Atrial Fibrillation

SALT LAKE CITY-- Amputations of frostbite-damaged fingers and toes can be prevented in some patients with the use of thrombolytic therapy within 24 hours of exposure, researchers here found.

EDMONTON, Alberta -- For patients with stable heart failure, cardiac rehabilitation that focuses on aerobic training can reverse left-ventricular remodeling and improve ejection fraction

ROTTERDAM, The Netherlands -- Before heart disease even develops among patients with heart disease, the effects on life expectancy have already begun, found researchers here.

PORTO, Portugal -- As metabolic syndrome becomes more severe, symptomatic heart failure and several cardiac structural and functional abnormalities may increase progressively, researchers here reported.

OXFORD, England -- Statin drugs are highly effective and are generally safe when used as indicated, a literature review confirmed.

WASHINGTON -- FDA Commissioner Andrew C. von Eschenbach, M.D., today told a congressional hearing that the FDA will beef up the cardiovascular warnings on the labels of both rosiglitazone (Avandia) and pioglitazone (Actos).

ATLANTA -- Credit for the near halving of the rate of coronary disease deaths in the U.S, from 1980 to 2000, belongs equally to reductions in risk factors and to the rise of evidence-based therapies, found CDC and British researchers.

CHICAGO -- Bevacizumab (Avastin) added to chemotherapy for bulky small-cell lung cancer led to modest anticancer activity without clinically significant hemoptysis, investigators reported here.

NEWCASTLE UPON TYNE, England, June 5 -- An interim analysis of the 4,447-patient RECORD trial did not confirman increased risk of myocardial infarction or cardiac death in patients taking rosiglitazone (Avandia) for treatment of type 2 diabetes, although the data suggest an increased risk of heart failure. So reported the New England Journal of Medicine online today, one day before a Congressional hearing on the safety of rosiglitazone.

ABSTRACT: Atypical clinical presentations in the quality, intensity, and radiation of pain are common in patients with acute coronary syndromes. Women with an acute myocardial infarction (AMI) are more likely to have atypical symptoms, such as dyspnea, than men. A history of acute anxiety or a psychiatric diagnosis does not preclude the possibility of an acute coronary event in a patient with chest pain. The clinical response to a GI cocktail, sublingual nitroglycerin, or chest wall palpation does not reliably identify the source of pain. Over-reliance on tests with poor sensitivity, such as the ECG, or on the initial set of cardiac biomarkers will miss many patients with MI. Serial troponin levels obtained at 3- to 6-hour intervals are recommended to evaluate the extent of myocardial damage. Coronary angiography that detects mild non-obstructive disease does not exclude the possibility of sudden plaque rupture and acute coronary occlusion.

Torsades de pointes, or polymorphic ventricular tachycardia, seen on ECG includes wide complex QRS morphology tachycardia, axis deviation of the QRS complexes around baseline.

abstract: Inflammatory bowel disease (IBD) can have a variety of extraintestinal manifestations, including pulmonary disease. Bronchial involvement is the most common, but other manifestations include upper airway disease; parenchymal involvement, such as bronchiolitis obliterans with organizing pneumonia (BOOP) and interstitial lung disease; and serositis, including pleural effusions and pericarditis. Patients with BOOP may present with fever, dyspnea, cough, and pleuritic chest pain. Chest radiographs show bilateral patchy airspace opacities or a diffuse process; CT scans often demonstrate the opacities to be pleural-based. Corticosteroids appear to be effective in the management of certain pulmonary manifestations of IBD, such as BOOP and pulmonary infiltrates with eosinophilia. (J Respir Dis. 2007;28(6):227-234)

WINSTON-SALEM, N.C. -- A simple exercise test measuring the ratio of oxygen consumption to carbon dioxide production can predict mortality risks in systolic heart failure, said researchers here.

PHILADELPHIA -- More than half of patients with atrial fibrillation are also likely to have obstructive sleep apnea, investigators suggested here.

PHILADELPHIA -- The most obvious clinical feature of obstructive sleep apnea may be weariness of mind, but this breathing disorder also slowly and silently wears down the heart, according to researchers.

SAN FRANCISCO -- A daily protocol to bring ICU patients out of a drug-induced coma and breathing on their own gets them home four days faster, researchers said here.

SAN FRANCISCO -- Sleep apnea may increase the risk of heart disease and mortality risk 40%, researchers said here.

LYNCHBURG, Va. -- Televalgelism pioneer Jerry Falwell, the founder of Moral Majority and a stalwart of the Christian right wing of the GOP, died today after collapsing in his office here. Falwell was 73 and had suffered in recent years from congestive heart failure and pneumonia.

SANTA MONICA, Calif. -- Women are less likely to achieve good control of both heart disease and diabetes than men because they get lower quality care, researchers here reported.

SEATTLE -- Gastric acid suppression with proton pump inhibitors appears to hold no excess risk of pneumonia in hospitalized older adults, researchers reported here.

ABBOTT PARK, Ill. -- A heart failure drug called levosimendan (Simdax), which has been in clinical trials, has been withdrawn from development by Abbott Laboratories and Finnish partners.

SAN FRANCISCO -- A successful once-a-year drug to treat postmenopausal osteoporosis, even though administered by an IV infusion, may be welcomed by women who dislike a weekly or monthly pill, researchers here reported.

EDINBURGH, Scotland -- When acute coronary syndrome guidelines get used, patients have had significant reductions in rates of heart failure, myocardial infarction, stroke, and death according to the multinational GRACE study.

abstract: Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoproteinaceous material in the alveoli. The most common symptoms are dyspnea on exertion and nonproductive cough. Weight loss, fatigue, chest pain, and hemoptysis have also been reported. Chest radiographs typically show bilateral, symmetrical airspace disease with an ill-defined nodular or confluent pattern, which gives a "bat wing" appearance, as is seen in heart failure. Pulmonary function tests usually demonstrate mild restrictive disease. Findings on examination of sputum specimens or bronchoalveolar lavage fluid can suggest the diagnosis; however, open lung biopsy is the diagnostic gold standard. Whole lung lavage remains the standard of care for PAP and is warranted in patients with severe dyspnea and hypoxemia. Subcutaneous human recombinant granulocyte-macrophage colony-stimulating factor appears to be a promising alternative to whole lung lavage for symptomatic patients. (J Respir Dis. 2007;28(5):177-184)

Patients with congenital heart disease and pulmonary arterial hypertension (PAH) are at risk for severe deterioration during pregnancy and delivery. We discuss the case of a 38-year-old woman who presented to the emergency department complaining of dyspnea 6 days after giving birth to her first child via cesare- an section. When PAH is untreated, maternal mortality may exceed 50%, but aggressive PAH treatment offers improved outcomes. Moreover, initial improvement in functional status made with parenteral prostanoids can be maintained with combination oral therapy.