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Query: UMLS:C0032285 (pneumonia)
 54,520 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied the performance characteristics of B-type natriuretic peptide (BNP) as a diagnostic test for congestive heart failure in the elderly dyspneic population. In a retrospective chart review study, dyspneic patients who had a BNP level drawn were included. To diagnose congestive heart failure (CHF), the Framingham Criteria were used. To diagnose pneumonia or a lower respiratory tract infection, the consensus development conference Criteria for Pneumonia/Lower Respiratory Tract Infection were used. Based on the criteria satisfied, the patients were categorized into one of 4 groups: group 1, pneumonia/lower respiratory tract infection; group 2, CHF; group 3, both; group 4, neither. Sensitivity, specificity, and positive and negative likelihood ratios were calculated for various BNP reference limits from 100 pg/ml upwards in increments of 100. A total of 70 patients (mean age 76.5) presenting with dyspnea were included in the study. Forty-six were females. The mean (+/-SD) BNP level for group 1 (n = 13) was 273 (+/-360) pg/ml, for group 2 (n = 30) it was 1394 (+/-934) pg/ml, for group 3 (n = 17) it was 1138 (+/-842) pg/ml, and for group 4 (n = 10) it was 403 (+/-362) pg/ml. Forty-seven patients (groups 2 and 3) met the Framingham criteria (CHF+). The other 23 (groups 1 and 4) did not (CHF-). The sensitivity and specificity of BNP for CHF at a cutoff of 100 pg/ml was 96% and 26%, respectively. The sensitivity (87%) and specificity (74%) were optimal at a cutoff of 400 pg/ml. Our study indicates that the specificity of a BNP level of > or = 100 pg/ml for diagnosing CHF in the elderly is poor. Our data suggest an optimal BNP value of > or = 400 pg/ml. Elderly patients frequently have multiple etiologies contributing to dyspnea. In our study, one-fourth of the patients satisfied the criteria for a dual diagnosis of CHF and pneumonia.
Crit Pathw Cardiol 2005 Sep
PMID:Utility of brain natriuritic peptide as a diagnostic tool for congestive heart failure in the elderly. 1834 Feb

Patients with heart failure (HF) are particularly vulnerable to the development of venous thromboembolism (VTE) and its related complications of pulmonary embolism and right ventricular failure. To improve our understanding of the clinical characteristics, prophylaxis, and initial management of patients with HF and deep vein thrombosis (DVT), we compared 685 patients with a history of HF with 3,890 patients without HF in a prospective registry of 5,451 consecutive patients with ultrasound-confirmed DVT. We excluded 876 patients for whom data regarding HF status were incomplete. Patients with HF had an increased frequency of co-morbid conditions such as neurologic disease including stroke (33% vs 26%, p = 0.0002), acute lung disease including pneumonia (31% vs 15%, p <0.0001), and acute coronary syndrome (11% vs 4%, p <0.0001) contributing to a higher medical acuity than in patients without HF. Furthermore, patients with HF were more likely to have VTE risk factors of immobilization (53% vs 42%, p <0.0001), acute infection (33% vs 27%, p = 0.01), and chronic obstructive pulmonary disease (29% vs 12%, p <0.0001). Patients with and without HF and DVT had a high frequency of recent hospitalization (48% vs 47%, p = 0.96). Fewer than 12 of patients with HF (46%) who subsequently developed DVT received any VTE prophylaxis. In conclusion, the combination of higher medical acuity, increased frequency of VTE risk factors, and low rate of VTE prophylaxis presents a "triple threat" to patients with HF.
Am J Cardiol 2008 Apr 01
PMID:Heart failure in patients with deep vein thrombosis. 1835 31

Purulent pericarditis in the antibiotic era has become an uncommon entity. It is typically an acute illness with a high mortality (about 30%) related to cardiac tamponade, a complication that accounts for 42-77% of cases. Few cases of purulent pericarditis associated with tamponade have been published in the literature. In this paper we describe a complicated case of purulent pericarditis secondary to left pneumonia. In particular, we emphasize the importance of early recognition, prompt institution of appropriate antibiotic therapy and early drainage for survival.
G Ital Cardiol (Rome) 2008 Mar
PMID:[A complicated case of purulent pericarditis secondary to pneumonia]. 1842 2

