Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · Apr 2008
[Electrocardiographic changes in patients presenting with an acute coronary syndrome: "apical ballooning" versus anterior myocardial infarction].
Transient left ventricular (LV) apical ballooning (AB) is characterized by chest pain, electrocardiographic (ECG) changes and LV apical akinesia mimicking anterior myocardial infarction (AMI) in the absence of coronary artery disease. This study aimed to assess if the ECG could reliably differentiate between these two syndromes with a similar clinical presentation. ⋯ ECG findings in AB patients are significantly different from those in AMI patients. At initial presentation, the extent of ST-segment elevation and the number of abnormal Q waves are greater in AMI. During follow-up, no Q wave, a longer QTc interval and a greater extent of T-wave inversion are typical findings in AB patients.
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Thyroid storm or thyrotoxic crisis is a rare but life-threatening condition requiring immediate treatment, preferably in an intensive care unit. Its incidence is about 1-2% among patients with overt hyperthyroidism. A thyrotoxic crisis occurs predominantly in the elderly and is three to five times more common in women than in men. ⋯ Medical treatment is based on three principles: 1) counteracting the peripheral effects of thyroid hormones; 2) inhibition of thyroid hormone synthesis; and 3) treatment of systemic complications. These measures should bring about clinical improvement within 12-24 hours. If death occurs it is most likely to be cardiopulmonary failure, particularly in the elderly.
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Apart from pregnancy-related ascending and hematogenous infections, non-pregnancy-associated may be a potential thread for pregnant women as well as for their unborn children. Infections are one of the causes of abortion during the first trimester, whereas during second and third trimester, they represent the primary cause of preterm birth. Both pregnant women and their physicians may feel profoundly uncertain with regards to appropriate treatment. ⋯ Glycopeptide and aminoglycoside antibiotics should be reserved for life-threatening maternal infections refractory to other antibiotics. Tetracyclins may only be used before the 12 (th) week of gestation. Quinolones should be strictly avoided due to potential toxicity for the unborn children.