Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0235886 (leg edema)
 674 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 63-year-old white woman with a history of hypertension and chronic obstructive pulmonary disease presented to the emergency room with worsening shortness of breath, anorexia, coughing, increased thirst, and leg edema of two weeks' duration. Medications included lisinopril 10 mg/d, which had been started six weeks earlier, sustained-release theophylline 300 mg q12h, and an albuterol inhaler. The lisinopril was discontinued on admission. Serum sodium concentration was 109 mmol/L; the osmolality of the blood and of the urine were 253 mOsmol and 438 mOsmol, respectively, with a specific gravity of 1.025 and a urine sodium of 17 mmol/L. The hyponatremia initially was considered to be the syndrome of inappropriate antidiuretic hormone secretion in response to the patient's suspected pneumonia. Due to worsening blood pressure, lisinopril was restarted and the serum sodium concentration dropped from 134 to 126 mmol/L. Evaluation of the patient's hyponatremia included assessment of thyroid, adrenal, hepatic, and cardiac function that were within normal limits. The patient was discharged on the following medications: sustained-release theophylline 300 mg tid, prednisone 10 mg/d, albuterol inhaler 2 puffs q6h, and sustained-release verapamil 240 mg/d for blood pressure control. Her serum sodium concentration has remained between 135 and 140 mmol/L during hospitalizations for exacerbations of chronic obstructive pulmonary disease and for pneumonias 10 and 12 months after discharge.
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PMID:Severe hyponatremia: an association with lisinopril? 165 42

May-Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, resulting in left iliofemoral deep vein thrombosis and severe leg edema. We report the case of a 41-year-old female who presented with severe left leg edema present for 1 day. One week earlier she had experienced acute shortness of breath and pleuritic chest pain. Duplex ultrasound revealed a left iliofemoral deep vein thrombosis. A computed tomography (CT) scan performed for abdominal pain revealed thrombosis of the entire left common and external iliac veins. A ventilation-perfusion scan diagnosed a pulmonary embolism. The patient was treated with systemic intravenous heparin and catheter-directed thrombolysis of the iliofemoral deep vein thrombosis. Complete thrombolysis and iliofemoral vein patency was achieved over 5 days. A persistent stenosis in the left common iliac vein consistent with May-Thurner syndrome was alleviated with percutaneous balloon angioplasty and placement of a Wallstent. Heparin therapy was terminated at the time of stenting because of suspected heparin-induced thrombocytopenia. The patient was started on a continuous infusion of 10% dextran 40, and warfarin therapy was initiated. Heparin-induced antibodies were confirmed by a C-14 serotonin release assay. The endovascular reconstruction remains patent 4 months later. Heparin-induced thrombocytopenia complicating endovascular reconstruction of the iliofemoral venous system in a patient with May-Thurner Syndrome is an uncommon occurrence. This case and a review of the literature are discussed.
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PMID:Treatment of May-Thurner syndrome with catheter-directed thrombolysis and stent placement, complicated by heparin-induced thrombocytopenia. 1039 65

Disease management programs (DMP) have been recently introduced in the German statutory healthcare sector by federal law. These compulsory programs are aimed at enhancing guideline-based treatment by primary care physicians. Based on a systematic analysis of disease models and deficits in healthcare delivery, patient-oriented DMP offer an alternative approach. Their standardized services include care calls, written educational material, reminder systems, health reports, and optional telemetric monitoring. As an example of this approach, the medical results of 151 patients participating in a comprehensive chronic heart failure (CHF) program were evaluated. Within the observation period of 12 months, the number of patients receiving appropriate prescriptions (ACE inhibitors, diuretics, or beta blockers) rose significantly. In many patients there was a remission of CHF key symptoms (leg edema, shortness of breath, dizziness). The daily weight monitoring was particularly appreciated by the patients. For further development of patient-oriented DMP in the German healthcare system, it will be crucial that financial savings can be convincingly demonstrated besides the clinical benefits. These include quality of life, particularly for those chronic conditions in which patient self-management has a large impact on disease course.
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PMID:[Patient-oriented healthcare programs. Concepts and practical experience in the field of chronic heart failure]. 1599 85

