Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proporti...Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF （HFrEF）, and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfimction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this dis- ease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF.展开更多
Rationale:Symmetrical peripheral gangrene is a rare acute condition triggered by several medical conditions.It needs to be recognized early and treated as an emergency.Patient’s Concern:A 40-year-old patient without ...Rationale:Symmetrical peripheral gangrene is a rare acute condition triggered by several medical conditions.It needs to be recognized early and treated as an emergency.Patient’s Concern:A 40-year-old patient without any comorbidities presented with sudden onset of pain,swelling,blistering and bluish discoloration of the fingers and toes associated with fever and constitutional symptoms.Later the fingers and toes turned dark and they were cold to touch.Diagnosis:Diagnosis of symmetrical peripheral gangrene was made and investigated.Blood culture isolated Escherichia coli indicating a possible role in the causation of symmetrical peripheral gangrene.Interventions:Patient was managed with antibiotics and anticoagulants along with supportive care.Outcomes:There was improvement in patient’s general condition along with development of gangrene demarcation line of the fingers and toes.Lessons:Awareness of this condition is needed and an early management is recommended including recognizing the cause and supportive therapy to prevent complications.展开更多
文摘Heart failure （HF） with preserved ejection fraction （HFpEF） is the most common form of HF in older adults, and is increasing in preva- lence as the population ages. Furthermore, HFpEF is increasing out of proportion to HF with reduced EF （HFrEF）, and its prognosis is worsening while that of HFrEF is improving. Despite the importance of HFpEF, our understanding of its pathophysiology is incomplete, and optimal treatment remains largely undefined. A cardinal feature of HFpEF is reduced exercise tolerance, which correlates with symptoms as well as reduced quality of life. The traditional concepts of exercise limitations have focused on central dysfimction related to poor cardiac pump function. However, the mechanisms are not exclusive to the heart and lungs, and the understanding of the pathophysiology of this dis- ease has evolved. Substantial attention has focused on defining the central versus peripheral mechanisms underlying the reduced functional capacity and exercise tolerance among patients with HF. In fact, physical training can improve exercise tolerance via peripheral adaptive mechanisms even in the absence of favorable central hemodynamic function. In addition, the drug trials performed to date in HFpEF that have focused on influencing cardiovascular function have not improved exercise capacity. This suggests that peripheral limitations may play a significant role in HF limiting exercise tolerance, a hallmark feature of HFpEF.
文摘Rationale:Symmetrical peripheral gangrene is a rare acute condition triggered by several medical conditions.It needs to be recognized early and treated as an emergency.Patient’s Concern:A 40-year-old patient without any comorbidities presented with sudden onset of pain,swelling,blistering and bluish discoloration of the fingers and toes associated with fever and constitutional symptoms.Later the fingers and toes turned dark and they were cold to touch.Diagnosis:Diagnosis of symmetrical peripheral gangrene was made and investigated.Blood culture isolated Escherichia coli indicating a possible role in the causation of symmetrical peripheral gangrene.Interventions:Patient was managed with antibiotics and anticoagulants along with supportive care.Outcomes:There was improvement in patient’s general condition along with development of gangrene demarcation line of the fingers and toes.Lessons:Awareness of this condition is needed and an early management is recommended including recognizing the cause and supportive therapy to prevent complications.
