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Loop diuretic, heart failure

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https://www.readbyqxmd.com/read/28902380/-organ-interactions-heart-and-kidney
#1
Daniel Salleck, Stefan John
The interactions between heart and kidney are various and of clinical relevance. Worsening of one organ often influences the function of the other. With NYHA and KDIGO we have classification systems for heart and kidney failure and those should be used for cardiorenal systems as well. Furthermore there is a useful classification system for cardiorenal syndromes itself. Cardiorenal syndrome is a complex illness which should be treated by interdisciplinary medical teams. A key roll in pathophysiology is the renin-angiotensin-aldosteron-system (RAAS)...
September 2017: Deutsche Medizinische Wochenschrift
https://www.readbyqxmd.com/read/28874938/availability-and-accuracy-of-ems-information-about-chronic-health-and-medications-in-cardiac-arrest
#2
Alexander Foster, Victor Florea, Carol Fahrenbruch, Jennifer Blackwood, Thomas D Rea
INTRODUCTION: Field information available to emergency medical services (EMS) about a patient's chronic health conditions or medication therapies could help direct patient care or be used to investigate outcome disparities. However, little is known about the field availability or accuracy of information of chronic health conditions or chronic medication treatments in emergent circumstances, especially when the patient cannot serve as an information resource. We evaluated the prehospital availability and accuracy of specific chronic health conditions and medication treatments among out-of-hospital cardiac arrest (OHCA) patients...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28865801/approach-to-acute-heart-failure-in-the-emergency-department
#3
REVIEW
Benton R Hunter, Jennifer Martindale, Osama Abdel-Hafez, Peter S Pang
Acute heart failure (AHF) patients rarely present complaining of 'acute heart failure.' Rather, they initially present to the emergency department (ED) with a myriad of chief complaints, symptoms, and physical exam findings. Such heterogeneity prompts an initially broad differential diagnosis; securing the correct diagnosis can be challenging. Although AHF may be the ultimate diagnosis, the precipitant of decompensation must also be sought and addressed. For those AHF patients who present in respiratory or circulatory failure requiring immediate stabilization, treatment begins even while the diagnosis is uncertain...
August 30, 2017: Progress in Cardiovascular Diseases
https://www.readbyqxmd.com/read/28835976/-medicinal-treatment-of-tricuspid-valve-regurgitation
#4
REVIEW
M Lankeit, K Keller, C Tschöpe, B Pieske
The vast majority of tricuspid valve regurgitations are of low degree without prognostic relevance in healthy individuals; however, morbidity and mortality increase with the degree of regurgitation, which can be secondary to either primary (structural) or secondary (functional) alterations of the valve. Due to the frequent lack of symptoms, echocardiographic examinations should be annually performed in patients with higher degree (at least moderate) tricuspid valve regurgitation, in particular in the presence of risk factors...
August 23, 2017: Herz
https://www.readbyqxmd.com/read/28834858/diuretic-resistance-in-acute-decompensated-heart-failure-a-challenging-clinical-conundrum
#5
Brent N Reed, Sandeep Devabhakthuni
Most patients with acute decompensated heart failure (ADHF) present with signs and symptoms of volume overload, and those with a significant history of diuretic exposure may demonstrate varying degrees of diuretic resistance. Although this phenomenon is commonly reported, no consensus definition exists and recommendations regarding an optimal therapeutic approach remain limited. Optimizing the use of intravenous (IV) loop diuretic therapy is the most common initial approach, and therapy may be augmented by the addition of a thiazide-type diuretic or an IV vasodilator...
October 2017: Critical Care Nursing Quarterly
https://www.readbyqxmd.com/read/28763374/the-veterans-affairs-cardiac-risk-score-recalibrating-the-atherosclerotic-cardiovascular-disease-score-for-applied-use
#6
Jeremy B Sussman, Wyndy L Wiitala, Matthew Zawistowski, Timothy P Hofer, Douglas Bentley, Rodney A Hayward
BACKGROUND: Accurately estimating cardiovascular risk is fundamental to good decision-making in cardiovascular disease (CVD) prevention, but risk scores developed in one population often perform poorly in dissimilar populations. We sought to examine whether a large integrated health system can use their electronic health data to better predict individual patients' risk of developing CVD. METHODS: We created a cohort using all patients ages 45-80 who used Department of Veterans Affairs (VA) ambulatory care services in 2006 with no history of CVD, heart failure, or loop diuretics...