Obesity has been found to be associated with left ventricular (LV) hypertrophy (LVH). However, the occurrence of LVH in obese teenagers who are involved in sport programs has not been studied. The objective of this study was to evaluate the prevalence of LVH and its correlation with obesity, gender, and symptoms in teenage athletes. We used echocardiographic database of 1,500 adolescences between the ages of 12 and 20 years who were actively involved in school sport programs. We evaluated associations between obesity and LVH (defined as LV wall thickness (LVWT)) >12 mm, or LV mass (LVM) >215 g or relative wall thickness (RWT) >0.43) and physical symptoms. Using univariate and multivariate analysis, male gender was associated with increased LVWT (multivariate odds ratio (OR) 4.87, confidence interval (CI) 2.41-9.82). Obesity was associated with parameters of LVH using univariate and multivariate analysis. (LVM > 215 g) occurred in 10.32% of obese athletes vs. 0.2% (1/445) of controls, (OR 51.33, CI 6.05-433.8), P < 0.001, LVWT >12 mm occurred in 16.5% of obese students vs. 3.6% of controls (OR 5.2, CI 2.7-10.1, P < 0.001), RWT >0.43 occurred in 41.4% of obese students vs. 15.7% of controls (OR 3.78, CI 2.11-6.76, P < 0.001). After adjusting for age and gender, reported history of shortness of breath (SOB), fatigue and leg edema were also significantly more prevalent in obese students and in students with LVH. In conclusion obesity is associated with LVH in a population of healthy teenagers actively involved in sport programs. Furthermore, the presence of LVH was independently associated with many physical symptoms suggesting negative effect of LVH on myocardial function.
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PMID:Left ventricular hypertrophy is associated with obesity, male gender, and symptoms in healthy adolescents. 1923 46

A 58-year-old woman with a past medical history significant for tobacco use presented with shortness of breath. Physical examination revealed a 30 mm Hg difference in upper-extremity blood pressures (right arm greater than left), elevated jugular venous pressure, and leg edema. A two-dimensional echocardiogram revealed an ejection fraction of 20%. During angiography a heavily calcified lesion was noted in the aortic arch, across which a significant gradient was measured. Computed tomographic scanning identified a focal calcified area in the aortic arch and diffuse atherosclerosis elsewhere. Acquired thromboatheromatous coarctation of the aorta is an uncommon entity found in patients who smoke and are hypertensive. It is almost always seen in conjunction with severe peripheral vascular disease, which this patient had. She was started on heart failure therapy and referred for surgical repair.
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PMID:Acquired atheromatous coarctation of the aortic arch. 2130 71

We herein report the case of a 39-year-old woman with a pulmonary embolism caused by intimal sarcoma of the pulmonary artery. She presented with shortness of breath and leg edema. Computed tomography showed a low density area that extended from the main pulmonary artery to the bilateral pulmonary arteries. We diagnosed her to have a pulmonary thromboembolism. The thrombosis did not decrease after the administration of anti-coagulant therapy, and she underwent resection of the thrombotic tissue. Histopathologically, the surgical specimen was not found to be thrombotic tissue but rather an intimal sarcoma of the pulmonary artery. After undergoing surgery, she received radiation therapy and chemotherapy; however, she died 31 months after being diagnosed.
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PMID:Pulmonary embolism caused by intimal sarcoma of the pulmonary artery. 2312 45

