Uncommon or commonly unrecognized causes of heart failure

Nutritional factors and heart failure in Nigerians with hypertensive heart disease

Thirty Nigerian hypertensives with heart failure and 30 without heart failure, matched for age and sex, were studied. Diastolic blood pressures were similar in the two groups (118 +/- 15 and 118.5 +/- 13.6 mmHg, respectively) (P greater than 0.5), while systolic blood pressures were higher in the non-heart failure group (176.7 +/- 29.7 and 198.8 +/- 29.8 mmHg, respectively) (P less than 0.01). The mean durations of initial detection of high blood pressure in the previously known hypertensives in the two groups were 4.9 +/- 3.8 and 4.4 +/- 3.3 years, respectively (P greater than 0.05), and their drug compliance prior to this study was similarly poor (P greater than 0.1). In the two groups, 33.3% and 10% were thiamine deficient, respectively (P less than 0.001), with TPP greater than 15%; 23.3% and 0% had hypoalbuminaemia (P less than 0.02), with a mean serum albumin of 35 +/- 7 and 42 +/- 3 g/l, respectively (P less than 0.001); while 36.7% and 13.3% were anaemic, respectively (P less than 0.05). Heart failure was more severe in those with more than one of these adverse factors (P less than 0.05). The results suggest that these factors, more prevalent in the heart failure group, would have hastened and worsened their heart failure. It is suggested that an active nutritional approach be incorporated into the management of hypertensives, particularly in the developing world.

Noninvasive diagnosis of the cardiomyopathies

The presenting clinical features of the cardiomyopathies are nonspecific. Echocardiography is useful in detecting patients with cardiomyopathy and determining proper management. Echocardiography can be used to determine both cardiac structural measurements and cardiac function.

Alcohol in toxic congestive cardiomyopathy

Though ethyl alcohol is known to be one of the exogenous toxins that can directly damage the myocardium, nonalcoholic additives to alcoholic beverages (as well as poor nutrition or viral infection) may also play a role in cardiomyopathy. The authors note the interesting fact that, unlike the liver, the heart does not contain an alcohol dehydrogenase and thus lacks a possible protective mechanism against alcohol's toxicity.

Classification of the secondary cardiomyopathies. The pathologist's view

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The cardiomyopathies--current perspectives

This paper is designed to provide a contemporary overview of primary myocardial disease. The cardiomyopathies are dealt with in the light of both pathophysiologic and etiologic classifications. A relatively simple diagnostic approach is based upon these classifications together with the clinical manifestations of the cardiomyopathies. The essential principles of the natural history are summarized, and treatment is dealt with in terms of specific curatives, general pharmacologic measures, and management of factors that modify, aggravate, or contribute to the development of primary myocardial disease.