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CARDIOVASCULAR ASPECTS OF PORPHYRIA
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Cardiocascular
Blood Pressure
Arythmia
Tachycardia

PORPHYRIA FACTS

CARDIOVASCULAR ASPECTS OF PORPHYRIA

Sudden death presumably due to cardiac arrhythmia may also occur.

SOURCE:
The Porphyrias
Dr. Karl E. Anderson M.D.
Cecil Textbook of Medicine
20th Edition 1996
+++++++++++++++++

There is often cariological aspects of the acute attacks in the porphyrias.

Blood pressure will often spike at the onset of an attack.

Tachycardia or fast pulse is most often present.

SOURCE:
Robert Johnson MD
Internal Medicine
+++++++++++++++++

In cases of sustained or severe rapid heart beat or significant hypertension,
physicians should monitor the patient closely.

Propanolol and other beta-blockers have been used to control these symptoms
but since they sometimes have severe side effects they only should be used
under close medical supervision.

There should be close monitoring of blood pressure and the heart rate.

SOURCE:
Disorders of Porphyrin Metabolism
A Goldberg et. al.
Plenum Medical Book Company
New York
1987
++++++++++++++++

Hepatic porphyrias are characterized by episodic acute attacks that consist of
various neuro-psychiatric symptoms and signs, such as abdominal pain,
vomiting, constipation, hypertension and tachycardia associated with increased
excretion of porphyrins and porphyrin precursors.



SOURCE:
Journal of Photodermatololy, Photoimmunologyand Photomedicine
1998 Apr;
14(2):48-54
"Management of the acute porphyrias."
Kauppinen R, M.D.
++++++++++++++++++++++
An autonomic neuropathy that may be seen in an acute attack of AIP is that of
labile hypertension

.SOURCE:
Acute Intermittent Porhyria
Anne LeMaistre, M.D.
1995
TMC
+++++++++++++++

Chronic hypertension is the most significant disorder.

SOURCE:
Cardiovascular disorders in acute porphyria.
KF Leonhardt MD
Wien Klin Wochenschr
October 1981
pages 580-4
+++++++++++++++++++
Hypertension is commonly associated with the acute porphyrias.

SOURCE:
McColl K.E. et.al.
Hypertension and renal impairment as complications of acute porphyria.
Nephrol Dial Transplant.
1992;7(10):986-90.
++++++++++++++++++

Autonomic neuropathy is damage to nerves of the autonomic nervous system.

This type of neuropathy can cause extreme drops in blood pressure when
standing up for example.

SOURCE:
Mosby Medical Encyclopedia
Revised Edition
Plume Books
+++++++++++++++++++
Tachycardia and hypertension are usually present, and hypertensive
encephalopathy may developin the acute porphyrias.

SOURCE:
Dr, Michael Moore
Porphyria Research Unit
Australia
+++++++++++++++++

Besides hypertension, severe postural hypotension, resulting in syncope may
occur. Hypertension may persist to some extent between attacks."


SOURCE:
Dr. Michael Moore
Porphyria Research Uni
Brisbane, Queensland
+++++++++++++++++++++

Cardiovascular features occur in 70 per cent of HCP cases and include
hypertension and tachycardia.

SOURCE:

The Porphyrias
Alana Adams RPH
Welsh Drug Information Center
Cardiff, Wales, U.K.
+++++++++++++++++++++

High cholesterol is commonly associated with porphyria patients with co-existing
hypertension.

SOURCE:
Prevalence of hyperlipidemia in persons with hypertension and/or diabetes
mellitus
Assmann G & Schulte H.
American Heart Journal
1988; 116: 1713 24.
+++++++++++++++++++


Tachycardia and hypertension are usually present, and hypertensive
encephalopathy may develop.

Besides hypertension, severe postural hypotension, resulting in syncope may
occur. Hypertension may persist to some extent between attacks.

SOURCE:
Porphyria Research Unit
Department of Medicine
Brisbane, Queensland
1999
+++++++++++++++++++++
Objective signs of autonomic neuropathy in porphyria is evidenced by abnormal
cardiovascular reflexes.

SOURCE:
Acute Porphyrias: Pathogenesis of
Neurological Manifestations
Urs. A Meyers M.D. et. al.
Seminars in Liver Disease
Vol. 18, Number 1
January 1998
+++++++++++++++++
Autonomic disorders play a major part and may provoke severe cardiovascular
symptoms.

