Herz
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Standardization is one of the fundamental methods for quality management. Standards describe first requirements for adequate delivery of diagnostic and therapeutic services (e.g. in the format of guidelines and protocols), second they define core data sets for documentation of real clinical outcome and of process and structure quality or third they define normal values (standards in the strict sense) or thresholds for critical parameters. This standardization is increasingly performed by the professional societies in international collaboration. ⋯ In our extended concept, these deviations are in addition symmetrically used to trigger, where necessary, the process of evaluation of the guideline. The often poor acceptance of guidelines should be improved both by integrating them into daily practice and by providing a feedback to the guideline authoring committee. We conclude that standardization activities are now entering into a new era due to increased involvement of physicians, international collaboration, integrated approaches to quality management, and improved computerized tools.
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Two hundred adults who underwent surgery for congenital heart disease at our institution within a four year period were the basis for this report. Clinical data was obtained, i.e. demographic details, past medical history, physical findings, EKGs, echocardiograms, catheterization and angiography material as well as the New York Heart Association (NYHA) class. Intraoperative findings, perioperative management, complications and morbidity and mortality were assessed. ⋯ The clinical status improved from a NYHA class mean of 2.1 +/- 0.9 to 1.2 +/- 0.45 (p < 0.001). In Germany significant numbers of adults with operated and unoperated congenital heart disease do exist. Detection of these patients can be difficult due to inconspicuous murmurs or stable clinical status.
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The association between alcohol use and rhythm disturbances, particularly supraventricular tachyarrhythmias in apparently healthy people is called "holiday heart syndrome". The syndrome was first described in persons with heavy alcohol consumption, who typically presented at weekends or after holidays, but it may also occur in patients who usually drink little or no alcohol. ⋯ The holiday heart syndrome should be considered particularly as a diagnosis in patients without overt heart disease presenting with new onset atrial fibrillation. Though recurrences occur, the clinical course is benign and specific antiarrhythmic therapy is usually not warranted.
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For nitrates their efficacy in acute and chronic heart failure has to be differentiated. In acute heart failure the hemodynamic and symptomatic improvements after administration of short term nitrate therapy render this form of therapy a standard medication. ⋯ On the contrary, nitrates in chronic heart failure tend to increase the sympathetic tone which is negatively correlated to survival. Thus, nitrates are only adjunctive therapy in patients with chronic heart failure.
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Between 1975 and 1991, 5 patients were operated for traumatic tricuspid insufficiency. The patients, all male, with the age at surgery of 15 to 61 years (mean 39 years), suffered previous nonpenetrating trauma to the chest 0.1 to 23 years (mean 13.2 years) earlier. Symptoms were known for 0 to 18 years (mean 10.5 years). ⋯ One patient died early, 2 patients died late during a total follow-up of 35.3 years after 7 and 9 years, 2 patients are alive 9 and 10 years after the operation and are presently in New York Heart Association class II to III and I. Traumatic tricuspid insufficiency is a rare event, but is not infrequently overlooked for a long period of time inspite of present symptoms. Results after operative correction seem to be comparable with the results in patients following tricuspid repair or replacement for functional and organic lesions.