Acta cardiologica
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Physicians have an ethical duty to keep up-to-date with current knowledge. Professional medical associations such as the European Society of Cardiology (ESC) support these obligations. In Europe, the costs of continuing medical education (CME) are insufficiently supported from governments and employers; however, medical associations have been criticized for accepting alternative financial support from industry. ⋯ Universities now frequently exhort their academic staff to protect their intellectual property or commercialize their research. Thus, it is not commercial activity or links per se that have become the target for criticism but the perceived influence of commercial enterprises on clinical decision-making or on messages conveyed by professional medical organizations. This document offers the perspective of the ESC on the current debate, and it recommends how to minimize bias in scientific communications and CME and how to ensure proper ethical standards and transparency in relations between the medical profession and industry.
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Case Reports
The link between intracranial haemorrhage and cardiogenic shock: a case of Takotsubo cardiomyopathy.
Myocardial dysfunction occurs frequently during subarachnoid haemorrhage (SAH) and it is often referred to as neurogenic stunned myocardium (NSM). Takotsubo cardiomyopathy (TTC), which can lead to life-threatening acute heart failure, has been considered a possible complication of SAH. Actually, NSM and TTC are believed to share the same pathophysiological mechanisms and are likely a manifestation of the same disease. ⋯ Rapid recovery of left ventricular function was observed after 8 days. Acute myocardial dysfunction due to TTC in the setting of SAH may lead to cardiogenic shock which is difficult to treat. Patients with SAH and haemodynamic instability warrant a careful assessment of ventricular function on admission to rule out TTC
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Aggressive mechanical ventilation can markedly and unpredictably affect cardiac function. The fall in cardiac output (CO) is due to a reduction in left ventricular stroke volume (SV). The aim of the present pilot study was to assess the effects of different positive end-expiratory pressure (PEEP) levels on circulatory function and to compare them with continuous wave (CW)-Doppler ultrasound cardiac output monitoring (USCOM) and a thermodilution-based haemodynamic monitoring system (PiCCO). ⋯ A significant influence of mechanical ventilation with PEEP on haemodynamic parameters was evident both with USCOM and PiCCO. While thermodilution methods like PiCCO are well established but time-consuming and invasive, CW-Doppler based USCOM constitutes an important tool for easy, rapid and reliable diagnosis and haemodynamic monitoring of critically ill patients.
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Cardiogenic shock is characterized by inadequate tissue perfusion due to cardiac dysfunction and is the leading cause of death in patients hospitalized with acute myocardial infarction. Mortality from cardiogenic shock still remains high. The development of cardiogenic shock is rarely unexpected; most patients who develop cardiogenic shock do so within 48 hrs of admission, with only 10% shocked on arrival. ⋯ Primary percutaneous coronary intervention is the most efficient therapy to restore coronary flow in the infarct-related artery. However, invasive strategy in a developing country like ours is not only costly but also technically demanding. We present a case of acute myocardial infarction complicated with cardiogenic shock that underwent primary percutaneous coronary intervention and also review the incidence, pathophysiology, management and outcome of cardiogenic shock complicating acute myocardial infarction.
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Ambulatory blood pressure monitoring not only provides information on the blood pressure level, but on the diurnal changes in blood pressure as well. The present review summarizes the main findings of the International Database on Ambulatory blood pressure in relation to Cardiovascular Outcome (IDACO) with regard to risk stratification based on short-term blood pressure variability. ⋯ Blood pressure variability represented by the average of the daytime and nighttime SD weighted for the duration of the daytime and nighttime interval (SDdn) and by average real variability (ARV24) predicted outcome, but only improved the prediction of the composite cardiovascular events by 0.1%. Overall, results of analyses using the IDACO support the concept that short-term blood pressure variability adds to risk stratification, but 24-hour ambulatory blood pressure level is the most valuable predictor for use in clinical practice.