Severe congestive heart failure in elderly patient with Paget’s disease

Palleschi, Lorenzo; Nunziata, Eleonora

doi:10.4081/gc.2017.6727

Cited by 4 publications

(6 citation statements)

References 14 publications

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“…Os sintomas e sinais cardíacos levantam a suspeita de IC, enquanto os exames de imagem cardíacos confirmam o diagnóstico. O diagnóstico diferencial se baseia no elevado débito cardíaco ou índice cardíaco e na presença de extremidades quentes [67][68][69][70] .…”

Section: Diagnóstico Diferencialunclassified

Insuficiência Cardíaca De Alto Débito: Causas, Manifestações Clínicas E Estratégias De Gerenciamento

Borguezan,

Ferreira,

Furtado

et al. 2024

Saúde Cardiovascular: Conhecimento, Prevenção E Cuidado

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Section: Diagnóstico Diferencialunclassified

Insuficiência Cardíaca De Alto Débito: Causas, Manifestações Clínicas E Estratégias De Gerenciamento

Borguezan,

Ferreira,

Furtado

et al. 2024

Saúde Cardiovascular: Conhecimento, Prevenção E Cuidado

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“…They reported 23 cases of high-output HF consisting of 13 male and 11 female patients. The cases included patients from all ages, ranging from as young as a 2-day premature infant [67] to older adults (84 years) [68]. The follow-up periods widely varied from a few days (2 days) to months (11 months).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Clinical evidence of HF include typical cardiac symptoms of HF, physical signs and imaging findings. The common cardiac symptoms included progressive exertional dyspnoea, lower extremities oedema, pulmonary oedema, fatigue and general weakness while the common sings in physical examination included elevated jugular venous pressure, hepatojugular reflux, third heart sound (gallop rhythm), laterally displaced apical impulse and pulmonary crepitation [48][49][50][51][53][54][55][56][57][58][59][60][61][62][65][66][67][68]. Others are tachycardia, cardiomegaly, and cardiac murmur [48,51,53,59,63,68].…”

Section: Differential Diagnosismentioning

confidence: 99%

“…For patients with high-output HF secondary to disease with vasodilatory pathophysiology, medical treatment is a common option. In addition to resolution of cardiac symptoms, anti-thyroid medications restore euthyroid state in hyperthyroidism patients [59], Metoprolol, furosemide & spironolactone relief of abdominal pain in pregnancy [54], and oral bisphosphonates in Paget's disease [67]. Diuretic and/ or anti-angiogenesis are not effective in resolving cardiac symptoms in patients with hepatic disease [62] but effective normalizing cardiac output in patients with multiple myeloma and high-output HF [53].…”

Section: Clinical Managementmentioning

confidence: 99%

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High output heart failure: A review of clinical status - epidemiology, pathophysiology, diagnosis, prognosis and clinical management

Albakri¹

2019

Med Clin Arch

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The clinical syndrome of heart failure (HF) has traditionally been associated with low or normal cardiac output accompanied by increased systemic vascular resistance. This association has led to the present under-appreciation of a minority group of HF patients presenting with high cardiac output but with normal cardiac function, clinically termed high-output HF. In these patients, the pathophysiological hallmark is decreased systemic vascular resistance. Because these patients lack proven therapies, treatment relies on evidence-based therapies developed for low-cardiac output HF. With a paucity of clinical trial data, evidence based from case reports suggest some of the established HF medications such as vasodilators and inotropes can be potentially detrimental for patients with high-output HF. These findings demonstrates an unmet clinical need for in-depth understanding of the pathophysiology, aetiology and clinical course of high-output HF, which forms the basis for the present review.

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“…The disease is characterized by an increased number and activity of osteoclasts and activity of osteoblasts [ 5 ], leading to the formation of a hyperplastic bone which is mechanically weaker, less compact and more susceptible to fractures compared with a normal adult bone [ 6 ]. At the same time, bone marrow fibrosis and increased bone marrow vascularization are observed, particularly in the osteolytic and mixed phases of the disease [ 7 – 9 ], while in the sclerotic phase the osteoblastic activity predominates and a sclerotic, hypovascular bone is found [ 2 ]. Serum alkaline phosphatase derives from osteoblasts during the process of bone formation, whereas hydroxyproline is excreted in urine because of bone collagen disruption in the osteolytic phase [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget’s disease: a combined registry and single-institution retrospective observational study

et al. 2021

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Background Total hip arthroplasty (THA) in patients with Paget’s disease can be associated with technical difficulties related to deformities and altered mechanical bone properties, and hypervascularity leads to significative intra-operative bleeding. The purpose of this registry and single-institution study was to investigate overall survival and causes of failure of THA in pagetic patients, together with an analysis of the clinical and radiological complications. Material and methods Registry-based survival and complication analysis, type of fixation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossification [HO]) data were reviewed. Results In total, 66 patients (27 males and 39 females, mean age at surgery 71.1 years for males and 74.8 years for female) from the registry study presented a 10-year survival of 89.5%. In the institutional study, involving 26 patients (14 males and 12 females, 69 years average) and 29 THAs, hip function improved significantly. Average cup orientation was 40.5°, while varus stem alignment was 13.8%. In total, 52% of hips had heterotopic ossifications. Peri-acetabular osteolysis was in 13.8% of implants and in 45% of hips was found around the stem. Allogenic and autologous blood transfusion rate were 68.2% and 31.8%, respectively, with an average transfusion of 2 units of blood (range 1–6 units). HHS improved by an average of 34 points, with excellent result in 64.3% of patients. Two implants failed, one due to traumatic ceramic head fracture 64 months after surgery, and one due to mobilization of the cup on the second post-operative day. Conclusion THA surgery in Paget’s patients is a safe procedure, and implant survival is only partly affected by bone remodelling and choice of fixation. The post-operative functional outcome is largely similar to that of other patients. Bleeding-related complications are the main complications; a careful pharmacological strategy should be recommended to decrease the risk of transfusions and of HO development. Level of evidence Level III

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Severe congestive heart failure in elderly patient with Paget’s disease

Cited by 4 publications

References 14 publications

Insuficiência Cardíaca De Alto Débito: Causas, Manifestações Clínicas E Estratégias De Gerenciamento

Insuficiência Cardíaca De Alto Débito: Causas, Manifestações Clínicas E Estratégias De Gerenciamento

High output heart failure: A review of clinical status - epidemiology, pathophysiology, diagnosis, prognosis and clinical management

Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget’s disease: a combined registry and single-institution retrospective observational study

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