Effect of Si Idenafi I on Ocular Haemodynamics

Total Page:16

File Type:pdf, Size:1020Kb

Effect of Si Idenafi I on Ocular Haemodynamics Effect of si Idenafi I on SEMA ORUC: DUNDAR, MEHMET DUNDAR, IZZET KOC:AK, ocular haemodynamics YELDA DAYANIR, SEYHAN BAHAR 0 ZKAN Abstract detail, ocular effects of sildenafil are still lacking. There are some reports in the literature Purpose To study the effect of sildenafil, on the retinal side-effects of sildenafi1.5,6 which is an effective agent for the treatment of However, to our knowledge, no data are erectile dysfunction, on ocular available on the ocular haemodynamic effects of haemodynamics. sildenafil. Methods In this prospective study we Colour Doppler imaging (CD!) is a non­ examined the effect of a single oral dose of invasive method for measuring blood flow 50 mg sildenafil (Viagra) in a group of healthy velocity of the retrobulbar circulation in vivo. young male volunteers, by using colour This is an ultrasound technique that combines Doppler ultrasound imaging to measure B-scan grey-scale imaging of tissue structure, haemodynamic variables in the central retinal coloured representation of blood flow based on artery (CRA), short temporal posterior ciliary Doppler shifted frequencies and pulsed artery (STPCA) and ophthalmic artery (OA). Doppler measurement of blood flow The following examinations were performed velocities?-12 on both eyes immediately before and 1 h after This study was designed to analyse the effect a single oral dose of 50 mg sildenafil: visual of a single oral dose of 50 mg sildenafil on the acuity, intraocular pressure (lOP), colour retrobulbar circulation in a group of healthy vision, anterior segment, fundus appearance, young male volunteers by means of COL resting heart rate, blood pressure and colour Doppler measurements. Results After sildenafil administration, peak Materials and methods systolic velocity, mean velocity and end­ Subjects diastolic velocity significantly increased in the Fourteen healthy sexually active male OA of both eyes. All Dopper indices remained volunteers between 20 and 38 years of age non-significant for the CRA and STPCA of (average 27.01 years) were studied. Informed both eyes. Sildenafil did not cause any consent was obtained from all participants. The significant change in lOP, colour vision, visual 5.0. Dundar subjects showed no evidence of any clinically acuity, systolic blood pressure or diastolic S.B. Ozkan significant disease, or clinically significant Department of blood pressure. However, heart rate abnormality following review of laboratory data Ophthalmology measurements increased significantly after Adnan Menderes University and full physical examination, and none were sildenafil administration compared with Aydin, Turkey taking medications. All had a normal eye baseline (p = 0.003). examination with a best-corrected visual acuity M. Dundar Conclusion The increased flow velocity in the of 20/20 or better. The intraocular pressure I. Ko<;ak ophthalmic artery seems to be due to a Department of Urology (lOP) was 19 mmHg or less and the anterior vasodilator effect of sildenafil. Adnan Menderes University segment and fundus examinations within the Aydin, Turkey normal range. Key words Central retinal artery, Colour Y. Dayanir Doppler ultrasound, Ophthalmic artery, Department of Radiology Sildenafil Study design Adnan Menderes University Aydin, Turkey A single oral dose of 50 mg sildenafil was Sildenafil (Viagra, Pfizer), an oral agent which administered to 14 healthy male volunteers. The Sema Oru<; Dundar � has proven effective for the treatment of erectile Adnan Menderes following tests were performed on both eyes dysfunction, is a novel inhibitor of the human Universitesi immediately before and 1 h after sildenafil Tip Fakultesi cGMP-specific phosphodiesterase type 5 administration: visual acuity, lOP (Goldmann Gaz Hastaliklari AD enzyme (POE 