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stroke with hypokalaemia

Nick Mattsson, Golnaz Sadjadieh, Preman Kumarathurai, Olav Wendelboe Nielsen, Lars Køber, Ahmad Sajadieh
AIMS: Severe hypokalaemia can aggravate arrhythmia tendency and prognosis, but less is known about risk of mild hypokalaemia, which is a frequent finding. We examined the associations between mild hypokalaemia and ambulatory cardiac arrhythmias and their prognosis. METHODS AND RESULTS: Subjects from the cohort of the 'Copenhagen Holter Study' (n = 671), with no history of manifest cardiovascular (CV) disease or stroke, were studied. All had laboratory tests and 48-h ambulatory electrocardiogram (ECG) recording...
April 2016: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
Chien-Min Chen, Chia-Hao Chang, Hung-Chih Hsu, Chu-Hsu Lin, Kai-Hua Chen
OBJECTIVE: To investigate the predictors of total medical costs for first-ever ischaemic stroke patients transferred to the rehabilitation ward from the acute ward. PATIENTS: A total of 311 first-ever ischaemic stroke patients (mean age 68.9 (standard deviation (SD) 12.2) years). METHODS: Data, including common complications and medical events, from July 2002 to June 2012 were collected retrospectively from a regional hospital in Taiwan in order to study the potential predictors for medical costs...
February 2015: Journal of Rehabilitation Medicine
Tadanori Hamano, Tomoko Yamamoto, Isamu Miyamori, Masaru Kuriyama
We report here an 83-year-old woman presenting with somnolence possibly induced by indapamide. She was diagnosed as having hypertension (180/110 mmHg), and 1 mg/day of indapamide was administered starting in October, 2002. Two months later, she complained of nausea, vomiting, and appetite loss and frequently fell down. On admission, she was hypotensive (90/54 mmHg). Neurologically, she was in a somnolent state (Japan Coma Scale 2-20), and showed brisk deep tendon reflexes of both upper limbs with bilateral Chaddock signs...
January 2008: Rinshō Shinkeigaku, Clinical Neurology
S Boveda, M Galinier, P Lagrange, M Delay, P Massabuau, B Dongay, N Prouteau, J Marti, J M Fauvel, J P Bounhoure
Half of all deaths occurring in patients with heart failure are sudden deaths probably related to a malignant ventricular arrhythmia. The pathophysiological mechanisms of these arrhythmias are unclear, but left ventricular function, hypokalaemia accentuated by diuretics and treatments altering inotropism play a definite role. Because of the diversity of aetiologies generating heart failure, the multiplicity of fatal arrhythmias and the multifactorial origin of these arrhythmias, there is no formal marker for the risk of sudden death in patients with heart failure, at the present time...
April 1999: Annales de Cardiologie et D'angéiologie
Knud Landmark
BACKGROUND: Hypokalaemia is known to precipitate cardiac arrhythmias. Hypokalaemia can also give rise to adverse cardiovascular effects not related to arrhythmias. MATERIAL AND METHODS: This article presents an evaluation of the relevant literature describing adverse effects of hypokalaemia and beneficial effects of potassium supplementation on cerebrovascular and cardiovascular disease. RESULTS AND INTERPRETATION: Diuretics-induced hypokalaemia may offset the beneficial effects of blood pressure reduction on cardiovascular events...
February 20, 2002: Tidsskrift for Den Norske Lægeforening: Tidsskrift for Praktisk Medicin, Ny Række
P M Stewart
Hypertension with hypokalaemia and suppression of plasma renin activity is known as mineralocorticoid hypertension. Although mineralocorticoid hypertension accounts for a small number of patients labelled as having "essential" hypertension, it is a potentially reversible cause of high blood pressure. The most common cause of mineralocorticoid hypertension is probably primary aldosteronism; controlled posture studies to measure plasma renin activity and aldosterone concentrations, followed by adrenal imaging, will ensure the differential diagnosis between an aldosterone-producing adenoma and idiopathic adrenal hyperplasia in most cases...
April 17, 1999: Lancet
M F Wong, N M Chin, T W Lew
Diabetes insipidus (DI) is an uncommon but important complication in the neurosurgical population. This retrospective study aimed to determine the incidence, profile and outcome of patients admitted to an 18-bedded neurosurgical intensive care unit who developed DI. The overall incidence was 3.7% (29/792 admissions). Aetiologies included subarachnoid haemorrhage (12/29), severe head injury (11/29), post-surgical excision of craniopharyngioma or pituitary adenoma (5/29) and acute haemorrhagic stroke (1/29). All patients were treated with a regime of fluid replacement, electrolyte correction, parenteral or intranasal desmopressin (DDAVP), or parenteral pitressin...
