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The absence of this conserved serine may be compensated by the presence of two adjacent serinyl residues in positions 3 and 4 of the catalytic motif APSS
(c) compliance to drug therapy, (d) causes of worsening like use of nonsteroidal anti-inflammatory drugs, ongoing myocardial ischemia, pulmonary emboli, systemic infection, or chronic right ventricular pacing (Alcohol abuse or binge drinking)
The invasive approach can also be offered to those who have not had a response to medical treatment