SOURCE:
Lili Jameson FNP
Cardiology
++++++++++++++++


Clinical findings support data describing supra- ventricular tachycardia as the
most important sign in acute porphyria patients.

SOURCE:
Robert Johnson MD
++++++++++++++++

Objective signs of autonomic neuropathy in porphyria is evidenced by abnormal
cardiovascular reflexes.

SOURCE:
Acute Porphyrias: Pathogenesis of Neurological Manifestations
Urs. A Meyers M.D. et. al.
Seminars in Liver Disease
Vol. 18, Number 1
January 1998
++++++++++++++++++


Tachycardia followed by hypertension, or rarely, hypotension,
cardioaarhythmias and cardiomyopathy all can present in the acute porphyrias.

Lili Jameson FNP
Cardiology
+++++++++++++++++

Autonomic neuropathy is damage to nerves of the autonomic nervous system.

This type of neuropathy can cause extreme drops in blood pressure when
standing up for example.

SOURCE:
Mosby Medical Encyclopedia
Revised Edition
Plume Books
+++++++++++++++++++
Blood pressure
The force that the circulating blood exerts on the walls of the arteries.

This measurement is divided into systolic (pressure during contraction of the
heart) and diastolic (pressure during relaxation phase).

Blood pressure varies with age and sex of the individual. A rough rule of thumb
for normal systolic pressure is 100 + Age of individual. In children 2 x (age) + 80
= systolic BP

The diastolic pressure should be roughly 2/3 the systolic pressure.

Hypertension
Persistently high arterial blood pressure. Hypertension may have no known
cause (essential or idiopathic hypertension) or be associated with other primary
diseases (secondary hypertension).

This condition is considered a risk factor for the development of heart disease,
peripheral vascular disease, stroke and kidney disease.

Hypertension can be experience as a part of the onset of an acute attack of
porphyria.

+++++++++++++++++
Hypertension , is particularly common in Chester porphyria.

SOURCE:
Chester porphyria.
Medicine 2002
++++++++++++++++++

Hypotension
Abnormally low blood pressure, seen in shock but not necessarily indicative of it.

One form is called labile hypotension and some times occurr during an acute
attack

Chronic hypertension
Chronic hypertension is the most significant disorder.

SOURCE:
Cardiovascular disorders in acute porphyria.
KF Leonhardt MD
Wien Klin Wochenschr
October 1981
pages 580-4
++++++++++++++++++++
Labile hypertension

An autonomic neuropathy that may be seen in an acute attack of AIP is that of
labile hypertension, and sinus tachycardia.


SOURCE:
Acute Intermittent Porhyria
Anne LeMaistre, M.D.
1995
TMC
+++++++++++++++++++
Palpitate
To beat rapidly and more strongly than usual; to throb; to bound with emotion or
exertion; to pulsate violently; to flutter; said specifically of the heart when its
action is abnormal, as from excitement.

In acute hepatic porphyrias a rapid heart beat [tachycardia] is often associated
with an attack.
++++++++++++++++++


Objective signs of autonomic neuropathy in porphyria is evidenced by abnormal
cardiovascular reflexes.
SOURCE:
Acute Porphyrias: Pathogenesis of
Neurological Manifestations
Urs. A Meyers M.D. et. al.
Seminars in Liver Disease
Vol. 18, Number 1
January 1998
+++++++++++++++++++

Autonomic disorders play a major part and may provoke severe cardiovascular
symptoms.

Findings support data describing supra- ventricular tachycardia as the most
important sign.

This is followed by hypertension, or rarely, hypotension, cardioaarhythmias and
cardiomyopathy.

Chronic hypertension is the most significant disorder.

SOURCE:
Cardiovascular disorders in acute porphyria.
KF Leonhardt MD
Wien Klin Wochenschr
October 1981
pages 580-4



Do latent AIP patients experience hypertension?

Hypertension is more common in acute AIP patients than in latent AIP patients.

SOURCE:
Hypertension in patients with AIP
C. Andersson et. al.
Journal of Internal Medicine 1994
236: 169-175
++++++++++++++++++++++++
Hypertension has been observed in asymptomatic AIP patients.

SOURCE:
Robert Johnson MD
Internl Medicine
++++++++++++++++++++++++
What percentage of AIP patients have hypertensionduring acute attacks?

Hypertension is found in 56% of AIP patients.

