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Acute Pulmonary Hypertension

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https://read.qxmd.com/read/30874487/lloprost-delivered-via-the-breelib-tm-nebulizer-a-review-of-the-clinical-evidence-for-efficacy-and-safety
#1
Tobias Gessler
Inhaled iloprost is a well-established medication to treat pulmonary arterial hypertension (PAH), a serious and potentially fatal disease of the pulmonary resistance vessels. The therapeutic administration of iloprost requires six to nine inhalations per day, due to the short biological half-life of this prostacyclin analogue. The I-NebTM AADTM , introduced in 2006, is the most commonly used nebulizer for delivering iloprost, requiring at least 6.5 min for an inhaled dose of 5 µg. In order to reduce inhalation time, a portable nebulizer based on modern-device technology was developed...
January 2019: Therapeutic Advances in Respiratory Disease
https://read.qxmd.com/read/30872398/obesity-hypoventilation-syndrome
#2
Juan F Masa, Jean-Louis Pépin, Jean-Christian Borel, Babak Mokhlesi, Patrick B Murphy, Maria Ángeles Sánchez-Quiroga
Obesity hypoventilation syndrome (OHS) is defined as a combination of obesity (body mass index ≥30 kg·m-2 ), daytime hypercapnia (arterial carbon dioxide tension ≥45 mmHg) and sleep disordered breathing, after ruling out other disorders that may cause alveolar hypoventilation. OHS prevalence has been estimated to be ∼0.4% of the adult population. OHS is typically diagnosed during an episode of acute-on-chronic hypercapnic respiratory failure or when symptoms lead to pulmonary or sleep consultation in stable conditions...
March 31, 2019: European Respiratory Review: An Official Journal of the European Respiratory Society
https://read.qxmd.com/read/30872344/isolated-myxoid-degeneration-of-aortic-valve-diagnostic-dilemma
#3
Htay Htay Kyi, Kewan Hamid, Luay Alkotob, Thair Dawood
Myxoid degeneration of the aortic valve as a cause of acute aortic valve regurgitation in young age is uncommon. We report a 39-year-old African-American man with a history of epilepsy and hypertension who presented with a 1-month history of worsening shortness of breath. He was diagnosed with acute pulmonary oedema. Transoesophageal echocardiogram showed normal ejection fraction but severe aortic valve insufficiency with small masses on the ventricular side of the right and non-coronary cusps, small vegetations cannot be ruled out but other valves were normal...
March 14, 2019: BMJ Case Reports
https://read.qxmd.com/read/30871795/acute-vasoreactivity-testing-during-cardiac-catheterization-of-neonates-with-bronchopulmonary-dysplasia-associated-pulmonary-hypertension
#4
Benjamin S Frank, Michal Schäfer, Alicia Grenolds, D Dunbar Ivy, Steven H Abman, Jeffrey R Darst
OBJECTIVES: To assess whether better baseline pulmonary hemodynamics or positive acute vasoreactivity testing (AVT) during cardiac catheterization are associated with improved outcomes in infants with bronchopulmonary dysplasia (BPD) and pulmonary hypertension (PH). STUDY DESIGN: This retrospective, single-center study included 26 premature neonates with BPD who underwent catheterization to evaluate PH. AVT was assessed with exposure to 100% fractional inspired oxygen with or without inhaled nitric oxide...
March 11, 2019: Journal of Pediatrics
https://read.qxmd.com/read/30860204/natriuretic-peptides-in-clinical-practice
#5
Yüksel Çavuşoğlu, Ahmet Taha Alper, Hakan Altay, Ahmet Çelik, Burcu Demirkan, Tolga Sinan Güvenç, Mehmet Serdar Küçükoğlu, Sanem Nalbantgil, Murat Özdemir, Bülent Özin, Tamer Sayın, Özlem Yıldırımtürk, Mehmet Birhan Yılmaz, Cafer Zorkun
Natriuretic peptides have long been introduced into clinical practice. These biomarkers have certainly been shown to provide useful information in the diagnosis, prognosis and risk stratification in heart failure and also may have a role in the guidance of heart failure therapy. Although, there are some limitations in using of these markers such as lack of specificity, aging, renal dysfunction or obesity, among the huge number of candidates for heart failure biomarkers, only natriuretic peptides are currently widely used in daily clinical practice in heart failure...