5) found in human corpus applanation tonometry), colour vision, anterior Aydin, 09100, Turkey cavernosum. This agent enables a natural segment, fundus appearance, resting heart rate, Tel: +90 256 2124078 erectile response to sexual stimulation by blood pressure and colour Doppler Fax: +90 256 2120146 enhancing the relaxant effect of nitric oxide measurements. The maximum effect of single e-mail: [email protected] (NO) on the corpus cavernosum.l--4 Although dose administration has been reported to be at Received: 31 May 2000 1 the role of sildenafil in erectile dysfunction is 1 h for sildenafil. 3 Therefore, 1 h after sildenafil Accepted in revised form: well understood and has been described in administration, we repeated the tests. 19 January 2001 Eye (2001) 15, 507-510 © 2001 Royal College of Ophthalmologists 507 Table 1. Heart rate, intraocular pressure, systolic blood pressure and Tables 2--4show PSV, EDV, MV, RI and PI in the CRA, diastolic blood pressure before and after sildenafil administration OA and STPCA calculated at baseline and after sildenafil Baseline Sildenafil p value administration. After sildenafil administration PSV, EDV Heart rate (beats/min) 80.14 :!: 8.16 92.28 :!: 14.6 0.003 and MV significantly increased in the OA of both eyes BP, systolic (rnmHg) 128.2 :!: 18.7 124.6 :!: 17.7 0.061 (p < 0.05, Table 2). All Doppler indices remained non­ :!: BP, diastolic (mmHg) 79.6 10.1 79.6 :!: 10.8 0.85 significant for CRA and STPCA of both eyes (p > 0.05, lOP, right eye (mmHg) 15.46 :!: 3.31 15.7 :!: 3.2 0.32 Tables 3, 4). lOP, left eye (mmHg) 15.07 :!: 3.15 15.3 :!: 2.8 0.52 Values are the mean :!: SD. BP, blood pressure; lOP, intraocular pressure. Discussion Sildenafil is a highly selective inhibitor of PDE5, Colour Doppler imaging responsible for the breakdown of cGMP in the corpus CDI was carried out using a colour Doppler ultrasound cavernosum.14-16 Inhibition of cGMP degradation allows machine (Hitachi EUB 555). A linear-array high­ for normal penile erection by the NO-cGMP-mediated resolution 7.5 MHz probe was used for imaging of the relaxation pathway.17,18 PDE5 is also found in platelets globe. All measurements were performed by one and vascular smooth muscle cells.19 experienced sonographer (Y.D.). With the subject in Sildenafil has been proven to be an effective treatment supine position sterile ophthalmic gel was applied as a in patients with impotence of no known organic or 20 2 couplant to the closed eyelid, and the probe was definable cause such as diabetes mellitus. , 1 In addition, positioned gently with minimal pressure. Peak systolic the drug is mostly used in elderly patients - an age group velocity (PSV), end-diastolic velocity (EDV) and mean who may have age-related ocular diseases such as velocity (MV) of the ophthalmic artery (OA), central macular degeneration and numerous ocular vascular retinal artery (CRA) and short temporal posterior ciliary disorders. Many of the adverse affects of sildenafil may arteries (STPCA) were measured in both orbits. After be related to the presence of PDE5 in tissues other than measurement of the flow velocities, the resistance index the corpus cavernosum or to the effects of the drug on 4 22 (RI) and pulsatility index (PI) were subsequently PDE6. , In vitro studies have shown that PDE6, found in calculated by computer for each vessel measured. RI and retinal photoreceptors, modulates the transduction 19 2 24 PI are calculated as follows: cascade. , 3, Sildenafil is mainly a specific PDE5 inhibitor and it is roughly 10% as effective in blocking RI = PSV-EDV /PSV S PDE6.6,14 Vobig and colleagues reported a decrease in PI = PSV-EDV /MV the a-wave and b-wave amplitudes in the Statistical analysis included a Wilcoxon rank-sum test. A electroretinogram after oral administration of 100 mg p value of less than 0.05 was considered statistically sildenafil and these changes completely