Percutaneous treatment of cardiogenic shock after myocardial infarction
Ever D. Grech in Practical Interventional Cardiology, 2017
Abnormalities of vasomotor tone may represent a target for drug treatment. MI may cause a systemic inflammatory response and vasodilatation. If mean arterial pressure is low and cardiac output is reasonable, then a vasoconstrictor such as noradrenaline or vasopressin may be used with care. Excessive use of vasoconstrictors is counter-productive and will only increase blood pressure at the cost of reduced cardiac output. Occasionally mean arterial pressure is high and cardiac output is low. In this situation, a vasodilator such as hydralazine, a phosphodiesterase inhibitor (milrinone, enoximone) or levosimendan may be administered. Inotropic agents may be given to increase cardiac contractility. All inotropic and vasoactive drugs may be harmful, particularly in higher doses. There is no definite evidence to support using one rather than the other. High levels of circulating endogenous catecholamines are inevitable in cardiogenic shock. One major benefit of monitoring the cardiac output is that it may enable the clinician to select the most physiologically appropriate agent and use this at the lowest necessary dose. A pulmonary artery flotation catheter is probably the most accurate method of achieving this in patients with very low cardiac output. Care should be given to the interpretation of the numbers issued from measurement with a PA catheter and no number should be evaluated in isolation.
Practical Considerations for Fluid Replacement for Athletes with a Spinal Cord Injury
Flavia Meyer, Zbigniew Szygula, Boguslaw Wilk in Fluid Balance, Hydration, and Athletic Performance, 2016
The loss of autonomic function following high thoracic and cervical level injury presents two distinct challenges to health and exercise performance, namely, orthostatic hypotension and autonomic dysreflexia. Vasomotor centers in the medulla reflexively control the cardiovascular system by adjusting sympathetic and parasympathetic outflow to the heart and peripheral vasculature in order to maintain blood pressure (Krassioukov 2009). The loss of sympathetic nervous system outflow in tetraplegia results in bradycardia and chronic hypotension induced via a constant state of vasodilation. Postural change to an upright position results in an unmodulated drop in blood pressure called orthostatic hypotension. Extreme hypo-tension is transient following an SCI, resolving within a few weeks of injury due to a compensatory reduction in parasympathetic outflow and return of sympathetic reflexes.
Autonomic Nervous System Disorders
Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw in Hankey's Clinical Neurology, 2020
The most common clinical manifestations of autonomic dysfunction are: Postural (orthostatic) hypotension.Erectile and ejaculatory dysfunction.Bladder dysfunction.Abnormalities of sweating.Vasomotor disturbances.
Vasomotor symptoms and management of women undergoing treatment for breast cancer: literature review with focus on the therapeutic potential of cytoplasmic pollen extract
Published in Gynecological Endocrinology, 2023
Stefano Lello, Ida Paris, Angelo Cagnacci, Donata Sartori, Salvatore Caruso, Aldo Iop
The survival rate of patients with breast cancer (BC) has significantly increased due to earlier diagnosis and advances in adjuvant therapies with 5-year relative survival of about 90% [1]. Treatments for BC, including endocrine therapy with or without ovarian function suppression and chemotherapy, suppress endogenous estrogen levels by different mechanisms to induce pharmacological menopause with symptoms that adversely affect women’s quality of life (QoL) [2]. Vasomotor symptoms (VMS) are common. However, despite the high discomfort they bring about, these adverse events are not always reported by patients, intercepted by physicians, appropriately assessed, and subsequently treated. Pharmacological and non-pharmacological options are available to treat VMS in patients with BC, although there are limited robust data to guide clinicians in the selection of therapies. Effective management of VMS in patients with BC is therefore a critical but frequent unmet need.
Psychometric properties of the French Hot Flash Related Daily Interference Scale (HFRDIS)
Published in Climacteric, 2023
I. Cavadias, R. Rouzier, M. Milder, C. Bonneau, J. Mullaert, D. Hequet
The menopausal transition in women is associated with a fluctuation in hormones produced by the ovaries. It is induced by a progressive decrease, until total cessation, of ovarian activity at menopause. These hormonal changes translate into more or less significant symptoms reflecting estrogen deficiency at menopause. The main symptoms reported by patients are vasomotor symptoms, vaginal discomfort associated with vulvovaginal atrophy, and sleep and mood disorders. Vasomotor symptoms, including hot flashes and night sweats, are very common. Hot flashes affect approximately 80% of postmenopausal women, 25% of whom in a very disabling way [1]. These symptoms last on average 5–7 years but can last beyond 10 years [2,3]. The frequency and intensity of hot flashes are extremely variable depending on the individual and can significantly affect quality of life.
Relation between blood pressure and genito-urinary symptoms in the years across the menopausal age
Published in Climacteric, 2022
A. Cagnacci, A. Gambera, G. Bonaccorsi, A. Xholli
As previously reported [25,26], recorded subjective symptoms were vaginal dryness, dyspareunia, itching and burning. Vaginal signs assessed by a physician were mucosal pallor, dryness, thinning of vaginal rugae, mucosal fragility and presence of petechiae. Vaginal pH was also determined. Vaginal atrophy (VA) was defined by the coexistence of vaginal pH > 5, a sensation of vaginal dryness and an objective sign, as assessed by a physician. The presence of vasomotor symptoms was also recorded. Office BP, after at least 5 min of rest, was taken spaced 1–2 min apart in the sitting position by trained doctors using a mercury sphygmomanometer. Phase I and V Korotkoff sounds were used to identify systolic blood pressure (SBP) and diastolic blood pressure (DBP). To minimize the white-coat effect, if any, measurements were taken until they differed <10 mmHg. The average of the last two measurements was taken into consideration as a measure of BP for data analysis [27]. Heart rate was also taken at the same time [27].
Related Knowledge Centers
- Endothelin
- Extracellular Fluid
- Tunica Media
- Blood Vessel
- Norepinephrine
- Neurotransmitter
- Vasodilation
- Angiotensin
- Adrenergic Receptor
- Vasoconstriction