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Chronic hypertension and acute hypertensive crisis
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
William F. Rayburn, Lauren Plante
The most experience with calcium channel blockers has been during the second half of pregnancy as a treatment for hypertension or arrhythmias (23–26) or for tocolysis (27–29). Nifedipine, the best known calcium channel blocker, exerts a greater effect on vascular smooth muscle than on the myocardium (30,31). A review on 102 women who received oral nifedipine for tocolysis concluded that therapy appeared safe for mother and fetus (32). A human investigation that utilized Doppler ultrasound techniques to assess fetal and uteroplacental circulation did not uncover any significant effects after short-term nifedipine therapy (33). Oral nifedi-pine is rapid acting and has been used without complications; however, long-term trials of calcium channel blockers during pregnancy are necessary (29). A comparison of nifedipine and atenolol reported no differences with either agent (34). Fetoplacental hemodynamics, birth weights, and Apgar scores were similar between the two groups.
Pulmonary Hypertension in Pregnancy
Published in Afshan B. Hameed, Diana S. Wolfe, Cardio-Obstetrics, 2020
Pulmonary hypertension in pregnancy carries a high maternal mortality rate estimated at 17%–33%, which represents an improvement in recent years, particularly in patients with severe pulmonary hypertension and Eisenmenger syndrome [13]. Mortality is mostly the result of the inability of the right ventricle to accommodate the increased pulmonary artery pressure, leading to right heart failure [2]. The risk of right heart failure is particularly high during the intrapartum and postpartum periods due to the changes in intravascular volume and pressure during these stages [14]. A retrospective review of 49 pregnant women with pulmonary hypertension reported a mortality of 16% [2]. Nearly all of these fatalities occurred in the postpartum period, with the primary cause of death being heart failure, followed by sudden death and thromboembolism. In addition, fetal risks include mortality (11%–28%), premature birth, and growth restriction [14] (Table 15.3). Because of the excess maternal morbidity and mortality risks, pregnancy is contraindicated in patients with PAH. Women who choose to continue pregnancy despite these risks should be followed closely throughout the pregnancy by a multidisciplinary team with expertise in this area [9]. Better outcomes are anticipated in patients who maintain a long-term favorable response to calcium channel blockers (CCBs) [15]. Poor outcomes have been reported in patients with decreased lung diffusion capacity at <45% of normal [3].
Adverse Reactions to Local Anesthetics
Published in Bernard J. Dalens, Jean-Pierre Monnet, Yves Harmand, Pediatric Regional Anesthesia, 2019
Gari Purcell-Jones, Felicity Reynolds
More important is the interaction that may occur with calcium channel blockers (which are infrequently used in children). Parris et al.222 found that verapamil potentiates bupivacaine-induced neural conditions blockade in vitro. This could be a useful means of prolonging blockade but for the fact that verapamil and nifedipine increase the toxicity of lidocaine and bupivacaine, respectively.223,224 Indeed, cardiovascular collapse is reported following regionally administered bupivacaine in patients treated with verapamil.225 It seems that verapamil is readily displaced from binding sites by clinical concentrations of lidocaine, bupivacaine, and diazepam.226 In addition, a synergistic myocardial effect may occur, since calcium channel blocking effects have been demonstrated with bupivacaine.227 Cardiovascular collapse has also been observed following the interaction of intercostal bupivacaine with the beta-adrenoceptor blocker timolol.228 Such pharmacodynamic changes might well be the result of potentiation of regional sympathetic blockade rather than a systemic interaction.
