Atrial Fibrillation

A 44-year-old man presents to the emergency department (ED) with light-headedness, nausea, and vomiting of 1 day's duration. He has also had intermittent palpitations but denies chest pain, dyspnea, and weakness.

In his article, "Heart Failure: Part 1, Diagnosis and Staging" (CONSULTANT, July 2007), why did Dr W. H. Wilson Tang omit central venous pressure and circulation time as means of diagnosing congestive heart failure? Is it possible that the simplicity and accuracy of these 2 tests, which can establish the diagnosis in 5 or 10 minutes in any hospital room-or physician's examining room-have been forgotten since the advent of testing of natriuretic peptide levels (which, as Dr Tang notes, "also increase in response to other noncardiac processes")?

Over the past 20 years, the treatment armamentarium for diabetes has greatly expanded: 8 different classes of non-insulin drugs and 8 different types of insulin are now available. The newer classes of agents include disaccharidase inhibitors, thiazolidinediones, meglitinides, glucagonlike peptide analogs, and dipeptidyl peptidase IV inhibitors.

PHILADELPHIA -- Patients taking beta-adrenergic receptor agonists were less likely to develop non-healing venous leg ulcers than those not taking the drugs, according to a large epidemiological study.

ROCKVILLE, Md. -- Eleven deaths and nearly 200 reports of serious cardiopulmonary events have been linked to microbubble contrast agents (Definity and Optison) used in echocardiography, according to the FDA.

DURHAM, N.C. -- Oncologists need to think heart when treating early breast cancer, according to clinicians here.

PARIS -- Fast assessment and treatment of transient ischemic attacks can reduce the risk of early recurrent stroke by 80%, according to researchers here and in England.

NEW YORK -- Subclinical hypothyroidism may modestly increase the risk of heart failure, researchers found.

DUNDEE, Scotland -- A five-month course of the ACE inhibitor perindopril (Aceon) was equivalent to six months of exercise training for elderly patients with mobility problems, researchers here found.

BOSTON -- Panic attacks may be an independent risk factor for cardiovascular events in older women, researchers said.

DURHAM, N.C. -- Women at risk of sudden cardiac death are two to three times less likely to receive an implantable cardioverter-defibrillator than men who are at risk, investigators here have found.

DALLAS -- Preoperative evaluation of patients with heart disease should focus on determining current medical status, not providing clearance for surgery, according to an update of guidelines from the American Heart Association and the American College of Cardiology.

A comatose 82-year-old woman is brought to the emergency department. Her husband reports that after dinner she began to have difficulty in speaking, lost consciousness, and fell to the floor. He tried to rouse her, but was unsuccessful and called for an ambulance.

Forty-eight hours ago, a 39-year-old man presented to the emergency department with emesis and severe upper abdominal pain of semi-acute onset, which radiated slightly to the back.

Your patient with peripheral vascular disease (PVD) or atrial fibrillation who is receiving therapeutic anticoagulation sustains a hemorrhagic stroke. This is an iatrogenic complication that all clinicians dread.

A 63-year-old man with a history of hypertension and gastroesophageal reflux disease presented with progressive, sharp mid-abdominal pain of 3 weeks' duration.

BURLINGTON, Mass. -- Pooled data from seven randomized trials of thiazolidinediones for type 2 diabetes confirmed a significant risk of congestive heart failure with either pioglitazone (Actos) or rosiglitazone (Avandia), but neither increased the risk of cardiovascular death.

WALTHAM, Mass. -- Only about 19% of patients had at least one rehab session in the year after a heart attack or coronary artery bypass graft, despite recommendations by professional groups for rehab in that population.

NEW YORK -- Inpatients cared for by full-time hospitalists were likely to be discharged almost a day sooner than those in the care of nonhospitalists, but there was no significant difference in readmission rates or mortality, researchers found.

AMSTERDAM -- Treatment regimens for type 2 diabetes that include pioglitazone (Actos) were associated with lower risk of stroke and myocardial infarction, claimed investigators for the drug's maker.

CALGARY, Alberta -- Nocturnal dialysis at home six times a week markedly reduced left ventricular hypertrophy in patients with end-stage renal disease compared with conventional treatment, according to a preliminary study.

SAN DIEGO -- With PET-guided lead placement, cardiac resynchronization therapy (CRT) can achieve significant clinical improvement in patients with severe ischemic heart failure, even in the presence of extensive scarring, investigators reported here.

Congestive heart failure and cirrhosis are the most common causes of transudative pleural effusions, while pneumonia and malignancy are responsible for the majority of exudative effusions. Plain chest films are valuable in confirming the presence of an effusion, providing clues to the cause, and directing the method of pleural fluid sampling. Thoracentesis is safe and simple, and it is diagnostic in about 75% of cases. Pleural biopsy is indicated for unexplained exudative effusions, most of which are found to result from malignancy or tuberculosis. Medical thoracoscopy, if available, is the procedure of choice for patients with these effusions. Thoracoscopy permits visually directed pleural biopsies and allows for therapeutic intervention at the time of diagnosis, obviating the need for subsequent invasive procedures.

Ischemic infarcts of the brain are usually caused by vascular disease, but 1 in 5 results from emboli that arise in the heart. The largest contributor to cardioembolic stroke is non-valvular atrial fibrillation, which is associated with a 5-fold increased risk of cerebral infarction.

SAN DIEGO -- Positron emission tomography (PET) can identify patients with ischemic heart failure who are most likely to benefit from cardiac resynchronization therapy, investigators reported here.

PHILADELPHIA -- The beta-blocker carvedilol (Coreg) does not appear to benefit children or adolescents with symptomatic systolic heart failure, suggest preliminary trial results.

CLEVELAND -- Meta-analyses of the two FDA-approved thiazolinediones for diabetes -- rosiglitazone (Avandia) and pioglitazone (Actos) -- left neither drug unscathed.

SAN FRANCISCO -- Neoadjuvant trastuzumab (Herceptin) may improve breast cancer chemotherapy response rates, but at what some oncologists called an unacceptable price in cardiac toxicity.

LOS ANGELES -- Dronedarone, an investigational drug, proved significantly more effective than placebo in maintaining sinus rhythm and in reducing the ventricular rate during recurrent atrial fibrillation.

NEW YORK -- Experiments in mice suggest that the type 2 diabetes drugs rosiglitazone (Avandia) and pioglitazone (Actos) increase uptake of both glucose and triglycerides in cardiac tissue, causing or exacerbating heart failure.