Is there Intracellular edema in congestive heart failure ?
I am unable to answer this question confidently even after spending 25 years in the specialty of cardiology. I thought, the answer was yes. Reality is definitely different. Such is the complexity in the biology of the fluid and circulatory systems. The heart’s function doesn’t seem to end with just pumping 6 liters of blood every minute, ultimately, it has to handle a huge load of water as well with delicate coordination with the kidney. (ANP,& RASS feedback). It is fascinating to note, that the heart transforms into a powerful endocrine organ as and when it is necessary.
Read further, with a caution: (The...
Source: Dr.S.Venkatesan MD - May 31, 2022 Category: Cardiology Authors: dr s venkatesan Tags: cardiac failure edema in heart failure Source Type: blogs
An elderly woman found down with bradycardia and hypotension
Submitted by Alex Bracey, with edits by Pendell Meyers and Steve SmithA female in her 70s with PMH of hypertension, coronary artery disease, and a remote history of an aortic valve replacement was brought into the ED after being found down by her son. On arrival she was confused. Her initial ECG isshownbelow.What do you think? - Sinus bradycardia with HR of ~50 BPM (plus artifact that mimics PVCs) - Peaked T waves particularly visible in leadsV1-V3, I, and aVL - RBBB with QRS duration 152 ms (comparison to prior shows similar RBBB morphology but with QRS duration of 116 ms)In addition to being bradycardic as seen on this E...
Source: Dr. Smith's ECG Blog - June 6, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
Additional thoughts on diuretics – a followup to the furosemide rant
Yesterday’s screed about loop diuretics initiated more twitter activity than any blog post this year. Who knew?
Several comments bear documenting.
Important information on comparative absorption and duration of diuretics – A wonderful long range colleague (you should follow @kidney_boy on twitter) posted this infographic concerning this question on his blog. This is a most important link.
@Ajauseon tweeted this: “aspired to teach ‘evidence-based’ diuresis on CCU this month only to find there isn’t any” This tweet reminds me that EBM does not work for all questions. This qu...
Source: DB's Medical Rants - December 27, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Things that Bug me 1 – improper use of diuretics
This month on our VA ward team we have had 3 admissions that involved complications of over diuresis for systolic dysfunction. We also see patients who do not have adequate diuresis.
Diuretics greatly help symptoms in patients with systolic dysfunction and volume overload. But diuretics are primarily symptom relief medications.
I often ask students and residents to write this sentence, memorize it, and use it:
The purpose of diuretic therapy in systolic heart failure is render the patient not wet, but not to make the patient dry.
The idea here is that we should only give enough diuretic therapy to relieve symptoms. ...
Source: DB's Medical Rants - December 22, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Why do we still use oral furosemide?
Most physicians do not understand pharmacology and pharmacokinetics. We use Lasix (furosemide) because we have always used furosemide. As an academic hospitalist, we often have patients admitted with heart failure (either right sided or left sided) who have gained significant fluid weight despite taking significant oral doses of furosemide. When they get admitted we start with IV furosemide and amazingly they pee like racehorses.
How many of us remember that oral furosemide is variably absorbed, with a general range of 20%-80%? You may not remember that, or you might just be in the habit of using Lasix. Lasix has a gr...
Source: DB's Medical Rants - March 11, 2015 Category: Internal Medicine Authors: rcentor Tags: Attending Rounds Source Type: blogs
