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https://www.readbyqxmd.com/read/28735156/adaptive-periodic-paralysis-allows-weaning-deep-sedation-overcoming-the-drowning-syndrome-in-ecmo-patients-bridged-for-lung-transplantation-a-case-series
#1
Irina Timofte, Michael Terrin, Erik Barr, June Kim, Joseph Rinaldi, Nicholas Ladikos, Jay Menaker, Ali Tabatabai, Zachary Kon, Bartley Griffith, Richard Pierson, Si Pham, Aldo Iacono, Daniel Herr
PURPOSE: Sedation in extracorporeal membrane oxygenation (ECMO) is challenging. Patients require deep sedation because of extremely high respiratory rates and increased work of breathing ("Drowning Syndrome") resulting in altered intra-thoracic pressure and reduced pump flow associated with hemodynamic compromise and decreased oxygenation. However, deep sedation impedes essential active rehabilitation with physical therapy. METHODS: We reviewed data on 3 ECMO patients for whom we used a novel approach to replace continuous drips with periodic sedation/paralysis...
July 17, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28502326/k-and-mg-2-dyshomeostasis-in-acute-hyperadrenergic-stressor-states
#2
REVIEW
Mannu Nayyar, Jawwad Yusuf, M Usman Khan, Karl T Weber
Acute stressor states are linked to neurohormonal activation that includes the adrenergic nervous system. Elevations in circulating epinephrine and norepinephrine unmask an interdependency that exists between K(+) and Mg(2+) based on their regulation of a large number of Mg(2+)-dependent Na(+)-K(+)-ATPase pumps present in skeletal muscle. The hyperadrenergic state accounts for a sudden translocation of cations into muscle with the rapid appearance of hypokalemia and hypomagnesemia. The resultant hypokalemia and hypomagnesemia will cause a delay in myocardial repolarization and electrocardiographic QTc prolongation raising the propensity for supraventricular and ventricular arrhythmias...
May 2017: American Journal of the Medical Sciences
https://www.readbyqxmd.com/read/28490198/drug-induced-takotsubo-cardiomyopathy
#3
Kazuhiko Kido, Maya Guglin
BACKGROUND: The most plausible hypothesis for takotsubo cardiomyopathy (TCM) is a catecholamine surge. Direct administration of catecholamines or medications causing catecholamine surge is frequently used in clinical practice. METHODS: A Medline/PubMed database search was conducted for case reports or series of drug-induced TCM. All reported cases of drug-induced TCM were systemically identified and analyzed. RESULTS: We identified 157 cases of drug-induced TCM...
January 1, 2017: Journal of Cardiovascular Pharmacology and Therapeutics
https://www.readbyqxmd.com/read/28424575/contribution-of-autonomic-reflexes-to-the-hyperadrenergic-state-in-heart-failure
#4
REVIEW
Edgar Toschi-Dias, Maria Urbana P B Rondon, Chiara Cogliati, Nazareno Paolocci, Eleonora Tobaldini, Nicola Montano
Heart failure (HF) is a complex syndrome representing the clinical endpoint of many cardiovascular diseases of different etiology. Given its prevalence, incidence and social impact, a better understanding of HF pathophysiology is paramount to implement more effective anti-HF therapies. Based on left ventricle (LV) performance, HF is currently classified as follows: (1) with reduced ejection fraction (HFrEF); (2) with mid-range EF (HFmrEF); and (3) with preserved EF (HFpEF). A central tenet of HFrEF pathophysiology is adrenergic hyperactivity, featuring increased sympathetic nerve discharge and a progressive loss of rhythmical sympathetic oscillations...
2017: Frontiers in Neuroscience
https://www.readbyqxmd.com/read/28414396/postural-tachycardia-syndrome-diagnosis-and-management-in-adolescents-and-young-adults
#5
Geoffrey L Heyer
Postural tachycardia syndrome (POTS) represents a common form of orthostatic intolerance that disproportionately affects young women from puberty through adulthood. Patients with POTS have day-to-day orthostatic symptoms with the hallmark feature of an excessive, sustained, and symptomatic rise in heart rate during orthostatic testing. Although considerable overlap exists, three subtypes of POTS have been described: neuropathic, hyperadrenergic, and hypovolemic forms. The wide spectrum of symptoms and comorbidities can make treatment particularly challenging...
