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Competing Interests: Disclosure The authors report no conflicts of interest in this work.

Iron deficiency (ID) occurs in up to 50% of patients with heart failure (HF). Even without presence of anaemia ID contributes to more severe symptoms, increased hospitalization and mortality. A number of randomized controlled trials demonstrated the clinical benefit of replenishment of iron stores with improvement of symptoms and fewer hospitalizations. Assessment of iron status should therefore become routine assessment in newly diagnosed and in symptomatic patients with HF. ID can be identified with simple and straightforward diagnostic steps. Assessment of Ferritin (indicating iron stores) and transferrin saturation (TSAT, indication capability to mobilise internal iron stores) are sufficient to detect ID. In this review a plain diagnostic algorithm for ID is suggested. Confounding factors for diagnosis and adequate treatment of ID in HF are discussed. A regular workup for iron deficiency parameters may benefit patients with heart failure by providing symptomatic improvements and fewer hospitalizations., (© Georg Thieme Verlag KG Stuttgart · New York.)

The IMPROVE-IT study has demonstrated a significant reduction of LDL-C when ezetimibe was given in addition to statins. Although the number of strokes and MI was reduced after 7 to 10 years of this treatment, mortality was unaffected, however. Additive ezetimibe treatment can be recommended only, if a better or longer life has been proved - which is not the case., (© Georg Thieme Verlag KG Stuttgart · New York.)

History and Admission Findings: A 70-year-old female patient was admitted with progressive dyspnea and peripheral edema. The patient had a medical history of myocardial hypertrophy, diastolic dysfunction and concomitant pulmonary hypertension (PH)., Investigations: The physical exam was suggestive of cardiac decompensation. Echocardiography showed myocardial hypertrophy, an enlarged left atrium as well as enlarged right-sided heart chambers. A prominent tricuspid regurgitation jet was present, and the estimated systolic right ventricular pressure was 65 mmHg. Invasive hemodynamic measurements showed a marked pressure elevation in the pulmonary circulation (mean PAP 51 mmHg), combined with an elevated left ventricular end-diastolic pressure (LVEDP) of 30 mmHg and a profound increase in the transpulmonary gradient (TPG, 21 mmHg)., Treatment and Course: The synopsis of these findings led to the diagnosis of postcapillary PH with a prominent precapillary involvement and cardiac decompensation. Due to signs of volume overload, an adequate diuretic therapy was initiated. The patient was recompensated and lost 7 kg of weight, which was associated with substantial clinical improvement. At invasive follow-up hemodynamic measurement, the patient's PAP was substantially decreased and almost reached normal values. The previously diagnosed precapillary involvement had disappeared., Conclusion: PH is a frequent phenomenon in patients with systolic and diastolic heart failure, and might initially appear as a combination of pre- and postcapillary involvement. The patients' volume status has a major influence on pulmonary hemodynamics. An adequate therapy of the underlying heart failure, especially an adequate diuresis, may have marked beneficial effects on pulmonary hemodynamics. Hemodynamic measurements should always be performed in compensated status., (© Georg Thieme Verlag KG Stuttgart · New York.)

Roflumilast is a new drug with innovative pharmacodynamic properties for use in patients with chronic obstructive pulmonary disease (COPD). By selective inhibition of phosphodiesterase-4 roflumilast targets inflammatory processes in COPD, with beneficial effects on smoking-induced bronchial inflammation, fibrotic remodeling, mucociliary malfunction and oxidative stress., (© Georg Thieme Verlag KG Stuttgart · New York.)

Background and Objective: The informed consent of the patient is required before any medical intervention can be done. The impact of the provided information on the subsequent knowledge of the patient is regularly questioned. In the present investigation we aimed to determine the knowledge of the patients about invasive coronary angiography (CA) after they had been optimally vs. standard vs. not at all informed., Patients and Methods: 300 consecutive patients who were admitted for planned CA were included. Of these, 150 in-patients were informed by especially trained physicians one day before CA and 50 out-patients were informed by their general practitioner or cardiologist several days before admission. 100 in-patients were included before they were informed. In a standardized interview the predefined knowledge of the patients was assessed by an independent physician before CA in previously informed patients and after hospital admission in non-informed patients., Results: The differences in knowledge between informed in- and out-patients were low. Especially their knowledge about potential complications was not different. Generally, patients could remember less serious complications better than life-threatening ones. Two previously informed patients (1 %) affirmed that they were not informed. The knowledge of non-informed patients was much lower than the knowledge of patients who had been informed., Conclusion: The knowledge and remembrance of patients after having detailed information about medical interventions is limited. Optimization of the informative interview did not really improve this knowledge. In contrast to non-informed patients the provided information did, however, increase the knowledge., (© Georg Thieme Verlag KG Stuttgart · New York.)