disappeared 5 h Significant. later. Results of all other electrophysiological and clinical tests such as visual acuity, colour vision and lOP were normal. In our study, we did not observe any change in Results visual acuity, colour vision and lOP, similar to Vobig et aZ.s There was no Significant effect of sildenafil on visual A previous study by Jackson et aZ,zs on the acuity and colour vision. None of the volunteers cardiovascular effects of sildenafil in healthy volunteers complained about visual disturbances after sildenafil. showed a Significant reduction in systolic and diastolic The examinations of anterior and posterior segments of blood pressure after intravenous administration and no the eye did not reveal any abnormality after drug significant change in heart rate. Webb et aZ,z6 also showed administration. No statistically significant difference in that sildenafil produced an average decrease of lOP, systolic blood pressure or diastolic blood pressure approximately 10 mmHg in blood pressure after a single was noted after sildenafil administration compared with oral dose of 100 mg. However, Sipsky et aZ,z7 reported baseline values (p> 0.05, Table 1). However, heart rate modest increases in heart rate and mild decreases in increased significantly after sildenafil administration blood pressure after sildenafil administration across all compared with baseline (p < 0.05, Table 1). stimulation conditions in premenopausal women with Table 2. Colour Doppler ultrasound measurements at baseline and after sildenafil administration in the ophthalmic artery Right eye Left eye Baseline Sildenafil p value Baseline Sildenafil p value PSV 42.12 :!: 7.34 50.48 :!: 15.1 0.048 40.85 :!: 7.35 51.19 :!: 13.74 0.035 EDV 13.61 :!: 4.53 18.49 :!: 5.64 0.019 13.75 :!: 3.18 17.57 :!: 5.22 0.047 MV 22.00 :!: 5.82 27.80 :!: 9.04 0.035 21.39 :!: 4.30 . 27.93 :!: 8.35 0.022 RI 0.67 :!: 0.07 0.64 :!: 0.07 NS 0.69 :!: 0.07 0.65 :!: 0.06 NS PI 1.34 :!: 0.35 1.20 :!: 0.29 NS 1.29 :!: 0.35 1.25 :!: 0.27 NS Values are the mean :!: SD. PSV, peak systolic velocity; EDV, end-diastolic velocity; MV, mean velocity; RI, resistance index; PI, pulsatility index.
Recommended publications
  • Radionuclear Measurement of Peripheral Hemodynamics In
    RadionuclearMeasurementof Peripheral Hemodynamics in Selection of Vasodilators for Treatment of Heart Failure Yasuhiro Todo, Mitsumasa Ohyanagi, Ryu Fujisue, and Tadaaki Iwasaki Hyogo College ofMedicine, Nishinomiya, Japan Inorder to select the optimal vasodilator for the treatment of patients with congestive heart failure (CHF), the acute effects of three vasodilators (isosorbide dinitrate (ISDN) 5 mg, nifedipine 10 mg, and prazosin 1 mg) on peripheral capacitance and resistance vessels (CV and RV)were evaluated by a newly devised radionuclear technique (Study 1).Thirty-six @ patients with chronic CHF were dividedinto Group A (ejectionfraction (EF) 35%, n = 20, mean EF: 47.2 ±6.5%) and B (EF < 35%, n = 16, mean EF: 24.8 ±7.1%). ISDNproduced the strongest CVdilatation(25% in both groups). Nifedipinereduced RVtone in Groups A and B (14% and 27%, respectively),and CVtone in Group A (6%). Prazosin had the most prominent effects on both vessels in Group B. From these results, it appeared: (a) ISDN is indicated for the cases with increased CV tone, (b) nifedipine is suitable for those with @ increased RV tone, (C)in cases of increased tone in both vessels, nifedipine (when EF 35%) or prazosin (when EF < 35%) is optimal.To evaluate the validityof this assignment, 49 subjects with CHF were divided into Group 1 (n = 16, increased CV tone), Group 2 (n = 17, increased RV tone), and Group 3 (n = 16, increased CV and RV tone) in Study 2. In Group 1, the changes of all indexes were not significantly different between the subjects treated with optimal drug based on the assignment (subgroup P) and those with a non-optimaldrug (subgroup N)after 2 wk of therapy.
