Variability of door-to-device times at a rural tertiary care center.

Objectives: Target door-to-device (DTD) time for ST-elevation myocardial infarction (STEMI) patients has been 90 minutes, with no distinction between urban and rural hospitals. Rural hospitals have longer DTD times for transferred patients attributed to long transportation times from referring hospitals. Longer DTD times have also been reported during after-hours.

Stiff heart syndrome.

Isolated cardiac amyloidosis, or "Stiff Heart Syndrome," is a rare manifestation of amyloidosis. Some degree of cardiac amyloid deposition is common in elderly patients, as reported in prior post-mortem studies; however, isolated cardiac involvement with predominantly cardiac symptoms and no evidence of systemic disease is a rare presentation. Establishing the correct diagnosis, even with the use of extensive testing including amyloid typing, understanding the clinical significance, and management can be challenging in such cases.

The secret behind profuse bleeding following a routine skin biopsy.

A 73-year-old man underwent a facial skin biopsy, after which he experienced persistent, severe bleeding over a 4-day period that could not be staunched by suturing or cauterization. Patient history suggested a bleeding diathesis. A condition of chronic disseminated intravascular coagulation (DIC) that decompensated into an acute state of DIC subsequent to the biopsy was diagnosed based on laboratory findings.