Fault-Tolerant Control Based on Current Space Vectors against Total Sensor Failures.

This paper proposes a fault-tolerant control (FTC) strategy using the current space vectors to diagnose sensor failures and enhance the sustained operation of a field-oriented (FO) controlled induction motor drive (IMD). Three space vectors are established for the sensor fault diagnosis technique, including one converted from the measured currents and the other two calculated from the current estimation technique, respectively, measured and with reference speeds. A mixed mathematical model using three space vectors and their components is proposed to accurately determine the fault condition of each sensor in the motor drive. After determining the operating status of each sensor, if the sensor signal is in good condition, the feedback signal to the controller will be the measured signal; otherwise, the estimated signal will be used instead of the failed signal. Failure states of the various sensors were simulated to check the effectiveness of the proposed technique in the Matlab/Simulink environment. The simulation results are positive: the IMD system applying the proposed FTC technique accurately detected the failed sensor and maintained stability during the operation.

Misfire Detection in Automotive Engines Using a Smartphone through Wavelet and Chaos Analysis.

Besides the failures that cause accidents, there are the ones responsible for preventing the car's motion capacity. These failures cause inconveniences to the passengers and expose them to the dangers of the road. Although modern vehicles are equipped with a failure detection system, it does not provide an online approach to the drivers. Third-party devices and skilled labor are necessary to manage the data for failure characterization. One of the most common failures in engines is called misfire, and it happens when the spark is weak or inexistent, compromising the whole set. In this work, two algorithms are compared, based on Wavelet Multiresolution Analysis (WMA) and another using an approach performing signal analysis based on Chaos using the density of maxima (SAC-DM) to identify misfare in a combustion engine of a working automotive vehicle. Experimental tests were carried out in a car to validate the techniques for the engine without failure, with failure in one piston, and with two failed pistons. The results made it possible to obtain the failure diagnosis for 100% of the cases for both WMA and SAC-DM methods, but a shorter time window when using the last one.

Online Frequency Response Analysis of Electric Machinery through an Active Coupling System Based on Power Electronics.

This paper presents an innovative concept for the online application of Frequency Response Analysis (FRA). FRA is a well known technique that is applied to detect damage in electric machinery. As an offline technique, the machine under testing has to be removed from service-which may cause loss of production. Experimental adaptations of FRA to online operation are usually based on the use of passive high pass coupling-which, ideally, should provide attenuation to the grid voltage, and at the same time, allow the high frequency FRA signals to be injected at the machine. In practice, however, the passive coupling results in a trade-off between the required attenuation and the useful area obtained at the FRA spectra. This paper proposes the use of an active coupling system, based on power electronics, in order to cancel the grid voltage at the terminals of FRA equipment and allow its safe connection to an energized machine. The paper presents the basic concepts of FRA and the issue of online measurements. It also presents basic concepts about power electronics converters and the operating principles of the Modular Multilevel Converter, which enables the generation of an output voltage with low THD, which is important for tracking the grid voltage with minimum error.

Do Patients With Acute Heart Failure and Preserved Ejection Fraction Have Heart Failure at Follow-Up: Implications of the Framingham Criteria.

BACKGROUND: Heart failure (HF) with preserved ejection fraction (HFpEF) may be misdiagnosed. We assessed prevalence and consistency of Framingham criteria signs and symptoms in acute vs subsequent stable HFpEF. METHODS: Three hundred ninety-nine patients with acute HFpEF according to Framingham criteria were re-assessed in stable condition. Four definitions of HFpEF at follow-up: (1) Framingham criteria alone, (2) Framingham criteria and natriuretic peptides (NPs), (3) Framingham criteria, NPs, and European Society of Cardiology HF guidelines echocardiographic criteria, (4) Framingham criteria, NPs, and the Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction (PARAGON) trial echocardiographic criteria. RESULTS: At follow-up, HFpEF was still present in 27%, 22%, 21%, and 22%, respectively. Most prevalent in acute HFpEF were dyspnea at exertion (90%), pulmonary rales (71%), persisting at follow-up in 70% and 13%, respectively. Characteristics at acute HF with greater or lesser odds of stable HFpEF; (1) jugular venous distention (odds ratio [OR] 1.80, 95% confidence interval [CI] 1.13-2.87; P = .013) and pleural effusion (OR 0.45, 95% CI 0.24-0.85; P = .014) and (4), older age (1.04, 95% CI 1.01-1.08; P = .014) and tachycardia (>100 bpm) 0.52, 95% CI 0.27-1.00; P = .048). CONCLUSIONS: In patients with acute HFpEF, one-quarter met the HF definition according to Framingham criteria at ambulatory follow-up. The proportion of patients with postdischarge HFpEF was largely unaffected by additional echocardiographic or NP criteria Older age and jugular venous distention at acute presentation predicted persistent HFpEF at follow-up, whereas pleural effusion and tachycardia may yield false HFpEF diagnoses. This finding has implications for HFpEF trial design.

