Dtsch Med Wochenschr
· 2025 Aug · PMID 40763751
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Atrial fibrillation (AF) is the most common arrhythmia among patients with cardiomyopathies and cardiac channelopathies, significantly increasing the risk of thromboembolic events and heart failure. This review aims to p...Atrial fibrillation (AF) is the most common arrhythmia among patients with cardiomyopathies and cardiac channelopathies, significantly increasing the risk of thromboembolic events and heart failure. This review aims to provide an overview on the management of AF in these populations, focusing on the integration of the "AF-CARE" concept, introduced in the 2024 ESC guidelines. AF-CARE emphasizes a comprehensive approach involving rhythm and rate control, stroke prevention, and the management of comorbidities. Given the elevated thromboembolic risk, anticoagulation decisions are guided by the specific cardiomyopathy and the CHA2DS2-VA score. Recent evidence supports rhythm control as the preferred strategy over rate control for better clinical outcomes. Continuous monitoring and individualized care are recommended to optimize long-term prognosis and quality of life in these patients.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40763750
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Atrial fibrillation (AF) is the most common sustained arrhythmia and has gained increasing importance due to demographic changes. The development of AF is multifactorial, including both non-modifiable risk factors such a...Atrial fibrillation (AF) is the most common sustained arrhythmia and has gained increasing importance due to demographic changes. The development of AF is multifactorial, including both non-modifiable risk factors such as age and genetic predisposition, as well as modifiable factors like obesity and alcohol consumption. Common comorbidities include arterial hypertension, heart failure, sleep apnea syndrome, and diabetes mellitus. Current studies show that treatment of these risk factors and comorbidities prevents the progression of AF and improves the results of rhythm control therapy. Preventive measures such as weight reduction, physical activity, abstinence and controlling cardiovascular risk factors are important measures to achieve pre-defined therapy goals. Both the German and European AF-guidelines advocate for a comprehensive treatment approach, incorporating an interdisciplinary strategy that fosters collaboration across multiple specialties to effectively treat risk factors and comorbidities.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40763749
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Atrial fibrillation is the most common persistent cardiac arrhythmia in adults. It is characterized by chaotic excitation of the atria, which leads to subsequent arrhythmic ventricular excitation. Due to the high prevale...Atrial fibrillation is the most common persistent cardiac arrhythmia in adults. It is characterized by chaotic excitation of the atria, which leads to subsequent arrhythmic ventricular excitation. Due to the high prevalence of atrial fibrillation in the general population, patients with this diagnosis are found in all medical specialties. The diagnosis and treatment of atrial fibrillation are subject to a steady increase in specialist knowledge, as demonstrated by the guidelines of the European Society of Cardiology (ESC) and the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) on the diagnosis and management of atrial fibrillation in clinical practice.The two guidelines show a high degree of consistency in their recommendations for optimal evidence-based atrial fibrillation therapy, but there are also interesting differences in key aspects: atrial fibrillation screening, choice of anticoagulant, and recommendations for primary pulmonary vein isolation. Some of these recommendations are based on local conditions, such as the more frequent use of phenprocoumon over warfarin in Germany. However, some of them also represent a different interpretation of the scientific evidence. In summary, due to their textbook-like nature, both guidelines provide a good overview of the current management of atrial fibrillation patients.
