol in Patients with Advanced Chronic Heart Failure

The Beta-Blocker Evaluation of Survival Trial Investigators — Thu, 31Â MayÂ 2001 00:00:00 -05:00

Background: Although beta-adrenergicâreceptor antagonists reduce morbidity and mortality in patients with mild-to-moderate chronic heart failure, their effect on survival in patients with more advanced heart failure is unknown.

Methods: A total...

ORIGINAL ARTICLE: Effect of Carvedilol on Survival in Severe Chronic Heart Failure

Thu, 31Â MayÂ 2001 00:00:00 -05:00

Background: Beta-blocking agents reduce the risk of hospitalization and death in patients with mild-to-moderate heart failure, but little is known about their effects in severe heart failure.

Methods: We evaluated 2289...

EDITORIAL: Racial Differences in the Response to Drugs â Pointers to Genetic Differences

Thu, 03Â MayÂ 2001 00:00:00 -05:00

All physicians recognize that individual patients respond differently to medications, so that at so-called standard doses, a drug may have toxic effects in some patients but fail to produce the...

EDITORIAL: Racial Profiling in Medical Research

Thu, 03Â MayÂ 2001 00:00:00 -05:00

Two articles in this issue of the Journal deal with the treatment of heart failure in white and black patients. One, concerning carvedilol, reports that the benefit of this beta-blocker...

ORIGINAL ARTICLE: Race and the Response to Adrenergic Blockade with Carvedilol in Patients with Chronic Heart Failure

Thu, 03Â MayÂ 2001 00:00:00 -05:00

Background: The benefits of angiotensin-convertingâenzyme inhibitors and beta-blockers may be smaller in black patients than in patients of other races, but it is unknown whether race influences the response to...

ORIGINAL ARTICLE: Lesser Response to Angiotensin-ConvertingâEnzyme Inhibitor Therapy in Black as Compared with White Patients with Left Ventricular Dysfunction

Thu, 03Â MayÂ 2001 00:00:00 -05:00

Background: Black patients with heart failure have a poorer prognosis than white patients, a difference that has not been adequately explained. Whether racial differences in the response to drug treatment...

ORIGINAL ARTICLE: Effects of Multisite Biventricular Pacing in Patients with Heart Failure and Intraventricular Conduction Delay

Thu, 22Â MarÂ 2001 00:00:00 -05:00

Background: One third of patients with chronic heart failure have electrocardiographic evidence of a major intraventricular conduction delay, which may worsen left ventricular systolic dysfunction through asynchronous ventricular contraction. Uncontrolled...

EDITORIAL: Diastolic Heart Failure â No Time to Relax

Thu, 04Â JanÂ 2001 00:00:00 -05:00

There are 4.6 million people in the United States with heart failure today, and 550,000 new cases are being reported annually.1 Approximately 30 to 50 percent of patients with heart...

ORIGINAL ARTICLE: Intravenous Nesiritide, a Natriuretic Peptide, in the Treatment of Decompensated Congestive Heart Failure

Thu, 27Â JulÂ 2000 00:00:00 -05:00

Background: Intravenous infusion of nesiritide, a brain (B-type) natriuretic peptide, has beneficial hemodynamic effects in patients with decompensated congestive heart failure. We investigated the clinical use of nesiritide in such...

EDITORIAL: Underlying Causes and Survival in Patients with Heart Failure

Thu, 13Â AprÂ 2000 00:00:00 -05:00

Heart failure is a major health problem in the United States. It is estimated that 4.6 million Americans are currently treated for heart failure and that approximately 550,000 new cases...

ORIGINAL ARTICLE: Heart-Rate Recovery Immediately after Exercise as a Predictor of Mortality

Thu, 28Â OctÂ 1999 00:00:00 -05:00

Background: The increase in heart rate that accompanies exercise is due in part to a reduction in vagal tone. Recovery of the heart rate immediately after exercise is a function...

REVIEW ARTICLE: Signaling Pathways for Cardiac Hypertrophy and Failure

John J. Hunter, M.D., and Kenneth R. Chien, M.D., Ph.D. — Thu, 21Â OctÂ 1999 00:00:00 -05:00

Heart failure is a leading cause of mortality in the United States. As a result of advances in genetic technology, a molecular basis of heart failure is emerging.12 This review...