SOURCE:
Hypertension in patients with AIP
C. Andersson et. al.
Journal of Internal Medicine 1994
236: 169-175
++++++++++++++++++

Is a racing heart/pulse a part of the onset of HCP?

Acute attacks of HCP are often with tachycardia.

SOURCE:Jean-Charles Deybach, M.D., Ph.D.
Hôpital L. Mourier and Faculté de Médecine X. Bichat
Université Paris 7, France
++++++++++++++++++

If the condition is severe, it may progress to cardiac paralysis in a few days.

It may also advance to a saltatory fashion over a period of several weeks,
resulting in a severe sensorimotor paralysis that improves only after many
months.


SOURCE:
Porphyric Polyneurathy
Principles of Neurology
Ray D. Adams et. al
6th Edition 1997
+++++++++++++++++
Can an AIP patient have both cardiocascular symptoms and kidney symptoms
in association with their AIP?

Renal damage and hypertension have both been identified in acute intermittent
porphyria pagtients.

SOURCE:
Hypertension and renal disease
in patients with acute intermittent porphyria.
Andersson C & Lithner F
Journal of Internal Medicine
1994; 236: 169 75.
+++++++++++++++++
Catecholamine levels can increase up to 10-fold during an exacerbation of AIP.

SOURCE:
Hypertension and renal disease in acute intermittent porphyria
Andersson C, Lithner F.
Journal of Internal Medicine
1994;236:169-175.
++++++++++++++++

Hypertension is more common in "manifest" AIP patients -- those who have
shown evidence of the disease -- than in individuals with latent disease or in
control groups.
SOURCE:
Prognosis of acute porphyria
Kauppinen R, Mustajoki P.
Medicine. 1992;71:1-13
++++++++++++++++
Chronic hypertension is the most significant disorder.in acute porphyria.

SOURCE:
Cardiovascular disorders in acute porphyria.
KF Leonhardt MD
Wien Klin Wochenschr
October 1981
pages 580-4
+++++++++++++++


Manifest hypertension in AIP is thought to be due to the renal vasoconstriction
seen in AIP.

SOURCE:
Prognosis of acute porphyria
Kauppinen R, Mustajoki P.
Medicine. 1992;71:1-13
++++++++++++++++++
In cases of sustained or severe rapid heart beat or significant hypertension,
physicians should monitor the patient closely.

Propanolol and other beta-blockers have been used to control these symptoms
but since they sometimes have severe side effects they only should be used
under close medical supervision.

There should be close monitoring of blood pressure and the heart rate.

SOURCE:
Disorders of Porphyrin Metabolism
A Goldberg et. al.
Plenum Medical Book Company
New York
1987
+++++++++++++++++++
What is a pulse?
A pulse is the rhythmic beating or vibrating movement of the heart. The heart
beat.

SOURCE:
Robert Johnson MD
Internakl Medicine
++++++++++++++++++
An autonomic neuropathy that may be seen in an acute attack of AIP is that of
sinus tachycardia.


SOURCE:


Acute Intermittent Porhyria
Anne LeMaistre, M.D.
1995
TMC
++++++++++++++++++++


Can porphyria patients experience sudden death due to the spiking of pulse and
blood pressure during anacute attacks?

Sudden death presumably due to cardiac arrhythmia may also occur in AIP, VP
and HCP.

SOURCE:
Disorders of Red Cells
The Porphyrias
Wintrobe's Clinical Hematology
Ninth Edition Volume 1 1993
++++++++++++++++++++++

What is the best- safe drugto use in porphyria to treathigh blood pressure and
fast pulse?


"Propanolol should be used in hepatic porphyria acute attacks toeffect
beta-blockade to control tachycardia and hypertension that occurs."

SOURCE:
Medicine Journal
August 6 2001
Volume 2, Number 8
Maureen Poh-Fitzpatrick, MD
Department of Internal Medicine
Division of Dermatology
University of Tennessee
College of Medicine
+++++++++++++++++

After several days an attack may resolve quite rapidly with abdominal pain
disappearing within a few hours and paresis within a few days.

SOURCE:
Disorders of Red Cells
The Porphyrias
Wintrobe's Clinical Hematology
Ninth Edition Volume 1 1993
+++++++++++++++++++



Are cardiac problems associated with AIP acute attacts?

15% of AIP patients die as a result of myocardial infarctioncommonly associated
with AIP.

