Congestive cardiac failure

Signs of cardiac failure/congestive heart failure owing to fluid overload... 

Plasma proteins are contraindicated in those with a history of allergic reactions to albumin, severe anemia, or cardiac failure in the presence of normal or increased intravascular volume and in patients on cardiopulmonary bypass. Plasma protein fractions are used cautiously in patients who are in shock or dehydrated and in those with congestive cardiac failure or hepatic or renal failure. These solutions are Pregnancy Category C drugp and are used cautiously during pregnancy and lactation. 

F5. Flear, C. T., Cawley, R, Quinton, A., and Cooke, W. T., The simultaneous determination of total exchangeable sodium and potassium and its significance, with particular reference to congestive cardiac failure and the steatorrhea syndrome. Clin. Sci. 17, 81-104 (1958). 

Angiotensin-II AT, Human cDNA Artherosderosis, cardiac hypertrophy, congestive heart failure, hypertension, myocardial infarction, renal disease, cancer, diabetes, obesity, glaucoma, cystic fibrosis, Alzheimer s disease, Parkinson s disease Smooth muscle contraction, cell proliferation and migration, aldosterone and ADH release, central and peripheral sympathetic stimulation, extracellular matrix formation, tubular sodium retention, neuroprotection... 

Norepinephrine NE transporter Human cDNA Depression, Alzheimer s disease, epilepsy, anxiety, attention deficit hyperactivity, angina, asthma, cardiac arrhythmia, cardiac hypertrophy, congestive heart failure, myocardial ischemia, hypertension, artherosclerosis, narcolepsy, orthostatic hypotension, prostatic hyperplasia, rhinitis, diabetes, diarrhea, glaucoma, impotence, obesity, opiate withdrawal pain, Raynaud s disease, preterm labor pain Modulation of norepinephrine concentration in the neuronal synaptic clefts, neuroprotection... 

Sinus bradycardia greater than first degree heart block cardiogenic shock congestive heart failure (CHF) unless secondary to a tachyarrhythmia treatable with -blockers overt cardiac failure hypersensitivity to -blocking agents. 

During the 14 day observation period some rabbits (2-8) died after 8-hour exposure to doses of 775-1,550 mg/kg applied directly to shaved skin (3.2 cm, but no deaths occurred in the 388 mg/kg dose group. The author calculated an LD o of 1,116 mg/kg from these data (Duprat and Gradiski 1978). Central nervous system depression was evident, as manifested by stupor. Some animals were weak and anorexic, while others showed signs of dyspnea and cyanosis. The lungs, liver, and kidneys were congested in animals that died. Death was reportedly due to respiratory or cardiac failure. 

Acetazola Epilepsy, Gloucoma, Congestive Cardiac-Failure)... 

Clinical manifestations occur in three phases. In the neurological stage, the patient appears intoxicated, with slurred speech, ataxia, stupor, and hallucinations, and may be comatose, with respiratory depression. The cardiopulmonary stage is delayed by 12-24 hours, when hypotension, tachycardia, muscle tenderness and congestive cardiac failure are seen. After 1-3 days the renal stage supervenes, with loin pain, crystalluria, oliguria and renal failure, as a result of calcium oxalate crystal deposition in the renal tract. Sequestration of calcium can cause profound hypocalcaemia, tetany, and cardiac arrhythmia. 

It is used in hyperthyroidism due to Graves disease, prior to surgical treatment of hyperthyroidism i.e., thyroidectomy. It is also used in the treatment of paroxysmal tachycardia and intractable congestive cardiac failure. 

Between 12 and 24 hours, there is tachypnea, tachycardia, hypertension, pulmonary edema, and congestive cardiac failure. 

All patients admitted to a hospital during 6 months who had taken at least one dose of metformin were retrospectively evaluated for susceptibility factors for metformin-associated lactic acidosis (8). There were 263 hospitalizations in 204 patients. In 71 admissions there was at least one contraindication, such as renal or liver disease, renal dysfunction, congestive cardiac failure, metabolic acidosis, or an intravenous iodinated contrast medium given within 48 hours of metformin. In 29 (41%) metformin was continued despite the contraindication. The most frequent contraindication was a raised serum creatinine, but in only eight of the 32 admissions was metformin withdrawn. Of nine patients using metformin who died (not necessarily directly related to metformin), six had an absolute contraindication. In two patients who died and in one who survived, blood lactate was increased and this was temporally related to the use of metformin. 

