Atrial Fibrillation

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.

SPRINGFIELD, Mass. -- Offering hospitals a relatively small financial incentive improved their quality of care for acute myocardial infarction, heart failure, and pneumonia, researchers here reported.

HAIFA, Israel -- The phosphodiesterase-5 inhibitors led to a 26.7% successful intercourse rate, compared with controls, for men with diabetes-related erectile dysfunction, according to a meta-analysis.

LOS ANGELES -- For heart failure patients, the "obesity paradox" of better survival rates with increasing heft appears to hold true during acute hospitalization as well, according to a large registry study.

SAN FRANCISCO -- B-type natriuretic peptide, a marker of myocardial stretch, predicted adverse coronary outcomes and mortality in patients with stable coronary heart disease, researchers reported.

CINCINNATI -- The occurrence rate of cerebral hemorrhage associated with the use of Coumadin (warfarin) quintupled in the 1990s, paralleling an increase in blood-thinner's prescriptions according to researchers here.

LONDON -- For early-stage breast cancer that is HER2-positive, a year of adjuvant Herceptin (trastuzumab) significantly improves overall survival two years later without undue cardiotoxicity, researchers here said.

ANN ARBOR, Mich. -- When a sophisticated electrocardiogram test appears to rule out the need for an implanted cardioverter-defibrillator in ischemic cardiomyopathy, the results are frequently ignored, according to researchers here and Cincinnati.

LOS ANGELES -- Performance measures adopted by the government and JCAHO to gauge hospital quality of care for heart failure have little impact on survival during the critical early post-discharge period, researchers here reported.

The introduction of effective antiretroviral therapy has resulted in dramatic clinical benefits for those persons who have access to it. Adherence to such therapy has emerged as both the major determinant and the Achilles' heel of this success. Many patients have levels of adherence too low for durable virologic control.

The authors report a case of adult-onset acute lymphoblastic leukemia (ALL) presenting with a right upper lobe infiltrate associated with acute fibrinous and organizing pneumonia (AFOP), which resolved spontaneously during the course of chemotherapy.

On a warm August day, a 79-year-old man is hospitalized because of progressive lethargy over the past week. Previously, he was alert and able to converse. He has no chest pain, dyspnea, or cough. His history includes hypertension of unknown duration, chronic obstructive pulmonary disease, and a recent hospitalization for pneumonia.

An 80-year-old woman has a 3-month history of increasing dysphagia (withboth solids and liquids), fatigue, and dyspnea on exertion. She has also involuntarilylost 50 lb during the same period. She reports no abdominal pain orchange in bowel function.

Q:Is periodic laboratory monitoring recommended for patients withosteoarthritis who are receiving long-term cyclooxygenase-2 (COX-2)inhibitor therapy and who have no GI or renal symptoms? Similarly,is laboratory monitoring recommended for women who take a selectiveCOX-2 inhibitor to alleviate menstrual cramps (eg, rofecoxib, 50 mg/d,3 to 5 days per month)?--Sarita Salzberg, MDColumbus, Ohio

Q:Do evidence-based data support combination therapy with anangiotensin-converting enzyme (ACE) inhibitor and an angiotensin IIreceptor blocker (ARB)?

Your middle-aged patientwith type 2 diabetes wishesto start a weight-trainingprogram. What recommendationswill you offerhim? Another diabetic patient hasperipheral neuropathy; which exercisesare safest for her?

An 83-year-old woman is hospitalized for treatment of deep venous thrombosisin her left leg. She underwent left hip replacement surgery 2 months earlier.At that time, mild anemia (hemoglobin level, 10 g/dL) was noted, and iron therapywas initiated. An iron panel obtained shortly after the hip surgery revealeda serum iron level of 80 μg/dL, a transferrin level of 360 mg/dL, and a ferritinlevel of 50 ng/mL.

Lately I have heard that "tissue ACE" properties are important in endothelial remodelingand in the prevention of myocardial infarction and stroke.

Q:Should hypertensive patients be discouraged from participating inmoderate to vigorous exercise?A:On the contrary, most patients with sustained hypertension should bestrongly encouraged to exercise regularly at moderate to vigorous levels.Randomized controlled clinical trials have demonstrated that increasedphysical activity can lower blood pressure (BP) and delay or prevent the developmentof hypertension and thus the need for antihypertensive medication.1In addition, physical activity can help reduce cardiovascular risk factors by improvinglipid profiles and reducing weight and blood glucose levels. In elderlypersons, exercise is associated with improvements in osteoporosis, depression,and physical functioning, as well as an enhanced sense of well-being.

Is treatment recommended for high-normalblood pressure (BP)-say, 135/88 mm Hg-ina postmenopausal woman?

I have read that mental confusion and paranoia may be potential side effects ofcertain angiotensin-converting enzyme (ACE) inhibitors.

A 62-year-old woman was found on thefloor of her bathroom at home with herwheelchair partially on top of her.She was unresponsive except to painfulstimulus.

What is the risk of dementia in patients who have had an ischemic stroke?