May 1998: Annals of the Academy of Medicine, Singapore
S C Reimold
To minimize drug problems in the treatment of supraventricular tachycardias, it is important to understand the spectrum of adverse events and to identify patients at high risk for these problems. Adverse cardiac and non-cardiac effects are associated, to varying degrees, with currently available antiarrhythmics. Cardiac adverse events include the development of rhythm disturbances, such as ventricular tachycardia or torsades des pointes, may result in syncope or death. In a meta-analysis of six randomized trials of quinidine vs placebo for atrial fibrillation, 1...
May 1997: European Heart Journal
M Stowasser, A W Bachmann, J R Jonsson, T J Tunny, S A Klemm, R D Gordon
1. Early diagnosis of Familial Hyperaldosteronism Type I (FH-I, glucocorticoid-suppressible hyperaldosteronism) in asymptomatic, affected individuals is essential if death from stroke is to be prevented. 2. In 21 patients with FH-I (presence of the causative hybrid 11 beta-hydroxylase/aldosterone synthase gene confirmed by Southern blot testing), various biochemical parameters were compared as possible screening tests. Hypokalaemia and elevated plasma aldosterone each detected only two (10%) of the affected individuals...
June 1995: Clinical and Experimental Pharmacology & Physiology
G T McInnes, P F Semple
Patients with mild to moderate hypertension require only a simple schedule of investigations, especially if there is a history of stroke or hypertension in first degree relatives. Tests are necessary to profile other cardiovascular risk factors and to detect target organ damage with only limited screening for secondary hypertension. Careful history, physical examination, repeated blood pressure measurements over months and measurements of body mass index, random cholesterol, routine blood chemistry and urinalysis using impregnated paper strips are all that are required...
April 1994: British Medical Bulletin
L E Ramsay, W W Yeo, P R Jackson
Hypokalaemia, hyperuricaemia, hypomagnesaemia and alterations to lipid and glucose metabolism undoubtedly occur with loop and thiazide diuretic treatment. Many of the metabolic effects induced by thiazide diuretics, however, can be limited by the use of low doses. Apart from precipitation of gout and worsening control of diabetes the clinical importance of these changes is slight. In hypertensive patients treated with diuretics, long-term outcome trials have shown significant benefit in terms of reduction in stroke and coronary events...
1994: Cardiology
D B Morgan, R M Young
An investigation of 70 unselected hospital inpatients with a plasma potassium of 2.8 mmol/l or less showed that the group contained an excess of women and of the elderly. In nearly half the patients no attempt had been made to correct the hypokalaemia with potassium supplements. 26 of the patients had been recently admitted with an acute medical condition, including stroke and myocardial infarction. Those in this group whose plasma potassium was measured again showed that plasma potassium rose to near or within the normal range in about 4 days, whether or not oral potassium supplements were given...
October 2, 1982: Lancet
R O Davies, H J Gomez, J D Irvin, J F Walker
Enalapril maleate is a prodrug which when administered orally is hydrolysed to release the active converting enzyme inhibitor enalaprilat. Enalapril maleate is 60% absorbed and 40% bioavailable as enalaprilat. Both compounds undergo renal excretion without further metabolism. The functional half-life for accumulation of enalaprilat is 11 h, and this is increased in the presence of a reduction in renal function. Inhibition of converting enzyme inhibition is associated with reductions in plasma angiotensin II and plasma aldosterone, and with increases in plasma renin activity and plasma angiotensin I...
1984: British Journal of Clinical Pharmacology
R Canepa-Anson, J R Dawson, P Kuan, P A Poole-Wilson, G C Sutton, B Cockrill, S R Reuben
The metabolic, hormonal and haemodynamic effects of oral pirbuterol, a new beta 2-adrenoceptor agonist, were studied acutely (n = 19) and after 3 months treatment (n = 11) in patients with severe heart failure receiving chronic frusemide therapy. In the acute study fasted patients (n = 10) showed reductions in plasma K+ (P less than 0.005) and cortisol (P less than 0.01) and increases in plasma glucose (P less than 0.005), insulin (P less than 0.01), lactate (P less than 0.005) and pyruvate (P less than 0.0025)...
