The Nerve Growth Factor (NGF) is a marker of the state of local sympathetic innervation of the myocardium. Patients with heart failure have changes in local sympathetic innervation, which must be considered when selecting therapy.

The purpose of the work: To study the effectiveness of the carvedilol (β-adrenoblocker (β-AB) with alpha blocking and antioxidant effects) and the nebivolol (drug with NO-synthesizing function) in comparison with the bisoprolol (selective β-AB without additional properties) on the functional state of the myocardium, duration of ischemia, frequency of cardiac rhythm disturbances and quality of life in elderly patients with Coronary Heart Disease (CAD) and Heart Failure with reduced Ejection Fraction (HFrEF) and different levels of NGF.

Materials and methods: Was study 72 patients at the age of 69.4 ± 7.5 years with a diagnosis of CAD: angina pectoris, II - III functional class, HFrEF II-III class NYHA. Control group - 30 patients at the age of 68.7 ± 6.5 years with a diagnosis of CAD angina pectoris, II - III functional class without HF. Depending on the level of NGF, patients were divided into 2 groups: 1 group -26 patients with a level of NGF greater than the control group (average level NGF =101.8 ± 8.2 ng/ml). 2 group consisted of 46 patients whose level of NGF was sharply reduced compared to the first and control groups (average level NGF = 17.9 ± 3.2 ng/ml). Average level NGF in control group – 65.3 ± 4.1 ng/ml. Each random sample group was divided into 2 subgroups (A and B). Patients in group 1A in addition to basic therapy received nebivolol, patients in the subgroup 2A-carvedilol. Patients in subgroups B (1B and 2B) were assigned bisoprolol as a research drug.

Results: It has been shown that the β-AR blockade promotes stabilization of the NGF in patients with CAD and HFrEF, but the use of selective β-AB bisoprolol does not restore the level of neurotrophin in individuals with significant deviations in the level of NGF. At the same time, the efficacy of β-AB with additional properties (carvedilol and nebivolol), according to the theoretical preconditions, resulted in the expected stabilization of the level of NGF and reduction of norepinephrine levels and a significant reduction in the manifestations of pathological remodeling of the left heart, reduce the duration of myocardial ischemia, the number of cardiac arrhythmias (ventricular and supraventricular extrasystoles), and quality of life in elderly patients with CAD and HFrEF.

Conclusions: The obtained data indicate that the level of NGF is a sensitive indicator for a differentiated choice of beta-blockers in patients with CAD and HFrEF. According to the results, carvedilol may be recommended as a drug of choice for patients with an NGF below 20 ng/ml; patients with a level of NGF greater than 100 ng/ ml - nebivolol.

Pericardial effusion is a rare but lethal complication of umbilical venous catheterization. We are reporting a case of preterm neonate developing pericardial effusion and tamponade in relation to umbilical venous catheter immediately after extubation which was confused as extubation failure. We are also elaborating a distinguished experience of external cardiac massage while resuscitating this baby. A gentle but ongoing cardiac compression was required to prevent bradycardia as described in this report.

Background: All guidelines by experts agree that Beta-Blockers (BB) should be used for patients with systolic heart failure (SHF) to improve survival. Despite recommendations, the dosages of BBs prescribed are frequently less than 50% of target dose. Under dosing is suggested by doses <50% of target dose and/or Sinus Rate (SR) >70 bpm. Chronic Obstructive Pulmonary Disease (COPD) is the most common reason for omitting and under-dosing BB therapy. This led to the question how patients with SHF are without COPD being treated with BBs.

Methods/Results: A retrospective chart review of SHF patients without COPD was made at the time of admission to Charleston Area Medical Center from January 1, 2010 through September 30, 2016. Dosages of BBs on admission, SR on admission and discharge, other cardiac medications, echocardiogram ejection fraction, and EKG data were recorded. Of the 144 HF patients without COPD, 124 (86.1%) were taking BBs, 69 (55.6%) carvedilol; 40 (32.2%) metoprolol succinate; 12 (9.7%) metoprolol tartrate; 3 (2.4%) other and 18(12.5%) were not taking BBs. Mean dose of carvedilol at admission was 18.7±14.8 mg (target dose 50 mg); mean dose of metoprolol succinate was 52.8±43.8mg (target dose 200 mg). Mean sinus rate (not atrial paced or atrial f ibrillation) at admission and discharge were 85.3±18.3 bpm and 76.0±16.6 bpm, respectively, for those whose BB dose did not change. 74% of patients had admission SR >70 bpm.

Conclusion: While almost all patients with diagnosed SHF are appropriately being prescribed BBs, a large percentage was not titrated up to the target doses established in the guidelines. Inappropriate dosing of BBs could potentially be responsible for worsening outcomes and overutilization of more expensive alternative treatments to adequately suppress SR.

The study of oxidative markers in an experimental model of atherogenesis induced by Hyperfibrinogenemia (HF) and Metabolic Syndrome (MS) proposes to analyze the relationship between inflammatory biomarkers and oxidative stress associated with insulin resistance to determine their involvement in ischemic vascular lesions and explain the potential pathophysiological mechanisms.

