cardiovascular-agents and Pulmonary-Edema

Acute cardiogenic pulmonary edema and cardiogenic shock are two of the main forms of presentation of acute heart failure. Both entities are serious, with high mortality, and require early diagnosis and prompt and aggressive management. Acute pulmonary edema is due to the passage of fluid through the alveolarcapillary membrane and is usually the result of an acute cardiac episode. Correct evaluation and clinical identification of the process is essential in the management of acute pulmonary edema. The initial aim of treatment is to ensure hemodynamic stability and to correct hypoxemia. Other measures that can be used are vasodilators such as nitroglycerin, loop diuretics and, in specific instances, opioids. Cardiogenic shock is characterized by sustained hypoperfusion, pulmonary wedge pressure > 18 mmHg and a cardiac index < 2.2l/min/m(2). The process typically presents with hypotension (systolic blood pressure < 90 mmHg or a decrease in mean arterial pressure > 30 mmHg) and absent or reduced diuresis (< 0.5 ml/kg/h). The most common cause is left ventricular failure due to acute myocardial infarction. Treatment consists of general measures to reverse acidosis and hypoxemia, as well as the use of vasopressors and inotropic drugs. Early coronary revascularization has been demonstrated to improve survival in shock associated with ischaemic heart disease.

Topics: Acute Disease; Cardiovascular Agents; Combined Modality Therapy; Diagnosis, Differential; Diuresis; Heart Failure; Humans; Hypotension; Hypoxia; Myocardial Infarction; Myocardial Revascularization; Narcotics; Oxygen Inhalation Therapy; Pulmonary Edema; Respiration, Artificial; Sepsis; Shock; Shock, Cardiogenic; Sodium Potassium Chloride Symporter Inhibitors; Vasoconstrictor Agents; Vasodilator Agents; Ventricular Dysfunction, Left

Lung injury is an increasing cause of morbidity and mortality in patients treated with cytotoxic and noncytotoxic drugs. Prompt diagnosis is important because early drug-induced lung injury will often regress with the cessation of therapy. Diagnosis requires a high index of suspicion because infection, radiation pneumonitis, and recurrence of the underlying disease can manifest clinically and radiologically in a similar manner. Because the lungs have only a limited number of histopathologic responses to injury, including pulmonary edema/diffuse alveolar damage, NSIP, BOOP, EP, and pulmonary hemorrhage, knowledge of these manifestations and the corresponding radiologic manifestations can often be useful in suggesting a diagnosis of drug-induced lung injury. An understanding of the drugs most commonly associated with lung injury can also facilitate diagnosis.

Topics: Anti-Infective Agents; Antineoplastic Agents; Cardiovascular Agents; Cryptogenic Organizing Pneumonia; Diagnosis, Differential; Hemorrhage; Humans; Lung; Lung Diseases; Lung Diseases, Interstitial; Pulmonary Edema; Pulmonary Eosinophilia; Radiography

Patients with atherosclerotic renal artery stenosis may develop hypertension, recurrent pulmonary edema and chronic renal failure, but have a much higher risk of dying from stroke or myocardial infarction than of progressing to end-stage renal disease. Indeed, atherosclerotic renal artery stenosis typically occurs in high risk patients with coexistent vascular disease elsewhere. Recent controlled trials comparing medication to revascularization have shown that only a minority of such patients can expect hypertension cure, whereas the results of trials designed to document the ability of revascularization to prevent progressive renal failure are not yet available. Revascularization should be undertaken in patients with atherosclerotic renal artery stenosis and resistant hypertension or heart failure, and probably in those with rapidly deteriorating renal function or with an increase in plasma creatinine levels during angiotensin-converting enzyme inhibition, especially if their renal resistance--index before revascularization is less than 80. With or without revascularization, medical therapy using antihypertensive agents, statins and aspirin is necessary in almost all cases.