EDITORIAL: Apnea and Periodic Breathing during Sleep

Thu, 23Â SepÂ 1999 00:00:00 -05:00

In this issue of the Journal, Javaheri reports on his ongoing studies of periodic breathing during sleep in patients with congestive heart failure.1 Since breathing is usually regular, periodic breathing,...

IMAGES IN CLINICAL MEDICINE: Pulsus Alternans

David P. McLaughlin, M.D. — Thu, 23Â SepÂ 1999 00:00:00 -05:00

Figure 1. A 51-year-old woman presented with dyspnea on exertion and cardiomegaly. She had a long-standing history of poorly controlled hypertension. Physical examination revealed an elevated jugular venous pressure, clear...

ORIGINAL ARTICLE: A Mechanism of Central Sleep Apnea in Patients with Heart Failure

Shahrokh Javaheri, M.D. — Thu, 23Â SepÂ 1999 00:00:00 -05:00

Background: Breathing is controlled by a negative-feedback system in which an increase in the partial pressure of arterial carbon dioxide stimulates breathing and a decrease inhibits it. Although enhanced sensitivity...

EDITORIAL: Atrial Fibrillation in Heart Failure

Thu, 16Â SepÂ 1999 00:00:00 -05:00

In 1920 Sir James Mackenzie reported that atrial fibrillation was present in 80 to 90 percent of patients who had congestive heart failure, which at that time was called âdropsy.â1...

ORIGINAL ARTICLE: Dofetilide in Patients with Congestive Heart Failure and Left Ventricular Dysfunction

Thu, 16Â SepÂ 1999 00:00:00 -05:00

Background: Atrial fibrillation occurs frequently in patients with congestive heart failure and commonly results in clinical deterioration and hospitalization. Sinus rhythm may be maintained with antiarrhythmic drugs, but some of...

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Apoptosis and Heart Failure

Thu, 02Â SepÂ 1999 00:00:00 -05:00

Programmed cell death (apoptosis) was unknown to William Osler and Paul Dudley White, but physicians today must grapple with the uneasy knowledge that all of our cells actively maintain the...

EDITORIAL: Aldosterone and Spironolactone in Heart Failure

Thu, 02Â SepÂ 1999 00:00:00 -05:00

Chronic heart failure occurs most commonly after earlier myocardial infarction or in the presence of long-standing hypertension. The inability of this normally efficient muscular pump to eject or receive blood...

ORIGINAL ARTICLE: The Effect of Spironolactone on Morbidity and Mortality in Patients with Severe Heart Failure

Thu, 02Â SepÂ 1999 00:00:00 -05:00

Background: and Methods: Aldosterone is important in the pathophysiology of heart failure. In a double-blind study, we enrolled 1663 patients who had severe heart failure and a left ventricular ejection...

REVIEW ARTICLE: Hormones and Hemodynamics in Heart Failure

Robert W. Schrier, M.D., and William T. Abraham, M.D. — Thu, 19Â AugÂ 1999 00:00:00 -05:00

Heart failure is a major cause of cardiovascular mortality and morbidity, resulting in more than 1 million hospitalizations per year, and is the most common hospital-discharge diagnosis among patients older...

ORIGINAL ARTICLE: Facilitating Transthoracic Cardioversion of Atrial Fibrillation with Ibutilide Pretreatment

Thu, 17Â JunÂ 1999 00:00:00 -05:00

Background: Atrial fibrillation cannot always be converted to sinus rhythm by transthoracic electrical cardioversion. We examined the effect of ibutilide, a class III antiarrhythmic agent, on the energy requirement for...

ORIGINAL ARTICLE: Racial Differences in the Outcome of Left Ventricular Dysfunction

Thu, 25Â FebÂ 1999 00:00:00 -05:00

Background: Population-based studies have found that black patients with congestive heart failure have a higher mortality rate than white patients with the same condition. This finding has been attributed to...

EDITORIAL: Inotropic Therapy for Heart Failure

Thu, 17Â DecÂ 1998 00:00:00 -05:00

Looking back reveals how the direction of therapy for heart failure has changed since the inception of the first large clinical trial of vesnarinone, an inotropic agent, in April 1990....