Methods: Seventy two male Wistar strain rats were divided in six groups: control (A), HF for 30 days (B) and HF for 60 days (C), rats with MS (D), HF for 30 days+MS (E) and MS+HF for 30 days (F). Induction of HF to trigger the proinflammatory process is carried out by medium and paramedian laparotomies every seven days. For induction of the metabolic syndrome fructose 10% was administered diluted in the drinking water for 6 weeks. We determined plasma levels of insulin, glucose, triglycerides, HDL, fibrinogen, L-citruline and superoxide dimustase. Statistically analysed by an ANOVA,p<0.05 level of significance.

Results: The MS group (D) showed increased insulinemia, glucose and triglycerides with respect to group (A), (B) and (C) (p<0.001). Similiar modifications showed groups (E) and (F), with insulinemia, glucose and triglycerides increased with respect to (A) (p<0.01,p<0.001 respectively). HDL significantly decreased in the groups (D), (E) and (F) compared to control (p<0.001) and groups (B) and (C) (p<0.001)

Conclusion: The potential importance of vascular wall inflammation in diseases, subclinical atherosclerosis and MS, as a therapeutic target remains an area not yet fully explored, where new knowledge on the involvement of inflammatory mediators may be relevant as the score validated risk assessment does not currently include these components, and their inclusion could assess the actual risk patients.

We aimed to determine the patterns and prevalence hypertensive complications among newly diagnosed individuals in Yaoundé. This cross-sectional study from January to April 2017 in four references hospitals of Yaoundé with newly diagnosed hypertensive (less than 6 months) patients, aged over 18 years. Qualitative variables were described as count and percentage while quantitative data were described by mean ± standard deviation. Overall, 338 patients (188 women) with a mean age of 57±12 years were included. The most frequent cardiovascular risk factors were dyslipidemia (71%), physical inactivity (69.82%) and obesity (68%). 84.6% of our sample presented at least one target organ damage at diagnosis. Stroke (mainly ischemic) was the most frequent complication found in 31.7% The increasing prevalence of hypertension in our context is associated with an important proportion of target organ damage at diagnosis.

Symptoms of acute myocardial infarction may vary and occur with manifold qualities. Due to this reason many patients may misinterpret their subjective perception. One drastic case was documented by a 69 year old patient himself, on his private typewriter starting at December 24, Christmas. Instead of consulting a physician this patient had documented his suffering in a personal diary. He handed his diary to the emergency doctor at the time of his admission. Here we would share the translation of the letter as it was written by the patient. “My stomach reacts to stress immediately and I constantly have some air-burping and swallowing difficulties. So at Christmas Eve, I felt severe oppressive pain behind my breastbone. We have had lots of fatty foods, alcohol and baked goods to eat. Due to the fact that I have had a myocardial infarction 1999 and the fact that I frequently feel angina pectoris in stressful times, I took two tablets of diazepam combined with a small glass of caraway-flavored liquor for relief. All physical complaints disappeared at first. At the third day however, the 26th of December, the pain had increased so badly that I felt like jumping out of the window because of the discomfort. At the same time my belly hardened unbelievably, as if cramping. Mucus moved up to my esophagus, my vocal chords felt coated and my tongue seemed strangely transformed, so white and covered with mucus. It was clear to me, that this was due to my stomach problems. I didn`t eat for the next two days. Furthermore I suffered from excruciating pain in both arms, in my hands and up to my ears.

Background: The non-invasive hemodynamic monitoring by photoplethysmography (PPG) stands out as it is easy to use and it can provide information on hemodynamic parameters at the bedside.

Objective: To compare the main PPG parameters with the age and hemodynamic variables in patients hospitalized in Intensive Care Units (ICUs).

Methods: A cross-sectional study was conducted in the ICU of Hospital Nossa Senhora da Conceição, located in south of Brazil. The following data was collected in the 1st 24h of hospitalization: age, Heart Rate (HR), Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), Pulse Pressure (PP), Hematocrit (Hct), and variables obtained with PPG: Perfusion Index (PI), Pleth Variability Index (PVI), Crest Time (CT), time between the systolic and diastolic peaks (?T), Augmented Index (AI), τparameter, and arterial aging (b/a). For comparison of the variables, a bivariate linear regression was performed.

Results: 190 individuals were evaluated. Most of them were male (6:5), median age 67.0 (54.0-75.0) years, main reasons for hospitalization: cardiovascular and neurological causes. With regard to PI, we observed a correlation with age (r=-0.163; p= 0.025), DBP (r=0.167; p= 0.021), MAP (r=0.171; p=0.019), and Htc (r=0.205; p=0.005). The PVI showed an association only with HR (r=0.150; p=0.038). The CT was correlated with SBP (r=0.185; p=0.011), PP (r=0.256; p<0.001), and HR (r=-0.651; p<0.001). The ?T interval showed an association only with HR (r=0.187; p=0.010). The AI was correlated with SBP (r=0.173; p=0.017), PP (r=0.195; p=0.007), and HR (r=-0.620; p<0.001). The τ parameter showed an association with SBP (r= 0.147;p= 0.043), PP (r=0.169; p=0.020), and HR (r=-0.649; p<0.001). The b/a index was correlated to age (r=0.254; p<0.001), SBP (r=0.257; p<0.001), MAP (r=0.200; p=0.006), PP (r=0.233; p=0.001), and HR (r=-0.312; p<0.001).

Conclusion: Associations were found, with plausibility in cardiovascular physiology, which allow a general view of the variables implied in the PPG. Such data can provide complementary information for hemodynamic monitoring and clinical judgment of the intensivist.