Topics: Angiotensin-Converting Enzyme Inhibitors; Arteriosclerosis; Aspirin; Cardiovascular Agents; Combined Modality Therapy; Creatinine; Diagnostic Imaging; Drug Therapy, Combination; Heart Failure; Humans; Hypertension, Renovascular; Hypolipidemic Agents; Myocardial Infarction; Platelet Aggregation Inhibitors; Pulmonary Edema; Radionuclide Imaging; Renal Artery; Renal Artery Obstruction; Risk Factors; Stroke

With the methods available today, most patients who arrive at the emergency department with acute cardiogenic pulmonary edema can be treated quickly and effectively. Modern pharmacologic therapy is based on directly counteracting the physiologic abnormalities that cause pulmonary edema. Agents that are useful in reducing LV preload and afterload and in managing hypotension are nitroglycerin, ACE inhibitors, vasodilators, vasopressors, and bipyrines. Noninvasive pressure support ventilation helps patients with pulmonary edema by decreasing the work of breathing, enhancing oxygen and carbon dioxide exchange, and increasing cardiac output. Use of BiPAP systems in emergency departments has averted endotracheal intubation in about 90% of patients with pulmonary edema who are experiencing acute respiratory failure.

Topics: Acute Disease; Cardiovascular Agents; Combined Modality Therapy; Emergency Treatment; Humans; Positive-Pressure Respiration; Pulmonary Edema; Ventricular Dysfunction, Left

Topics: Acute Disease; Bisoprolol; Cardiomegaly; Cardiomyopathies; Cardiovascular Agents; Echocardiography; Genetic Testing; Heart Failure; Humans; Loeys-Dietz Syndrome; Losartan; Male; Middle Aged; Mutation; Pulmonary Edema; Receptor, Transforming Growth Factor-beta Type I; Spironolactone; Treatment Outcome; Ventricular Dysfunction, Left

Ambulatory measurement of intrathoracic impedance (ITI) with an implanted device may detect increases in pulmonary fluid retention early, but the clinical utility of this method is not well established. The goal of this study was to test whether conventional ITI-derived parameters can diagnose fluid retention that may cause early stage heart failure (HF).. HF patients implanted with high-energy devices with OptiVol (Medtronic) monitoring were enrolled in this study. Patients were monitored remotely. At both baseline and OptiVol alert, patients were assessed on standard examinations, including analysis of serum brain natriuretic peptide (BNP). From April 2010 to August 2011, 195 patients from 12 institutes were enrolled. There were 154 primary OptiVol alert events. BNP level at the alerts was not significantly different from that at baseline. Given that ITI was inversely correlated with log BNP, we added a criterion specifying that the OptiVol alert is triggered only when ITI decreases by ≥4% from baseline. This change improved the diagnostic potential of increase in BNP at OptiVol alert (sensitivity, 75%; specificity, 88%).. BNP increase could not be identified based on OptiVol alert. Decrease in ITI ≥4% compared with baseline, in addition to the alert, however, may be a useful marker for the likelihood of HF (Clinical trial info: UMIN000003351).

Topics: Acute Disease; Aged; Aged, 80 and over; Algorithms; Biomarkers; Cardiac Resynchronization Therapy; Cardiography, Impedance; Cardiovascular Agents; Clinical Alarms; Combined Modality Therapy; Defibrillators, Implantable; Electric Impedance; Female; Heart Diseases; Heart Failure; Humans; Male; Middle Aged; Natriuretic Peptide, Brain; Prospective Studies; Pulmonary Edema; ROC Curve; Telemedicine; Vena Cava, Inferior; Weight Gain

Acute coronary syndromes (ACS) may precipitate up to a third of acute heart failure (AHF) cases. We assessed the characteristics, initial management, and survival of AHF patients with (ACS-AHF) and without (nACS-AHF) concomitant ACS.. Data from 620 AHF patients were analyzed in a prospective multicenter study. The ACS-AHF patients (32%) more often presented with de novo AHF (61% vs. 43%; P < .001). Although no differences existed between the 2 groups in mean blood pressure, heart rate, or routine biochemistry on admission, cardiogenic shock and pulmonary edema were more common manifestations in ACS-AHF (P < .01 for both). Use of intravenous nitrates, furosemide, opioids, inotropes, and vasopressors, as well as noninvasive ventilation and invasive coronary procedures (angiography, percutaneous coronary intervention, coronary artery bypass graft surgery), were more frequent in ACS-AHF (P < .001 for all). Although 30-day mortality was significantly higher for ACS-AHF (13% vs. 8%; P = .03), survival in the 2 groups at 5 years was similar. Overall, ACS was an independent predictor of 30-day mortality (adjusted odds ratio 2.0, 95% confidence interval 1.07-3.79; P = .03).. Whereas medical history and the manifestation and initial treatment of AHF between ACS-AHF and nACS-AHF patients differ, long-term survival is similar. ACS is, however, independently associated with increased short-term mortality.