ORIGINAL ARTICLE: A Dose-Dependent Increase in Mortality with Vesnarinone among Patients with Severe Heart Failure

Thu, 17Â DecÂ 1998 00:00:00 -05:00

Background: Vesnarinone, an inotropic drug, was shown in a short-term placebo-controlled trial to improve survival markedly in patients with severe heart failure when given at a dose of 60 mg...

REVIEW ARTICLE: Carvedilol

William H. Frishman, M.D. — Thu, 10Â DecÂ 1998 00:00:00 -05:00

Carvedilol is a Î²-adrenoreceptorâantagonist drug with Î±1-adrenoreceptorâantagonist activity. It was approved in the United States in September 1995 for the treatment of patients with essential hypertension and in May 1997,...

REVIEW ARTICLE: Implantable Left Ventricular Assist Devices

Daniel J. Goldstein, M.D., Mehmet C. Oz, M.D., and Eric A. Rose, M.D. — Thu, 19Â NovÂ 1998 00:00:00 -05:00

Congestive heart failure affects about 1 percent of adults in the United States1 and is a contributing factor in over 250,000 deaths annually.2 It is diagnosed in 400,000 Americans each...

REVIEW ARTICLE: Diuretic Therapy

D. Craig Brater, M.D. — Thu, 06Â AugÂ 1998 00:00:00 -05:00

Diuretic drugs are widely used for the treatment of patients with edema. Among these drugs, loop diuretics such as furosemide are perhaps the most frequently prescribed, and their clinical pharmacology...

REVIEW ARTICLE: Nitrate Therapy for Stable Angina Pectoris

John D. Parker, M.D., and John O. Parker, M.D. — Thu, 19Â FebÂ 1998 00:00:00 -05:00

The organic nitrates are widely used in the management of coronary artery disease. They are given not only to patients with stable angina pectoris, but also to those with unstable...

ORIGINAL ARTICLE: Idiopathic Giant-Cell Myocarditis â Natural History and Treatment

Thu, 26Â JunÂ 1997 00:00:00 -05:00

Background: Idiopathic giant-cell myocarditis is a rare and frequently fatal disorder. We used a multicenter data base to define the natural history of giant-cell myocarditis and the effect of treatment.

Methods:...

EDITORIAL: Prediction of Heart Failure â An Art Aided by Technology

Thu, 08Â MayÂ 1997 00:00:00 -05:00

Heart failure is common, has a poor prognosis,1 and can be treated.2 The incidence is increasing, partly because of improved survival after myocardial infarction and partly because the population is...

ORIGINAL ARTICLE: Left Ventricular Dilatation and the Risk of Congestive Heart Failure in People without Myocardial Infarction

Thu, 08Â MayÂ 1997 00:00:00 -05:00

Background: Left ventricular dilatation is a well-recognized precursor of ventricular dysfunction and congestive heart failure after myocardial infarction. The effect of left ventricular dilatation on the risk of heart failure...

ORIGINAL ARTICLE: Apoptosis in the Failing Human Heart

Thu, 17Â AprÂ 1997 00:00:00 -05:00

Background: Loss of myocytes is an important mechanism in the development of cardiac failure of either ischemic or nonischemic origin. However, whether programmed cell death (apoptosis) is implicated in the...

EDITORIAL: End of the Oldest Controversy in Medicine â Are We Ready to Conclude the Debate on Digitalis?

Thu, 20Â FebÂ 1997 00:00:00 -05:00

The role of digitalis in treating cardiovascular disease has been at the center of the oldest continuing controversy in the history of medicine. Ever since its clinical introduction by William...

ORIGINAL ARTICLE: The Effect of Digoxin on Mortality and Morbidity in Patients with Heart Failure

The Digitalis Investigation Group — Thu, 20Â FebÂ 1997 00:00:00 -05:00

Background: The role of cardiac glycosides in treating patients with chronic heart failure and normal sinus rhythm remains controversial. We studied the effect of digoxin on mortality and hospitalization in...

ORIGINAL ARTICLE: Apoptosis in Myocytes in End-Stage Heart Failure

Thu, 17Â OctÂ 1996 00:00:00 -05:00

Background: Heart failure can result from a variety of causes, including ischemic, hypertensive, toxic, and inflammatory heart disease. However, the cellular mechanisms responsible for the progressive deterioration of myocardial function...

