ABSTRACT
Acute limb ischemia (ALI) is defined as a sudden decrease (<14 days) in limb perfusion causing a potential threat to limb viability. Endovascular treatment of ALI is an effective and appropriate primary treatment strategy in patients with a viable acutely ischemic limb due to a recent arterial occlusion. We present a case of acute limb ischemia and discuss percutaneous interventional treatment strategies including catheter-directed thrombolysis, rheolytic thrombectomy, and utilization of distal protection devices.
Subject(s)
Endovascular Procedures/methods , Ischemia/therapy , Leg/blood supply , Acute Disease , Aged, 80 and over , Angiography, Digital Subtraction , Arterial Occlusive Diseases/diagnostic imaging , Arterial Occlusive Diseases/therapy , Female , Femoral Artery/diagnostic imaging , Humans , Ischemia/diagnostic imaging , Leg/diagnostic imaging , Limb Salvage/methods , Thrombectomy , Thrombolytic TherapyABSTRACT
This is a case of a patient with a univentricular heart and transposition of the great arteries who was treated with a pulmonary artery banding as a child. We describe his clinical course and crucial factors associated with his prolonged survival.
Subject(s)
Abnormalities, Multiple/surgery , Cardiac Surgical Procedures , Heart Defects, Congenital/surgery , Heart Ventricles/abnormalities , Pulmonary Artery/surgery , Transposition of Great Vessels/surgery , Abnormalities, Multiple/diagnosis , Abnormalities, Multiple/physiopathology , Cardiac Catheterization , Echocardiography , Electrocardiography, Ambulatory , Exercise Test , Heart Defects, Congenital/diagnosis , Heart Defects, Congenital/physiopathology , Heart Ventricles/physiopathology , Humans , Magnetic Resonance Imaging, Cine , Male , Middle Aged , Palliative Care , Pulmonary Artery/physiopathology , Respiratory Function Tests , Time Factors , Transposition of Great Vessels/diagnosis , Transposition of Great Vessels/physiopathology , Treatment OutcomeABSTRACT
Heart failure continues to be a major global concern. Despite greater understanding of the 'maladaptive' mechanisms that contribute to its development and progression, morbidity and mortality from heart failure remain high. Existing treatment modalities have been hampered by the development of electrolyte abnormalities, diuretic resistance and the cardiorenal syndrome. This review focuses on the pharmacological properties and clinical data of therapeutic agents under investigation that target vasopressin and adenosine receptors for the treatment of patients with heart failure.
Subject(s)
Diuretics/therapeutic use , Drug Delivery Systems , Heart Failure/drug therapy , Animals , Antidiuretic Hormone Receptor Antagonists , Clinical Trials as Topic , Disease Progression , Diuretics/pharmacology , Drug Resistance , Heart Failure/mortality , Heart Failure/physiopathology , Humans , Kidney Diseases/etiology , Kidney Diseases/physiopathology , Purinergic P1 Receptor Antagonists , Syndrome , Water-Electrolyte Imbalance/etiologyABSTRACT
The global healthcare burden attributable to heart failure is ever increasing. Patients presenting with refractory heart failure should be evaluated for compliance with medical regimens and sodium and/or fluid restriction, and every attempt should be made to optimize conventional strategies. Reversible causes such as ischemia should be identified and revascularization considered in persistently symptomatic patients, particularly those with a viable myocardium. Carefully selected patients who continue to deteriorate clinically in spite of optimization of medical therapy may be considered for advanced treatment strategies, such as continuous inotropic infusions, mechanical circulatory support devices, cardiac transplantation, or referral to hospice care. We discuss the clinical presentation and management of patients with advanced/refractory (Stage D) heart failure.