Topics: Acute Coronary Syndrome; Acute Disease; Aged; Cardiovascular Agents; Disease Management; Female; Finland; Heart Failure; Hospital Mortality; Hospitalization; Humans; Male; Myocardial Revascularization; Prospective Studies; Pulmonary Edema; Shock, Cardiogenic; Survival Analysis

We describe a case report of a young Gabonese lady who presented an acute pulmonary oedema and we suspected a paripartum cardiomyopathy. Subsequent investigations showed isolated left ventricular noncompaction. A few months later, the same disease was disclosed at her 9 year-old son who presented a cardiac insufficiency. Therefore, we suspect a family form of left ventricular noncompaction. And it is the first description in subsaharan Africa. The hereditary character of this new form of cardiomyopathy linked to a genetic mutation on the X chromosome is well known. This disease is associated with heart failure, high incidence of systemic thromboembolism complications or ventricular arrhythmia. The echocardiography and the cardiac magnetic resonance imaging has been reported to be tools for diagnosis. In Africa, access to these techniques remains a privilege. So the discovery of illness is often late and the family screening are special. In our area, the therapeutic management is the medical treatment of heart failure. Implatable cardioverter defibrillator or heart transplantation are not available. So long-term prognosis of our patients with congestive heart failure stays poor. With best equipment in our hospitals and good training of African cardiologists, we should improve the management of our patients.

Topics: Adult; Barth Syndrome; Black People; Cardiovascular Agents; Child; Developing Countries; Drug Therapy, Combination; Echocardiography; Female; Gabon; Genetic Testing; Health Services Accessibility; Heart Failure; Humans; Magnetic Resonance Imaging; Male; Poverty Areas; Prognosis; Puerperal Disorders; Pulmonary Edema; Quality of Health Care

Takotsubo cardiomyopathy (TC) is increasingly recognised in patients presenting with features of acute coronary syndrome. We present a single centre experience of TC with medium term follow up.. Fifty-two consecutive patients presenting with a diagnosis of TC were included. The clinical presentation, complications, baseline and follow-up echocardiograms and cardiac magnetic resonance imaging were analysed.. Fifty-one patients were female. A stressful event preceded presentation in 37 (71%) patients. Chest pain was the most common symptom (83%). Two patients presented with an out-of-hospital cardiac arrest. ST segment elevation (40%) and global T wave inversion (44%) were the most frequent electrocardiogram changes. Left ventricular assessment demonstrated typical apical ballooning in 41 patients and 11 patients demonstrated the mid-wall variant. In-hospital complications occurred in 11 patients (21%) and included acute pulmonary oedema (n = 2), cardiogenic shock (n = 5); two of whom had a significant left ventricular outflow gradient, atrial fibrillation (n = 1), left ventricular thrombus (n = 2) and a cerebrovascular event (n = 2). Left ventricular function at presentation and follow up was compared in 40 patients. The mean ejection fraction in this group at presentation was 47% (20-70%) compared with that at follow up of 63% (44-76%). There were no significant complications or recurrences at follow up.. While TC is a reversible condition with low rates of complications and recurrence at follow up it is, as demonstrated in our cohort, associated with significant in-hospital morbidity in a proportion of patients.

