Precipitating factors

TABLE 3-3. Exacerbating or Precipitating Factors in Heart Failure... 

Identify exacerbating or precipitating factors that may worsen BE s heart failure. 

It is important for the clinician to identify the cause(s) of AHF in order to maximize treatment efficacy and reduce future disease exacerbations. Cardiovascular, metabolic, and lifestyle factors can all precipitate AHF. The most common precipitating factors for acute decompensation and how they contribute pathophysiologically are listed in Table 3-3. 

Other diagnostic tests should also be obtained in order to rule out precipitating factors (chest radiograph) and to evaluate cardiac function (ECG). 

O Portal hypertension is the precipitating factor for the complications of cirrhotic liver disease—ascites, spontaneous bacterial peritonitis (SBP), variceal bleeding, and hepatic encephalopathy. Lowering portal pressure can reduce the complications of cirrhosis and decrease morbidity and mortality. 

Obtain a seizure history from the patient or family members, including precipitating factors and duration of seizure activity. 

List underlying causes and precipitating factors of different types of headache disorders. 

Assess the patient complaint to yield a detailed description of headache precipitating factors presence or absence of prodromal symptoms location, intensity, and duration of pain changes in sensory acuity and neurologic alterations. 

Evaluate and correct infection or other precipitating factors. 

Psoriasis is a T-lymphocyte-mediated inflammatory disease that results from a complex interplay between multiple genetic factors and environmental influences. Genetic predisposition coupled with some precipitating factor triggers an abnormal immune response, resulting in the initial psoriatic skin lesions. Keratinocyte proliferation is central to the clinical presentation of psoriasis. 

Atrial flutter is characterized by rapid (270 to 330 atrial beats/min) but regular atrial activation. The ventricular response usually has a regular pattern and a pulse of 300 beats/min. This arrhythmia occurs less frequently than AF but has similar precipitating factors, consequences, and drug therapy. 

If patients are hemodynamicaUy stable, the focus should be directed toward control of ventricular rate. Drugs that slow conduction and increase refractoriness in the AV node should be used as initial therapy. In patients with normal LV function (left ventricular ejection fraction >40%), IV j3-blockers (propranolol, metoprolol, esmolol), diltiazem, or verapamil is recommended. If a high adrenergic state is the precipitating factor, IV /J-blockers can be highly effective and should be considered first. In patients with left ventricular ejection fraction <40%, IV diltiazem and verapamil... 

Underlying precipitating factors should be corrected by ensuring proper oxygenation and ventilation and by correcting acid-base or electrolyte disturbances. 

If severe symptoms are present, synchronized DCC should be instituted immediately to restore sinus rhythm. Precipitating factors should be corrected if possible. If VT is an isolated electrical event associated with a transient initiating factor (e.g., acute myocardial ischemia, digitalis toxicity), there is no need for long-term antiarrhythmic therapy after precipitating factors are corrected. 

Common precipitating factors that may cause a previously compensated patient to decompensate include noncompliance with diet or drug therapy, coronary ischemia, inappropriate medication use, cardiac events (e.g., MI, atrial fibrillation), pulmonary infections, and anemia. 

The first step in managing chronic HF is to determine the etiology or precipitating factors. Treatment of underlying disorders (e.g., anemia, hyperthyroidism) may obviate the need for treating HF. 

Precipitating factors include exercise, cold environment, walking after a meal, emotional upset, fright, anger, and coitus. Relief occurs with rest and within 45 seconds to 5 minutes of taking nitroglycerin. 

General treatment goals for patients with skin disorders are to relieve bothersome symptoms, remove precipitating factors, prevent recurrences, avoid adverse treatment effects, and improve quality of life. 

Control precipitating factor Reverse encephalopathy Hospital/inpatient therapy... 

The first approach to treatment of HE is to identify any precipitating causes. Precipitating factors and therapy alternatives are presented in Table 21-6. 

The patient and family should be asked to characterize the seizure for frequency, duration, precipitating factors, time of occurrence, presence of an aura, ictal activity, and postictal state. 

Transient (two to three nights) and short-term (less than 3 weeks) insomnia is common and is usually related to a precipitating factor. Chronic insomnia (greater than 1 month) may be related to medical or psychiatric disorders or medication, or it may be psychophysiologic. 

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