Cardiac dysfunction

This is not a distinct clinical entity. The most frequent form of the condition is primarily associated with severe cardiac dysfunction often in combination with dysmorphy. It is confusing, however, because a paralytic attack is accompanied by extrasystoles and tachycardia. Serum may be high, low or normal. A familial form of the disorder is exacerbated by cold and high but is relieved by Na loading. It is, however, not associated with any specific changes in serum K. ... 

Hachfeld del Balzo U, Levi R, Polley MJ Cardiac dysfunction caused by purified hiunan C3a anaphy-latoxin. Proc Natl Acad Sci USA 1985 82 886. del Balzo U, Polley MJ, Levi R Cardiac anaphylaxis. Complement activation as an amphfication system. Circ Res 1989 65 847. 

The only way to determine if a comatose patient has SE is by EEG. EEG monitoring should be used for patients who remain unconscious after initial antiepileptic treatment, and for those who received a long-acting paralytic agent or require prolonged therapy for RSE. Treatment should never be delayed while awaiting EEG results. An electrocardiogram (ECG) should be obtained to rule out cardiac dysfunction when hypotension or an abnormal heart rate is observed. 

Ventricular assist devices can be used in the short-term (days to several weeks) for temporary stabilization of patients awaiting an intervention to correct the underlying cardiac dysfunction. They can also be used long term (several months to years) as a bridge to heart transplantation. Permanent device implantation has recently become an option for patients who are not candidates for heart transplantation. 

Y., Kawamura, N. Feldman, A. M., Tsutsui, H., Shimokawa, H., Takeshita, A., Involvement of inducible nitric oxide synthase in cardiac dysfunction with tumor necrosis factor-alpha, Am. J. Physiol. Heart Circ. Physiol. 282 (2002),... 

Renal function impairment Reduce dosage in impaired renal function. Carefully monitor ECG for signs of overdosage. The controlled-release form is not recommended for patients with severe renal insufficiency (Ccr up to 40 mL/min). Hepatic function impairment Impairment increases plasma half-life reduce dosage in such patients. Carefully monitor the ECG. Patients with cardiac dysfunction have a higher potential for hepatic impairment. 

There are suggestions that for the prevention of HF some agents should be better avoided, although the logic for these believes has not been proven. Many HF programs, for example, limit alcohol consumption to some extent. Smoking, the use of cocaine or amphetamines are also believed to be toxic. However it is well known that certain anti-tumor agents such as anthracyclines and also irradiation of the mediastinum may cause cardiac dysfunction. There is no clear evidence for the benefit of early treatment of these subjects, but close attention is certainly advisable. 

Paternostro G, Vignola C, Bartsch DU, Omens JH, McCulloch AD, Reed JC. (2001) Age-associated cardiac dysfunction in Drosophila melanogaster. Circ Res 88, 1053-8. 

P MRS of the open-chested mouse at 4.7T. In a P MRSI study performed on a 9.4-T vertical-bore spectrometer, Flogel et al. were able to map localized energetics in several regions of the heart in a transgenic murine cardiomyopathy model. They found that cardiac dysfunction in the mutant was associated with impaired energy state. 

Herceptin with cisplatin, doxorubicin or epirubicin plus cyclophosphamide, or paclitaxel. A comparison of serum levels of trastuzumab given in combination with various chemotherapeutic agents did not suggest the possibility of any pharmacokinetic interactions except in combination with paclitaxel. Although not statistically signihcant, mean serum trough concentrations of trastuzumab were consistently elevated, about 1.5-fold, when Herceptin was administered in combination with paclitaxel. However, trastuzumab and paclitaxel were used concurrently in clinical trials with positive outcome results. The concurrent administration of anthracyclines, cyclophosphamide, and trastuzumab increased the incidence and severity of cardiac dysfunction during clinical trials. 

The toxicity of di(2-ethylhexyl) phthalate was evaluated in 28 term infants with respiratory failure, 18 of whom received extracorporeal membrane oxygenation (ECMO) and were compared with 10 untreated infants. Various clinical parameters of liver, pulmonary and cardiac dysfunction were found to be unaffected in treated infants, even though the rate of administration ranged up to 2 mg/kg bw di(2-ethylhexyl) phthalate over 3-10 days (mean peak plasma concentration, 8 pg/mL). ECMO is considered to be the clinical intervention that results in the highest intravenous dose of di(2-ethylhexyl) phthalate (Karle et al., 1997). 

The prolonged half-lives occur in individuals who are genetically different in CYP 2D6 or who have significant hepatic, renal, or left ventricular cardiac dysfunction. TCAs are metabolized in the liver by three pathways ... 

Duda, M., O Shea, K., Tintinu, A., Xu, W., Khairallah, R., Barrows, B., Chess, D., Azimzadeh, A., and Harris, W. (2009). Fish oil, but not flaxseed oil, decreases inflammation and prevents pressure overload-induced cardiac dysfunction. Cardiovasc. Res. 81,319-327. 

Akagi, M., Hamada, K., Nishioka, E., Fukuishi, N., Akagi, R., 1995. Role of histamine H3 receptor on hypoxia-reoxygenation induced cardiac dysfunction in guinea pigs. Meth. Find. Exp. Clin. Pharmacol. 17 (C), 30-35. 

When thiazolidinediones are combined with insulin, edema can develop if there is cardiac dysfunction (296). 

Cardiac dysfunction increases insulin resistance, suggesting that thiazolidinediones, which reduce insulin resistance might be a good choice in patients with diabetes and cardiac dysfunction. However, this case suggests that they can worsen fluid retention, perhaps by vasodilatation (57). 

A review of trials has suggested that vasopressin is more likely to cause adverse effects at doses of 0.04 U/minute or more when it is used to treat septic shock mesenteric ischemia and cardiac dysfunction and ischemia were particularly associated with high doses (30). The authors suggested that limiting the dosage to 0.03 U/minute may minimize these effects. This suggestion has been supported by a retrospective audit of the effects of continuous vasopressin infusion in septic shock in 102 men and women, mean age 53 years (31). There were adverse events that may have been linked to vasopressin in 18 patients cardiac arrest (n = 9) ischemic/mottled digits (n = 8) myocardial infarction (n = 1) and hyponatremia (n = 1). Adverse events occurred with doses of vasopressin of 0.04 units/minute and over, except in one patient (dose not stated). 

Life-threatening cardiac dysfunction in a 7-year-old boy required urgent carnitine supplementation (SEDA-17, 74). 

Significant depression of myocardial contractility has been observed in individuals who acutely consume moderate amounts of alcohol, ie, at a blood concentration above 100 mg/dL. Myocardial biopsies in humans before and after infusion of small amounts of alcohol have shown ultrastructural changes that may be associated with impaired myocardial function. Acetaldehyde is implicated as a cause of cardiac dysfunction by altering myocardial stores of catecholamines. 

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