Hyponatremia is frequently seen in patients with liver cirrhosis. The presence of hyponatremia in these patients has been shown to be associated with severe ascites, impaired kidney function, higher rates of hepatorenal syndrome, spontaneous bacterial peritonitis, and hepatic encephalopathy. The main physio pathological mechanisms involved in the occurrence of hyponatremia in patients with liver cirrhosis are systemic vasodilatation and increased secretion of antidiuretic hormone. The therapeutic management of these patients presents a series of particularities. At serum sodium values of less than 120 mEq/L or in presence of neurological symptoms associated with hyponatremia, water restriction of 1-1.5 L/day is recommended. The lack of response to this therapeutic measure, the drop in sodium values to less than 110 mEq/l, or severe hyponatremia in patients about to undergo liver transplant require the administration of hyperon saline. Other therapeutic measures that can contribute to the increase of serum sodium values include the correction of hypokalemia and the intravenous administration of albumin. The only situation in which vaptan can be administered orally remains severe hyponatremia in patients awaiting liver transplantation. Patients with liver cirrhosis and hyponatremia require careful monitoring due to the increased risk of complications and death.

Infective endocarditis (IE) is a rare condition, with high morbidity and mortality. It has an annual incidence of 3–10/100,000 of the population, with a mortality of up to 30% at 30 days. In the post pandemic period, with greater use of intravenous lines and increasing use of implantable intracardiac devices, the epidemiology of IE has changed. Staphylococcus aureus is now the most prevalent cause of IE (in most studies ~26.6% of all cases), followed by viridans group streptococci (18.7%), other streptococci (17.5%) and enterococci (10.5%). These microorganisms together account for 80–90% of all cases of endocarditis. Early clinical suspicion and a rapid diagnosis are essential to enable the correct treatment pathways to be accessed and to reduce complication and mortality rates. Impressive steps have been made since 1955, when the first guideline on IE prophylaxis, diagnosis and treatment were issued. In the current review, the aim is to detail the latest guidelines of the European Society of Cardiology (ESC) for the evaluation and management of patients with IE - new therapeutic strategies depending on the pathogen involved and the new drugs available.

Pericarditis represents the inflammation of the pericardial sac and is probably the most common disease involving the pericardium. When the fluid accumulation becomes hemodynamically significant (the effusion is large or the rate of accumulation is too fast), the fluid can compress the cardiac chambers, determining cardiac tamponade. This pathology can be isolated or a cardiac manifestation of a system disease. Pericarditis may result from infectious, non-infectious, and idiopathic etiologies. European Society of Cardiology guidelines recommend 2 out of 4 criteria for the positive diagnosis of pericarditis: chest pain, pericardial rub, ECG changes or increase of pericardial effusion. Echocardiography represents the most important imaging method in pericarditis. It is used for quantification of pericardial effusion and monitoring its evolution over time. Cardiac magnetic resonance is used in cases of unclear echocardiographic images, suspicion of myocardial involvement and in patients with multiple recurrences. The sequence – late gadolinium enhancement – of cardiac magnetic resonance has a sensitivity of 94% and can assure information about the severity of pericardial inflammation. The most important treatment in acute pericarditis is anti-inflammatory therapy, which should continue until symptom relief. Most patients recover completely. Recurrent pericarditis occurs in 30% of cases not treated adequately.

Microelements play a central role in metabolism and the maintenance of tissue function. In good health and with an adequate diet individuals will have optimal tissue levels. Trace elements are those minerals essential for normal function of the body found in quantities less than 5g. The following minerals are considered to be essential: chromium, cobalt, copper, fluoride, iodine, iron, selenium and zinc. An adequate intake of microelements is necessary to sustain metabolism and tissue function, but the excess supplements to individuals who do not need them may be harmful. Severe deficiency of trace elements may lead to a characteristic disease state which can be corrected only by supply of the deficiency micronutrient.

Gastrointestinal bleeding is one of the most common pathologies in patients who present to the emergency department, especially in those under anticoagulant or antiplatelet therapy. This therapy is fundamental in preventing and treating cardiovascular and cerebrovascular diseases in a wide spectrum of patients. When a bleeding event occurs, any anticoagulant or antiplatelet treatment should be interrupted. This interruption could significantly increase the risk of thromboembolic complications. Besides, clinicians should weight very carefully the moment and the circumstances for resuming the anticoagulant therapy depending on the severity of the bleeding, patients’ comorbidities, drug interactions, thromboembolic and hemorrhagic risks. It is a serious problem and a decision difficult to make, considering that there is a lack of clinical practice guidelines about how to approach these situations.