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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 71-year-old man with a long-standing history of rheumatoid arthritis required methotrexate treatment since 1986, with a total dose of 210 mg. In April 1987, before arthroplastic surgery, methotrexate was discontinued. Four weeks later a syndrome of fever, dry cough, shortness of breath, and diffuse air-space consolidations on the chest radiograph evolved. An antibiotic therapy had no beneficial effect, and a bronchoscopy yielded no pathogens. An open lung biopsy led to the diagnosis of methotrexate-induced pneumonitis. This is the first report of a case where methotrexate-induced pneumonitis developed several weeks after cessation of the treatment. Methotrexate can cause four types of pulmonary adverse reactions: pneumonitis, pulmonary edema, pulmonary fibrosis, and pleuritis. Possible pathogenetic mechanisms, symptoms, treatment, and prognosis are discussed.
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PMID:Methotrexate-induced pneumonitis: appearance four weeks after discontinuation of treatment. 280 69

Severe shortness of breath is a prominent symptom in acute heart failure (pulmonary oedema) and is related to left atrial pressure. A reduction of this pressure almost always leads to an improvement in symptoms. Patients with chronic heart failure complain of both shortness of breath and tiredness even when fluid overload has been corrected by the appropriate use of diuretics. Shortness of breath under these circumstances is not related simply to central haemodynamics but is determined more by the interaction of changes in respiratory pattern and the metabolic consequences of reduced perfusion of exercising skeletal muscle. An important clinical consequence is that when such patients are optimally treated with diuretics, further improvement of symptoms would not be expected from drugs which merely alter central haemodynamics without influencing other factors such as skeletal muscle blood flow on exercise, or lung perfusion.
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PMID:The origin of symptoms in patients with chronic heart failure. 304 95

A case of high altitude pulmonary edema with high altitude cerebral edema was reported. A young Japanese male complained of severe palpitation and shortness of breath on the third day of climbing at 3,000 m above sea level. During the next 2 d at altitude, the following symptoms occurred: cough with foamy sputum, cyanosis, and loss of consciousness. Soon after evacuation, he showed severe hypoxemia and deep coma with decerebrate rigidity; electroencephalogram showed diffuse alpha waves, indicating "alpha wave coma." Brain computerized tomography revealed brain edema, showing small compressed ventricles and diffuse low density of the cerebrum. Pulmonary edema on chest roentgenogram disappeared by the fifth hospital day, and his consciousness recovered gradually during the next 2 weeks after the admission. He was examined serially by electroencephalography and brain computerized tomography. He recovered fully, but there were transient psychological abnormalities soon after discharge and mild brain atrophy was observed by brain computerized tomography 6 years later.
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PMID:A case of high altitude pulmonary edema followed by brain computerized tomography and electroencephalogram. 320 90

Patients with heart failure should stop smoking, maintain an optimal weight and limit their intake of salt. Alcohol abuse should be avoided. The detection and early treatment of hypertension appears to have had a major impact in preventing heart failure. Diuretics revolutionized the treatment of congestive heart failure and their proper and appropriate use can alleviate peripheral and pulmonary oedema. Diuretics should not be overused and care should be taken to avoid hypokalaemia. Controversy surrounds the use of digoxin in patients in sinus rhythm; the drug should be used in patients in atrial fibrillation. The use of an inotropic drug may be harmful in the presence of coronary artery disease. A reduction in the current use of digoxin might be of benefit to many patients with heart failure. When the drug is prescribed it should be used in a therapeutic and not homeopathic dose. Recent interest has been directed toward the use of vasodilators and the angiotensin-converting enzyme inhibitors in patients with heart failure. In my opinion, these drugs should be used after patients have been treated with thiazide and loop diuretics. Vasodilators are particularly beneficial in acute heart failure or in patients with chronic heart failure when the symptoms are related to fluid overload and volume expansion. The cause of symptoms in patients with chronic heart failure optimally treated with diuretics is controversial. Shortness of breath may not be simply related to the left atrial pressure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Changing ideas in the treatment of heart failure--an overview. 330 Sep 78

Hypertensive emergencies usually present to the emergency department. Nifedipine was administered to 15 patients presenting to the emergency department with a diastolic blood pressure greater than 120 mm Hg with chest pain, shortness of breath, or focal neurological symptoms. Average blood pressure on entry was 215/134.9 mm Hg and decreased to 158/88 mm Hg over a two-hour period. No patient had any worsening of symptoms or suffered deleterious effects. All patients with pulmonary edema or chest pain noted prompt improvement in symptoms. One patient became hypotensive without clinical significance. Two patients failed to respond to nifedipine and were treated with nitroprusside. Nifedipine appears to be safe and effective in the management of hypertensive crises.
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PMID:Nifedipine in hypertensive emergencies: a prospective study. 332 99

Between 1975 and 1982 a total of 47 cases of high-altitude pulmonary edema occurred in Vail, Colorado, elevation 2,500 m (8,200 ft). All occurred in visitors from lower altitudes. The mean age of the patients was 35.6 years, and 93% were men. Most patients had tachycardia, tachypnea and fever. The mean time of onset of cough and shortness of breath was 2.5 days after arrival. The average total ascent of the patients was 2,330 m (7,644 ft) in less than one day from a mean residential elevation of 170 m (556 ft). Also, 91% of the cases occurred between December and April, when the average daily temperature was -4.3 degrees C (24.3 degrees F) and the ambient barometric pressure was 22.37 in of mercury.
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PMID:High-altitude pulmonary edema in Vail, Colorado, 1975-1982. 371 17

