South Dakota medicine : the journal of the South Dakota State Medical Association
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Takotsubo cardiomyopathy, also called "broken heart" syndrome or apical ballooning syndrome, is a reversible cardiomyopathy characterized by left ventricular dysfunction and ballooning of the left ventricular apex on imaging during systole. It predominantly occurs in post-menopausal women and is commonly associated with emotional or physical stress. Patients commonly present with chest pain and electrocardiographic evidence of ST segment elevation or T-wave-mimicking acute coronary syndrome, but with an absence of angiographic evidence of obstructive coronary disease. ⋯ Near complete resolution of left ventricular wall motion dyskinesis occurs in the majority of takotsubo cardiomyopathy patients within a month. Although the prognosis is generally favorable, there are reports of complications during the acute phase, including cardiogenic shock, pulmonary edema, ventricular tachycardia, apical thrombus formation, and death. This review article will briefly discuss the epidemiology, etiology, clinical features, diagnostic evaluation, and treatment of this condition.
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Skin abscesses can be a significant source of morbidity and are frequently encountered by physicians across the country. Incision and drainage (I&D) remains the standard of care; however, significant variability exists in the treatment of abscesses after I&D. Some recent evidence has suggested that routinely performed treatment modalities may not be beneficial. We examine the available evidence investigating if I&D alone is sufficient as the sole management for the treatment of uncomplicated abscesses, specifically focusing on wound packing and post-procedural antibiotics. ⋯ Regardless of supplemental post-procedural treatment, all studies demonstrate high rates of clinical cure following I&D. While the number of studies is small, there is data to support the elimination of abscess packing and routine avoidance of antibiotics post-I&D in an immunocompetent patient; however, antibiotics should be considered in the presence of high risk features. Due to limited studies and conflicting data, we are unable to make a recommendation in support or opposition of adjunctive post-procedural packing and antibiotics in an immunocompromised patient.