Decompensated heart failure accounts for approximately 1 million hospitalizations in the United States annually, and this number is expected to increase significantly in the near future. Diuretics provide the initial management in most patients with fluid overload. However, the development of diuretic resistance remains a significant challenge in the treatment of heart failure. Due to the lack of a standard definition, the prevalence of this phenomenon remains difficult to determine, with some estimates suggesting that 25–30% of patients with heart failure have diuretic resistance. Certain characteristics, including low systolic blood pressures, renal impairment, and atherosclerotic disease, help predict the development of diuretic resistance. The underlying pathophysiology is likely multifactorial, with pharmacokinetic alterations, hormonal dysregulation, and the cardiorenal syndrome having significant roles. The therapeutic approach to this common problem typically involves increases in the diuretic dose and/or frequency, sequential nephron blockade, and mechanical fluid movement removal with ultrafiltration or peritoneal dialysis. Paracentesis is potentially useful in patients with intra-abdominal hypertension.
the effect of pulmonary edema on surfactant function (2). Studies in patients and animal models, discussed below, demonstrate that high capillary pressures cause lung injury and possibly lung inflammation, and these events need consideration when managing patients with cardiogenic pulmonary edema. In this review we discuss studies relevant to lung anatomy, experimental hydrostatic pulmonary edema, experimental studies with surfactant, clinical studies on surfactant, surfactant release during episodes of
Swimming-induced pulmonary edema occurs when fluid accumulates in the lungs in the absence of water aspiration during swimming and produces acute shortness of breath and a cough with blood-tinged sputum. We report a case of a 58-year-old female athlete presenting with acute dyspnea during the swimming portion of a half-triathlon competition. She had complete resolution within 24 h of presentation.
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