Herz
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The majority of ventricular tachycardias (VTs) occurs in patients with structural heart disease, predominantly coronary heart disease. Implantable cardioverter defibrillators (ICDs) are first-line therapy in patients with VT and structural heart disease. In patients who receive an ICD after a spontaneous sustained VT, recurrent VT episodes or an electrical storm are major problems. ⋯ Thus, catheter ablation of sustained VT in the setting of structural heart disease can only be considered an adjunctive therapy which, in general, will require ICD therapy. Numerous "modern" mapping technologies have been developed, which have increased success rates of catheter ablation of VT in patients with and without structural heart disease. The aim of the present article is to review current three-dimensional mapping systems in comparison to conventional mapping and to describe a reasonable, tailored approach for the individual patient with VT.
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Documented mortality from acute myocardial infarction (AMI) has significantly decreased from around 30% in the 1960s to currently 6-7%, following the introduction of intensive-care treatment, thrombolysis, effective antithrombotic therapy, and coronary angioplasty. However, the approximate mortality of 70-80% of patients with cardiogenic shock following AMI has hardly improved despite the introduction of modern treatment strategies. The major cause of in-hospital AMI mortality remains myocardial failure with consecutive cardiogenic shock and multiorgan failure. ⋯ In patients with clinical signs of hypotension, however, the guidelines recommend to stabilize the patient before administering an oral beta-receptor blocker, mainly because of the hypotensive effects of the substance class. In this situation, selective heart rate reduction, e.g., via administration of ivabradine without side effects of hypotension may be advantageous and better tolerated in patients with cardiogenic shock. The aim of the present review is to briefly summarize the treatment options of cardiogenic shock and the mechanisms of action of ivabradine as well as to present a case report of a patient with cardiogenic shock due to main trunk occlusion, where treatment with ivabradine seemed to beneficially influence the outcome.
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For symptomatic patients with severe aortic valve stenosis, open heart surgery for aortic valve replacement (AVR) with use of cardioplegia under cardiopulmonary bypass remains the gold standard. Cumulative surgical experience and technical improvement for more than 5 decades have led to excellent perioperative results with low mortality and morbidity. Long-term results are convincing, long-term survival is close to the average population, and durability of biological prostheses is favorable in the elderly. ⋯ Softening the indication for PAVI is ethically not acceptable yet. Randomized, prospective studies with long-term follow-up are mandatory to evaluate the valvular longevity and the consequences of system-immanent complications of PAVI compared to AVR. Selection of patients, conduction of the procedure and treatment of potentially life-threatening complications require a team of cardiac surgeons, interventional cardiologists and anesthesiologists with a fully equipped hybrid operating room including extracorporeal circulation.
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Review
[Left ventricular assist devices in chronic therapy of heart failure. Indication, results, risks].
Three generations of left ventricular assist devices are available for the therapy of heart failure. In the current development, pulsatile devices are being displaced by axial flow pumps. ⋯ In addition, by implanting a left ventricular assist device the quality of life was improved. Consequently, the importance of left ventricular assist devices in the therapy of heart failure is increasing.
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More and more patients are treated with antiplatelet drugs today. In this context a sufficient inhibition of platelet aggregation, on the one hand, is of essential importance to the efficiency of prophylaxis of myocardial and cerebral infarction and to avoiding thrombosis of drug-eluting stents. On the other hand, this medication can result in an increased risk of perioperative bleeding. In both situations control of the efficiency of therapy or rather the assessment of the impairment of hemostasis is of vital importance. ⋯ Due to their easy handling the described POC devices are applicable to perioperative coagulation management as well as during and after coronary intervention or to monitoring of platelet function in cardiologic practice. They enable a quick assessment of platelet function and an individually guided therapy.