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Street Drug, an Inotrope in Heart Failure?

Methamphetamine is one of the most commonly abused illegal stimulants and causes the release of dopamine, norepinephrine and serotonin. These neurotransmitters trigger vasospasm, causing persistent tachycardia, hypertension, and direct myocardial toxicity. Moderate usage of methamphetamine can increase cardiac output and myocardial contractility. However, larger doses can cause depression of the myocardium.
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Refractory Hypotension Caused By Prone Position in a Child Undergoing Scoliosis Corrective Surgery

We report a case of a teenager with scoliosis and pectus excavatum who developed intraoperative refractory hypotension associated with prone position during posterior surgical correction of scoliosis. In this case, it was more difficult for the anesthetists to figure out the reason leading to severe hypotension when a surgery was partially completed, because there might be many confounding factors during surgery. Furthermore, TEE was difficult to be considered to be first diagnosis choice when patient have already underwent posterior spinal fusion surgery, compared to the cases previous reported that the surgery still did not begin.
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Nutritional Aspects in Heart Failure

Heart failure (HF) is a complex clinical syndrome, of a progressive character, that has a limited prognostic factor and manifested by various extracardiac aspects. It represents a serious and growing public health problem worldwide, both for its high prevalence and the severity of its clinical manifestations, being the final common pathway of most diseases. Undernutrition is often associated with HF, especially in the later stages of the disease, and may chronically reach cardiac cachexia, a severe manifestation related to poor clinical prognosis.
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