Update orale Plättchenhemmer: Positionspapier der deutschen Gesellschaft für Kardiologie

[Cardiac causes of chest pain]

Because of the life-threatening character and a high prevalence in emergency rooms, cardiac causes are important differential diagnoses of acute chest pain with the need for rapid clarification. In this context the working diagnosis "acute coronary syndrome" (ACS) plays a major role. In a synopsis of the clinical presentation, medical history, electrocardiogram and analysis of cardiac biomarkers, ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina pectoris can be specified as entities of ACS. The treatment of ACS consists of an immediate anti-ischemic therapy, anti-thrombotic therapy and invasive coronary diagnostics with subsequent interventional or operative revascularization therapy. The timing of invasive management is essentially determined by the individual patient risk, with the exception of STEMI where interventional revascularization must be undertaken within 120 min of diagnosis. In this context the GRACE 2.0 and TIMI risk score have become established as reliable tools. Another rare but fatal cause of acute chest pain is aortic dissection. An abrupt onset of tearing and sharp chest pains, deficits in pulse as well as the presence of high-risk factors, such as advanced age, arterial hypertension, atherosclerosis, known collagenosis and previous aortic or coronary artery procedures are highly indicative for aortic dissection and additional diagnostic imaging and the highly sensitive D‑dimer should be undertaken. Additionally, inflammatory diseases, such as pericarditis and myocarditis can be associated with chest pains and mimic the character of ACS and should also be considered in the differential diagnostics.

[Transurethral resection of bladder tumors: management of complications]

As a frequent endourological procedure, transurethral resection of bladder tumors (TURB) represents a major field of activity for urological surgeons. Although TURB represents an endoscopic training procedure for urology residents, there are clear requirements for the quality of the surgical procedure as such. The knowledge of possible complications and their management are essential for urologists active in the clinical field. Bleeding complications, bladder perforation, infections and injuries to the ureteral orifice are the most frequently observed complications. This article summarizes the essential risks and complications as well as the corresponding preventive and therapeutic measures.