Edema & Nocturnal Paroxysmal Dyspnea & Pulsus Alternans: Causes & Reasons

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Patient File

Sex unknown, Age unknown

Reported Symptoms

Edema, Nocturnal Paroxysmal Dyspnea, Pulsus Alternans,

Negated

None

Unsure

None

Possible Causes

Congestive Heart Failure

Examples of edema in specific organs: Pedal edema (dependent edema of legs) is extracellular fluid accumulation in the legs. [en.wikipedia.org]

Features due to left heart failure: Dyspnea, orthopnea and paroxysmal nocturnal dyspnea: These symptoms develop due to congestion of the lungs. [symptoma.com]

alternans (alternating large and small pulse pressures) and a raised JVP. [patient.info]

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Heart Failure

edema in patients who in fact have cardiogenic edema. [emedicine.com]

Major criteria: · Paroxysmal nocturnal dyspnea · Neck vein distention · Rales · Radiographic cardiomegaly (increasing heart size on chest radiography) · Acute pulmonary edema [medicalcriteria.com]

alternans (alternating large and small pulse pressures) and a raised JVP. [patient.info]

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Cardiomyopathy

DIAGNOSIS: The chest x-ray revealed pulmonary edema. [ncbi.nlm.nih.gov]

Symptoms: Patients with cardiomyopathy will typically present with dyspnea, orthopnea, paroxysmal nocturnal dyspnea, bilateral edema, and fatigue. [symptoma.com]

Examples of edema in specific organs: Pedal edema (dependent edema of legs) is extracellular fluid accumulation in the legs. [en.wikipedia.org]

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Pulmonary Edema

Pulmonary edema from different causes can either present acutely or chronically. [symptoma.com]

/or comorbid paroxysmal nocturnal dyspnea and orthopnea are present, even in patients with preeclampsia. [ncbi.nlm.nih.gov]

alternans or presence of valvular heart disease 발생기전 혈관내 용질과 액체가 간질로 빠져나가서 발생 4가지 기전 정수압의 상승 Starling equation Q(iv-int) Kf[(Piv - Pint) - Summationf( iv - int)] Q net rate [clinicclinic2.cafe24.com]

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Dilated Cardiomyopathy

Examples of edema in specific organs: Pedal edema (dependent edema of legs) is extracellular fluid accumulation in the legs. [en.wikipedia.org]

nocturnal dyspnea (waking up in the middle of the night out of breath) Fatigue, decreased exercise capacity Swelling in the lower limbs (edema) or stomach However, some patients [icm-mhi.org]

Pulsus alternans is an infrequent, complex pathophysiologic sign often associated with severe heart failure. [ncbi.nlm.nih.gov]

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Ischemic Cardiomyopathy

[…] in the lower extremities Rapid weight gain A common symptom of non-ischemic cardiomyopathy is edema in the lower extremities. [study.com]

Pulmonary congestion reduces when the patient is in erect position, it results in improvement in symptoms. [1],[2],[5] Paroxysmal nocturnal dyspnea Paroxysmal nocturnal dyspnea [explainmedicine.com]

Signs include congestive heart failure, angina edema, weight gain and fainting, among others. [en.wikipedia.org]

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Alcoholic Cardiomyopathy

We describe a patient with pancytopenia, jaundice, and diffuse edema after a distal splenorenal shunt. His shunt was angiographically proved patent. [ncbi.nlm.nih.gov]

Furthermore, some will have paroxysmal nocturnal dyspnea and episodic coughs that produce frothy sputum. [symptoma.com]

Leg elevation promptly reversed the pulsus alternans, and the echocardiographic abnormality. [ncbi.nlm.nih.gov]

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Acute Myocarditis

Among many cardiac imaging techniques, only cardiac magnetic resonance (CMR) and computer tomography permit a direct detection of edema during acute myocarditis. [ncbi.nlm.nih.gov]

BACKGROUND: The purpose of the present study was to investigate the diagnostic value of T2-mapping in acute myocarditis (ACM) and to define cut-off values for edema detection [ncbi.nlm.nih.gov]

Abstract To quantify myocardial edema by using a T2 relaxometry approach with a dual-contrast turbo spin-echo (dcTSE) sequence in patients with acute myocarditis regarding [ncbi.nlm.nih.gov]

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Primary Cardiomyopathy

Symptoms of heart failure may include shortness of breath, fatigue, cough, orthopnea, paroxysmal nocturnal dyspnea, and edema. [aafp.org]

[…] pseudoaneurysm仮［性］心室瘤、仮性動脈瘤、偽［性］動脈瘤 pulmonary arteriostenosis 肺動脈狭窄症 pulmonary artery (PA) 肺動脈 pulmonary artery wedge pressure肺動脈毛細［血］管圧 pulmonary congestion肺うっ血 pulmonary edema [tokyo-med.ac.jp]

[…] severity of heart failure was quantified using the cardiovascular profile score (CVPS) ( Table 1 ) with 2 modifications to the original scoring system (replacement of “skin edema [heartfailure.onlinejacc.org]

