losartan-potassium and Tachycardia

To determine whether increasing red blood cell volume with erythropoietin reverses the hemodynamic response to standing in patients with orthostatic tachycardia.. Eight patients (2 men, 6 women) with orthostatic tachycardia were administered erythropoietin (50 U/kg body weight 3 times a week for 6 to 12 weeks) in order to reverse their red blood cell volume deficit. Six of the patients also received fludrocortisone (0.1 mg/d). Plasma and red blood cell volumes as well as the hemodynamic response to orthostatic stress were measured before and after erythropoietin therapy.. Erythropoietin therapy increased the mean +/- hematocrit from 37.6 +/- 1.0 to 46.4 +/- 1.4 (+/- standard error) (P < 0.01) and increased the red blood cell volume from 17.7 +/- 1.1 to 24.6 +/- 2.0 mL/kg (P < 0.01). Treatment increased supine mean blood pressure (from 87 +/- 4 to 93 +/- 5 mm Hg, P < 0.025) and standing mean blood pressure (from 87 +/- 4 to 94 +/- 5 mm Hg, P < 0.025). Erythropoietin therapy, however, failed to reverse orthostatic tachycardia. Following treatment, the mean heart rate after 5 minutes standing was 129 +/- 7 bpm, not significantly different from the pretreatment standing heart rate (134 +/- 5 bpm).. Although patients with the orthostatic tachycardia syndrome have a deficit in red blood cell volume, this is not the cause of their abnormal hemodynamic response to standing. Erythropoietin therapy fails to reverse orthostatic tachycardia.

Topics: Adult; Aged; Blood Volume; Erythropoietin; Female; Hematocrit; Hemodynamics; Humans; Male; Middle Aged; Posture; Tachycardia; Treatment Failure

An 80-year-old man with multiple comorbidities presented to the emergency department with tachypnea, tachycardia, fever, and critically low O

Topics: Aged, 80 and over; Anemia; Antiviral Agents; Betacoronavirus; Biomarkers; Clinical Laboratory Techniques; Convalescence; Coronavirus Infections; COVID-19; COVID-19 Testing; Critical Illness; Erythropoietin; Fever; Humans; Iran; Male; Pandemics; Pneumonia, Viral; Reverse Transcriptase Polymerase Chain Reaction; RNA, Viral; SARS-CoV-2; Tachycardia; Tachypnea; Tomography, X-Ray Computed; Treatment Outcome

Anemia is common among patients with malignant tumors, due to the disease and chemotherapy. Anemia decreases patient's quality of life, and worsens the dose-intensity of chemotherapy. The aim of this retrospective data-analysis was to evaluate quality of life and hemoglobin levels in 19 consecutive lung cancer patients receiving beta-erythropoietin, due to chemotherapy induced anemia. A self developed, patient source data based quality of life questionnaire was used. The mean pre-erythropoietin hemoglobin concentration of the patients was 96.31±6.72 g/L (mean±SD), the post-treatment hemoglobin concentration 111.63±14.05 g/L (p<0.05). During the chemotherapy of the 19 patients with lung cancer, transfusion was given only four times. The mean quality of life total score of the patients increased significantly during erythropoietin treatment that was resulted by the improvements of scores determining dizziness, tachycardia, and fatigue. Main limitations of this real life data analysis are low patient number and the lack of validation in the used questionnaire. In summary, according to our experiences, the use of beta-erythropoietin in patients with lung cancer results improved quality of life and a low rate of transfusions.

Topics: Adult; Aged; Anemia, Hypochromic; Antineoplastic Agents; Blood Transfusion; Dizziness; Erythropoietin; Fatigue; Female; Hematinics; Hemoglobins; Humans; Lung Neoplasms; Male; Middle Aged; Quality of Life; Recombinant Proteins; Retrospective Studies; Surveys and Questionnaires; Tachycardia; Treatment Outcome

