Mitral valve prolapse: a review of the literature

Sudden sensorineural hearing loss

Sudden sensorineural hearing loss is usually unilateral and can be associated with tinnitus and vertigo. In most cases the cause is not identified, although various infective, vascular, and immune causes have been proposed. A careful examination is needed to exclude life threatening or treatable causes such as vascular events and malignant diseases, and patients should be referred urgently for further assessment. About half of patients completely recover, usually in about 2 weeks. Many treatments are used, including corticosteroids, antiviral drugs, and vasoactive and oxygen-based treatments. Although no treatment is proven, we recommend a short course of oral high-dose corticosteroids. There is much to learn about pathogenesis of sudden sensorineural hearing loss, and more clinical trials are needed to establish evidence-based management.

Return-to-play decisions in athletes with cardiac conditions

Many sets of guidelines written by experts in their fields can assist sports medicine physicians to make return-to-play decisions for athletes with known or suspected cardiac conditions. These guidelines can be divided into pre-participation screening guidelines, such as the 2007 American Heart Association (AHA) 12-element screening examination, and specific recommendations for those with heart disease or symptoms. Several important documents fall into the latter category. Among these are the 36th Bethesda Guidelines, the European Society of Cardiology Guidelines, the AHA Consensus Document for Young People with Genetic Conditions, the Heart Rhythm Society Guidelines, and the Guidelines for Masters Athletes. Guidelines are designed to enhance the sports medicine physician's probability of detecting heart disease and making wise participation and return-to-play decisions in athletes with high-risk cardiac conditions, such as hypertrophic cardiomyopathy, anomalous coronary artery, myocarditis, and valvular heart disease. Guidelines also aid in writing exercise prescriptions for those deemed too high risk for sports participation. Because the guidelines may not be entirely consistent on all topics, or based on opinion rather than research evidence, many cases require additional input from a cardiologist or electrophysiologist. Guidelines address not only specific disease entities, but also how corrective surgery, ablations, implantable defibrillators, or drug therapy can influence return-to-play decisions. They are updated as new studies become available to provide physicians with the most up-to-date information.

Evaluating the Patient With Chest Pain

Chest pain is one of the most common presenting symptoms in healthcare settings and one of the most difficult diagnostic challenges. A comprehensive history is the cornerstone of evaluation and diagnosis and one of the most important skills in distinguishing among the many causes of chest pain. Because the differential diagnosis for chest pain ranges from conditions as minor as muscle strain to life-threatening conditions, such as an acute myocardial infarction or dissecting thoracic aortic aneurysm, the advanced practice nurse must quickly and systematically assess the patient.