A 26-year-old man presented with sudden onset of palpitations and shortness of breath after incidentally taking tadalafil. He had no other symptoms and no history of illnesses during childhood. He drank socially but denied smoking and use of illicit drugs.
A 38-year-old man with a history of alcoholism, intravenous drug use, and cerebrovascular accident was referred for assessment of possible endocarditis, based on history, fever 39 °C (102.9 °F) and mildly elevated troponin level.
For years, GI toxicity and risk of bleeding were the issues of most concern when deciding to prescribe an NSAID. The cardiac effects associated with these drugs were considered a positive in that least some have been shown to provide prophylaxis against myocardial infarction.
A 41-year-old woman came to the emergency department complaining of pain in the lower right portion of her abdomen that had become steadily worse over the past 2 days.
A 48-year-old African American man with no significant medical history sustained a gunshot wound to the face and shoulder.
A review of 140 trials and 26 observational studies supports metformin as the best first-line treatment for type 2 diabetes in adults, both stand-alone and in combination with other medications. But second-line treatments are still a judgment call.
An 88-year-old man presents with a 2-month history of a non-healing ulcer on his right lower limb.
Cirrhosis and ascites developed in a 52-year-old man with a history of chronic hepatitis C and alcohol abuse. He was hospitalized because of bleeding esophageal varices, which were successfully treated with elastic band ligation.
Exercising at least 4 times a week can increase left ventricular mass and preserve elasticity, thereby reducing the risk of diastolic heart failure. Researchers from Texas presented their study results at the American College of Cardiology’s 60th Annual Scientific Session.
Here: a succinct review of the diagnosis and treatment of pemphigus vulgaris, dermatomyositis, cicatricial pemphigoid, linear IgA bullous disease, coma bullae, and stasis bullae.
A Danish study found no clinical benefit from using NT-proBNP (b-type natriuretic peptide) to identify and monitor high-risk patients with chronic heart failure, according to research from the NorthStar study presented at the American College of Cardiology’s 60th Annual Scientific Session in New Orleans.
Compared with medical therapy alone, coronary artery bypass grafting (CABG) significantly reduced cardiovascular deaths and the composite end point of all-cause deaths and cardiovascular-related hospitalizations, reported investigators from the Surgical Treatment of Ischemic Heart Failure (STICH) trial. However, the effect of the two management strategies on overall survival in patients with ischemic heart failure was similar.
The panel presented three challenging cases of heart failure with preserved ejection fraction (HFPEF) (see Update on Diastolic Heart Failure). In an innovative twist, the panel solicited feedback from a standing-room-only audience through SmartPhone technology-attendees voted for their favored diagnostic approach, therapy, or final diagnosis, with voting results instantly integrated into the presenter’s Powerpoint display.
Diastolic heart failure (or HFPEF-heart failure with preserved ejection fraction) is characterized by inadequate myocardial relaxation and diastolic filling ("stiff ventricle"), with heart failure signs and symptoms despite normal ejection fraction. The most common cause is long-standing hypertension.
Systemic inflammation has been identified as a risk factor for the development of heart failure in population studies. In the 5-year prospective MESA study, researchers from Johns Hopkins Hospital in Baltimore recorded a baseline nonspecific marker of systemic inflammation, C-reactive protein (CRP).
Researchers from Massachusetts General Hospital in Boston presented results from the PROTECT (ProBNP Outpatient Tailored Chronic Heart Failure) study. NT-proBNP (b-type natriuretic peptide) is a biomarker released from myocardial tissue in response to high levels of wall stretch and has been studied as a marker for decompensated systolic heart failure.
A 44-year-old man presents for a preemployment physical examination. He is healthy, and he currently takes no long-term medications. A detailed review of systems reveals no ischemic chest pain, dyspnea with exertion, orthopnea, or any other symptoms of either coronary artery disease (CAD) or heart failure.
A 53-year-old woman presented with sudden onset of left upper quadrant abdominal pain. She had a history of atrial fibrillation, hypertension, and congestive heart failure.
A 50-year-old man was brought to the emergency department (ED) after a witnessed syncopal event. He was awake but confused and unable to provide a history.
A 72-year-old obese man with chronic atrial fibrillation, hypertension, hyperlipidemia, and a history of tobacco use presented for a routine office visit. A year earlier, he began to experience recurrent chest pain, but an ECG had shown normal T waves.
A previously healthy 55-year-old woman complained of fever, weakness, and generalized malaise for the past 3 to 4 weeks. She had been treated with ciprofloxacin, amoxicillin, and azithromycin for 21 days with no resolution of her symptoms. Five days before she was hospitalized, multiple nonspecific constitutional complaints developed.
Elective splenectomy has been scheduled for a 60-year-old man with severe idiopathic thrombocytopenic purpura (ITP) that has responded poorly to treatment. His current platelet count ranges from 5000/μL to 10,000/μL despite several months of aggressive therapy, including 2 courses of high-dose corticosteroids and 2 courses of intravenous immunoglobulin.
From the perspective of a harried primary care physician, it’s very difficult to sort out arguments and data when two respected specialists diametrically disagree.
A previously healthy 19-year-old woman presents with a sore throat that has become progressively more painful over the course of 1 week. She also has left-sided neck swelling, light-headedness, and intermittent headaches. She denies recent sexual activity.
