Medical uses
Metformin is used to lower the blood sugar in those with type 2 diabetes. It is also used as a second-line agent for infertility in those with polycystic ovary syndrome. Type 2 diabetes
The American Diabetes Association and the American College of Physicians both recommend metformin as a first-line agent to treat type 2 diabetes. It is as effective as repaglinide and more effective than all other oral diabetes mellitus type 2 drugs. Efficacy
Treatment guidelines for major professional associations, including the European Association for the Study of Diabetes, the European Society for Cardiology, and the American Diabetes Association, describe evidence for the cardiovascular benefits of metformin as equivocal. A 2020 Cochrane systematic review did not find enough evidence of reduction of cardiovascular mortality, non-fatal myocardial infarction or non-fatal stroke when comparing metformin monotherapy to other glucose-lowering drugs, behaviour change interventions, placebo or no intervention.The use of metformin reduces body weight in people with type 2 diabetes mellitus in contrast to sulfonylureas, which are associated with weight gain. Some evidence shows that metformin is associated with weight loss in obesity in the absence of diabetes. Metformin has a lower risk of hypoglycemia than the sulfonylureas, although hypoglycemia has uncommonly occurred during intense exercise, calorie deficit, or when used with other agents to lower blood glucose. Metformin modestly reduces low density lipoprotein and triglyceride levels. Polycystic ovarian syndrome
In those with polycystic ovarian syndrome (PCOS), tentative evidence shows that metformin use increases the rate of live births.
In a normal person, this redistribution of blood has little effect on respiratory function as the left ventricle has the adequate capacity to suddenly increase its stroke volume (as a result of the Frank-Starling mechanism). In a person with heart failure, the left ventricle has an inadequate capacity to respond to increased arrival of blood from the pulmonary circulation. This leads to the pooling up of blood in the pulmonary circulation and doesnt change its volume enough. The increased intra-parenchymal pulmonary intravascular pressure can also result in hydrostatic pressure related fluid transudation into the alveoli, thus causing cardiogenic pulmonary edema and further worsening shortness of breath. Thus, shortness of breath is commonly experienced after a reasonably short time lying near to flat for a person with left ventricular failure. This is different from the dyspnea experienced by someone with lung parenchymal pathology (both restrictive and obstructive) when lying down, which is sudden and instead related to an acute change in diaphragmatic/accessory respiratory muscle mechanical advantage lost when moving the body into a more horizontal position. Diagnosis
Diagnosis is based mostly on the clinical features and symptoms, as well as finding causes like heart failure. Treatment
Based on the cause, Orthopnea can be treated with respiratory support devices such as CPAP or biPAP while the disease causing it is addressed. Etymology
The word orthopnea uses combining forms of ortho- + -pnea, from Greek ortho, straight, regular, + pnoia, breath. See pronunciation information at dyspnea. See also
Paroxysmal nocturnal dyspnoea
Platypnea
Trepopnea
Bendopnea
Shortness of breath

References


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