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(Sales document type RK) This document proposes a new way of processing complaints and issuing credit and debit memos The document allows you to correct the quantity and or the price for one or more faulty items on an invoice Each invoice correction request is made in reference to an (mandatory) invoice (You cannot create one in reference to an order or quotation) Each invoice correction request contains two items for each item in the invoice The first item is the value and quantity copied from the invoice; this appears as the credit item The second item is the debit item, which represents the correct quantity and or value Should you change this second debit

Standard therapy for heart failure should include ACE inhibitor, -blockers, diuretics, and an aldosterone antagonist Digoxin is a second-line drug but remains favored as an adjunct by some clinicians Calcium channel blockers should generally be avoided Sodium restriction is helpful, especially in acute cardiomyopathy When atrial fibrillation is present, heart rate control is important if sinus rhythm cannot be established or maintained Many patients may now be candidates for cardiac synchronization therapy with biventricular pacing and an implantable defibrillator Few cases of cardiomyopathy are amenable to specific therapy for the underlying cause Alcohol use should be discontinued There is often marked recovery of cardiac function following a period of abstinence in alcoholic cardiomyopathy Endocrine causes (thyroid dysfunction, acromegaly, and pheochromocytoma) should be treated Immunosuppressive therapy is not indicated in chronic dilated cardiomyopathy The management of CHF is outlined in the section on heart failure

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Presents as an acute anterior myocardial infarction, but coronaries normal at cardiac catheterization ECG often with deep anterior T wave inversion Imaging reveals apical left ventricular ballooning due to anteroapical stunning of the myocardium

LV apical ballooning can follow a high catecholamine stress The resulting shape of the LV suggests a rounded ampulla form similar to an octopus pot (takotsubo pot) The acute myocardial injury that occurs is more common in postmenopausal women It has been described following some stressful event, such as hypoglycemic, lightning strikes, earthquakes, postventricular tachycardia, during alcohol withdrawal, following surgery, during hyperthyroidism, and following emotional stress

The symptoms are similar to any acute coronary syndrome Typical angina and dyspnea is usually present Syncope is rare

The prognosis of dilated cardiomyopathy without clinical heart failure is variable, with some patients remaining stable, some deteriorating gradually, and others declining rapidly Once heart failure is manifest, the natural history is similar to that of other causes of heart failure, with an annual mortality around 11 13% Arterial and pulmonary emboli are more common in dilated cardiomyopathy than in ischemic cardiomyopathy Suitable candidates may benefit from long-term anticoagulation, and all patients with atrial fibrillation should be so treated Some patients may be candidates for cardiac transplantation

Ardehali H et al Endomyocardial biopsy plays a role in diagnosing patients with unexplained cardiomyopathy Am Heart J 2004 May;147(5):919 23 [PMID: 15131552] Burkett EL et al Clinical and genetic issues in familial dilated cardiomyopathy J Am Coll Cardiol 2005 Apr 5;45(7):969 81 [PMID: 15808750] Felker GM et al Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy N Engl J Med 2000 Apr 13;342(15):1077 84 [PMID: 10760308] Maisch B et al Dilated cardiomyopathies as a cause of congestive heart failure Herz 2002 Mar;27(2):113 34 [PMID: 12025458] Sen-Chowdhry S et al Arrhythmogenic right ventricular cardiomyopathy: clinical presentation, diagnosis, and management Am J Med 2004 Nov 1;117(9):685 95 [PMID: 15501207]

The ECG reveals ST segment elevation consistent with an acute myocardial infarction The chest radiograph is either normal or reveals pulmonary congestion

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