Immunomodulatory properties of antihypertensive drugs and digitalis glycosides
Published in Expert Review of Cardiovascular Therapy, 2022
Paweł Bryniarski, Katarzyna Nazimek, Janusz Marcinkiewicz
Calcium channel blockers reduce the entry of calcium ions into muscle cells. Drugs from this class are divided into two subgroups. Both of these subgroups influence the arteries, relaxing them. Non-dihydropyridine derivatives (diltiazem, verapamil) affect the heart, slowing the frequency of its contractions and reducing its contractility. In contrast, dihydropyridine derivatives (nitrendipine, isradipine, nifedipine, amlodipine, lacidipine, and felodipine) do not have such effects. Indications for the use of calcium channel blockers are coronary artery disease (especially Prinzmetal’s angina), hypertension and arrhythmias (verapamil and diltiazem). The most important contraindications to the use of verapamil and diltiazem are symptomatic bradycardia, sick sinus syndrome, atrioventricular block, Wolf-Parkinson-White syndrome, too low blood pressure (hypotension) and heart failure. In the case of other calcium antagonists, the most important contraindications are severe aortic stenosis, hypertrophic cardiomyopathy with outflow tract obstruction, acute coronary syndrome, hypotension and heart failure. Side effects of calcium antagonists are swelling (mainly of the feet and shins), headache, facial flushing, constipation, slow heart rate, hypotension, and rash.
Angiotensin converting enzyme and angiotensin converting enzyme inhibitors in dermatology: a narrative review
Published in Expert Review of Clinical Pharmacology, 2022
Angiotensin converting enzyme inhibitors (ACEI) are commonly used medications for the treatment of hypertension, heart failure, and diabetic nephropathy [1]. Angiotensin-converting enzyme (ACE) is a membrane-bound, zinc-dependent peptidyl dipeptidase that inhibits the transformation of angiotensin I to angiotensin II (ATII) by removing the carboxy-terminal dipeptide [2]. ACE plays a central role in the renin angiotensin system (RAS) that regulates blood pressure [3,4]. There are 287 base pair insertion/deletion polymorphisms in the intron 16 of the ACE gene [3], and the ACE gene insertion/deletion (I/D) polymorphism is associated with cardiovascular diseases [4]. Interestingly, ACE serum level and the distribution of different genotypes, including II, ID and DD, are also associated with several diseases in dermatology [5–7]. The cutaneous adverse effects to antihypertensive agents, especially calcium channel blockers (CCBs) [8–10] and ACEI, are well known in dermatology [9–11]. Compared to systemic RAS, there are some local tissues that contain RAS independent from systemic RAS [12]. RAS in the skin has been widely discussed recently [13–15], but reports of its use as dermatologic treatment is currently limited. This review article aims to provide up-to-date information for the therapeutic use of ACEI in dermatology and their cutaneous adverse reactions.
Epidemiological, clinical, and echocardiographic features of twenty ‘Takotsubo-like’ reversible myocardial dysfunction cases with normal coronarography following immersion pulmonary oedema
Published in Acta Cardiologica, 2021
Raphaël Demoulin, Raphaël Poyet, Olivier Castagna, Emmanuel Gempp, Arnaud Druelle, Paul Schmitt, Eléonore Capilla, Gwénolé Rohel, Frédéric Pons, Christophe Jégo, François-Xavier Brocq, Gilles R. Cellarier
We have reported 20 cases of patients who showed an IPE from underwater diving complicated by RMD (Table 1). Although these cases were not collected prospectively, we estimate the incidence of this type of RMD in our centre to be three cases per year. To our knowledge, we have had only one case of permanent myocardial dysfunction following a diving accident during this time period (secondary to a myocardial infarction). Nineteen of our patients used an open circuit diving apparatus with gas mixture composed of air while one patient used a semi-closed rebreather circuit with nitrox. The clinical and radiological criteria of IPE were met. The average age of our population was 61.9 years, 7 were men and 13 were women. Half of our patients showed a CVRF other than age. The main CVRF were arterial hypertension (five patients), smoking (five patients), and dyslipidaemia (five patients). Two patients were treated with calcium channel blockers and one with ACE inhibitors. No patient was under β-blocker therapy. None of the patients reported chest pain on admission. Nineteen patients showed elevated troponin levels (Hs-cTnT > 14 ng/L/cTnT > 0.35 μg/L) and 17 patients showed elevated levels of natriuretic peptides (BNP > 100 ng/L and NT-proBNP > 300 ng/L). The average levels of troponin were 334.5 ng/L for Hs-cTnT and 0.82 µg/L for cTnT. The average levels of the natriuretic peptides were 3,187 ng/L for NT-proBNP and 194 µg/L for BNP. ECG anomalies were observed in 95% of the cases over the course of the follow-up (19 patients).