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https://www.readbyqxmd.com/read/27904524/integration-of-medical-therapy-and-mechanical-circulatory-support-in-the-management-of-acute-heart-failure
#1
Patrick Horn, Malte Kelm, Ralf Westenfeld
Acute heart failure is still characterized by poor prognosis with high mortality. Diagnosis is based on clinical symptoms and hemodynamic measurements. Early coronary revascularization in cardiogenic shock complicating myocardial infarction improves outcome. The further contemporary therapeutic options in the management of acute heart failure are limited to a merely symptomatic effect with relief of dyspnea, reduction of volume overload and improvement of hemodynamic parameters by vasodilators (in hypertension) or inotropic and vasopressor agents (in hypotension)...
December 1, 2016: Archives of Medical Science: AMS
https://www.readbyqxmd.com/read/27809354/shock-associated-with-endothelial-dysfunction-in-omental-microvessels
#2
Lewis B Somberg, David D Gutterman, Miura Hiroto, Raminder Nirula, Ossama A Hatoum
BACKGROUND: Impaired microvascular function leads to a poor outcome in a variety of medical conditions. Our aim was to determine if vasodilator responses to acetylcholine (Ach) are impaired in human omental arterioles from patients with severe trauma. MATERIALS AND METHODS: Patients with massive blood loss and severe shock requiring damage control procedures were included. Tissues was collected at the first (FEL) and the second explorative laparotomy (SEL). Control tissues were collected from non-trauma patients...
November 2, 2016: European Journal of Clinical Investigation
https://www.readbyqxmd.com/read/27787407/vasodilators-in-septic-shock-resuscitation-a-clinical-perspective
#3
Thiago Domingos Corrêa, Roberto Rabello Filho, Murillo Santucci Cesar Assunção, Eliézer Silva, Alexandre Lima
Microcirculatory abnormalities have been shown to be frequent in patients with septic shock despite "normalization" of systemic hemodynamics. Several studies have explored the impact of vasodilator therapy (prostacyclin, inhaled nitric oxide, topic acetylcholine and nitroglycerin) on microcirculation and tissue perfusion, with contradictory findings.In this narrative review, we briefly present the pathophysiological aspects of microcirculatory dysfunction, and depict the evidence supporting the use of vasodilators and other therapeutic interventions (fluid administration, blood transfusion, vasopressors and dobutamine) aiming to improve the microcirculatory flow in septic shock patients...
October 26, 2016: Shock
https://www.readbyqxmd.com/read/27776076/extracellular-elevation-of-adrenomedullin-a-gene-associated-with-schizophrenia-suppresses-heat-shock-protein-1a-1b-mrna
#4
Zhilei Zhao, Seiichiro Jinde, Chihiro Kakiuchi, Kiyoto Kasai
Several recent gene expression studies on schizophrenia, including one using monozygotic twins discordant for the disease, have reported the upregulation of adrenomedullin (ADM), which was initially identified as a vasodilator hormone. It has been hypothesized that upregulation of ADM may be a susceptibility factor for schizophrenia, although the exact role of ADM in the central nervous system remains unclear. In this study, we used a microarray analysis to investigate the changes in global gene expression induced by the administration of exogenous ADM in SK-N-SH cells, which allowed us to evaluate the effects of elevated ADM on the central nervous system...
October 21, 2016: Neuroreport
https://www.readbyqxmd.com/read/27770520/changes-of-endothelin-1-content-and-blood-rheological-properties-in-crush-syndrome
#5
N Gamkrelidze, N Pavliashvili, R Otarashvili
This study describes hematocrit values and quantitative changes in plasma endothelin-1 (ET-1) levels according to the severity of crush syndrome (CS) compression and decompression periods. The experiments were carried out on 50 randomly selected 200-250 gr mass Wistar rats with the use of the standard crush syndrome modeling method. The plasma level of ET-1 was determined by the immuneenzyme method with the use of ELISA REDEAR URIT 660. Hematocrit was determined using the standard method and measured according to tube column divisions...
