Cardiology

A panel of experts presented a general strategy for evaluating patients with refractory hypertension, but ultimately cautioned the audience to assume non-compliance until proven otherwise.

The panel presented three challenging cases of heart failure with preserved ejection fraction (HFPEF) (see Update on Diastolic Heart Failure). In an innovative twist, the panel solicited feedback from a standing-room-only audience through SmartPhone technology-attendees voted for their favored diagnostic approach, therapy, or final diagnosis, with voting results instantly integrated into the presenter’s Powerpoint display.

Diastolic heart failure (or HFPEF-heart failure with preserved ejection fraction) is characterized by inadequate myocardial relaxation and diastolic filling ("stiff ventricle"), with heart failure signs and symptoms despite normal ejection fraction. The most common cause is long-standing hypertension.

Systemic inflammation has been identified as a risk factor for the development of heart failure in population studies. In the 5-year prospective MESA study, researchers from Johns Hopkins Hospital in Baltimore recorded a baseline nonspecific marker of systemic inflammation, C-reactive protein (CRP).

Researchers from Massachusetts General Hospital in Boston presented results from the PROTECT (ProBNP Outpatient Tailored Chronic Heart Failure) study. NT-proBNP (b-type natriuretic peptide) is a biomarker released from myocardial tissue in response to high levels of wall stretch and has been studied as a marker for decompensated systolic heart failure.

Global humanitarian James Orbinski, MD, will deliver the Franz M. Groedel Presidential Plenary Lecture at this year's Scientific Showcase Session on Sunday, April 3.

On December 18, 2005, Ariel Sharon, Prime Minister of Israel, experienced the sudden onset of aphasia. Despite being overweight, he had none of the traditional risk factors for cerebrovascular disease-hypertension, history of smoking, diabetes, or elevated cholesterol levels.

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.