Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0344232 (blurred vision)
 2,072 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We report on the distress associated with physical symptoms in 761 male hypertensive patients enrolled in a clinical trial of the effects of captopril, methyldopa or propranolol on quality of life. Educational level at entry into the trial showed a negative association with a series of physical symptom distress items among patients not previously treated with antihypertensive medications but no association with symptoms among the previously treated. Over the 24 weeks of therapy captopril as monotherapy was associated with no change from baseline in distress in all symptoms examined. In contrast, distress increased in the methyldopa treated patients for dry mouth and blurred vision. Propranolol treated patients had increased "trouble getting breath," bradycardia, shortness of breath or wheezing, and blurred vision. Between group comparisons revealed significant differences favorably comparing captopril to both methyldopa and propranolol in regard to fatigue, and blurred vision, as well as to methyldopa alone for dry mouth and "feeling worn out." There were significant differences as well between captopril and propranolol with patients on propranolol worsening in bradycardia. Other comparisons of patients on propranolol and methyldopa monotherapy showed propranolol patients worsening in bradycardia and loss of taste, but methyldopa patients reported more dry mouth and feeling worn out than those on propranolol. The addition of hydrochlorothiazide to therapy worsened total physical symptom distress scores for methyldopa and propranolol patients. This study confirms the value of methods which assess the degree of distress associated with symptoms commonly reported by hypertensive patients receiving antihypertensive medications. This approach can be useful in establishing a treatment regimen least likely to cause distress and can be of value in preserving quality of life, preventing noncompliance, and withdrawal from treatment.
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PMID:Self-reported side effects from antihypertensive drugs. A clinical trial. Quality of Life Research Group. 240 65

One hundred adults with a chief complaint of chronic fatigue were evaluated in an outpatient setting to determine a possible association with somatization disorder. Somatization disorder was diagnosed in 15 patients. Eight functional somatic symptoms were reported more frequently by these patients: pain in extremities, joint paint, chest pain, other pain, shortness of breath, blurred vision, muscle weakness, and sexual indifference (p less than 0.001). Current mood disorders, anxiety disorders, and psychoactive substance use disorders were less common in patients with somatization disorders than in patients without this diagnosis (p less than 0.01).
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PMID:Somatization disorder in patients with chronic fatigue. 279 31

A case of intravenous labetalol in the treatment of a resistant hypertensive emergency is reported. Although there have been several reports of the use of oral labetalol in resistant hypertension, no intravenous administration in hypertensive emergency resistant to other drugs has been reported to date. A 36-year-old black female with BP of 270/160 mm Hg with complaints greater than one month's duration of dizziness, severe headaches, blurred vision, shortness of breath, vomiting, palpitations, flushing, agitation, diarrhea, weakness, and weight loss, was treated successfully with intravenous labetalol after she failed to respond to other established parenteral antihypertensive drugs. The patient received labetalol 20 mg iv bolus, and then 20 mg every ten minutes until a cumulative dose of 200 mg was attained. Labetalol produced a prompt but smooth reduction in BP without any reflex tachycardia or other adverse effects. Intravenous labetalol may be safe and effective for the management of rapid BP control in hypertensive emergencies resistant to other parenteral antihypertensive agents.
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PMID:Intravenous labetalol in the management of resistant hypertensive emergency. 360 97

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

In this discussion of infection control in patients with acquired immune deficiency syndrome (AIDS), attention is directed to nursing. Due to the fact that the majority of individuals who suffer with AIDS will be homosexual, intravenous drug users, or both, it is essential that the nurse historian be aware of his/her own feelings about the lifestyles of these patients. History-taking should be done in a nonjudgmental manner. A major pitfall to be avoided when taking a history is making assumptions about an individual's sexual preferences or activities based on the response to a simple question about marital status. It is important to note whether or not the person has a monogamous relationship or leads a polyandrous lifestyle. Another area that should be tactfully but explicitly explored when interviewing an individual who is homosexual or bisexual is the number of different sexual partners that he/she has been involved with on a weekly or monthly basis. Whether the patient has a history of sexually transmitted diseases should be determined. The use of recreational drugs should be explored. When taking the history of a client who uses intravenous drugs, it is important for the nurse to record the agents and sites of injection as well as to note whether the individual uses his/her own equipment. When reviewing the major body systems and the presence or absence of related symptoms, the nurse should note whether the client has experienced skin rashes/lesions, swollen lymph nodes, fever, extreme fatigue, weight loss, shortness of breath, changes in bowel habits, cuts or bruises that do not heal, and headaches, dizziness, blurred vision, or stiff neck. The physical examination of the individual with AIDS and an opportunistic infection usually will reveal positive findings in the central nervous system, respiratory system, gastrointestinal system, and/or the integumentary system, as well as the lymphatic system. As the leading cause of morbidity in the compromised host is infection, infection prevention should be regarded as a pragmatic necessity. 2 major things that nurses can do in the acute care setting to control infection are to limit the frequency of invasive or traumatic procedures and to reduce the acquisition of new potential pathogens.
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PMID:Infection control in the patient with AIDS. 608 77