Heart failure in sub-Saharan Africa: review of the aetiology of heart failure and the role of point-of-care biomarker diagnostics.

Within Africa, the burden of heart failure is significant. This arises from the increase in cardiovascular disease and associated risk factors such as hypertension and diabetes, as well as causes of heart failure which are particular to sub-Saharan Africa, such as endomyocardial fibrosis. The lack of access to echocardiography and other imaging modalities, from a cost and technical perspective, combined with the predominantly rural nature of many countries with poor transport links, means that the vast majority of people never obtain an appropriate diagnosis. Similarly, research has been limited on the causes and treatment of heart failure in Africa and in particular endemic causes such as EMF and rheumatic heart disease. This review outlines the burden of heart failure in Africa and highlights the opportunity to expand diagnosis through the use of biomarkers, in particular natriuretic peptides. This builds on the success of point-of-care testing in human immunodeficiency virus and tuberculosis which have been extensively deployed in community settings in Africa.

Determining the optimal cutoff values of plasma N-terminal pro-B-type natriuretic peptide levels for the diagnosis of heart failure in children of age up to 14 years.

BACKGROUND: Plasma N-terminal fragment of pro-B-type natriuretic peptide (NT-proBNP) is a biomarker of heart failure (HF). However, the optimal cutoff value of plasma NT-proBNP for the diagnosis of HF in children is unknown. The objective of this study was to determine the appropriate cutoff value of plasma NT-proBNP for the diagnosis of HF in children ≤14 years old. METHODS AND RESULTS: Plasma NT-proBNP concentrations were detected in pediatric HF patients using standard clinical assays. Patients were stratified into 4 groups by age: 0-1 year, 1-3 years, 4-7 years, and 8-14 years. Case-matched healthy children were recruited as control subjects. HF was diagnosed with the use of the modified Ross score. The optimal cutoff value of plasma NT-proBNP for the diagnosis of HF was determined by analyzing receiver operating characteristic (ROC) curves and the resulting sensitivity, specificity, and Youden index (J). In healthy children, plasma NT-proBNP level and age were negatively correlated (r = -0.739; P < .001). In HF patients aged 0-1 year, 1-3 years, 4-7 years, and 8-14 years, respectively, areas under the ROC curves were 0.795, 0.786, 0.783, and 0.696; 95% confidence intervals were 0.689-0.901, 0.669-0.903, 0.662-0.904, and 0.487-0.905; and J values were 0.715, 0.708, 0.706, and 0.679. Optimal cutoff values of plasma NT-proBNP for the diagnosis of HF were 502 ng/L, 456 ng/L, 445 ng/L, and.355 ng/L. CONCLUSIONS: Age-stratified analysis of plasma NT-proBNP levels in children provides new parameters for diagnosing HF.

An event-driven Spike-DBN model for fault diagnosis using reward-STDP.

Deep neural networks (DNNs) have shown high accuracy in fault diagnosis, but they struggle to effectively capture changes over time in multivariate time-series data and suffer from resource consumption issues. Spike deep belief networks (spike-DBNs) address these limitations by capturing the change in time-varying signals and reducing resource consumption, but they sacrifice accuracy. To overcome these limitations, we propose integrating an event-driven approach into spike-DBNs through the Latency-Rate coding method and the reward-STDP learning rule. The encoding method enhances the event representation capability, while the learning rule focuses on the global behavior of spiking neurons triggered by events. Our proposed method not only maintains low resource consumption but also improves the fault diagnosis ability of spike-DBNs. We conducted a series of experiments to verify our model's performance, and the results demonstrate that our proposed method improves the accuracy of fault classification of manipulators and reduces learning time by nearly 76% compared to spike-CNN under the same conditions.

The Potential Role of Salivary NT-proBNP in Heart Failure.

