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1.
Heart Failure Update: Outpatient Management.
Wojnowich, K, Korabathina, R
FP essentials. 2016;:18-25
Abstract
Outpatient management of heart failure (HF) is aimed at treating symptoms and preventing hospitalizations and readmissions. Management is initiated in a stepwise approach. Blockade of the renin-angiotensin system is a cornerstone of therapy and should be started, along with beta blockers, as soon as the diagnosis of HF is made. Other drugs, including diuretics, aldosterone antagonists, hydralazine, and nitrates, may be added based on symptoms and American College of Cardiology/American Heart Association stage. Despite a great interest in and theoretical benefit of naturoceutical products in the mitigation of oxidative stress and HF progression, none has been proven to be beneficial, and concerns exist regarding their interactions with standard HF drugs. Other nonpharmacologic interventions, including sodium restriction, regular exercise, and/or cardiac rehabilitation, should be initiated at diagnosis. HF often is progressive, and clinicians should be aware of late stage management options, including implantable devices, cardiac transplantation, and hospice care.
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2.
Raynaud disease.
Butendieck, RR, Murray, PM
The Journal of hand surgery. 2014;(1):121-4
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3.
Postpartum cerebral angiopathy treated with intra-arterial nicardipine and intravenous immunoglobulin.
Samaniego, EA, Dabus, G, Generoso, GM, Tari-Capone, F, Fuentes, K, Linfante, I
Journal of neurointerventional surgery. 2013;(3):e12
Abstract
Postpartum cerebral angiopathy (PCA) is a rare vasoconstriction syndrome that can lead to severe disability and death. The pathophysiology of PCA is unknown. A case of a 39-year-old woman who developed PCA 3 days after twin delivery is reported. She presented with right hemiparesis, aphasia and lethargy. Imaging studies demonstrated severe segmental narrowing of multiple cerebral arteries comprising the anterior and posterior circulations. She continued to deteriorate despite induced hypertension, immunosuppression, intravenous magnesium and oral nimodipine. Intra-arterial administration of nicardipine on three consecutive occasions reversed the angiographic vasospasm and led to symptom resolution. Definite improvement occurred after a 5 day course of intravenous immunoglobulin (IVIg). The patient described in this report developed recalcitrant PCA-induced vasospasm which resolved with endovascular administration of nicardipine and immunotherapy with IVIg.
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4.
Coronary stenting in patients with medically resistant vasospasm.
Khitri, A, Jayasuriya, S, Habibzadeh, MR, Movahed, MR
Reviews in cardiovascular medicine. 2010;(4):264-70
Abstract
Formally described by Prinzmetal and colleagues in 1959, variant angina represents a syndrome of resting angina that results from severe coronary artery vasospasm associated with ST elevation. The majority of patients respond to nitrates or calcium channel blockers. However, medical treatment-resistant vasospasm can occur in up to 20% of cases, thus requiring further interventions. We present a rare instance of coronary vasospasm associated with complete heart block resistant to medical therapy that was successfully treated with stenting. This case example is followed by a detailed review of the literature with regard to percutaneous or surgical coronary revascularization of patients with medically resistant vasospasm.
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5.
Nicorandil induced perianal ulceration.
Tiernan, JP, Baraza, W, Chelham, W, Garner, J, Angel, C, Shrestha, BM
JNMA; journal of the Nepal Medical Association. 2009;(175):239-41
Abstract
Nicorandil is a cardioprotective drug which is used in the prophylaxis and long-term treatment of angina pectoris. Debilitating perianal ulcer is a rare complication of Nicorandil therapy which can cause diagnostic and management dilemmas. We describe the management of a case of Nicorandil-induced perianal ulcer and review pertinent contemporary literature.
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6.
Coronary artery spasm: a 2009 update.
Stern, S, Bayes de Luna, A
Circulation. 2009;(18):2531-4
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7.
A probable case of nitroprusside intoxication.
Nicoletta, G, Cascelli, M, Marchesini, L, Tesoro, S
Minerva anestesiologica. 2007;(9):471-3
Abstract
This article describes the clinical history of a patient admitted to the Emergency Room after severe infrascapular pain unaffected by breathing or postural changes. After thoracic CT a type B aortic dissection was diagnosed. On admission to the CCU, the patient's blood pressure was still high (210/120 mmHg). Sodium nitroprusside (1 microg/kg/min drip) was initiated. As blood pressure remained high after 24 h, the infusion rate was increased gradually up to 18 microg/kg/min. In the evening of the following day the patient was transferred to the operating room because acute renal failure (BUN 108 mg/dL, Cr 4.00 mg/dL) occurred and arterial pressure was still high (180/60 mmHg). A thoracic endoprosthesis was then inserted. During this procedure the patient was relaxed and his blood pressure was satisfactory (140/80 mmHg) without drugs. In order to further lower blood pressure and afterload before positioning the second prosthetic segment within the aortic arch, 1 microg/kg/min nitroprusside drip was continued. A few minutes initiation of the drip an abrupt rise in blood pressure (systolic 200 mmHg) was observed, which had to be controlled before continuing the procedure. Increased nitroprusside infusion and repeated boluses of 10 mg urapidil (3-4 boluses with an interval of 15 min) and 30 microg clonidine were unsuccessful. After 15 min with an increased nitroprusside infusion rate, the patient showed psychomotor agitation and O2 his saturation dropped to 91% while arterial pH was 7.2 and lactate concentration was 3.5 mmol/L. Nitroprusside infusion was discontinued, while 0.1 microg/kg/min fenoldopam (started when the patient arrived in the operating room) was continued without improvement. In order to complete the procedure, general anaesthesia with sevflurane (2 MAC) in air (FiO2= 40%) was induced. After successful reduction in blood pressure the procedure was completed. In the postoperative course the patient was admitted to the ICU.