Significant Shortness Of Breath Research Articles

Heyde Syndrome as Cause of New-onset Heart Failure in the Setting of Bioprosthetic Aortic Valve: A Case Report

This report describes the case of a 70-year-old female with a history of bioprosthetic aortic valve replacement. She presented to the emergency department with significant shortness of breath and bilateral lower extremity edema, which was found to be secondary to new-onset acute symptomatic congestive heart failure in the setting of Heyde syndrome.

Factors associated with home epinephrine-treated reactions during peanut and tree-nut oral immunotherapy

BackgroundHome reactions requiring epinephrine administration, a marker of their severity, restrict the widespread use of oral immunotherapy (OIT), but their risk factors are largely not known. ObjectiveTo identify risk factors for such reactions during OIT to most allergenic foods. MethodsAll patients who began OIT for peanut, tree nuts, sesame, or egg allergy at the Shamir Medical Center between April 2010 and January 2020 were enrolled. The patients were instructed to use their epinephrine autoinjectors during reactions consisting of severe abdominal pain, significant shortness of breath, or lethargy, or whenever in uncertainty of reaction severity. Patients with and without home epinephrine-treated reactions (HETRs) were compared. ResultsA total of 757 OIT treatments for peanut (n = 346), tree nuts (n = 221; walnut n = 147, cashew n = 57, hazelnut n = 16, almond n = 1), sesame (n = 115), and egg (n = 75) allergies were administered to 644 patients. Eighty-three (10.9%) patients experienced HETRs. The highest rate of HETRs was experienced during walnut (20.4%) or hazelnut (25%) OIT, followed by peanut (9.8%), sesame (6.1%), egg (6.7%), and cashew (5.3%) OIT. Risk factors for HETRs included a reaction treated in an emergency department (ER) (P = .005) before starting OIT and a reaction treated with epinephrine during in-clinic induction (P < .001). Significantly fewer patients with (73.6%) than without (88.3%) HETRs achieved full desensitization (P = .001), but only a few patients with HETRs (8.4%) failed treatment. ConclusionPrevious reaction severity is the main predictor for HETRs during OIT. These reactions are more frequent during walnut and hazelnut OIT than during OIT for other foods studied. Most patients experiencing HETRs achieved desensitization.

Pulmonary Cement Emboli After Kyphoplasty: A Case Of Bilateral Pulmonary Emboli And Exacerbation Of Interstitial Lung Disease

Abstract Introduction/Objective Osteoporosis often complicates the management of vertebral conditions, including spinal stenosis and vertebral fractures in the geriatric population. In addition to pharmacologic pain management; surgical interventions are employed if the pain is not adequately managed. The surgical interventions include vertebroplasty and kyphoplasty. These procedures involve the introduction of a cement polymer, Polymethylmethacrylate (PMMA), into the vertebral body. Cement leakage is a reported complication more commonly seen in vertebroplasty (30-75%) compared to kyphoplasty (8-33%). This occurs due to distant leakage of cement into the venous plexus or retrograde migration into the aorta which leads to pulmonary cement emboli (PCE). PCE are usually asymptomatic; few patients are symptomatic; seen in 0.9% for vertebroplasty and 0.4% for kyphoplasty. PMMA has a prothrombotic effect, contributing to the thrombosis of the pulmonary vessels. Symptoms typically arise weeks to months after the procedure. In addition, it has been reported that rarely PCE can present with ARDS especially in patients with interstitial lung abnormalities. Methods We present a case of an 80-year-old female with a history of hypertension, diabetes mellitus and osteoporosis who underwent a kyphoplasty procedure with use of PMMA for spinal stenosis. Her post-operative course was complicated by multiple surgical revisions. She was noted to have pulmonary cement emboli five months post kyphoplasty and developed significant shortness of breath eight months post procedure. She ultimately developed cardio-pulmonary failure and was found to have bilateral pulmonary emboli and cement emboli at autopsy. Microscopic examination of the cement emboli documented round to oval vacuole-like cavities within and around blood vessels consistent with PMMA. Conclusion The histo-pathologic findings of cement emboli are not well documented in human beings compared to animal models. We attempt to highlight the gross and microscopic findings of PMMA cement emboli which is essential in the clinical-histo-pathologic correlation and characterization of pulmonary emboli at autopsy.

