Heart failure chronic obstructive pulmonary disease

Many elderly persons, whether demented or cognitively intact, have medical conditions that disrupt sleep. Untreated insomnia and daytime sleepiness have been associated with nursing home placement and mortality. Medically ill older adults admitted to acute care hospitals are particularly vulnerable to sleep disruptions, which appear to be created as much by the various treatments and procedures, unfamiliar routines, and environmental conditions, as by the pain, anxiety, and discomfort associated with their underlying medical condition. Medical conditions especially likely to disrupt sleep are congestive heart failure, chronic obstructive pulmonary disease, Parkinson s disease, gastroesophageal reflux disease, arthritis, and nocturia. 

In developed countries, naturally, the critical issue of delivering quality health care to all citizens remains. The focus, however, moves away from managing acute and infectious diseases to managing chronic and complex diseases, such as congestive heart failure, chronic obstructive pulmonary disease, and diabetes. However, even in the most economically advanced countries, the need to deliver quality health care in an economically viable and sustainable fashion is of concern, as is the issue of continuum of care across the various health services. With increasingly aging populations, the demands on limited health resources will escalate over the next decade. 

Heart failure, chronic obstructive pulmonary disease, thyrotoxicosis, constrictive pericarditis, ischemic heart disease, sepsis, pulmonary embolus, rheumatic heart disease, hypertension, mitral stenosis, atrial irritation, or complication of coronary bypass or valve replacement surgery. 

The most serious side effects early in ACS are hypotension, bradycardia, and heart block. Initial acute administration of //-blockers is not appropriate for patients presenting with decompensated heart failure. However, therapy may be attempted in most patients before hospital discharge after treatment of acute heart failure. Diabetes mellitus is not a contraindication to //-blocker use. If possible intolerance to //-blockers is a concern (e.g., due to chronic obstructive pulmonary disease), a short-acting drug such as metoprolol or esmolol should be administered IV initially. 

Comorbidities (chronic obstructive pulmonary disease, diabetes, renal or congestive heart failure, malignancy)... 

Many disorders benefit from exercise (Pederson Saltin, 2005). These include asthma, cancer, chronic heart failure, coronary artery disease, chronic obstructive pulmonary disease (COPD), depression, type 1 diabetes melUtus, type 2 diabetes melUtus, hypertension, intermittent claudication, osteoarthritis, osteoporosis, rheumatoid arthritis and obesity. 

Kato M, Komamura K, Kitakaze M. (2006) Tiotropium, a novel muscarinic M3 receptor antagonist, improved symptoms of chronic obstructive pulmonary disease complicated by chronic heart failure. Circ J 70 1658-1660. 

Propranolol, nadolol, timolol, penbutolol, carteolol, sotalol, and pindolol Bronchial asthma or bronchospasm, including severe chronic obstructive pulmonary disease. Metoprolol Treatment of Ml in patients with a heart rate less than 45 beats/min significant heart block greater than first degree (PR interval 0.24 seconds or more) systolic blood pressure less than 100 mm Hg moderate to severe cardiac failure. Sotalol Congenital or acquired long QT syndromes. 

CHF congestive heart failure CHI closed head injury CLA cis-linoleic acid CLL chronic lymphocytic leukemia CML chronic myelogenous leukemia CMV cytomegalovirus CNS central nervous system Comps complications COMT catechol-O-methyltransferase Contra contraindicated COPD chronic obstructive pulmonary disease COX cyclooxygenase CP chest pain... 

The principal use of theophylline is in the management of asthma. It is also used to treat the reversible component of airway obstruction associated with chronic obstructive pulmonary disease and to relieve dyspnea associated with pulmonary edema that develops from congestive heart failure. 

Contraindications Bronchial asthma, cardiogenic shock, CHF secondary to tachyarrhythmias, chronic obstructive pulmonary disease (COPD), patients receiving MAOI therapy, second- or third-degree heart block, sinus bradycardia, uncontrolled cardiac failure... 

Reconsideration of contraindications has also been proposed in a prospective study in patients with serum creatinine concentrations of 130-220 pmol/1 and coronary heart disease (n — 226), congestive heart failure (n = 94) and chronic obstructive pulmonary disease (n = 91). Half of the patients continued to take metformin and the other half stopped (39). Bodyweight and HbAic increased over 4 years in those who stopped taking metformin. Lactic acid concentrations were similar in the two groups. Deaths were similar in the two groups (62 and 64 respectively). The incidences of myocardial infarction, all cardiovascular events, and cardiovascular mortality were the same. Changes in additional therapy were only significant for insulin (30% versus 45% respectively) and diet (25% versus 0% respectively). 

