MMW Fortschritte der Medizin
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After learning that they have cancer, increasing numbers of patients seek a second opinion from another specialist. The heavy burden of the diagnosis, together with the flood of information they receive can confuse the patients. ⋯ Openness with regard to the second opinion strengthens the doctor-patient relationship rather than weakening it. For the primary physician it is important to know that the patient's motivation for obtaining a second opinion is, as a rule, a need for reorientation and an ability to cope with a feeling of helplessness, but not dissatisfaction with the primary physician.
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Chronic heart failure has a multitude of cardiological causes the most common being coronary artery disease, dilatory cardiomyopathy or arterial hypertension. Clinical examination, ECG and radiography can support the suspected diagnosis of heart failure. ⋯ Depending upon the etiology, further investigations are necessary, in particular in the case of coronary artery disease. In doubtful cases, low levels of natriuretic peptide can exclude heart failure.