BACKGROUND: Serum natriuretic peptides (NPs) have an established role in heart failure (HF) diagnosis. Saliva NT-proBNP that may be easily acquired has been studied little. METHODS: Ninety-nine subjects were enrolled; thirty-six obese or hypertensive with dyspnoea but no echocardiographic HF findings or raised NPs served as controls, thirteen chronic HF (CHF) patients and fifty patients with acute decompensated HF (ADHF) requiring hospital admission. Electrocardiogram, echocardiogram, 6 min walking distance (6MWD), blood and saliva samples, were acquired in all participants. RESULTS: Serum NT-proBNP ranged from 60-9000 pg/mL and saliva NT-proBNP from 0.64-93.32 pg/mL. Serum NT-proBNP was significantly higher in ADHF compared to CHF (p = 0.007) and in CHF compared to controls (p < 0.05). There was no significant difference in saliva values between ADHF and CHF, or between CHF and controls. Saliva and serum levels were positively associated only in ADHF patients (R = 0.352, p = 0.012). Serum NT-proBNP was positively associated with NYHA class (R = 0.506, p < 0.001) and inversely with 6MWD (R = -0.401, p = 0.004) in ADHF. Saliva NT-proBNP only correlated with age in ADHF patients. CONCLUSIONS: In the current study, saliva NT-proBNP correlated with serum values in ADHF patients, but could not discriminate between HF and other causes of dyspnoea. Further research is needed to explore the value of saliva NT-proBNP.

Nanopore discrimination and sensitive plasma detection of multiple natriuretic peptides: The representative biomarker of human heart failure.

Natriuretic peptides can relieve cardiovascular stress and closely related to heart failure. Besides, these peptides also have preferable interactions of binding to cellular protein receptors, and subsequently mediate various physiology actions. Hence, detection of these circulating biomarkers could be evaluated as a predictor ("Gold standard") for rapid, early diagnosis and risk stratification in heart failure. Herein, we proposed a measurement to discriminate multiple natriuretic peptides via the peptide-protein nanopore interaction. The nanopore single-molecular kinetics revealed that the strength of peptide-protein interactions was in the order of ANP > CNP > BNP, which was demonstrated by the simulated peptide structures using SWISS-MODEL. More importantly, the peptide-protein interaction analyzing also allowed us to measure the peptide linear analogs and structure damage in peptide by single-chemical bond breakup. Finally, we presented an ultra-sensitive detection of plasma natriuretic peptide using asymmetric electrolyte assay, obtaining a detection limit of ∼770 fM for BNP. At approximately, it is 1597 times lower than that of using symmetric assay (∼1.23 nM), 8 times lower than normal human level (∼6 pM), and 13 times lower than the diagnostic values (∼10.09 pM) complied in the guideline of European Society of Cardiology. That said, the designed nanopore sensor is benefit for natriuretic peptides measurement at single molecule level and demonstrates its potential for heart failure diagnosis.

Decongestion Models and Metrics in Acute Heart Failure: ESCAPE Data in the Age of the Implantable Cardiac Pressure Monitor.

The United States Food and Drug Administration restricts the use of implantable cardiac pressure monitors to patients with New York Heart Association (NYHA) class III heart failure (HF). We investigated whether single-pressure monitoring could predict survival in HF patients as part of a model constructed using data from the ESCAPE (Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness) trial. We validated survival models in 204 patients, using all-cause 180-day mortality. Two levels of model complexity were tested: 1) a simplified 1-pressure model based on pulmonary artery mean pressure ([PAM]1P) (information obtainable from an implanted intracardiac monitor alone), and 2) a pair of 5-variable risk score models based on right atrial pressure (RAP) + pulmonary capillary wedge pressure (PCWP) ([RAP+PCWP]5V) and on RAP + PAM ([RAP+PAM]5V). The more complex models used 5 dichotomous variables: a congestion index above a certain threshold value, baseline systolic blood pressure of <100 mmHg, baseline blood urea nitrogen level of ≥ 34 mg/dL, need for cardiopulmonary resuscitation or mechanical ventilation, and posttreatment NYHA class IV status. The congestion index was defined as posttreatment RAP+PCWP or posttreatment RAP+PAM, with congestion thresholds of 34 and 42 mmHg, respectively (median pulmonary catheter indwelling time, 1.9 d). The 5-variable models predicted survival with areas under the curve of 0.868 for the (RAP+PCWP)5V model and 0.827 for the (RAP+PAM)5V model, whereas the 1-pressure model predicted survival with an area under the curve of 0.718. We conclude that decongestion as determined by hemodynamic assessment predicts survival in HF patients and that it may be the final pathway for treatment benefit despite improvements in pharmacologic intervention since the ESCAPE trial.

