[Use of vasopressors and inotropics in cardiogenic shock]. / Einsatz von Vasopressoren und Inotropika im kardiogenen Schock.

Vasoactive drugs and inotropic agents are important for the hemodynamic management of cardiogenic shock. In this article the use of different vasoactive and ionotropic drugs in cardiogenic shock is presented. Hemodynamic management during cardiogenic shock occurs after initial moderate volume delivery by dobutamine to increase inotropism. If adequate perfusion pressures are not achieved norepinephrine is administered. If a sufficient increase in cardiac performance can still not be achieved by the treatment, administration of levosimendan or phosphodiesterase (PDE) inhibitors may be necessary. Levosimendan is superior to PDE inhibitors for patients in cardiogenic shock. The aim of hemodynamic management in cardiogenic shock is to allow the transient use of inotropics and vasopressors in the lowest necessary dose and only as long as necessary. The daily question is whether the dose can be reduced or in the case of deterioration whether the use of an extracorporeal circulatory support system should be considered. There are currently no available data on mortality that demonstrate the benefit of hemodynamic monitoring using target criteria. The advantage, however, results from the economic use of inotropics and vasopressors by certain target criteria.

[Infective endocarditis : Update on prophylaxis, diagnosis, and treatment]. / Infektiöse Endokarditis : Update zur Prophylaxe, Diagnostik und Therapie.

The diagnosis of infective endocarditis is often delayed in clinical practice. Timely diagnosis and rapid antibiotic treatment is important. Higher age of patients, new risk factors, and increasing use of intravascular prosthetic materials resulted in changes in microbial spectrum. Nowadays, nonspecific symptoms, critically ill patients, and immunocompromised patients require a high level of diagnostic expertise.The new guidelines from the European Society of Cardiology provide various diagnostic algorithms and recommendations for antibiotic treatment. The new guidelines also recommend the formation of an endocarditis team with various medical disciplines, including a cardiac surgeon, to improve treatment because in half of all endocarditis patients, antibiotic therapy alone does not result in successful management of the infection. If complications occur, early surgical treatment should be performed.In this overview, diagnostic strategies and therapeutic approaches for the treatment of infectious endocarditis according to the current guidelines and aspects of surgical treatment are provided.

[Special aspects of analgosedation in cardiogenic shock patients]. / Spezielle Aspekte der Analgosedierung bei Patienten mit kardiogenem Schock.

Patients with cardiogenic shock pose a challenge to physicians due to cardiorespiratory instability in addition to the underlying medical condition. If analgosedation and ventilation are indicated, commonly administered drugs themselves often influence hemodynamics and oxygenation. The present article provides an overview of the available substances with consideration of the patients' condition, then monitoring and optimization of analgosedation.

[Modern drug therapy in cardiovascular intensive care medicine]. / Moderne Arzneitherapie in der kardiovaskulären Intensivmedizin.

Vasoactive drugs and inotropes are important in the hemodynamic management of patients with cardiogenic shock despite modest volume administration. Currently, the concept of cardiac relief is pursued in the treatment of acute heart failure. In this article we present the use of different drugs in the intensive care unit for acute heart failure and cardiogenic shock. In acute heart failure catecholamines are only used during the transition from heart failure to cardiogenic shock. Here, the therapeutic concept of ventricular unloading is more sought after. This can be achieved by the use of diuretics, nitrates, levosimendan (inodilatator), or in the future serelaxin. The hemodynamic management in cardiogenic shock occurs after moderate volume administration with dobutamine to increase inotropy. If no adequate perfusion pressures are achieved, norepinephrine can be administered as a vasopressor. If there is still no sufficient increase in cardiac output, the inodilatator levosimendan can be used. Levosimendan instead of phosphodiesterase inhibitors in this case is preferable. The maxim of hemodynamic management in cardiogenic shock is the transient use of inotropes and vasopressors in the lowest dose possible and only for as long as necessary. This means that one should continuously check whether the dose can be reduced. There are no mortality data demonstrating the utility of hemodynamic monitoring based on objective criteria­but it makes sense to use inotropes and vasopressors sparingly.

The hand-foot syndrome--a frequent secondary manifestation in antineoplastic chemotherapy.

The hand-foot syndrome (HFS) (palmoplantar erythrodysesthesia) designates acute, painful erythemas of the palms and soles of the feet caused by antineoplastic chemotherapies. The most frequent trigger substances are 5-fluoruracil and its derivates. At maximum severity, the HFS is bullous to erosive or ulcerous in character. The pathogenesis has not yet been clarified. Histologically, the HFS is characterized by a toxic keratinocyte reaction. Furthermore, there is sub-basal edema with a tendency to bullae, dilated blood and lymph capillaries and usually only mild perivascular lymphocytic infiltration. Early recognition and delineation from other differential diagnoses is prerequisite to targeted management of the disease. Depending on the severity, HFS requires dose reduction, interruption or switch in the antineoplastic chemotherapy.