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BMJ 2005; 331 doi: (Published 28 July 2005) Cite this as: BMJ 2005;331:257
  1. Alison Tonks, associate editor (

    Sharp rise in stress related cardiomyopathy after Japanese earthquakes

    In October 2004 three powerful earthquakes hit the centre of Niigata in Japan, and the aftershocks, which eventually numbered about 90, went on for weeks. A retrospective look at cardiac admissions to the eight hospitals in the area found 52 people who had an acute cardiovascular event in the week after the earthquakes. This was a significant increase on the four weeks before the earthquakes and on the corresponding four weeks in 2002 and 2003.

    Credit: JAMA

    The cardiovascular events included an increase in sudden cardiac death, but the most noticeable feature was a sharp rise in the number of people admitted with “takotsubo” cardiomyopathy, a reversible ventricular dysfunction thought to be caused by stress. There were 25 cases in the four weeks after the earthquakes, compared with only one case in the previous four weeks and none or one in the same four weeks in 2002 and 2003 (P < 0.001).

    This is the first study to show a link between a natural disaster and stress related cardiomyopathy. The authors suggest that, as there were no extra admissions for acute coronary syndrome after these quakes, the increase in sudden deaths was at least partly due to stress related cardiomyopathy. It's impossible to say for certain because people who died suddenly did not have postmortem examinations.

    Diagnostic aid for deep vein thrombosis score can't replace clinical judgment

    Accurate diagnosis of deep vein thrombosis has always been a challenge, and various clinical scoring systems are available to help doctors get it right. The nine point version of the Wells score is one of the most popular, although it seems to be more accurate in hospitals than in primary care settings, according to two recent papers.

    In the first paper, a meta-analysis of 54 studies, the Wells score seemed to be good for categorising patients in clinics or emergency departments as at high …

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