[Cardiac myopathy due to overt hypothyroidism]. / Kardiale Myopathie bei manifester Hypothyreose.

HISTORY AND ADMISSION FINDINGS: A 51-year-old man presented with progressive tiredness, proximal muscle weakness, hair loss and weight gain for months. The patient showed mild pretibial myxedema and dry skin. Laboratory findings revealed strongly elevated cardiac enzymes as well as marked hypothyroidism. INVESTIGATIONS: The electrocardiogram, echocardiography, abdominal sonography and chest X-ray were unremarkable. Thyroid ultrasound demonstrated features of Hashimoto thyroiditis. TREATMENT AND COURSE: The findings supported the diagnosis of an overt hypothyroidism with myxedema and rhabdomyolysis. After starting levothyroxine and volume substitution laboratory parameters and clinical condition slowly normalized. CONCLUSION: Severe overt hypothyroidism may rarely present primarily as myopathy with myositis and cardiac involvement.

[Syncope--algorithms for emergency medicine]. / Synkope--Algorithmen in der Notfallmedizin.

Syncope is a common symptom in the emergency department. While most causes are benign and self-limiting not requiring extensive in-hospital evaluation, others are potentially severe. The optimal evaluation of patients with syncope follows a risk-adapted diagnostic algorithm in order to exclude life-threatening conditions and to identify those with high risk for further deterioration, such as structural heart diseases requiring further diagnostic evaluation. Low risk patients can be discharged without further extensive diagnostic work-up. This article presents an algorithm for the diagnostics of syncope in accordance with current guidelines.