Deutsche medizinische Wochenschrift
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Mechanical circulatory support can be used in patients suffering from acute heart failure if conventional measures are inadequate to provide hemodynamic stabilization to avoid organ hypoperfusion. In addition to treating the underlying disease such measures therefore play an important role in emergency and intensive care medicine, resulting in a reduction of the high mortality in untreated cardiogenic shock from up to 80 % to 40 %. Novel minimally-invasive circulatory support systems may extend the spectrum of indications in the future.
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Dtsch. Med. Wochenschr. · Jun 2009
Review[Chronic obstructive pulmonary disease (COPD) as a systemic disease].
Chronic obstructive pulmonary disease (COPD) is defined as a progressive, usually only partially reversible, obstruction of the airways The disease is associated with an inflammatory response of the lungs to noxious particles, particularly cigarette smoke. Numerous epidemiological studies have shown a significant association between impaired lung function and the presence of cardiovascular, metabolic or other extrapulmonary comorbidities. Systemic inflammation may be the missing link between COPD and its extrapulmonary manifestations, although the exact mechanism of this relationship remains unclear. ⋯ Based on the concept of COPD as a systemic disease, a concept is needed which describes in detail the pharmacological treatment of the pulmonary and extrapulmonary manifestations of the disease. In addition, the part of the disease that is treatable with physiotherapy and rehabilitation must be fully taken into account. Such multimodal treatment regimens have so far not been implemented into clinical guidelines.
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The critically ill patient in acute heart failure continues to present an exceptional challenge concerning diagnostic procedures, monitoring and treatment. The European Society of Cardiology guidelines was the first to classify patients in acute heart failure into distinct clinical entities. Further management and choice of monitoring relies on this classification. ⋯ The greater the increase in tidal volume for the same lung compliance, the greater is the transient decrease in venous return and the subsequent decrease in left ventricular output. Variations in systolic pressure or pulse pressure are reliable measures of preload responsiveness. More clinical validation of these measures must be done before they can become standard measures of monitoring patients in acute heart failure.