scholarly journals Medical Nutrition Therapy in Ischemic Hepatitis and Acute Kidney Injury Due to Congestive Heart Failure NYHA III

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 865-865
Author(s):  
Naldi Yanwar ◽  
Agussalim Bukhari
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Total Bilirubin ◽  
Kidney Injury ◽  
Ideal Body Weight ◽  
Nutritional Therapy ◽  
Shortness Of Breath ◽  
Ischemic Hepatitis ◽  
History Of ◽  
Ideal Body

Abstract Objectives Congestive Heart Failure is a major public health problem with an estimated prevalence of 1–2% of the adult population in developed countries, rising to ≥ 10% among persons > 70 years of age. The incidence of impaired liver function in the form of congestive hepatopathy and ischemic hepatitis ranges from 15% to 65% of patients with significant heart failure. Methods Mr.T, Male, 63 years old was suffered from ischemic hepatitis due to congestive heart failure NYHA III. He had history of hipertension since 2011 and a history of heart disease since 2011. The patient has reduced oral intake since 2 weeks ago and worsening 5 days ago due to decreased appetite and shortness of breath. Anthropometric examination found body length was 166 cm, ideal body weight was 59.4 Kg, Mid Upper Arm Circumference (MUAC) was 19 cm and Handgrips strength 8,6 kg. Laboratory assessments found leukocytosis (13,100 103 /ml), impaired kidney function (Ureum was 206 mg/dL and Creatinine was 3.51 mg/dl), increased transminase enzymes (SGOT 4113 U/L and SGPT 4721 U/L) and increased levels of bilirubin (Total Bilirubin 9.79 mg/dL and Bilirubin Direk 7.79 mg/dL). Results Medical Nutritional Therapy was determined with a calorie target of 1700 kcal; protein 1,4 gr/Kg ideal body weight/day; 50% carbohydrates and 30% fat, respectively. We provided oral suplementation in the form of zinc, vitamin B Complex and curcuma. The Patient was discharged after being treated for 11 days and recovered from shortness of breath and jaundice, with adequate nutritional intake (according to calorie targets), increased anthropometric parameters (MUAC was little increased 19,3 cm but handgrips strength was significantly increased to 28,3 kg), improved laboratory result including leukocytes decreased to normal (9.940 103/ml), ureum and creatinine were also turned to normal (47 mg/dL and 1,1 mg/dL, respectively), liver function was markedly decreased (SGOT 71 U/L, SGPT 468 U/L) as well as total bilirubin (2,90 mg/dL) and direct bilirubin (1,20 mg/dL). Conclusions Optimal treatment of the underlying disease (CHF) and adequate nutritional therapy could improve nutritional status and quality of life patients with CHF NYHA III with complications of ischemic hepatitis and acute kidney injury. Funding Sources The author(s) received no financial support for research, authorship, and/or publication of this article.

Theophylline Clearance in Obese Patients in Relation to Smoking and Congestive Heart Failure

1983 ◽  
Vol 17 (4) ◽  
pp. 274-276 ◽  
Author(s):  
Richard L. Slaughter ◽  
Robert A. Lanc
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Body Weight ◽  
Ideal Body Weight ◽  
Total Body Weight ◽  
Obese Patients ◽  
Ideal Body ◽  
Total Body ◽  
Nonobese Patients ◽  
Body Clearance

The effect of obesity on the total body clearance (Cltot) of theophylline was evaluated in nonsmokers and smokers with and without congestive heart failure (CHF). The obese patients were compared with similar nonobese subjects with regard to age, sex, and disease state. The total patient population numbered 150 adults. Cltot of theophylline, based on total body weight (TBW), averaged 0.60 ± 0.20 ml/min/kg in obese nonsmokers and did not differ from the nonobese, nonsmoking group. In obese nonsmoking patients with CHF, Cltot based on TBW was 0.40 ± 0.14 ml/min/kg, which was similar to Cltot values in nonsmoking CHF patients who were not obese. A trend toward a reduction in Cltot, based on TBW, as TBW increased, in nonsmoking patients with and without CHF, was observed. In contrast to the Cltot in nonsmokers, the Cltot of theophylline in obese smokers with and without CHF was similar to the Cltot values in nonobese populations only when based on ideal body weight. However, when compared with nonsmoking, nonobese patients, no differences were observed when Cltot was corrected for TBW. These findings suggest that theophylline maintenance dose can be based on TBW in obese patients who are smokers and nonsmokers (with and without CHF), using the average Cltot obtained for the nonsmoking patients with and without CHF.

