Presentation
We herein present a unique case of a difficult-to-treat Graves' disease presenting with severe pulmonary hypertension resulting in low cardiac output thyroid storm. [ncbi.nlm.nih.gov]
Entire Body System
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Fatigue
OBJECTIVE: Little attention has been paid to possible cardiovascular involvement in patients with chronic fatigue syndrome (CFS), although many of their symptoms and signs suggest cardiovascular dysfunction. [ncbi.nlm.nih.gov]
Assess for reports of fatigue and reduced activity tolerance. Fatigue and exertional dyspnea are common problems with low cardiac output states. Close monitoring of the patient’s response serves as a guide for optimal progression of activity. [nurseslabs.com]
Physical activity increases the demands placed on the heart; fatigue and exertional dyspnea are common problems with low cardiac output states. [nursingcareplan.blogspot.com]
See Patent foramen ovale as a cause of fatigue. The heart muscle itself is diseased - e.g. Cardiomyopathy. It is likely this is caused by mitochondrial failure so. See CFS - The Central Cause: Mitochondrial Failure and /or poor antioxidant status. [drmyhill.co.uk]
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Falling
Ineffective Airway Clearance Ineffective Breathing Pattern Ineffective Coping Ineffective Therapeutic Regimen Management Ineffective Tissue Perfusion Latex Allergy Response Powerlessness Rape Trauma Syndrome Risk for Aspiration Risk for Bleeding Risk for Falls [nurseslabs.com]
Ventricular fibrillation causes cardiac output to fall to zero, and therefore leads to profound hypotension. [cvphysiology.com]
Although beating faster helps to maintain cardiac output as the stroke volume falls, a faster heart rate can be counterproductive because it allows less time for the ventricle to fill with blood after each heartbeat. [northshore.org]
Fluid is withdrawn until intrapericardial pressure falls below right atrial pressure, usually to subatmospheric levels. [merckmanuals.com]
[…] ventricle, with subsequent engorgement of the systemic veins, producing pitting edema, enlargement of the liver, and ascites. low-output heart failure Forward failure syndrome, low cardiac output syndrome A clinical condition in which the cardiac output falls [medical-dictionary.thefreedictionary.com]
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Weight Gain
Pulses are weak with reduced cardiac output. * Assess fluid balance and weight gain. Compromised regulatory mechanisms may result in fluid and sodium retention. [nursingcareplan.blogspot.com]
Furthermore, people with decreased heart output may also experience orthopnea, weight gain, dizziness and confusion. Anxiety, weakness and tiredness are also some of the symptoms that can appear when this heart disorder is in the question. [ic.steadyhealth.com]
Inspect fluid balance and weight gain. Weigh patient regularly prior to breakfast. Check for pedal and sacral edema. Compromised regulatory mechanisms may result in fluid and sodium retention. [nurseslabs.com]
If the latter, the patient may complain of weight gain, ankle swelling, or a bloating sensation). Nocturnal cough ( pink frothy sputum) or wheeze. Light-headedness or syncope. Anorexia. [patient.info]
Patients with symptomatic constrictive pericarditis (eg, with dyspnea, unexplained weight gain, a new or increased pleural effusion, or ascites) and those with markers of chronic constriction (eg, cachexia, atrial fibrillation, hepatic dysfunction, pericardial [merckmanuals.com]
Cardiovascular
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Heart Disease
Abstract: The purpose of this review is to discuss the management of the low cardiac output syndrome (LCOS) following surgery for congenital heart disease. [eurekaselect.com]
Therefore, it is even expectable that congenital heart disease and myocardial infarction will cause the heart to malfunction and pump less amounts of blood per minute. [ic.steadyhealth.com]
KEYWORDS: Cardiogenic shock; Congenital heart disease; Heart failure; Intensive care; Neonates; Vasoactive [ncbi.nlm.nih.gov]
Abstract In 42 children with congenital heart disease coagulation factor levels were studied serially during the first 20 hours following cardiopulmonary bypass surgery. [jcp.bmj.com]
Urogenital
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Oliguria
Low cardiac output was defined as metabolic acidosis (pH 2 mmol/L, or base excess -5), oliguria (urine output CONCLUSIONS: Splanchnic and/or renal hypoxemia as detected by near-infrared spectroscopy may not be an accurate indicator of low cardiac output [ncbi.nlm.nih.gov]
