Non-invasive ventilation in severe asthma attack, its possibilities and problems.
Panminerva Med. 2011 Jun;53(2):87-96
Authors: Murase K, Tomii K, Chin K, Niimi A, Ishihara K, Mishima M
Abstract
Asthma attack i…

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The management of acute heart failure.

Panminerva Med. 2010 Mar;52(1):53-66

Authors: Milo-Cotter O, Bettari L, Kleijn L, Bugatti S, Lombardi C, Rund M, Metra M, Voors AA, Cotter G, Kaluski E, Weatherley BD

Hospitalization for acute heart failure (AHF) is one of the burdensome aspects of 21st century medicine, leading to significant debilitating symptoms, high morbidity and mortality and consuming significant portion of the health care budget. Management of AHF is thought-provoking given the heterogeneity of the patient population, absence of a universally accepted definition, incomplete understanding of the pathophysiology and the beneficial and adverse effects of currently used therapies and lack of robust evidence-based guidelines. The article will discuss the clinical approach to the patients admitted with AHF, reviewing types of intervention (both approved and investigational) and will delineate their role and timing in specific AHF presentations. One of the challenges of AHF management is to effectively treat the subsets of patients with slow improvement or those with refractory AHF or early recurrence (worsening HF) during their initial admission. Unfortunately, the majority of these patients are at increased risk for subsequent complications and adverse outcomes. Therefore, considerable efforts in AHF management should be directed towards this population. Regretfully, to date no specific targeted therapy was proven beneficial for these patients, being one of the leading reasons for the lack of improvement in AHF outcomes over the last 30 years.

PMID: 20228726 [PubMed - indexed for MEDLINE]

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Renal dysfunction and heart failure.

Panminerva Med. 2010 Mar;52(1):67-78

Authors: Escobar A, Echarri R, Barrios V

The cardiorenal syndrome is a relative frequent complication in patients with advanced heart failure (HF) and left ventricular dysfunction. Its presence is associated with a worse prognosis. The pathophysiology of cardiorenal syndrome may vary according to the specific clinical circumstances and conditions of the patients. Thus, the different factors that take part in this syndrome vary among subjects and in the same patient along the time. These mechanisms are multifactorial and many of them are not well defined. These include hemodynamic factors, systemic neurohormonal factors, drug treatment resistances and anemia. The first step in the treatment of cardiorenal syndrome is the optimization of HF therapy that includes diuretics, renin angiotensin system antagonists and beta blockers. However, despite these treatments, the prognosis of this syndrome remains very poor. There has been a growing interest for cardiorenal syndrome in the last years, its pathophysiology and the multiple interactions between heart and kidney. This has made that new therapies for the treatment of this syndrome have been tested, with encouraging results. In this manuscript, the definition, pathophysiology, clinical management and new therapies are reviewed.

PMID: 20228727 [PubMed - indexed for MEDLINE]

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