SOURCE:
Hypertension in patients with AIP
C. Andersson et. al.
Journal of Internal Medicine 1994
236: 169-175
++++++++++++++++++


A rapid heart rate and bounding pulse can occur together, but can also occur
separately.

A rapid pulse can be a symptom of arrhythmias.

A bounding pulse is often a sign that there is excessive fluid in the circulation
(called fluid overload).

SOURCE:

Elena Sgarbossa, MD
Department of Cardiology
Rush-Presbyterian St. Luke's Medical Center
Chicago, IL.
+++++++++++++++++++

Is hypertension part of an acute crisis in porphyria?

Clinically manifest acute poprhyriais characterized by episodic bouts of
hypertension.

SOURCE:
Acute Intermittent Porphyria
Herbert Bonkovsky M.D. et. al.
The AMerican Journal of Gastronterology
Vol. 86 No. 8
August 1991
+++++++++++++++++

Can a person experience cardiac symptoms with an acute attack of HCP?

Hypertension, and tachycardia may occur with manifestation of HCP.

SOURCE:
Journal of Photodermatololy, Photoimmunology
and Photomedicine
1998 Apr;
14(2):48-54
"Management of the acute porphyrias."
Kauppinen R, M.D.
Department of Medicine,
University Hospital
++++++++++++++++++


Is high cholesterol normally associated with acute porphyrias?


Hpercholesterolemia is a fairly frequent finding in patients with acute porphyria.

SOURCE:
The Porphyrias
Kappas, A. et. al.
The Metabolic Basis of Inherited Disease
7th Edition 1995
++++++++++++++++++++++++++++


Heart rate
The heart rate is number of beats per minute.

Normal resting heart rates are variable with age, sex, size and overall
cardiovascular condition.

Heart rate can be determined by taking the pulse.

Normal heart rate for an average sized adult is in the range of 60-85
beats/minute.

Pulse
The pulse is the number of beats per minute.

Normal resting heart rates are variable with age, sex, size and overall
cardiovascular condition. Heart rate can be determined by taking the pulse.

Normal heart rate for an average sized adult is in the range of 60-85
beats/minute.

SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++++++

The pulse should be measured correctly.

Heart beats will vary according to the excertion one has is exp[eriencing.

SOURCE:
Molly Williamson RM
+++++++++++++


The pulse is measured at the wrist, neck, temple, groin, behind the knees, or
on top of the foot.

In these areas, the artery passes close to the skin.

To measure the pulse at the wrist, place the index and middle finger over the
underside of the opposite wrist, below the base of the thumb.

Press firmly with flat fingers until you feel the pulse.

To measure the pulse on the neck, place the index
and middle finger just to the side of the Adam's apple,
in the soft hollow area.

Press firmly until the pulse is located.

Once you find the pulse, count the beats for 1 full minute, or for 30 seconds and
multiply by 2.

This will give the beats per minute.

If the resting heart rate is to be determined, you must have been resting for at
least 10 minutes.

The exercise heart rate is obtained while you are exercising.

SOURCE:
Medline
U.S. National Library of Medicine,
8600 Rockville Pike,
Bethesda, MD 20894
+++++++++++++

Systolic
Systolic readings are indicating the maximum arterial pressure during
contraction of the left ventricle of the heart.

Systolic blood pressure

Systolic blood pressure is the pressure exerted on the walls of the arteries
during the contraction phase of the heart.

Considered abnormally elevated if consistently over 150 mmHg. Systolic blood
pressure varies with age, sex, size and relative condition.
+++++++++++


Tachycardia

Tachycardia is the excessive rapidity in the action of the heart, the term is
usually applied to a heart rate above 100 per minute and may be qualified as
atrial, junctional (nodal) or ventricular and as paroxysmal.
+++++++++++++++
Autonomic nervous system

The autonomic nervous system is the part of the nervous system that regulates
vital functions of the body that are not consciously controlled (involuntary).


It includes the activity of the heart, the smooth muscles (as digestive muscles),
and the glands.

It has two divisions: the sympathetic nervous system speeds up the heart
rate,narrows blood vessels, and raises blood pressure.

The parasympathetic nervous system slows heart rate, increases intestinal and
gland activity, and relaxes ringlike muscles thaT close passages (splincters)".


