ABSTRACT
Background: Continuous infusion of short life vasodilators are employed to test reversibility of pulmonary hypertension in cardiac transplant candidates. Sublingual isosorbide administration has not been described in the literature and it might be a simpler alternative. Aim: To evaluate sublingual isosorbide administration as a test of reversibility of pulmonary hypertension in heart failure. Patients and Methods: Prospective evaluation of patients referred for cardiac transplant evaluation. Patients underwent right catheterization for hemodynamic measurements at baseline and after repeated doses of 5 mg sublingual isosorbide every 5 minutes until observing a decrease in pulmonary vascular resistance decrease or symptomatic hypotension. Results: Twenty one patients, 18 men, age 49±15 years, were studied. Fourteen (66%) were transplanted. The mean sublingual isosorbide dose was 15±5 mg. After isosorbide administration, there was a significant decrease in mean arterial pressure (80±8.5 to 71±6.6 mmHg, p <0.0001), mean pulmonary artery pressure (38±11 to 26±7.8 mmHg, p <0.0001), systemic vascular resistance (1540±376 to 1277±332 dyn*s/cm5 p <0.001), pulmonary vascular resistance (3.5±2.2 to 2,5±1.6 Wood Units, p <0.05) and transpulmonary gradient (13±7 a 10±4 mmHg, p <0.004). The cardiac output increased from 3.96±0.7 to 4.38±0.9 L/min, p=0.05. The relation between pulmonary and systemic vascular resistance before and after isosorbide was 0.17 and 0.15, respectively (p=0.04). One transplanted patient with partial reversibility of pulmonary hypertension developed acute right heart failure. Conclusions: Sublingual isosorbide administration is useful and well tolerated to evaluate the reversibility of pulmonary hypertension prior cardiac transplant.
Subject(s)
Female , Humans , Male , Middle Aged , Cardiac Output, Low/surgery , Diuretics, Osmotic/administration & dosage , Heart Transplantation , Hypertension, Pulmonary/drug therapy , Isosorbide/administration & dosage , Vasodilator Agents/administration & dosage , Administration, Sublingual , Cardiac Output, Low/etiology , Cardiac Catheterization , Prospective StudiesABSTRACT
No abstract available.
Subject(s)
Humans , Adrenergic beta-Antagonists/administration & dosage , Drug Therapy, Combination , Esophageal and Gastric Varices/complications , Gastrointestinal Hemorrhage/complications , Hepatic Veins/physiopathology , Isosorbide/administration & dosage , Liver Cirrhosis/complications , Peritonitis/complications , Propranolol/administration & dosage , Venous PressureABSTRACT
Although fibrosis and vasculopathy coexist in most patients with progressive systemic sclerosis, it is not clear if these events are the result of an unique etiologic factor or if one is consequence of the other. We report two cases of progressive systemic sclerosis that evolved to a renal scleroderma crisis. A 36 years old female presented with a Sjögren syndrome and painful subcutaneous nodules whose biopsy showed perivascular lymphocytic infiltration, perivascular thickening and normal skin. The ESR was 100 mm/h. She developed an hypertensive crisis and progressive renal failure, followed by a rapidly evolving progressive systemic sclerosis. The patient died in the course of this crisis. A 32 years old female with a progressive systemic sclerosis refractory to D-penicillamine treatment, receiving cyclosporin, presented a renal scleroderma crisis, that was successfully treated, with complete recovery of renal function. We highlight the different evolution of these cases, probably due to an early diagnosis and a better experience in the management of this condition
Subject(s)
Humans , Female , Adult , Fibrosis/etiology , Acute Kidney Injury/pathology , Scleroderma, Systemic/pathology , Pulmonary Edema/drug therapy , Hydrocortisone/administration & dosage , Nitroprusside/administration & dosage , Captopril/administration & dosage , Nifedipine/administration & dosage , Isosorbide/administration & dosage , Renal Dialysis , Hypertension/drug therapy , Sjogren's Syndrome/diagnosisABSTRACT
En un estudio clínico aleatorizado se evaluaron 36 pacientes con preclampsia severa divididos en dos grupos de 18 pacientes c/u. Grupo A: Recibieron 1.25 mg de isosorbide en aerosol oral al ingreso, repitiéndose la dosis a los 10 minutos si la reducción en la presión arterial media fue < 15 por ciento, Grupo B: Recibieron sulfato de magnesio en infusión continua intravenosa, 4 g la primera hora y después un gramo por hora durante cinco horas. En ambos grupos se administró terapia con líquidos parenterales y se vigiló con monitor la presión arterial desde el ingreso, se determinó frecuencia cardiaca materna (FCM), fetal (FCF) y proteinuria antes y después del fármaco, así como el Apgar del producto al minuto y a los cinco minutos. El grupo A presentó disminución significativa de la presión arterial (p<0.0002), FCM (p<0.005), FCF (p<0.05), 13 pacientes con una aplicación y cinco con dos. En el grupo B tres pacientes no respondieron, y el resto tuvo un mal control de la presión arterial (p>0.05), sin cambios en FCM. FCM y proteinuria. En ningún caso hubo progresión a eclampsia. Al comparar ambos grupos entre sí, hubo una diferencia significativa para la presión arterial (<0.005), FCM (p<0.05), FCF (p<0.002) y Apgar al minuto (p<0.01) en el grupo con isosorbide. Los datos sugieren que el isosorbide es eficaz y seguro en el manejo de la preeclampsia severa
Subject(s)
Humans , Female , Pregnancy , Adult , Diuretics, Osmotic/administration & dosage , Hypertension/etiology , Hypertension/drug therapy , Isosorbide/administration & dosage , Pre-Eclampsia/complicationsABSTRACT
Se presenta el caso clínico de una paciente enferma de 75 años, con infarto antiguo del miocardio y angina de pecho inestable, en quien el tratamiento con nitroglicerína empeoró el angor pectoris. Los autores exponen el origen del secuestro sanguíneo coronario y explican el desarrollo y efecto protector de la circulación coronaria colateral, grandamente desarrollada en esta enferma