Atrial Fibrillation

ROCKVILLE, Md., Nov. 17 -- The FDA said today it has expanded approval of Herceptin (trastuzumab) to include its use as adjuvant therapy in the treatment of early stage HER2 positive breast cancer.

CHICAGO -- A noninvasive office-based test can improve the chance that implantable cardioverter defibrillators (ICDs) will go to the patients most likely to benefit from them, researchers reported today.

CHICAGO -- Stenting for an acute myocardial infarction has a better outcome when the reperfusion is followed up with an infusion of carperitide, a human atrial natriuretic peptide, Japanese researchers reported here.

CHICAGO -- A widely available blood test for heart failure should be used more frequently when patients arrive at the emergency department with shortness of breath, researchers said here.

CHICAGO -- Tolvaptan, an investigational selective oral vasopressin V2 -receptor antagonist, restored serum sodium concentrations in heart failure and cirrhosis patients with hyponatremia, researchers reported here.

SAN FRANCISCO -- Older men with limited life expectancies are getting screened much too often for prostate cancer, given the potential harm that may follow a positive test versus the likelihood of benefit, researchers here reported.

NEW YORK -- Uncomplicated diabetes does not affect 10-year heart transplant survival, but patients with diabetes-related renal disease or stroke do not do as well, reported surgeons here.

ROCHESTER, Minn. -- Mortality rates for heart failure patients with preserved left ventricular ejection fraction (non-systolic) are similar to those for patients with a reduced ejection fraction (systolic). However, a higher systolic pressure on admission was a marker of better prognosis.

CHICAGO -- Induction therapy with Taxotere (docetaxel), Platinol (cisplatin), and 5-FU (fluorouracil) leading up to chemoradiation improved complete response in patients with inoperable stage III or IV squamous cell carcinoma of the head and neck, researchers reported here.

CHICAGO -- When treating non-small cell lung cancer, the success of trimodality therapy -- chemoradiation followed by pneumonectomy -- depends upon the experience of the clinical center and the location of the lesion.

LONDON -- For a handful of carefully selected patients, a combination of mechanical and pharmacologic interventions has reversed severe heart failure and restored normal ventricular function, investigators here reported.

OAKLAND, Calif. -- Statins appear to be beneficial in reducing death and hospitalizations in heart failure patients, according to researchers here.

Abstract: Our understanding of the pathobiology of pulmonary arterial hypertension (PAH) has evolved considerably over the past 2 decades, with increasing recognition of the important role that aberrant vasoproliferative responses play in conjunction with disordered vasoconstriction. Classification of the many forms of PAH into categories sharing a similar pathophysiology and clinical presentations help the practicing clinician approach a complex differential diagnosis. Noninvasive tests can be used to narrow this differential but must be applied with an appreciation for their limitations. Transthoracic echocardiography is the screening tool of choice; the workup should also include chest radiography and electrocardiography. However, right heart catheterization is ultimately required to establish the diagnosis. While PAH remains a progressive and generally fatal disease, existing therapies have a significant impact on survival and new therapeutic targets offer great hope for improving the prognosis. (J Respir Dis. 2006;27(11):487-493)

ABSTRACT: Establishing the time of symptom onset is essential to selecting the appropriate therapy. Intravenous tissue-type plasminogen activator (t-PA), administered within 3 hours of symptom onset, is the only FDA-approved treatment for acute ischemic stroke. Intra-arterial and combined intra-arterial-intravenous thrombolytic therapy may be considered for patients whose condition does not improve or who present within 3 to 6 hours of symptom onset. Other options for treating acute ischemic stroke are balloon angioplasty with or without stenting (for symptomatic patients with more than 50% intracranial stenosis in whom medical therapy has failed) and mechanical clot retrieval (for those with an NIH Stroke Scale score greater than 10 who present after the 3-hour window for intravenous t-PA and can be treated within 8 hours of symptom onset or who present within 3 hours of symptom onset but in whom intravenous thrombolysis is contraindicated).

THECASE:An 84-year-old man with a history of stable angina, type 2 diabetes, hyperlipidemia, and hypertension presents to the emergency department with worsening dyspnea and peripheral edema. Congestive heart failure is diagnosed, and the patient is admitted to the care of a hospitalist. A standard therapeutic regimen, including diuretics, angiotensin-converting enzyme inhibitors, and oxygen, is instituted, in addition to the patient's home regimen of isosorbide mononitrate, glipizide, and amlodipine. The hospitalsubstitutes pravastatin for the patient's atorvastatin. A Foley catheter is inserted by a urologist because of the patient's benign prostatic hypertrophy. The patient complains of insomnia and is given diphenhydramine. His hospital course is otherwise uneventful.

If Rip Van Winkle were a primary care physician who fell asleep a generation ago and woke up today, what would he think? He would have missed the arrival of managed care. He wouldn't know what a hospitalist does. He might ask how this evasive concept called quality is measured . . . and then cringe at the idea of "report cards" and "pay for performance."

ABSTRACT: Establishing the time of symptom onset is essential to selecting the appropriate therapy. Intravenous tissue-type plasminogen activator (t-PA), administered within 3 hours of symptom onset, is the only FDA-approved treatment for acute ischemic stroke. Intra-arterial and combined intra-arterial-intravenous thrombolytic therapy may be considered for patients whose condition does not improve or who present within 3 to 6 hours of symptom onset. Other options for treating acute ischemic stroke are balloon angioplasty with or without stenting (for symptomatic patients with more than 50% intracranial stenosis in whom medical therapy has failed) and mechanical clot retrieval (for those with an NIH Stroke Scale score greater than 10 who present after the 3-hour window for intravenous t-PA and can be treated within 8 hours of symptom onset or who present within 3 hours of symptom onset but in whom intravenous thrombolysis is contraindicated).

A 78-year-old woman requests evaluation of worsening dyspnea. A long-time smoker, she quit when chronic obstructive pulmonary disease (COPD) developed. At each of the last several visits, her hair had been uniformly white.

An 84-year-old man with a history of stable angina, type 2 diabetes, hyperlipidemia, and hypertension presents to the emergency department with worsening dyspnea and peripheral edema.

If Rip Van Winkle were a primary care physician who fell asleep a generation ago and woke up today, what would he think?

BOLOGNA, Italy -- A month after discontinuation of anticoagulation, patients with an abnormal d-dimer level have a significant rate of recurrent venous thromboembolism, according to researchers here.

GRENOBLE, France -- The risk of deep venous thromboembolism (DVT) in older patients could be significantly reduced if clinicians in post-acute care settings took to heart evidence-based guidelines, according to French researchers.

ROCKVILLE, Md. -- The FDA has approved five new indications for Gleevec (imatinib mesylate), a tyrosine kinase inhibitor, all rare life-threatening disorders. At the same time the FDA added a precaution to Gleevec's label about congestive heart failure.

HOUSTON -- Pediatric dilated cardiomyopathy is a diverse disorder with outcomes that depend largely on cause, age, and heart failure status at presentation, as well as sex and race, according to researchers here.

SAN FRANCISCO -- Polypharmacy is a juggling act for Medicare-age patients, with too many drugs boosting the risk of harm and too few medications risking a lack of potential benefit.