Acute coronary syndromes are not uncommon in medical intensive care units. Multiple molecular, pharmacologic, and hemodynamic mechanisms may contribute to the pathogenesis resulting in increased mortality in this setting. Tako-tsubo cardiomyopathy is a recently defined uncommon cardiac syndrome with characteristic features often encountered in patients with hyperadrenergic situations such as emotional stress. Although myocardial depression in sepsis can be expected in previously healthy individuals; tako-tsubo cardiomyopathy is rarely reported in septic patients. In this case report we present a 52 year-old man with sepsis secondary to Pseudomonas pneumonia who developed significant segmental wall motion abnormalities during the disease course. The patient's myocardial function recovered completely soon after the sepsis resolved. Clinical, echocardiographic, and coronary angiographic findings suggested the diagnosis of tako-tsubo cardiomyopathy in this patient.
Int J Cardiol 2009 Jun 12
PMID:Severe reversible myocardial depression in a patient with Pseudomonas aeruginosa sepsis suggesting tako-tsubo cardiomyopathy. 1859 33

A 57-year-old female patient, who was initially suspected to have subarachnoid hemorrhage, was admitted to our hospital. She experienced severe dyspnea and chest pain owing to pneumonia on the fourth admission day. Electrocardiography showed ST-segment elevation in leads V(2) through V(5), and echocardiography revealed hypokinetic left ventricular wall motion. No stenosis was found in the coronary arteries by urgent coronary angiography. However, left ventriculography revealed that the basal and apical areas were hyperkinetic and the mid portion was akinetic. After a month, left ventricular wall motion was improved and coronary artery spasm provocation tests were negative. Although the clinical course of this patient was similar to that of neurogenic myocardial stunning, the shape of her left ventricle was not typical.
J Cardiol 2008 Aug
PMID:A case of neurogenic myocardial stunning presenting transient left ventricular mid-portion ballooning simulating atypical takotsubo cardiomyopathy. 1863 78

The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease was established in 2005 with the goal of providing the infrastructure, spanning geographical and subspecialty boundaries, for collaboration between health care professionals interested in the analysis of outcomes of treatments provided to patients with congenital cardiac disease, with the ultimate aim of improvement in the quality of care provided to these patients. The purpose of these collaborative efforts is to promote the highest quality comprehensive cardiac care to all patients with congenital heart disease, from the fetus to the adult, regardless of the patient's economic means, with an emphasis on excellence in teaching, research and community service. This manuscript provides the Introduction to the 2008 Supplement to Cardiology in the Young titled: "Databases and The Assessment of Complications associated with the Treatment of Patients with Congenital Cardiac Disease". This Supplement was prepared by The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease. The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease offers the following definition of the term "Complication": "A complication is an event or occurrence that is associated with a disease or a healthcare intervention, is a departure from the desired course of events, and may cause, or be associated with, suboptimal outcome. A complication does not necessarily represent a breech in the standard of care that constitutes medical negligence or medical malpractice. An operative or procedural complication is any complication, regardless of cause, occurring (1) within 30 days after surgery or intervention in or out of the hospital, or (2) after 30 days during the same hospitalization subsequent to the operation or intervention. Operative and procedural complications include both intraoperative/intraprocedural complications and postoperative/postprocedural complications in this time interval." The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease offers the following definition of the term "Adverse Event": "An adverse event is a complication that is associated with a healthcare intervention and is associated with suboptimal outcome. Adverse events represent a subset of complications. Not all medical errors result in an adverse event; the administration of an incorrect dose of a medication is a medical error, but it does not always result in an adverse event. Similarly, not all adverse events are the result of medical error. A child may develop pneumonia after an atrial septal defect repair despite intra- and peri-operative management that is free of error. Complications of the underlying disease state, which are not related to a medical intervention, are not adverse events. For example, a patient who presents for medical care with metastatic lung cancer has already developed a complication (Metastatic spread) of the primary lung cancer without any healthcare intervention. Furthermore, complications not associated with suboptimal outcome or harm are not adverse events and are known as no harm events. The patient who receives an incorrect dose of a medication without harm has experienced a no harm event, but not an adverse event." Based on the above definitions, it is apparent that The Multi-Societal Database Committee for Pediatric and Congenital Heart Disease has taken an inclusive approach to defining the universe of complications. Complications may or may not be associated with healthcare intervention and may or may not be associated with suboptimal outcome. Meanwhile, adverse events must be associated with healthcare intervention and must be associated with suboptimal outcome.
Cardiol Young 2008 Dec
PMID:Introduction--databases and the assessment of complications associated with the treatment of patients with congenital cardiac disease. 1906 74

