An 89-year-old man presents with worsening heart failure

Clinical introduction An 89-year-old man with a history of heart failure with preserved ejection fraction presented with worsening dyspnoea, reduced exercise capacity and peripheral oedema. His medical history was significant for hypertension, paroxysmal atrial fibrillation (AF), chronic obstructive pulmonary disease and Lyme disease (1983). Admission cardiovascular medications included aspirin 75 mg once a day, perindopril 6 mg once a day, furosemide 40 mg two times a day, flecainide 100 mg two times a day and simvastatin 40 mg one a night. On examination, he was normothermic and clinically in heart failure with raised jugular venous pressure, bibasal pulmonary crepitations and oedema up to abdomen. Cardiac markers were negative. Other laboratory tests demonstrated a normocytic anaemia, C reactive protein 18.7 mg/L (0–7.9), urea 19.4 mmol/L (2.8–7.2) and creatinine 162 µmol/L (72–127), which had trended above a baseline of 110 µmol/L for 4 months. Electrolytes including sodium, potassium, magnesium, corrected calcium and inorganic phosphate were within normal range. His admission...
Source: Heart - Category: Cardiology Authors: Tags: Drugs: cardiovascular system, Echocardiography, Image challenges, Hypertension, Right sided valvular heart disease, Clinical diagnostic tests, Epidemiology, Metabolic disorders Source Type: research

Related Links:

Authors: Rombauts A, Abelenda-Alonso G, Cuervo G, Gudiol C, Carratalà J Abstract INTRODUCTION: Despite adequate antibiotic coverage, community-acquired pneumonia (CAP) remains a leading cause of hospitalization and mortality worldwide. It induces both a local pulmonary and a systemic inflammatory response, particularly significant in severe cases. The intensity of the dysregulated host response varies from patient to patient and has a negative impact on survival and other outcomes. AREAS COVERED: This comprehensive review summarizes the pathophysiological aspects of the inflammatory response in CAP, brie...
Source: Expert Review of Anti-Infective Therapy - Category: Infectious Diseases Tags: Expert Rev Anti Infect Ther Source Type: research
Publication date: Available online 30 September 2020Source: Journal of Hazardous MaterialsAuthor(s): Anthony Beauvois, Delphine Vantelon, Jacques Jestin, Martine Bouhnik-Le Coz, Charlotte Catrouillet, Valérie Briois, Thomas Bizien, Mélanie Davranche
Source: Journal of Hazardous Materials - Category: Environmental Health Source Type: research
Authors: Musio F Abstract INTRODUCTION: Anemia has and will continue to be a central theme in medicine particularly as clinicians are treating a burgeoning population of complex multi-organ system processes. As a result of multiple randomized controlled trials (RCTs), meta-analyses, and societal recommendations overly restrictive paradigms and under-administration of erythropoiesis stimulating agents (ESAs) have likely been followed by clinicians among all specialties. AREAS COVERED: A review of anemia in the context of chronic kidney disease, hematologic malignancies and cancer is presented with focus on the e...
Source: Expert Review of Hematology - Category: Hematology Tags: Expert Rev Hematol Source Type: research
Authors: Bergland OU, Søraas CL, Larstorp ACK, Halvorsen LV, Hjørnholm U, Hoffman P, Høieggen A, Fadl Elmula FEM Abstract PURPOSE: The blood pressure (BP) lowering effect of renal sympathetic denervation (RDN) in treatment-resistant hypertension shows variation amongst the existing randomised studies. The long-term efficacy and safety of RDN require further investigation. For the first time, we report BP changes and safety up to 7 years after RDN, compared to drug adjustment in the randomised Oslo RDN study. MATERIALS AND METHODS: Patients with treatment-resistant hypertension, defined...
Source: Blood Pressure - Category: Hematology Tags: Blood Press Source Type: research
Authors: Zhang W, Xu JZ, Lu XH, Li H, Wang D, Wang JG Abstract PURPOSE: We hypothesise that dietary sodium intake interacts with serum uric acid to influence blood pressure (BP) in children and adolescents. In the present study, we investigated ambulatory BP in relation to hyperuricaemia, dietary sodium intake and their interaction in children and adolescents with hypertension. MATERIALS AND METHODS:  A total of 616 study participants were 10-24 years old and had primary hypertension diagnosed after admission in a specialised inpatient ward. Ambulatory BP monitoring was performed during hospitalisat...
Source: Blood Pressure - Category: Hematology Tags: Blood Press Source Type: research
Publication date: Available online 9 October 2020Source: Mutation Research/Reviews in Mutation ResearchAuthor(s): Klaudia Kulczynska-Figurny, James J. Bieker, Miroslawa Siatecka
Source: Mutation Research Reviews in Mutation Research - Category: Genetics & Stem Cells Source Type: research
Authors: Saavedra J, Reyes JG, Salinas DG Abstract Cytosolic Ca2+ concentration ([Ca2+ ]) has an important role in spermatozoa and hence it regulates fertilization. In male germinal cells, there are indirect evidences that this ion could regulate physiological processes in spermatogenesis. Since little is known about Ca 2+ homeostasis in spermatogenic cells, in this work we propose a mathematical model that accounts for experimental [Ca2+ ] dynamics triggered by blockade of the SERCA transport ATPase with thapsigargin in round rat spermatids, without external Ca2+ and with different extracellular lactate concentrat...
Source: Channels - Category: Molecular Biology Tags: Channels (Austin) Source Type: research
Publication date: Available online 10 October 2020Source: Nutrition, Metabolism and Cardiovascular DiseasesAuthor(s): Naila Choudhary, Katia Bravo-Jaimes, Carmen Smotherman, Saadia Sherazi, Dale F. Kraemer, Gladys P. Velarde
Source: Nutrition, Metabolism and Cardiovascular Diseases - Category: Nutrition Source Type: research
CONCLUSIONS: Neuro-ophthalmologic findings are mostly normal in patients with visual snow syndrome. Retinal or neurological diseases must be excluded as possible causes of visual snow. PMID: 33029971 [PubMed]
Source: Journal of Clinical Neurology - Category: Neurology Tags: J Clin Neurol Source Type: research
CONCLUSIONS: Young adult IS patients in Korea exhibit low awareness and poor management of their risk factors. Although the short-term outcome was relatively favorable in those patients, having SLE was associated with unfavorable outcomes. More attention needs to be paid for improving awareness and controlling risk factors in this population. PMID: 33029967 [PubMed]
Source: Journal of Clinical Neurology - Category: Neurology Tags: J Clin Neurol Source Type: research
More News: Anemia | Aspirin | Atrial Fibrillation | Calcium | Cardiology | Cardiovascular | Chronic Obstructive Pulmonary | Epidemiology | Furosemide | Heart | Heart Disease | Heart Failure | Hypertension | Laboratory Medicine | Lyme Disease | Magnesium | Normocytic Normochromic Anemia | Simvastatin | Sports Medicine | Statin Therapy | Zocor