Rhode Island medical journal (2013)
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Level I trauma centers are required to provide screening and brief interventions for alcohol abuse. The World Health Organization (WHO) Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is a validated screening measure for all substances of abuse. This study is the first to use the ASSIST to screen a trauma population. ⋯ The ability of the ASSIST to identify misuse of multiple substances makes it a good candidate for the screening measure used by trauma centers.
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Takotsubo cardiomyopathy is a reversible cardiomyopathy which has increasingly been recognized in the differential diagnosis of patients presenting with acute coronary syndrome. It is characterized by transient systolic ventricular dysfunction with regional wall motion abnormalities beyond a single vascular territory and in the absence of significant epicardial coronary artery obstruction. Often, there is an acute emotional or physical stressor immediately preceding the presentation. ⋯ Catecholamine excess and cardiotoxicity is the most compelling putative mechanism. The long-term prognosis is excellent but serious complications including cardiogenic shock and arrhythmias may occur acutely. Supportive treatment is the mainstay of therapy.
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Despite the fact that up to half of all heart failure occurs in patients without evidence of systolic cardiac dysfunction, there are no universally accepted diagnostic markers and no approved therapies for heart failure with preserved ejection fraction (HFpEF). HFpEF, otherwise known as diastolic heart failure, has nearly the same grim prognosis as systolic heart failure, and diastolic heart failure is increasing in incidence and prevalence. ⋯ Even criteria for diagnosis of HFpEF are still debated, and there is still no gold standard marker to detect diastolic dysfunction. Here, we will review some promising new insights into the pathogenesis of diastolic dysfunction that may lead to new diagnostic and therapeutic tools.