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Congestive Heart Failure
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Pulmonary edema causes anxiety because of a sensation of suffocation, severe dyspnea, and restlessness. Often, there is coughing that produces a reddened sputum, cyanosis, pallor, and extreme sweating. There may be frothing from the mouth, but extreme hemoptysis is rare. While the BP can be variable, the pulse is rapid but of low volume. Significant hypertension indicates that the cardiac reserve is increased. A dangerous sign is hypotension in which the systolic BP is lower than 100 mg Hg. Over both lung fields, inspiratory fine crackles are dispersed anteriorly and posteriorly. Severe cardiac asthma may develop, causing wheezing. Efforts to breathe are noisy and often complicate auscultation of heart sounds. A merger of the third and fourth heart sounds, known as a summation gallop, may develop. Signs of RV failure may occur, including neck vein distention and peripheral edema.
Rheology of Cerebrovascular Disease
Published in Gordon D. O. Lowe, Clinical Blood Rheology, 2019
Factors raising blood viscosity, notably the hematocrit, have been demonstrated to have an important effect on reducing cerebral blood flow. This might explain why patients with high hematocrit are more likely to develop cerebral vascular disease. Reducing hematocrit produces substantial increases in cerebral blood flow which may be of potential benefit in the treatment of acute stroke. Furthermore, reducing hematocrit may prove to be of value in reducing the chance of stroke occurring, especially in patients who are at risk of occlusive cerebral events. More experimental work needs to be done on plasma factors that influence viscosity and also on red cell flexibility, before their effects on the cerebral circulation can be satisfactorily assessed. The potential dangers of rheological treatment should be appreciated, particularly the reduction in oxygen carrying capacity of blood after hemodilution. This is most likely to be a problem in patients with impaired cardiac reserve who have difficulty in increasing cardiac output and blood flow to compensate. Following venesection, certain individuals may suffer an adverse effect on platelet function, which will tend to increase the likelihood of thrombus development and spread, although this theoretical risk has not been confirmed so far.
The heart
Published in Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella, Essentials of Human Physiology and Pathophysiology for Pharmacy and Allied Health, 2019
Laurie K. McCorry, Martin M. Zdanowicz, Cynthia Y. Gonnella
A primary determinant is the level of activity of the body. During intense exercise in an average sedentary person, CO may increase to 18–20 L/min. In a trained athlete, the increase in CO is even greater and may be as much as 30–35 L/min. Cardiac reserve is the difference between the CO at rest and the maximum volume of blood that the heart is capable of pumping per minute. The effect of endurance training is to significantly increase cardiac reserve so that a greater volume of blood can be pumped to the working muscles. In this way, exercise performance is maximized and fatigue of the muscles is delayed. On the other hand, patients with heart conditions, such as congestive heart failure or mitral valve stenosis, are not able to increase their CO as much, if at all, during exercise. Therefore, these patients are forced to limit their level of exertion as the disease process progresses.
Perioperative pharmacotherapy to prevent cardiac complications in patients undergoing noncardiac surgery
Published in Expert Opinion on Pharmacotherapy, 2021
Kirtipal Bhatia, Bharat Narasimhan, Gaurav Aggarwal, Adrija Hajra, Soumya Itagi, Shathish Kumar, Sandipan Chakraborty, Neelkumar Patel, Vardhmaan Jain, Dhrubajyoti Bandyopadhyay, Birendra Amgai, Wilbert S Aronow
Tremendous advances in cardiovascular medicine have left us with a large and growing elderly demographic with a significant comorbidity burden. Similar strides in surgical and anesthetic techniques have led to increasingly complicated and intricate surgeries on patients previously deemed too high risk for such undertakings. The logical consequence of the aforementioned progress is that a greater number of patients with cardiovascular comorbidities are undergoing high-risk surgeries than ever before. The impact of these interventions – either as a result of anesthesia, the surgery itself, or the physiological consequences of a catecholaminergic state – imposes varying degrees of stress on the cardiovascular system. These are often well tolerated by healthy individuals but are of particular significance in high-risk patients with an impaired cardiac reserve. The importance of perioperative care is of vital importance in these patients.
Management of fluid status and cardiovascular function in patients with diffuse skin inflammation
Published in Journal of Dermatological Treatment, 2019
Arash Taheri, Amanda D. Mansouri, Parisa Mansoori, Rahimullah Imran Asad
Patients with chronic, widespread skin inflammation, such as erythroderma, usually develop their pathology and vascular changes gradually over time. First, there is a mild reduction in blood pressure. Patients with access to water and good nutrition will compensate for this reduction in blood pressure by retaining salt and water. Fluid retention leads to an increase in intravascular and extravascular volume and presents as peripheral edema. After adequate compensations, these patients have sufficient preload and venous return to the heart and do not require intravascular fluid infusion. However, the blood pressure of most of these patients remains lower than their baseline due to peripheral vasodilation in the skin. Most patients with good cardiac reserve function can compensate for peripheral vasodilation and blood shunting with increased cardiac output and blood pumping (1). They can maintain their blood pressure at a level sufficient for internal organ perfusion. However, if the heart cannot support increased cardiac output, the patients’ blood pressure may remain too low. Patients with heart failure or reduced cardiac reserve cannot pump more blood to compensate for the shunting of blood through the skin. The resulting hypotension and internal organ hypo-perfusion cause severe compensatory fluid retention, which leads to a significant increase in central venous pressure and pulmonary vascular pressure, decompensated congestive heart failure, and pulmonary edema (17). This condition is called high-output heart failure (12).
The lethal effects and determinants of microcystin-LR on heart: a mini review
Published in Toxin Reviews, 2021
Muwaffak Alosman, Linghui Cao, Isaac Yaw Massey, Fei Yang
Saraf et al. (2018) also investigated the effect of MC-LR cardiotoxicity, and reported a drop-in blood flow from MCs intoxication and attributed it to sequestration of blood in the liver. It was also noted that there was a diminution of the physiological cardiac reserve, which they explained that it could have been caused by the normal response to circulatory insufficiency. On the other hand, Sedmak et al. (2009), suggested that death caused by MC intoxication might be pointing at the involvement of a cardiogenic component. Detection mechanism can also be done using cellular uptake of MCs to uncover the fall or increase in blood pressure.