Deutsche medizinische Wochenschrift
-
Dtsch. Med. Wochenschr. · Jun 2021
[Cardiac diagnostics after ischemic stroke or transitory ischemic attack].
Stroke is the most common cause of permanent disability and one of the most common causes of death. Cardio-embolic strokes are associated with a poor prognosis and a high risk of recurrence compared to other stroke etiologies. ⋯ A structured evaluation after ischemic stroke includes taking the medical history, a physical examination, 12-lead ECG recording, rhythm monitoring for 72 h, transthoracic echocardiography and transesophageal echocardiography, if an atrial embolic source of stroke is suspected. Extended cardiac work-up (e. g., MRI/CT, prolonged rhythm monitoring) should be performed in selected patients based on diagnostic findings.
-
Dtsch. Med. Wochenschr. · Jun 2021
[Alpha-1 antitrypsin deficiency: cause and cofactor for liver disease].
Alpha-1-antitrypsin deficiency (AATD) is a genetic disorder arising due to mutation in alpha1-antitrypsin (AAT). AAT mutations interfere with the AAT production/secretion, cause decreased AAT serum levels and accumulation of AAT in the liver. The excess AAT leads to a proteotoxic liver disease, while the lack of AAT in systemic circulation predisposes to lung injury. ⋯ In individuals with non-alcoholic fatty liver disease or alcohol misuse it promotes the development of liver cirrhosis. While no drug treatment exists for AATD-related liver disease, there are several compounds in clinical phase II/III-trials. These either silence the AAT production via siRNA or facilitate the secretion of AAT from the liver due to an improved folding.
-
Dtsch. Med. Wochenschr. · Jun 2021
[Diagnosis and treatment of HIV-associated lymphoma: Update 202].
The risk of malignant lymphomas is markedly increased in HIV-infected persons even in the era of effective combination antiretroviral therapy. Major risk factors are the depth of CD4-cell nadir and HIV viremia. R-CHOP remains treatment of choice for diffuse large B-cell lymphoma. ⋯ Favourable results have been reported with a stage adapted treatment for HIV-Hodgkin lymphoma. Patients with relapsed/refractory HIV-lymphoma should undergo autologous stem cell transplantation if indicated. Successful anti-CD19 CAR T-cell therapy was also reported in HIV-infected patients with refractory B-cell lymphoma.
-
Psychocardiological research has contributed a better understanding of mental health, psychosocial factors and quality of life of in patients with cardiovascular diseases. In this update of psychocardiology in 2021, stressful experiences in childhood and adolescence are found to increase the risk of type II diabetes mellitus, coronary heart disease and stroke along the life course. ⋯ Summarizing the update of psychocardiological interventions, the effectiveness of team-based treatment ("blended collaborative care") in secondary prevention is currently being tested in Germany in the randomized, controlled TEACH multicenter trial of patients with coronary heart disease and distress. Interventions such as positive psychology and mindfulness training can lead to a significant reduction in anxiety, stress and depression in heart patients.
-
Dtsch. Med. Wochenschr. · Jun 2021
[Update on treatment resistant hypertension and secondary hypertension].
Resistant hypertension (RH) is defined in patients who do not meet their blood pressure targets despite the daily intake of three antihypertensive drugs in maximally tolerated dosages. This triple treatment should comprise (1) an angiotensin-converting enzyme inhibitor (ACE-I) or angiotensin receptor blocker (ARB), (2) a calcium channel blocker and (3) a diuretic. RH should also be diagnosed in patients on four or more antihypertensive drug classes. ⋯ In most patients on triple treatment (ACE-I or ARB plus calcium channel blocker plus diuretic), mineralocorticoid receptor antagonists (MRA) should be the next treatment choice. As MRA may be associated with hyperkalemia (particularly in patients with chronic kidney disease), the concurrent use of potassium-lowering agents such as patiromer may allow a safe long-term treatment. In contrast, novel interventional treatment options in RH such as renal denervation are still controversially discussed.