February 1987: British Journal of Clinical Pharmacology
C J Bulpitt, P F Bulpitt, M Daymond, K Hartley, C T Dollery
The survival has been determined for the 404 patients who presented to the Hammersmith Hospital Hypertension Clinic during the years 1962 to 1966 and in whom the untreated blood pressure was known. The fifteen year survival ranged from 72% for young men aged 30-49 at presentation to 27% for men aged 60-69. Sixty-eight percent of the deaths were cardiovascular or renal, 33% of all deaths were from ischaemic heart disease (IHD), 17% from stroke and 3% from renal causes. Death from any cause was predicted with statistical significance by age, the presence of accelerated or malignant hypertension, impaired renal function, smoking at presentation and systolic blood pressure...
May 1986: Postgraduate Medical Journal
C G Isles, L M Walker, G D Beevers, I Brown, H L Cameron, J Clarke, V Hawthorne, D Hole, A F Lever, J W Robertson
The mortality of 3783 non-malignant hypertensive patients attending the Glasgow Blood Pressure Clinic between 1968 and 1983 and followed for an average of 6.5 years was compared with that in three control groups: the general population of Strathclyde a group of 15 422 subjects aged 45-64 years and screened in Renfrew and Paisley between 1972 and 1976, and a group of hypertensives seen in a blood pressure clinic based on general practice in Renfrew. Average blood pressure for men at entry to the Glasgow Clinic was 181/111 mmHg falling to 158/96 mmHg during treatment...
April 1986: Journal of Hypertension
H J Gomez, V J Cirillo, J D Irvin
Enalapril, an orally-active, long-acting, nonsulphydryl angiotensin-converting enzyme (ACE) inhibitor, is extensively hydrolysed in vivo to enalaprilat, its bioactive form. Bioactivation probably occurs in the liver. Metabolism beyond activation to enalaprilat is not observed in man. Administration with food does not affect the bioavailability of enalapril; excretion of enalapril and enalaprilat is primarily renal. Peak serum enalaprilat concentrations are reached 4 hours post-dose, and the profile is polyphasic with a prolonged terminal half-life (greater than 30 hours) due to the binding of enalaprilat to ACE...
1985: Drugs
M K Tham, J Cheng, K M Fock
Heat stroke is the most serious entity amongst the heat disorders. Whilst potentially fatal, it is preventable and salvageable. A retrospective study involving 27 patients admitted for exertional heat stroke to the Medical Unit, Toa Payoh Hospital, Singapore from January, 1984 to January, 1987 was carried out. These patients presented with a rectal temperature of greater than 40 degrees C and central nervous system disturbances. All were males and, except for three, were local born. All except two were below thirty years old...
April 1989: Singapore Medical Journal
A Fletcher, A Amery, W Birkenhäger, C Bulpitt, D Clement, P de Leeuw, M L Deruyterre, A de Schaepdryver, C Dollery, R Fagard
Hypertensive patients over the age of 60 years were admitted to a double-blind placebo-controlled trial. Patients in the actively treated group received a combined potassium-losing and -sparing diuretic (triamterene 50 mg plus hydrochlorothiazide 25 mg; n = 416); this dose could be doubled and methyldopa (up to 2 g, daily) was added in 35% of patients when blood pressure remained high. The placebo group (n = 424) received matching capsules and tablets. Adverse effects were assessed in the double-blind period of the trial by calculating the incidence of abnormal biochemical results, investigator reports of diseases and prescriptions of concomitant therapy and a self-administered symptom questionnaire completed by patients...
March 1991: Journal of Hypertension
A Hoey, A Page, L Brown, R B Atwell
Injection of triiodothyronine (T3) (1 mg/kg per day subcutaneously for 14 days) to 10 healthy dogs produced a hyperthyroid state characterised by high serum T3 concentrations, hypokalaemia, hyperactivity, loss of weight, diarrhoea and thirst. Electrocardiographic measurements showed that these dogs had an increase in heart rate of 63 +/- 11 beats/min with a significantly increased T wave amplitude without changes in R wave amplitude. Echocardiographic measurements showed no changes in fractional shortening and no evidence of ventricular hypertrophy, in contrast to reports in humans, cats and rats...
November 1991: Australian Veterinary Journal
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