Deutsche medizinische Wochenschrift
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The assessment of the QT interval has been an integral part of ECG interpretation since the first descriptions of long QT syndrome by Wolff in 1950 and by Jervell and Lange-Nielsen in 1957. The correct measurement of the QT interval as well as a correct interpretation of the causes and of the clinical consequences of a QT prolongation, however, may be difficult even for trained internists and cardiologists. In this review, we give an overview on physiological determinants of cardiac repolarization, its marker in the surface ECG - the QT interval -, methods to correctly assess QT interval duration, causes for pathologically prolonged QT intervals, and resulting clinical consequences. ⋯ The therapeutic approaches for LQTS are multimodal. Prevention is the basis of the therapy and includes avoiding known risk factors / and potentially QT-prolonging drugs, and a pharmacological treatment with non-selective beta blockers. According to the risk profile and to the patient's lifestyle the implantation of an ICD or a pacemaker should be considered.
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Dtsch. Med. Wochenschr. · Apr 2020
[Resuscitation - practical implementation of guidelines and standards in the hospital].
Out of hospital cardiac arrest (OHCA) requiring cardio-pulmonary resuscitation (CPR) remains a mojor public health concern. OHCA affects nearly 275 000 people in Europe annualy with more than 70 000 of those in Germany alone. It represents of the major causes of death in Europe. ⋯ Thus, optimization of the initial CPR treatment with reducing overall no-flow time (time from collaps with cardiac arrest to start of CPR) and optimization and streamlining of treatment algorithms and quality in hospitals receiving patients after cardiac arrest have been a strong focus to improve overall survival. Current guidelines suggest creation of Cardiac Arrest Centers as specialized hospitals who focus on high quality of post-resuscitation care with standardized processes and interdisciplinary treatment of patients after OHCA to establish fast, secure and effective treatment that is widely available in all regions. This article will address the relevant items to be considered in daily practice of resuscitation and post-resuscitation care for cardiac arrest.
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Dtsch. Med. Wochenschr. · Apr 2020
[Barrett Esophagus - Update of clinical management and therapy options].
Adenocarcinomas of the esophagus are very similar to those of the stomach and most likely develop in the gastric cardia, from where proliferating cells expand into the esophagus and form benign Barrett's mucosa. An additional genomic instability leads to the clonal evolution of certain cells, which can lead to the development of adenocarcinoma. ⋯ The curatively intended endoscopic resection is the standard therapy for dysplastic Barrett's metaplasia, mucosal (T1a m) and superficial submucosal (T1a sm1) adenocarcinoma. Here, cap and ligature resection as well as endoscopic submucosal dissection (ESD) represent the recommended resection techniques and, in combination with radiofrequency ablation, the therapy according to guidelines.
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Rhythm control therapy, comprising antiarrhythmic drugs, cardioversion, and AF ablation, is an important component in the management of patients with atrial fibrillation (AF). Catheter ablation for AF, mainly targeting isolation of the pulmonary veins (AF ablation), has markedly improved the effectiveness of rhythm control therapy. Rhythm control improves symptoms and quality of life in patients with symptomatic AF. ⋯ AF ablation appears to improve left ventricular function in a subset of patients. Summarized, rhythm control therapy in patients with symptomatic AF is safe and improves quality of life, including elderly patients with stroke risk factors. Further studies are needed to determine whether rhythm control therapy reduces AF-related complications while improving patient outcome with regard to prognosis.