Risk stratification according to the initial electrocardiogram in patients with suspected acute myocardial infarction

Article Abstract:

In order to best prepare for the diagnosis of patients having a heart attack and related complications, over 400 patients with suspected myocardia infarction (heart attack) were categorized into low, intermediate and high risk groups according to previously developed criteria relating to the patients' electrocardiogram (ECG), which reflects the electrical activity of the heart. Compared to patients with normal ECGs, patients with positive ECGs (indicating myocardial infarction) had a three times greater risk of requiring additional treatment, a greater risk of life-threatening complications and a 14 times greater risk of having myocardial infarction. Compared to patients with abnormal ECGs, the patients with positive ECGs had nearly a two times greater risk of requiring additional treatment, a two-and-one-half times greater risk of life-threatening complications and a five times greater risk of having myocardial infarction. Assigning 'high' risk to any patient who required treatment during the initial emergency evaluation improved the ability to predict which patients were at greater risk of having myocardial infarction. Risk for the remainder of patients was assigned according to the ECG criteria, with normal ECG having low risk, abnormal ECG having intermediate risk and positive ECG having a high risk. Hospitals with a limited number of intensive care beds may be able to use these predictive guidelines for determining admissions and transfers for patients with suspected acute myocardial infarction.

Standards, Research, Analysis, Case studies, Heart attack, Electrocardiography, Health risk assessment, Emergency medicine

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Acute ulcerative proctocolitis associated with primary cytomegalovirus infection

Article Abstract:

Cytomegalovirus (CMV) is a viral agent that rarely causes clinical infection in patients with competent immune systems. If a symptom is present, it is most often mononucleosis. The clinical course of mononucleosis is usually mild but may be complicated by the presence of other conditions, such as myocarditis, vasculitis, or thrombocytopenia. There have been reports of CMV infection associated with acute ulcerative colitis, an ulcerative condition of the colon characterized by cramping abdominal pains, rectal bleeding, and loose discharges of blood, pus, and mucus in the stool. The case of a patient with ulcerative colitis and CMV infection confirmed by virus studies is reported. The 39-year-old pregnant patient was admitted to the hospital because of a spiking fever, headache, abdominal pain, and the presence of bloody diarrhea. Examination of her colon by sigmoidoscopy revealed swollen, inflamed mucosa with pus and small hemorrhages in the rectum and the sigmoid colon. The patient had a classic clinical picture of mononucleosis and primary CMV infection. The simultaneous occurrence of CMV infection and ulcerative colitis suggests a direct relationship. The importance of diagnosing CMV-related ulcerative colitis may become greater because of the possibility of treating the gastrointestinal complications with ganciclovir, as seen from the recent experience of patients with immunodeficiency syndrome and CMV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Causes of, Cytomegalovirus infections, Ulcerative colitis

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A new noninvasive management strategy for patients with suspected pulmonary embolism

Article Abstract:

Pulmonary embolism is the movement of blot clots formed elsewhere in veins into the capillary beds of the lung. Once lodged in the lung tissue, the embolism can severely affect the normal physiologic gas exchange mechanism, and death frequently results. However, not all clots in peripheral veins are associated with a high risk of pulmonary embolism. Research has demonstrated a close association between clots forming in deep peripheral veins and the development of pulmonary embolism. A new strategy has been developed to avoid unnecessary treatment of peripheral vein thrombosis, clot formation, while protecting patients from the dangers of pulmonary embolism associated with clots in the deep proximal veins. A group of 874 patients with suspected pulmonary embolism was studied for the presence of proximal vein disease. The data suggest that two types of populations are involved: those with deep vein disease who require treatment with anticoagulant drugs, and those without deep vein disease, who have an excellent prognosis without anticoagulation therapy. This classification has resulted in patient management strategies that can significantly reduce the number of patients who undergo anticoagulation therapy when pulmonary embolism is detected.

Usage, Drug therapy, Anticoagulants (Medicine), Anticoagulants, Pulmonary embolism, Thromboembolism, Blood clotting, Blood coagulation

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