scholarly journals A simple nomogram to predict contrast-induced acute kidney injury in patients with congestive heart failure undergoing coronary angiography

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Lei ◽  
Y He ◽  
Z Guo ◽  
B Liu ◽  
J Liu ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Prediction Models ◽  
Validation Cohort ◽  
Kidney Injury ◽  
Class Ii ◽  
Functional Class ◽  
Killip Class

Abstract Background Patients with congestive heart failure (CHF) are vulnerable to contrast-induced acute kidney injury (CI-AKI), but few prediction models are currently available. Objectives We aimed to establish a simple nomogram for CI-AKI risk assessment for patients with CHF undergoing coronary angiography. Methods A total of 1876 consecutive patients with CHF (defined as New York Heart Association functional class II-IV or Killip class II-IV) were enrolled and randomly (2:1) assigned to a development cohort and a validation cohort. The endpoint was CI-AKI defined as serum creatinine elevation of ≥0.3 mg/dL or 50% from baseline within the first 48–72 hours following the procedure. Predictors for the nomogram were selected by multivariable logistic regression with a stepwise approach. The discriminative power was assessed using the area under the receiver operating characteristic (ROC) curve and was compared with the classic Mehran score in the validation cohort. Calibration was assessed using the Hosmer–Lemeshow test and 1000 bootstrap samples. Results The incidence of CI-AKI was 9.06% (n=170) in the total sample, 8.64% (n=109) in the development cohort and 9.92% (n=61) in the validation cohort (p=0.367). The simple nomogram including four predictors (age, intra-aortic balloon pump, acute myocardial infarction and chronic kidney disease) demonstrated a similar predictive power as the Mehran score (area under the curve: 0.80 vs 0.75, p=0.061), as well as a well-fitted calibration curve. Conclusions The present simple nomogram including four predictors is a simple and reliable tool to identify CHF patients at risk of CI-AKI, whereas further external validations are needed. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Age-Related Frailty: A Clinical Model for Geroscience?

2020 ◽  
Vol 24 (10) ◽  
pp. 1140-1143 ◽  
Author(s):  
Catherine Takeda ◽  
D. Angioni ◽  
E. Setphan ◽  
T. Macaron ◽  
P. De Souto Barreto ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Medical History ◽  
Older Age ◽  
The Other ◽  
Everyday Practice ◽  
Clinical Model ◽  
Main Contributor ◽  
Age Related ◽  
History Of

AbstractIn their everyday practice, geriatricians are confronted with the fact that older age and multimorbidity are associated to frailty. Indeed, if we take the example of a very old person with no diseases that progressively becomes frail with no other explanation, there is a natural temptation to link frailty to aging. On the other hand, when an old person with a medical history of diabetes, arthritis and congestive heart failure becomes frail there appears an obvious relationship between frailty and comorbidity. The unsolved question is: Considering that frailty is multifactorial and in the majority of cases comorbidity and aging are acting synergistically, can we disentangle the main contributor to the origin of frailty: disease or aging? We believe that it is important to be able to differentiate age-related frailty from frailty related to comorbidity. In fact, with the emergence of geroscience, the physiopathology, diagnosis, prognosis and treatment will probably have to be different in the future.

Impact of Underlying Congestive Heart Failure on In-Hospital Outcomes in Patients with Septic Shock

2021 ◽  
pp. 088506662110614
Author(s):  
Mohinder R. Vindhyal ◽  
Liuqiang (Kelsey) Lu ◽  
Sagar Ranka ◽  
Prakash Acharya ◽  
Zubair Shah ◽  
...  
Keyword(s):  
Heart Failure ◽  
Septic Shock ◽  
Congestive Heart Failure ◽  
Hospital Mortality ◽  
Secondary Analysis ◽  
Kidney Injury ◽  
Cross Sectional ◽  
Increased Risk ◽  
Icd 10 ◽  
Nationwide Readmission Database