Erythropoietin (EPO) is a hematopoietic factor, which is produced primarily by the adult kidney in response to tissue hypoxia. There is strong evidence that EPO may also be synthesized in the brain and act as a neuroprotector or neuromodulator in the central nervous system. The present study investigated the effect of centrally administered EPO on cardiovascular and respiratory parameters in anaesthetized rats. The animals were anaesthetized with ketamine (70 mg/kg) and xylazine (10 mg/kg) mixture. EPO at doses of 0.06, 0.12, 0.25 and 0.50 IU/5 microl or 0.9% saline as a control were injected intracerebroventricularly and blood pressure, heart rate, respiratory rate, tidal volume and minute ventilation were recorded. Following the administration of EPO, there was a significant increase in blood pressure, heart and respiratory rates, tidal volume and minute ventilation which were time and dose dependant. In order to investigate whether these effects of centrally injected EPO was caused by the diffusion of the drug to the periphery, the highest dose EPO (0.5 IU) in the present study, was injected intravenously but intravenously injected EPO showed no significant effect in these parameters. In conclusion, our findings showed that centrally injected erythropoietin caused pressor and tachycardic response, an increase in respiratory frequency and volume in anaesthetized rats. Moreover intravenous injection of the highest dose of EPO used in the study caused no effect suggesting a central mechanism of action for the agent. Hence, one can hypothesize that erythropoietin may play a role in the central regulation of cardiovascular and respiratory system as a neuromodulator or neuromediator.

Topics: Anesthesia; Animals; Blood Pressure; Central Nervous System; Erythropoietin; Female; Heart Rate; Injections, Intravenous; Injections, Intraventricular; Neurotransmitter Agents; Rats; Rats, Sprague-Dawley; Respiratory Mechanics; Tachycardia; Tidal Volume

Patients with postural tachycardia syndrome (POTS) experience considerable disability, but in most, the pathophysiology remains obscure. Plasma volume disturbances have been implicated in some patients. We prospectively tested the hypothesis that patients with POTS are hypovolemic compared with healthy controls and explored the role of plasma renin activity and aldosterone in the regulation of plasma volume.. Patients with POTS (n=15) and healthy controls (n=14) underwent investigation. Heart rate (HR), blood pressure (BP), plasma renin activity, and aldosterone were measured with patients both supine and upright. Blood volumes were measured with 131I-labeled albumin and hematocrit. Patients with POTS had a higher orthostatic increase in HR than controls (51+/-18 versus 16+/-10 bpm, P<0.001). Patients with POTS had a greater deficit in plasma volume (334+/-187 versus 10+/-250 mL, P<0.001), red blood cell volume (356+/-128 versus 218+/-140 mL, P=0.010), and total blood volume (689+/-270 versus 228+/-353 mL, P<0.001) than controls. Despite the lower plasma volume in patients with POTS, there was not a compensatory increase in plasma renin activity (0.79+/-0.58 versus 0.79+/-0.74 ng x mL(-1) x h(-1), P=0.996). There was a paradoxically low level of aldosterone in the patients with POTS (190+/-140 pmol/L versus 380+/-230 pmol/L; P=0.017).. Patients with POTS have paradoxically unchanged plasma renin activity and low aldosterone given their marked reduction in plasma volume. These patients also have a significant red blood cell volume deficit, which is regulated by the renal hormone erythropoietin. These abnormalities suggest that the kidney may play a key role in the pathophysiology of POTS.

Topics: Adult; Aldosterone; Blood Volume; Case-Control Studies; Erythropoietin; Female; Hemodynamics; Humans; Hypovolemia; Male; Middle Aged; Posture; Prospective Studies; Renin; Renin-Angiotensin System; Tachycardia

Head upright tilt table testing has emerged as an accepted modality for identifying an individual's predisposition to episodes of autonomically mediated hypotension and bradycardia that are sufficiently profound so that transient loss of consciousness ensues (neurocardiogenic syncope). However it has also become apparent that less dramatic falls in blood pressure, while not sufficient to cause full syncope, may produce symptoms such as near syncope, vertigo, dizziness, and TIA-like episodes. We have identified a subgroup of individuals with a mild form of autonomic dysfunction with symptoms of postural tachycardia and lightheadedness, disabling fatigue, exercise intolerance, dizziness, and near syncope. During baseline tilt table testing these patients demonstrated a heart rate increase of > or = 30 beats/min (or a maximum heart rate of 120 beats/min) within the first 10 minutes upright (unassociated with profound hypotension), which reproduced their symptom complex. In addition these patients exhibit an exaggerated response to isoproterenol infusions. Similar observations have been made by others who have dubbed this entity the Postural Orthostatic Tachycardia Syndrome (POTS). We conclude that POTS represents a mild (and potentially treatable) from of autonomic dysfunction that can be readily diagnosed during head upright tilt table testing.

Topics: Adult; Atenolol; Autonomic Nervous System Diseases; Erythropoietin; Female; Fludrocortisone; Humans; Male; Posture; Recombinant Proteins; Selective Serotonin Reuptake Inhibitors; Syncope, Vasovagal; Tachycardia; Tilt-Table Test