Consensus on improving the comprehensive care of patients with acute heart failure

The latest acute heart failure consensus document from the Spanish Society of Cardiology, Spanish Society of Internal Medicine, and Spanish Society of Emergency Medicine was published in 2015, which made an update covering the main novelties regarding acute heart failure from the last few years necessary. These include publication of updated European guidelines on heart failure in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding acute heart failure such as early treatment, intermittent treatment, advanced heart failure, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to acute heart failure and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.

Consensus on improving the comprehensive care of patients with acute heart failure

The latest acute heart failure (AHF) consensus document from the Spanish Society of Cardiology (SEC, for its initials in Spanish), Spanish Society of Internal Medicine (SEMI), and Spanish Society of Emergency Medicine (SEMES) was published in 2015, which made an update covering the main novelties regarding AHF from the last few years necessary. These include publication of updated European guidelines on HF in 2016, new studies on the pharmacological treatment of patients during hospitalization, and other recent developments regarding AHF such as early treatment, intermittent treatment, advanced HF, and refractory congestion. This consensus document was drafted with the aim of updating all aspects related to AHF and to create a document that comprehensively describes the diagnosis, treatment, and management of this disease.

Hyponatraemia and congestive heart failure refractory to diuretic treatment. Utility of tolvaptan

Heart failure (HF) is currently one of the most significant healthcare problems in Spain and has a continuously increasing prevalence. Advances in our understanding of the various biological responses that promote cardiac remodelling and pulmonary venous congestion constitute the basis of current treatment. This article, prepared by members of the HF groups of the Spanish Society of Cardiology and the Spanish Society of Internal Medicine, discusses the current therapeutic strategies for patients with congestion refractory to diuretic treatment. The article includes our clinical experience with the use of tolvaptan as an additional treatment for congestion associated with hyponatraemia. To this end, we propose an algorithm for the use of tolvaptan in patients with congestive HF, natraemia <130mEq/l and poor response to conventional diuretic treatment.

[Functional mitral regurgitation. Physiopathology and impact of medical therapy and surgical techniques for left ventricle reduction]

Functional mitral regurgitation is frequently observed in the setting of left ventricular dyfunction. This finding is a marker of poor outcome in patients with either ischemic or dilated cardiomyopathy. The mechanism accounting for this phenomenon is an altered balance of tethering versus coapting forces acting on the mitral valves in the failing heart. Tethering forces represent an anomalous tension on the mitral valves due to displacement of mitral valve attachments secondary to increased left ventricular chamber sphericity associated with systolic ventricular dysfunction. On the other hand, coapting forces are weak and unable to counteract the abnormal tension acting on the mitral valve, which restricts closure and leads to regurgitation. Vasodilators and inotropic drugs are effective in the management of functional mitral regurgitation. Although partial left ventriculectomy or Batista's procedure is still investigational, this new technique seems to provide an optimal control of functional mitral regurgitation and improve functional capacity and survival of some patients with heart failure.

Free amino acids in preterm and term milk from mothers delivering appropriate- or small-for-gestational-age infants

Free amino acids were quantitated in human milk collected during the first month postpartum from mothers of appropriate preterm (26-32 and 33-36 wk gestation) and term (small or appropriate-for-gestational-age) infants. Glutamic acid and taurine were the most abundant amino acids in all four groups at all stages of lactation. The ratio of essential to nonessential amino acids was higher in colostrum than in mature milk although the total amino acid level of mature milk was double that of the colostrum. Nonprotein amino acids amount to approximately 40% of the free-amino acid pool in colostrum. Differences in the content and changes in free-amino acid levels during lactation among the groups were observed.

Bile salt-stimulated lipase activity in human colostrum from mothers of infants of different gestational age and birthweight

The bile salt-stimulated lipase (BSSL) activity was measured in milk collected at 3-4 days postpartum (colostrum) from 36 mothers divided into three groups according to gestational age and birthweight of their infants. BSSL activity changed with the length of gestation. Preterm colostrum presented a mean activity significantly higher than the term groups (small-for-gestational age and appropriate-for-gestational age) which had similar values. The ratio of BSSL activity to the estimated fat content was 6.33 in colostrum of mothers who delivered preterm and 4.20 in colostrum of both groups of term mothers. These data suggest that preterm colostrum has a higher fat digesting potential than term colostrum and that it is the gestational age rather than the adequacy or non-adequacy of birthweight to gestational age that may influence the BSSL activity.

Proteins in preterm and term milk from mothers delivering appropriate or small-for-gestational age infants

The concentrations of total protein, secretory immunoglobulin A (IgA), lactotransferrin (LTF) and serum albumin (SA) were measured in sequential samples of colostrum, transitional and mature milk from 53 mothers divided into four groups according to gestational age and birthweight of their infants. Individual proteins were determined by single radial immunodiffusion. From the covariance analysis of data controlling for the day of lactation and the milk volume it was found that these covariables were significantly negative correlated with total protein and IgA. The concentration of LTF was also significantly negative correlated with the day but positively with the volume; whereas the contrary occurs for SA although the correlation was not significant for the volume. Differences in the total protein and IgA contents have been found among the mothers. The LTF content varied among the groups. Mean protein contents did not change in a similar way in all groups during lactation. Preterm milk maintained a more constant level of proteins.

[Ovarian intestial syndrome. (authors transl)]

Authors report the case of a newborn with a sudden picture of abdominal distension, bilious vomiting and blood stools due to a twisted ovarian cyst with ileal volvulus. Patient cured after surgical excision of both ovary and necrotic bowel. A high perinatal gonadotrophic activity could be at the origin of neonatal ovarian cycts. Association with ileal volvulus seems to have been reported only in three other instances.