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Viral Myocarditis

The overall agreement between CMR criteria for edema and viral PCR was 84%. [ncbi.nlm.nih.gov]

He was managed conservatively with intravenous hydration and developed acute pulmonary edema. [ncbi.nlm.nih.gov]

However, extensive ST-segment elevations in the electrocardiogram appeared with a positive troponin test, and the patient developed pulmonary edema on day 3. [ncbi.nlm.nih.gov]

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Secondary Cardiomyopathy

Chest X-ray (Figure 1 ) showed bilateral patchy opacities representing pulmonary edema or possible hemorrhage. [bmcresnotes.biomedcentral.com]

nocturnal dyspnea, and edema. [aafp.org]

There was no lower-extremity edema. The patient’s skin was dry and hot. Serum for investigations and blood cultures were obtained. [radcliffecardiology.com]

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Peripartum Cardiomyopathy

This report describes the presentation and anesthetic management of a parturient who was admitted with a diagnosis of severe preeclampsia in whom pulmonary edema and heart [ncbi.nlm.nih.gov]

/or comorbid paroxysmal nocturnal dyspnea and orthopnea are present, even in patients with preeclampsia. [ncbi.nlm.nih.gov]

Symptoms may include shortness of breath, persistent cough, dyspnea on exertion, orthopnea, paroxysmal nocturnal dyspnea, chest pain, palpitations, dizziness, and abdominal [appliedradiology.com]

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Rheumatic Heart Disease

We report a case of a young female who developed flash pulmonary edema during parturition and was found to have abnormal rheumatic involvement of her aortic, mitral, and tricuspid [ncbi.nlm.nih.gov]

[…] atrial fibrillation (Paf)発作性心房細動 paroxysmal nocturnal dyspnea発作性夜間呼吸困難 paroxysmal supraventricular tachycardia(PSVT)発作性上室性頻拍 paroxysmal ventricular tachycardia (PVT)発作性心室頻拍 [tokyo-med.ac.jp]

The patient finally died due to heart failure and acute pulmonary edema. Long standing RHD can lead to secondary AA amyloidosis. [ncbi.nlm.nih.gov]

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Toxic Myocarditis

A computed tomographic scan ruled out cerebral edema. The patient died of irreversible cardiac arrest 40 hours after admission. [ncbi.nlm.nih.gov]

Uremia : Fatty degeneration and edema of the myocardium due to uremic intoxication. [histopathology-india.net]

Sometimes ST segment elevation can mimic ECG changes of a myocardial infarction. [2] Chest X-ray [2] Features of heart failure (pulmonary edema, Kerley B lines, upper lobe [explainmedicine.com]

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High Output Heart Failure

Abstract Detailed hemodynamic, metabolic and blood volume studies were performed in a patient with hydatidiform mole who developed pulmonary edema associated with a high cardiac [ncbi.nlm.nih.gov]

He denied orthopnea, paroxysmal nocturnal dyspnea, and lower-extremity swelling. He also denied abdominal pain, hematochezia, melena, diarrhea, and flushing. [annals.org]

alternans (alternating large and small pulse pressures) and a raised JVP. [patient.info]

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Myocardial Fibrosis

In addition, although myocardial edema partly subsides, a process of global microscopic fibrosis develops in its place, detected as early as 4 months. [ncbi.nlm.nih.gov]

Additionally, fatigue, paroxysmal nocturnal dyspnea, and orthopnea may be present. Thromboembolic complications may occur in EMF. [emedicine.medscape.com]

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Chronic Right-Sided Congestive Heart Failure

Examples of edema in specific organs: Pedal edema (dependent edema of legs) is extracellular fluid accumulation in the legs. [en.wikipedia.org]

Sometimes there is intermittent shortness of breath at night (paroxysmal nocturnal dyspnea). [sharecare.com]

alternans, (alternating pulses, strong weak), Increased heart rate, PMI displaced inferiorly and posteriorly. [quizlet.com]

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Bacterial Myocarditis

It can aid in the assessment of necrotic or fibrotic changes, pericardial effusion, edema or functional irregularities.In symptomatic patients, myocarditis is suspected in [symptoma.com]

A history of shortness of breath at rest, orthopnea, ankle edema, or paroxysmal nocturnal dyspnea is suggestive of congestive heart failure. 3.2 Chest pain Chest pain is usually [intechopen.com]

Uremia : Fatty degeneration and edema of the myocardium due to uremic intoxication. [histopathology-india.net]

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Hypersensitivity Myocarditis

Luke's Medical Center with a 1-month history of progressive dyspnea on exertion, orthopnea, and dependent edema. [ncbi.nlm.nih.gov]

Luke’s Medical Center with a 1-month history of progressive dyspnea on exertion, orthopnea, and dependent edema. [amphetamines.com]

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Giant Cell Myocarditis

[…] antibiotic therapy for the treatment of traumatic wound of a finger, she presented to the emergency room with a hypersensitivity reaction characterized by facial rash with edema [ncbi.nlm.nih.gov]

