Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Mar 2021
Review[Embolic stroke of undetermined source (ESUS) - Classification of a new stroke entity].
Embolic stroke of undetermined source (ESUS) represents a subpopulation of cryptogenic strokes defined by its embolic stroke pattern on imaging and if after a carefully performed diagnostic evaluation, a specific, well recognized cause of stroke has not been identified. This review article analyses the basics of the ESUS concept and provides an overview of the evidence from recent cohort studies. The definition, aetiology and diagnosis of ESUS are reassessed. Targeted diagnostics in ESUS patients can reduce the number of cryptogenic strokes by making a specific diagnosis.
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Dtsch. Med. Wochenschr. · Mar 2021
Review[Symptom control in heart failure patients - how to handle GFR decrease and hyperkalaemia].
For heart failure patients with reduced ejection fraction, optimised medication improves symptom control and reduces mortality. Substances influencing the renin-angiotensin-aldosteron-system, so-called RAAS-inhibitors, are the cornerstone of heart failure treatment. This article summarises a consensus between experts in cardiology and in nephrology on a pragmatic approach to manage a drop in glomerular filtration rate and incident hyperkalaemia - the two most common reasons for reducing or discontinuing heart failure medication.
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Since its beginning, 30 years ago, magnetic resonance imaging of the heart made tremendous progress. Starting from an almost experimental level in the 90 s it has now become a routine tool within cardiac diagnostics. This article presents a selection of present applications of cardiac magnetic resonance imaging. ⋯ Perfusion imaging allows detection of ischemia, and measurement of blood flow quantifies cardiac shunts and valve disorders. In combination with Positron Emission Tomography, the relationship of molecular/cellular processes and functional, microstructural alterations become visible in myocarditis and amyloidosis. Recent contraindications of cMRI/MRI as cardiac devices MRI have been resolved; however, image quality of the heart is still a challenge.