April 1, 2017: Pediatric Annals
https://www.readbyqxmd.com/read/28060200/early-fever-as-a-predictor-of-paroxysmal-sympathetic-hyperactivity-in-traumatic-brain-injury
#6
Holly E Hinson, Martin A Schreiber, Amber L Laurie, Ian J Baguley, Dennis Bourdette, Geoffrey S F Ling
OBJECTIVE: Paroxysmal sympathetic hyperactivity (PSH) is characterized by episodic, hyperadrenergic alterations in vital signs after traumatic brain injury (TBI). We sought to apply an objective scale to the vital sign alterations of PSH in order to determine whether 1 element might be predictive of developing PSH. SETTING/PARTICIPANTS/DESIGN: We conducted an observational study of consecutive TBI patients (Glasgow Coma Scale score ≤12) and monitored the cohort for clinical evidence of PSH...
January 5, 2017: Journal of Head Trauma Rehabilitation
https://www.readbyqxmd.com/read/27938459/recent-advances-in-the-understanding-of-the-mechanisms-underlying-postural-tachycardia-syndrome-in-children-practical-implications-for-treatment
#7
Xiaochun Zheng, Yonghong Chen, Junbao Du
Postural tachycardia syndrome is defined by a heart rate increment of 40 beats/minute (bpm) (or a heart rate that exceeds 125 bpm) within 10 minutes of change from the supine position to an upright position in the absence of obvious orthostatic hypotension. There are multiple pathophysiological mechanisms that underlie postural tachycardia syndrome, including peripheral denervation, β-receptor supersensitivity, hypovolaemia, and impaired muscle pump. Some children afflicted with postural orthostatic tachycardia syndrome and hypovolaemic dysregulation have been found to have perturbed renin-angiotensin-aldosterone profile, disturbed vascular endothelial function, and abnormal vasodilation...
April 2017: Cardiology in the Young
https://www.readbyqxmd.com/read/27739268/broken-heart-syndrome
#8
REVIEW
Vikrant Mahajani, Vidya Suratkal
Takotsubo Cardiomyopathy (TC) is also known as Stress Induced Cardiomyopathy or Broken Heart Syndrome. Typically there is transient systolic dysfunction of the apical or the mid segments of the left ventricle that occurs in the presence of acute emotional stress. Some atypical variants have been described. Hyperadrenergic state associated with emotional stress is cited as the probable etiology. It mimics Acute Myocardial Infarction with concomitant rise in cardiac biomarkers, ECG, 2D-Echocardiography abnormalities comprising of left ventricular dysfunction with regional wall motion abnormality, no significant Coronary Artery Disease on angiography...
June 2016: Journal of the Association of Physicians of India
https://www.readbyqxmd.com/read/27693072/acute-toxicity-from-topical-cocaine-for-epistaxis-treatment-with-labetalol
#9
John R Richards, Erik G Laurin, Nabil Tabish, Richard A Lange
BACKGROUND: Topical cocaine is sometimes used for the treatment of epistaxis, as it has both potent anesthetic and vasoconstrictive properties. Cocaine has unpredictable cardiovascular effects, such as sudden hypertension, tachycardia, coronary arterial vasoconstriction, and dysrhythmia. CASE REPORT: We report a case of acute iatrogenic cardiovascular toxicity from the use of topical cocaine in a 56-year-old man presenting to the Emergency Department with profound epistaxis...
March 2017: Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27660311/clinical-challenges-in-the-diagnosis-and-management-of-postural-tachycardia-syndrome
#10
Pearl K Jones, Brett H Shaw, Satish R Raj
Postural tachycardia syndrome (POTS) is a multifactorial clinical syndrome defined by an increase in heart rate of ≥30 bpm on standing from supine position (or ≥40 bpm in children). It is associated with symptoms of cerebral hypoperfusion that are worse when upright and improve when in supine position. Patients often have additional symptoms including severe fatigue and difficulty concentrating. There are several possible pathophysiologic mechanisms including hypovolaemia, small-fibre peripheral neuropathy and hyperadrenergic states...