In another review it was suggested that the risk of lactic acidosis when metformin is used as recommended is close to zero (84). The author discussed the COSMIC study, which compared metformin treatment for 1 year (n = 7227) with usual care with other antidiabetic agents (n = 1505). There were no cases of lactic acidosis. The findings in controlled trials contrast with case reports of lactic acidosis. About one million patients have received metformin in the USA and the FDA has received 47 reports of lactic acidosis (20 fatal). Of these, 43 patients had renal insufficiency or susceptibility factors for lactic acidosis, such as congestive cardiac failure. Only four cases appeared to have no other susceptibility factors, one of which may have been precipitated by urinary sepsis none of these four died. 

The authors speculated about the role of rosiglitazone, suggesting that it may have precipitated congestive cardiac failure, which then led to ischemic hepatitis. A direct hepatotoxic effect was thought to be unlikely. 

Berry P. Severe congestive cardiac failure and ischaemic hepatitis associated with rosiglitazone. Pract Diabetes Int 2004 21 199-200. 

When the heart can no longer pump an adequate supply of blood to meet the metabolic needs of the tissues or in relation to venous return, cardiac failure may ensue. The causes of cardiac failure are complex, but stem from mechanical abnormalities (e.g., pericardial tamponade), myocardial failure (e.g., cardiomyopathy and inflammation), and arrhythmias. In high-output failure, the cardiac output, which may be normal or even higher than normal, is not sufficient to meet the metabolic requirement of the body. Cardiac failure may predispose a patient to congestive heart failure, which is a state of circulatory congestion. Toxic injury, caused by agents such as doxorubicin, the alkaloid emetine in ipecac syrup, cocaine, or ethyl alcohol, is another way by which the functional integrity of the heart may also be compromised. 

Theophylline (Uniphyllin) treatment and prophylaxis of bronchospasm associated with asthma, chronic obstructive pulmonary disease and chronic bronchitis. Also indicated for the treatment of left ventricular and congestive cardiac failure. 

Possible uses. Arteriolar vasodilators are given to lower blood pressure in hypertension (p.314), to reduce cardiac work in angina pectoris (p.318), and to reduce ventricular afterload (pressure load) in cardiac failure (p.322). Venous vasodilators are used to reduce venous filling pressure (preload) in angina pectoris (p. 318) or congestive heart failure (p.322). Practical uses are indicated for each drug group. 

Demographic ncreasing age Previous medicai history Cerebrovascular disease Ischemic heart disease Congestive cardiac failure Left ventricular failure Peripheral vascular disease Diabetes Hypertension Smoking Event Territory... 

Cardiovascular Cardiac dysrhythmia, congestive heart failure (rare), sinus bradycardia... 

Cardiovascular Disorders and Copper. Sudden cardiac failure has been associated with copper deficiency (91J. There are two attractive mechanisms. First, the coronary arteries and aorta may become weakened from an inability to synthesize elastin due to a decrease in lysyl oxidase activity. Rupture of these major blood vessels has been shown to cause sudden death in animals suffering from copper deficiency. Second, a decrease in cytochrome oxidase activity during copper deficiency Impairs aerobic metabolism of the heart and increases the risk of hypertrophy. Hypertrophy, which may lead to high output congestive heart failure, is exacerbated by hypochromic anemia also caused by copper deficiency. 

Glucose (metabolized), mannitol, urea, glycerin (non-metabolized) and iodine radiocontrast media (incidental) produce an overexpansion of the extracellular fluid and circulatory overload (and are therefore contraindicated in congestive cardiac failure). This is often accompanied by dilutional hyponatraemia, and hyperkalaemia is also possible. Elimination is renal (80-90%). 

---