There was no history of chest pain, cough, expectoration, hemoptysis, paroxysmal nocturnal dysnea, ankle swelling, fever, and rash. [atmph.org]

Chest x-ray showed acute pulmonary edema. [revespcardiol.org]

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Acute Aortic Regurgitation

Chest X-ray: This may show signs of heart failure, such as pulmonary edema. Coronary angiography is important to search for coronary artery disease. [symptoma.com]

Symptoms include exertional dyspnea, orthopnea, paroxysmal nocturnal dyspnea, palpitations, and chest pain. [merckmanuals.com]

Physical Examination – Acute AR • Tachycardia • Peripheral vasoconstriction • Cyanosis • Pulmonary edema • Arterial pulsus alternans; normal LV impulse • Early mitral valve [slideshare.net]

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Cardiac Asthma

Wheezing can be heard in acute pulmonary edema cases. [symptoma.com]

Cardiac asthma is also called paroxysmal nocturnal dyspnea or paroxysmal dyspnea. It is not an asthma in true sense. It is wheezing caused by congestive heart failure. [breath.ygoy.com]

alternans (alternating large and small pulse pressures) and a raised JVP. [patient.info]

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Fungal Myocarditis

Uremia : Fatty degeneration and edema of the myocardium due to uremic intoxication. [histopathology-india.net]

Once heart dysfunction sets in, signs of cardiac failure may manifest, such as pulmonary edema (fluid accumulation in the lungs), peripheral oedema, hypoxemia, pulsus alternans [medindia.net]

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Chronic Pulmonary Edema

[…] pulmonary edema Maternal hypertension Maternal hypertension Neurogenic pulmonary edema Non-cardiogenic pulmonary edema O/E - pulmonary edema Postoperative pulmonary edema [healthprovidersdata.com]

In some patients, extreme edema may result in paroxysmal nocturnal dyspnea, although the pathogenesis of this conditions is not well-understood. [pathwaymedicine.org]

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Pulsus Alternans

We describe a patient with recurrent pulmonary edema, hypertension, bilateral renal artery stenosis, but with normal systolic function. [ncbi.nlm.nih.gov]

Pulsus alternans Other names Cardiac alternans, mechanical alternans Pulse pressure waveform displaying the variation in pressure between beats in pulsus alternans. [en.wikipedia.org]

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S3 Gallop

Right-sided S3 is accompanied by the constellation of findings classically seen in right-sided heart failure: hepatosplenomegaly, peripheral edema, pleural effusions, and [thoracickey.com]

A) dyspnea at rest - paroxysmal nocturnal dyspnea - dyspnea with exertion - orthopnea B) exertional dyspnea - orthopnea - paroxysmal nocturnal dyspnea - dyspnea at rest C) [quizlet.com]

Vital signs usually include a low blood pressure, tachycardia, and pulsus alternans, a pulse that alternates strong and weak beats and usually happens in patients with severe [acphospitalist.org]

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Myocardial Infarction

The man was bitten on the left index finger and subsequently developed localized edema followed by hypotension, chest pain, and altered mental status. [ncbi.nlm.nih.gov]

nocturnal dyspnea, 57 nausea or vomiting, 40, 53, 62, 65, 67 indigestion, 55 loss of appetite, 46, 57 weakness or fatigue, 46, 53 cough, 53, 62 dizziness, 53 and palpitations [doi.org]

Neutrophilic infiltration (acute inflammation), edema and hemorrhage are also first visible at 4-12 hours but generally closer to 12 hours. [histopathology-india.net]

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Aortic Valve Stenosis

[…] increasingly sustained high diastolic left atrial pressures to fill the ventricle which is transmitted retrogradely into the pulmonary circulation, resulting in pulmonary edema [pathwaymedicine.org]

Other symptoms associated with AS are related to cardiac failure, such as paroxysmal nocturnal dyspnea, orthopnea, and dyspnea on exertion. [symptoma.com]

Pulsus alternans can occur in the presence of LV systolic dysfunction. [emedicine.medscape.com]

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Suppurative Pericarditis

Manifestations of cardiogenic pulmonary edema may also be present. [radiopaedia.org]

The chest discomfort noted with acute pericarditis, as well as orthopnea and paroxysmal nocturnal dyspnea, does not usually occur in individuals with constrictive pericarditis [tele.med.ru]

alternans 交互脈 pulsus paradoxus 奇脈 pupillary reaction 瞳孔反応 pure gonadal dysgenesis 純型性腺形成不全 pure red cell aplasia 赤芽球癆 PRCA purified protein derivative 精製ツベルクリン PPD purine [jpeds.or.jp]

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Right-Sided Heart Failure

Principal symptoms include distal edema and profuse weakness and dyspnea. [symptoma.com]

Attacks of breathlessness severe enough to wake the patient frequently occur during sleep ( paroxysmal nocturnal dyspnea ). [medical-dictionary.thefreedictionary.com]

Pulsus alternans is usually associated with an S 3 gallop, signifies advanced myocardial disease, and often disappears with treatment of heart failure. [emedicine.medscape.com]

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