Hypereosinophilic syndrome: a rare cause of ST-elevation myocardial infarction and thrombus formation on the aortic valve.

We present a case of a man in his 30s presenting with ST-segment elevation myocardial infarction and eosinophilia. The patient underwent thrombus aspiration and initially echocardiographic evaluation was normal. The patient was discharged after 2 days, but was hospitalised again after 6 days. Echocardiographic evaluation now revealed a thrombus formation on the aortic valve. Laboratory data revealed increasing eosinophilia, and treatment with high-dosage corticosteroids and hydroxyurea was initiated as eosinophilic disease with organ manifestations could not be precluded. Eosinophils normalised and the patient was discharged again. The combination of hypereosinophilia and absence of infection, rheumatological disorders and malignancy, led to reactive or idiopathic hypereosinophilic syndrome being the most plausible diagnoses. The patient was closely monitored in the cardiology and haematology outpatient clinics. Echocardiographic evaluation, performed 6 weeks after the patient was discharged, showed significant regression in the size of the thrombus mass.

Physician-led in-hospital multidisciplinary team conferences with multiple medical specialities present - A scoping review.

Introduction: Multidisciplinary Team Conferences (MDTs) are complex interventions in the modern healthcare system and they promote a model of coordinated patient care and management. However, MDTs within chronic diseases are poorly defined. Therefore, the aim of this scoping review was to summarise the current literature on physician-led in-hospital MDTs in chronic non-malignant diseases. Method: Following the PRISMA-ScR guideline for scoping reviews, a search on MDT interventions in adult patients, with three or more medical specialties represented, was performed. Results: We identified 2790 studies, from which 8 studies were included. The majority of studies were non-randomised and focused on a single disease entity such as infective endocarditis, atrial fibrillation, IgG4-related disease, or arterial and venous thrombosis. The main reason for referral was confirmation or establishment of a diagnosis, and the MDT members were primarily from medical specialties gathered especially for the MDT. Outcomes of the included studies were grouped into process indicators and outcome indicators. Process indicators included changes in diagnostic confirmation as well as therapeutic strategy and management. All studies reporting process indicators demonstrated significant changes before and after the MDT. Conclusion: MDTs within chronic diseases appeared highly heterogeneous with respect to structure, reasons for referral, and choice of outcomes. While process indicators, such as change in diagnosis, and treatment management/plan seem improved, such have not been demonstrated through outcome indicators.

Evaluation of telemedicine in patients suspected of acute coronary syndrome at a non-invasive centre.

INTRODUCTION: The benefits of prehospital electrocardiograms (ECG) for patients with ST-elevation myocardial infarction (STEMI) are well-known. Evaluation of the present algorithm for prehospital ECG transmission is important to ensure correct and expeditious patient care. The purpose of this study was to evaluate ECGs transmitted from the prehospital setting to a non-invasive department of cardiology. METHODS: At Lillebaelt Hospital, the cardiologist on-call evaluated and entered the transmitted ECGs and the associated transmission criteria into the Clinical Measurement System database (KMS). Furthermore, data from the KMS and the diagnoses at discharge were obtained from 2012 to 2015. RESULTS: A total of 9,751 ECGs were included in the study. ECG transmission increased by 35% from year one to year three (p less-than 0.05). A total of 362 patients (3.7%) had STEMI. 25% of all ECGs were transmitted without any obvious cardiac symptom but produced a diagnosis of other cardiac illnesses than acute coronary syndrome in 28% of these patients. The number of ECGs sent per adult inhabitant in the area per year was 1:85. CONCLUSIONS: A large number of ECGs are transmitted annually and at an increasing rate, and STEMI only comprises a very limited proportion of all transmitted ECGs to a non-invasive centre in Denmark. The high number of ECGs challenge the available resources, which are limited and should be used effectively, particularly in a period characterised by increased healthcare demands. FUNDING: none. TRIAL REGISTRATION: not relevant.