[The physical examination - a vanishing art?] / Die klinische Untersuchung ­ ein Auslaufmodell?

This report describes the case of a 63-year-old female patient who presented with progressive dyspnea to a specialized internal medicine practice. Prior consultations with her primary care physician and a cardiologist followed by hospitalizations in an acute care hospital and in a specialist clinic for cardiology had not yielded a conclusive diagnosis. During the physical examination, significant bilateral lower extremity edema, as well as pronounced jugular venous distention was noted while in a seated position. This prompted further targeted diagnostic examination and testing and resulted in the final diagnosis of constrictive pericarditis of tuberculous origin.The establishment of the diagnosis is discussed in the context of increasingly technologized medical practice, where clinical skills and the significance of the patient history and physical examination are declining. In addition, we discuss the problem of less common diseases of the myo- and pericardium with primarily diastolic (constrictive or restrictive) dysfunction being overlooked in routine cardiological diagnostic procedures, with a focus on coronary heart disease, valve disorders and the impairment of systolic ventricular function ("ejection fraction").

Chloroquine cardiomyopathy - a review of the literature.

Chloroquine and hydroxychloroquine are still used for the prevention and treatment of malaria. Moreover, they are experiencing a renaissance in the long-term therapy of connective tissue diseases (particularly in systemic lupus erythematosus). They induce a lysosomal dysfunction with an accumulation of pathologic metabolic products, which can be seen in ultrastructural histology as pathognomonic cytoplasmic inclusion bodies. Due to its lower toxicity, hydroxychloroquine is the form used predominantly today. Retinopathy as a toxic result of this medication is well known. Cardiac side effects are rarely reported, but in some cases can be severe and irreversible - two cases of organ transplantation have been described in the literature. They comprise conduction disturbances (bundle-branch block, atrioventricular block) and cardiomyopathy - often with hypertrophy, restrictive physiology and congestive heart failure. As the clinical features of cardiotoxicity are unspecific, the identification and follow-up of potentially affected patients is of utmost importance. Confirming the diagnosis of this toxic storage disease requires histological examination of the myocardium in conjunction with electron microscopy. The primary clinical parameters (diagnostic criteria for this cardiomyopathy, differential diagnostics, incidence, risk factors, prognosis) as well as the diagnostic procedures are discussed against the background of the available literature.