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The Patient with Non-Group 2 Pulmonary Hypertension
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Sophia Anastasia Mouratoglou, George Giannakoulas
CTEPH is the only category of PH that can be fully treated with resolution of symptoms, either by surgical treatment with pulmonary endarterectomy (PEA) or, more recently, by percutaneous intervention with balloon pulmonary angioplasty (BPA). PEA is the preferred therapeutic option in CTEPH, offering significant improvement in hemodynamic profile, clinical status, and mortality in patients with operable lesions, compared with those treated with medical therapy alone (90% three-year92 and 72% ten-year survival,93 compared with 70% three-year survival of non-operated CTEPH patients). Therefore, patients with CTEPH should be evaluated for potential interventions by multidisciplinary teams in centers with surgical expertise. Although the definition of operability remains elusive, patients with prior history of venous thromboembolism, no signs of right heart failure, no comorbidities, and in retained functional class (WHO functional class II or III), as well as patients with more clear radiological disease, especially when located in lower lobes, and those with lower PVR (<1000 dyn.sec.cm−5) have better long-term prognosis after PEA.94
A motorcycle accident
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
The eventual result is mediastinal shift, the trachea is deviated away from the side of the pneumothorax; compression of the vena cava and right heart structures causes decreased diastolic filling and cardiac output. This can lead to pulseless electrical activity (PEA) and eventually asystole. There is also shunting of blood to underventilated areas of lung, causing a ventilation-perfusion mismatch. The result is hypoxaemia, acidosis, and further impairment of tissue oxygenation.
Pea
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Palmitoylethanolamide appears to have many applications in inflammatory and immune-modulatory diseases. The profound effects on PPAR-α, NF-κB, inflammatory cytokines, COX, and substance P mast cell activation support the use of PEA in the treatment of pain, neurodegenerative diseases, neural injury, ophthalmic disorders, and viral infections, among a multitude of other diseases. With such a phenomenal safety profile as well as no documented drug or disease interactions, it is a wonder that PEA is not utilized more often.
A Combination of α-Lipoic Acid (ALA) and Palmitoylethanolamide (PEA) Blocks Endotoxin-Induced Oxidative Stress and Cytokine Storm: A Possible Intervention for COVID-19
Published in Journal of Dietary Supplements, 2023
Francesca Uberti, Sara Ruga, Mahitab Farghali, Rebecca Galla, Claudio Molinari
Currently, new strategies can act to counteract the symptoms of infection, reduce oxidative stress, and improve anti-inflammatory and immunomodulatory functions; in this context PEA is very interesting, which is an amide of palmitic acid with known anti-inflammatory properties (31). The main reason for using PEA is related to its ability to mitigate "cytokine storm syndrome," which is a critical consequence of COVID-19 infection. In general, patients experience uncontrolled inflammation with overproduction of cytokines on the plasma sample followed by edema, gas exchange dysfunction, acute respiratory syndrome, acute heart injury, and secondary infection (6). In the inflammatory process triggered by coronavirus infection, the Toll-Like four receptor pathway (TLR4) plays an important role, generating numerous proinflammatory cytokines such as IL-1, IL-6 and TNFα; however, anti-inflammatory cytokines such as IL-10 also participate in the development of the clinical picture (41).
Risk stratification in chronic thromboembolic pulmonary hypertension predicts survival
Published in Scandinavian Cardiovascular Journal, 2021
Anna Sandqvist, David Kylhammar, Sven-Erik Bartfay, Roger Hesselstrand, Clara Hjalmarsson, Mohammad Kavianipour, Magnus Nisell, Göran Rådegran, Gerhard Wikström, Barbro Kjellström, Stefan Söderberg
A total of 32% of all patients underwent PEA within a median of 5 (6) months after baseline (20% in the low-risk, 72% in the intermediate-risk, and 8% in the high-risk group). The 1, 3, and 5 years survival rates were 96%, 92%, and 88% for patients who underwent PEA, and 90%, 75%, and 59% for those without PEA (p < .001) (Figure 1). These differences remained after excluding patients ≥70 years at baseline (data not shown). PEA was associated with improved survival at baseline compared to non-operated patients even after adjustment for risk group, pharmacological treatment, sex, and age (hazard ratio [95% confidence interval]: 0.38 [0.18–0.82]). Improved survival was seen in patients <70 years (0.11 [0.02–0.53]), but the impact of PEA was attenuated in those ≥70 years (0.80 [0.33–1.99]). Similarly, the point estimates indicated improved survival for those having PEA after the follow-up (0.57 [0.24–1.33]), although non-significant.
Naturally Occurring Cannabinoids and their Role in Modulation of Cardiovascular Health
Published in Journal of Dietary Supplements, 2020
Elnaz Karimian Azari, Aileen Kerrigan, Annalouise O’Connor
In a mouse model of atherosclerosis (ApoE-/- mice fed a western diet), daily dosing of PEA for 4 weeks reduced atherosclerotic lesion size in early disease. In established disease, PEA improved aspects of plaque stability, including reduced macrophage accumulation, reduced necrotic core size, increased collagen deposition and reduced M1-type macrophages markers. Additionally, PEA was seen to enhance macrophage efferocytosis via GPR55 signaling (Rinne et al. 2018). These findings led to the first clinical study using PEA on endothelial function and intra-occular pressure. In a randomized placebo-controlled, double-blind, cross-over study in individuals with occular hypertension, 300 mg PEA twice daily for 3 months improved endothelial function (flow mediated dilatation) and intra-occular pressure compared with placebo intervention (Strobbe et al. 2013). Further clinical studies will be needed to clarify the cardioprotective role of PEA in a near future.