Purpose: Septic shock (SS) manifests with profound circulatory and cellular metabolism abnormalities and has a high in-hospital mortality (25%-50%). Congestive heart failure (CHF) patients have underlying circulatory dysfunction and compromised cardiac reserve that may place them at increased risk if they develop sepsis. Outcomes in patients with CHF who are admitted with SS have not been well studied. Materials and Method: Retrospective cross sectional secondary analysis of the Nationwide Readmission Database (NRD) for 2016 and 2017. ICD-10 codes were used to identify patients with SS during hospitalization, and then the cohort was dichotomized into those with and without an underlying diagnosis of CHF. Results: Propensity match analyses were performed to evaluate in-hospital mortality and clinical cardiovascular outcomes in the 2 groups. Cardiogenic shock patients were excluded from the study. A total of 578,629 patients with hospitalization for SS were identified, of whom 19.1% had a coexisting diagnosis of CHF. After propensity matching, 81,699 individuals were included in the comparative groups of SS with CHF and SS with no CHF. In-hospital mortality (35.28% vs 32.50%, P < .001), incidence of ischemic stroke (2.71% vs 2.53%, P = .0032), and acute kidney injury (69.9% vs 63.9%, P = .001) were significantly higher in patients with SS and CHF when compared to those with SS and no CHF. Conclusions: This study identified CHF as a strong adverse prognosticator for inpatient mortality and several major adverse clinical outcomes. Study findings suggest the need for further investigation into these findings’ mechanisms to improve outcomes in patients with SS and underlying CHF.

Rhabdomyolysis: An evidence-based approach

2021 ◽  
pp. 175114372110507
Author(s):  
Sarah Burgess
Keyword(s):  
Fluid Overload ◽  
Kidney Injury ◽  
Community Acquired Pneumonia ◽  
Evidence Based ◽  
Shortness Of Breath ◽  
Past Medical History ◽  
Urine Dipstick ◽  
The Past ◽  
Acting Insulin ◽  
History Of

A 76-year-old lady was found on the floor following a fall at home. She was uninjured, but unable to get up, and had been lying on the floor for roughly 18 hours before her son arrived. She had been unwell for the past 3 days with a cough and shortness of breath. She had a past medical history of diabetes, hypertension, hypercholesterolaemia and atrial fibrillation (AF). On examination, she was alert but distressed, clinically dehydrated, febrile and tachycardic. She was treated for community acquired pneumonia with co-amoxiclav and was fluid resuscitated with Hartmann’s solution. Her hyperkalaemia was treated with 50 mL of 50% glucose containing 10 units of rapid-acting insulin. Her creatinine kinase (CK) on admission was 200,000, and she had an acute kidney injury (AKI). Urine dipstick was positive for blood. However, her renal function continued to deteriorate over the succeeding 48 h, when she required renal replacement therapy (RRT) due to fluid overload and anuria.

Abstract 16010: Congestive Heart Failure and Coronavirus Disease 2019 Illness Severity

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Max Ruge ◽  
Joanne Michelle D Gomez ◽  
Gatha G Nair ◽  
Setri Fugar ◽  
Jeanne du Fay de Lavallaz ◽  
...  
Keyword(s):  
Heart Failure ◽  
At Risk ◽  
Congestive Heart Failure ◽  
Case Fatality ◽  
Severity Of Illness ◽  
Severe Infection ◽  
Severe Illness ◽  
Increased Risk ◽  
History Of ◽  
Male Sex

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has killed hundreds of thousands worldwide. Those with cardiovascular disease represent a vulnerable population with higher risk for contracting COVID-19 and worse prognosis with higher case fatality rates. Congestive heart failure (CHF) may lead to worsening COVID-19 symptoms. However, it is unclear if CHF is an independent risk factor for severe COVID-19 infection or if other accompanying comorbidities are responsible for the increased risk. Methods: From March to June 2020, data was obtained from adult patients diagnosed with COVID-19 infection who were admitted in the Rush University System for Health (RUSH) in Illinois. Heart failure patients, determined by ICD code assignments extracted from the electronic medical records, were identified. Multivariable logistic regression was performed between predictor variables and a composite outcome of severe infection consisting of Intensive Care Unit (ICU) admission, intubation, or in-hospital mortality. Results: In this cohort (n=1136), CHF [odds ratio (OR) 1.02] alone did not predict a more severe illness. Prior myocardial infarction [(MI), OR 3.55], history of atrial fibrillation [(AF), OR 2.14], and male sex (OR 1.55) were all significantly (p<0.001) associated with more severe COVID-19 illness course when controlling for CHF (Figure 1). In the 178 CHF patients, more advanced age (68.8 years vs. 63.8 years; p<0.05) and female sex (54.5% vs. 39.1%; p<0.05) were associated with increased severity of illness. Conclusions: Prior MI, history of AF, and male sex predicted more severe COVID-19 illness course in our cohort, but pre-existing heart failure alone did not. However, CHF patients who are females and older in age are at risk for severe infection. These findings help clinicians identify patients with comorbidities early at risk for severe COVID-19 illness.

