Zeitschrift für Kardiologie
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Randomized Controlled Trial Comparative Study Clinical Trial
[The use of digitalis glycosides in atrial fibrillation].
The role of cardiac glycosides for conversion of atrial fibrillation to simus rhythm is controversially discussed. In a prospective study, 45 patients with paroxysmal atrial fibrillation were randomly assigned to one of three treatment groups (of 15 patients each). ⋯ The use of digoxin remains a mainstay of treatment for rate control in atrial fibrillation. To convert atrial fibrillation to sinus rhythm, however, the addition of a type I or III antiarrhythmic agent is necessary.
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Over the past five years, the results of six prospective randomized trials have set new standards in the primary and secondary prevention of thromboembolism in "nonvalvular" ("nonrheumatic") atrial fibrillation. On the one hand, they have confirmed the increased risk of stroke in these patients amounting to about 5% per year and an annual recurrence rate after a recent transient ischaemic attack or minor stroke of 12%. ⋯ Both clinical and echocardiographic features allow the identification of subgroups at low or high risk of thromboembolic complications and provide the basis for the individual benefit-to-risk assessment of anticoagulant therapy. Aspirin is currently recommended as a second choice therapy for patients who are poor candidates for oral anticoagulants or who are considered to be at low risk for thromboembolism.
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Surgical resection for lung cancer provides the only real chance for cure. However, there is a high risk of postoperative complications including death for patients with pulmonary dysfunction. Therefore preoperative identification of patients at risk is necessary. ⋯ The positive predictive values of RLF and PVR are disappointing, while the negative predictive values are acceptable. Measurement of VO2 is simple, noninvasive and might predict survivable morbidity, as suggested in the literature. Obviously, additional studies are necessary.
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Cardiogenic shock is a syndrome of different etiologies resulting in the inability of the heart to provide adequate O2 delivery to peripheral organs and tissues with or without signs of severe pulmonary congestion or pulmonary edema. Clarification of the underlying etiologies is essential for prognosis and therapy. Depending on the various etiologies, the therapeutic procedure may be totally different. ⋯ Catecholamines still represent the initial first line treatment. A Swan-Ganz catheter is mandatory in such situations. In view of the rapid beta 1-receptor down-regulation induced by endogenous catecholamines, long-term administration of exogenous catecholamines (adrenalin, dopamine, dobutamine), seems essentially problematic, since these compounds intensify and accelerate this process.(ABSTRACT TRUNCATED AT 250 WORDS)
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The indications for the use of mechanical cardiac assist-devices are sudden death, cardiogenic shock, severe coronary ischemia and high-risk PTCA. Among the cardiac assist-devices, currently available for cardiologists and cardiac surgeons, are the Intraaortal Balloon Pump (IABP), the implantable turbine-pump, the percutaneous cardiopulmonary support (PCPS), centrifugal pumps which are connected via a thoracotomy and intra- and extrathoracic total artificial hearts. It is easy to position the IABP, which can be continuously used over the course of several days. ⋯ In therapy-resistant circulatory arrest, approximately 30% of patients could be saved with this system, provided that there is a very quick access to it, as there is for example in the cardiac cath lab. Centrifugal pumps, which are inserted via a thoracotomy, and artificial hearts have become very important and are now used routinely in cardiac surgery to support patients, who have developed therapy-refractory heart failure, and in transplantation-surgery as "bridging to transplant". These systems, however, bear the complications of hemorrhage and thromboembolism.(ABSTRACT TRUNCATED AT 400 WORDS)