Ritter P, Schönland S, Weiler M
… +4 more, Beimler J, Aus dem Siepen F, Müller-Tidow C, Hegenbart U
Dtsch Med Wochenschr
· 2025 Sep · PMID 40759168
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Systemic amyloidoses present with non-specific symptoms which lead to a wide spectrum of possible differential diagnoses. In this retrospective study we analyzed a patient cohort that was referred to the amyloidosis cent...Systemic amyloidoses present with non-specific symptoms which lead to a wide spectrum of possible differential diagnoses. In this retrospective study we analyzed a patient cohort that was referred to the amyloidosis center Heidelberg under the suspicion of amyloidosis but ultimately did not receive the diagnosis of amyloidosis after diagnostic work-up. The usefulness of differential diagnosis (DDX) generators in the diagnostic process of amyloidosis is unclear.Included in this retrospective analysis were the data of patients who were referred to the amyloidosis center between 2014 and 2020 and who did not receive the diagnosis of amyloidosis.In order to test the usefulness of the DDX-Generator, 90 patients without amyloidosis were selected from this cohort and compared to another cohort of 30 random patients with confirmed amyloidosis.The diagnosis of amyloidosis was ruled out in 351/2829 (12,4%) patients. The most frequent diagnoses were polyneuropathies (n=129/351, 36,7%) and cardiomyopathies (n=76/351, 21,7%). Plasma cell dyscrasia associated diseases were only present in 17/351 (4,8%) of patients. The cause of the disease remained unknown in 160/186 (86,0%) patients with a mean follow-up time of 34,5 months.In the non-amyloidosis cohort, the DDX generator listed amyloidosis as a possible differential diagnosis in the top 10 differential diagnoses in 25/90 (27,8%) cases.In the amyloidosis-cohort, amyloidosis was significantly more often present in the top 10 differential diagnoses (n=28/30, 93,3%,).Point of contact for patients with unknown or rare diseases are the centers for rare diseases. DDX-Generators could aid physicians to consider amyloidosis as a possible differential diagnosis.
Janssens U, Jahnke L, Deffner T
… +2 more, Nothacker M, Hoffmann F
Dtsch Med Wochenschr
· 2025 Aug · PMID 40690936
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The growing proportion of women in medical studentship and medical practice contrasts with their under-represented role in leadership positions in medical professional associations in Germany. Against this background, th...The growing proportion of women in medical studentship and medical practice contrasts with their under-represented role in leadership positions in medical professional associations in Germany. Against this background, the proportion of women in top positions of medical professional associations in Germany has been analysed.A total of 1460 individuals were counted in the analysis of the composition of the boards/presidia of the 183 professional societies. The proportion of women on the boards/executive committees was 32.6%. Of the 183 professional societies, 47 (25.7%) were led by a woman as president. 72 (39.3%) women served as vice presidents. Only 39 (21.3%) professional societies had a proportion of women on the boards/executive committees ≥50%.There is a significant imbalance of female leadership positions in medical professional associations in Germany. To address this inequality, a strategy with multiple initiatives is needed that includes both career development programmes such as mentoring and the design of congress participation to ensure a balanced gender representation.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40690935
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A 65-year-old female patient presented to the emergency department with a history of progressive bilateral leg weakness. Her medical background included arterial hypertension, morbid obesity, and nicotine abuse.On clinic...A 65-year-old female patient presented to the emergency department with a history of progressive bilateral leg weakness. Her medical background included arterial hypertension, morbid obesity, and nicotine abuse.On clinical examination, the patient exhibited flaccid paraparesis without palpable foot pulses. Subsequently, the patient developed acute hypoxemia. CT angiography revealed an acute Leriche- syndrome with complete occlusion of the abdominal aorta and iliacal vessels, along with bilateral pulmonary embolisms.Therapeutic anticoagulation was administered and emergency thrombectomy performed. The patient was managed in the intensive care unit due to cardiogenic and hypovolemic shock resulting from reperfusion syndrome and pulmonary embolism. Despite, she died from subsequent complications.Acute Leriche syndrome refers to occlusion of the aortoiliac segment. The clinical mnemonic "the 6 P's" (paresthesia, pulselessness, pallor, pain, paralysis, and prostration) aid in recognizing acute limb ischemia. Notably, a sensomotor deficit may be the sole initial symptom. Prompt revascularization is essential; however, mortality remains high due to associated complications.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40690934
