Augmentation of ECG QRS complexes after fluid removal via a mechanical ultrafiltration pump in patients with congestive heart failure.

Background: Augmentation of the amplitude of ECG QRS complexes, correlating with loss of weight or fluid volume removed, has been documented in patients with congestive heart failure (CHF).

Methods: We investigated the effect of an ultrafiltration (UF) pump on the fluid removal and the amplitude of ECG QRS complexes in patients with CHF. Nine patients aged 48.

Ultrafiltration in heart failure.

Managing volume overload is essential for the treatment of symptomatic heart failure. Traditionally, it is achieved with oral and intravenous diuretics. Alternatively, the excess fluid can be removed via ultrafiltration.

Factors determining extreme brain natriuretic peptide elevation.

Brain natriuretic peptide (BNP) level is elevated in heart failure and reflects its severity. It is unknown why some patients have extremely high BNP levels. The authors retrospectively reviewed data on 179 consecutive patients whose BNP levels fell within one of several predetermined ranges: mild elevation, 500 to 1000 pg/mL (n=82); moderate elevation, 2000 to 3000 pg/mL (n=48); and high elevation, 4000 to 20,000 pg/mL (n=49).

Treatment of massive fluid overload as a result of constrictive pericarditis with ultrafiltration in the emergency department.

We present a case of massive fluid overload as a result of chronic lupus-related constrictive pericarditis, which was treated in the emergency department (ED) with ultrafiltration. With this novel technique, a large volume (7,350 mL) was extracted during 19 hours, with dramatic clinical improvement. The patient was hemodynamically stable throughout the intervention, and the procedure was tolerated without complication.

Therapeutic potential of vasopressin receptor antagonists.

Arginine vasopressin (AVP) is a neuropeptide hormone that plays an important role in circulatory and sodium homeostasis, and regulating serum osmolality. Several clinical conditions have been associated with inappropriately elevated levels of AVP including heart failure, cirrhosis of the liver and the syndrome of inappropriate secretion of antidiuretic hormone. Three receptor subtypes that mediate the actions of AVP have been identified (V(1A), V(2) and V(1B)).

Aldosterone antagonists: the most underutilized class of heart failure medications.

Background: Aldosterone antagonists have been proven to be beneficial in severe heart failure (HF) as a result of systolic dysfunction. We sought to determine if there is a disparity in their utilization compared with ACE inhibitors and beta-adrenoceptor antagonists (beta-blockers).

Methods: In the first part of the study, we asked physicians to answer a questionnaire presenting a hypothetical HF patient.

Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure.

Objectives: This study was designed to compare the safety and efficacy of veno-venous ultrafiltration and standard intravenous diuretic therapy for hypervolemic heart failure (HF) patients.

Background: Early ultrafiltration may be an alternative to intravenous diuretics in patients with decompensated HF and volume overload.

Methods: Patients hospitalized for HF with > or =2 signs of hypervolemia were randomized to ultrafiltration or intravenous diuretics.

Electrocardiograms with pacemakers: accuracy of computer reading.

Objective: We analyzed the accuracy with which a computer algorithm reads electrocardiograms (ECGs) with electronic pacemakers (PMs).

Methods: Electrocardiograms were screened for the presence of electronic pacing spikes. Computer-derived interpretations were compared with cardiologists' readings.

Cardiovascular effects of erythropoietin: anemia and beyond.

We did a PubMed and Cochrane Database System review of different studies on the diverse effects of erythropoietin (EPO), focusing mainly on the cardiovascular system. The direct erythropoietic action of EPO is well studied and widely used. Published studies report dramatic improvement in the course of heart failure with EPO treatment.

Common errors in computer electrocardiogram interpretation.

Objective: The aim of the study was to determine the frequency and nature of errors in computer electrocardiogram (ECG) reading.

Methods: The ECGs were collected in the tertiary care VA Hospital from both inpatients and outpatients. They were read by the electrocardiograph built-in computer software, and then reread by two cardiologists.

Immediate and 1-year survival of out-of-hospital cardiac arrest victims in southern New Jersey: 1995-2000.

Most studies report the out-of-hospital cardiac arrest (OHCA) survival to hospital discharge. One-year survival and neurological outcomes in southern New Jersey in 1996-2000 were analyzed using a retrospective data review. There were 1,597 cases of OHCA.

Pulmonary edema after transfusion in a patient with end-stage renal disease.

Aims: To describe a patient with end-stage renal disease who developed non-cardiogenic pulmonary edema after transfusion of packed red blood cells.

Design: Case report and literature review.

Results: The patient under consideration is a 60-year-old woman who developed acute pulmonary edema after transfusion of packed red blood cells without concomitant dialysis.

Cardiac disease in myasthenia gravis: a literature review.

Patients with myasthenia gravis might develop various cardiac disorders, yet a causal relationship remains unestablished. Because causes of sudden death in this population have not been ascertained, further attention to possible cardiac disease in this population is warranted. We summarize the current literature and describe the possible etiologies and implications of cardiac disease in myasthenics.