December 2016: Practical Neurology
https://www.readbyqxmd.com/read/27216458/%C3%AE-hydroxybutyrate-elevation-as-a-compensatory-response-against-oxidative-stress-in-cardiomyocytes
#11
Manabu Nagao, Ryuji Toh, Yasuhiro Irino, Takeshige Mori, Hideto Nakajima, Tetsuya Hara, Tomoyuki Honjo, Seimi Satomi-Kobayashi, Toshiro Shinke, Hidekazu Tanaka, Tatsuro Ishida, Ken-Ichi Hirata
Recent studies have shown that the ketone body β-hydroxybutyrate (βOHB) acts not only as a carrier of energy but also as a signaling molecule that has a role in diverse cellular functions. Circulating levels of ketone bodies have been previously reported to be increased in patients with congestive heart failure (HF). In this study, we investigated regulatory mechanism and pathophysiological role of βOHB in HF. First, we revealed that βOHB level was elevated in failing hearts, but not in blood, using pressure-overloaded mice...
July 8, 2016: Biochemical and Biophysical Research Communications
https://www.readbyqxmd.com/read/27037294/bilateral-adrenal-masses-a-single-centre-experience
#12
Nilesh Lomte, Tushar Bandgar, Shruti Khare, Swati Jadhav, Anurag Lila, Manjunath Goroshi, Rajeev Kasaliwal, Kranti Khadilkar, Nalini S Shah
BACKGROUND: Bilateral adrenal masses may have aetiologies like hyperplasia and infiltrative lesions, besides tumours. Hyperplastic and infiltrative lesions may have coexisting hypocortisolism. Bilateral tumours are likely to have hereditary/syndromic associations. The data on clinical profile of bilateral adrenal masses are limited. AIMS: To analyse clinical, biochemical and radiological features, and management outcomes in patients with bilateral adrenal masses...
March 2016: Endocrine Connections
https://www.readbyqxmd.com/read/26883121/inflammatory-cytokine-and-chemokine-profiles-are-associated-with-patient-outcome-and-the-hyperadrenergic-state-following-acute-brain-injury
#13
Alex P Di Battista, Shawn G Rhind, Michael G Hutchison, Syed Hassan, Maria Y Shiu, Kenji Inaba, Jane Topolovec-Vranic, Antonio Capone Neto, Sandro B Rizoli, Andrew J Baker
BACKGROUND: Traumatic brain injury (TBI) elicits intense sympathetic nervous system (SNS) activation with profuse catecholamine secretion. The resultant hyperadrenergic state is linked to immunomodulation both within the brain and systemically. Dysregulated inflammation post-TBI exacerbates secondary brain injury and contributes to unfavorable patient outcomes including death. The aim of this study was to characterize the early dynamic profile of circulating inflammatory cytokines/chemokines in patients admitted for moderate-to-severe TBI, to examine interrelationships between these mediators and catecholamines, as well as clinical indices of injury severity and neurological outcome...
February 16, 2016: Journal of Neuroinflammation
https://www.readbyqxmd.com/read/26743349/autonomic-findings-in-takotsubo-cardiomyopathy
#14
Lucy Norcliffe-Kaufmann, Horacio Kaufmann, Jose Martinez, Stuart D Katz, Lisa Tully, Harmony R Reynolds
Takotsubo cardiomyopathy (TC) often occurs after emotional or physical stress. Norepinephrine levels are unusually high in the acute phase, suggesting a hyperadrenergic mechanism. Comparatively little is known about parasympathetic function in patients with TC. We sought to characterize autonomic function at rest and in response to physical and emotional stimuli in 10 women with a confirmed history of TC and 10 age-matched healthy women. Sympathetic and parasympathetic activity was assessed at rest and during baroreflex stimulation (Valsalva maneuver and tilt testing), cognitive stimulation (Stroop test), and emotional stimulation (event recall, patients)...
January 15, 2016: American Journal of Cardiology
https://www.readbyqxmd.com/read/26717337/hypertensive-emergency-due-to-pheochromocytoma-crisis-complicated-with-refractory-hemodynamic-collapse
#15
Mert İlker Hayıroğlu, Özlem Yıldırımtürk, Mehmet Bozbay, Mehmet Eren, Seçkin Pehlivanoğlu
Hypertensive emergency usually appears in older patients with previous recurrent episodes, and is among the most frequent admissions to emergency departments. A 29-year-old woman was referred to our clinic with the diagnosis of hypertensive emergency. The patient complained of severe headache, dyspnea, palpitation, diaphoresis, and confusion due to hypertensive encephalopathy. Her blood pressure was 250/150 mmHg on admission. At the referral hospital, the patient had undergone cranial CT because of her confused state and this excluded acute cerebral hemorrhage...