A hypertensive urgency should be distinguished from a hypertensive emergency. Although the distinction may not always be obvious, certain guidelines may help the clinician determine which therapeutic approaches are most appropriate for each patient. Hypertensive emergencies include those conditions in which new or progressive severe end-organ damage is present and a delay in appropriate therapy might result in permanent damage, progression of complications, and a poor prognosis. Hypertensive urgencies include those conditions with minimal to no obvious end-organ damage in which blood pressure should be lowered expeditiously. The risk of immediate complications or organ damage is less likely to occur, and thus the immediate prognosis is better, although the ultimate prognosis, if untreated, is poor. There is a marked individual, racial, sexual, and age difference in the ability to tolerate high intraarterial pressure, as evidenced by patients' symptoms and signs of end-organ damage. Patients may have no symptoms of elevated blood pressure until significant intraarterial levels are reached. If symptoms are present, they may include headache, dizziness, blurred vision, shortness of breath (especially with exertion), chest pain, rapid pulse, palpitations, malaise and fatigue, nocturia, or pedal edema. Signs of hypertensive disease vary and depend not only on the level of blood pressure but also include funduscopic changes with arteriolar narrowing, atrioventricular nicking, hemorrhages, exudates or papilledema, central nervous system changes and neurologic abnormalities, cardiac changes with gallop rhythm, cardiomegaly, tachycardia, ectopic ventricular beats, left ventricular hypertrophy or signs of congestive heart failure, pulmonary edema, and signs of renal insufficiency.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Hypertensive emergencies and urgencies: pathophysiology and clinical aspects. 394 53

A 23-year-old black woman with mixed connective tissue disease developed acute onset of shortness of breath and evidence of pulmonary edema. Cardiac isoenzymes, electrocardiograms and radionuclide myocardial scintigraphy were consistent with focal myocardial necrosis. The patient has had no further myocardial complication since initiation of therapy with steroids.
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PMID:Myocardial necrosis in a patient with mixed connective tissue disease. 399 75

A case report of pulmonary edema associated with the use of a betamimetic agent in preterm labor is reported. A 31-year-old, black multigravida woman, 28 weeks pregnant, was admitted to the hospital with dysuria, vaginal bleeding, and uterine contractions. She had experienced premature labor in her previous pregnancies, and she had a history of kidney stones, confirmed by pyelography, and repeated urinary tract infections. Eighteen hours after admission, the contractions were occurring every five minutes. Terbutaline sulfate constant infusion (10-20 micrograms/min) was started. By hospital day 2, the uterine contractions were occurring every 1-2 minutes and lasting 50 seconds. The terbutaline therapy was discontinued, and isoxsuprine hydrochloride infusion was started at 240 micrograms/min and gradually increased to 800 micrograms/min. The patient complained of smothering and became tachypneic after one hour and 40 minutes of therapy. The shortness of breath and tachypnea continued in spite of the administration of oxygen and positional changes. The isoxsuprine was discontinued. The diagnosis of pulmonary edema was confirmed by abnormal findings in the chest roentgenogram, bilateral rales, and a decrease in arterial blood oxygen pressure. A literature review of pulmonary edema associated with the administration of beta sympathomimetic drugs is presented, which suggests this adverse effect is multifactorial in origin. Precipitating factors may include corticosteroids, fluid overload, low levels of serum potassium, twin gestations, a sustained tachycardia greater than 140 beats per minute, undiagnosed cardiopulmonary disease, or catecholamine-induced cardiac injury. Patients requiring betamimetics for the delay of premature labor should be monitored closely to obviate this complication.
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PMID:Pulmonary edema associated with the use of betamimetic agents in preterm labor. 611 3

All the 79 (7.4%) complications of 1066 fiberoptic bronchoscopies performed under standardized topical anaesthesia in in- and outpatients were analyzed retrospectively. With the 4.9 mm bronchoscope the transnasal route was possible in all cases, and with the 6.0 mm bronchoscope in 92%. There were no deaths and no major complications, with the exception of one tension-pneumothorax, one pneumonia, one pulmonary edema and one 500 ml hemorrhage. The most frequent complications were minor hemorrhages (4.1%) which occurred mainly after biopsies and were rarely recognized by the patients. laryngospasms (1.5%) and bronchospasms (1.4%). The rate of complications was higher in patients with a FEV1 of less than 60% predicted (p = 0.02) and in patients with a pO2 below 50 mm Hg (p = 0.06). We recommend the administration of oxygen during fiberoptic bronchoscopy. Fever within 36 hours after bronchoscopy was observed in 12% and subsided without antibiotic therapy. In the light of these risks, patients should be informed prior to the procedure of the possible occurrence of shortness of breath, hemorrhage and fever.
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PMID:[How bothersome is fiber bronchoscopy under local anesthesia?]. 651 66


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