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Organ donation is often the only treatment option for patients with severe, life-threatening organ insufficiencies. The precondition for organ donation in Germany is the irreversible loss of brain function (ILB). When IL...Organ donation is often the only treatment option for patients with severe, life-threatening organ insufficiencies. The precondition for organ donation in Germany is the irreversible loss of brain function (ILB). When ILB occure, multiple changes in the organism take place, including the endocrinological system. Organ-protective therapy includes all essential organ systems and, in addition to differentiated volume and catecholamine therapy, lung-protective ventilation and the maintenance of homeostasis with regard to the acid-base balance, electrolytes and also the endocrinological system. Endocrinological management is of equal importance to hemodynamic management in the context of organ-protective therapy. In some cases, endocrinological changes in severe brain damage also determine the hemodynamic situation. This means that endocrinological dysfunctions must be treated even before an ILB is diagnosed. In the most severe cerebral pathologies and then also with the onset of ILB, multiple pathophysiological changes in the endocrinological system usually take place. These changes then also require specific therapy. The changes are complex and include the dysfunction of the hypothalamic-pituitary axis and the destruction of the vagus nuclei. This results in significant endocrinological changes. This article is intended to provide a brief overview of the post-mortem changes and the possibilities of therapy in the context of organ-protective treatment of endocrinological changes prior to organ donation.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40690933
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BACKGROUND: Electrolyte disorders are among the most frequent presentations in emergency internal medicine and may represent initial manifestations of underlying endocrine disease. This review highlights the pathophysiol...BACKGROUND: Electrolyte disorders are among the most frequent presentations in emergency internal medicine and may represent initial manifestations of underlying endocrine disease. This review highlights the pathophysiological background, diagnostic strategies and therapeutic recommendations for electrolyte imbalances in endocrine emergencies. CONTENT: Hyponatremia still marks the most prevalent electrolyte disorder and may indicate underlying adrenal insufficiency, hypopituitarism, the syndrome of inappropriate antidiuresis (SIAD), or immunotherapy-induced endocrinopathies. The diagnostic evaluation includes clinical volume assessment and paired measurements of serum and urine sodium and osmolality. Acute symptomatic hyponatremia requires immediate correction using hypertonic saline, overcorrection can be avoided by using proactive or reactive desmopressin protocols. SIAD remains a diagnosis of exclusion, with fluid restriction remaining first-line therapy and osmotic agents and tolvaptan as second-line options. Hypernatremia may occur in the context of diabetes insipidus and requires careful fluid management and, in central forms, desmopressin substitution. Hypokalemia can result from hyperaldosteronism or hypercortisolism and should prompt endocrine evaluation, especially in patients with hypertension. Hypercalcemia is frequently caused by hyperparathyroidism but may also be present in thyrotoxicosis, adrenal insufficiency or due to excessive intake of cholecalciferol or lithium. CONCLUSION: Electrolyte disturbances may serve as important clinical indicators and red flags of endocrine disorders. Early recognition and targeted diagnostic and therapeutic strategies are essential to prevent life-threatening complications. This review provides a structured approach for clinicians to evaluate and manage electrolyte disorders with a focus on endocrine etiologies in acute care settings.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40690932
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Thyrotoxic crisis and myxedema coma are rare but highly life-threatening endocrinological emergencies. Both conditions require rapid clinical diagnosis and intensive care treatment, as mortality remains high despite trea...Thyrotoxic crisis and myxedema coma are rare but highly life-threatening endocrinological emergencies. Both conditions require rapid clinical diagnosis and intensive care treatment, as mortality remains high despite treatment (up to 30% in thyrotoxic crisis, up to 60% in myxedema coma). While thyrotoxic crisis is characterized by hypermetabolism with fever, tachycardia, agitation, and multiorgan failure, myxedema coma manifests as a hypometabolic state with hypothermia, bradycardia, impaired consciousness, and respiratory failure. Diagnosis is primarily based on the clinical picture; laboratory findings should not delay initiation of treatment. Both emergencies usually arise from decompensation of a known thyroid disorder under the influence of precipitating factors, the identification and treatment of which are essential. Treatment for thyrotoxic crisis includes the simultaneous administration of beta-blockers, high-dose antithyroid drugs, glucocorticoids, and intensive care support. In myxedema coma, immediate intravenous hormone replacement (L-thyroxine) and hydrocortisone administration are paramount. Interdisciplinary care and consistent follow-up treatment of the underlying disease are crucial for the prognosis.
