Tag Archive for: Cardiovascular

Why we Should Consider Not Using Morphine in Acute Heart Failure

02 Aug
August 2, 2018

Background/Introduction: Acute heart failure is a common diagnosis encountered among patients presenting to the Emergency Department with complaints of shortness of breath. The emergency treatment of these patients has traditionally focused on alleviation of their symptoms of breathlessness and anxiety in addition to optimization of hemodynamics and rapid reduction in both preload and afterload. The treatment of associated symptoms has often included the administration of morphine, which has been posited to have both beneficial physiologic (vasodilation, reduction of preload) and central nervous system (reduction of breathlessness, anxiety, and pain) effects. However, recent experimental and experiential data have pointed to morphine’s potential for effecting negative physiological and CNS responses, thereby raising the possibility of increasing patient morbidity and/or mortality. Additionally, no large randomized controlled trials have been conducted to study the potential risks and benefits of morphine administration in patients presenting with acute heart failure. Despite these factors, a contingent of Emergency Physicians continue to routinely use morphine in the treatment of patients presenting with acute heart failure. Read more →

Bacterial Endocarditis

04 Dec
December 4, 2017

Background:

  • Definition
    • Infective Endocarditis (IE) = Inflammation of the endothelium of the heart, heart valves (or both) (Osman 2013)
  • Epidemiology
    • Annual incidence = 5-7 cases per 100,000 (Fraimow 2013)
    • 40,000 to 50,000 new cases in the US per year. Average hospital charges in excess of $120,000 per patient (Bor 2013)
    • Slightly higher male predominance (1.5:1 – 2:1) (Moreillon 2010)
    • In-hospital mortality of 14–22% and 1-year mortality of 20-40% (Gomes 2017, (Habib 2006)
    • Before antibiotics and surgery it was almost universally fatal  (Aretz 2010, Osman 2013)
  • Pathophysiology (Moreillon 2010, Faza 2013, Tan 2014, Osman 2013, Kokowski 2018)
    • The normal, undamaged valve endothelium is very resistant to colonization and infection by circulating bacteria
    • Micro-trauma (caused by turbulent flow, intracardiac devices, etc) or chronic diseases (rheumatic heart disease, congenital heart disease, prosthetic valves, previous IE) can cause damage to the endothelium
    • Damage to endothelium produces a fibin and platelet sterile thrombus.  Microbes can seed that thrombus during transient episodes of bacteremia, fungemia and viremia
  • Risk factors –  (Faza 2013, Moreillon 2010).
    • Diseased/damaged heart (highest risk)
    • IV drug use (IVDU)
    • Low immune function –
    • Poor oral hygiene. (Faza 2013)
    • Nosocomial

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