SOURCE:
Mosby Medical Encyclopedia
Revised Edition
Plume Books
++++++++++++++ +++


Acute hepatic porphyrias delta-aminolaevulinic acid dehydratase deficiency
porphyria (ALA-D), acute intermittent porphyria (AIP) , hereditary
coproporphyria (HCP) and variegate porphyria (VP) are characterized by
cardiovascular manifestations.


SOURCE:
Erythropoietic and hepatic porphyrias.
Gross U, Hoffmann GF, Doss MO.
Division of Clinical Biochemistry,
Faculty of Medicine
Philipps University, Marburg, Germany.
Journal of Inherited Metabolic Disease
2000 Nov;23(7):641-61
+++++++++++++

BLOOD PRESSURE

Hypertension can be experienced by 43% of patients during acute
attacks of Acute Intermittent Porphyria (AIP).

SOURCE:

Columbia Health Care
1998
++++++++++

Postural hypotension is experienced by 24% of acute porphyria patients during
acute attacks.

SOURCE:
United Health Services
Medical Education Department
1999
++++++++++

Hypotension can be a feature ofAcute Intermittent Porphyria (AIP).

SOURCE:
Columbia Health Care
1998
++++++++++++

Hypertension (high blood presure) is found in over half of acute porphyria
patients.

SOURCE:
Medicine Journal
February 22 2002
Volume 3, Number 2
++++++++++++

For AIP patients, beta-blockers, loop diuretics, and calcium-channel blockers are
safe and effective agents for the management of hypertension

SOURCE:
Treatment of Hypertension in a Patient With Acute Intermittent Porphyria?
Bruce Gardner, MD
Associate Clinical Professor of Family Medicine
University of Washington, Seattle
Attending Physician, Family Medicine
Swedish Hospital and Medical Center, Seattle

Labile hypotension is epxerienced by 44% of acute porphyria patients.

The patients have a diastolic reading of less than 90.

SOURCE:
United Health Services
Medical Education Department
1999
++++++++++

Loop diuretics are indicated in renal artery hypertension, and are safe
for use in patients with AIP.

SOURCE:
Treatment of Hypertension in a Patient With Acute Intermittent Porphyria?
Bruce Gardner, MD
Associate Clinical Professor of Family Medicine
University of Washington, Seattle
Attending Physician, Family Medicine
Swedish Hospital and Medical Center, Seattle
+++++++++++

Hypertension is observed in half of acute porphyria patients and may persist
between attacks.

SOURCE:
"Acute intermittent porphyria"
Thomas G DeLoughery, MD
Associate Director
Department of TransfusionMedicine
Division of Clinical Pathology
Associate Professor
Department of Medicine
Division of Hematology and Medical Oncology
Oregon Health Sciences University
Portland, Oregon
++++++++++++


Hypertension is often found present during acute attacks of porphyria in HCP
patients.

SOURCE:
Porphyria Resources
United Medical Services
1996
++++++++++

Unfortunately, angiotensin-converting enzyme inhibitors have been associated
with attacks of AIP and should not be used.

SOURCE:
Treatment of Hypertension in a Patient With Acute Intermittent Porphyria?
Bruce Gardner, MD
Associate Clinical Professor of Family Medicine
University of Washington, Seattle
Attending Physician, Family Medicine
Swedish Hospital and Medical Center, Seattle.
++++++++++

Hypertension is more common in "manifest" AIP patients -- those who have
shown evidence of the disease -- than in individuals with latent disease or in
control groups.

This is thought to be due to the renal vasoconstriction seen in AIP.

SOURCE:
Treatment of Hypertension in a
Patient With Acute Intermittent Porphyria?
Bruce Gardner, MD
Associate Clinical Professor of Family Medicine
University of Washington, Seattle
Attending Physician, Family Medicine
Swedish Hospital and Medical Center, Seattle.
++++++++++++++

Clinically manifest acute poprhyria is characterized by episodic bouts
of hypertension.

SOURCE:
Acute Intermittent Porphyria
Herbert Bonkovsky M.D. et. al.
The AMerican Journal of Gastronterology
Vol. 86 No. 8
August 1991
++++++++++



Hypertension is usually present, and hypertensive encephalopathy may develop
in the acute porphyrias.

SOURCE:
Porphyria Research Unit
Department of Medicine
Brisbane, Queensland
1999
++++++++++++++

Tachycardia and hypertension are usually present, in acute porphyria.

Hypertension may persist to some extentbetween attacks.

