Atrial Fibrillation

A 24-year-old woman who is 14 weeks pregnant with her first child is heterozygousfor factor V Leiden. The patient is healthy, has no chronic medical conditions,and takes no long-term medications.

A vigorous 61-year-old man presents for a preemployment physical examination.He has no symptoms of angina pectoris or congestive heart failure (CHF).

A 76-year-old woman presents with chest pain-which she describes as“muscle tightness”- that began when she awoke in the morning. Thepain is constant, exacerbated by deep inspiration, and accompanied by asubjective sense of slight dyspnea; she rates its severity as 3 on a scale of1 to 10. She denies pain radiation, nausea, diaphoresis, palpitations, andlight-headedness. Her only cardiac risk factors are hypertension and a distanthistory of smoking.

A30-year-old man complains of chest pain, dyspnea, fever, and nonproductivecough that began earlier in the day. The pain is constant and does notdiminish with rest; it worsens somewhat with deep inspiration and has localizedto the left chest. The patient has had no nausea, vomiting, or abdominal pain.He has been immobile for several years secondary to spinal cord disease buthas no history of cardiopulmonary disease.

PITTSBURGH -- For women with HER2-positive, advanced-stage breast cancer, the time to disease progression may be doubled by adding Tykerb (lapatinib) to Xeloda (capecitabine) chemotherapy, according to a study that was halted early.

ERLANGEN, Germany -- Gleevec (imatinib mesylate), the cancer drug, may be useful in blocking the pathways involved in systemic sclerosis, according to researchers here.

IRVINE, Calif.-- Methamphetamine users may develop carotid artery dissections, leading to a severe stroke, an effect also seen in cocaine users, according to researchers here.

OAKLAND, Calif. -- HIV-infected patients having surgery were more likely to develop post-op pneumonia or to die within 12 months than matched non-infected patients, researchers here reported.

OAKLAND, Calif. -- HIV-infected patients having surgery were more likely to develop post-op pneumonia or to die within 12 months than matched non-infected patients, researchers here reported.

SAN ANTONIO, Dec. 19 -- New biologic agents are proving useful in breast cancer treatment, but optimizing therapy requires careful attention to adverse event risk.

TORONTO -- For patients with fluid-retaining conditions, the simple act of lying down in bed at night may cause a fluid shift to the upper body that results in obstructive sleep apnea, a small study here suggested.

TORONTO -- For patients with fluid-retaining conditions, the simple act of lying down in bed at night may cause a fluid shift to the upper body that results in obstructive sleep apnea, a small study here suggested.

ROCKVILLE, Md. -- The FDA announced today it had narrowed the indications for Trasylol (aprotinin injection), a drug used control bleeding during heart surgery, partly because of belatedly revealed risks of death or serious kidney damage.

ROCKVILLE, Md. -- The FDA announced today it had narrowed the indications for Trasylol (aprotinin injection), a drug used control bleeding during heart surgery, partly because of belatedly revealed risks of death or serious kidney damage.

SAN ANTONIO -- Breast cancer patients may get similar benefit with less toxicity from adjuvant chemotherapy containing Taxotere and Herceptin but not the cardiotoxic anthracycline Adriamycin, researchers said.

SAN ANTONIO -- Breast cancer patients may get similar benefit with less toxicity from adjuvant chemotherapy containing Taxotere and Herceptin but not the cardiotoxic anthracycline Adriamycin, researchers said.

PHILADELPHIA -- Performance measures for hospitals adopted by Medicare and the Joint Commission on Accreditation of Healthcare Organizations may only be loosely related to patient outcomes.

PHILADELPHIA -- Performance measures for hospitals adopted by Medicare and the Joint Commission on Accreditation of Healthcare Organizations may only be loosely related to patient outcomes.

ORLANDO -- Young patients with acute myeloid leukemia are not only surviving into adulthood but thriving well into life, albeit with an increased risk for secondary cancers or heart disease, show data from the Childhood Cancer Survivor Study.

ORLANDO -- For preventing venous thromboembolism following a total knee replacement, the investigational oral anticoagulant dabigatran etexilate was comparable to Lovenox, investigators reported here.

PORTLAND, Ore. -- Gleevec (imatinib) has led to an overall 60-month survival rate of 95% for chronic myeloid leukemia (CML) patients with who took the tyrosine kinase inhibitor daily, found an international study. Yet the drug doesn't cure the disease.

CAPE TOWN, South Africa -- The thiazolidinedione Avandia (rosiglitazone) has a more durable response than two older oral type 2 diabetes agents, but it was more expensive and had more side effects, researchers reported here.

I enjoyed Dr Henry Schneiderman’s “What’s Your Diagnosis?” case of an elderly woman with severe facial ecchymoses from a fall. Would Dr Schneiderman elaborate on several points about that case? This woman did not trip or complain of dizziness before she fell. What caused her to fall?

Idiopathic pulmonary fibrosis (IPF) is a chronic progressive lung disease with unknown etiology and a grim prognosis.1,2 The median survival is about 3 years after diagnosis or 5 years from the onset of symptoms. Its pathologic findings are those of usual interstitial pneumonia.2 Surgical lung biopsy is needed for diagnosis when these findings are not present. Usual interstitial pneumonia is the histopathologic pattern that characterizes IPF (Figure).

A 79-year-old woman with a history of atrial fibrillation was referred to the pulmonary service for preoperative evaluation for hip replacement surgery. She reported that 20 or more years ago she had been told by her physician that she has an "extra blood vessel" in the right lung. It had not caused her any difficulty. Her medical history was also notable for a heart murmur and gastroesophageal reflux disease secondary to a large hiatal hernia. She was a nonsmoker.