A 10-year-old girl with acute shortness of breath

A 10-year-old girl with known allergies and asthma presented with a 2-year gradual worsening of asthma symptoms and recent dramatic escalation, including multiple exacerbations requiring emergency department treatment but no intubation or ICU admission. Her asthma was well controlled on minimal treatment until age 8. Presenting symptoms included shortness of breath, chest tightness, audible wheeze, abnormal voice quality, and frequent rapid-onset attacks with hoarse voice and inspiratory difficulty unresponsive to short-acting bronchodilators. She also had significant shortness of breath on exertion resulting in restricted activity. Respiratory symptoms at school, particularly in one area, caused severe anxiety resulting in home-schooling, social isolation, and agoraphobia. Over 2 years, her asthma therapy had been escalated from low-dose inhaled corticosteroid (ICS) to combined anti-IgE antibody, very high-dose ICS, long-acting bronchodilator, leukotriene receptor antagonist, and short-term oral steroids more than monthly for breakthrough symptoms. Additional medications included nasal steroid, oral antihistamine, proton pump inhibitor, and an oral contraceptive. Side effects of frequent oral steroids included weight gain (body mass index > 95th percentile) and comorbidities included gastroesophageal reflux. Spirometry and physical examination were normal. An additional investigation revealed the diagnosis.

Clinical course of asthma in 4 cases of coronavirus disease 2019 infection

Clinical course of asthma in 4 cases of coronavirus disease 2019 infection

SARS-CoV-2 presentation, with atypical chest CT findings and what we have learned being on the front lines

COVID 19 is a pandemic that has had a catastrophic impact. The healthcare infrastructure in most countries has been seriously tested, with the resolve of healthcare workers at truly heroic measures. The disease was first described in the Hubei region of China, but since has spread to 196 countries. Diagnosis has been the keystone of management, being as there does not exist a viable treatment regimen, medication or vaccine. We present a 51 year old female who was overcome by significant shortness of breath. Her laboratory testing and diagnostic imaging were not classically indicative of COVID 19. Her eventual confirmatory test, via RT-PCR was positive. She was managed with supportive care. COVID 19 patients classically present with fever, cough and increased fatigue. Laboratory findings predominantly include leukopenia, elevated lactate dehydrogenase (LDH), however these are not pathognomonic. The real time reverse transcriptase polymerase chain reaction, RT-PCR, test is advocated as the confirmatory test in presumptive positive patients. Diagnostic imaging, in particular CT Chest, has been important in establishing diagnoses, revealing ground glass opacities as characteristic findings in COVID 19 positive patients. Until a cure and/or vaccine are developed, the clinician’s index of suspicion along with diagnostic tests remain the only viable defense to prevent this pandemic from further spread and catastrophe.

Design of a Biocompatible Drug-Eluting Tracheal Stent in Mice with Laryngotracheal Stenosis.

Laryngotracheal stenosis (LTS) is a pathologic narrowing of the subglottis and trachea leading to extrathoracic obstruction and significant shortness of breath. LTS results from mucosal injury from a foreign body in the trachea, leading to tissue damage and a local inflammatory response that goes awry, leading to the deposition of pathologic scar tissue. Treatment for LTS is surgical due to the lack of effective medical therapies. The purpose of this method is to construct a biocompatible stent that can be miniaturized to place into mice with LTS. We demonstrated that a PLLA-PCL (70% poly-L-lactide and 30% polycaprolactone) construct had optimal biomechanical strength, was biocompatible, practicable for an in vivo placement stent, and capable of eluting drug. This method provides a drug delivery system for testing various immunomodulatory agents to locally inhibit inflammation and reduce airway fibrosis. Manufacturing the stents takes 28-30 h and can be reproduced easily, allowing for experiments with large cohorts. Here we incorporated the drug rapamycin within the stent to test its effectiveness in reducing fibrosis and collagen deposition. Results revealed that PLLA-PCL tents showed reliable rapamycin release, were mechanically stable in physiological conditions, and were biocompatible, inducing little inflammatory response in the trachea. Further, the rapamycin-eluting PLLA-PCL stents reduced scar formation in the trachea in vivo.

Shortness of Breath During Pregnancy: Could a Cardiac Factor Be Involved?

