Cognitive and neurological symptoms are common after cardiac arrest brain injury. Establishing specialised neurorehabilitation centres is essential for treating these patients.
Clinical presentation, treatment, and long-term outcomes... 231 INTROduCTION Takotsubo cardiomyopathy (TTC), also known as stress cardiomyopathy or apical ballooning syndrome, is defined as a temporary left ventricular dysfunction caused mainly by stress, with left ventricular regional wall hypokinesis extending beyond a single coronary artery distribution and without any significant coronary lesions (FIGuRE 1). 1,2 Clinical presentation of this severe cardiac disorder is indistinguishable from acute coronary syndrome (ACS), 3,4 but due to TTC pathophysiology, the American Heart Association classified this stress syndrome as a primary acquired cardiomyopathy. 5 To diagnose TTC and to differentiate it from ACS, Prasad et al. 1 proposed the modified Mayo Clinic criteria for the diagnosis of TTC: 1 transient hypokinesis, akinesis, or dyskinesis in the left ventricular mid segments with or
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Background: Recent reports suggest that torasemide might be more beneficial than furosemide in patients with symptomatic heart failure (HF). The aim was to compare the effects of torasemide and furosemide on clinical outcomes in HF patients. Methods: This study pilot consisted of data from the ongoing multicenter, randomized, unblinded endpoint phase IV TORNADO (NCT01942109) study. HF patients in New York Heart Association (NYHA) II-IV class with a stable dose of furosemide were randomized to treatment with equipotential dose of torasemide (4:1) or continuation of unchanged dose of furosemide. On enrollment and control visit (3 months after enrollment) clinical examination, 6-minute walk test (6MWT) and assessment of fluid retention by ZOE Fluid Status Monitor were performed. The primary endpoint was a composite of improvement of NYHA class, improvement of at least 50 m during 6MWT and decrease in fluid retention of at least 0.5 W after 3-months follow-up. Results: The study group included 40 patients (median age 66 years; 77.5% male). During follow-up 7 patients were hospitalized for HF worsening (3 in torasemide and 4 in furosemide-treated patients). The primary endpoint reached 15 (94%) and 14 (58%) patients on torasemide and furosemide, respectively (p = 0.03). Conclusions: In HF patients treated with torasemide fluid overload and symptoms improved more than in the furosemide group. This positive effect occurred already within 3-month observation. (Cardiol J 2019; 26, 6: 661-668)
SummaryBackgroundA serious complication of heparin treatment, heparin-induced thrombocytopenia (HIT) is rarely observed in pregnant women. Drug therapy during pregnancy should always be chosen to minimize fetal risk. The management of HIT in pregnancy represents a medical challenge. Unlike heparins, the anticoagulants used in patients with HIT do cross the placenta, with unknown fetal effects.Case ReportWe present a case of a 24-year-old female presenting for care at 34 weeks of gestation with acute pulmonary embolism treated initially with unfractionated heparin (UFH) and low molecular weight heparin (LMWH), who developed HIT. She was then successfully treated with fondaparinux.ConclusionsTo the best of our knowledge, this is one of the first case reports describing a successful use of fondaparinux in the treatment of HIT in a third-trimester pregnant woman, providing a novel approach for this subset of patients.
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