Deutsche medizinische Wochenschrift
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Lipoprotein(a) - Lp(a) - is an hepatically synthesized lipoprotein, structurally similar to low-density-lipoprotein, and an important marker for cardiovascular risk. Lp(a) plasma concentrations are genetically determined and can hardly be modified by diet, exercise or oral drugs. ⋯ The current treatment for high Lp(a) is early intensive risk factor management with optimal lowering of LDL-cholesterol. Potent new RNA-targeting therapies are currently assessed in clinical trials and may be available in a couple of years.
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TTS is an acute heart failure syndrome that usually affects postmenopausal women. The Syndrome is often preceded by an emotional or physical trigger. TTS strongly resembles acute myocardial infarction from a clinical standpoint and also exhibits ECG changes in the same proportion. ⋯ Therapy is based on the hemodynamic state and the presence of left ventricular outflow tract obstruction or cardiogenic shock. TTS has a comparable mortality to acute myocardial infarction. Pathophysiologically, the activation of the brain-heart axis with acute catecholamine storm seems to inherit a central role.
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Dtsch. Med. Wochenschr. · Nov 2022
Observational Study[Disease sequelae on function in persons 70 years and older and the acceptance of a new supporting network, the NetzWerk GesundAktiv (NWGA)].
The growing need of nursing care as life expectancy increases is a problem. The Netzwerk AktivGesund (NWGA) tries to change this development in a positive way. In a pilot region of the city of Hamburg, persons 70 years and older were invited by their health insurance companies to participate in the NWGA supportive network. Results of the acceptance analysis are described here. ⋯ The results show that impairments of motoric and cognitive functions, in particular, and sociodemographic factors have impact on the acceptance of the NWGA. The recruitment for participation should be improved using approaches that are differentiated, respectively. Awareness of functional impairment as disease sequelae and pacemaker of need of nursing care, in general, might facilitate health promotion and prevention in older persons. An interest in preventative activities was remarkably frequent among the persons 70 years and older.
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Peripartum cardiomyopathy (PPCM) is a rare but potentially life-threatening heart disease, with onset in the last month of pregnancy or in the first months after delivery in previously heart-healthy women. PPCM patients typically present with heart failure due to left ventricular (LV) dysfunction with an LV ejection fraction (EF) < 45 %. In the last years clinical and experimental studies contributed to a better understanding of the pathophysiology and the clinical course of PPCM. ⋯ Some patients present with mild forms, whereas some PPCM patients display severely reduced LV function and cardiogenic shock. Especially the latter cases are still challenging, as treatment with β1-adrenergic receptor agonists is associated with progression of heart failure and a worse cardiac outcome. Therefore, patients with cardiogenic shock complicating PPCM should be treated in centers experienced in mechanical circulatory support in combination with bromocriptine treatment.
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Dtsch. Med. Wochenschr. · Nov 2022
[The law of emergency representation in intensive care medicine].
In case of patients who are incapable of decisionmaking, familiy members are only authorised for representative decisionmaking (in accordance with the presumed will of the patient) if they can submit a (written) health care disposition or have been appointed as guardians by court. In urgent cases, the court can also enforce the patient's right to self-determination itself by ruling (§ 1908i and § 1846 BGB = German Civil Code). With effect from 01.01.2023, spouses will by law (automatically) become representatives in all matters of health care. However, this new regulation contains a number of conditions and reservations as well as it raises some questions about implementation in clinical practice.