September 2017: Medical Care
https://www.readbyqxmd.com/read/28739647/compensatory-distal-reabsorption-drives-diuretic-resistance-in-human-heart-failure
#7
Veena S Rao, Noah Planavsky, Jennifer S Hanberg, Tariq Ahmad, Meredith A Brisco-Bacik, Francis P Wilson, Daniel Jacoby, Michael Chen, W H Wilson Tang, David Z I Cherney, David H Ellison, Jeffrey M Testani
Understanding the tubular location of diuretic resistance (DR) in heart failure (HF) is critical to developing targeted treatment strategies. Rodents chronically administered loop diuretics develop DR due to compensatory distal tubular sodium reabsorption, but whether this translates to human DR is unknown. We studied consecutive patients with HF (n=128) receiving treatment with loop diuretics at the Yale Transitional Care Center. We measured the fractional excretion of lithium (FELi), the gold standard for in vivo assessment of proximal tubular and loop of Henle sodium handling, to assess sodium exit after loop diuretic administration and FENa to assess the net sodium excreted into the urine...
July 24, 2017: Journal of the American Society of Nephrology: JASN
https://www.readbyqxmd.com/read/28735756/incidence-and-determinants-of-hyperkalemia-and-hypokalemia-in-a-large-healthcare-system
#8
Erik Nilsson, Alessandro Gasparini, Johan Ärnlöv, Hairong Xu, Karin M Henriksson, Josef Coresh, Morgan E Grams, Juan Jesus Carrero
BACKGROUND: Hypo- and hyperkalemia in clinical settings are insufficiently characterized and large-scale data from Europe lacking. We studied incidence and determinants of these abnormalities in a large Swedish healthcare system. METHODS: Observational study from the Stockholm CREAtinine Measurements project, including adult individuals from Stockholm accessing healthcare in 2009 (n=364,955). Over 3-years, we estimated the incidence of hypokalemia, defined as potassium<3...
July 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28728476/a-perspective-on-diuretic-resistance-in-chronic-congestive-heart-failure
#9
Niel Shah, Raef Madanieh, Mehmet Al Kan, Muhammad U Dogar, Constantine E Kosmas, Timothy J Vittorio
Chronic congestive heart failure (CHF) is a complex disorder characterized by inability of the heart to keep up the demands on it, followed by the progressive pump failure and fluid accumulation. Although the loop diuretics are widely used in heart failure (HF) patients, both pharmacodynamic and pharmacokinetic alterations are thought to be responsible for diuretic resistance in these patients. Strategies to overcome diuretic resistance include sodium intake restriction, changes in diuretic dose and route of administration and sequential nephron diuretic therapy...
July 1, 2017: Therapeutic Advances in Cardiovascular Disease
https://www.readbyqxmd.com/read/28711449/intrarenal-flow-alterations-during-transition-from-euvolemia-to-intravascular-volume-expansion-in-heart-failure-patients
#10
Petra Nijst, Pieter Martens, Matthias Dupont, W H Wilson Tang, Wilfried Mullens
OBJECTIVES: The goal of this study was to assess: 1) the intrarenal flow in heart failure (HF) patients during the transition from euvolemia to intravascular volume overload; and 2) the relationship between intrarenal flow and diuretic efficiency. BACKGROUND: Intrarenal blood flow alterations may help to better understand impaired volume handling in HF. METHODS: Resistance index (RI) and venous impedance index (VII) were assessed in 6 healthy subjects, 40 euvolemic HF patients with reduced ejection fraction (HFrEF) and 10 HF patients with preserved ejection fraction (HFpEF)...
July 6, 2017: JACC. Heart Failure
https://www.readbyqxmd.com/read/28701888/pharmacological-treatment-of-heart-failure-with-preserved-ejection-fraction
#11
REVIEW
Kazuhiro Yamamoto
Heart failure with preserved ejection fraction is a socioeconomic burden in Japan as well as other developed countries. Diuretics are widely used to attenuate symptoms and signs of congestion in both heart failure with preserved and reduced ejection fraction, although their effects on long-term prognosis of both phenotypes of heart failure have not been demonstrated because of an ethical difficulty in designing a randomized and prospective clinical trial. Guidelines do not provide any guidance on therapy choice, and physicians blindly choose furosemide among loop diuretics in current clinical settings...