    [Show full text]
  • Relationship Between Vasodilatation and Cerebral Blood Flow Increase in Impaired Hemodynamics: a PET Study with the Acetazolamide Test in Cerebrovascular Disease
    CLINICAL INVESTIGATIONS Relationship Between Vasodilatation and Cerebral Blood Flow Increase in Impaired Hemodynamics: A PET Study with the Acetazolamide Test in Cerebrovascular Disease Hidehiko Okazawa, MD, PhD1,2; Hiroshi Yamauchi, MD, PhD1; Hiroshi Toyoda, MD, PhD1,2; Kanji Sugimoto, MS1; Yasuhisa Fujibayashi, PhD2; and Yoshiharu Yonekura, MD, PhD2 1PET Unit, Research Institute, Shiga Medical Center, Moriyama, Japan; and 2Biomedical Imaging Research Center, Fukui Medical University, Fukui, Japan Key Words: acetazolamide; cerebrovascular disease; cerebral The changes in cerebral blood flow (CBF) and arterial-to- blood volume; vasodilatory capacity; cerebral perfusion pressure capillary blood volume (V0) induced by acetazolamide (ACZ) are expected to be parallel each other in the normal circula- J Nucl Med 2003; 44:1875–1883 tion; however, it has not been proven that the same changes in those parameters are observed in patients with cerebro- vascular disease. To investigate the relationship between changes in CBF, vasodilatory capacity, and other hemody- namic parameters, the ACZ test was performed after an The ability of autoregulation to maintain the cerebral 15O-gas PET study. Methods: Twenty-two patients with uni- blood flow (CBF), which resides in the cerebral circulation lateral major cerebral arterial occlusive disease underwent despite transient changes in systemic mean arterial blood 15 PET scans using the H2 O bolus method with the ACZ test pressure, has been shown to occur via the mechanism of 15 after the O-gas steady-state method. CBF and V0 for each arteriolar vasodilatation in the cerebral circulation (1). The subject were calculated using the 3-weighted integral vasodilatory change in the cerebral arteries is assumed for method as well as the nonlinear least-squares fitting method.
    [Show full text]
  • Hemodynamic Effects of Vasodilators and Long-Term Response in Heart Failure
    JACC Vol. 3, No.6 1521 June 1984:1521-30 REPORTS ON THERAPY Hemodynamic Effects of Vasodilators and Long-Term Response in Heart Failure JOSEPH A. FRANCIOSA, MD, FACC, W. BRUCE DUNKMAN, MD, FACC,* CHERYL L. LEDDY, MD* Philadelphia, Pennsylvania and Little Rock, Arkansas Hemodynamic responses to vasodilators are commonly ml/min per kg (p < 0.01), and exercise duration also assessed when starting long-term vasodilator treatment increased by 1.8 ± 3.5 minutes (p < 0.01). Changes in in patients with chronic left ventricular failure, although maximal oxygen uptake, however, did not correlate with the relation between short- and long-term responses is short-term changes in pulmonary wedge pressure (cor• not established. Thus, short- and long-term hemody• relation coefficient [r] = - 0.14), cardiac index (r = namic responses to placebo and vasodilators (isosorbide - 0.01) or systemic vascular resistance (r = - 0.20). dinitrate, minoxidil and enalapril or captopril) were Long-term hemodynamic changes also failed to correlate measured and long-term clinical efficacy was assessed with changes in exercise capacity. Baseline hemody• by changes in exercise capacity after 1 to 5 months of namics, cardiac dimensions and left ventricular ejection vasodilator administration (plus digitalis and diuretic fraction before vasodilator administration all failed to agents) in 46 patients with New York Heart Association correlate with baseline exercise capacity or with long• fun~tional class II to IV heart failure caused by cardio• term changes in exercise capacity. myopathy. There were no significant changes in hemo• Thus, hemodynamic measurements at initiation or dynamics or exercise capacity during placebo treatment.
    [Show full text]
  • Medical Management of Advanced Heart Failure
    CLINICAL CARDIOLOGY CLINICIAN’S CORNER Medical Management of Advanced Heart Failure Anju Nohria, MD Context Advanced heart failure, defined as persistence of limiting symptoms de- Eldrin Lewis, MD spite therapy with agents of proven efficacy, accounts for the majority of morbidity and mortality in heart failure. Lynne Warner Stevenson, MD Objective To review current medical therapy for advanced heart failure. EART FAILURE HAS EMERGED AS Data Sources We searched MEDLINE for all articles containing the term advanced a major health challenge, in- heart failure that were published between 1980 and 2001; EMBASE was searched from creasing in prevalence as age- 1987-1999, Best Evidence from 1991-1998, and Evidence-Based Medicine from 1995- adjusted rates of myocardial 1999. The Cochrane Library also was searched for critical reviews and meta-analyses Hinfarction and stroke decline.1 Affect- of congestive heart failure. ing 4 to 5 million people in the United Study Selection Randomized controlled trials of therapy for 150 patients or more States with more than 2 million hospi- were included if advanced heart failure was represented. Other common clinical situ- talizations each year, heart failure alone ations were addressed from smaller trials as available, trials of milder heart failure, con- accounts for 2% to 3% of the national sensus guidelines, and both published and personal clinical experience. health care budget. Developments her- Data Extraction Data quality was determined by publication in peer-reviewed lit- alded in the news media increase pub- erature or inclusion in professional society guidelines. lic expectations but focus on decreas- Data Synthesis A primary focus for care of advanced heart failure is ongoing iden- ing disease progression in mild to tification and treatment of the elevated filling pressures that cause disabling symp- moderate stages2,3 or supporting the cir- toms.
