Deutsche medizinische Wochenschrift
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A cirrhotic cardiomyopathy (CCM) can be observed in patients with end-stage liver disease and is characterized by a systolic and/or diastolic dysfunction in the absence of pre-existing heart diseases. While the cardiac dysfunction is often masked at rest, it typically manifests itself during cardiovascular challenges such as hypovolemia, physical stress, or sepsis. ⋯ There is no specific therapy for CCM. Supportive measures and regular cardiac evaluation of high-risk patients and transplant candidates are important to reduce the risks associated with invasive procedures and treatments.
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Right heart catheterisation is a frequently used procedure in cardiology and intensive care medicine, especially for the differential diagnosis of pulmonary hypertension, shunt diagnostics and accurate calculation of the important haemodynamic parameters. Various catheters are available for the examination; the most common and safest is the use of a Swan-Ganz catheter. The complete examination includes probing of the right atrium, right ventricle, pulmonary artery and pulmonary capillary bed. In this "step-by-step" article, the authors discuss the practical aspects of this method.
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Urinary incontinence and gait disorders are common health related problems that occur especially in old age. Therefore they are called geriatric syndromes. ⋯ And further, both syndroms seem to interact closely and can be influenced by improvements of each other. Knowing and recognizing the interaction of micturition and physical performance is essential to working towards prevention of UI and to improving quality of treatment and quality of life.
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Dtsch. Med. Wochenschr. · Aug 2021
[Intravenous fluid therapy and acute kidney injury - What's new?]
Optimization of intravascular volume is crucial for patients who are at risk or undergo Acute Kidney Injury. In sepsis or after acute fluid loss extensive fluid expansion is mostly needed. However, in cardiorenal syndroms fluid overload can even lead to AKI itself and reduction of intravascular volume is needed. Thus, an individualized fluid guidance in terms of a "fluid management stewartship" for the right patient, the right drug, the right route and the right dose 1 has to be applied.
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Dtsch. Med. Wochenschr. · Aug 2021
[Coronary revascularization: Interventional therapy or coronary bypass surgery].
Coronary artery disease remains the leading cause of death and is responsible for myocardial infarction, heart failure and angina. Therapy combines optimal control of cardiovascular risk factors with coronary revascularization performed by interventional therapy or bypass surgery. ⋯ Both revascularization strategies perform similar for low level complexity three vessel or left main disease while coronary bypass surgery proved superior for more complex coronary artery disease. Heart team decision should be based on vascular anatomy and expected revascularization success under consideration of operative risk and patient preference.