Shortness of breath at night and health status in congestive heart failure: Effects of environmental conditions and health-related and dietary factors

2009 ◽  
Vol 109 (2) ◽  
pp. 166-174 ◽  
Author(s):  
Mark S. Goldberg ◽  
Nadia Giannetti ◽  
Richard T. Burnett ◽  
Nancy E. Mayo ◽  
Marie-France Valois ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Health Status ◽  
Environmental Conditions ◽  
Dietary Factors ◽  
Shortness Of Breath ◽  
Health Related

scholarly journals Derivation of a clinical decision rule for chest radiography in emergency department patients with chest pain and possible acute coronary syndrome

CJEM ◽  
2010 ◽  
Vol 12 (02) ◽  
pp. 128-134 ◽  
Author(s):  
Erik P. Hess ◽  
Jeffrey J. Perry ◽  
Pam Ladouceur ◽  
George A. Wells ◽  
Ian G. Stiell
Keyword(s):  
Heart Failure ◽  
Emergency Department ◽  
Congestive Heart Failure ◽  
Chest Pain ◽  
Chest Radiography ◽  
Clinical Decision ◽  
Chest Radiographs ◽  
Clinical Decision Rule ◽  
Coronary Syndrome ◽  
History Of

ABSTRACTObjective:We derived a clinical decision rule to determine which emergency department (ED) patients with chest pain and possible acute coronary syndrome (ACS) require chest radiography.Methods:We prospectively enrolled patients over 24 years of age with a primary complaint of chest pain and possible ACS over a 6-month period. Emergency physicians completed standardized clinical assessments and ordered chest radiographs as appropriate. Two blinded investigators independently classified chest radiographs as “normal,” “abnormal not requiring intervention” and “abnormal requiring intervention,” based on review of the radiology report and the medical record. The primary outcome was abnormality of chest radiographs requiring acute intervention. Analyses included interrater reliability assessment (with κ statistics), univariate analyses and recursive partitioning.Results:We enrolled 529 patients during the study period between Jul. 1, 2007, and Dec. 31, 2007. Patients had a mean age of 59.9 years, 60.3% were male, 4.0% had a history of congestive heart failure and 21.9% had a history of acute myocardial infarction. Only 2.1% (95% confidence interval [CI] 1.1%–3.8%) of patients had radiographic abnormality of the chest requiring acute intervention. The κ statistic for chest radiograph classification was 0.81 (95% CI 0.66–0.95). We derived the following rule: patients can forgo chest radiography if they have no history of congestive heart failure, no history of smoking and no abnormalities on lung auscultation. The rule was 100% sensitive (95% CI 32.0%–10.4%) and 36.1% specific (95% CI 32.0%–40.4%).Conclusion:This rule has potential to reduce health care costs and enhance ED patient flow. It requires validation in an independent patient population before introduction into clinical practice.

scholarly journals Acute Coronary Syndrome in Patients with Thrombotic Thrombocytopenic Purpura

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 4-5
Author(s):  
Moataz Ellithi ◽  
Fouad Khalil ◽  
Smitha N Gowda ◽  
Waqas Ullah ◽  
Radowan Elnair ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Thrombotic Microangiopathy ◽  
Kidney Injury ◽  
Coronary Syndrome ◽  
Icd 10 ◽  
History Of ◽  
Artery Disease