Staphylococcus aureus is a relatively common pathogen causing pneumonia in the community, hospital ward and intensive care unit. Although pneumonia is responsible for significant morbidity and mortality, especially in elderly and immunocompromised patients, it is usually uncomplicated and resolves without complications. The case of a woman who developed a para-aortic abscess after a community-acquired S aureus pneumonia infection is presented. A number of diagnostic imaging modalities were used to reach the diagnosis. This complication has not been reported previously and it is likely secondary to suppurative lymphadenitis of a station 5 or 6 node. The patient was successfully managed nonsurgically with computed tomography-guided drainage and intravenous antibiotics.
Can J Cardiol 2009 Apr
PMID:Para-aortic arch abscess secondary to Staphylococcus aureus pneumonia. 1934 Mar 49

Natriuretic peptides (NP) are quantitative plasma biomarkers of heart failure, which are widely used in clinical practice in many countries. NP levels are accurate in the diagnosis of heart failure in patients presenting with dyspnea. The use of NP improves patient management and reduces total treatment costs in patients with dyspnea. As NP levels quantify disease severity in patients with established heart failure, NP levels are powerful predictors of outcome in predicting death and rehospitalization. NP-guided therapy may improve morbidity in patients with chronic heart failure. Although NP levels also risk-stratify patients with many other conditions such as stable or unstable coronary artery disease, pulmonary embolism and community-acquired pneumonia, there is insufficient evidence on how patient outcome could be altered in patients identified as high risk.
Future Cardiol 2008 Nov
PMID:Natriuretic peptides and their evolving clinical applications. 1980 53

Several forms of pulmonary disease occur among patients treated with amiodarone, i.e. chronic interstitial pneumonitis, organizing pneumonia, ARDS, a solitary pulmonary mass of fibrosis. The prevalence is estimated to be about 5%. Two major hypotheses of amiodarone-induced pulmonary injury include direct cytotoxicity and a hypersensitivity reaction. Given the frequency and potential severity of amiodarone-induced pulmonary toxicity, early detection is desirable. Unfortunately, there are no adequate predictors of pulmonary toxicity due to amiodarone. Patients who should benefit from amiodarone should be carefully selected and the lowest effective dosage of amiodarone should be taken. Amiodarone-induced pulmonary toxicity is a diagnosis of exclusion. Pulmonary evaluation with chest X-ray and pulmonary function testing, including diffusion capacity for carbon monoxide is recommended when amiodarone is started. A documented decline in the diffusing capacity of greater than 20% is useful in suggesting the need for closer monitoring or for further diagnostic testing. Although the optimal frequency of follow-up has not been determined, most cases of amiodarone-induced lung injury develop during the first 2 years of treatment and disease onset usually is slow. Pulmonary function tests and imaging may be performed every 3-6 months, depending on the presumed individual risk. Treatment of amiodarone pulmonary toxicity consists primarily of stopping amiodarone. Corticosteroid therapy can be life-saving for severe cases and for patients with less severe disease in whom withdrawal of amiodarone is not desirable. Due to its accumulation in fatty tissues and long elimination half-life, pulmonary toxicity may initially progress despite drug discontinuation and may recur after steroid withdrawal. The prognosis of amiodarone lung disease is generally favourable.
Clin Res Cardiol 2010 Nov
PMID:Amiodarone-induced pulmonary toxicity: an under-recognized and severe adverse effect? 2062 29

Purulent pericarditis is an exceptionally rare complication of pneumococcal pneumonia in infants but a rapidly fatal disease if left untreated. A previously healthy 4-month-old boy presented at our emergency department with a 10-day history of fever and non-productive cough. No signs of heart failure or cardiac friction rub were evidenced. Chest radiography showed lobar pneumonia, right pleural effusion and cardiomegaly. Echocardiography revealed a massive pericardial effusion, and an emergency drainage was performed. Streptococcus pneumoniae grew up from purulent pericardial fluid and blood cultures. After intravenous antibiotherapy, the outcome was favourable. The introduction of the pneumococcal vaccine may favour an increase in the incidence of non-vaccine serotypes which most commonly cause empyaema and perhaps pericarditis. Therefore, pericarditis should always be considered a possible complication in patients with pneumococcal pneumonia and empyaema.
Acta Cardiol 2010 Jun
PMID:Pericarditis as a rare complication of pneumococcal pneumonia in a young infant. 2066 78


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