[COVID-19 infection-update]. / COVID-19-Infektion ­ Update: Was muss der Gefäßmediziner wissen?

At the end of December 2019 many cases of severe pulmonary inflammation were reported in Hubei Province, China. Nearly all of the affected individuals had had contact to the wet fish market, which was believed to be the source of the novel infection and was closed on 1 January 2020. Subsequently, the Chinese health authorities confirmed that the pathogen was a previously unknown severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which belongs to the Coronaviridae family. The disease was then designated as coronavirus disease 2019 (COVID-19) and rapidly spread initially in Asia and later worldwide. In March 2020 the COVID-19 outbreak was declared a global pandemic by the World Health Organization. At the time of manuscript submission, more than 20 million people were affected by COVID-19, with more than 500,000 deaths worldwide. The article gives a general overview on the novel COVID-19 with a specific clinical focus on vascular involvement. The article is essentially based on the currently available evidence and the experiences of the authors.

[A case of cardiac AA amyloidosis]. / AA-Amyloidose mit kardialer Beteiligung.

HISTORY AND CLINICAL FINDINGS: A 51-year-old woman was referred for kidney transplant evaluation. An HIV infection had been diagnosed ten years ago, viral load being negative at present. Renal type AA-amyloidosis was demonstrated by kidney biopsies. The patient had no symptoms. Clinical examination revealed no significant abnormalities with exception of a systolic murmur. A 12-channel electrocardiogram demonstrated peripheral low voltage. Echocardiography showed severe diastolic dysfunction, ventricular hypertrophy and biatrial dilatation. In addition, the aortic valve displayed a calcified mass. TREATMENT AND COURSE: Treatment with an ACE-inhibitor for diastolic heart failure was continued, and the patient was included into the renal transplantation program. CONCLUSIONS: Amyloidosis is characterized by an abnormal folding of certain proteins and their extracellular deposition in several organs. This leads to corresponding dysfunction and can result in organ failure. Cardiac involvement is usually associated with immunoglobulin-light-chain (AL) - or familial transthyretin-associated (ATTR) - amyloidosis and indicates a poor prognosis. This report demonstrates a rare case of pronounced cardiac manifestation of the amyloid protein A (AA) - amyloidosis.

[Apixaban: pharmacology and action profile]. / Apixaban: Pharmakologie und klinisches Wirkprofil.

Vitamin K antagonists are currently the most frequently used anticoagulants. However, practical limitations of their application, such as variability in dose response, a narrow therapeutic index and numerous drug and dietary interactions, have lead to development of new oral anticoagulants with better efficacy and safety profile. Recent advances included the development of orally active FXa inhibitors rivaroxaban and apixaban. Rivaroxaban received its marketing approval in September 2008. Apixaban has recently been approved for prevention of venous thromboembolism after total hip or knee replacement. This review describes the pharmacological properties of apixaban and discusses the latest findings from clinical trials.

[Natriuretic peptides in the therapy of acute decompensated heart failure]. / Akut dekompensierte Herzinsuffizienz: klinischer Stellenwert einer Therapie mit natriuretischen Peptiden.

Heart failure is the most frequent cause of hospitalization in elderly population. Unlike the therapy of congestive heart failure, there was only a modest progress in the medical treatment for acutely decompensated heart failure over the past several decades. Moreover, current treatment is associated with many limitations in clinical practice. The family of natriuretic peptides consists of several structurally similar polypeptides (ANP, BNP, CNP, urodilatin, DNP). ANP and BNP are the most characterized substances and represent an important compensatory mechanisms in heart failure because of their vasodilatory, natriuretic and antiproliferative effects. Nesiritide is a recombinant human BNP which has been shown to be effective in treating heart failure in several clinical trials. However, a recent meta-analysis revealed a nesiritide-associated increased 30-day-mortality rate. The results of initial small-sized trials suggest beneficial hemodynamic effects of urodilatin in decompensated heart failure. Despite of being approved for the treatment of decompensated heart failure in some countries, the clinical relevance of nesiritide is currently unclear. Urodilatin might represent a potential alternative.

[Treatment of pseudoaneurysms by thrombin injection]. / Perkutane Thrombininjektion bei Aneurysma Spurium.

The incidence of pseudoaneurysms after percutaneus arterial procedures is a quite common complication. Ultrasound-guided thrombin injection is an effective and elegant therapy with a low procedural risk, when the physician is trained in the technique. This paper provides a tutorial for physicians including tips and pitfalls.

[ADP receptor blockers: new insights in the therapy and prophylaxis of ischemic heart disease]. / ADP-Rezeptor-Antagonisten: neue Erkenntnisse zur Therapie und Prophylaxe der ischämischen Herzerkrankung.

Adenosine diphosphate (ADP)-induced platelet activation plays a pivotal role in the thrombocyte aggregation and pathogenesis of ischemic heart disease. The long-term benefit of dual anti-platelet therapy with ADP-receptor antagonists, such as clopidogrel, in combination with aspirin is well established for patients following coronary stent implantation. This review discusses latest developments in the field of ADP-receptor antagonists.

[Hemodynamic monitoring in the intensive care unit: pulmonary artery catheter versus PiCCO]. / Hämodynamisches Monitoring auf der Intensivstation: Pulmonalarterienkatheter versus PiCCO.

Hemodynamic monitoring is essential in the diagnosis and management of critically ill patients. Cardiac output represents a major monitoring parameter. There are a number of methods for measurement of cardiac output with various invasive capacities and functional reliability. Thermodilution pulmonary artery catheter and pulse contour analysis by PiCCO are widely used techniques to measure cardiac output in intensive care unit. This review describes the basic principles, limitations and complications of both monitoring tools.