Background: Syncope represents a common condition among the general population. It is also a frequent complaint of patients in the emergency department (ED). Pulmonary embolism (PE) considers a differential diagnosis, particularly in a case of syncope without chest pain. Study Question: What is the prevalence of PE among patients who presented an episode of syncope to the ED and among those hospitalized for syncope in a tertiary care hospital? Study Design: From January 2012 to December 2017, we conducted a prospective observational study among adult patients presenting themselves to the ED consecutively or admitted for syncope. Measures and Outcomes: Syncope and PE were defined by professional guidelines. PE was ruled out in patients who had a low pretest clinical probability, as per Wells score and a negative D-dimer assay. In other patients, computed tomography pulmonary angiography was performed. Results: Seventeen thousand eight-two patients (mean age 71.3 +/- 13.24 years) visited the ED for syncope. PE was detected in 45 patients (mean age 65.75 6 +/- 9.45 years): 4 with low risk, 26 with intermediate risk, and 15 with high risk. The prevalence of PE in those hospitalized with syncope was 11.47%, which is 45 of 392 (confidence interval 95% 8.48-15.04), and was 2.52%, 45 of 1782 (confidence interval 95% 1.8-3.3), in patients presenting with syncope to the ED. The location of the embolus was bilateral in 24 patients (53.33%), in a main pulmonary artery in 10 (22.22%), in a lobar artery in 10 (22.22%), and in a segmental artery in 1 (2.22%). Conclusions: The occurrence of syncope, if not explained otherwise, should alert one to consider PE as a differential diagnosis. PE rate, presenting as syncope, is the highest in patients with large thrombi, which is responsible for bilateral or proximal obstruction in a main or lobar pulmonary artery.

The objective was to compare short-term mortality after a first acute myocardial infarction with ST elevation (STEMI) in patients with and without diabetes mellitus (DM). Between 1.01.2000 - 31.12.2009, 1335 STEMI patients were admitted in the Baia Mare Emergency Hospital: 660 (142 DM) had no thrombolysis, 675 (136 DM) received thrombolysis. In-hospital mortality was 19.4% in the 278 DM patients and 14.3% in the 1057 non-DM patients (p=0.002). Mortality in the subgroups was different: 11.3% in the 539-thrombolysed non-DM patients, 16.5 % in the 136-DM thrombolysed patients (p=0.01) and 21.4% in 142 DM patients without thrombolysis (p<0.0001). DM patients had more failed thrombolysis, 5.8% vs. 2.1%, and more recurrent ischemia, 9.3 % vs. 4.6 %, than non-DM patients had (p=0.002). Short-term mortality after a first STEMI in DM patients is higher due to a worse clinical profile but also to a less effective myocardial reperfusion.

UNLABELLED:The epidemiological characteristics, the methods used in treating the patients, as well as the evolution of the myocardial infarction are not known in the Romanian county and municipal hospitals.MATERIAL AND METHODS:Six hundred and fifty one cases of acute myocardial infarction were retrospectively recorded in the Emergency County Hospital of Baia Mare from 1.01.1999 till 30.09.2003. Data on treatment delay, therapeutic strategies, duration of hospitalization and outcome were collected. The study was completed by a postal investigation which was carried out from the 1st of October until the 31st of December 2003. This investigation consisted in one application form (multiple choice answers were requested) which had been handed out to the patients who survived the acute episode and left the hospital.RESULTS:The first medical care took place for 60.9% of the patients in hospital. About 72% of these patients were male and the mean age was 66 +/- 12 years. The types of myocardial infarction with ST-segment elevation STE-MI represented 67%, followed by 29.5% with no ST-segment elevation NSTE-MI, and 3.5% with undetermined ECG. The maximum values of Killip class during the first 48 hours were: I in 55% of the patients, II in 23%, III in 14% and IV in 9% of them. The thrombolytic therapy was done in 31% of the patients who were recommended to receive a reperfusion treatment. During their first period in hospital, 37% of the patients had an effort test and 2.45% were transferred to a tertiary care hospital for invasive procedures. The overall median hospital stay was 9 days. The mortality in hospital was 13.6%, respectively 8.1% in the study group who received the reperfusion therapy and 15.2% among those who had followed the standard care. The results of the mail survey revealed that only 62% of the patients who answered the questionnaire (N=498) had regular cardiologic check ups and 43% underwent a treatment with beta-blockers and 12% a treatment with statins. Out of these patients 16% had a revascularization procedure that was performed in a specialised University Hospital. The overall mortality in the responder group was 35.5% with an estimate 7.5% year rate.CONCLUSIONS:The analysis of the present data and especially the rate of mortality suggest until two times higher values in comparison to the European average. These results demonstrate the fact that it is imperative to generalize the thrombolytic therapy in all the hospitals in Romania and give a wider access to the myocardial revascularization therapies.