Clinical medicine (London, England)
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Case Reports
Lesson of the month 1: Case reports of arrhythmogenic cardiomyopathies in military personnel.
In military recruits, sudden cardiac death rates have been reported as varying from 2 to 13 per 100,000 per year which are mostly related to exercise. However, the development of structural heart changes that may be associated with ventricular arrhythmias have not been reported among this cohort, despite them undergoing endurance training similar to athletes. Here, we report two cases where military personnel were found to have life-threatening cardiac arrhythmias associated with structural heart disease, highlighting the importance of early recognition and treatment of these arrhythmias.
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When travelling, patients with inflammatory bowel disease (IBD) have a higher risk of morbidity. We identified barriers to travel, specific health concerns and several areas for service improvement among patients. In total, 136 patients were given a 32-question service improvement questionnaire. ⋯ Ninety-two percent were unaware that high altitudes could precipitate flares; 27% travelled abroad to high-altitude destinations, of which 46% subsequently had flare-ups. Existing IBD travel services remain unknown such as the 'Can't wait' card (72%) and 'IBD passport' (96%). Service improvements in the IBD clinic need to be implemented to facilitate safer travel overseas.
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Widespread use of anticoagulant drugs for treatment and -prevention of thromboembolic events means it is common to encounter patients requiring reversal of anticoagulation for management of bleeding or invasive procedures. While supportive and general measures apply for patients on all agents, recent diversification in the number of licensed agents makes an understanding of drug-specific reversal strategies essential. ⋯ It is also necessary to reduce the need for reversal through correct prescribing and by employing appropriate periprocedural bridging strategies for elective and semi-elective procedures. Finally, consideration of whether and when to reintroduce an anticoagulant drug following reversal is important not only to balance bleeding and thrombotic risks for individual patients but also for timely management of discharge.