Revista clínica española
-
Revista clínica española · Jul 2020
Variation in intraabdominal pressure in patients with acute heart failure according to left ventricular ejection fraction. Results of an intraabdominal pressure study.
The increase in intraabdominal pressure (IAP) has been correlated with increased creatinine levels in patients with heart failure with severely reduced left ventricular ejection fraction (HFrEF). However, IAP has not been examined in more stable patients or those with heart failure with preserved ejection fraction (HFpEF). ⋯ During the decompensation episodes, the patients with HFrEF had a greater increase in IAP and a higher degree of systemic congestion.
-
Revista clínica española · Jul 2020
Which are the most prevalent ethical conflicts for Spanish internists?
Clinicians face a multitude of ethical conflicts in their daily practice. There have been no studies on the types of ethical conflicts encountered most frequently and that are of most concern to clinicians in Spain. The aim of this study is to report the most common ethical conflicts faced by Spanish internists, as well as the importance that the practitioners attribute to each conflict. ⋯ The most common and relevant ethical conflicts among Spanish internists are related to managing patients' end of life, followed by those related to the doctor-patient relationship and the management of noncompetent patients. It is essential that training programs be designed to better address and recognise these problems.
-
Revista clínica española · Jul 2020
ReviewClinical and radiological diagnosis of pulmonary thromboembolism.
Pulmonary thromboembolism has poorly specific clinical symptomatology, which increases the diagnostic suspicion, multiplying the number of patients who will need to undergo imaging tests to confirm the diagnosis. In recent years, pulmonary angiography using multidetector scanners (CT angiography) has been the most widely used imaging test due to its availability and accuracy, which exceeds that of lung ventilation-perfusion (V/Q) scintigraphy. ⋯ We therefore need to base our approach on previously validated strategies that, taking into account the clinical probability and using highly sensitive diagnostic tests such as D-dimer, will enable us to exclude many patients from undergoing this imaging test. In this article, we review the diagnostic techniques and strategies that are applied for diagnosing pulmonary thromboembolism in hemodynamically stable and unstable outpatients, hospitalised patients, patients with a history of venous thromboembolism and pregnant women.