Zeitschrift für Kardiologie
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Three-dimensional (3D) echocardiographic imaging has been introduced as a tool to improve the assessment of both morphologic and functional parameters of the cardiovascular system. In the past, data acquisition was limited due to time-consuming sequential acquisition of multiple triggered 2D image planes from 10-60 heart cycles using transesophageal rotational, transthoracic rotational or transthoracic freehand approaches. Recent improvements in the size of matrix array probes and in computing power of modern ultrasound equipment have significantly increased both spatial and temporal resolution of "second-generation" real-time 3D scanners. ⋯ Qualitative and quantitative analyses of regional wall motion at rest and during stress become possible. Combination with 3D color Doppler data allows additional assessment of valvular function as well as determination of flow in the left ventricular outflow tract and across septal defects. The integration and future quantification of these new parameters together with on-line review allows new insights into cardiac function, morphology and synchrony that offer great potentials in the evaluation of right and left ventricular global and regional function, diagnosis of small areas of ischemia, congenital and valvular heart disease and effects of biventricular pacing in dilated heart asynchrony.
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Setting clear priorities for the sequence and importance of actions during cardiopulmonary resuscitation (CPR) is of utmost importance for future guidelines. Unless performed under the rare condition of hypoxic arrest, combined compression and ventilation is usually not necessary in one-rescuer resuscitation of adults. After notifying the emergency medical services (EMS), precordial compression at a rate of 100/min is just as effective or may even be preferable in the majority of cases caused by arrhythmic arrest. ⋯ However, training for basic cardiopulmonary resuscitation of adults with cardiac arrest should also stress the importance of chest compression over ventilation. Moreover, current studies controversially discuss the optimal time point of defibrillation after collapse. These findings point to the enormous demand for research in the field of cardiopulmonary resuscitation.
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The primary and not yet accomplished goal remains to treat all patients with coronary heart disease to the LDL cholesterol target < 100 mg/dl. To date there is no conclusive evidence for a recommendation of a LDL cholesterol goal lower than 100 mg/dl for all patients. Patients with high vascular risk benefit from statin therapy irrespective of cholesterol levels, underlining the importance of the assessment of global vascular risk as the basis of modern lipid therapy.