We present a case of a 54-year-old man with carcinoid heart disease and mitral valve involvement. He had hepatic carcinoid with an extremely elevated urinary excretion of 5-hydroxyindole acetic acid and was referred to our division for shortness of breath and leg edema. Transthoracic echocardiography showed the thickened and retracted tricuspid valve leaflets and severe tricuspid regurgitation. Moderate mitral regurgitation was observed, with the involvement of mitral valve leaflets. A patent foramen ovale was not detected on transesophageal echocardiography. The extremely high concentration of circulating serotonin and/or other vasoactive substances may have contributed to left- as well as right-sided carcinoid heart disease.
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PMID:Right- and left-sided carcinoid heart disease without intracardiac shunting. 2727 49

Trans-diaphragmatic intercostal hernia is a rare entity. Patient with multiple medical comorbidities, including obstructive sleep apnoea, presents with shortness of breath, leg oedema and a bulging swelling through the right chest wall. CT shows partial herniation of the right lung and liver through intercostal space and an echocardiogram reveals right heart failure. He was treated initially with continuous positive airway pressure with poor response and subsequently treated with adaptive servo ventilation with much better symptomatic relief and treatment tolerance.
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PMID:Non-traumatic trans-diaphragmatic intercostal hernia and cor pulmonale in a patient with poorly controlled obstructive sleep apnoea. 2779 67

A 60-year-old man presented with leg edema and shortness of breath. He was being treated with medication for chronic heart failure for the past 3 years and had been in a traffic accident when he was 13 years old. Computed tomography showed a huge right renal arteriovenous fistula (AVF). The right renal artery measured 16 mm in diameter, the renal aneurysm was observed to be 60 mm, renal vein 87 mm, and the inferior vena cava 60 mm in diameter. His high-output heart failure was attributed to his right renal AVF, for which treatment was deemed necessary. Due to the risk of pulmonary embolism associated with transcatheter arterial embolization, we performed a nephrectomy with temporary interruption of renal blood flow using a balloon catheter. He was observed to be asymptomatic immediately after surgery.
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PMID:[RENAL ARTERIOVENOUS FISTULA (ANEURYSMAL TYPE) TREATED BY NEPHRECTOMY UNDER BALLOON CATHETER OCCLUSION OF RENAL ARTERY: A CASE REPORT]. 3100 41

Peripartum cardiomyopathy (PPCM) is a potentially life-threatening condition typically presenting as heart failure with reduced ejection fraction (HFrEF) in the last month of pregnancy or in the months following delivery in women without another known cause of heart failure. This updated position statement summarizes the knowledge about pathophysiological mechanisms, risk factors, clinical presentation, diagnosis and management of PPCM. As shortness of breath, fatigue and leg oedema are common in the peripartum period, a high index of suspicion is required to not miss the diagnosis. Measurement of natriuretic peptides, electrocardiography and echocardiography are recommended to promptly diagnose or exclude heart failure/PPCM. Important differential diagnoses include pulmonary embolism, myocardial infarction, hypertensive heart disease during pregnancy, and pre-existing heart disease. A genetic contribution is present in up to 20% of PPCM, in particular titin truncating variant. PPCM is associated with high morbidity and mortality, but also with a high probability of partial and often full recovery. Use of guideline-directed pharmacological therapy for HFrEF is recommended in all patients respecting contraindications during pregnancy/lactation. The oxidative stress-mediated cleavage of the hormone prolactin into a cardiotoxic fragment has been identified as a driver of PPCM pathophysiology. Pharmacological blockade of prolactin release using bromocriptine as a disease-specific therapy in addition to standard therapy for heart failure treatment has shown promising results in two clinical trials. Thresholds for devices (implantable cardioverter-defibrillators, cardiac resynchronization therapy and implanted long-term ventricular assist devices) are higher in PPCM than in other conditions because of the high rate of recovery. The important role of education and counselling around contraception and future pregnancies is emphasised.
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PMID:Pathophysiology, diagnosis and management of peripartum cardiomyopathy: a position statement from the Heart Failure Association of the European Society of Cardiology Study Group on peripartum cardiomyopathy. 3124 66


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