    [Show full text]
  • Chapter 9 Monitoring of the Heart and Vascular System
    Chapter 9 Monitoring of the Heart and Vascular System David L. Reich, MD • Alexander J. Mittnacht, MD • Martin J. London, MD • Joel A. Kaplan, MD Hemodynamic Monitoring Cardiac Output Monitoring Arterial Pressure Monitoring Indicator Dilution Arterial Cannulation Sites Analysis and Interpretation Indications of Hemodynamic Data Insertion Techniques Systemic and Pulmonary Vascular Resistances Central Venous Pressure Monitoring Frank-Starling Relationships Indications Monitoring Coronary Perfusion Complications Electrocardiography Pulmonary Arterial Pressure Monitoring Lead Systems Placement of the Pulmonary Artery Catheter Detection of Myocardial Ischemia Indications Intraoperative Lead Systems Complications Arrhythmia and Pacemaker Detection Pacing Catheters Mixed Venous Oxygen Saturation Catheters Summary References HEMODYNAMIC MONITORING For patients with severe cardiovascular disease and those undergoing surgery associ- ated with rapid hemodynamic changes, adequate hemodynamic monitoring should be available at all times. With the ability to measure and record almost all vital physi- ologic parameters, the development of acute hemodynamic changes may be observed and corrective action may be taken in an attempt to correct adverse hemodynamics and improve outcome. Although outcome changes are difficult to prove, it is a rea- sonable assumption that appropriate hemodynamic monitoring should reduce the incidence of major cardiovascular complications. This is based on the presumption that the data obtained from these monitors are interpreted correctly and that thera- peutic decisions are implemented in a timely fashion. Many devices are available to monitor the cardiovascular system. These devices range from those that are completely noninvasive, such as the blood pressure (BP) cuff and ECG, to those that are extremely invasive, such as the pulmonary artery (PA) catheter. To make the best use of invasive monitors, the potential benefits to be gained from the information must outweigh the potential complications.
    [Show full text]
  • Hemodynamic Parameters in the Assessment of Fluid Status in A
    PERIOPERATIVE MEDICINE ABSTRACT Background: Measuring fluid status during intraoperative hemorrhage is challenging, but detection and quantification of fluid overload is far more diffi- cult. Using a porcine model of hemorrhage and over-resuscitation, it is hypoth- Hemodynamic Parameters esized that centrally obtained hemodynamic parameters will predict volume status more accurately than peripherally obtained vital signs. in the Assessment Methods: Eight anesthetized female pigs were hemorrhaged at 30 ml/min to a blood loss of 400 ml. After each 100 ml of hemorrhage, vital signs (heart of Fluid Status in a rate, systolic blood pressure, mean arterial pressure, diastolic blood pressure, pulse pressure, pulse pressure variation) and centrally obtained hemodynamic Porcine Hemorrhage and parameters (mean pulmonary artery pressure, pulmonary capillary wedge pressure, central venous pressure, cardiac output) were obtained. Blood Resuscitation Model volume was restored, and the pigs were over-resuscitated with 2,500 ml of crystalloid, collecting parameters after each 500-ml bolus. Hemorrhage Eric S. Wise, M.D., Kyle M. Hocking, Ph.D., and resuscitation phases were analyzed separately to determine differences Monica E. Polcz, M.D., Gregory J. Beilman, M.D., among parameters over the range of volume. Conformity of parameters during Colleen M. Brophy, M.D., Jenna H. Sobey, M.D., hemorrhage or over-resuscitation was assessed. Philip J. Leisy, M.D., Roy K. Kiberenge, M.D., Bret D. Alvis, M.D. Results: During the course of hemorrhage, changes from baseline euvolemia were observed in vital signs (systolic blood pressure, diastolic blood pressure, ANESTHESIOLOGY 2021; 134:607–16 and mean arterial pressure) after 100 ml of blood loss.