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., (© Georg Thieme Verlag KG Stuttgart · New York.)

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., (© Georg Thieme Verlag KG Stuttgart · New York.)

Calcium is of vital importance to cardiac cell function and plays an important role in heart failure. The mechanism of calcium regulation by mitochondria is still not fully resolved. This review is focused on the function, regulation, and possible therapeutic potential of cardiac mitochondrial Ca(2+) channels., (© Georg Thieme Verlag KG Stuttgart · New York.)

Sudden loss of consciousness can be caused by syncope or epileptic seizure, which therefore requires a diagnostic work-up including cardiological and neurological examinations. Thus, in clinical practice cooperation of these two medical specialties is common and of high relevance. Seizures may lead to cardiac arrhythmia or ictal asystole, and "sudden unexpected death in epilepsy" (SUDEP) is an important field of epilepsy research. Cardiac channelopathies such as long QT syndrome may be associated with seizures, suggesting a possible link between cardiac and cerebral channelopathy. We here review in detail cardiac effects due to epileptic seizures as well as possible pathogenetic correlations between cardiac and epileptic diseases., (© Georg Thieme Verlag KG Stuttgart · New York.)

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., (© Georg Thieme Verlag KG Stuttgart · New York.)

Platelet activation plays a pivotal role in the pathogenesis of coronary artery disease. The long-term benefit of dual anti-platelet therapy with clopidogrel and aspirin is well established for patients with acute coronary syndrome and for secondary prophylaxis of coronary artery disease. This review discusses latest developments in the field of the thienopyridines. Particularly, we focus on the evidence-based use of prasugrel or prasugrel versus clopidogrel in clinical practice., (Georg Thieme Verlag KG Stuttgart, New York.)

Amiodarone, a diiodinated benzofuran derivative, is widely used for treating ventricular and supraventricular tachyarrhythmias. Amiodarone is highly lipophilic and accumulation in the liver can be 500 times higher than serum amiodarone levels. Due to a long half-life and the lipophilic properties, the stored drug is capable of damaging the liver long after the drug has been stopped. Serious liver damage can lead to acute liver failure, cirrhosis and the need for liver transplantation. In this article we describe amiodarone-induced liver dysfunction and the diagnostic and therapeutic challenges in patients on amiodarone., (Georg Thieme Verlag KG Stuttgart, New York.)

Amiodarone treatment affects thyroid status in about the half of patients. Amiodarone causes a wide spectrum of effects on the thyroid function including hypothyroidism and thyreotoxicosis. Amiodaron-induced thyroid dysfunction is the most reason for discontinuation of amiodaron therapy. In this report we describe amiodaron-induced thyroid dysfunction and the diagnostic and therapeutic challenges in such patients., (Georg Thieme Verlag KG Stuttgart. New York.)

History and Admission Findings: A 77-year-old woman suffered an ischemic stroke during an operation, which under narcosis became apparent by large variations in blood pressure. At the same time a myocardial infarction was suspected due to typical ST segment elevations and positive troponin T in the serum., Investigations and Diagnosis: The CT scan showed a right sided medial ischemic stroke. The myocardial infarction could not be confirmed by coronary angiography. Nevertheless, myocardial damage was clearly confirmed by ECG, echocardiography as well as the typical course of cardiac markers in the blood. An ischemic stroke with direct myocardial damage was diagnosed., Treatment and Course: Under conservative treatment the ECG and cardiac markers in the blood normalized. However, the contractile dysfunction in the affected cardiac segment remained., Conclusion: Patients with stroke have a high cardiac morbidity and mortality. Especially in acute stroke, cardiac pathology has been linked to an impaired central autonomic regulation. This should be considered in the diagnostic routine to identify those patients with acute stroke that would benefit from an early treatment with cardio-protective medications.

Not just since the results of ACCORD, ADVANCE and VADT were published, it is clear that lowering blood glucose alone does not reduce the cardiovascular risk of patients with type 2 diabetes. In fact, many studies also indicate that some treatment strategies may even have adverse effects. To treat type 2 diabetes appropriately, the co-morbidities such as diabetic dyslipidaemia, hypertension or nephropathy must also be taken into account. Thiazolidinediones reduce insulin resistance thus allowing to direct the treatment of type 2 diabetes towards its pathophysiologic origin. Due to their mechanism of action, thiazolidinediones not only lower blood glucose but have also beneficial effects on inflammatory and atherogenic parameters, blood pressure and microalbuminuria. Furthermore pioglitazone improves dyslipidaemia and reduces mortality, myocardial infarction and stroke in high risk patients. Effects of rosiglitazone on the cardiovascular risk are yet unclear. Numerous studies document the efficacy and safety of thiazolidinediones and provide a basis for an evidence-based therapeutic approach beyond blood glucose control.