SOURCE:
Porphyria Research Unit
Department of Medicine
Brisbane, Queensland
1999
+++++++++++++

Besides hypertension, severe postural hypotension, resulting in syncope may
occur in the acute porphyrias.

SOURCE:
Porphyria Research Unit
Department of Medicine
Brisbane, Queensland
1999
++++++++++++++

Often hypertension may persist during periods of remission of acute porphyria.

SOURCE:
Robert JOhnson MD
Internal Medicine
+++++++++++

Hypertension may persist to some extent between attacks.

SOURCE:
Porphyria Research Unit
Department of Medicine
Brisbane, Queensland
1999
++++++++++++++


What medications are most suitable for treating hypertension in a patient with
acute intermittent porphyria?

Hypertension is more common in "manifest" AIP patients -- those who have
shown evidence of the disease -- than in individuals with latent disease or in
control groups.

This is thought to be due to the renal vasoconstriction seen in AIP. Data from a
study by Kauppinen and Mustajoki showed that patients taking
hydrochlorothiazide, beta-blockers, calcium-channel blockers, and nitrates
remained free of AIP symptoms.

SOURCE:
from Bruce Gardner, MD,
Primary Care
08/26/2002
+++++++++

TACHYCARADIA & ARRYTHMIA

Tachycardia is having a fast heart beat or fast pulse.


Tachycardia is experienced by 50% of all acute porphyria patients.

SOURCE:
United Health Services
Medical Education Department
1999
++++++++++

Tachycardia is the medical term for a rapid heart rate.

SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++++

Acute hepatic porphyrias delta-aminolaevulinic acid dehydratase deficiency
porphyria (ALA-D), acute intermittent porphyria (AIP) , hereditary
coproporphyria (HCP) and variegate porphyria (VP) are characterized by
variable extrahepatic gastrointestinal, neurological-psychiatric and
cardiovascular manifestations including hypertension and tachycardia.


SOURCE:
Erythropoietic and hepatic porphyrias.
Gross U, Hoffmann GF, Doss MO.
Division of Clinical Biochemistry,
Faculty of Medicine
Philipps University, Marburg, Germany.
Journal of Inherited Metabolic Disease
2000 Nov;23(7):641-61
+++++++++++




Tachycardia is having a bounding pulse which has a strong and forceful pulse.

Tachycardia is a heart rate that is faster than normal.

It can occur alone, or it can accompany a bounding pulse.

SOURCE:
Elena Sgarbossa, MD
Department of Cardiology
Rush-Presbyterian
St. Luke's Medical Center
Chicago. ILL.
+++++++++++

Tachycardia is often present during the onset of an acute episode of acute
porphyria.

SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++


A bounding pulse can often be seen over arteries that are close to the skin.

A rapid heart rate and bounding pulse can occur together, but can also occur
separately.

A rapid pulse can be a symptom of arrhythmias.
SOURCE:
Elena Sgarbossa, MD
Department of Cardiology
Rush-Presbyterian
St. Luke's Medical Center
Chicago. ILL.
+++++++++++


Cardiac arrythmias are seen in the acute porphyrias.

SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++++


A bounding pulse is often a sign that there is excessive fluid in the circulation
(called fluid overload).

SOURCE:
Elena Sgarbossa, MD
Department of Cardiology
Rush-Presbyterian
St. Luke's Medical Center
Chicago. ILL.
+++++++++++

Clinically manifest acute poprhyria is characterized by episodic bouts
of tachycardia.

SOURCE:
.Acute Intermittent Porphyria
Herbert Bonkovsky M.D. et. al.
The American Journal of Gastronterology
Vol. 86 No. 8
August 1991
+++++++++


A bounding pulse is often associated with high blood pressure or fluid overload.

Fluid overload can occur with renal failure, and other conditions
which can occur in the acute porphyrias.

SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++++

The onset of convulsions may be a sign of hypertensive encephalopathy, and
the blood pressure should be checked.

The pulse should be taken.

SOURCE:
Dr. Michael R. Moore
Porphyria Research Unit
University of Queensland
Department of Medicine
Brisbane, Australia 1999
++++++++++


Propranolol has long been prescribed for the symptoms of tachycardia in acute
porphyria patients.

SOURCE:
Robert Johnson MD
Internal Medicine
++++++++++++

Tachycardia is experienced by 57% of
Acute Intermittent Porphyria (AIP)
patients.