    [Show full text]
  • Cerebral Hemodynamics During Cerebral Ischemia Induced by Acute Hypotension
    Cerebral Hemodynamics during Cerebral Ischemia Induced by Acute Hypotension Frank A. Finnerty Jr., … , Lloyd Witkin, Joseph F. Fazekas J Clin Invest. 1954;33(9):1227-1232. https://doi.org/10.1172/JCI102997. Research Article Find the latest version: https://jci.me/102997/pdf CEREBRAL HEMODYNAMICS DURING CEREBRAL ISCHEMIA INDUCED BY ACUTE HYPOTENSION 1 BY FRANK A. FINNERTY, JR., LLOYD WITKIN, AND JOSEPH F. FAZEKAS WITH THE TECHNICAL ASSISTANCE OF MARIE LANGBART AND WILLIAM K. YOUNG (From the Department of Medicine, Georgetown University School of Medicine and the George- town and George Washington Medical Divisions, District of Columbia General Hospital, Washington, D. C.) (Submitted for publication February 1, 1954; accepted May 20, 1954) The extreme dependence of the brain upon its seven patients with malignant hypertension. In seven circulation for substrates essential for the main- subjects, the mean arterial pressure was reduced sig- nificantly below normal but not to the extent of inducing tenance of its metabolic activity is well recognized. signs of cerebral ischemia. Five patients with spontane- A cessation of the cerebral circulation for only a ous postural hypotension were also studied. few minutes, as occurs in cardiac arrest, results in Control studies were obtained after the subject had been irreversible brain damage. The brain, for the most tilted (head up) 30 to 40 degrees for a period of at least part, is an aerobic organ and its large oxygen de- 30 minutes. The subjects in the drug-induced hypo- tension group were then given a 1 per cent solution of mands probably account for its unusual suscepti- hexamethonium 2 intravenously at a rate of 1 mg.
    [Show full text]
  • Persistent Hemodynamic Benefits of Cardiac Resynchronization
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Elsevier - Publisher Connector Journal of the American College of Cardiology Vol. 53, No. 7, 2009 © 2009 by the American College of Cardiology Foundation ISSN 0735-1097/09/$36.00 Published by Elsevier Inc. doi:10.1016/j.jacc.2008.08.079 Cardiac Resynchronization Therapy Persistent Hemodynamic Benefits of Cardiac Resynchronization Therapy With Disease Progression in Advanced Heart Failure Wilfried Mullens, MD, Tanya Verga, RN, Richard A. Grimm, DO, FACC, Randall C. Starling, MD, MPH, FACC, Bruce L. Wilkoff, MD, FACC, W. H. Wilson Tang, MD, FACC Cleveland, Ohio Objectives Our aim was to determine the potential hemodynamic contributions of cardiac resynchronization therapy (CRT) in patients admitted for advanced decompensated heart failure. Background CRT restores synchrony of the heart resulting in hemodynamic support that can facilitate the reversal of left ven- tricular (LV) remodeling in some patients. Methods A total of 40 consecutive patients with advanced decompensated heart failure and CRT implanted Ͼ3 months, admitted due to hemodynamic derangements, underwent simultaneous comprehensive echocardiographic and invasive hemodynamic evaluation under different CRT settings. Results All patients (mean LV ejection fraction 22 Ϯ 7%, LV end-diastolic volume 323 Ϯ 140 ml, 40% ischemic) had experienced progressive cardiac remodeling despite adequate LV lead positions and continuous biventricular pacing. A significant worsening of hemodynamics was observed immediately when CRT was programmed OFF in the majority (88%) of patients (systolic blood pressure: 105 Ϯ 12 mm Hg to 98 Ϯ 13 mm Hg; pulmonary capil- lary wedge pressure: 17 Ϯ 6mmHgto21Ϯ 7 mm Hg; cardiac output: 4.6 Ϯ 1.4 l/min·m2 to 4.0 Ϯ 1.1 l/min·m2; all p Ͻ 0.001).
