Chest
-
As seen in this CME online activity (available at http://copdcme.elsevierresource.com/, COPD is characterized by pulmonary airflow obstruction that is not completely reversible. COPD presents clinically with diverse phenotypes ranging from relatively asymptomatic people to patients with severe chronic cough, abnormal sputum production, and dyspnea with exertion. Exacerbations accelerate the downward cycle of breathing difficulties, activity avoidance, and physical decline that characterizes progressive COPD. ⋯ Evidence-based education that addresses individualized maintenance regimens are needed to improve long-term outcomes in COPD. Within this CME/CE Snapshot educational series, an expert pulmonologist and a primary care educator discuss how to best longitudinally evaluate patients with COPD and incorporate the principles of pulmonary rehabilitation to maximize patient function and quality of life. They explain therapeutic tailoring over the course of disease and describe the importance of engaging patients in shared decision-making to promote acceptance of the diagnosis, appropriate physical activity, and treatment adherence.
-
A 62-year-old woman with no medical history was admitted to the ED for fever, acute respiratory failure, and pain in the right lower limb. Three months prior to presentation, she had spent 45 days travelling through India and Thailand. ⋯ Despite this antibiotic treatment, her symptoms worsened and she developed, over the following 3 weeks, general weakness and arthralgia/myalgia. Due to the severity of hypoxemia, the patient was immediately transferred to the ICU.
-
Clinical Trial
Left Atrial Volume as a Biomarker of Target Organ Damage in Cardionephrology: A Study in a Wide Range of Renal Function.
Cardiac chamber size was previously studied by echocardiography, among patients with progressive kidney disease only. We aimed to explore the relations between all heart chamber volumes as assessed by CT pulmonary angiography and renal function, throughout all ranges. ⋯ A simple concomitant volumetric analysis of all four cardiac chambers by CT pulmonary angiography demonstrated that differences in volume correlate with renal function even within the normal range spectrum. The difference was most evident in the left atrium. This finding may be the first clue to evolving cardiorenal syndrome and may serve as a target for early therapeutic interventions.
-
The role of decreased pulmonary arterial (PA) compliance (C), equivalent to increased PA stiffness (1/C), as a critical determinant of right ventricular dysfunction and prognosis has been emphasized in pulmonary arterial hypertension (PAH). ⋯ In incident idiopathic PAH, PA stiffness was related to mPAP and heart rate, and this finding outperformed the potential influences of age and sex. Baseline PA stiffness did not independently predict outcome. The great dispersion of the PVR × C product implied that PVR and PA stiffness were differently affected by the disease process.
-
An obesity paradox, wherein patients who are obese have lower mortality, has been described in cardiopulmonary diseases, including pulmonary arterial hypertension (PAH). Our objective was to determine whether obesity and BMI are associated with mortality in patients with PAH. ⋯ Obesity was not associated with mortality in the overall population, but there was an age-obesity interaction with increased mortality among young patients who were morbidly obese. These results have implications for active weight management in younger patients who are morbidly obese who are otherwise candidates for lung transplantation.