Shortness of breath (SOB) is common among healthy women with normal pregnancies. However, when no overt cardiac or extra cardiac etiology is found, a subtle cardiac source must be excluded. Pregnancy may induce or unmask myocardial dysfunction that may cause SOB. Healthy pregnant women with significant SOB were recruited for this study. We performed a comprehensive echocardiographic assessment including tissue Doppler imaging (TDI) and 2- dimensional strain imaging (2DS). The echocardiographic data obtained were compared with that of a control group of pregnant women without SOB. Thirty pregnant women with SOB were enrolled in the study (age, 31.8 ± 4.9 years, and gestation, 38.2 ± 2.8 weeks) for whom no overt etiology for SOB was detected. Patients with SOB compared with controls had thicker hearts (septum: 10.1 ± 1.1 vs 8.9 ± 0.9 mm; P < 0.001; posterior wall: 9.4 ± 1.1 vs 8.9 ± 0.9 mm; P < 0.01), shorter E-wave deceleration time (158.0 ± 50.1 vs 187.1 ± 37.6 msec; P = 0.01), and higher pulmonary artery pressure (26.8 ± 6.2 vs 19.0 ± 6.5 mm Hg, P < 0.01). Women with SOB tended to have a lower S' velocity TDI (P = 0.05) and a trend toward increased torsion on 2DS (P = 0.09). Significant SOB during otherwise normal pregnancy is associated with significant echocardiographic findings that may suggest a subtle cardiac involvement. Further investigation is necessary to verify such an association, which may have therapeutic implications for treating SOB of pregnancy.

Anterolateral Papillary Muscle Rupture Caused by Myocardial Infarction: A case report

&lt;p&gt;Abstract &lt;/p&gt;&lt;p&gt;Background: &lt;/p&gt;&lt;p&gt;The rupture of the anterolateral papillary muscle is less common than the posteromedial papillary muscle since the anterolateral muscle has dual blood supplies, while the posteromedial papillary muscle has a single blood supply. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Case presentation: &lt;/p&gt;&lt;p&gt;We present a case report of a 62 year old Sudanese male presenting with acute inferior ST segment elevation myocardial infarction (STEMI), underwent primary PCI (percutaneous intervention) to the right coronary artery. One hour after the PCI, he had sudden heart failure Kilip class IV, with significant shortness of breath, required intubation. Diagnosed to have mitral regurgitation from the complete rupture of the anterolateral papillary muscle due to coronary artery disease. The Transthoracic images were not enough to show the mitral valve apparatus and the transeophageal echocardiography as a gold standard showed clearly the rupture of the antero-lateral papillary muscle. The patient underwent a mitral valve replacement and concomitant coronary artery bypass grafting of the right coronary artery and left circumflex artery. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;Conclusion: &lt;/p&gt;&lt;p&gt;Acute mitral regurgitation can be precipitated by acute myocardial infarction due to rupture of the anterolateral papillary muscle. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;

Effects of disability on pregnancy experiences among women with impaired mobility.

Little is known about how functional impairments might affect the pregnancies of women with mobility disability. We aimed to explore complications that arise during pregnancy that are specifically related to physical functional impairments of women with significant mobility disabilities. Qualitative descriptive analysis. Telephone interviews with women from 17 USA states. 22 women with significant mobility difficulties who had delivered babies within the prior 10years; most participants were recruited through social networks. We conducted 2-h, in-depth telephone interviews using a semi-structured, open-ended interview protocol. We used NVIVO software to sort interview transcript texts for conventional content analyses. Functional impairment-related complications during pregnancy. The women's mean (standard deviation) age was 34.8 (5.3)years. Most were white, well-educated, and higher income; eight women had spinal cord injuries, four cerebral palsy, and 10 had other conditions; 18 used wheeled mobility aids; and 14 had cesarean deliveries (eight elective). Impairment-related complications during pregnancy included: falls; urinary tract and bladder problems; wheelchair fit and stability problems that reduced mobility and compromised safety; significant shortness of breath, sometimes requiring respiratory support; increased spasticity; bowel management difficulties; and skin integrity problems (this was rare, but many women greatly increased skin monitoring during pregnancy to prevent pressure ulcers). In addition to other pregnancy-associated health risks, women with mobility disabilities appear to experience problems relating to their functional impairments. Pre-conception planning and in-depth discussions during early pregnancy could potentially assist women with mobility disabilities to anticipate and address these difficulties.