ORIGINAL ARTICLE: Effect of Amlodipine on Morbidity and Mortality in Severe Chronic Heart Failure

Thu, 10Â OctÂ 1996 00:00:00 -05:00

Background: Previous studies have shown that calcium-channel blockers increase morbidity and mortality in patients with chronic heart failure. We studied the effect of a new calcium-channel blocker, amlodipine, in patients...

ORIGINAL ARTICLE: Effect of Theophylline on Sleep-Disordered Breathing in Heart Failure

Thu, 22Â AugÂ 1996 00:00:00 -05:00

Background: Theophylline has been used to treat central apnea associated with CheyneâStokes respiration (periodic breathing). We studied the effect of short-term oral theophylline therapy on periodic breathing associated with stable...

REVIEW ARTICLE: The Management of Chronic Heart Failure

Jay N. Cohn, M.D. — Thu, 15Â AugÂ 1996 00:00:00 -05:00

Heart failure is a complex of symptoms â fatigue, shortness of breath, and congestion â that are related to the inadequate perfusion of tissue during exertion and often to the...

EDITORIAL: Î²-Adrenergic Blockers and Survival in Heart Failure

Thu, 23Â MayÂ 1996 00:00:00 -05:00

Only in the past decade have well-conducted clinical trials advanced the treatment of congestive heart failure from palliation to prolongation of life. In 1986, the Veterans Administration Cooperative VasodilatorâHeart Failure...

ORIGINAL ARTICLE: The Effect of Carvedilol on Morbidity and Mortality in Patients with Chronic Heart Failure

Thu, 23Â MayÂ 1996 00:00:00 -05:00

Background: Controlled clinical trials have shown that beta-blockers can produce hemodynamic and symptomatic improvement in chronic heart failure, but the effect of these drugs on survival has not been determined.

Methods:...

NEJM â Collection Updates for Heart Failure

IMAGES IN CLINICAL MEDICINE: Kinked Carotids

CLINICAL PRACTICE: Systolic Heart Failure

ORIGINAL ARTICLE: A Sensitive Cardiac Troponin T Assay in Stable Coronary Artery Disease

EDITORIAL: Anemia and Iron Deficiency â New Therapeutic Targets in Heart Failure?

ORIGINAL ARTICLE: Ferric Carboxymaltose in Patients with Heart Failure and Iron Deficiency

EDITORIAL: Rise of the Machines â Left Ventricular Assist Devices as Permanent Therapy for Advanced Heart Failure

CLINICAL THERAPEUTICS: Mitral-Valve Repair for Mitral-Valve Prolapse

ORIGINAL ARTICLE: Advanced Heart Failure Treated with Continuous-Flow Left Ventricular Assist Device

EDITORIAL: Deleterious Effects of Right Ventricular Pacing

ORIGINAL ARTICLE: Biventricular Pacing in Patients with Bradycardia and Normal Ejection Fraction

EDITORIAL: The Confirmatory Trial in Comparative-Effectiveness Research

ORIGINAL ARTICLE: Defibrillator Implantation Early after Myocardial Infarction

EDITORIAL: MADIT-CRT â Breathtaking or Time to Catch Our Breath?

ORIGINAL ARTICLE: Cardiac-Resynchronization Therapy for the Prevention of Heart-Failure Events

BOOK REVIEW:

EDITORIAL: Surgical Ventricular Reconstruction for Heart Failure

ORIGINAL ARTICLE: Coronary Bypass Surgery with or without Surgical Ventricular Reconstruction

IMAGES IN CLINICAL MEDICINE: Kerley's A, B, and C Lines

ORIGINAL ARTICLE: Racial Differences in Incident Heart Failure among Young Adults

ORIGINAL ARTICLE: Irbesartan in Patients with Heart Failure and Preserved Ejection Fraction

BOOK REVIEW:

ORIGINAL ARTICLE: Quality of Life with Defibrillator Therapy or Amiodarone in Heart Failure

EDITORIAL: Life and Death after ICD Implantation

ORIGINAL ARTICLE: Prognostic Importance of Defibrillator Shocks in Patients with Heart Failure

BOOK REVIEW:

IMAGES IN CLINICAL MEDICINE: Spontaneous Thrombolysis of an Obstructed Mechanical Aortic Valve

EDITORIAL: Rhythm Control in Atrial Fibrillation â One Setback after Another

ORIGINAL ARTICLE: Increased Mortality after Dronedarone Therapy for Severe Heart Failure