Prognostic Value of 6-Minute Walk Distance in Patients Undergoing Percutaneous Coronary Intervention: a Veterans Affairs Prospective Study.

The 6-minute walk distance (6MWD) test is a useful prognostic tool in chronic heart failure. Its usefulness after percutaneous coronary intervention is unknown. In a prospective observational study, patients underwent a 6MWD test within 2 weeks after percutaneous coronary intervention. The primary endpoint was major adverse cardiovascular events (MACE) (death, acute coronary syndrome, and heart failure admission) at one year. Receiver operating characteristic curves and area under the curve were used to determine the 6MWD test's predictive power, and the Youden index was used to measure its effectiveness. A total of 212 patients were enrolled (98% men; mean age, 65 ± 9 yr). Major comorbidities were hypertension in 187 patients (88%), dyslipidemia in 186 (88%), and diabetes mellitus in 95 (45%). Among the 176 patients (83%) who completed the 6MWD test, the incidence of MACE at one year was 22% (acute coronary syndrome in 17%; heart failure admission in 4%; and death in 3%). The area under the curve for MACE was 0.59, and 6MWD was shorter for patients with MACE than for those without (290 vs 326 m; P=0.03). For 39 patients with previous heart failure who completed the 6MWD test, the area under the curve was 0.64 for MACE and 0.78 for heart failure admission. The 6MWD test predicted reasonably well the incidence of MACE one year after percutaneous coronary intervention. In a subgroup of patients with previous heart failure, it fared even better in predicting heart failure admission. Larger studies are needed to confirm these findings.

Catastrophic Antiphospholipid Syndrome Presenting as Congestive Heart Failure in a Patient with Thrombotic Microangiopathy.

Thrombotic microangiopathic syndromes are characterized by thrombus formation leading to microangiopathic hemolytic anemia, thrombocytopenia, and end-organ injury that most often affects the kidney and brain. Patients with thrombotic microangiopathy can also present with cardiac involvement, which has been shown to worsen their prognosis. We describe the case of a 46-year-old woman who presented with acute congestive heart failure as a manifestation of catastrophic antiphospholipid syndrome, which is characterized by rapidly progressing multiorgan involvement. Targeted therapy improved our patient's cardiomyopathy and saved her life. Increased recognition of thrombotic microangiopathy as an underlying pathophysiologic mechanism in heart failure and initiation of timely treatment may help to prevent death in patients with thrombotic microangiopathy.

Developing a disease management program for the improvement of heart failure outcomes: the do's and the don'ts.

INTRODUCTION: Heart failure is a highly prevalent condition affecting approximately 2% of people worldwide. Heart failure disease management programs (DMP) have shown a reduction in mortality and reduced hospitalization and are an established part of clinical guidelines; however, their presence is not widespread. Focusing on the application of proven therapies, patient education, diagnosis with work up of cause and easy access for clinical deterioration should be fundamental to the structure of the DMP. Multidisciplinary team care with early and timely recognition of potentially critical patients is essential, along with the inclusion of patients diagnosed in hospital as well as the community. Areas covered: The fundamental structure of a DMP along with the current gaps in evidence is outlined. Current challenges with the heart failure condition along with the current best evidence are covered. Articles were searched using MEDLINE containing the keywords; Chronic Heart Failure, Disease Management Program. We have also provided clinical opinion. Expert opinion: A multidisciplinary approach to disease management programs is essential to providing adequate care to patients. DMPs are an established part of current guidelines and should be a benchmark of treatment. Future resources should be focused on identifying patients at risk and early prevention.

Identification of Retinal Ganglion Cell Firing Patterns Using Clustering Analysis Supplied with Failure Diagnosis.

