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Query: UMLS:C0392680 (shortness of breath)
 5,217 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The common symptoms of constrictive pericarditis, i.e. dyspnea on exertion, shortness of breath and cough, relate to impairment of ventricular filling and to a progressive rise in systemic and pulmonary venous pressures. Myocardial ischemia, angina and myocardial infarction are rarely associated with this disease. We have encountered two patients with constrictive pericarditis, one presenting with angina and the other with acute anterior wall infarction. Possible etiologies of constrictive pericarditis in the first case include cardiac surgery, chronic renal failure and myocarditis; in the second case, Crohn's disease. The proposed mechanism of chest pain in the first patient was a reduced cardiac output resulting in underperfusion of the coronary arteries, although it is possible that the patient experienced angina due to the presence of severe coronary artery disease. In the second patient an anterior wall infarction and post-infarction angina were attributed to obliteration of the left anterior descending artery by constraint of a thickened pericardium. In both cases non-invasive imaging modalities were not of use in establishing the diagnosis of constrictive pericarditis. Clinical awareness and accurate hemodynamic measurements continue to play a key role in the diagnostic process.
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PMID:Observations of angina and myocardial infarction in constrictive pericarditis. 831 45

Patients with chronic renal failure (CRF) are at risk for unique medical emergencies, many of which require hemodialysis for their definitive treatment. This study describes the use of emergency department (ED) hemodialysis in the management of CRF patients. A retrospective chart review was conducted of patients who underwent ED hemodialysis at a regional dialysis center between April 1994 and September 1996. Data were collected on presenting complaint, ED diagnosis, indication for hemodialysis, ED pharmacologic treatment, ED airway management, cardiovascular stability, and disposition. Fifty episodes of ED hemodialysis were identified in 37 different patients. Presenting complaints included: shortness of breath, 38 (69%); weakness, 8 (15%); chest pain, 3 (5%); and other, 6 (11%). ED diagnoses included: congestive heart failure, 36 (65%); hyperkalemia, 13 (24%); and other, 6 (11%). Indications for hemodialysis included: cardiovascular instability, 33 (38%); respiratory distress, 22 (26%); cardiac monitoring, 16 (19%), timing, 13 (15%); and other, 2 (2%). Predialysis stabilization included: nitroglycerin, 29 (26%); sublingual captopril, 17 (15%); calcium chloride, 13 (11%); sodium bicarbonate, 12 (11%); insulin/dextrose, 11 (10%); none, 12 (11%); and other, 18 (16%). Airway support included: noninvasive pressure support ventilation (NPSV), 9 (18%); and endotracheal intubation, 6 (12%). NPSV was provided with a bilevel positive airway pressure system. Three of the endotracheal intubation patients were weaned to NPSV during dialysis, and all NPSV patients were weaned from respiratory support during their hemodialysis in the ED. Some patients had more than one problem. Sixteen patients (32%) were admitted, while 34 (68%) were discharged, including 3 NPSV patients and 22 initially unstable patients. ED hemodialysis in conjunction with additional medical care is a useful emergency medicine technique that can prevent hospital admission in patients with acute renal emergencies.
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PMID:ED hemodialysis for treatment of renal failure emergencies. 1033 96

A 67-year-old woman with hypertension, diabetes, hypothyroidism and chronic renal failure reported to the hospital for her regularly scheduled hemodialysis, complaining of shortness of breath. Despite fluid removal during her hemodialysis, she remained tachypneic and developed stridor. She was admitted to the hospital for a work-up of a known mediastinal mass, thought to be a goiter. However, she deteriorated over the next several hours and expired. A post-mortem examination confirmed fatal pulmonary emboli. This case illustrates the fact that, while most patients with chronic renal failure are considered to be at low risk for pulmonary emboli, it is often not diagnosed when present. In this paper, we will review the epidemiological data supporting this notion, examine proposed pathophysiological mechanisms, and review the diagnostic approach that should be considered in the setting of chronic renal failure.
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PMID:Fatal dyspnea in a patient with renal failure. 1203 70