ORIGINAL ARTICLE: Rhythm Control versus Rate Control for Atrial Fibrillation and Heart Failure

REVIEW ARTICLE: Biomarkers in Heart Failure

ORIGINAL ARTICLE: Cardiac Troponin and Outcome in Acute Heart Failure

CLINICAL PROBLEM-SOLVING: A Key Miscommunication â An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting

IMAGES IN CLINICAL MEDICINE: Mapping the Atrioventricular Node

ORIGINAL ARTICLE: Cardiac-Resynchronization Therapy in Heart Failure with Narrow QRS Complexes

ORIGINAL ARTICLE: Use of a Continuous-Flow Device in Patients Awaiting Heart Transplantation

PERSPECTIVE: Bridge to Life â Cardiac Mechanical Support

CLINICAL IMPLICATIONS OF BASIC RESEARCH: MicroRNAs and the Failing Heart

IMAGES IN CLINICAL MEDICINE: A Complication of Central Venous Catheterization

REVIEW ARTICLE: The Failing Heart â An Engine Out of Fuel

EDITORIAL: When the Failing, End-Stage Heart Is Not End-Stage

ORIGINAL ARTICLE: Left Ventricular Assist Device and Drug Therapy for the Reversal of Heart Failure

EDITORIAL: Diastolic Heart Failure â A Common and Lethal Condition by Any Name

CLINICAL THERAPEUTICS: Biventricular Pacing

ORIGINAL ARTICLE: Outcome of Heart Failure with Preserved Ejection Fraction in a Population-Based Study

ORIGINAL ARTICLE: Trends in Prevalence and Outcome of Heart Failure with Preserved Ejection Fraction

ORIGINAL ARTICLE: Association of Parental Heart Failure with Risk of Heart Failure in Offspring

ORIGINAL ARTICLE: Continuous Positive Airway Pressure for Central Sleep Apnea and Heart Failure

IMAGES IN CLINICAL MEDICINE: Ebstein's Anomaly

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2005 â A 48-Year-Old Man with Sudden Loss of Consciousness while Jogging

SPECIAL ARTICLE: Care in U.S. Hospitals â The Hospital Quality Alliance Program

SPECIAL ARTICLE: Quality of Care in U.S. Hospitals as Reflected by Standardized Measures, 2002â2004

PERSPECTIVE: The Controversy over Guidant's Implantable Defibrillators

PERSPECTIVE: Nesiritide â Not Verified

EDITORIAL: Sudden Death after Myocardial Infarction â Who Needs Prophylaxis, and When?

ORIGINAL ARTICLE: Sudden Death in Patients with Myocardial Infarction and Left Ventricular Dysfunction, Heart Failure, or Both

EDITORIAL: Resynchronizing Ventricular Contraction in Heart Failure

ORIGINAL ARTICLE: The Effect of Cardiac Resynchronization on Morbidity and Mortality in Heart Failure

IMAGES IN CLINICAL MEDICINE: Medical Mystery â 50 Years of Medical Progress

EDITORIAL: Atrial Fibrillation and Heart Failure â Five More Years

ORIGINAL ARTICLE: Catheter Ablation for Atrial Fibrillation in Congestive Heart Failure

EDITORIAL: NitrosoâRedox Balance in the Cardiovascular System

ORIGINAL ARTICLE: Combination of Isosorbide Dinitrate and Hydralazine in Blacks with Heart Failure

PERSPECTIVE: Race-Based Therapeutics

CLINICAL PRACTICE: Diastolic Heart Failure

CLINICAL PROBLEM-SOLVING: Undercover and Overlooked

ORIGINAL ARTICLE: Cardiac Replacement with a Total Artificial Heart as a Bridge to Transplantation

PERSPECTIVE: Building a Bridge to Heart Transplantation

REVIEW ARTICLE: Managing Hyperkalemia Caused by Inhibitors of the ReninâAngiotensinâAldosterone System

ORIGINAL ARTICLE: Rates of Hyperkalemia after Publication of the Randomized Aldactone Evaluation Study

PERSPECTIVE: Treatment of Heart Failure with Spironolactone â Trial and Tribulations