A case is presented of a 32-year old gravida 3, para 1, ab 1, presented at 26 weeks with chief complaints of periorbital edema, headaches, and blurred vision for about 1 week. 2 weeks prior to admission she had experienced shortness of breath and decreased fetal movement. Admission was at 28 weeks with uncontrolled hypertension, blood pressure 190/120, pulse 100/min. Temperature was 98.8 degrees. Attempted induction of labor with oxytocin was unsuccessful. A hydralazine infusion decreased the blood pressure to 180/100 and a 20 mg prostaglandin (PG) E2 suppository was inserted. A few hours later the blood pressure had dropped to 100/60 and the hydrazaline infusion was discontinued. About 3 hours later a stillborn female infant was born; post delivery examination revealed a large gap in the wall of the uterus extending into the lateral vaginal fornix. A total abdominal hysterectomy and right salpingo-oophorectomy was then performed and recovery was uneventful. PGE2 reliably initiates labor even in the presence of an "uninducible cervix" and is prone to increase intrauterine pressure to a level beyond that of normal labor with a lag in cervical changes. The 2 most common traumata reported following PG administration for therapeutic abortion are either cervico-vaginal fistulas or lateral tears. In this case since there was no indication of any congenital weakness of the uterine wall, it is reasonable to assume that the mechanism leading to the rupture was intense and prolonged uterine contractions combined with a rigid cervix.
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PMID:Uterine rupture associated with the use of vaginal prostaglandin E2 suppositories. 658 51

We examined the discriminant ability and responsiveness of the General Well-Being Adjustment Scale in patients enrolled in a randomized clinical trial of antihypertensive therapy. We also tried to translate the effects of physical symptoms on general well-being. This secondary analysis used demographic, clinical, physical symptom, and general well-being data for 545 white, male hypertensive patients. General well-being was measured by the General Well-Being Adjustment Scale (GWB) collected on 2 occasions over 8 weeks of treatment. Patients with any one of 14 physical symptoms or problems, compared to those without symptoms, had lower GWB scores (p < 0.003 to p < 0.0001). Decreases of 2.83-8.76 points in GWB scores were observed in patients developing physical symptoms over the 8 week study period (p < 0.05 to p < 0.0001). These effects were demonstrated in patients developing cold sensitivity, sexual problems, chest pain, shortness of breath, loss of taste, nausea, hot or cold spells, numbness and tingling, dry mouth, blurred vision, and dizziness. We conclude that the GWB is responsive to clinically meaningful changes in symptoms and may provide a more complete evaluation of the effects of medical treatment. The GWB is a valid and responsive measure of health status outcomes in the evaluation of antihypertensive treatment.
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PMID:Responsiveness and calibration of the General Well-Being Adjustment Scale in patients with hypertension. 773 Aug 42

A 47-year-old man reported becoming confused, disoriented, and anxious while driving his car. He recalled sweating and having blurred vision, palpitations, and a diffuse headache shortly before pulling to the side of the road and losing consciousness. Emergency service personnel arrived about 15 minutes later and administered a 50% solution of dextrose intravenously. On regaining consciousness, the patient had no weakness,shortness of breath, chest pain, or loss of bowel or bladder function. He had experienced a similar episode one week earlier and several others in the distant past. Each time, symptoms had been alleviated by eating.
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PMID:An obese man with anxiety, sweating, and headache. 1156 39

Thrombotic microangiopathy (TMA) is a recognized complication of malignant hypertension (HTN). Such patients have blood pressures > or = 200/140 mmHg but the condition is defined by the presence of papilledema and is frequently complicated by acute renal failure. Here we report two patients with severe HTN (systolic > or = 180 mmHg or diastolic > or = 120 mmHg), TMA, thrombocytopenia, renal failure, and, in one case, neurological changes (4 of 5 manifestations of the TTP pentad). A 50-year-old male with HTN presented with blurred vision, dizziness, headache, confusion, renal failure, and a TMA (PLT = 39 x 10(9)/L and LD = 2,781 normal <600 U/L). On presentation, BP was 214/133 mmHg and an ophthalmic exam demonstrated no papilledema. With HTN control over 7 days, his platelet count rebounded (220 x 10(9)/L), LD declined (1,730 U/L), and mental status improved. A 60-year-old female with diabetes, HTN, Lupus erythematosus, mild chronic anemia, and thrombocytopenia presented with abdominal pain, shortness of breath, renal failure, and a TMA (PLT = 83 x 10(9)/L and LD = 2,929 U/L). Blood pressures were 180-210/89-111 mmHg and ophthalmic exam demonstrated no papilledema. With HTN control over 8 days, her platelet count rebounded (147 x 10(9)/L), and LD declined (1,624 U/L). Although in both cases a diagnosis of TTP was considered because of overlap with the classic diagnostic pentad, neither received plasmapheresis. TTP is a diagnosis of exclusion, where there is no other likely diagnosis to explain the TMA. In cases of severe HTN (with or without papilledema), the diagnosis of TTP should be held in abeyance until the effect of HTN control can be assessed.
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PMID:Differentiating thrombotic microangiopathies induced by severe hypertension from anemia and thrombocytopenia seen in thrombotic thrombocytopenia purpura. 1549 50

Enhanced sympathetic activity causes an exaggerated heart rate response to standing in the postural tachycardia syndrome (POTS). All patients describe symptoms of orthostatic intolerance such as dizziness, blurred vision, shortness of breath, palpitations, tremulousness, chest discomfort, headache, lightheadedness and nausea, but only one third suffer loss of consciousness. We report four patients with POTS, who had long ventricular pauses (i.e. asystole) and syncope during head-up tilt test. This suggests that a subset of patients with POTS can have a surge in parasympathetic outflow that precedes vasovagal syncope.
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PMID:Postural tachycardia syndrome with asystole on head-up tilt. 1795 28


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