March 2019: Anatolian Journal of Cardiology
https://read.qxmd.com/read/30857600/effects-of-vasopressin-during-a-pulmonary-hypertensive-crisis-induced-by-acute-hypoxia-in-a-rat-model-of-pulmonary-hypertension
#6
Yoh Sugawara, Yusuke Mizuno, Shinya Oku, Takahisa Goto
BACKGROUND: A pulmonary hypertensive crisis (PHC) can be a life-threatening condition. We established a PHC model by exposing rats with monocrotaline (MCT)-induced pulmonary hypertension to acute hypoxia, and investigated the effects of vasopressin, phenylephrine, and norepinephrine on the PHC. METHODS: Four weeks after MCT 60 mg kg-1 administration i.v., right ventricular systolic pressure (RVSP), systolic BP (SBP), mean BP (MBP), cardiac index (CI), and pulmonary vascular resistance index (PVRI) were measured...
April 2019: British Journal of Anaesthesia
https://read.qxmd.com/read/30849428/ocular-manifestations-of-pulmonary-hypertension
#7
REVIEW
Natalia Lewczuk, Alexander Zdebik, Joanna Bogusławska, Anna Turno-Kręcicka, Marta Misiuk-Hojło
Pulmonary hypertension (PH), if left untreated, may result in increasing cardiac back pressures and lead to right heart failure and death. An increase in venous pressure in pulmonary hypertension influences other organs. The ocular complications occur as a result of elevated venous pressure in the superior vena cava and in the ophthalmic veins that cause dilation of the ocular veins, resulting in congestion of the choroid and leading to complications such as ciliary detachment,1 central retinal vein occlusion, acute serous retinal detachment, macular edema, retinal neovascularization, choroidal effusions, chemosis, angle-closure glaucoma, transient myopia, and proptosis...
March 5, 2019: Survey of Ophthalmology
https://read.qxmd.com/read/30838168/end-stage-renal-disease-secondary-to-anti-glomerular-basement-membrane-disease-in-a-child-with-common-variable-immunodeficiency
#8
Sai Sudha Mannemuddhu, William Clapp, Renee Modica, Melissa E Elder, Kiran Upadhyay
BACKGROUND: Anti-glomerular basement membrane (GBM) disease is caused by autoantibodies against the α3-chain of type IV collagen in the GBM. Common variable immunodeficiency (CVID) is a primary immunodeficiency manifested by hypogammaglobulinemia, inability to make functional antibody, and recurrent infections. This report extends the phenotype of CVID-associated autoimmune diseases to include anti-GBM disease. CASE PRESENTATION: A 15-year-old Caucasian female with prior normal renal function presented with nephrotic proteinuria, pedal edema, oliguria, acute kidney injury, and was found to have positive serum anti-GBM antibody...
2019: Clinical nephrology. Case studies
https://read.qxmd.com/read/30825643/pulmonary-vascular-resistance-is-associated-with-brachial-ankle-pulse-wave-velocity-and-adverse-clinical-outcomes-in-patients-with-heart-failure-with-preserved-ejection-fraction
#9
Takamitsu Nakamura, Manabu Uematsu, Juntaro Deyama, Yosuke Watanabe, Kazuto Nakamura, Tsuyoshi Kobayashi, Yukio Saito, Daisuke Fujioka, Ken-Ichi Kawabata, Jun-Ei Obata, Kiyotaka Kugiyama
BACKGROUND: The precise mechanisms underlying the high prevalence of pulmonary hypertension (PH) with increased pulmonary vascular resistance (PVR) in heart failure with preserved ejection fraction (HFpEF) remain largely unknown. Measurements of brachial-ankle pulse wave velocity (baPWV) have been shown to be useful for risk assessment in HF patients. Thus, this study sought to define the association of PVR with baPWV and clinical outcomes in HFpEF. METHODS AND RESULTS: Patients with HFpEF (n=198) had measurements of baPWV and PVR by right heart catheterization, and were prospectively followed-up for <96 months or until the occurrence of a composite of all-cause death, hospitalization with worsening HF, and non-fatal acute coronary syndrome...
February 27, 2019: Journal of Cardiac Failure
https://read.qxmd.com/read/30822427/ropivacaine-inhibits-pressure-induced-lung-endothelial-hyperpermeability-in-models-of-acute-hypertension
#10
Milan Patel, Andreia Z Chignalia, Ayman Isbatan, Nikhil Bommakanti, Randal O Dull
AIMS: Increases in hydrostatic pressure results in endothelial hyperpermeability via eNOS-dependent pathways. Ropivacaine is known to inhibit eNOS activation and to attenuate lung injury. Herein, we sought to determine if ropivacaine regulates pressure-induced lung endothelial hyperpermeability. MAIN METHODS: The effects of ropivacaine on lung permeability were assessed in two models of acute hypertension (AH): the isolated perfused lung preparation where acute increases in left atrial pressure model the hemodynamic changes of severe hypertension, and an animal model of AH induced by norepinephrine...
