Flash Pulmonary Oedema after Relief of Haemodialysis Graft Stenosis.

Dec 2012 

Vélez-Martínez M, Weinberg BD, Mishkin JD.

Source

Cardiology Division, UT Southwestern Medical Center at Dallas, USA; Department of Internal Medicine, UT Southwestern Medical Center at Dallas, USA. Electronic address: mariella.velez-martinez@phhs.org.

Abstract

Heart failure (HF) and chronic kidney disease (CKD) are undoubtedly very much interrelated, especially in patients with end-stage renal disease (ESRD) who are dependent on renal replacement therapy. Haemodialysis (HD) is of particular interest in cardiovascular patients due to the creation of a haemodialysis vascular access and the haemodynamic changes associated with it. Adequate HD though is very dependent on a properly functioning vascular access. Unfortunately, these surgical vascular accesses are vulnerable to stenoses and occlusions. Percutaneous endovascular treatment of these stenoses is often performed and has been found to be safe and effective. Despite its frequent use, acute medical complications of this percutaneous procedure have not been well-documented. In this report, we describe a patient who developed flash pulmonary oedema after balloon angioplasty treatment of an arteriovenous graft (AVG) stenosis.

Elsevier SciVerse

Cardiogenic Acute Pulmonary Edema

Image from the article:

Cardiogenic Acute Pulmonary Edema – Causes, Symptoms, Diagnosis And Treatment





From:  Heart Failure and Your Lungs



Medical Exhibits

An Orally Active TRPV4 Channel Blocker Prevents and Resolves Pulmonary Edema Induced by Heart Failure.

Nov 2012

Thorneloe KS, Cheung M, Bao W, Alsaid H, Lenhard S, Jian MY, Costell M, Maniscalco-Hauk K, Krawiec JA, Olzinski A,Gordon E, Lozinskaya I, Elefante L, Qin P, Matasic DS, James C, Tunstead J, Donovan B, Kallal L, Waszkiewicz A, Vaidya K, Davenport EA, Larkin J, Burgert M, Casillas LN, Marquis RW, Ye G, Eidam HS, Goodman KB, Toomey JR, Roethke TJ,Jucker BM, Schnackenberg CG, Townsley MI, Lepore JJ, Willette RN.

Source

Heart Failure Discovery Performance Unit, Metabolic Pathways and Cardiovascular Therapy Area Unit, GlaxoSmithKline, 709 Swedeland Road, King of Prussia, PA 19406, USA.

Abstract

Pulmonary edema resulting from high pulmonary venous pressure (PVP) is a major cause of morbidity and mortality in heart failure (HF) patients, but current treatment options demonstrate substantial limitations. Recent evidence from rodent lungs suggests that PVP-induced edema is driven by activation of pulmonary capillary endothelial transient receptor potential vanilloid 4 (TRPV4) channels. To examine the therapeutic potential of this mechanism, we evaluated TRPV4 expression in human congestive HF lungs and developed small-molecule TRPV4 channel blockers for testing in animal models of HF. TRPV4 immunolabeling of human lung sections demonstrated expression of TRPV4 in the pulmonary vasculature that was enhanced in sections from HF patients compared to controls. GSK2193874 was identified as a selective, orally active TRPV4 blocker that inhibits Ca(2+) influx through recombinant TRPV4 channels and native endothelial TRPV4 currents. In isolated rodent and canine lungs, TRPV4 blockade prevented the increased vascular permeability and resultant pulmonary edemaassociated with elevated PVP. 

Furthermore, in both acute and chronic HF models, GSK2193874 pretreatment inhibited the formation of pulmonary edema and enhanced arterial oxygenation. Finally, GSK2193874 treatment resolved pulmonary edemaalready established by myocardial infarction in mice. These findings identify a crucial role for TRPV4 in the formation of HF-induced pulmonary edema and suggest that TRPV4 blockade is a potential therapeutic strategy for HF patients.

PubMed-Science Translocational Medicine

Edema is a symptom that has many possible causes

August 2012

DEAR DOCTOR K: What can I do about my edema? The diuretics my doctor prescribed haven't helped.

DEAR READER: Edema is swelling caused by a buildup of extra fluid. Edema most often affects the feet and legs, but it can affect the hands and even the face. The skin becomes puffy and swollen.

The fluid in your body is in three places: inside each of the 13 trillion cells in your body; in the blood (which means inside all your blood vessels); and in the space between your cells and your blood vessels. Edema occurs when unusual amounts of fluid leak out of the blood vessels and into the space between your blood vessels and cells.

Diuretics, also known as water pills, are often used to treat edema. They help your kidneys eliminate excess fluid in your body.

Edema is a symptom that may be caused by many conditions. Your doctor will need to identify and treat the condition that is causing it. Possible causes include:

-- Prolonged standing or sitting. This can cause edema in your feet and lower legs. That's because gravity is pulling more blood into the blood vessels of your legs. When the blood vessels swell with fluid, some of the fluid leaks out of the vessels and into the tissues.

-- Venous insufficiency from varicose veins. Valves inside the veins of the legs weaken, making it more difficult for the veins to pump blood back to the heart. This leads to fluid buildup.

-- Severe chronic lung diseases. Emphysema and chronic bronchitis weaken the heart's ability to pump, particularly the right side of the heart.

-- Congestive heart failure. The left or right side of the heart can no longer pump efficiently.

-- Pregnancy. The enlarged uterus with the fetus inside can pinch off the veins carrying blood from the legs to the heart.

-- Pre-eclampsia. This serious condition can occur during pregnancy.

-- Low blood-protein levels. These can be caused by malnutrition, kidney and liver disease.

As for treatments, increasing the dose of your diuretic might solve the problem. A low-salt diet usually helps, since salt causes the body to retain fluid. You also should avoid drinking too much fluid.

If the edema is in your feet and legs, prop them up whenever you are sitting. This counters the effect of gravity and encourages more blood to move out of your legs. Compression stockings can help squeeze the edema fluid out of your tissues. Finally, if your edema is caused by varicose veins, traditional surgery or newer laser procedures can treat the condition.

It's important to protect feet and legs swollen by edema from pressure, injury and extreme temperatures. The skin over swollen legs becomes more fragile over time. Cuts, scrapes and burns in areas that have edema take much longer to heal and are more likely to get infected.

(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, Mass. 02115.)

Souix City Journal

Unilateral Pulmonary Edema: A Rare Initial Presentation of Cardiogenic Shock due to Acute Myocardial Infarction.

Feb 2012

Shin JH, Kim SH, Park J, Lim YH, Park HC, Choi SI, Shin J, Kim KS, Kim SG, Hong MK, Lee JU.

Source

Division of Cardiology, Hanyang University Guri Hospital, Guri, Korea.

Abstract

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.

PubMed