Topics: Acute Coronary Syndrome; Adult; Aged; Aged, 80 and over; Atrial Fibrillation; Cardiac Catheterization; Cardiovascular Agents; Chest Pain; Diagnosis, Differential; Electrocardiography; Female; Follow-Up Studies; Heart Arrest; Humans; Magnetic Resonance Imaging; Male; Middle Aged; Platelet Aggregation Inhibitors; Pulmonary Edema; Queensland; Shock, Cardiogenic; Stress, Psychological; Stroke Volume; Takotsubo Cardiomyopathy; Ultrasonography; Ventricular Dysfunction, Left

Rheumatic heart disease (RHD) remains an important health issue for indigenous women of child-bearing age in northern Australia. However, the influence of RHD on maternal outcomes with current clinical practice is unclear.. To determine maternal cardiac complications and obstetric outcomes in patients with RHD.. Retrospective case note analysis of women with RHD who received obstetric care between July 1999 and May 2010 at Cairns Base Hospital in north Queensland. Outcome measures were obstetric interventions and outcomes, cardiac interventions and complications, stratified according to a cardiac risk score (CRS).. Ninety-five confinements occurred in 54 patients, of whom 52 were Indigenous Australians. There were no maternal or neonatal deaths. With a CRS of 0, cardiac complications occurred in 0 of 70 confinements; with a CRS of 1, complications occurred in 5 of 17 confinements (29%); with a CRS of >1, complications occurred in 2 of 4 confinements (50%). Another four patients were first diagnosed with RHD after developing acute pulmonary oedema during the peripartum period..   RHD has a major impact on maternal cardiac outcomes. However, with current management practices, maternal and fetal mortality are low, and the incidence of complications is predictable based on known risk factors.

Topics: Adult; Cardiovascular Agents; Delivery, Obstetric; Female; Heart Valve Diseases; Humans; Infant, Newborn; Native Hawaiian or Other Pacific Islander; Parity; Pregnancy; Pregnancy Complications, Cardiovascular; Pregnancy Outcome; Puerperal Disorders; Pulmonary Edema; Queensland; Retrospective Studies; Rheumatic Heart Disease; Ultrasonography; Ventricular Dysfunction, Left; Young Adult

Topics: Anti-Bacterial Agents; Bacteremia; Borrelia; Cardiopulmonary Resuscitation; Cardiovascular Agents; Ceftriaxone; Child; Combined Modality Therapy; Cytokines; Doxycycline; Endotoxins; Female; Humans; Hypotension; Positive-Pressure Respiration; Pulmonary Edema; Relapsing Fever; Shock, Cardiogenic; Tachycardia; Unconsciousness

The apical ballooning syndrome is a relatively rare and underrecognized transient cardiomyopathy precipitated by emotional or physical stress. The role of myocardial bridging in its cause is unknown and extremely rarely reported. We present a case of a 68-year-old woman with apical ballooning syndrome and transient myocardial bridging of the left anterior descending coronary artery, clinically manifested as pulmonary edema. Ischemic ECG changes and mild elevation of cardiac biomarkers were present. She recovered well on medical treatment, and follow-up echocardiography revealed complete recovery of the left ventricular systolic function, whereas repeated coronary angiography after 1 year showed no signs of myocardial bridging. To the best of our knowledge, this is the first report of transient myocardial bridging in a patient with Takotsubo cardiomyopathy with documented normalization of the left ventriculogram and disappearance of left anterior descending coronary artery myocardial bridging.

Topics: Aged; Biomarkers; Cardiovascular Agents; Coronary Angiography; Echocardiography; Electrocardiography; Female; Humans; Myocardial Bridging; Pulmonary Edema; Radionuclide Ventriculography; Takotsubo Cardiomyopathy; Treatment Outcome; Up-Regulation

A 42-year-old obese man presented with acute pulmonary edema. He had a history of chronic residual schizophrenia for which he had been taking clozapine for 7 years, but had no known prior cardiac disease. Echocardiography demonstrated severe biventricular systolic and diastolic dysfunction with severe left ventricular enlargement. Cardiac catheterization showed no coronary artery disease.. Physical examination, chest radiography, electrocardiography, transthoracic echocardiography, laboratory testing, viral serology, cardiac catheterization, coronary angiography and abdominal and renal ultrasonography.. Clozapine-induced dilated cardiomyopathy.. Intravenous nesiritide, furosemide and morphine followed by oral heart-failure therapy comprising ramipril, metoprolol succinate, spironolactone, and furosemide. Clozapine therapy was withdrawn.