February 26, 2019: Life Sciences
https://read.qxmd.com/read/30822171/pre-clinical-assessment-of-a-water-in-fluorocarbon-emulsion-for-the-treatment-of-pulmonary-vascular-diseases
#11
Scott K Ferguson, David I Pak, Justin L Hopkins, Julie W Harral, Katherine M Redinius, Zoe Loomis, Kurt R Stenmark, Mark A Borden, Thies Schroeder, David C Irwin
Hypoxic pulmonary vasoconstriction (HPV) is a well-characterized vascular response to low oxygen pressures and is involved in life-threatening conditions such as high-altitude pulmonary edema (HAPE) and pulmonary arterial hypertension (PAH). While the efficacy of oral therapies can be affected by drug metabolism, or dose-limiting systemic toxicity, inhaled treatment via pressured metered dose inhalers (pMDI) may be an effective, nontoxic, practical alternative. We hypothesized that a stable water-in-perfluorooctyl bromide (PFOB) emulsion that provides solubility in common pMDI propellants, engineered for intrapulmonary delivery of pulmonary vasodilators, reverses HPV during acute hypoxia (HX)...
December 2019: Drug Delivery
https://read.qxmd.com/read/30817356/concordance-between-registry-and-administrative-data-in-the-determination-of-comorbidity-a-multi-institutional-study
#12
David A Etzioni, Cynthia Lessow, Liliana G Bordeianou, Hiroko Kunitake, Sarah E Deery, Evie Carchman, Christina M Papageorge, George Fuhrman, Rachel V Seiler, James Ogilvie, Elizabeth B Habermann, Yu-Hui H Chang, Samuel R Money
MINI: We compared administrative data and National Surgical Quality Improvement Program data regarding the presence of 12 patient-level comorbidities. The level of disagreement between these data sources raises concerns regarding their ability to generate an accurate/unbiased estimate of patient-level risk. OBJECTIVE: To characterize agreement between administrative and registry data in the determination of patient-level comorbidities. BACKGROUND: Previous research finds poor agreement between these 2 types of data in the determination of outcomes...
February 16, 2019: Annals of Surgery
https://read.qxmd.com/read/30815050/normal-ventilation-perfusion-lung-scan-in-patients-with-extensive-chronic-thromboembolism-pulmonary-hypertension-a-case-report
#13
Alaa Alduraibi, Ahmed Fathala
Chronic thromboembolism pulmonary hypertension (CTEPH) is a common cause of severe pulmonary hypertension, resulting in significant morbidity and mortality. In patients with unexplained pulmonary hypertension, a ventilation-perfusion (VQ) scan should be considered the initial diagnostic test of choice. VQ scans are widely available with excellent sensitivity, specificity, and diagnostic accuracy. However, the occurrence of a normal VQ scan in the presence of CTEPH is believed to be rare. In fact, the rate of actual false negatives in VQ scans is unknown because pulmonary digital subtraction angiography and computed tomography pulmonary angiography are rarely performed in patients with a normal VQ scan...
April 2019: Radiology Case Reports
https://read.qxmd.com/read/30808080/acute-hemodynamic-changes-after-single-administration-of-udenafil-in-pulmonary-arterial-hypertension-a-phase-iia-study
#14
Sung A Chang, Hyung Kwan Kim, Hyuk Jae Chang, Duk Kyung Kim
BACKGROUND AND OBJECTIVES: Udenafil, a new phosphodiesterase-5 inhibitor (PDE5i), has been used to treat erectile dysfunction. Given the proven benefit of PDE5i in pulmonary arterial hypertension (PAH), we evaluated serial hemodynamic changes after single udenafil administration to determine the appropriate therapeutic dose. METHODS: Eighteen patients were randomly allocated into one of 3 groups: placebo, udenafil 50 mg (U50), and udenafil 100 mg (U100). Diagnosis for inclusion was idiopathic PAH or PAH associated with connective tissue disease...
December 10, 2018: Korean Circulation Journal
https://read.qxmd.com/read/30808072/chronic-thromboembolic-pulmonary-hypertension-endovascular-treatment
#15
REVIEW
Chul Min Ahn, Matsubara Hiromi
Chronic thromboembolic pulmonary hypertension (CTEPH) is a rare cause of pulmonary hypertension; less than 5% of pulmonary hypertension is caused by recurrent pulmonary thromboembolism (PTE). By definition, CTEPH happens within the first two years after symptomatic PTE; however, cases are often diagnosed without a history of acute PTE. Because of the poor functional status and chronicity of this disease, the classic and curative strategy of open pulmonary endarterectomy cannot be applied in some patients with lesions that involve the distal subsegmental pulmonary artery...