    [Show full text]
  • Clinical and Research Considerations
    Journal of Cardiac Failure Vol. 22 No. 8 2016 Consensus Statement Clinical and Research Considerations for Patients With Hypertensive Acute Heart Failure: A Consensus Statement from the Society of Academic Emergency Medicine and the Heart Failure Society of America Acute Heart Failure Working Group SEAN P. COLLINS, MD, MSc,1,* PHILLIP D. LEVY, MD, MPH,2 JENNIFER L. MARTINDALE, MD,3 MARK E. DUNLAP, MD,4 ALAN B. STORROW, MD,1 PETER S. PANG, MD, MSc,5 NANCY M. ALBERT, RN, PhD,6 G. MICHAEL FELKER, MD, MS,7 GREGORY J. FERMANN, MD,8 GREGG C. FONAROW, MD,9 MICHAEL M. GIVERTZ, MD,10 JUDD E. HOLLANDER, MD,11 DAVID J. LANFEAR, MD,12 DANIEL J. LENIHAN, MD,13 JOANN M. LINDENFELD, MD,13 W. FRANK PEACOCK, MD,14 DOUGLAS B. SAWYER, MD, PhD,15 JOHN R. TEERLINK, MD,16 AND JAVED BUTLER, MD, MPH, MBA17 Nashville, Tennessee; Detroit, Michigan; New York and Long Island, New York; Cleveland and Cincinnati, Ohio; Indianapolis, Indiana; Raleigh-Durham, North Carolina; Los Angeles and San Francisco, California; Boston, Massachusetts; Philadelphia, Pennsylvania; Houston, Texas; and Portland, Maine ABSTRACT Management approaches for patients in the emergency department (ED) who present with acute heart failure (AHF) have largely focused on intravenous diuretics. Yet, the primary pathophysiologic derangement un- derlying AHF in many patients is not solely volume overload. Patients with hypertensive AHF (H-AHF) represent a clinical phenotype with distinct pathophysiologic mechanisms that result in elevated ventricu- lar filling pressures. To optimize treatment response and minimize adverse events in this subgroup, we propose that clinical management be tailored to a conceptual model of disease based on these mechanisms.
    [Show full text]
  • INDE 221 Spring 2010 Syllabus Part 2
    Human Health & Disease Mondays, Tuesdays, Thursdays and Fridays 9:00 - 11:50 AM Lectures: Room M-112, Labs: Fleischmann IINNDDEE 222211 SSpprriinngg 22001100 Syllabus SSyyllllaabbuuss PPaarrtt 22 (2010) Year's Last Syllabus (2010) Year's Last Human Health & Disease Inde 221 Spring 2010 Table of Contents CARDIOVASCULAR BLOCK SYLLABUS SCHEDULE 7 SYLLABUS PREFACE 11 CARDIAC MUSCLE AND FHC 15 EXCITATION-CONTRACTION COUPLING Syllabus27 NERNST POTENTIAL AND OSMOSIS 43 EXCITABILITY AND CONDUCTION 51 CIRCULATORY VESSEL HISTOLOGY LAB 63 CARDIAC ACTION POTENTIAL 71 CONTROL OF HEART RHYTHM (2010) 85 AUTONOMIC DRUGS OVERVIEW I 97 ELECTROCARDIOGRAM (ECG) 99 LESIONS OF BLOOD VESSELS 109 THROMBOEMBOLIC DISEASE 117 CARDIAC REFLEXESYear's 123 AUTONOMIC DRUGS OVERVIEW II 141 ECG SMALL GROUPS 143 LastAUTONOMIC DRUGS: CHOLINERGICS 147 CARDIAC MUSCLE MECHANICS 149 AUTONOMIC DRUGS: ANTICHOLINERGICS 175 ARRHYTHMIAS 177 AUTONOMIC DRUGS: SYMPATHOMIMETICS I 203 VENTRICULAR PHYSIOLOGY 205 AUTONOMIC DRUGS: SYMPATHOMIMETICS II 235 STARLING CURVE AND VENOUS RETURN 237 CARDIAC OUTPUT AND CATHETERIZATION 245 AUTONOMIC DRUGS: ADRENOCEPTOR BLOCKERS 267 PHYSICS OF CIRCULATION Syllabus269 CASE DISCUSSIONS: AUTONOMIC DRUGS 289 SMOOTH MUSCLE 291 ISCHEMIC AND VALVULAR HEART DISEASE 303 RENAL CIRCULATION (2010) 323 HYPERTENSION 333 CARDIOMYOPATHY, MYOCARDITIS AND ATRIAL MYXOMA 351 ENDOTHELIUM AND CORONARY CIRCULATION 369 ANGINA PECTORIS 389 DRUGS USEDYear's IN HYPERTENSION 397 SHOCK 399 ADULT CARDIAC LAB 413 CARDIAC ANESTHESIA & BYPASS 421 LastEXERCISE PHYSIOLOGY 431 ISCHEMIC
    [Show full text]
  • Basics of Hemodynamics