Topics: Administration, Oral; Adult; Antipsychotic Agents; Cardiac Catheterization; Cardiomyopathy, Dilated; Cardiovascular Agents; Clozapine; Coronary Angiography; Echocardiography; Humans; Infusions, Intravenous; Male; Pulmonary Edema; Schizophrenia; Treatment Outcome

To report the efficacy of nesiritide in treating noncardiogenic pulmonary edema.. A 50-year-old African American woman with a complex medical history including morbid obesity, acute bronchitis, obstructive sleep apnea, hypertension, and numerous hospitalizations for volume overload presented to the emergency department with severe dyspnea. A portable chest X-ray displayed perihilar congestion and bilateral pulmonary edema. An echocardiogram demonstrated normal left-ventricular systolic and diastolic function. She was aggressively treated with nitrates, diuretics, bronchodilators, and oxygen. Despite these efforts, the patient's arterial blood gas (ABG) continued to show respiratory acidosis, the oxygen saturation was significantly depressed, and the dyspnea continued. Since standard therapies were failing after 12 hours, the patient was treated with intravenous nesiritide. The results were profound in terms of rapid symptomatic and prognostic improvement (i.e., ABG) beginning within 45 minutes of administration, and the patient was discharged after a 5-day hospital course.. Nesiritide is a human B-type natriuretic peptide that has been shown to improve hemodynamic function and symptoms associated with decompensated heart failure. This is primarily due to the actions of this medication, including diuresis, decreased mean arterial pressure, and improvement of pulmonary arterial occlusion pressure as determined by published clinical trial outcomes. This case describes the use of nesiritide as an effective adjunctive therapy in treating a patient with noncardiogenic pulmonary edema.. Nesiritide appears to be an efficacious treatment for acute pulmonary edema, resistant to standard-of-care therapies, in the presence of normal left-ventricular function.

Topics: Blood Gas Analysis; Cardiovascular Agents; Diuretics; Drug Therapy, Combination; Female; Humans; Middle Aged; Natriuretic Agents; Natriuretic Peptide, Brain; Pulmonary Edema; Ventricular Function, Left

Alveolar fluid resorption occurs by active epithelial sodium transport and is accelerated by terbutaline in healthy lungs. We investigated the effect of terbutaline on the rate of alveolar fluid resorption from rat lungs injured by hyperoxia. Rats exposed to > 95% O2 for 60 h, sufficient to increase wet-to-dry lung weight and cause alveolar edema, were compared with air-breathing control rats. After anesthesia, the animals breathed 100% O2 for 10 min through a tracheostomy. Ringer solution was instilled into the alveoli, and the steady-state rate of volume resorbed at 6 cmH2O pressure was measured via a pipette attached to the tracheostomy tubing. Ringer solution in some animals contained terbutaline (10(-3) M), ouabain (10(-3) M), or both. Normoxic animals resorbed 49 +/- 6 microliters.kg-1.min-1; ouabain reduced this by 39%, whereas terbutaline increased the rate by 75%. The effect of terbutaline was blocked by ouabain. Hyperoxic animals absorbed 78 +/- 9 microliters.kg-1.min-1; ouabain reduced this by 44%. Terbutaline increased the rate by a mean of 39 microliters.kg-1.min-1, similar to the absolute effect seen in the normoxic group, and this was blocked by ouabain. Terbutaline accelerates fluid resorption from both normal and injured rat lungs via its effects on active sodium transport.

