[Progressive respiratory failure and weakness in a 61-year-old woman]. / Progrediente Luftnot und Schwäche bei einer 61-jährigen Patientin.

A 61-year-old woman was admitted with a suspected diagnosis of atypical pneumonia. Extended diagnostic measures revealed interstitial lung disease (ILD), polyserositis, polyarthritis and myopathy. With detection of an antibody against PL-7 (anti-threonyl-transfer-RNA synthetase) the diagnosis of anti-synthetase syndrome (ASS) was established. ASS are rare inflammatory myopathies which frequently present as multisystemic diseases with severe organ involvement. An immunosuppressive regimen with steroids and cyclophosphamide led to successful induction of disease remission. Maintenance therapy will be conducted with azathioprine. ASS should always be considered in the differential diagnosis of myopathies and ILDs.

Emotional attitudes toward symptoms and inadequate coping strategies are major determinants of patient delay in acute myocardial infarction.

BACKGROUND: Early reperfusion treatment in acute myocardial infarction (AMI) preserves ventricular function and saves lives. After onset of AMI symptoms, patients often delay for hours until the decision to seek medical help. AIM: Of the MI-heart (Myocardial Infarction--HElp seeking And ReacTions) study was to identify factors determining patient decision delay. METHODS: 739 consecutive patients with confirmed AMI (median age 65.3 years, 30.2% females) were studied after transfer from the intensive care unit. A standardized interview covered AMI symptoms, attitudes toward symptoms, coping strategies, and clinical and sociodemographic variables. RESULTS: Of patients, 93.3% knew an AMI could be deadly. 43.9% of the patients who suspected an AMI, and knew it could be deadly, decided late (> 1 hour) to seek medical help. In univariate analyses, attitudes toward symptoms and coping strategies had the highest impact on a late decision. Stepwise logistic regression identified the following independent contributors to a late decision to seek medical help (relative risk, 95% confidence interval): wanting to wait and see (3.53; 2.32-5.39), not taking symptoms seriously (2.47; 1.64-3.72), not wanting to bother anybody (2.14; 1.29-3.57), symptoms improving at first (2.33; 1.52-3.56), asking others for advice (0.46; 0.30-0.71), taking pain medication (2.01; 1.01-4.03), age > 65 years (1.69; 1.17-2.44), very strong intensity of angina (0.60; 0.42-0.87). CONCLUSIONS: Emotional attitudes to AMI symptoms and inadequate coping strategies are the major determinants of patient decision delay. They should be considered as a key factor in patient and public education. Modification of these emotional factors might best be achieved by an individualized approach.