High output heart failure

Mehta, Paresh A; Dubrey, Simon W

doi:10.1093/qjmed/hcn147

Cited by 139 publications

(217 citation statements)

References 51 publications

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“…Cardiac index (a vasodynamic parameter that relates the cardiac output to body surface area) was calculated as a major index for high cardiac output. (18) The study was approved by the local ethical committee, and all subjects had given informed consent to being included.…”

Section: Pagetic Pedigreementioning

confidence: 99%

Giant cell tumor occurring in familial Paget's disease of bone: Report of clinical characteristics and linkage analysis of a large pedigree

Gianfrancesco¹,

Rendina²,

Merlotti³

et al. 2012

Journal of Bone and Mineral Research

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Neoplastic degeneration represents a rare but serious complication of Paget's disease of bone (PDB). Although osteosarcomas have been described in up to 1% of PDB cases, giant cell tumors are less frequent and mainly occur in patients with polyostotic disease. We recently characterized a large pedigree with 14 affected members of whom four developed giant cell tumors at pagetic sites. The high number of affected subjects across multiple generations allowed us to better characterize the clinical phenotype and look for possible susceptibility loci. Of interest, all the affected members had polyostotic PDB, but subjects developing giant cell tumors showed an increased disease severity with a reduced clinical response to bisphosphonate treatment and an increased prevalence of bone pain, deformities, and fractures. Together with an increased occurrence of common pagetic complications, affected patients of this pedigree also evidenced a fivefold higher prevalence of coronary artery disease with respect to either the unaffected family members or a comparative cohort of 150 unrelated PDB cases from the same geographical area. This association was further enhanced in the four cases with PDB and giant cell tumors, all of them developing coronary artery disease before 60 years of age. Despite the early onset and the severe phenotype, PDB patients from this pedigree were negative for the presence of SQSTM1 or TNFRSF11A mutations, previously associated with enhanced disease severity. Genome-wide linkage analysis identified six possible candidate regions on chromosomes 1, 5, 6, 8, 10, and 20. Because the chromosome 8 and 10 loci were next to the TNFRSF11B and OPTN genes, we extended the genetic screening to these two genes, but we failed to identify any causative mutation at both the genomic and transcription level, suggesting that a different genetic defect is associated with PDB and potentially giant cell tumor of bone in this pedigree. ß

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Section: Pagetic Pedigreementioning

confidence: 99%

Giant cell tumor occurring in familial Paget's disease of bone: Report of clinical characteristics and linkage analysis of a large pedigree

Gianfrancesco¹,

Rendina²,

Merlotti³

et al. 2012

Journal of Bone and Mineral Research

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“…6 With a fall in systemic vascular resistance and arterial blood pressure, baroreceptor activation of the renin-angiotensin-aldosterone system, sympathetic nervous system, and arginine vasopressin occurs. This in turn leads to salt retention and circulating blood volume expansion, and pulmonary or systemic venous congestion 7,8 (Figure 8). This mechanism of salt retention is similar to that which occurs in low-output cardiac failure as a response to arterial hypotension secondary to decreased cardiac output.…”

Section: Discussionmentioning

confidence: 99%

The Thrill Is Gone

2015

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Foreword Information about a real patient is presented in stages (boldface type) to expert clinicians (Drs Beckman and Sobieszczyk), who respond to the information, sharing his reasoning with the reader (regular type). A discussion by the authors follows.A n 85-year-old white woman with longstanding atrial fibrillation and hypertension presented to our emergency department with a 2-day history of progressive dyspnea. Earlier that week she had been seen by an outpatient provider and was found to be hypotensive. Her home bumetanide was discontinued, and she developed dyspnea that progressed after missing 2 doses. She reported that she was sleeping with more pillows and that she had a limited ability to walk and a new cough.Her recent history was notable for progressive fatigue and dyspnea over the past year. In the past 3 months she had been treated as an outpatient with loop diuretics for presumed congestive heart failure by a cardiologist. Her recent history was also notable for recurrent hematochezia requiring 5 admissions, including an intensive care unit admission for hemorrhagic shock, over the preceding 6 months. An extensive evaluation, including esophagastroduodenoscopy, several colonoscopies, and a small-intestine capsule study were unrevealing; she was noted only to have severe diverticulosis. During this period, her warfarin and, after additional bleeding episodes, her aspirin were stopped in light of her recurrent bleeding.Additional medical history included a diagnosis of cataracts, macular degeneration, and osteoarthritis. Medications included bumetanide 1 mg daily, metoprolol succinate 50 mg daily, omeprazole 40 mg daily, and calcium supplements. She had no known drug allergies.Dr Beckman: Dyspnea in an older patient is a common concern and is predominantly caused by a range of cardiopulmonary diseases. In this case, the patient's presentation is notable for progressive dyspnea over 1 year that has acutely worsened over several days. Her report of orthopnea, cough, and exertional intolerance suggest that an exacerbation of congestive heart failure is likely. Moreover, her diagnosis of congestive heart failure is only presumed, and further investigation is needed to understand this acute presentation. Other etiologies of progressive dyspnea include anemia related to her recent gastrointestinal bleeding, or a primary pulmonary process such as interstitial lung disease, chronic obstructive pulmonary disease, malignancy, pulmonary hypertension, or an infectious process such as a viral respiratory infection or pneumonia. Patient presentation (continued):Initial vital signs on presentation included an oral temperature of 95°F, a heart rate of 81 beats per minute, blood pressure of 110/56 mm Hg, respiratory rate of 20 breaths per minute, oxygen saturation of 85% on room air with improvement to 95% on 3 L nasal cannula oxygen supplementation. Physical examination was notable for a cachectic-appearing woman in no acute distress. Her neck examination revealed marked internal jugular venous engorgement with v...

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“…The clinical presentation of wet beriberi can be quite varied. The chronic type or slowly developing wet beriberi often presents with peripheral vasodilation, leading to a high cardiac output state [11]. This decreased vascular resistance leads to fluid retention mediated through the renin-angiotensin-aldosterone system.…”

Section: Discussionmentioning

confidence: 99%

Thiamine Deficiency (Beriberi) Induced Polyneuropathy and Cardiomyopathy: Case Report and Review of the Literature

Cui

2014

J Med Cases

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Thiamine, also known as vitamin B1, is an essential nutrient required for all living tissues. It can be found in high concentration inside the heart, kidneys, brain and skeletal muscles. A severe depletion is not commonly seen, except in cases of inadequate nutrition and/or alcoholism. The major manifestation of thiamine deficiency involves the nervous (dry beriberi, or neuropathy and/or WernickeKorsakoff syndrome) and cardiovascular (wet beriberi or cardiomyopathy) systems. This report details the case of a female patient with severe thiamine deficiency secondary to dysphagia caused by radiation injury. She developed debilitating polyneuropathy and cardiomyopathy with decreased ejection fraction. Early recognition and adequate thiamine replacement led to a full recovery in this case. In addition, we will discuss the potential benefits of thiamine supplementation in treating congestive heart failure.

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High output heart failure

Cited by 139 publications

References 51 publications

Giant cell tumor occurring in familial Paget's disease of bone: Report of clinical characteristics and linkage analysis of a large pedigree

Giant cell tumor occurring in familial Paget's disease of bone: Report of clinical characteristics and linkage analysis of a large pedigree

The Thrill Is Gone

Thiamine Deficiency (Beriberi) Induced Polyneuropathy and Cardiomyopathy: Case Report and Review of the Literature

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