Cachexia is loss of weight, muscle atrophy, fatigue, weakness and significant loss of appetite. It is seen in patients with cancer, acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease and congestive heart failure. Underlying causes are poorly understood, but there is an involvement of inflammatory cytokines, such as TNF-a, IFN-y, IL-6 and tumour-secreted proteolysis-inducing factor. Related syndromes are kwashiorkor and marasmus, although these are most often symptomatic of severe malnutrition. 

Half-life. Plasma half-life, 3 to 13 hours in normal subjects (mean 7) but decreased in smokers and in children, and increased in premature neonates and in certain disease states such as hepatic disease, heart failure, and chronic obstructive pulmonary disease. The half-life may also be affected by the amount of dietary methylxanthines ingested. 

An 86-year-old woman, with a history of stable schizophrenia, chronic obstructive pulmonary disease, ischemic cardiomyopathy, and type 2 diabetes, was admitted with cardiac insufficiency, which was treated by introduction of enalapril. A chest infection was treated with co-amoxiclav with gradual alleviation of sjmp-toms over 10 days. At this point, furosemide was begun, because of persistent signs of heart failure. After 3 days, erythema and bullae were noted on her pahns and soles, and later on the trunk, extremities, hard palate, and buccal mucosa. Biopsy showed the characteristic features of linear IgA bullous dermatosis, with linear deposition of IgA along the basement membrane. Co-amoxiclav and furosemide were withdrawn no new lesions were noted thereafter. 

The safety of perflenapent has been evaluated in multicenter phase II studies in 146 patients with congestive heart failure (NYHA class III or IV, mean age 68 years), of whom 99 received perflenapent and 47 received isotonic saline, and in 134 patients with severe chronic obstructive pulmonary disease (FEVi no more than 60% of predicted, mean age 65 years), of whom 91 received perflenapent and 43 received isotonic saline (13). Blood pressure, heart rate, respiratory rate, oxygen saturation, the electrocardiogram, FEVi, complete serum biochemistry, hematology, and mental state were assessed. Adverse events were mild and required no treatment. There was no significant difference in the incidence of adverse reactions between those given perflenapent (15%) and those given placebo (11%). The most frequent adverse events with perflenapent were vasodilatation (n = 8), taste disturbance (n = 6), nausea (n = 5), and headache (n = 3). 

Key M male F female DM diabetes mellltus HTN hypertension CAD coronary artery disease COPD chronic obstructive pulmonary disease CHF congestive heart failure ESRD end stage renal disease OSPS oral sodium phosphate solution PEG polyethylene glycol AKI acute kidney Injury na not available HD hemodialysis. 

Atrial fibrillation is a relatively frequent supraventricular arrhythmia (10-12% of cases) (Figure 4.16 Sugiura et al, 1985), as other supraventricular arrhythmias are typically related to atrial involvement (Liu, Greenspan and Piccirillo, 1961 Zimerman, 1968) and/or pericarditis. Atrial fibrillation occurs usually in the most extensive ACSs. However, in patients with ACS due to RCA occlusion, it may be explained by vagal overdrive and maybe accompanied by AV block. Age, presence of abnormal P wave (Agarwal, 2003), chronic obstructive pulmonary disease (COPD) and heart failure are triggering factors. The incidence of atrial fibrillation has decreased in the post-thrombolytic era. 

The development of a bedside assay for plasma BNP has focused considerable attention on the use of BNP as an aid in the diagnosis of suspected heart failure. Plasma BNP concentration is positively correlated with the degree of left ventricular dysfunction and heart failure, and this assay is now used frequently in acute care settings to assist in the differential diagnosis of dyspnea [heart failure versus asthma, chronic obstructive pulmonary disease (COPD), or infection]. Recent studies found that an elevated BNP concentration is an independent predictor of heart failure as the cause of dyspnea and that in patients with decompensated heart failure, an elevated pre-hospital discharge BNP concentration is associated with an increased risk of death or readmission. Additional research is ongoing to better characterize the role of BNP measurement in the diagnosis and treatment of heart failure. 

ADHD, attention-deficit/hyperactivity disorder AV, atrioventricular BPH, benign prostatic hypertrophy CAD, coronary artery disease CHF, congestive heart failure COPD, chronic obstructive pulmonary disease CV, cardiovascular DA, dopamine Dl, subtype 1 dopamine receptor Epi, epinephrine FFA, free fatty acids 5-HT, serotonin ISA, intrinsic sympathomimetic activity MI, myocardial infarction NE, norepinephrine NO, nitric oxide PVR, peripheral vascular resistance. 

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