Endomyocardial biopsy in patients with cardiomyopathy of unknown origin: does specialized center experience apply to a tertiary care hospital?

BACKGROUND: In patients with cardiomyopathy of unknown origin, endomyocardial biopsy provides the possibility of improved diagnosis and tailored treatment. Specific guidance has been developed based on cardiovascular centre of excellence experience but it is unknown if the benefits also extend into the tertiary care hospital setting. METHODS: Endomyocardial biopsies was performed in patients with cardiomyopathy of unknown origin. The outcomes were mirrored against the current ESC recommendations. RESULTS: A total of 57 patients with cardiomyopathy of unknown origin underwent endomyocardial biopsy with a mean age of 54 years and 28 % being women. In 17 patients (30 %), viruses were detected in the biopsy material, in 6 patients (11 %) cardiac amyloidosis was found of which 3 had also a positive test for viruses. The overall mortality rate was 18 % in the mean follow up period of 30 months, with a rate of 24 % in those with virus detection (mean FU 24 months) and 15 % in those without virus detection (mean FU 31 months. Death rates were 83 % in patients with cardiac amyloidosis (mean FU 10 months). CONCLUSION: We conclude that, limited by uncertainty stemming from the small number of included patients, endomyocardial biopsy may not prove to have a clinical impact on treatment decisions and outcomes in a tertiary care hospital setting. We consider cardiac amyloidosis to be an exception, since the mortality rate with or without concomitant virus load was extremely high.

[Prinzmetal angina after licorice consumption]. / Prinzmetal-Angina nach Lakritz-Konsum.

Medical history | We report on a 44-year-old patient with recurrent thoracic pain occurring 4 months apart. The patient complained about intense thoracic pain and acute dyspnoea in the morning. In the course of the second presentation the anamnesis revealed that the previous day the patient had consumed an entire bag of licorice (200 g). Investigations | The blood pressure was 90/65 mmHg, heart rate 68 beats / min. Neither the performed ECG nor the transthoracic echocardiography showed abnormalities. The blood tests revealed elevated troponin levels only. No coronary artery stenosis was evident on left heart catheterization. After 4 months- the symptoms reappeared- the blood pressure was 110/50 mmHg. An ECG showed infarct-typical ST elevations. The performed coronary angiography showed no stenosis or embolism. Intracoronary nitro administration resulted in significant vasodilatation. After 6 hours in the control- ECG the ST elevations were missing. We diagnosed a Prinzmetal angina. Treatment and course | The patient was given advice not to consume licorice in the future. Her medication was adjusted to 2.5 mg amlodipine per day. There has been no further presentation with similar symptoms since then. Conclusion | Case reports provide evidence of unknown potential side- effects concerning well-known medical plants or substances. It is already known that the ingredients of licorice may induce hypertension. Potential spastic reactions, such as a Prinzmetal angina, due to the possible cardiac effects caused by glycyrrhizin and glycyrrhetinic acid are rare side effects of licorice ingestion.

Substantial increase in incidence of severe hypoglycemia between 1997-2000 and 2007-2010: a German longitudinal population-based study.

OBJECTIVE: To compare the incidences of severe hypoglycemia and corresponding clinical circumstances in a German population between 2007-2010 and 1997-2000. RESEARCH DESIGN AND METHODS: A screening for severe hypoglycemia was performed in the Lippe-Detmold area in Germany to sensitively detect severe hypoglycemia. This was defined as a symptomatic event requiring treatment with intravenous glucose and being confirmed by a blood glucose measurement of <50 mg/dL. RESULTS: Severe hypoglycemia increased considerably from 264 events in 1997-2000 to 495 events in 2007-2010, which translated into an increase in frequency of severe hypoglycemia among all emergency admissions from 0.68 to 0.83% (P = 0.015). This was mostly related to intensification of antihyperglycemic therapy, particularly in the increasingly morbid group of hypoglycemic patients with type 2 diabetes indicated by lower HbA(1c), more comedication (3.3 vs. 7.7 drugs), and more concomitant diseases (3.6 vs. 4.4) (all P values <0.001). CONCLUSIONS: Within a 10-year period, there was an intensification of antihyperglycemic therapy in increasingly comorbid subjects, leading to a considerably higher incidence of severe hypoglycemia.