June 2017: Yonago Acta Medica
https://www.readbyqxmd.com/read/28688888/observation-of-patients-transitioned-to-an-oral-loop-diuretic-before-discharge-and-risk-of-readmission-for-acute-decompensated-heart-failure
#12
Benjamin Laliberte, Brent N Reed, Sandeep Devabhakthuni, Kristin Watson, Vijay Ivaturi, Tao Liu, Stephen S Gottlieb
BACKGROUND: Heart failure (HF) is associated with high 30-day readmission rates and places significant financial burden on the health care system. The aim of this study was to determine if the duration of observation on an oral loop diuretic before discharge is associated with a reduction in 30-day HF readmission in patients with acute decompensated HF (ADHF). METHODS AND RESULTS: This was a retrospective study of adult patients admitted for ADHF at a large academic medical center...
July 5, 2017: Journal of Cardiac Failure
https://www.readbyqxmd.com/read/28645802/comparative-effects-of-long-and-short-acting-loop-diuretics-on-mortality-in-patients-with-chronic-heart-failure
#13
Shu Kasama, Takuji Toyama, Masahiko Kurabayashi
BACKGROUND: We previously reported that the long-acting loop diuretic azosemide improves cardiac sympathetic nerve activity (CSNA) in patients with chronic heart failure (CHF), compared with short-acting furosemide. However, its influence on mortality has not been determined. METHODS: The present study was a further analysis of our previously published study in which azosemide showed improved (123)I-metaiodobenzylguanidine scintigraphic findings compared with furosemide in CHF patients with reduced left ventricular ejection fraction (LVEF)...
June 15, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28641794/time-to-furosemide-treatment-and-mortality-in-patients-hospitalized-with-acute-heart-failure
#14
MULTICENTER STUDY
Yuya Matsue, Kevin Damman, Adriaan A Voors, Nobuyuki Kagiyama, Tetsuo Yamaguchi, Shunsuke Kuroda, Takahiro Okumura, Keisuke Kida, Atsushi Mizuno, Shogo Oishi, Yasutaka Inuzuka, Eiichi Akiyama, Ryuichi Matsukawa, Kota Kato, Satoshi Suzuki, Takashi Naruke, Kenji Yoshioka, Tatsuya Miyoshi, Yuichi Baba, Masayoshi Yamamoto, Koji Murai, Kazuo Mizutani, Kazuki Yoshida, Takeshi Kitai
BACKGROUND: Acute heart failure (AHF) is a life-threatening disease requiring urgent treatment, including a recommendation for immediate initiation of loop diuretics. OBJECTIVES: The authors prospectively evaluated the association between time-to-diuretic treatment and clinical outcome. METHODS: REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure) was a prospective, multicenter, observational cohort study that primarily aimed to assess the association between time to loop diuretic treatment and clinical outcome in patients with AHF admitted through the emergency department (ED)...
June 27, 2017: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/28633650/effects-of-tolvaptan-in-patients-with-acute-heart-failure-a-systematic-review-and-meta-analysis
#15
Chunbin Wang, Bo Xiong, Lin Cai
BACKGROUND: Acute heart failure, which requires urgent evaluation and treatment, is a leading cause for admission to the emergency department. The aim of this meta-analysis was to evaluate the effects of tolvaptan on acute heart failure and compare them with the effects of conventional therapy or placebo. METHODS: The electronic databases PubMed, EMBASE, and the Cochrane Controlled Trial registry were searched from their starting dates to October 24, 2016. Two authors independently read the trials and extracted related information from the included studies...
June 20, 2017: BMC Cardiovascular Disorders
https://www.readbyqxmd.com/read/28633477/loop-diuretics-for-chronic-heart-failure-a-foe-in-disguise-of-a-friend
#16
Chris J Kapelios, Konstantinos Malliaras, Elisabeth Kaldara, Stella Vakrou, John N Nanas
Loop diuretics are recommended for relieving symptoms and signs of congestion in patients with chronic heart failure and are administered to more than 80% of them. However, several of their effects have not systematically been studied. Numerous cohort and four interventional studies have addressed the effect of diuretics on renal function; apart from one prospective study, which showed that diuretics withdrawal is accompanied by increase in some markers of early-detected renal injury, all others converge to the conclusion that diuretics receipt, especially in high doses is associated with increased rates of renal dysfunction...