September 2016: Georgian Medical News
https://www.readbyqxmd.com/read/27760056/experimental-study-on-the-efficacy-of-site-specific-pegylated-human-serum-albumins-in-resuscitation-from-hemorrhagic-shock
#6
Xinlei Song, Shu Zhang, Yanna Cheng, Ting Zhao, Qianqian Lian, Lu Lu, Fengshan Wang
OBJECTIVES: To evaluate the resuscitative efficacy and the effect on reperfusion injury of two site-specific PEGylated human serum albumins modified with linear or branched PEG20kDa, compared with saline, 8% human serum albumin and 25% human serum albumin, in a hemorrhagic shock model. SETTING: Laboratory. SUBJECTS: Male Wistar rats. DESIGN: Prospective study. INTERVENTIONS: Rats were bled to hemorrhagic hypovolemic shock and resuscitated with different resuscitation fluids...
November 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27713887/new-role-of-biomarkers-mid-regional-pro-adrenomedullin-the-biomarker-of-organ-failure
#7
REVIEW
Francisco Valenzuela-Sánchez, Blanca Valenzuela-Méndez, Juan Francisco Rodríguez-Gutiérrez, Ángel Estella-García, María Ángela González-García
Mid-regional pro-adrenomedullin (MR-proADM) has a good biomarker profile: its half-life is several hours, and its plasma concentrations can be determined in clinical practice, it is essentially irrelevant, but proportionally represents the levels and activity of adrenomedullin (ADM). ADM synthesis is widely distributed in tissues, including bone, adrenal cortex, kidney, lung, blood vessels and heart. Its fundamental biological effects include vasodilator, positive inotropic, diuretic, natriuretic and bronchodilator...
September 2016: Annals of Translational Medicine
https://www.readbyqxmd.com/read/27638027/takotsubo-syndrome-scientific-basis-for-current-treatment-strategies
#8
REVIEW
Elmir Omerovic
Takotsubo syndrome (TS) is characterized by severe reversible left ventricular (LV) wall motion abnormality in the absence of explanatory coronary lesion. Despite an increasing number of patients diagnosed with TS worldwide, there are no randomized clinical trials. In mild cases, no treatment or a short course of limited anticoagulation therapy may be sufficient. Positive inotropic and vasodilating agents should be avoided. In severe cases with refractory cardiogenic shock, early treatment with mechanical support using venoarterial extracorporeal membrane oxygenation or a LV assist device should be considered...
October 2016: Heart Failure Clinics
https://www.readbyqxmd.com/read/27614253/bacterial-toxins-activation-of-abbreviated-urea-cycle-in-porcine-cerebral-vascular-smooth-muscle-cells
#9
Rajesh G Mishra, Tzu-Ling Tseng, Mei-Fang Chen, Po-Yi Chen, Tony J-F Lee
Nitric oxide (NO) overproduction via induction of inducible nitric oxide synthase (iNOS) is implicated in vasodilatory shock in sepsis, leading to septic encephalopathy and accelerating cerebral ischemic injury. An abbreviated urea-cycle (L-citrulline-L-arginine-NO cycle) has been demonstrated in cerebral perivascular nitrergic nerves and endothelial cells but not in normal cerebral vascular smooth muscle cell (CVSMC). This cycle indicates that argininosuccinate synthase (ASS) catalyzes L-citrulline (L-cit) conversion to form argininosuccinate (AS), and subsequent AS cleavage by argininosuccinate lyase (ASL) forms L-arginine (L-arg), the substrate for NO synthesis...
September 7, 2016: Vascular Pharmacology
https://www.readbyqxmd.com/read/27600825/25-hydroxycholesterol-impairs-endothelial-function-and-vasodilation-by-uncoupling-and-inhibiting-endothelial-nitric-oxide-synthase
#10
Zhi-Jun Ou, Jing Chen, Wei-Ping Dai, Xiang Liu, Yin-Ke Yang, Yan Li, Ze-Bang Lin, Tian-Tian Wang, Ying-Ying Wu, Dan-Hong Su, Tian-Pu Cheng, Zhi-Ping Wang, Jun Tao, Jing-Song Ou
Endothelial dysfunction is a key early step in atherosclerosis. 25-Hydroxycholesterol (25-OHC) is found in atherosclerotic lesions. However, whether 25-OHC promotes atherosclerosis is unclear. Here, we hypothesized that 25-OHC, a proinflammatory lipid, can impair endothelial function, which may play an important role in atherosclerosis. Bovine aortic endothelial cells were incubated with 25-OHC. Endothelial cell proliferation, migration, and tube formation were measured. Nitric oxide (NO) production and superoxide anion generation were determined...
