[Lifestyle and the eligibility for left ventricular assist device implantation]. / Leefstijl en de indicatie voor een steunhart.

BACKGROUND: Advanced heart failure is defined as severe cardiac dysfunction combined with hospital admissions due to heart failure and major functional limitations. Selected patients with advanced heart failure can be treated with a left ventricular assist device. Patients with the newest generation of devices have a five-year survival of approximately 60%. CASE DESCRIPTION: We describe the case of a 54-year-old patient with advanced heart failure due to coronary artery disease, who was referred from a secondary to a tertiary care center to evaluate candidacy for LVAD therapy. Due to significant multimorbidity and unhealthy lifestyle (BMI 33 kg/m2, eGFR 29 ml/min/1.73m2, smoking, peripheral vascular disease, very poorly controlled diabetes mellitus), the patient was not considered a suitable candidate. Due to a rigorous change in his lifestyle, a number of (relative) contraindications changed in such a way that an LVAD was successfully implanted in the patient with a good functional status afterwards. CONCLUSION: Candidacy for LVAD therapy is determined on an individual basis through a vigilant screening process. Eligibility for this treatment can be positively influenced by a change in lifestyle. Intensive guidance of care providers is important in this respect.

[Dyspnoea due to ticagrelor after recent myocardial infarction]. / Dyspneu bij gebruik van ticagrelor na recent myocardinfarct.

BACKGROUND: Ticagrelor is a frequently prescribed platelet aggregation inhibitor used in patients with acute coronary syndrome. A rare side effect is severe dyspnoea. CASE DESCRIPTION: A 76 year old woman experiences severe shortness of breath three weeks after percutaneous coronary intervention because of acute myocardial infarction. Physical examination and additional investigation showed no pulmonary or cardiac explanation for her complaints. Shortly after cessation of ticagrelor, her complaints disappeared. CONCLUSION: Ticagrelor-related severe dyspnoea in post-myocardial infarction patients is a diagnosis by exclusion of other reasonable causes of dyspnoea. Unfamiliarity with this side effect can lead to excess diagnostics and unnecessary referrals.