An important goal in visual neuroscience is to understand how neuronal population coding in vertebrate retina mediates the broad range of visual functions. Microelectrode arrays interface on isolated retina registers a collective measure of the spiking dynamics of retinal ganglion cells (RGCs) by probing them simultaneously and in large numbers. The recorded data stream is then processed to identify spike trains of individual RGCs by efficient and scalable spike detection and sorting routines. Most spike sorting software packages, available either commercially or as freeware, combine automated steps with judgment calls by the investigator to verify the quality of sorted spikes. This work focused on sorting spikes of RGCs into clusters using an integrated analytical platform for the data recorded during visual stimulation of wild-type mice retinas with whole field stimuli. After spike train detection, we projected each spike onto two feature spaces: a parametric space and a principal components space. We then applied clustering algorithms to sort spikes into separate clusters. To eliminate the need for human intervention, the initial clustering results were submitted to diagnostic tests that evaluated the results to detect the sources of failure in cluster assignment. This failure diagnosis formed a decision logic for diagnosable electrodes to enhance the clustering quality iteratively through rerunning the clustering algorithms. The new clustering results showed that the spike sorting accuracy was improved. Subsequently, the number of active RGCs during each whole field stimulation was found, and the light responsiveness of each RGC was identified. Our approach led to error-resilient spike sorting in both feature extraction methods; however, using parametric features led to less erroneous spike sorting compared to principal components, particularly for low signal-to-noise ratios. As our approach is reliable for retinal signal processing in response to simple visual stimuli, it could be applied to the evaluation of disrupted physiological signaling in retinal neurodegenerative diseases.

Implementation of an embedded system for real-time detection of rotor bar failures in induction motors.

In this work, the implementation of an embedded system for real-time detection of rotor bar failures in induction motor has been realized. The device is a prototype measurement device which can detect broken rotor bars on the field without any additional setup or third-party software. This study has focused to derive a new method from previous studies on diagnosing of rotor failures and developed a microcontroller based embedded measurement device. A new method which is combining Fast Fourier Transform and Grey Relational Analyses to get best diagnosis results has been developed for an embedded system within a compact and low-cost measurement device. Although, there are some computer-based techniques and motor drivers that can detect internal failures of induction motor, there is no such a measurement device that can do all process by itself.

Síndrome de Alport: una genómica para tener presente

Introducción. El síndrome de Alport es una alteración heterocigótica que afecta las cadenas alfas del colágeno tipo IV, manifestándose clínicamente de forma variable principalmente por hematuria persistente. Existen diferentes manifestaciones clínicas en esta patología, encontrando casos de enfermedad renal crónica. Es crucial establecer medidas que permitan la detección oportuna disminuyendo las complicaciones. Objetivo. Describir la relación e importancia entre el síndrome de Alport y las alteraciones renales, resaltar las manifestaciones clínicas y manejo terapéutico. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed y Scielo orientada hacia artículos actualizados y relevantes en inglés o español publicados en los últimos 5 años. Se evaluó a relación entre el síndrome de Alport y la patología renal permitiendo describir importancia clínica, diagnóstico y tratamiento. Resultados. Diferentes estudios evidencian la relación directa entre el síndrome de Alport y la disfunción renal asociado a procesos inflamatorios crónicos. El tratamiento no está estandarizado, pero se encuentra dirigido al bloqueo del sistema renina-angiotensina aldosterona. Se deben continuar los estudios evaluando el desenlace de la afectación renal asociada a esta patología. Conclusiones. El síndrome de Alport es una causa importante de disfunción renal, primordialmente si no se asocia a un tratamiento; por lo cual, es importante realizar un diagnóstico oportuno mediante la sospecha inicial, diagnóstico diferencial y abordaje adecuado partiendo del reconocimiento clínico de esta entidad asociada con el deterioro de la función renal

Introduction. Alport syndrome is a heterozygous alteration that affects the alpha chains of type IV collagen, manifesting itself clinically in a variable manner, mainly by persistent hematuria. There are different clinical manifestations in this pathology, fnding cases of chronic renal disease. It is crucial to establish measures that allow timely detection, thus reducing complications. Objective. To describe the relationship and importance between Alport syndrome and renal alterations, highlight the clinical manifestations and therapeutic management. Methods. A literature search was performed in PubMed and Scielo databases oriented towards updated and relevant articles in English or Spanish published in the last 5 years. The relationship between Alport syndrome and renal pathology was evaluated to describe clinical signifcance, diagnosis and treatment. Results. Different studies show a direct relationship between Alport syndrome and renal dysfunction associated with chronic inflammatory processes. The treatment is not standardized, but is aimed at blocking the renin-angiotensin-aldosterone system. Studies should continue to evaluate the outcome of renal involvement associated with this pathology. Conclusions. Alport syndrome is an important cause of renal dysfunction, especially if it is not associated with treatment; therefore, it is important to make a timely diagnosis through initial suspicion, differential diagnosis and appropriate approach based on the clinical recognition of this entity associated with the deterioration of renal function

