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The Patient with Ischemic Heart Failure
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Konstantinos Aznaouridis, Constantina Masoura, Charalambos Vlachopoulos
The medical treatment of patients with ischemic heart failure comprises a combination of (1) medical treatment of heart failure, plus (2) secondary prevention of coronary artery disease, as well as anti-ischemic/anti-anginal therapy, if needed. In brief, treatment includes a beta-blocker, an angiotensin-converting enzyme inhibitor (ACEi), a statin at high dose (at least 40 mg of atorvastatin or 20 mg of rosuvastatin daily), and antiplatelet therapy (low-dose aspirin at 75 to 160 mg daily). An angiotensin receptor blocker is given to patients who do not tolerate ACEi (due to hypersensitivity or non-productive cough). Loop diuretics are given to patients with volume overload for symptomatic relief. Other medications, such as mineralocorticoid receptor antagonists (spironolactone or eplerenone), ivabradine, and neprilysin inhibitors (i.e., sacubitril-valsartan), are considered for particular patients.16,17
Preparing the Malnourished Patient for Parenteral Nutrition (PN)
Published in Michael M. Rothkopf, Jennifer C. Johnson, Optimizing Metabolic Status for the Hospitalized Patient, 2023
Michael M. Rothkopf, Jennifer C. Johnson
Parenteral nutrition can be associated with significant volume overload. This is particularly relevant because malnourished patients generally have low circulating proteins with a low oncotic pressure. As a result, they often have nutritional edema. When you administer PN, the patient may third space the additional intravenous fluids.
Blood Salvage
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
The following complications are more commonly associated with massive transfusion (>10 U or a transfusion of more than the patient’s blood volume): Coagulopathy— massive transfusion results in dilutional effects on platelets and clotting factors (V and VIII). DIC may also occur. FFP and platelets may need to be administered.Biochemical abnormalities—hyperkalaemia, metabolic acidosis, metabolic alkalosis (as citrate is converted to bicarbonate), hypocalcaemia secondary to citrate toxicity and hypoalbuminia.Hypothermia — results in a shift of the oxygen dissociation curve to the left.Volume overload.Iron overload occurs following multiple transfusions over a long period of time. It causes myocardial and hepatic damage as a result of haemosiderin deposition.
Effect of bioelectrical impedance technology on the prognosis of dialysis patients: a meta-analysis of randomized controlled trials
Published in Renal Failure, 2023
Kaibi Yang, Shujun Pan, Nan Yang, Juan Wu, Yueming Liu, Qiang He
Fluid overload is highly associated with patient mortality [30]. Clinical auxiliary tools allow clinicians to better manage the dry weight of dialysis patients; however, before applying these tools on a large scale, we must first establish their benefit to patients. The clear criterion is the mortality rate of the patient. The results of our meta-analysis demonstrate that bioelectrical impedance technology could reduce the risk of death of patients. Volume overload has been presumed to be one of the main causes of death in dialysis patients. However, the results of the current three meta-analyses showed that although bioelectrical impedance technology intervention could reduce systolic blood pressure and excessive hydration in dialysis patients, it has no positive effect on their mortality [31–33]. The factors affecting the death of dialysis patients are intricate. Studies have shown that age, diabetes, tumors, smoking, inflammation, residual renal function, and LVH are related to the death of dialysis patients [34,35]. Adjusting the fluid volume in patients with end-stage renal failure to an appropriate ‘dry body weight’ is a slow and persistent process that must be followed up long enough to observe clinically meaningful results. Previous meta-analyses included relatively few RCTs; we included more RCTs with larger sample sizes. Hence, the results are more convincing.
Visit-to-visit ultrafiltration volume variability predicts all-cause mortality in patients receiving hemodialysis
Published in Renal Failure, 2023
Quanchao Zhang, Ning Wang, Ling Nie, Caibao Lu, Hongwei Chen, Wenchang He, Moqi Li, Yiqin Wang, Jinghong Zhao, Jiachuan Xiong
HD patients frequently experience unpleasant symptoms, such as postdialysis light-headedness, fatigue and worsening cramps during dialysis treatment [5]. This suggests that volume management is essential and a vital component of dialysis treatment for HD patients [4]. Volume overload results in peripheral edema, breathlessness-induced hypertension, left ventricular hypertrophy, and heart failure [6]. Extracellular volume overload is a critical contributor to the high risk of cardiovascular mortality in patients undergoing HD [7,8]. However, aggressive volume removal is associated with intradialytic hypotension (IDH), myocardial stunning, and greater mortality and morbidity [9]. Currently, there are no precise indicators of fluid volume, and there is uncertainty about how to achieve ideal volume, especially in extracellular water.
RAS-challenge as a first-look test for detection of primary aldosteronism in patients with treatment-resistant hypertension
Published in Blood Pressure, 2023
Christian Beger, Theresa Karg, Jan B. Hinrichs, Bastian Ringe, Hermann Haller, Bernhard C. Meyer, Florian P. Limbourg
The patients were selected for an initial screening for PA according to the criteria of the current guidelines. Before taking a blood sample it was ensured that each patient had been in therapy with ACEi/ARB for at least four weeks. Any therapy with a beta-blocker or alpha-2 agonist was tapered off beforehand (for at least two weeks). No patient had been prescribed NSAIDs (according to history and medication schedule). Furthermore, no clinical signs of volume overload should be present in the physical examination. Blood samples were drawn from ambulatory patients after resting and while sitting in the mid-morning. Ethylenediaminetetraacetic acid (EDTA) plasma samples were all analysed in the central laboratory of the Hannover Medical School. Active renin and aldosterone were determined based on a chemiluminescence assay (CLIA) with the DiaSorin (Saluggia, Italy) Liaison analyser.