Atrial Fibrillation

SEATTLE -- Combining thrombolytic medication with a clot removal device effectively dissolves extensive deep vein thrombosis (DVT) in a single session, according to a retrospective study.

ATLANTA -- An estimated 16.8% of the U.S. population ages 20 and older has chronic kidney disease, reported researchers from the National Center for Chronic Disease Prevention and Health Promotion.

abstract: Depression and anxiety are common comorbidities in patients with chronic obstructive pulmonary disease (COPD), and like COPD, they are often underrecognized. Both of these comorbidities can adversely affect the course of COPD. Anxiety, for example, is associated with more severe dyspnea, greater disability, and impaired functional status; it also is a significant predictor of hospitalizations for acute exacerbations of COPD. When evaluating depressive symptoms, it is important to rule out cognitive impairment, particularly in patients with severe COPD and hypoxemia. Treatment options include antidepressants and cognitive behavioral therapy. Participation in a pulmonary rehabilitation program also can help reduce anxiety and depressive symptoms in patients with COPD. (J Respir Dis. 2007;28(3):94-103)

**IPF is the most common form of idiopathic interstitial lung disease. The recent development of histopathological and clinical criteria that accurately define IPF has resulted in expansion of our scientific knowledge, development of novel therapies, and initiation of high-quality clinical trials.

A 3-year-old girl is brought to the office because of a1-week history of hematuria and dysuria. Her motherhad noticed bright red blood in the child’s urine anddiaper. The child did not have dysuria initially but latercomplained of a burning sensation.

ABSTRACT: Antiplatelet agents used to treat non-ST-segment elevation myocardial infarction (NSTEMI) and unstable angina include aspirin, clopidogrel, and glycoprotein (GP) IIb/IIIa inhibitors. Aspirin is recommended for all patients with acute coronary syndromes (ACS). Clopidogrel can also be used in all patients with ACS, although this agent increases the risk of major bleeding complications if coronary artery bypass grafting is performed less than 5 days after the last dose. Early use of a GP IIb/IIIa inhibitor provides additional benefit in patients with NSTEMI, particularly those who undergo percutaneous coronary intervention. Agents used for anticoagulation in patients with NSTEMI or unstable angina include unfractionated heparin, low molecular weight heparins (LMWHs), and the direct thrombin inhibitor bivalirudin. Enoxaparin-the only LMWH currently indicated for treatment of patients with NSTEMI-can be considered as an alternative to unfractionated heparin, particularly in those who do not require urgent cardiac catheterization.

A 43-year-old woman presented withuncontrolled type 2 diabetes mellitus.Her hemoglobin A1c level was 12%,and self-measured glucose levels hadbeen above 400 mg/dL for 3 months.She was taking insulin 70/30,70 units twice daily.

LOS ANGELES -- Interrupting antiretroviral therapy for HIV patients increases the risk of cardiovascular disease by more than 50% over four years, a British researcher said here.

WALTHAM, Mass. -- Pulse pressure, the difference between systolic and diastolic pressures, may be a risk factor for the onset of atrial fibrillation independent of arterial pressure and other known factors, researchers said.

WASHINGTON -- An observational study of 60,000 postmenopausal women found that about 40% have prehypertension, and that level of blood pressure was associated with a 58% higher risk of cardiovascular death than for normotensive women.

OMAHA, Neb. -- A get-tough program with hospitalized cardiac disease patients who smoke has proved to be a life-saver here, cutting mortality by 77% over two years compared with standard smoking cessation programs.

SAN FRANCISCO -- Tight glucose control during hospitalization for a stroke may not improve survival, British researchers said here.

