Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 55-year-old man is convalescing from mitral valve replacement five days earlier. He had severe calcific mitral stenosis and moderately severe hypertension, with repeated attacks of acute pulmonary edema. He had always been in normal sinus rhythm, except for a single episode of atrial fibrillation associated with one of his episodes of acute pulmonary edema. He had been taking digoxin (0.25 mg daily) but this was stopped the day before the operation. The cardiac rhythm has been mostly regular since the operation, but occasional irregularities have been noted. An ECG on the fifth postoperative day is shown.
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PMID:Changing P waves after mitral valve replacement. 641 62

Diuretic therapy was withdrawn from 42 patients receiving modest drug doses for reasons other than hypertension, active heart failure and renal or hepatic oedema, with frequent assessment by clinical, biochemical and radiological methods for 12 weeks. Of 38 patients who could have completed the study, 27 (71%) did so without ill-effect. Eleven (29%) patients deteriorated clinically or radiologically, 7 within 2 weeks of discontinuing diuretics, and 1 of them died after acute pulmonary oedema and a haematemesis, despite intensive resuscitation. The outcome of drug withdrawal could be predicted in 35 of the patients using a multifactorial discriminant analysis but individual parameters had poor predictive value. The lack of demonstrable benefit in many patients and the incidence of adverse effects associated with long-term diuretic therapy suggest that withdrawal should be considered more often in this type of patient. However, there is a need for caution in this situation and withdrawal should only be attempted if close medical supervision and radiological examination of the chest are possible.
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PMID:Diuretic withdrawal--a need for caution. 662 73

The hemodynamic parameters were evaluated before and after Hd, Hf, Uf procedures, in patients with chronic renal failure with either hypertension, oedema or acute pulmonary oedema. The arterial and wedge pressures were increased in all of these patients. Fluid removal corrected these pressures whatever procedure was used. There is a correlation between fluid removal and the variation of these pressures. The curves of the ventricular function showed a decrease of the mean myocardiac performance. Hd and Hf with an acetate solution decreased the systemic vascular resistances (SVR) and increased the cardiac index (CI). Hd and Hf with a bicarbonate solution had little influence on these parameters. Pure Uf increased the SVR and decreased the CI. The evaluation of the hemodynamic parameters gives important information on the nature of the disturbances in the cardio-circulatory function and allows by means of permanent monitoring to guide their correction. It also helps in the choice of the procedure to be used.
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PMID:[Hemodynamic studies in chronic terminal renal insufficiency--Effects of hemodialysis (Hd), hemofiltration (Hf) and ultrafiltration (Uf) procedures (author's transl)]. 729 Mar 1

Congestive heart failure (CHF) is a common clinical problem and in its advanced stage has a poor prognosis. Approximately 400,000 individuals develop heart failure each year (Parmley 1989). CHF can be caused by coronary artery disease such as myocardial infarction, ischemia and hypertension. Should heart failure occur as a result of acute myocardial infarction, a classification tool developed by Killip can be used to assess the degree of CHF. Killip's classification is organised into the following four categories: Class I: no heart failure Class II: mild to moderate failure Class III: acute pulmonary oedema Class IV: cardiogenic shock (Killip, as cited by Benz 1989). This system helps in organising clinical signs and symptoms of heart failure. Due to the fact that CHF is now the most common hospital discharge diagnosis for those over the age of 65, critical care nurses need to be able to recognise complications and intervene rapidly (Parmley 1989) in collaboration with medical staff. The purpose of this paper is first to discuss cardinal signs and symptoms and clinical data associated with CHF. Second, critical care nurses' management of CHF is organised around common nursing diagnoses.
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PMID:Nursing management of congestive heart failure. Part I. 749 86

Sixty cases of severe eclampsia were treated in an intensive care unit between January 1989 and September 1993. Mean age was 26, and 70% of patients were primipara. The pregnancy has been unsupervised in almost all cases. All had visceral lesions and/or hematologic problems and there was impaired conscious level in 9 cases out of 10. Medical treatment involved the control of seizures and of hypertension. Cesarean section was performed in 34 cases. The maternal death rate was 23.3%. Our experience indicates that mortality depends upon visceral lesions (cerebral, disseminated intravascular coagulation, acute pulmonary edema, Hellp syndrome). Better awareness of severity factors in preeclampsia improves both maternal and fetal prognosis by precisely indicating the best time for fetal extraction.
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PMID:[Maternal prognostic factors in severe eclampsia]. 764 67

