V zadnjih 30 letih od prvega opisa v strokovni literaturi je sindrom takotsubo postal prepoznavna in uveljavljena klinična entiteta. Podatki kažejo, da znaša prevalenca bolnikov s sindromom takotsubo ...približno 1–3 % vseh bolnikov z elevacijami spojnice ST in simptomi, ki posnemajo akutni koronarni sindrom. Hkrati približno 4 % bolnikov po akutni fazi sindroma takotsubo vsaj enkrat ponovno zboli za to boleznijo. Gre za vrsto akutnega srčnega popuščanja neishemične etiologije s sorazmerno hitrim okrevanjem krčljivosti miokarda. Sindrom pogosto sproži močan stresni dogodek, ali fizični (npr. sepsa) oz. psihični (npr. izguba bližnjega), pri približno tretjini bolnikov pa jasnega sprožilnega dogodka ne uspemo zanesljivo opredeliti. Glede na klinični potek v akutni fazi bolezni bolnike s sindromom takotsubo delimo v 2 podskupini; bolnike s simptomi akutnega koronarnega sindroma in bolnike s simptomi, katerih simptomi niso v skladu z akutnim koronarnim sindromom. Zaradi nespecifičnih simptomov in znakov je prepoznavanje bolnikov s sindromom takotsubo še vedno diagnostični izziv. Hipoteze o hitrem okrevanju krčljivosti srčne mišice in ugodnem poteku bolezni so nedavno izzvali izsledki novejših raziskav, ki so pokazali primerljivo smrtnost in pogostost akutnih srčno-žilnih zapletov med bolniki s sindromom takotsubo in akutnim koronarnim sindromom. Prav tako novejši podatki kažejo, da podskupina bolnikov po akutni fazi sindroma takotsubo lahko razvije kronično srčno popuščanje. Sindrom takotsubo tako ni benigna bolezen in zahteva nove pristope k diagnostični in terapevtski obravnavi teh bolnikov. V članku želimo predstaviti novosti za razumevanje patogeneze in novosti pri obravnavi bolnikov s sindromom takotsubo in spremljati svoje izkušnje pri obravnavi teh bolnikov.
Lipoprotein a lipoprotein mali a, Lp (a) je poznan in dobro raziskan dejavnik tveganja za aterosklerotične srčno-žilne bolezni. Lp (a) se s svojimi protrombogenimi in proaterogenimi lastnostmi ...pomembno vpleta v patogenezo ateroskleroze. Povišane koncentracije Lp (a) so se – neodvisno od ostalih dejavnikov tveganja – izkazale kot neodvisni napovedni dejavnik za miokardni infarkt oz. ishemično bolezen srca ter možgansko kap. Degenerativna aortna stenoza je najpogostejša bolezen zaklopk, povezana s podobnimi dejavniki tveganja kot ishemična bolezen srca. Povišane vrednosti Lp (a) igrajo pomembno vlogo tudi pri nastanku in napredovanju degenerativne aortne stenoze, saj Lp (a) sodeluje v procesu kalcificiranja zaklopke, ki je eden pomembnejših dejavnikov za razvoj bolezni. Patofiziološka vloga Lp (a) v nastanku degenerativne aortne stenoze pa se zrcali tudi v opazovalnih in genetskih raziskavah, v katerih so ugotovili, da so povišane vrednosti Lp (a) povezane z višjim tveganjem za stenozo aortne zaklopke. Nekoliko manj pa je jasna vloga hiperlipoproteinemije a pri razvoju srčnega popuščanja. Med polimorfizmi Lp (a) sta dva povezana z razvojem srčnega popuščanja (rs3798220 in rs10455872). Povečini je srčno popuščanje pri populaciji s povišanimi vrednostmi Lp (a) posledica miokardnega infarkta oz. ishemične bolezni srca ter degenerativne aortne stenoze. Kljub temu pa je polimorfizem rs3798220 povezan z višjo pojavnostjo srčnega popuščanja, ki ni posledica ishemične bolezni srca ali aortne stenoze. V preglednem članku predstavljamo patofiziološki in klinični pomen hiperlipoproteinemije a pri ishemični bolezni srca, degenerativni aortni stenozi ter srčnem popuščanju, vključno z razpravljanjem.
Respiratory transfusion-related reactions are not very frequent, partly also because recognition and reporting transfusion reactions is still underemphasized. Tis article describes the most important ...respiratory transfusion reactions, their pathophysiology, clinical picture and treatment strategies. Respiratory transfusion related reactions can be primary or secondary. The most important primary transfusion-related reactions are TRALI - transfusion-related acute lung injury, TACO – transfusion-associated circulatory overload, and TAD - transfusion-associated dyspnea. TRALI is immuneassociated injury of alveolar basal membrane, which becomes highly permeable and causes noncardiogenic pulmonary edema. Treatment of TRALI is mainly supportive with oxygen, fluids (in case of hypotension) and in cases of severe acute respiratory failure also mechanic ventilation. TACO is caused by volume overload in predisposed individuals, such as patients with heart failure, the elderly, infants, patients with anemia and patients with positive fluid balance. Clinical picture is that of a typical pulmonary cardiogenic edema, and the therapy is classical: oxygen and diuretics, and in severe cases also non-invasive or invasive mechanical ventilation. TAD is usually a mild reaction of unknown cause and cannot be classified as TACO or TRALI, nor can it be ascribed to patient’s preexisting diseases. Although the transfusion-related reactions are not very common, knowledge about them can prevent serious consequences. On the one hand preventive measures should be sought, and on the other early recognition is beneficial, so that proper treatment can take place.
Heart failure is common in the nursing home population and presents many diagnostic and therapeutic challenges. Point-of-care ultrasonography is a bedside method that can be used to assess volume ...status more reliably than clinical examination. This trial was conceived to test whether point-of-care ultrasonography-guided management improves heart failure outcomes among nursing home residents.
Nursing home residents with heart failure will be enrolled in a multi-centre, prospective, randomised controlled trial. Residents will first be screened for heart failure. Patients with heart failure will be randomised in 1:1 fashion into two groups. Nursing home physicians will adjust diuretic therapy according to volume status for six months. Point-of-care ultrasonography will be used in the test group and clinical examination in the control group. The primary endpoint will be heart failure deterioration, defined as a composite of any of the following four events: the need for an intravenous diuretic application, the need for an emergency service intervention, the need for unplanned hospitalisation for non-injury causes, or death from whatever cause.
The expected prevalence of heart failure among nursing home residents is above 10%. Point-of-care ultrasonography-guided heart failure management will reduce the number of deteriorations of heart failure in the nursing home population.
This study will explore the usefulness of point-of-care ultrasonography for heart failure management in the nursing home population.
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