October 1, 2016: American Journal of Physiology. Endocrinology and Metabolism
https://www.readbyqxmd.com/read/27599454/cardiac-catheterization-in-children-with-pulmonary-arterial-hypertension
#11
Hiroyuki Matsuura
Cardiac catheterization of childhood pulmonary arterial hypertension (PAH) plays a pivotal role in assessing the severity of the disease as well as its prognosis, selection of the most adequate pulmonary vasodilators, and evaluation of effectiveness. However, sudden deterioration of cardiovascular hemodynamics can be easily induced by pain, a patient's agitation, catheter manipulation, and by vasodilator provocation tests; these could trigger a pulmonary hypertension crisis, vagotony, respiratory distress, and hemoptysis resulting in critical complications, including death...
September 7, 2016: Pediatrics International: Official Journal of the Japan Pediatric Society
https://www.readbyqxmd.com/read/27545736/anaphylaxis
#12
REVIEW
Lorenzo Hernandez, Sarah Papalia, George G A Pujalte
Anaphylaxis is an acute, systemic reaction mediated by immunoglobulin E hypersensitivity. Release of bioactive factors causes vasodilation and bronchiole constriction that can lead to hypotensive shock and asphyxiation. Differential diagnosis includes acute asthma, localized angioedema, syncope, and anxiety/panic attacks. Diagnostic tests lack specificity. Clinical diagnosis is based on demonstration of specific airway or cardiovascular compromise within proximity of allergen exposure. Treatment includes epinephrine, antihistamines, fluid resuscitation, and airway management...
September 2016: Primary Care
https://www.readbyqxmd.com/read/27365878/using-extracorporeal-membrane-oxygenation-support-preoperatively-and-postoperatively-as-a-successful-bridge-to-recovery-in-a-patient-with-a-large-infarct-induced-ventricular-septal-defect
#13
Samuel Jacob, Mitesh J Patel, Brian Lima, Joost Felius, Rajasekhar S Malyala, Themistokles Chamogeorgakis, Juan C MacHannaford, Gonzalo V Gonzalez-Stawinski, Aldo E Rafael
Rupture of the ventricular septum during acute myocardial infarction usually occurs within the first week. The event is usually followed by low cardiac output, heart failure, and multiorgan failure. Despite the many advances in the nonoperative treatment of heart failure and cardiogenic shock, including the intra-aortic balloon pump and a multitude of new inotropic agents and vasodilators, these do not supplant the need for operative intervention in these critically ill patients. This article describes the successful use of extracorporeal membrane oxygenation support as a bridge to recovery postoperatively in a patient with a large infarct-produced ventricular septal defect...
July 2016: Proceedings of the Baylor University Medical Center
https://www.readbyqxmd.com/read/27315070/-cardiac-hemodynamics-during-shock-management-in-daily-clinical-routine
#14
A Kersten
In caring for critically ill patients, a sophisticated approach to treating hemodynamic instability in acute circulatory failure is a major concern of modern critical care. Depending on the form of shock-distributive, cardiogenic, hypovolemic or obstructive, with the possibility of overlapping forms of shock-preload, afterload, cardiac output, and contractility are altered in various ways. Modern critical care uses hemodynamic monitoring and bedside echocardiography in addition to clinical evaluation to treat the underlying cause and sequelae of shock...
June 17, 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/27282767/adrenomedullin-and-endothelin-1-are-associated-with-myocardial-injury-and-death-in-septic-shock-patients
#15
Oscar H M Lundberg, Lill Bergenzaun, Jörgen Rydén, Mari Rosenqvist, Olle Melander, Michelle S Chew
BACKGROUND: Adrenomedullin and endothelin-1 are hormones with opposing effects on the cardiovascular system. Adrenomedullin acts as a vasodilator and seems to be important for the initiation and continuation of the hyperdynamic circulatory response in sepsis. Endothelin-1 is a vasoconstrictor and has been linked to decreased cardiac performance. Few studies have studied the relationship between adrenomedullin and endothelin-1, and morbidity and mortality in septic shock patients. High-sensitivity troponin T (hsTNT) is normally used to diagnose acute cardiac injury but is also prognostic for outcome in intensive care...