Our aim was to assess clinically whether there was any benefit in adding a single dose of sublingual nifedipine (a slow calcium channel blocker) to prazosin in the management of the cardiovascular manifestations of envenoming by the Indian red scorpion (Mesobuthus tamulus). A total of 163 patients stung by this species was admitted to hospital at Mahad between January 1991 and October 1993. Cardiovascular abnormalities were hypertension (59), of whom 42 had bradycardia and 17 had tachycardia; pulmonary oedema (14), of whom eight had hypertension and six hypotension; supraventricular tachycardia (eight), of whom three had hypotension and one died. Of the remaining patients, 78 demonstrated severe excruciating local pain at the site of sting but had no systemic involvement. Nineteen patients with hypertension and tachycardia were given a single dose of sublingual nifedipine plus prazosin on admission, then prazosin alone repeated 6 hourly. Five patients with massive life-threatening pulmonary oedema recovered after being given intravenous sodium nitroprusside. Prazosin alone helped to alleviate cardiovascular manifestations in the remaining 52 victims. One patient was admitted in a deep coma, 12 hr after the sting, and died. Eight victims whose blood pressure had been controlled in hospital by nifedipine plus prazosin developed acute pulmonary oedema necessitating additional doses of prazosin for recovery. Fifty-two victims treated with prazosin alone did not develop pulmonary oedema and the drug appeared to hasten the recovery. In the presence of high blood pressure, tachycardia, a murmur and impending myocardial failure, nifedipine appeared to contribute to cardiopulmonary instability and to augment myocardial oxygen consumption. In this situation calcium channel blockers should probably be avoided.
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PMID:Vasodilators: scorpion envenoming and the heart (an Indian experience). 780 38

This is a case of a 28-yr-old man who underwent general anaesthesia for emergency repair of a right lid laceration and lacrimal apparatus. Following induction of anaesthesia and local nasal application of phenylephrine (0.25%) he developed transient elevation of blood pressure, which was treated immediately with labetalol. Subsequently the patient developed acute pulmonary oedema which responded to treatment with morphine and furosemide. The diagnosis of pulmonary oedema was confirmed by blood gas studies, chest x-ray and serial echocardiograms. Subsequent investigation revealed that he was a cocaine user, as the urine tested positive for cocaine. Considering that the patient was young and otherwise healthy and that the hypertension was transient, it is unlikely that phenylephrine was the main cause of pulmonary oedema. Cardiac morbidity was most likely precipitated by the interaction of phenylephrine-induced hypertension with a cocaine-depressed myocardium.
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PMID:Intraoperative pulmonary oedema in a young cocaine smoker. 800 Dec 5

The diagnosis of pheochromocytoma is usually considered in the presence of permanent hypertension with exacerbations. However, pheochromocytoma may be responsible for a varied range of adrenergic symptomatology and hemodynamic equilibrium may be threatened by the spontaneous or induced massive release of pressor amines. Three cases form the basis of a description of unusual situations: acute pulmonary edema, acute circulatory failure and myocardial infarction with normal coronary vessels. The divercity and severity of these clinical situations are such that the possibility should always be suspected when confronted by any cardiomyopathy without obvious etiology, in particular in a hypertensive patient. The only treatment remains ablation of the tumour and diagnosis as an emergency is based, apart from history, on ultrasonography and/or abdominal CT scan and assay of urinary catecholamine derivative levels, which can be obtained within a few hours.
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PMID:[Uncommon cardiac manifestations disclosing pheochromocytoma. Apropos of 3 cases]. 808 72

Experiments were performed in pentobarbital-anesthetized rats, to study the mechanism of the acute pulmonary edema induced by Tityus serrulatus scorpion venom. In control rats injection of venom (50 micrograms/100 g, i.v.) induced arterial hypertension and lung edema (lung/body index or LBI equal to 1.01 +/- 0.09). In rats pretreated with heparin (100 IU/100 g 30 min previously) the venom induced similar hypertensive effects, but no edema was detected (LBI = 0.63 +/- 0.06, P > 0.05). Similarly, in rats pretreated with the PAF antagonist BN-52021 (0.5 mg/100 g, i.v., 30 min previously), the venom-induced hypertension was not modified but the acute pulmonary edema was prevented (LBI = 0.67 +/- 0.08, P > 0.05). It is concluded that PAF plays an important role on the genesis of pulmonary edema induced by scorpion venom in the rat. It is suggested that the inhibitory action of heparin could be related to a decrease in the vascular permeability in the lungs.
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PMID:Heparin or a PAF antagonist (BN-52021) prevents the acute pulmonary edema induced by Tityus serrulatus scorpion venom in the rat. 826 52

Cocaine abuse is widespread in North America. It is estimated that almost one in every four Americans has used cocaine at least once in his/her lifetime. In the past two decades, cocaine related cardiovascular complications have mushroomed because cocaine has become cheaper and more readily available. The fundamental effects of cocaine on cardiovascular system are similar to those observed following an intense, sympathetic stimulation. Cocaine intake results in marked increase in blood pressure, myocardial oxygen demand and heart rate. Coronary blood flow, which increases in response to exercise (endogenous sympathetic stimulation) however, is decreased by cocaine intake. Increased demand of oxygen by the myocardium in the face of decreased supply in subjects with cocaine use, leads to myocardial ischemia, which in turn forms a substrate for most of the cardiovascular complications, namely, myocardial infarction, cardiac arrhythmias and acute pulmonary edema. Hypertension related complications, dissection and rupture of aortic aneurysm, hemorrhagic stroke, in addition to infective endocarditis, myocarditis, cardiomyopathy all occur more frequently in cocaine addicts. In this review, pertinent clinical pharmacology and cardiovascular risks associated with cocaine abuse are presented.
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PMID:Cardiovascular effects of cocaine abuse. 829 63


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