LVAD support can improve contractile strength of intact myocardium and reverse the negative FFR associated with end-stage heart failure. The expression of genes encoding for proteins involved in Ca(2+) cycling is upregulated (reverse molecular remodeling), but only the protein content of SERCA2a is increased.

Vasopressin is a uniquely effective pressor in the irreversible phase of hemorrhagic shock unresponsive to volume replacement and catecholamine vasopressors. Vasopressin deficiency may contribute to the pathogenesis of this condition.

Maximum structural reverse remodeling by left ventricular assist devices is complete by about 40 days. Molecular reverse remodeling of sarcoplasmic endoreticular calcium adenosine triphosphatase 2a expression is quicker, being complete by about 20 days.

The patient with an implanted cardiac device can safely undergo surgery as long as certain precautions are taken.

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This series provides an update on the best use of different imaging methods for common or important clinical presentations. The series advisers are Fergus Gleeson, consultant radiologist, Churchill Hospital, Oxford, and Kamini Patel, consultant radiologist, Homerton University Hospital, London. To suggest a topic for this series, please email us at practice@bmj.com.A 52 year old man presented to the emergency department with nausea and vomiting after sudden onset of headache two days previously that had radiated to his cervical spine. He had associated dizziness and had fallen twice. He had no medical history of note, but he smoked. On examination, he had blood pressure 160/88 mm Hg, Glasgow coma score 15, normal reactive pupils, and no other signs or focal neurology. Blood tests showed a mild neutrophilia and mildly raised C reactive protein and cholesterol concentration. His clotting and all other tests were normal.

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