Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Idiopathic edema patients abusing diuretics are occasionally becoming dependent to such a degree on increasing doses of diuretics that their withdrawal results in severe cardiorespiratory failure, occasionally even pulmonary edema. Two such patients are described and 1 is investigated in depth as to the mechanism of the diuretic abuse-induced excessive tubular avidity for sodium. An extreme diuretic-induced secondary hyperaldosteronism and atrial natriuretic factor suppression, although tapering off when diuretics are stopped, results in a continuous tubular sodium hyper-reabsorption. Since the most affected patient was deprived of the benefits of converting enzyme inhibitors because of their side effects, the only way to partially overcome this condition was a generous combination of several diuretics acting at several segments of the nephron. This contrasted with a similar patient who was relatively well controlled by a converting enzyme inhibitor combined with lower dose diuretics. Diuretic abuse-induced secondary hyperaldosteronism and diuretic resistance are apparently best prevented by converting enzyme inhibitors. When nonpharmacological preventive measures fail, converting enzyme inhibitors are preferable to diuretics as the first-choice treatment of idiopathic edema patients.
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PMID:Extreme diuretic dependence in idiopathic edema: mechanisms, prevention and therapy. 973 May 76

We report a patient with primary aldosteronism (PA) complicated with hypertrophic nonobstructive cardiomyopathy (HNCM) who underwent resection of a left adrenal tumor. Amrinone was administered to improve the features of congestive heart failure induced by retention of body fluid. Maintaining adequate preload and afterload and preventing excessive increases in contractility are important in the anesthetic management of patients with hypertrophic obstructive cardiomyopathy (HOCM). Although the preoperative diagnosis may be HNCM, stenosis of the left ventricular outflow tract may occur due to hemodynamic changes during surgery. Therefore amrinone is not often used for patients with HNCM. We inserted a pulmonary arterial catheter (Swan-Ganz CCO Thermodilution Catheter) and measured the cardiac output continuously to monitor hemodynamic changes. The symptoms of pulmonary edema were diminished one month after the surgery. These findings suggest that the increased blood volume induced by PA is a main factor aggravating preoperative congestive heart failure with HNCM.
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PMID:[General anesthesia for a patient with primary aldosteronism complicated with hypertrophic nonobstructive cardiomyopathy]. 1058 55

We used PiCCO (Pulsion Ltd) device to measure the intrathoracic blood volume by transpulmonary thermodilution method in order to estimate infusion rate in patients undergoing laparoscopic adrenectomy for primary aldosteronism. A systemic blood volume in patients with primary aldosteronism might increase by an oversecreted aldosteron and the patients usually suffer from hypertension, because of increasing systemic blood volume. During anesthesia, we should carefully perform fluid therapy in order not to cause pulmonary edema. After anesthesia induction, the intrathoracic blood volume increased. And, during surgery, the blood epinephrine concentration increased due to direct tumor manupulation by surgeon, leading to induced hypertension. Because of induced hypertension, it was difficult to estimate the systemic blood volume. Under these conditions, PiCCO device was a useful monitor to estimate the systemic blood volume during surgery in patients with primary aldosteronism.
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PMID:[Intrathoracic blood volume during laparoscopic adrenectomy for primary aldosteronism under general anesthesia]. 2016 61

Most patients with hypertension have no clear etiology and are classified as having primary hypertension. However, 5% to 10% of these patients may have secondary hypertension, which indicates an underlying and potentially reversible cause. The prevalence and potential etiologies of secondary hypertension vary by age. The most common causes in children are renal parenchymal disease and coarctation of the aorta. In adults 65 years and older, atherosclerotic renal artery stenosis, renal failure, and hypothyroidism are common causes. Secondary hypertension should be considered in the presence of suggestive symptoms and signs, such as severe or resistant hypertension, age of onset younger than 30 years (especially before puberty), malignant or accelerated hypertension, and an acute rise in blood pressure from previously stable readings. Additionally, renovascular hypertension should be considered in patients with an increase in serum creatinine of at least 50% occurring within one week of initiating angiotensin-converting enzyme inhibitor or angiotensin receptor blocker therapy; severe hypertension and a unilateral smaller kidney or difference in kidney size greater than 1.5 cm; or recurrent flash pulmonary edema. Other underlying causes of secondary hypertension include hyperaldosteronism, obstructive sleep apnea, pheochromocytoma, Cushing syndrome, thyroid disease, coarctation of the aorta, and use of certain medications.
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PMID:Secondary Hypertension: Discovering the Underlying Cause. 2909 13

BACKGROUND Although the effect of percutaneous transluminal renal angioplasty (PTRA) on clinical outcomes has not been established in previous clinical studies, some case reports showed that PTRA drastically improved patient outcomes. The appropriateness of PTRA should be discussed in detail. CASE REPORT A 59-year-old man had been on treatment for hypertension for 5 years, but his blood pressure (BP) had been poorly controlled for the past 5 months. He was hospitalized for pulmonary edema due to heart failure with preserved ejection fraction (HFpEF). During hospitalization, ultrasound and plain computed tomography revealed atrophy of the right kidney, and laboratory investigations indicated secondary aldosteronism with high plasma renin activity (PRA). Unenhanced magnetic resonance imaging (MRI) suggested severe stenosis or occlusion of the right renal artery. PTRA was performed for total occlusion at the origin of the right renal artery, resulting in favorable dilation of the vessel and good blood flow. A differential renal vein renin assay showed a right-left difference of PRA before PTRA, but this disappeared after the procedure. Both PRA and the plasma aldosterone concentration were normalized after PTRA. In addition, the patient's BP decreased, proteinuria was reduced, diuretics could be discontinued, and his calcium channel blocker dosage was decreased. CONCLUSIONS The present case suggests that screening for renal artery stenosis by unenhanced MRI may be useful in patients who have HFpEF because PTRA can be used to achieve marked improvement of hypertension, endocrine abnormalities, and heart failure if stenosis is detected.
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PMID:Successful Depressor Effect Concomitant with Complete Normalization of High Renin and Aldosterone Profile by Percutaneous Transluminal Renal Angioplasty in a Patient with Acute Exacerbated Heart Failure with Preserved Ejection Fraction. 3173 10