CLINICAL IMPLICATIONS OF BASIC RESEARCH: Sparking the Failing Heart

EDITORIAL: Electromechanical Associations

IMAGES IN CLINICAL MEDICINE: Acquired Arteriovenous Fistula

ORIGINAL ARTICLE: Cardiac-Resynchronization Therapy with or without an Implantable Defibrillator in Advanced Chronic Heart Failure

PERSPECTIVE: Evidence-Based Use of Cardiac Procedures and Devices

ORIGINAL ARTICLE: Diastolic Heart Failure â Abnormalities in Active Relaxation and Passive Stiffness of the Left Ventricle

PERSPECTIVE: Understanding âDiastolicâ Heart Failure

IMAGES IN CLINICAL MEDICINE: Eruptive Xanthomas Associated with Hypertriglyceridemia and New-Onset Diabetes Mellitus

ORIGINAL ARTICLE: Use of B-Type Natriuretic Peptide in the Evaluation and Management of Acute Dyspnea

NEJM â Collection Updates for Heart Failure

EDITORIAL: Anemia and Iron Deficiency â New Therapeutic Targets in Heart Failure?

EDITORIAL: Rise of the Machines â Left Ventricular Assist Devices as Permanent Therapy for Advanced Heart Failure

EDITORIAL: MADIT-CRT â Breathtaking or Time to Catch Our Breath?

EDITORIAL: Rhythm Control in Atrial Fibrillation â One Setback after Another

CLINICAL PROBLEM-SOLVING: A Key Miscommunication â An 81-year-old woman presented to the emergency department with increasing abdominal distention, nausea, and vomiting

PERSPECTIVE: Bridge to Life â Cardiac Mechanical Support

REVIEW ARTICLE: The Failing Heart â An Engine Out of Fuel

EDITORIAL: Diastolic Heart Failure â A Common and Lethal Condition by Any Name

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 26-2005 â A 48-Year-Old Man with Sudden Loss of Consciousness while Jogging

SPECIAL ARTICLE: Care in U.S. Hospitals â The Hospital Quality Alliance Program

SPECIAL ARTICLE: Quality of Care in U.S. Hospitals as Reflected by Standardized Measures, 2002â2004

PERSPECTIVE: Nesiritide â Not Verified

EDITORIAL: Sudden Death after Myocardial Infarction â Who Needs Prophylaxis, and When?

IMAGES IN CLINICAL MEDICINE: Medical Mystery â 50 Years of Medical Progress

EDITORIAL: Atrial Fibrillation and Heart Failure â Five More Years

EDITORIAL: NitrosoâRedox Balance in the Cardiovascular System

REVIEW ARTICLE: Managing Hyperkalemia Caused by Inhibitors of the ReninâAngiotensinâAldosterone System

PERSPECTIVE: Treatment of Heart Failure with Spironolactone â Trial and Tribulations

ORIGINAL ARTICLE: Diastolic Heart Failure â Abnormalities in Active Relaxation and Passive Stiffness of the Left Ventricle

PERSPECTIVE: Understanding âDiastolicâ Heart Failure

EDITORIAL: Angiotensin-Receptor Blockade in Acute Myocardial Infarction â A Matter of Dose

PERSPECTIVE: Heart Failure in Aortic Stenosis â Improving Diagnosis and Treatment

CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL: Case 2-2003 â A 60-Year-Old Man with Mild Congestive Heart Failure of Uncertain Cause

EDITORIAL: Heart Failure â An Epidemic of Uncertain Proportions

PERSPECTIVE: Digoxin â New Perspective on an Old Drug

EDITORIAL: Obesity and Heart Failure â Risk Factor or Mechanism?

PERSPECTIVE: B-Type Natriuretic Peptide â A Window to the Heart

EDITORIAL: Mechanical Cardiac-Support Devices â Dreams and Devilish Details

EDITORIAL: Racial Differences in the Response to Drugs â Pointers to Genetic Differences

ORIGINAL ARTICLE: Lesser Response to Angiotensin-ConvertingâEnzyme Inhibitor Therapy in Black as Compared with White Patients with Left Ventricular Dysfunction

EDITORIAL: Diastolic Heart Failure â No Time to Relax

ORIGINAL ARTICLE: Idiopathic Giant-Cell Myocarditis â Natural History and Treatment

EDITORIAL: Prediction of Heart Failure â An Art Aided by Technology

EDITORIAL: End of the Oldest Controversy in Medicine â Are We Ready to Conclude the Debate on Digitalis?