Introdução. A síndrome de Alport é uma desordem heterozigótica que afeta as cadeias alfa do colágeno tipo IV. afeta as cadeias alfa do colágeno tipo IV, manifestando-se clinicamente de forma variável, principalmente pela hematúria persistente. Existem diferentes manifestações clínicas desta patologia, incluindo casos de doença renal crônica. É crucial estabelecer medidas que permitam a detecção oportuna e reduzam as complicações. Objetivo. Para descrever a relação e a importância entre a síndrome de Alport e as alterações renais, destacar as manifestações clínicas e o manejo terapêutico. Métodos. Foi realizada uma pesquisa bibliográfica nas bases de dados PubMed e Scielo, orientada para artigos atualizados e relevantes em inglês ou espanhol publicados nos últimos 5 anos. A relação entre a síndrome de Alport e a patologia renal foi avaliada para descrever seu significado clínico, diagnóstico e tratamento. Resultados. Diferentes estudos mostram uma relação direta entre a síndrome de Alport e as disfunções renais associadas aos processos inflamatórios crônicos. O tratamento não é padronizado, mas visa bloquear o sistema renina-angiotensina aldosterona. Outros estudos devem continuar a avaliar o resultado do envolvimento renal associado a esta patologia. Conclusões. A síndrome de Alport é uma causa importante de disfunção renal, especialmente se não associada ao tratamento; portanto, é importante fazer um diagnóstico oportuno através da suspeita inicial, diagnóstico diferencial e abordagem apropriada baseada no reconhecimento clínico desta entidade associada à função renal prejudicada

Creep-Fatigue Failure Diagnosis.

Failure diagnosis invariably involves consideration of both associated material condition and the results of a mechanical analysis of prior operating history. This Review focuses on these aspects with particular reference to creep-fatigue failure diagnosis. Creep-fatigue cracking can be due to a spectrum of loading conditions ranging from pure cyclic to mainly steady loading with infrequent off-load transients. These require a range of mechanical analysis approaches, a number of which are reviewed. The microstructural information revealing material condition can vary with alloy class. In practice, the detail of the consequent cracking mechanism(s) can be camouflaged by oxidation at high temperatures, although the presence of oxide on fracture surfaces can be used to date events leading to failure. Routine laboratory specimen post-test examination is strongly recommended to characterise the detail of deformation and damage accumulation under known and well-controlled loading conditions to improve the effectiveness and efficiency of failure diagnosis.

Improving care for patients with acute heart failure: before, during and after hospitalization.

Acute heart failure (AHF) is a common and serious condition that contributes to about 5% of all emergency hospital admissions in Europe and the USA. Here, we present the recommendations from structured discussions among an author group of AHF experts in 2013. The epidemiology of AHF and current practices in diagnosis, treatment, and long-term care for patients with AHF in Europe and the USA are examined. Available evidence indicates variation in the quality of care across hospitals and regions. Challenges include the need for rapid diagnosis and treatment, the heterogeneity of precipitating factors, and the typical repeated episodes of decompensation requiring admission to hospital for stabilization. In hospital, care should involve input from an expert in AHF and auditing to ensure that guidelines and protocols for treatment are implemented for all patients. A smooth transition to follow-up care is vital. Patient education programmes could have a dramatic effect on improving outcomes. Information technology should allow, where appropriate, patient telemonitoring and sharing of medical records. Where needed, access to end-of-life care and support for all patients, families, and caregivers should form part of a high-quality service. Eight evidence-based consensus policy recommendations are identified by the author group: optimize patient care transitions, improve patient education and support, provide equity of care for all patients, appoint experts to lead AHF care across disciplines, stimulate research into new therapies, develop and implement better measures of care quality, improve end-of-life care, and promote heart failure prevention.

Isolated cardiac involvement in primary amyloidosis: presenting as sick sinus syndrome and heart failure.

Cardiac amyloidosis is an infiltrative cardiomyopathy with a grave prognosis. Its clinical manifestations include restrictive cardiomyopathy, diastolic heart failure, conduction defects, and arrhythmias. Isolated cardiac involvement and significant conduction disturbances are reported very infrequently. We report a rare case of isolated cardiac involvement in primary amyloidosis, in a 76-year-old man who initially presented with sick sinus syndrome that necessitated permanent pacemaker insertion. Subsequent symptoms of heart failure led to additional evaluation, including an endomyocardial biopsy that revealed primary cardiac amyloidosis. Medical therapy improved the patient's symptoms, and he was discharged from the hospital in stable condition. In addition to discussing the patient's case, we review the relevant medical literature.