Introduction: Thrombotic thrombocytopenic purpura (TTP) is a life-threatening clinical syndrome characterized by microangiopathy and a variable degree of end-organ ischemic damage. Cardiac involvement has been recognized as a major cause of mortality in these patients (Patschan et al, Nephrol Dial Transplant, 2006; Benhamou et al, J Thromb. Haemost, 2015). In this study, we aim to investigate clinical predictors and outcomes of acute coronary syndrome in the setting of TTP admissions. Methods: The National Inpatient Sample (NIS) was queried for all hospitalizations with a primary diagnosis of thrombotic microangiopathy (ICD- 9-CM code 4466 and ICD-10-CM code M3.11) from 2002 to 2017. Using ICD-9-CM procedure codes (9972), (9971), and (9979), as well as ICD-10-CM procedure codes (6A551Z3) and (6A550Z3) we identified patients who received plasma exchange (PLEX) during the same admission. Due to the wide spectrum of thrombotic microangiopathy diseases, we decided to include only those who received PLEX to get a more specific subpopulation who were presumed to have TTP. We stratified patients based on whether or not they had acute coronary syndrome (ACS) during the admission, defined as presence of any ICD code for either ST-segment elevation myocardial infarction (STEMI), Non-STEMI, or unstable angina. Baseline characteristics and inpatient outcomes were compared between groups. Statistical analysis was performed using SPSS v26 (IBM Corp, Armonk, NY, USA). The odds ratio (OR) and 95% confidence interval (CI) were calculated using the Cochran-Mantel-Haenszel test. A multivariate regression model was deployed to assess predictors of inpatient mortality. Complex weights were used throughout all calculations, enabling appropriate national projections. Results: A total of 15,640 patients with the diagnosis of thrombotic microangiopathy were identified during the studied period. Of those, 6,214 patients had received PLEX treatment during their admission (39.7%). The annual admission rate for TTP was ranging between 5-7/100,000 admissions. Patients had a mean age of 47.8 years; 67% were females, and 46.5% were Caucasian. Stratifying by geographic region, 24% were from the Northeast, 21% from the Midwest, 42% from the South, and 13% from the West. The most common primary payer was private insurance (42.7%). Overall inpatient mortality was 9.1%. The most common complications reported included acute kidney injury (42.5%), followed by acute respiratory failure (14.9%), incident dialysis (14.3%), acute encephalopathy (7.7%), acute heart failure (7.3%), acute cerebrovascular accident (7.2%), and acute coronary syndrome (6.3%). ACS was documented in 6.7% of patients. Compared with patients without ACS, those with ACS were relatively older and had a relatively higher prevalence of coronary artery disease, dyslipidemia, diabetes mellitus, essential hypertension, chronic kidney disease, and heart failure. Patients with ACS had a 3-fold higher in-hospital mortality and a longer mean hospital stay (19 days vs. 15 days, P&lt;0.001). Using stepwise logistic regression, we identified age (aOR 1.03; 95% CI, 1.02 - 1.03; P &lt;0.001), history of heart failure (aOR 2.02; 95% CI, 1.53-2.67; P &lt;0.001), and history of coronary artery disease (aOR 2.69; 95% CI, 2.03 - 3.57; P &lt;0.001) as independent predictors of ACS among patients hospitalized with TTP. On another regression analysis, certain complications were more prevalent in the ACS group including acute cerebrovascular accidents, acute heart failure, acute kidney injury, cardiogenic shock, and respiratory failure. Conclusion: Despite wider utilization of therapeutic plasmapheresis and improved supportive treatments for patients with TTP, associated morbidity and mortality remain significant. We demonstrate from this large retrospective cohort that ACS is an independent predictor of higher morbidity and mortality in TTP patients. We identified older age, history of heart failure, and history of coronary artery disease as independent predictors of ACS among patients admitted with TTP. Further studies are warranted to develop risk stratification models for patients with TTP. Figure Disclosures Anwer: Incyte, Seattle Genetics, Acetylon Pharmaceuticals, AbbVie Pharma, Astellas Pharma, Celegene, Millennium Pharmaceuticals.: Honoraria, Research Funding, Speakers Bureau.

SWEATING IN CONGENITAL HEART DISEASE

PEDIATRICS ◽  
1968 ◽  
Vol 41 (1) ◽  
pp. 123-129
Author(s):  
Blanche P. Alter ◽  
Emily E. Czapek ◽  
Richard D. Rowe
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Sweat Test ◽  
Endocardial Fibroelastosis ◽  
History Of Or ◽  
History Of ◽  
Sweat Tests

Sweating was found to be increased in children with congenital heart disease who had a propensity to congestive heart failure, e.g., children with endocardial fibroelastosis or large or moderate sized left-to-right shunts. This was suggested in a review of cardiac clinic records of 220 patients and was supported by the results of pilocarpine sweat tests which were performed on 34 cardiac patients. By history and by measurement of the amount of sweat produced, children with a history of or tendency toward heart failure could be predicted though patients did not need to be in failure when tested. Contrary to previous opinion, the left-to-right shunt was not in itself sufficient to cause the child to sweat. The shunt had to be large enough to be associated with failure at some time. It is suggested that the pilocarpine sweat test might actually be useful as an aid in predicting a child's potential for heart failure. Several theories regarding the mechanism of sweating in these situations are discussed.

Sign in / Sign up

Export Citation Format

Share Document