Oliguria can reflect decreased renal perfusion. Diuresis is expected with diuretic therapy. * Assess for chest pain. [nursingcareplan.blogspot.com]
Oliguria is a classic sign of decreased renal perfusion. Assess heart sounds for gallops (S 3, S 4 ). S 3 indicates reduced left ventricular ejection and is a class sign of left ventricular failure. [nurseslabs.com]
[…] level of consciousness Cool peripheries, mottled peripheries and delayed capillary refill time Hypotension Tachycardia or bradycardia Thready pulse Raised jugular venous pressure Breathlessness and hypoxaemia Evidence of pulmonary and peripheral edema Oliguria [clinicaladvisor.com]
Renal compensation for reduced perfusion results in diminished glomerular filtration, causing oliguria and subsequent renal failure. [emedicine.medscape.com]
Neurologic
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Confusion
Restlessness is noted in the early stages; severe anxiety and confusion are seen in later stages. * Assess heart rate and blood pressure. [nursingcareplan.blogspot.com]
Furthermore, people with decreased heart output may also experience orthopnea, weight gain, dizziness and confusion. Anxiety, weakness and tiredness are also some of the symptoms that can appear when this heart disorder is in the question. [ic.steadyhealth.com]
Other Nursing Diagnoses Activity Intolerance Acute Confusion Acute Pain Anxiety Caregiver Role Strain Constipation Chronic Pain Decreased Cardiac Output Deficient Fluid Volume Deficient Knowledge Diarrhea Disturbed Body Image Disturbed Thought Processes [nurseslabs.com]
Clinical features of the condition Fatigue, confusion, agitation and/or decreased level of consciousness Cool peripheries, mottled peripheries and delayed capillary refill time Hypotension Tachycardia or bradycardia Thready pulse Raised jugular venous [clinicaladvisor.com]
Classification Acute and chronic Heart failure has traditionally been described as acute or chronic but this can be confusing and should be used to describe time, rather than severity. [patient.info]
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Dizziness
Furthermore, people with decreased heart output may also experience orthopnea, weight gain, dizziness and confusion. Anxiety, weakness and tiredness are also some of the symptoms that can appear when this heart disorder is in the question. [ic.steadyhealth.com]
[SVO2], cardiac output) * Arrhythmias, electrocardiogram (ECG) changes * Rales, tachypnea, dyspnea, orthopnea, cough, abnormal arterial blood gases (ABGs), frothy sputum * Weight gain, edema, decreased urine output * Anxiety, restlessness * Syncope, dizziness [nursingcareplan.blogspot.com]
Acute decrease of blood pressure can result in the shock syndrome, whereas long-term reduction leads to lethargy, fatigue, weakness, dizziness, fainting and other symptoms. [news-medical.net]
The patient says he experienced an acute onset of dizziness, and “everything went black real fast.” [emsworld.com]
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Altered Mental Status
A decline in higher cortical function may indicate diminished perfusion of the brain, which leads to an altered mental status ranging from confusion and agitation to flaccid coma. The heart plays a central role in propagating shock. [emedicine.medscape.com]
Hypoventilation can be caused by altered mental status such as overdose, sedation, intoxication, postictal states, head trauma, or stroke, or by a tiring CHF patient. [medicscribe.com]
The AHA defines patients as unstable if any of the following are present: 17 Hypotension; New-onset altered mental status; Signs of shock; Ischemic chest discomfort; Acute heart failure. [emsworld.com]
Workup
MEASUREMENTS AND MAIN RESULTS: Clinical and echocardiographic assessment of hemodynamics was performed within 48 hours of sepsis workup and repeated at least 24 hours later. [ncbi.nlm.nih.gov]
(See DDx, Workup .) Cardiogenic shock continues to be a difficult clinical problem; the management of this condition requires a rapid and well-organized approach. (See Prognosis, Treatment, and Medication .) [emedicine.medscape.com]
An echocardiogram and an electrocardiogram are standard in the workup of dyspnea that may be due to cardiac disease. [clevelandclinicmeded.com]
Serum
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Lactate Decreased
Six hours after calcium initiation, A-V oxygen saturation difference decreased by 7.4 % (32.6 2.1 to 25.2 2.0 %, p 0.001), rSO2 increased by 5.5 % (63.1 vs 68.6 %, p 0.001), and serum lactate decreased by 0.9 mmol/l (3.3 vs 2.4 mmol/l, p 0.001) with no [ncbi.nlm.nih.gov]
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Base Deficit