Exercise Helped Even Elders With Moderate Kidney Disease

SAN DIEGO – A 12-week exercise program improved the physical capacity of elderly patients with stage 3 and 4 chronic kidney disease, results from a single-center study demonstrated. The intervention also improved patient perceptions of general health, vitality, and physical functioning. “We believe that renal rehabilitation exercise programs can be integrated into standard chronic kidney disease treatment,” Dr. Ana Paula Rossi, a nephrology fellow at Maine Medical Center, Portland, said at the meeting Kidney Week. “We need longer follow-up and larger studies to determine if this will translate into decreased mortality rates and slow the progression of CKD.” In a 12-week study conducted in 2011, Dr. Rossi and her associates randomized 48 patients with stage 3 and 4 CKD to usual care and 59 patients to an exercise intervention, which consisted of guided exercise at a cardiac rehabilitation facility 2 times per week for 3 months. Patients were encouraged to exercise an additional day per week on their own. Exercise consisted of treadmill walking, stationary cycling, or both. The duration was increased by 2-3 minutes per session, with the ultimate goal of 60 minutes of continuous exercise. Patients also did weight training with upper and lower extremity extensions and flexions with free weights. They started with one set of 10 repetitions per exercise, which was increased to a goal of three sets of 15 repetitions before the weight was increased. They also did stretching exercises. Outcomes included the results of the 6-minute walk test (the number of feet walked per 6 minutes), the sit-to-stand test in which the patient is asked to sit and stand up 10 times (time reported is the percentage of age-predicted time), and the gait-speed test, a measurement of centimeters per second walked over a distance of 20 feet. To assess quality of life, the researchers administered the RAND 36-item Short Form Health Survey. Patients with ongoing angina or transient ischemic attacks were excluded from the study, as were those with chronic lung disease resulting in significant shortness of breath or oxygen desaturation at rest, and those with lower extremity amputation with no prosthesis or with an orthopedic disorder severely exacerbated by activity. Patients in both groups were around 69 years old and had similar baseline reported levels of activity. After the 12-week study period, the usual care group had no significant improvements in the three main outcomes. Patients in the exercise intervention group had significant improvements in the 6-minute walk test (19%, from 1,117 to 1,327 feet per 6 minutes; P < .0001) and in the sit-to-stand test (29%, from 68% to 97% of age predicted; P = .0004), but not in the gait-speed test (183 vs. 171 cm; P = .06). Compared with their counterparts in the usual-care group, patients in the intervention group reported significant improvements in energy (P = .01), physical functioning (P < .01), and in general health (P = .03). Neither group experienced significant improvements in pain, emotional well-being, or in social functioning. The study was funded by the Maine Medical Center Research Institute. Dr. Rossi said that she had no relevant financial conflict to disclose. The meeting was sponsored by the American Society of Nephrology.

Possible Oseltamivir-Induced Angioedema in a Patient with Chronic Renal Failure

Objective To report a case of angioedema possibly associated with oseltamivir administration in a patient with chronic renal failure. Case Summary A 46-year-old female with an extensive allergy history and multiple co-morbidities, including chronic renal failure, was diagnosed with H1N1 influenza and given prescriptions for oseltamivir and methylprednisolone at an outside emergency department. She was sent home and took the first dose of both medications. The following day, the patient developed tongue swelling and left-sided edema. She discontinued methylprednisolone but continued oseltamivir. Her symptoms continued to worsen with the development of hivelike lesions and significant shortness of breath leading to hospitalization. Upon admission, oseltamivir was discontinued and the patient was started on dialysis. The patient's symptoms gradually improved, and she was discharged on hospital day 8. Discussion Oseltamivir was thought to be the causative agent due to the abrupt onset and resolution of symptoms associated with the administration and discontinuation of the medication. Application of the Naranjo probability scale found that oseltamivir was a possible cause of the patient's angioedema. Conclusion Health care providers should be aware of the rare but potentially life-threatening angioedema that may be associated with oseltamivir use.

Intraluminäre Verfahren der Glottiserweiterung bei bilateraler Stimmlippenparese

Bilateral vocal fold paralysis with paramedian position of the vocal chords can result from iatrogenic or traumatic nerve injuries, neurologic disorders and extralaryngeal malignancies and usually causes significant shortness of breath while the voice is only slightly affected. Only about 10% of the affected patients tolerate the narrowed airway caused by bilateral vocal fold paralysis in adduction, so most patients are candidates for a surgical intervention. Today, a range of intraluminal surgical procedures for enlargement of the glottis in bilateral vocal fold paralysis have been described which intend to avoid or supersede tracheostomy and which have replaced time-consuming external approaches to the glottis. This report provides an overview of the most important intraluminal surgical procedures for bilateral vocal fold paralysis in adduction and comments in detail on indications, surgical techniques, advantages and potential complications of the presented procedures for temporary or definitive enlargement of the glottis.

