[Early warning system for pulmonary fluid status monitoring in terminal XXXX ].

@entity1 @entity712 @entity390 @entity296 @entity3126 @entity1353 @entity714 @entity4 @entity1283 @entity301 @entity358 @entity1823 @entity551
HISTORY AND ADMISSION FINDINGS: A 38-year-old @entity1 was admitted for increasing @entity1353 , @entity390 and emesis during the preceding year. Clinically he was in @entity712 NYHA stage III. He had not been on any regular medication and had no other medical complaints. Physical examination revealed a pulse of 100/min., @entity551 (100/60 mmHg) and @entity1823 . Bilateral pulmonary rales were noted on auscultation. A slight @entity4 of both lower legs was noted. INVESTIGATIONS: A 12-lead electrocardiogram showed complete @entity714 with a QRS duration of 160 ms. Chest x-ray revealed @entity1283 with @entity358 . Transthoracic echocardiography demonstrated reduced left ventricular function with an ejection fraction of 10-15%. Left heart catheterization excluded @entity301 and confirmed the decreased left ventricular function. TREATMENT AND COURSE: Medical treatment for @entity712 secondary to dilated @entity296 was initiated without significant improvement in clinical status. Cardiac resynchronization therapy (CRT) was therefore performed with implantation of a biventricular pacer with defibrillator (CRT-D) and a fluid status monitoring system (OptiVol). Subsequently the @entity1 was able to increase his physical activity to NYHA class II and was followed in our outpatient clinic. Since initial treatment the @entity1 has been seen twice for clinical signs of @entity3126 . Both times the fluid monitoring system of the CRT-D gave an alarm signal early enough to allow cardiac re-compensation by expanding the current medication. Both times hospital admission was avoided. CONCLUSIONS: Cardiac resynchronization therapy has been established as an adjunct to optimal pharmacological therapy in eligible @entity1 with severe @entity712 . A fluid status monitoring system integrated into the device measures intrathoracic impedance, allowing @entity1 to be alerted before the onset of symptoms of fluid overload. Thus, treatment can be adjusted and hospitalization is avoidable.