Dtsch Med Wochenschr
· 2025 Aug · PMID 40690931
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According to long-term studies, patients with adrenal insufficiency (AI) exhibit a reduced quality of life and increased mortality. In addition to cardiovascular and malignant diseases, the risk of mortality is particula...According to long-term studies, patients with adrenal insufficiency (AI) exhibit a reduced quality of life and increased mortality. In addition to cardiovascular and malignant diseases, the risk of mortality is particularly increased by adrenal crises. Fatal adrenal crises could be completely prevented by timely intravenous or subcutaneous administration of glucocorticoids. In the case of an established diagnosis of AI, a deterioration in the general condition, gastroenteritis symptoms, exsiccosis and a clinical picture of sepsis must lead to the suspicion of an adrenal crisis. However, the diagnosis is only confirmed by the response to glucocorticoids. So-called check-point inhibitors are becoming increasingly important as a cause of AI. Therefore, AI and adrenal crises continue to pose a challenge for patients, their relatives and the treating physicians.
Genetic factors play a pivotal role in personalized care for heart failure. This article explores hereditary cardiomyopathies, a heterogeneous group of genetic heart muscle disorders, representing a major cause of heart...Genetic factors play a pivotal role in personalized care for heart failure. This article explores hereditary cardiomyopathies, a heterogeneous group of genetic heart muscle disorders, representing a major cause of heart failure. They are classified into distinct clinical phenotypes: hypertrophic (HCM), dilated (DCM), non-dilated left ventricular (NDLVC), arrhythmogenic right ventricular (ARVC), and restrictive cardiomyopathy (RCM). Diagnosis integrates a multiparametric approach, including clinical evaluation, electrocardiography, advanced imaging, and genetic testing. Genetic counselling and testing are recommended for precise subtyping, prognosis, and therapy guidance. Family cascade screening is critical due to variable penetrance and age-dependent clinical expression, identifying asymptomatic carriers and reducing follow-up burden in low-risk relatives. High-risk genotypes require individualized risk stratification, particularly for life-threatening arrhythmias and sudden cardiac death. Emerging genotype-specific strategies are advancing precision medicine.
This review provides an overview of the basic knowledge of drug pain therapy in the palliative situation. Pain is one of the main symptoms in 60 to 90% of cancer patients. Pain also develops with neurological and other d...This review provides an overview of the basic knowledge of drug pain therapy in the palliative situation. Pain is one of the main symptoms in 60 to 90% of cancer patients. Pain also develops with neurological and other diseases that occur in end-of-life situations. To address this symptom, a holistic strategy is required that encompasses all physical, psychological, social, and spiritual aspects of the multi-dimensional pain experience ("total pain" concept).Drug treatment for cancer pain has been based on a stepwise approach for many years, starting with non-opioid analgesics, followed by moderate and strong opioids. In contrast, today's pain management is determined more by the actual intensity of this aversive event.The pain assessment should be tailored to identify a nociceptive vs. a neuropathic pain component that needs to be challenged by the most appropriate drug therapies. Non-opioid analgesics are ideal substances for relieving nociceptive pain. Antidepressants and anticonvulsants reduce the intensity of new neuropathic pain. Opioids are suitable for all types of pain, but are restricted to a second-line choice. Among all opioids are Tilidine and Tramadol prodrugs, which only relieve pain after activation in the liver. Drug-drug interactions may also block this activation. Rapid release opioids should be used for break-through cancer pain. Transdermal opioid applications are recommended in case of swallowing disorders, but usually not to initiate pain control. An opioid change can be performed if side effects such as hallucinations for the selected opioid are more pronounced than the pain reduction.
Recognizing the dying phase is often a major challenge for professional carers. The associated adaption of medical and nursing measures and knowledge of options for drug and non-drug symptom control, including off-lable-...Recognizing the dying phase is often a major challenge for professional carers. The associated adaption of medical and nursing measures and knowledge of options for drug and non-drug symptom control, including off-lable-use (OLU), are the basis of care for the dying. Treating the dying also always means caring for the informal carers as a unit of care. With the help of a multi-professional team, it is possible to meet the needs of patients and their family caregivers in all dimensions of a human being. Meeting the existential needs of the dying and their relatives requires a benevolent attitude on the part of those treating them, an awareness of the importance of communication and a willingness to accept dying. When patients are preparing to die, we can take their wishes into account, such as the place of death.