A Clinical Perspective of Venous Thromboembolism

A large number of individuals develop venous thromboembolism (VTE) every year.1 Each patient’s episode of DVT or PE is, naturally, unique. To highlight a variety of aspects about VTE a compilation case is presented that is composed of clinical data and images from several real patients. ### History of Present Illness A 36-year-old woman presents to the Emergency Department with severe shortness of breath and moderately intense anterior chest pain, worse on deep inspiration, which had started suddenly that morning. She also reports a 6-wk history of mild shortness of breath, for which she had been seen 4 wk earlier by her primary care physician who diagnosed her with “asthma.” Bronchodilators and steroids were prescribed but led to no significant improvement in her symptoms. She also gives a history of mild left calf pain that had started about 2 months earlier without preceding trauma, immobilization, or surgery. Her primary care physician had seen her and prescribed Ibuprofen for a “pulled muscle.” However, in the 1 week before her present presentation her leg symptoms worsened, and she had increased diffuse leg pain and swelling and slightly bluish discoloration of the whole leg. Her past medical history is only significant for an appendectomy at age 16. She has never been pregnant. She is on no medications, except for an estrogen and progestin-containing oral contraceptive, started 10 months earlier. She does not smoke. There is no family history of venous thromboembolism, although the patient reports that her paternal grandmother had a “swollen leg for many years” until she died in her 70’s, but no further details are known of the patient. ### Physical Examination The patient’s weight is 86 kg and her height 165 cm, calculating to a body mass index (weight divided by [height in meters]2) of 31.6 kg/m2, ie, she has grade 1 obesity. Her …

Metastatic Shoulder Liposarcoma to the Right Ventricle

Metastatic cardiac liposarcoma is rare. A right ventricular liposarcoma metastasis is described in a 46-year-old man, who was admitted with significant shortness of breath and fatigue, and in whom a large lobulated low attenuation mass occupying most of the right ventricular cavity, with extension through the right ventricular apex and a small-to-moderate pericardial effusion was detected by electrocardiogram-gated cardiac computed tomography. The patient had an antecedent history of a left upper arm liposarcoma treated with surgical resection, chemotherapy, and postoperative radiotherapy 3 years earlier. Surgical resection was performed with the majority of the neoplasm removed though; the right ventricular apex and epicardial extension of tumor could not be fully resected. The histopathologic analysis revealed a liposarcoma, similar to the one resected in the left arm 3 years earlier. Electrocardiogram-gated cardiac computed tomography was able to visualize the metastatic tumor within the heart, accurately evaluate cardiac function and allow for prompt surgical treatment that produced relief of symptoms, and assess for further metastatic disease within the thorax.

Seasonal Dyspnea

A 63-year-old white man with a history of coronary artery disease, hypertension, and diabetes mellitus was referred to the pulmonary clinic for persistent dry cough and shortness of breath. In May 2000, he began to have dry cough, malaise, and occasional chills. Previously, he had been able to walk for a mile without significant shortness of breath, but by the end of the summer months he was unable to walk 10 feet without significant dyspnea. He reported no fever or purulent sputum. He also denied hemoptysis, rhinorrhea or sinus congestion, chest pain, orthopnea, paroxysmal nocturnal dyspnea, or peripheral edema. He did report an unintended weight loss of eight pounds over the course of the summer. On further questioning, he admitted to having had similar symptoms during the previous three summers that resolved after the first frost in the autumn. His review of systems was significant for the absence of visual abnormalities, dermatitis, arthralgia, myalgia, or recurrent infection. He has a remote history of tobacco use, approximately 10 pack-years. He is a farmer who grows herbs and vegetables but not roses or flowers. He lives in an 80-year-old log home and does not have any pets. He denied significant exposure to asbestos or silica, but has had annual exposure to pesticides and fertilizers.

Dry-air and long-term water (thermally indifferent) baths for the treatment of chronic nephritis

Case VІ. Patient O. A., 45 years old, a peasant. Admitted to the clinic on October 10, 1906 with complaints of edema of the face, abdomen, extremities, penis and scroti, significant shortness of breath when walking even on an even place, frequent headaches and a feeling of general weakness. Considers himself sick since September 15, 1906: first, after drinking cold water, a sore throat (probably Angina); after 3-4 days the pain disappeared, but the face and legs began to swell up to the knees, and then the swelling of the arms and abdomen appeared. Of the illnesses suffered earlier, it indicates gonorrhoeam, a "fever" that has been a few times, but not for long. At the time, the patient had scrofula (a white cicatricial spot on the skin of the abdomen in the mesogastrii dextri area is still present). I consumed alcoholic beverages in quite significant quantities. There are no clear indications on Lues. The patient is of average height, correct body build and satisfactory nutrition. The musculoskeletal system and the layer of subcutaneous adipose tissue are sufficiently developed. The color of the skin and visible mucous membranes is rather pale. There are significant ascites and anasarca (fluctuatio vera pronounced clearly). The upper boundaries of both lungs are normal. The lower ones are moved one intercostal space up. The right border of the superficial dullness of the heart is the right edge of the sterni; upper lower edge of the third rib, pushing of the heart apex in the Ѵ-m intercostal space (left side of the chest wall), 2 ctm. outwards from Linea mamil. sinistra. The pulse is low, low filling, normal frequency, correct.