2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/27196698/a-systematic-analysis-of-methylene-blue-for-drug-induced-shock
#16
Brandon J Warrick, Anita Paula Tataru, Susan Smolinske
CONTEXT: Pharmacologically induced shock can be refractory to standard resuscitation. Methylene blue (MB) acts to prevent nitric oxide-mediated vasodilation and may be a potential treatment for refractory shock. OBJECTIVE: A systematic analysis of the literature to evaluate MB in pharmacologically induced shock. Primary outcome was survival and secondary outcome was hemodynamic improvement. MATERIALS AND METHODS: A search of MedLine/PubMed, EMBASE, Cochrane Library, TOXLINE, Google Scholar and Google was performed 10 August 2015 using a combination of text words and keywords related to MB, shock and specific drugs...
August 2016: Clinical Toxicology
https://www.readbyqxmd.com/read/27173069/vasopressin-as-therapy-during-nonocclusive-mesenteric-ischemia
#17
Hagen Bomberg, Heinrich V Groesdonk, Miriam Raffel, Peter Minko, Wolfram Schmied, Matthias Klingele, Hans-Joachim Schäfers
BACKGROUND: Vasopressin is used as an adjunct to norepinephrine to support blood pressure in vasodilatory shock after cardiopulmonary bypass (CPB). In this study, we report our observation of vasopressin treatment in 11 patients with nonocclusive mesenteric ischemia (NOMI). METHODS: In an observational cohort study, 78 patients were studied after having been treated for NOMI with intraarterial iloprost infusion after elective cardiac operation. All patients received norepinephrine as vasopressor for marked vasodilation...
September 2016: Annals of Thoracic Surgery
https://www.readbyqxmd.com/read/27147845/vasogenic-shock-physiology
#18
REVIEW
Sotiria Gkisioti, Spyros D Mentzelopoulos
Shock means inadequate tissue perfusion by oxygen-carrying blood. In vasogenic shock, this circulatory failure results from vasodilation and/or vasoplegia. There is vascular hyporeactivity with reduced vascular smooth muscle contraction in response to α1 adrenergic agonists. Considering vasogenic shock, one can understand its utmost importance, not only because of its association with sepsis but also because it can be the common final pathway for long-lasting, severe shock of any cause, even postresuscitation states...
2011: Open Access Emergency Medicine: OAEM
https://www.readbyqxmd.com/read/27136356/papaverine-prevents-vasospasm-by-regulation-of-myosin-light-chain-phosphorylation-and-actin-polymerization-in-human-saphenous-vein
#19
Kyle M Hocking, Gowthami Putumbaka, Eric S Wise, Joyce Cheung-Flynn, Colleen M Brophy, Padmini Komalavilas
OBJECTIVE: Papaverine is used to prevent vasospasm in human saphenous veins (HSV) during vein graft preparation prior to implantation as a bypass conduit. Papaverine is a nonspecific inhibitor of phosphodiesterases, leading to increases in both intracellular cGMP and cAMP. We hypothesized that papaverine reduces force by decreasing intracellular calcium concentrations ([Ca2+]i) and myosin light chain phosphorylation, and increasing actin depolymerization via regulation of actin regulatory protein phosphorylation...
2016: PloS One
https://www.readbyqxmd.com/read/27134631/aseptic-osteonecrosis-of-the-hip-in-the-adult-current-evidence-on-conservative-treatment
#20
REVIEW
Raymond Klumpp, Carlo Trevisan
Treatment of Avascular Osteonecrosis (AVN) of the femoral head to prevent progression to an arthritic hip is a challenging subject. Many conservative treatment options have been proposed in the literature. Weight bearing restriction as a stand-alone therapy is insufficient in preventing disease progression but it may be useful when combined with pharmacological agents or surgery. Bisphosphonate treatment in AVN might be efficient in early stages of disease, however there are no clear recommendations on length of treatment and therapeutic dosage and, considered the limited evidence and potential side effects of treatment, it could be considered in a pre-collapse stage in selected cases...
January 2015: Clinical Cases in Mineral and Bone Metabolism
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