La Revue du praticien
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Unstable angina is the first diagnosis to consider in a patient with transient chest pain; if managed in the setting of a coronary care unit, this condition leads to myocardial infarction in less than 5% of patients. Conversely half of acute myocardial infarctions have been heralded by unrecognised unstable anginal; thus a good proportion of the 120,000 infarctions occurring yearly in France could be avoided. Pre-hospital diagnosis is based on chest pain characterisation since physical examination and electrocardiogram are usually normal when the patient is pain free. The major concern being to avoid underdiagnosis, sensitivity is in this setting more important than specificity the patient should be hospitalised whenever a reasonable doubt exists.
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Out-of-hospital cardiac arrest remains a clinical problem with a survival rate of less than 5%. Prompt initiation of cardiopulmonary resuscitation and rapid delivery of advanced cardiac-life procedures are required. ⋯ Accurate diagnosis by immediate coronary angiography can be followed if necessary by coronary angioplasty. Survivors undergo extensive work-up to determine the indications of an implantable defibrillator or coronary revascularization.
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Sarcoidosis is a multisystem granulomatous disease, of unknown cause, characterised by non-caseating granulomas. The most common organs involved are the lung, thoracic lymph nodes, skin and eyes. ⋯ The non specific ocular manifestations of the disease make it as a difficult diagnosis. The "suspected sarcoidosis" diagnosis is made with regards to clinical, radiological and (or) biological criteria and the "definitive diagnosis" require the demonstration of a non-caseating, granulomatous, non-infectious inflammation process on biopsy.