§ Lactate 2mmol/L § Base deficit -4 mmol/L correlates with inadequate tissue oxygenation and increased morbidity. · Impaired oxygen delivery also leads to •Low mixed venous oxygen saturation (SvO 2 ) and central venous oxygen saturation (ScvO 2 ) • [clinicaladvisor.com]
Treatment
Echocardiographic, Doppler-derived, time interval-based index of myocardial performance (Tei index) was used to study cardiac function prior to and while on intravenous milrinone treatment for 18-24 hours. [ncbi.nlm.nih.gov]
Prognosis
[…] considerably high P-AVP (5.9 6.1 pg/ml) negatively correlated with serum sodium concentration (S-Na, 135.3 5.8 mEq/L, r -0.548 [P CONCLUSIONS: Low cardiac output stimulates AVP release via a non-osmotic process that results in hyponatremia and poor prognosis [ncbi.nlm.nih.gov]
Other parameters may be more important than MELD score to predict prognosis. [gut.bmj.com]
Etiology
BACKGROUND: The etiology of chronic fatigue syndrome (CFS) is unknown. Orthostatic intolerance (OI) is common in CFS patients. Recently, small heart with low cardiac output has been postulated to be related to the genesis of both CFS and OI. [ncbi.nlm.nih.gov]
Depending on etiological factors, common medications include digitalis therapy, diuretics, vasodilator therapy, antidysrhythmics, ACE inhibitors, and inotropic agents. * Maintain optimal fluid balance. [nursingcareplan.blogspot.com]
Routine blood work can provide insight into the etiology of heart failure and extent of decompensation. A low serum sodium level often is observed with advanced heart failure and can be a poor prognostic sign. [nurseslabs.com]
Objectives List the cardiac etiologies of syncope. Differentiate between the various cardiac etiologies of syncope. Discuss the treatment of syncope of cardiac etiology. [emsworld.com]
Epidemiology
[…] [email protected] 2 The Heart Institute, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH, 45229, USA. 3 The Heart Center, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA. 4 Division of Biostatistics and Epidemiology [ncbi.nlm.nih.gov]
Epidemiology [ 1, 3 ] Currently around 920,000 people in the UK have a diagnosis of heart failure. Prevalence in developed countries is approximately 1-2% of the adult population, increasing to 10% or more in those over 70 years of age. [patient.info]
Epidemiology The prevalence of the ‘low cardiac output state’ is difficult to define. [clinicaladvisor.com]
Epidemiology United States statistics The incidence rate of cardiogenic shock ranges from 5% to 10% in patients with acute MI. [8] In the Worcester Heart Attack Study, a community-wide analysis, the reported incidence rate was 7.5%. [9] The literature [emedicine.medscape.com]
Pathophysiology
Etiology of low cardiac states by pathophysiological category Table IV. [clinicaladvisor.com]
Many overlapping mechanisms account for descriptive terms used in the medical literature, such as "air hunger," "chest tightness," and many others. 1 Pathophysiology The mechanisms and pathophysiology of dyspnea involve interactions between the respiratory [clevelandclinicmeded.com]
To understand more fully the physiology and pathophysiology of hypotension, see the Blood Pressure Regulation Tutorial. [cvphysiology.com]
They may also predict early in-hospital outcomes and can be useful for identifying young children at increased risk for LCOS and death after heart surgery under CPB. 9 Adrenomedullin (ADM) is reportedly associated with the pathophysiology of LCOS. [revespcardiol.org]
Etiology Pathophysiology Symptoms Physical Examination Diagnosis Treatment RELATED CONTENT: Mitral Stenosis Quiz Mitral Stenosis Case Questions Introduction The area of a normal mitral valve is 4 to 6 cm 2. [healio.com]
Prevention
Nursing goals, in response to hypovolemia, are to increase the circulating volume, optimize oxygen delivery, stabilize hemodynamics, improve tissue perfusion, and prevent shock. [ncbi.nlm.nih.gov]
Furthermore, effective prevention, whether primary or secondary, is backed by the findings of several landmark trials. Vascular disease is a complex field with primary care physicians and nurse practitioners as well as several specialties involved. [ingentaconnect.com]
It helps to prevent pulmonary congestion and its associated pulmonary hemorrhage. [thieme-connect.com]
See Arteriosclerosis - what causes it and how to prevent it. Poor conversion of fuel and oxygen into ATP ie mitochondrial failure. See CFS - The Central Cause: Mitochondrial Failure. Not enough blood in circulation. See Anaemia. [drmyhill.co.uk]
In our study, all the data were adjusted for the patients’ age and bodyweight to prevent these variables from influencing our results. [revespcardiol.org]