December 2015: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/26715163/alterations-in-sympathetic-nerve-traffic-in-genetic-haemochromatosis-before-and-after-iron-depletion-therapy-a-microneurographic-study
#16
Gino Seravalle, Alberto Piperno, Raffaella Mariani, Irene Pelloni, Rita Facchetti, Raffaella Dell'Oro, Cesare Cuspidi, Giuseppe Mancia, Guido Grassi
AIMS: Haemochromatosis (HH) displays a number of circulatory alterations concurring at increase cardiovascular risk. Whether these include sympathetic abnormalities in unknown. METHODS AND RESULTS: In 18 males with primary HH (age: 42.3 ± 10.4 years, mean ± SD), clinic and beat-to-beat blood pressure (BP, Finapres), heart rate (HR, EKG), and muscle sympathetic nerve activity (MSNA, microneurography) traffic were measured in the iron overload state and after iron depletion therapy...
March 21, 2016: European Heart Journal
https://www.readbyqxmd.com/read/26586775/propranolol-and-mesenchymal-stromal-cells-combine-to-treat-traumatic-brain-injury
#17
Daniel J Kota, Karthik S Prabhakara, Alexandra J van Brummen, Supinder Bedi, Hasen Xue, Bryan DiCarlo, Charles S Cox, Scott D Olson
UNLABELLED: More than 6.5 million patients are burdened by the physical, cognitive, and psychosocial deficits associated with traumatic brain injury (TBI) in the U.S. Despite extensive efforts to develop neuroprotective therapies for this devastating disorder, there have been no successful outcomes in human clinical trials to date. Retrospective studies have shown that β-adrenergic receptor blockers, specifically propranolol, significantly decrease mortality of TBI through mechanisms not yet fully elucidated but are thought to counterbalance a hyperadrenergic state resulting from a TBI...
January 2016: Stem Cells Translational Medicine
https://www.readbyqxmd.com/read/26386646/hemodynamic-profile-and-heart-rate-variability-in-hyperadrenergic-versus-non-hyperadrenergic-postural-orthostatic-tachycardia-syndrome
#18
COMPARATIVE STUDY
Luka Crnošija, Magdalena Krbot Skorić, Ivan Adamec, Mila Lovrić, Anamari Junaković, Antonija Mišmaš, Vladimir Miletić, Rujana Šprljan Alfirev, Antun Pavelić, Mario Habek
OBJECTIVES: To investigate differences in hemodynamic profile between hyperadrenergic and non-hyperadrenergic postural orthostatic tachycardia syndrome (POTS) in response to head-up tilt test (HUTT). METHODS: Ten patients with hyperadrenergic and 33 patients with non-hyperadrenergic POTS underwent HUTT consisting of a 10-min supine phase and 30-min 70° tilted phase. Heart rate (HR), systolic and diastolic blood pressure (dBP), and heart rate variability (HRV) parameters of the two groups were compared...
February 2016: Clinical Neurophysiology: Official Journal of the International Federation of Clinical Neurophysiology
https://www.readbyqxmd.com/read/26380574/morphine-an-effective-abortive-therapy-for-pediatric-paroxysmal-sympathetic-hyperactivity-after-hypoxic-brain-injury
#19
Deborah S Raithel, Kirsten H Ohler, Isabel Porto, Alma R Bicknese, Donna M Kraus
Paroxysmal sympathetic hyperactivity (PSH) is a life-threatening condition characterized by hyperadrenergic activity and autonomic dysfunction. Also termed autonomic storms, PSH can occur after a variety of cerebral insults, most commonly traumatic brain injury. Limited pediatric literature is available, especially in patients with brain injury from hypoxia. No consensus exists for the terminology, diagnostic criteria, or treatment algorithm for PSH. Thus, the optimal management, including medication selection and dosing, remains unclear...
July 2015: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/26302015/alcohol-withdrawal-syndrome-improving-outcomes-through-early-identification-and-aggressive-treatment-strategies
#20
REVIEW
Joseph H Yanta, Greg S Swartzentruber, Anthony F Pizon
Alcoholism is a prevalent medical and psychiatric disease, and, consequently, alcohol withdrawal is encountered frequently in the emergency department. This issue reviews the pathophysiology of the alcohol withdrawal syndrome, describes the 4 manifestations of alcohol withdrawal, and looks at the available evidence for optimal treatment of alcohol withdrawal in its diverse presentations. Patients commonly manifest hyperadrenergic signs and symptoms, necessitating admission to the intensive care unit, intravenous benzodiazepines, and, frequently, adjunctive pharmacotherapy...
June 2015: Emergency Medicine Practice
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