Cardiology

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.

Recently, my wife and I received a gift certificate for one of our favorite restaurants, and we wasted no time in using it. The food and conversation were delightful, and the meal turned out to be exciting and enlightening on many levels. A patron of the restaurant, who was celebrating his 55th wedding anniversary, sustained a witnessed, public cardiac arrest. The experience led to an analysis of my involvement in the resuscitation.

Analysis of a number of studies led to a practical suggestion: persons at known risk for myocardial infarction (MI) as well as older adults should carry a few tablets of soluble aspirin with them at all times, and they should chew and swallow the tablets in the event of chest pain-the earlier the better.

Sitting in front of a TV or computer for long periods can raise the risk of cardiovascular disease and death, reported investigators recently in the Journal of the American College of Cardiology. The risk does not appear to be offset by physical activity.

Yes, ACE inhibitors should be used with caution in patients with acute renal injury and high-grade renal vascular lesions, but these drugs are designed to help, not hurt kidneys. Now fast forward to another caveat: avoid or discontinue statins in patients who have elevated liver enzyme levels. Get ready for a therapeutic paradigm shift.

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.

Often patients don’t realize thatduring auscultation of the heart andlungs we can’t hear them, and theycontinue to talk.

Right Ventricular involvement in acute inferior MI is an independent predictor of major complications and in-hospital death, as this case demonstrates. While in-hospital prognosis after left ventricular infarction is directly related to the postinfarct LV ejection fraction, involvement of the right ventricle drastically alters that linear relationship.

A 23-year-old woman presents to the emergency department (ED) with left-sided burning chest pain that radiates to the epigastrium. The pain, which woke her from sleep 12 hours earlier, is intermittent and is not associated with eating or exertion. She had a single bout of nausea and emesis.

A new patient with a history of atrial fibrillation (AF) and heart failure presents for an initial visit. The 72-year-old man denies exertional chest pain and paroxysmal nocturnal dyspnea. He is able to perform all his routine daily activities and can even climb 2 flights of stairs without dyspnea-although with more vigorous effort, he does become short of breath. He occasionally experiences pedal edema at the end of the day, but the condition resolves by morning.

Because infants often start to cry as soon as a stethoscope makes contact with their skin, it can be difficult to hear defects during a cardiac examination.

According to the Sgarbossa criteria, the patient had an acute MI: ECG revealed a greater than 1-mm ST-segment depression in lead V2 and about 5-mm discordant ST-segment elevation in leads II, III, and aVF.

Clinicians sometimes give patients a choice of medication or lifestyle changes to control blood pressure (BP) or cholesterol levels.

Up to 40% of patients who present with what may look like simple, isolated superficial venous thrombosis have concomitant deep venous thrombosis. This finding has led clinicians to first rule out DVT bilaterally via compression Doppler ultrasonography before treatment is considered.

A 92-year-old woman presented with signs and symptoms of heart failure, including marked bilateral lower extremity edema, jugular vein distention, and difficulty in breathing at rest. Her medical history was significant for hyperthyroidism, chronic asthmatic bronchitis, and senile dementia. Medications included oral methimazole, 10 mg/d, and oral theophylline, 200 mg/d.

Case 1: Mr A. is a 55-year-old man who comes to your office for a routine physical examination. He is a traveling salesman and has recently gained weight. He does not exercise much and is a frequent visitor to fastfood establishments. His father had “a touch of diabetes” and died of a myocardial infarction (MI) at age 59.

Chest pain and dyspnea of acute onset prompted a 49-year-old man to seek urgent medical attention. Two months earlier, he had sustained fractures to the right arm and both ankles after a 25-ft fall. Ten days before presentation, the patient’s rehabilitation physician had discontinued daily enoxaparin because of improved mobility and a presumed decreased risk of thromboembolism.

A 59-year-old man presented with painful paraparesis of acute onset, severe low back pain, and shortness of breath. On initial examination, he had 0/5 strength and numbness in his lower extremities. The skin from below his umbilicus to his lower legs was pale.

Palpitations and dizziness prompted a previously healthy 21-year-old cable lineman from southeastern Pennsylvania to seek medical attention. An ECG showed first-degree heart block. The young man was scheduled for outpatient cardiology consultation, but his symptoms worsened and he presented to an emergency department with chest pain and fever 2 days later. Further evaluation revealed that for the past 3 weeks he had myalgia; arthralgia; fatigue; and an expanding, erythematous, nonpruritic rash on his trunk and extremities. He did not recall any tick bites.

Osler nodes may accompany bacteremia without endocarditis, septic endarteritis, typhoid fever, gonococcemia, systemic lupus erythematosus, and nonbacterial thrombotic endocarditis.

Ventricular versus supraventricular tachycardia? This case offers diagnostic and treatment strategies when the diagnosis is uncertain.

Kawasaki syndrome is a serious disorder affecting children aged 1 to 8 years. It mimics a range of other diseasesof childhood. Diagnosis is based on physical examination findings coupled with the exclusion of other causes.

A 27-year-old woman with hypertension, type 1 diabetes mellitus, and end-stage renal disease presents to an outpatient renal clinic complaining of generalized weakness. She missed her last dialysis session 2 days earlier.

The morning after an 88-year-old woman with symptomatic second-degree type I (Wenckebach) atrioventricular block underwent placement of a dual chamber pacemaker without complication, she awoke with uncomfortable pulsations in her abdomen. The pacing thresholds and impedance had remained unchanged since implantation.

Systolic hypertension is an independent risk factor for coronary artery disease, stroke, and end-stage renal disease. Nonpharmacological interventions for systolic hypertension include limitation of dietary sodium and alcohol intake along with weight reduction and aerobic exercise.