Erythropoietin is a hypoxia-induced hormone that is a major regulator of normal erythropoiesis. Over the last decade, the production of recombinant human erythropoietin has revolutionized the treatment of anemia associated with chronic renal failure, and has led to a greater understanding of anemia pathophysiology and to the elucidation of the interactions of erythropoietin, iron, and erythropoiesis. Anemia has been shown to be independently associated with increased mortality and disease progression. Potential survival benefits associated with correction of anemia have expanded considerably the indications of erythropoietin use in various patient populations and are leading to consideration of earlier, more aggressive treatment of mild to moderate anemia. The results of such treatment are promising in a variety of new clinical settings, including anemia associated with congestive heart failure. Furthermore, the erythropoietin receptor is widely distributed in the cardiovascular system, including endothelial cells, smooth muscle cells and cardiomyocytes and preclinical studies have established erythropoietin to be a pleiotropic cytokine with anti-apoptotic activity and tissue-protective actions in the cardiovascular system, beyond correction of hemoglobin levels. Despite some potential adverse effects, such as hypertension, and the occurrence of erythropoietin resistance, early studies in heart failure patients with anemia suggest that erythropoietin therapy is safe and effective in reducing left ventricular hypertrophy, enhancing exercise performance and increasing ejection fraction. Anemia is found in about one-third of all cases of congestive heart failure (CHF). The most likely common cause is chronic renal insufficiency, which is present in about half of all CHF cases. However, anemia can occur in CHF without renal insufficiency and is likely to be due to excessive cytokine production. The anemia itself can worsen cardiac function, both because it causes cardiac stress through tachycardia and increased stroke volume, and because it can cause a reduced renal blood flow and fluid retention, adding further stress to the heart. Long-standing anemia of any cause can cause left ventricular hypertrophy, which can lead to cardiac cell death through apoptosis and worsen CHF. Therefore, a vicious circle, cardio-renal anemia syndrome, is set up wherein CHF causes anemia, and the anemia causes more CHF and both damage the kidneys worsening the anemia and the CHF further and increasing mortality. There is now evidence that early correction of the CHF anemia with subcutaneous erythropoietin and intravenous iron improves shortness of breath and fatigue, cardiac function, renal function and exercise capacity, reducing the need for hospitalization and improving quality of life. In the present review we discuss the data on current clinical use of erythropoietin in cardiovascular disease, with the main focus on the treatment of congestive heart failure, and summarize the advances and progress made in the understanding of the hematopoietic and pleiotropic effects of erythropoietin in the cardiovascular system.
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PMID:Erythropoietin in heart failure and other cardiovascular diseases: hematopoietic and pleiotropic effects. 1624 29

A 67-year-old Chinese man presented to the emergency department with a history of abdominal bloating and shortness of breath. Initial electrocardiogram (ECG) showed atrial tachycardia (AT) with 2:1 atrioventricular (AV) conduction block. Six days after admission, he developed acute dyspnoea and confusion. Repeat ECG demonstrated a regular wide-complex tachycardia. Serum analysis revealed hyperkalaemia secondary to acute on chronic renal failure. Emergency treatment with intravenous calcium gluconate, 50% dextrose solution and short-acting insulin was instituted. The ECG promptly reverted to a narrow-complex AT with 2:1 AV conduction block. The diagnosis and treatment of AT are discussed.
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PMID:Electrocardiographical case. Elderly man with acute breathlessness. Atrial tachycardia with variable AV conduction block and transient hyperkalaemia-induced aberrant conduction. 1745 8

A 28-year-old male patient who was a nonsmoker presented with bilateral symmetrical polyarthritis and polyarthralgia, suggestive of rheumatoid arthritis (RA), along with shortness of breath, fever and cough, suggestive of chronic renal failure and nephrotic range proteinuria. The chest radiograph was suggestive of panacinar emphysematous changes with bilateral central bronchiectasis. The patient reported that two of his brothers had died in their third decade because of renal failure. Renal biopsy showed focal and segmental glomerulosclerosis (FSGS). FSGS with panacinar emphysema and bronchiectasis is a rare entity in RA patients, and considering the possibilities of a familial pattern of FSGS, transient receptor potential cation channel 6 channelopathy was the most valid diagnosis.
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PMID:Bronchiectasis and Focal Segmental Glomerulosclerosis in Rheumatoid Arthritis. 3078 1

The number of cases of superior vena cava syndrome (SVCS) increased due to increased cardiac devices and central venous catheters. Management of benign SVCS is still controversial. A 51-year-old male known to have ischemic cardiomyopathy and chronic renal failure on regular hemodialysis. In the last 12 months, he had progressive shortness of breath and swelling of his upper part of the body. Examination revealed engorgement of the neck veins, facial puffiness, and pitting edema of both upper limbs. Venography showed occluded SVC. We applied a 50 Watt of energy via electrocautery pen to a Hi-Torque 0.014 Astato guidewire to cross the occluded segment retrogradely. We used 2 stents 39 mm, mounted on BIB 20/40 mm. Final angiography revealed full restoration of SVC flow. Diathermy use to cross a chronic total SVC obstruction is feasible and safe. Endovascular techniques are suitable as initial management of benign SVC syndrome.
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PMID:Diathermy-assisted recanalization of chronic superior vena cava obstruction, case report. 3254 73