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Mitral regurgitation (MR) is one of the most common valvular defects in the eldery. In patients suffering from heart failure, secondary MR is common and associated with worse prognosis. Due to the usually very high operative risk these patients are immensely under-treated. This leads to an increased need for interventional treatment strategies. Until now there were no randomized data regarding the prognostic impact of interventional treatment of secondary MR. This article is supposed to sum up evidence derived from recent studies regarding this issue. Finally we will provide an outlook on catheter-based mitral valve prothesis., Competing Interests: Dr. Körber gibt an, dass kein Interessenkonflikt besteht.Prof. Pfister erhielt Reisekostenerstattung und Vortragshonorar von Abbott.Prof. Baldus hat educational grants und research grants von Abbott und Edwards erhalten., (© Georg Thieme Verlag KG Stuttgart · New York.)

The determination of the cardiac preload is still a challenge for intensive care physicians. In addition to clinical assessment, both non-invasive and invasive methods exist for evaluating fluid responsiveness. The following article demonstrates one possible approach for systematic assessment of fluid responsiveness using a practical algorithm for critical care patients., Competing Interests: C. Adler gibt an, dass kein Interessenkonflikt besteht.S. Treskatsch erhielt Honorare für Vortragstätigkeiten von Edwards, Carinopharm, Orion Pharma und Smith & Nephews.R. Pfister erhielt Honorare für Vortragstätigkeiten von Medtronic, Abbott, Orion Pharma.G. Michels erhielt Honorare für Vortragstätigkeiten von Pfizer, Novartis, Servier, Zoll, Getinge und Orion Pharma.Anmerkung: Die Interessenkonflikte stehen in keinem Zusammenhang mit der vorliegenden Arbeit., (© Georg Thieme Verlag KG Stuttgart · New York.)

History and Clinical Finding: A 76-year-old patient suffered a non-ST-elevation myocardial infarction (NSTEMI) and was admitted to our Chest Pain Unit (CPU) for further diagnostics and therapy., Examinations and Diagnosis: Coronary angiography revealed an occlusion of the right coronary artery and catheter intervention with stent implantation was performed. Due to a high thrombotic burden, application of tirofiban was initiated. In the following, the patient developed hemodynamic instability, hemoptysis and a substantial decrease of the platelet count., Therapy and Course: Tirofiban therapy was immediately stopped. Volume therapy led to hemodynamic stabilisationand hemoptysisdisappeared. Thrombocytes normalised after application of a platelet concentrate and prednisolone. One day later, the patient developed pulmonary hemorrhage with asphyxial cardiac arrest.Within the next few days, a renewed decrease of thrombocytes occurred. Despite normalization of thrombocytes after another transfusion, the patient died in consequence of a severe sepsis., Conclusions: Thrombocytopenia is a rare but potentially severe complication of tirofiban therapy. Therapeutic strategies include termination of the triggering medication, clarification of differential diagnoses and transfusion of platelet concentrates, if necessary., Competing Interests: Disclosure The authors report no conflicts of interest in this work., (© Georg Thieme Verlag KG Stuttgart · New York.)

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