Atrial Fibrillation

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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.

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

NEW ORLEANS -- The potential impact of the COURAGE trial -- the headline-making study that matched medicine to stenting in patients with chronic stable angina -- appears to be in the eye of the clinical beholder.

NEW YORK -- When low-dose aspirin is taken for cardiovascular risk reduction and ibuprofen for the pain of osteoarthritis, the heart may be the loser, found investigators here.

NEW ORLEANS -- Nurse-led education and counseling in disease-management programs may improve outcomes for heart failure patients, but setting and patient age may be determining factors, according to separate studies.

The role of anticoagulation in the treatment of patients who have been permanently immobilized as a result of neurological impairments is unique. Patients with spinal injuries have been comprehensively studied, and the data are very clear: the risk of DVT falls sharply 4 to 6 months after the injury and onset of immobility.

NEW ORLEANS -- In the first mouth-to-mouth comparison between the omega-3 heavy Mediterranean and the AHA's low-fat diets for secondary prevention, outcomes didn't seem to differ so long as MI patients stuck with dietary intervention.

NEW ORLEANS -- An investigational oral thrombin receptor antagonist led to a trend toward reduced fatal and non-fatal cardiac events, with a low bleeding risk, in a phase II trial of patients with percutaneous coronary interventions, mostly stenting.