SOURCE:
Columbia Health Care
1998
++++++++++


Cardiac arrhythmia refers to an abnormality in the rhythm or rate of the
heart.The normal heart rate should be regular and between 60-85 beats per
minute in a state of rest.

The perception by the patient of an irregular heart beat, or an accelerated rate
are commonly referred to as palpitations.

There are many conditions and disorders which can cause cardiac arrhythmias,
either as a primary manifestation of a disease process, or as a secondary effect.

Serious heart arrhythmias are often associated with cardiac symptoms. In cases
of shortness of breath, chest pain, sweating, nausea, faintness, or fainting
associated with palpitations immediate emergency evaluation is required.

SOURCE:
Methodist Healthcare
2002
++++++++++

The pulse and blood pressure should be closely monitored, as they tend to be
labile and hypertensive encephalopathy may develop.

SOURCE:
Dr. Michael R. Moore
Porphyria Research Unit
University of Queensland
Department of Medicine
Brisbane, Australia 1999
++++++++++

A bounding pulse is a strong and forceful pulse.

Tachycardia is a heart rate that is faster than normal.
SOURCE:
Elena Sgarbossa, MD,
Department of Cardiology,
Rush-Presbyterian
St. Luke's Medical Center,
Chicago, IL.
++++++++++

Any deviation from normal heart rate can indicate a medical condition.

Fast pulse may signal the presence of an infection or dehydration. In emergency
situations, the pulse rate can help determine if the patient's heart is pumping.

SOURCE:
Poune Saberi, M.D., M.P.H.
Department of Family Practice
Community Medicine
University of Pennsylvania Medical Center
Philadelphia, PA.
++++++++++
A normal pulse range for adults is 60 to 100 beats per minute.

SOURCE:
Poune Saberi, M.D., M.P.H.
Department of Family Practice
Community Medicine
University of Pennsylvania Medical Center
Philadelphia, PA.
++++++++++


A bounding pulse can often be seen over arteries that are close to the skin.

A rapid heart rate and bounding pulse can occur together, but can also occur
separately.

A rapid pulse can be a symptom of arrhythmias.

SOURCE:
Elena Sgarbossa, MD,
Department of Cardiology,
Rush-Presbyterian
St. Luke's Medical Center,
Chicago, IL.
++++++++++

Arrhythmias include tachycardias (the heartbeat is too fast), bradycardias (the
heartbeat is too slow), and "true" arrhythmias (a disturbed rhythm).
Arrhythmias can be life-threatening.

SOURCE:
Jacqueline A. Hart, M.D.
Department of Internal Medicine
Newton-Wellesley Hospital
Harvard University.
++++++++++

Arrhythmias are caused by a disruption of the normal electrical conduction
system of the heart.

Normally, the four chambers of the heart (two atria and two ventricles) contract
in a very specific, coordinated manner.

Problems can occur anywhere along the conduction system, causing various
arrhythmias.

SOURCE:
Jacqueline A. Hart, M.D.
Department of Internal Medicine
Newton-Wellesley Hospital
Harvard University.
++++++++++


The pulse is measured at the wrist, neck, temple, groin, behind the knees, or on
top of the foot. In these areas, the artery passes close to the skin.

To measure the pulse at the wrist, place the index and middle finger over the
underside of the opposite wrist, below the base of the thumb.

Press firmly with flat fingers until you feel the pulse.

To measure the pulse on the neck, place the index and middle finger just to the
side of the Adam's apple, in the soft hollow area.

Press firmly until the pulse is located. Once you find the pulse, count the beats
for 1 full minute, or for 30 seconds and multiply by 2.

This will give the beats per minute.

SOURCE:
Poune Saberi, M.D., M.P.H.
Department of Family Practice
Community Medicine
University of Pennsylvania Medical Center
Philadelphia, PA.
++++++++++

If there is any sudden, severe, or persistent increase in the pulse intensity or
rate (particularly when accompanied by other symptoms, or when not relieved by
resting for a few minutes), you should call your health care provider.

SOURCE:
Elena Sgarbossa, MD,
Department of Cardiology,
Rush-Presbyterian
St. Luke's Medical Center,
Chicago, IL.
++++++++++

An arrhythmia is any disorder of heart rate or rhythm.
SOURCE:
Jacqueline A. Hart, M.D.
Department of Internal Medicine
Newton-Wellesley Hospital
Harvard University.
++++++++++






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