Lyme carditis--diagnosis, treatment and prognosis.

BACKGROUND: There are 60,000 to 100,000 new cases of borreliosis in Germany each year. This infectious disease most commonly affects the skin, joints, and nervous system. Lyme carditis is a rare manifestation with potentially lethal complications. METHODS: This review is based on selected publications on the clinical manifestations, diagnosis, and treatment of Lyme carditis, and on the authors' scientific and clinical experience. RESULTS: Lyme carditis is seen in 4% to 10% of all patients with Lyme borreliosis. Whenever the clinical suspicion of Lyme carditis arises, an ECG is mandatory for the detection or exclusion of an atrioventricular conduction block. Patients with a PQ interval longer than 300 ms need continuous ECG monitoring. 90% of patients with Lyme carditis develop cardiac conduction abnormalities, and 60% develop signs of perimyocarditis. Borrelia serology (ELISA) may still be negative in the early phase of the condition, but is always positive in later phases. Cardiac MRI can be used to confirm the diagnosis and to monitor the patient's subsequent course. The treatment of choice is with antibiotics, preferably ceftriaxone. The cardiac conduction disturbances are usually reversible, and the implantation of a permanent pacemaker is only exceptionally necessary. There is no clear evidence at present for an association between borreliosis and the later development of a dilated cardiomyopathy. When Lyme carditis is treated according to the current guidelines, its prognosis is highly favorable. CONCLUSION: Lyme carditis is among the rarer manifestations of Lyme borreliosis but must nevertheless be considered prominently in differential diagnosis because of the potentially severe cardiac arrhythmias that it can cause.

No evidence for involvement of prothrombotic platelet receptor polymorphisms in acute coronary stent thrombosis.

Polymorphisms of receptors involved in platelet adhesion and aggregation modulate platelet thrombogenicity and were found to predispose to premature arterial thromboses in individuals at risk. In our current study, we assessed the potential relevance of prothrombotic platelet receptor polymorphisms for the pathogenesis of acute coronary stent thrombosis. Comparing the genotype prevalences of respective polymorphisms in patients with acute coronary stent thrombosis and healthy control subjects, our data do not indicate an increased risk of carriers of prothrombotic variants of platelet receptors for this complication. Other factors such as the remodelling process and antiplatelet medication appear to be more relevant in this clinical setting. Along with our findings, screening for respective polymorphisms for risk assessment prior to coronary stenting is not indicated.

[Foundation of a Health Care Ethics Committee (HEC) in a nonconfessional hospital. Initial experiences and prospects of the future]. / Etablierung eines Klinischen Ethikkomitees an einem nichtkonfessionellen Schwerpunktklinikum: Erste Erfahrungen und Perspektiven.

BACKGROUND: Whereas Health Care Ethics Committees (HECs) are well established in the USA, they are still an exception in Germany. In this study, the authors report of the implementation of an HEC at the SLK Hospital Heilbronn, Germany, and discuss the further development within the first 2 years. IMPLEMENTATION AND PROJECTS: After a 1-year preparatory period the official establishment of the HEC followed in March 2004. The hospital management was implicated in the implementation from the beginning. 17 HEC members were recruited proportionally to the own four hospital locations. An ethics forum existing besides the HEC represents an institution open to all clinic employees. After training of moderators with a specially developed training concept, an individual case consultation was established. In a next step, working groups were founded for the projects "advance directive", "dying in hospital", "limitation of treatment" and "patient advocate" in order to develop guidelines. Education in ethics is offered in the ethics forum. CONCLUSION: This report elucidates that a great readiness of committee members and a tight integration of the clinic management are essential for a successful establishment of an HEC. The structure converted within the authors' HEC permits a discussion of ethical problems beyond existing hierarchies and occupational groups. In this new institution the authors see a great potential for improvement in dealing with ethical problems within the hospital.

[Spontaneous coronary spasm as a rare cause of survived sudden cardiac death]. / Spontaner Koronarspasmus als seltene Ursache eines überlebten plötzlichen Herztodes.

CASE REPORT: A 39-year-old man was admitted to our intensive care unit after successful resuscitation because of ventricular fibrillation with clinical and electrographic signs of acute myocardial infarction. Coronary angiography showed normal coronary arteries. MINC syndrome (myocardial infarction with angiographically normal coronary arteries) was due to a severe proximal spontaneous spasm of the left anterior descending artery (LAD). Intracoronary ultrasound imaging demonstrated an eccentric fibrous plaque in the proximal segment of LAD and a fibrofatty plaque distal to the spastic segment. At the time of electrophysiologic study, the patient was noninducible. After starting therapy with calcium antagonist, nitrate and molsidomine, the patient was stable and symptom-free. CONCLUSION: Coronary spasm without significant organic stenosis is an important cause of sudden cardiac arrest and MINC syndrome. Because of the good prognosis under adequate treatment, exact diagnosis is important in the prevention of sudden death.