March 2019: Korean Circulation Journal
https://read.qxmd.com/read/30804801/circulating-apoptotic-signals-during-acute-and-chronic-exposure-to-high-altitude-in-kyrgyz-population
#16
Djuro Kosanovic, Simon Maximilian Platzek, Aleksandar Petrovic, Akylbek Sydykov, Abdirashit Maripov, Argen Mamazhakypov, Meerim Sartmyrzaeva, Kubatbek Muratali Uulu, Meerim Cholponbaeva, Aidana Toktosunova, Nazgul Omurzakova, Melis Duishobaev, Christina Vroom, Oleg Pak, Norbert Weissmann, Hossein Ardeschir Ghofrani, Akpay Sarybaev, Ralph Theo Schermuly
Background: Circulating apoptotic signals (CASs) have been described in the pathologies associated with dysregulated apoptosis, such as cancer, heart diseases, and pulmonary hypertension (PH). However, nothing is known about the expression profiles of these markers in the circulation of humans exposed to acute and chronic effects of high altitude (HA). Methods: Gene expression levels of different apoptotic signals (ASs) were analyzed in human pulmonary artery smooth muscle cells (PASMCs) upon hypoxia incubation...
2019: Frontiers in Physiology
https://read.qxmd.com/read/30789367/predictors-of-operability-in-children-with-severe-pulmonary-hypertension-associated-with-congenital-heart-disease
#17
Shi-Bing Xi, Shu-Shui Wang, Ming-Yang Qian, Yu-Mei Xie, Jun-Jie Li, Zhi-Wei Zhang
BACKGROUND: Pulmonary artery hypertension associated with congenital heart disease (PAH-CHD) occurs predominantly among patients with uncorrected CHD. Treatment of severe pediatric PAH-CHD remains a major intractability. This study evaluated the predictors and prognoses of children with PAH-CHD who underwent surgical correction. METHODS: The data for 59 children with severe PAH-CHD who underwent surgical correction, with or without postoperative medication between May 2011 and June 2015 at the Guangdong Provincial People's Hospital were analyzed retrospectively...
February 15, 2019: Chinese Medical Journal
https://read.qxmd.com/read/30788016/reversed-pulsus-paradoxus-in-right-ventricular-failure
#18
Maan Malahfji, Salman Arain
Reversed pulsus paradoxus was first described in 1973 as a rise in peak systolic pressure on inspiration in patients with idiopathic hypertrophic subaortic stenosis or isorhythmic ventricular rhythm and in patients with left ventricular systolic dysfunction on positive pressure ventilation. Positive pressure ventilation, for example, may impel blood from the pulmonary capillaries and venules into the left atrium. This may increase left ventricular preload and accelerate ventricular emptying, which in turn may cause the systolic arterial pressure to rise during inspiration...
October 2018: Methodist DeBakey Cardiovascular Journal
https://read.qxmd.com/read/30773522/acute-pulmonary-hypertension-crisis-after-adalimumab-reduction-in-rheumatoid-vasculitis
#19
Gentaro Yamasaki, Mitsumasa Okano, Kazuhiko Nakayama, Naoe Jimbo, Sho Sendo, Naoki Tamada, Kenta Misaki, Yuto Shinkura, Kenichi Yanaka, Hidekazu Tanaka, Kengo Akashi, Akio Morinobu, Hiroshi Yokozaki, Noriaki Emoto, Ken-Ichi Hirata
Rheumatoid vasculitis is a rare etiology for pulmonary hypertension (PH) in patients with connective tissue disease. We encountered a case of acute PH crisis in a case with rheumatoid vasculitis eight months after undergoing adalimumab reduction. Since no repetition of arthralgia occurred after the adalimumab reduction, we decided to not increase the dose of adalimumab. However, hemodynamic collapse thereafter developed and even though steroid pulse therapy was administered, the patient nevertheless died. The autopsy showed clusters of acute and chronic inflammation around the remodeled pulmonary arteries along with micro-thrombi in the vessel lumen...
2019: Internal Medicine
https://read.qxmd.com/read/30767723/increased-healthcare-associated-infections-in-a-surgical-intensive-care-unit-related-to-boarding-non-surgical-patients
#20
Edward K Len, Ritesh Akkisetty, Sandia Royal, Maryanne Brooks, Susette Coyle, Rajan Gupta, Matthew Lissauer
BACKGROUND: Hospital over-capacity often forces boarding patients outside of their designated intensive care unit (ICU). Anecdotal evidence suggested medical intensive care unit (MICU) patients boarding in the surgical intensive care unit (SICU) were responsible for increases in healthcare-associated infection (HAI) rates. We studied the effect of ICU boarding on rates of SICU HAIs. METHODS: This single-center, retrospective two-year database study compared primary SICU patients (Home) to MICU patients boarding in the SICU (Boarders)...
February 15, 2019: Surgical Infections
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