Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

Acute Heart Failure Acute Lymphoblastic Leukemia 29

■Ultrafiltration: may require only peripheral IV lines; may preserve

renal function, avoid hypokalemia and reduce rehospitalization

➣Indication: usually used for large volume removal

➣Side Effects and Complications: Hypotension, filter and access

complications, risks associated with anticoagulation

➣Absolute Contraindications: Uncontrolled symptomatic hypo-

tension

■Intra-aortic balloon counterpulsation pump: usually inserted via fe-

moral artery; requires invasive blood pressure and ECG monitoring.

➣Indication: Augments diastolic coronary flow and forward out-

put, afterload reduction

➣Side Effects and Complications: arrhythmias, headache, nausea/

vomiting, peripheral vascular insufficiency, emboli, infarction

and gangrene, aortic dissection, rupture, pericardial tamponade

➣Absolute Contraindications: aortic insufficiency, aortic aneu-

rysm or dissection

➣Relative Contraindications: severe peripheral vascular disease

follow-up

During Treatment

■Often requires intensive care or telemetry unit monitoring early in

course of treatment

■Monitor electrolytes, especially potassium, and renal function

Routine

■Follow-up after treatment of acute episode: diagnose and treat

underlying abnormalities (ischemia, hypertension)

■Emphasize lifestyle changes such as reduced sodium intake, com-

pliance with medications

complications and prognosis

■Complications usually related to underlying pathophysiology

■3–5% in-hospital mortality

■10–25% 6-month mortality

Acute Lymphoblastic Leukemia...........................

MICHAEL R. GREVER, MD

history & physical

Etiology

■Children with Down syndrome (trisomy 21) or other inherited dis-

orders (e.g., ataxia-telangiectasia) have an increased risk; evidence