Medical therapy in heart failure--is polypharmacy necessary?

The concept of heart failure has undergone several paradigm shifts in the past few decades. Therapeutic targets directed at the heart pump have shifted to circulatory haemodynamics to the current neurohormonal model. Consequently, therapeutic modalities have similarly evolved alongside clinical trials. Successive trials have tested newer drugs in addition to established therapies, resulting in evidence-based treatments necessitating polypharmacy. Optimal heart failure therapy has therefore become increasingly complex. It is only after understanding the precise modes of drug action, as well as the relevance of the design of clinical trials, will physicians hopefully be able to tailor the medical therapy optimally towards the individual patient with heart failure.

Neoplasia after heart transplantation.

Transplant recipients have a higher incidence of cancer compared with the general population. This increased risk is related to the intensity and chronicity of immunosuppression that these patients receive. The common types and presentations of posttransplant tumors are reviewed and discussed. Regular surveillance is of paramount importance in detecting such tumors. Treatment invariably includes attempts to reduce immunosuppression.

Cortical blindness following coronary angiography.

A 53-year-old man developed transient cortical blindness after coronary angiography, which appears to be an adverse reaction to contrast agent. A possible mechanism of this complication is contrast penetration of the blood-brain barrier with direct neurotoxicity to the occipital cortex.