PubMed · 9335650
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S Nerlich. 1997. Oxygen therapy.. https://pubmed.ncbi.nlm.nih.gov/9335650/
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Author is first dealing with the debate about supranormal oxygen delivery and with the Consensus Conference, closing the debate. Author is emphasizing the significance of the regional tissue-oxygenisation, which can be measured--in the splanchnic region--indirectly by tonometry, suitable for prognostic index too. The continuous blood gas analysis became already a fact and for the estimation of the cerebral circulation are also developed new methods: the measurement of the ajvDO2 and the near infrared spectroscopy. Author outlines the new parameters, determining the oxygen-availability (px, Cx, Qx). Finally, author is discussing two new american concepts for reducing healthcare costs: flexible monitoring and subacute centers.
HISTORY AND CLINICAL FINDINGS: A 48-year-old man with advanced light-chain plasmacytoma was admitted because of severe dyspnoea and tachycardia. Physical examination revealed peripheral cyanosis and signs of right heart failure. INVESTIGATIONS: The partial pressure of oxygen and CO2 in arterial blood were both reduces (72 mm Hg and 33 mm Hg, respectively). Liver enzyme activities were increased, there was right heart enlargement radiologically and the ECG showed low voltage and typical signs of right heart strain. Echocardiography revealed cardiac metastases of the plasmacytoma with subtotal right ventricular outflow tract obstruction (RVOTO), without any signs of pulmonary emboli. TREATMENT AND COURSE: Palliative radiotherapy to the heart reduced the intracardiac tumor size and improved the patients' general condition. The signs of the RVOTO were markedly reduced in both the ECG and the echocardiogram. But after this initial improvement pneumonia developed, of which the patient died. Autopsy revealed radiation pneumonia with extensive fibrosis as the immediate cause of death. CONCLUSION: In patients with advanced neoplasia cardiac metastasis should be included in the differential diagnosis of dyspnoea, tachycardia or hypotension of uncertain etiology. Echocardiography is the diagnostic tool of choice.
Dyspnea is a common symptom and, in most cases, can be effectively managed in the office by the family physician. The differential diagnosis is composed of four general categories: cardiac, pulmonary, mixed cardiac or pulmonary, and noncardiac or nonpulmonary. Most cases of dyspnea are due to cardiac or pulmonary disease, which is readily identified with a careful history and physical examination. Chest radiographs, electrocardiograph and screening spirometry are easily performed diagnostic tests that can provide valuable information. In selected cases where the test results are inconclusive or require clarification, complete pulmonary function testing, arterial blood gas measurement, echocardiography and standard exercise treadmill testing or complete cardiopulmonary exercise testing may be useful. A consultation with a pulmonologist or cardiologist may be helpful to guide the selection and interpretation of second-line testing.