Topics: Adrenergic beta-Agonists; Animals; Body Fluids; Cardiovascular Agents; Hyperoxia; Lung; Male; Organ Size; Ouabain; Pulmonary Alveoli; Pulmonary Edema; Rats; Rats, Sprague-Dawley; RNA, Messenger; Sodium-Potassium-Exchanging ATPase; Stimulation, Chemical; Terbutaline

The oxygen consumption (VO2)/oxygen delivery (DO2) relationship was analyzed in ten patients with severe congestive heart failure (CHF) and normal blood lactate levels. First dobutamine and then enoximone, after a washout period, were administered to each patient to increase cardiac output by at least 15 percent. Similar increases in DO2 were obtained with both drugs: from 285 +/- 46 to 393 +/- 87 ml/min/m2 for dobutamine, and from 285 +/- 54 to 392 +/- 99 ml/min/m2 for enoximone. However, while VO2 did not change (132 +/- 24 vs 132 +/- 21 ml/min/m2) (VO2/DO2 independency) with a dobutamine infusion (mean dose of 10 +/- 2 micrograms/kg/min), a significant increase in VO2 from 134 +/- 22 to 157 +/- 21 ml/min/m2 was observed with a bolus infusion of enoximone (mean dose of 1.7 +/- 0.5 mg/kg). These results, observed in patients with CHF without patent oxygen debt, suggest that an artefactual VO2/DO2 dependency might be induced by the cardiovascular drug used to elevate DO2, probably because of a drug-induced oxygen demand increase.

Topics: Acute Disease; Aged; Aged, 80 and over; Cardiovascular Agents; Catheterization, Swan-Ganz; Chronic Disease; Dobutamine; Enoximone; Female; Heart Failure; Hemodynamics; Humans; Imidazoles; Male; Middle Aged; Oxygen Consumption; Phosphodiesterase Inhibitors; Pulmonary Edema

Accumulation of radioisotope labelled transferrin in the lungs of guinea pigs was determined with an external detection system. The method is based on the intravascular and extravascular distribution of indium-113m labelled transferrin compared with the intravascular distribution of technetium-99m labelled red blood cells. Guinea pigs were given iloprost, a prostacyclin analogue and potent pulmonary vasodilator, and noradrenaline, a pulmonary vasoconstrictor, in an attempt to increase and decrease respectively the blood volume in the lungs. Neither agent altered transferrin accumulation in the lung by comparison with a saline infusion. Iloprost infused before and after oleic acid infusion reduced macro-molecular leakage when compared with oleic acid alone. These data suggest that the double isotope method can distinguish between hydrostatic and injury induced pulmonary oedema.

Topics: Animals; Cardiovascular Agents; Erythrocytes; Guinea Pigs; Iloprost; Indium Radioisotopes; Lung; Male; Norepinephrine; Oleic Acid; Oleic Acids; Pulmonary Edema; Radionuclide Imaging; Technetium; Transferrin

Topics: Body Fluids; Body Water; Cardiovascular Agents; Dyspnea; Heart; Heart Failure; Humans; Lung; Lung Diseases; Mitral Valve Stenosis; Pleural Effusion; Positive-Pressure Respiration; Pulmonary Edema

Topics: Aminophylline; Cardiovascular Agents; Digoxin; Diuretics; Dobutamine; Dopamine; Heart Failure; Humans; Morphine; Nitroglycerin; Nitroprusside; Pulmonary Edema; Verapamil

Topics: Cardiovascular Agents; Heart Failure; Humans; Myocardial Infarction; Pulmonary Edema; Shock, Cardiogenic

Topics: Alkaloids; Cardiovascular Agents; Edema; Epinephrine; Ergot Alkaloids; Pulmonary Edema; Secale

Topics: Alkaloids; Cardiovascular Agents; Edema; Ergot Alkaloids; Hydrocarbons, Chlorinated; Pulmonary Edema; Secale

Topics: Animals; Cardiovascular Agents; Epinephrine; Lung Diseases; Muscle Relaxants, Central; Pulmonary Edema; Rabbits; Research

Topics: Cardiovascular Agents; Curare; Edema; Epinephrine; Lung Diseases; Muscle Relaxants, Central; Poisons; Pulmonary Edema

Topics: Cardiovascular Agents; Edema; Lung Diseases; Muscle Relaxants, Central; Pulmonary Edema; Sympatholytics

Topics: Cardiovascular Agents; Dihydroergotamine; Epinephrine; Ergot Alkaloids; Humans; Lung; Oxytocics; Pulmonary Edema