DALLAS -- Patients who receive an implantable cardioverter defibrillators (ICD) for primary prevention should take a least a week before driving, according to guidelines issued here.

abstract: In the past, constrictive pericarditis was most often caused by tuberculosis. Today, however, it is more likely to be preceded by injury or trauma, infection, or previous cardiac surgery. Most patients with constrictive pericarditis present with dyspnea and have elevated jugular venous pressure. Other potential symptoms and signs include peripheral edema, abdominal fullness, hepatomegaly, ascites, and chest pain. Electrocardiography demonstrates nonspecific ST-segment and T-wave changes and generalized T-wave inversion or flattening. In many cases, chest radiography and CT reveal pericardial calcification, and echocardiography shows increased pericardial thickness and calcification. Treatment may include NSAIDs, corticosteroids, antibiotics, angiotensin-converting enzyme inhibitors, and diuretics. Surgery is the treatment of choice for chronic disease, and pericardiectomy is typically effective. (J Respir Dis. 2007;28(2):49-56)

A 69-year-old man with a history of atrial fibrillation, pulmonary embolism, asthma, and obstructive sleep apnea presented to the emergency department for evaluation of dyspnea and light-headedness. He had been treated for paroxysmal atrial fibrillation over the past 5 years; fairly good control had been achieved with metoprolol and amiodarone. However, over the past several months, he had been experiencing intermittent episodes of atrial fibrillation.

An 80-year-old man presents to the emergency department (ED) with intermittent dyspnea and chest pain. He has hypertension and osteoarthritis but no known cardiac disease. Vital signs are normal. No jugular venous distention is noted. The lungs are clear with equal breath sounds, and the heart rate is regular, without murmurs, gallops, or rubs. The chest wall is not tender. No edema or asymmetry is evident in the extremities.

ABSTRACT: Angiotensin-converting enzyme (ACE) inhibitor therapy is recommended for all patients with heart failure (HF) and a reduced ejection fraction. It is generally initiated in the hospital at low doses as inotropic therapy is tapered. Angiotensin II receptor blockers may be a suitable alternative for patients who cannot tolerate ACE inhibitors. For patients who cannot tolerate either class of drug, a combination of hydralazine and a nitrate is recommended. ß-Blockers are first-line therapy for patients with current or previous symptoms of HF and reduced left ventricular function, as well as all patients hospitalized for HF. An aldosterone antagonist may be added to the regimen of patients with moderately severe to severe symptoms and reduced ejection fraction whose renal function and potassium concentration can be monitored.

The initial assessment of acute severe asthma includes confirmation of the diagnosis and rapid assessment of mental status and degree of respiratory distress. The severity of airflow obstruction is best determined by forced expiratory volume in 1 second or peak expiratory flow rate. While inhaled ß2-agonists are the initial therapy, the combination of ipratropium and a ß2-agonist can enhance results in some patients. There also is evidence that inhaled corticosteroids can lead to a more rapid improvement in pulmonary function. (J Respir Dis. 2007;28(2):57-64)

SAN DIEGO -- Endovascular stents appear to have advantages over open surgery for repairing traumatic aortic rupture among critically injured patients, researchers said here.

SAN DIEGO -- Although computed tomography angiography showed striking results in a small study reported here among patients with known heart disease, the decision to proceed with a coronary bypass still seems to need a visit by a catheter.

SAN DIEGO -- Off-pump coronary artery bypass surgery for women nearly eliminates the gender gap for cardiac morbidity and mortality, researchers said here. However, men still did better.

KANSAS CITY -- New clinical-practice guidelines for the diagnosis and management of venous thromboembolism in primary care were released jointly by the American Academy of Family Physicians here and the American College of Physicians.

SOUTH SAN FRANCISCO -- The 0.5 mg dose of Lucentis (ranibizumab injection), the targeted therapy for neovascular age-related macular degeneration, is associated with a significantly higher risk of stroke than the 0.3 mg dose (P=0.02), according to Genentech.

LEUVEN, Belgium -- Ventricular arrhythmias that occur in endurance athletes such as competitive bicyclists may originate on the right side of the heart, and could be a consequence of no-holds barred training and performance.

SAN FRANCISCO -- A new prognostic tool called ABCD2 for predicting the early risk of a major stroke after a transient ischemic attack (TIA) may help physicians determine which patients need emergency care, researchers said.