    P1: RNK/... P2: RNK 9781405176255 BLUK110-Stouffer August 1, 2007 13:57 PART I Basics of hemodynamics 1 P1: RNK/... P2: RNK 9781405176255 BLUK110-Stouffer August 1, 2007 13:57 2 P1: RNK/... P2: RNK 9781405176255 BLUK110-Stouffer August 1, 2007 13:57 CHAPTER 1 Introduction to basic hemodynamic principles James E. Faber, George A. Stouffer Hemodynamics is concerned with the mechanical and physiologic properties controlling blood pressure and flow through the body. A full discussion of hemodynamic principles is beyond the scope of this book. In this chapter, we present an overview of basic principles that are helpful in understanding hemodynamics. 1. Energy in the blood stream exists in three interchangeable forms: pressure arising from cardiac output and vascular resistance, hydrostatic pressure from gravitational forces, and kinetic energy of blood flow Daniel Bernoulli was a physician and mathematician who lived in the eigh- teenth century. He had wide-ranging scientific interests and won the Grand Prize of the Paris Academy 10 times for advances in areas ranging from astron- omy to physics. One of his insights was that the energy of an ideal fluid (a hypothetical concept referring to a fluid that is not subject to viscous or fric- tional energy losses) in a straight tube can exist in three interchangeable forms: perpendicular pressure (force exerted on the walls of the tube perpendicular to flow; a form of potential energy), kinetic energy of the flowing fluid, and pressure due to gravitational forces. Perpendicular pressure is transferred to the blood by cardiac pump function and vascular elasticity and is a function of cardiac output and vascular resistance.
    [Show full text]
  • Physiologic Blood Flow Is Turbulent
    www.nature.com/scientificreports OPEN Physiologic blood fow is turbulent Khalid M. Saqr1*, Simon Tupin1, Sherif Rashad2,3, Toshiki Endo3, Kuniyasu Niizuma2,3,4, Teiji Tominaga3 & Makoto Ohta1 Contemporary paradigm of peripheral and intracranial vascular hemodynamics considers physiologic blood fow to be laminar. Transition to turbulence is considered as a driving factor for numerous diseases such as atherosclerosis, stenosis and aneurysm. Recently, turbulent fow patterns were detected in intracranial aneurysm at Reynolds number below 400 both in vitro and in silico. Blood fow is multiharmonic with considerable frequency spectra and its transition to turbulence cannot be characterized by the current transition theory of monoharmonic pulsatile fow. Thus, we decided to explore the origins of such long-standing assumption of physiologic blood fow laminarity. Here, we hypothesize that the inherited dynamics of blood fow in main arteries dictate the existence of turbulence in physiologic conditions. To illustrate our hypothesis, we have used methods and tools from chaos theory, hydrodynamic stability theory and fuid dynamics to explore the existence of turbulence in physiologic blood fow. Our investigation shows that blood fow, both as described by the Navier–Stokes equation and in vivo, exhibits three major characteristics of turbulence. Womersley’s exact solution of the Navier–Stokes equation has been used with the fow waveforms from HaeMod database, to ofer reproducible evidence for our fndings, as well as evidence from Doppler ultrasound measurements from healthy volunteers who are some of the authors. We evidently show that physiologic blood fow is: (1) sensitive to initial conditions, (2) in global hydrodynamic instability and (3) undergoes kinetic energy cascade of non-Kolmogorov type.
    [Show full text]