June 19, 2017: European Heart Journal. Cardiovascular Pharmacotherapy
https://www.readbyqxmd.com/read/28602369/heart-failure-complicating-acute-mtyocardial-infarction
#17
REVIEW
Wilbert S Aronow
Factors predisposing the older person with acute myocardial infarction (MI) to develop heart failure (HF) include an increased prevalence of MI, multivessel coronary artery disease, decreased left ventricular (LV) contractile reserve, impairment of LV diastolic relaxation, increased hypertension, LV hypertrophy, diabetes mellitus, valvular heart disease, and renal insufficiency. HF associated with acute MI should be treated with a loop diuretic. The use of nitrates, angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, aldosterone antagonists, beta-blockers, digoxin, and positive inotropic drugs; treatment of arrhythmias and mechanical complications; and indications for use of implantable cardioverter-defibrillators and cardiac resynchronization is discussed...
July 2017: Heart Failure Clinics
https://www.readbyqxmd.com/read/28597798/ultrafiltration-versus-intravenous-loop-diuretics-in-patients-with-acute-decompensated-heart-failure-a-meta-analysis-of-clinical-trials
#18
Mohamad Kabach, Hassan Alkhawam, Sachil Shah, Georges Joseph, Elie M Donath, Noah Moss, Robert S Rosenstein, Robert Chait
Background Intravenous loop diuretics are the first-line therapy for acute decompensated heart failure (ADHF) but many patients are discharged with unresolved congestion resulting in higher re-hospitalization and mortality rates. Ultrafiltration (UF) is a promising intervention for ADHF. However, studies comparing UF to diuretics have been inconsistent in their clinical outcomes. Methods A comprehensive literature search was performed. Trials were included if they met the following criteria: (1) randomization with a control group, (2) comparison of UF with a loop diuretic, and (3) a diagnosis of ADHF...
April 2017: Acta Cardiologica
https://www.readbyqxmd.com/read/28572743/design-and-rationale-of-the-high-sensitivity-troponin-t-rules-out-acute-cardiac-insufficiency-trial
#19
Benton R Hunter, Sean P Collins, Gregory J Fermann, Phillip D Levy, Changyu Shen, Syed Imran Ayaz, Mette L Cole, Karen F Miller, Adam A Soliman, Peter S Pang
BACKGROUND: Acute heart failure (AHF) is a common presentation in the Emergency Department (ED), and most patients are admitted to the hospital. Identification of patients with AHF who have a low risk of adverse events and are suitable for discharge from the ED is difficult, and an objective tool would be useful. METHODS: The highly sensitive Troponin T Rules Out Acute Cardiac Insufficiency Trial (TACIT) will enroll ED patients being treated for AHF. Patients will undergo standard ED evaluation and treatment...
2017: Pragmatic and Observational Research
https://www.readbyqxmd.com/read/28552097/community-acquired-staphylococcus-aureus-bacteremia-studies-of-risk-and-prognosis-with-special-attention-to-diabetes-mellitus-and-chronic-heart-failure
#20
Jesper Smit
Community-acquired Staphylococcus aureus bacteremia (CA-SAB) is a serious infection with detrimental clinical effects. Chronic diseases constitute some of the most important risk and prognostic factors for CA-SAB. The prevalence of diabetes and chronic heart failure (CHF) is rapidly increasing on a global scale, nevertheless, there are few data available specifically elucidating the influence of these chronic conditions on CA-SAB risk and outcome. Therefore, to extend the current knowledge, we aimed to I) elucidate the impact of different definitions of healthcare-associated (HCA) infection on the prevalence of HCA-SAB, patient characteristics, and mortality, II) to investigate whether diabetes is a risk factor for CA-SAB, III) to ascertain the prognostic influence of diabetes on CA-SAB outcome, and IV) to investigate the influence of CHF on mortality in patients with CA-SAB...
May 2017: Danish Medical Journal
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