Atrial Fibrillation

ADELAIDE, Australia -- Men appear to have a 50% higher risk than women of recurrent venous thromboembolism after stopping anticoagulant treatment, researchers here reported.

PHILADELPHIA -- Gleevec (imatinib), the major prominent symbol of the age of targeted anti-cancer drugs, can on occasion cause serious cardiotoxicity with congestive heart failure, according to researchers.

GRONINGEN, The Netherlands -- Two decades after they were treated with Adriamycin (doxorubicin) for osteogenic sarcoma or malignant fibrous histiocytoma, the cardiac status of 22 long-term survivors continues to worsen.

ROCHESTER, Minn. -- Although the prevalence of heart failure with preserved ejection fraction has increased, survival rates for these patients with diastolic heart failure remain similar to those with a reduced ejection fraction, according to two studies.

A staff nurse calls the physician to see "something really bizarre-we have no idea what this is": the plastic of a urine collection bag of an 81-year-old woman has turned purple, although the urine within is more orange-brown and distinctly less odd looking. Patient has had an indwelling urethral catheter for 7 months, and this discoloration had not been noted before. Current history includes marked constipation, atrial fibrillation, and symptomatic osteoarthrosis of the hips and knees.

ROCHESTER, Minn. -- Repair of a faulty mitral valve is worth the risk regardless of patient age, even though it has been considered a perilous procedure, according to researchers here.

BOSTON -- Protection against congestive heart failure (CHF) by moderate drinking appears to be conferred by a previously unsuspected mechanism, according to researchers here.

FRAMINGHAM, Mass. -- Children of parents who develop heart failure appear to be predisposed themselves to both left-ventricular systolic dysfunction and overt heart failure, researchers here reported.

BALTIMORE -- For an investigational beta-blocker found to have no beneficial effect on heart failure the story may not be over.

Abstract: Although excessive daytime sleepiness is most often simply the result of inadequate sleep, other causes must be considered as well. Common causes of daytime sleepiness include obstructive sleep apnea/hypopnea syndrome (OSAHS) and medication side effects. The differential diagnosis also includes narcolepsy and restless legs syndrome (RLS). In many cases, the answers to a few simple questions can provide the necessary clues to the diagnosis. Loud snoring is associated with OSAHS, while sudden muscle weakness triggered by intense emotion is consistent with narcolepsy. Referral for sleep evaluation is indicated to evaluate for OSAHS, narcolepsy, RLS, and idiopathic hypersomnia. Methods of measuring daytime sleepiness include the Multiple Sleep Latency Test and the Epworth Sleepiness Scale. (J Respir Dis. 2005;26(6):253-259)

A 68-year-old woman presents with recurrent nausea, vomiting, left upper quadrant pain, decreased appetite, and a 2.3-kg (5-lb) weight loss 1 month after she underwent selective splenic artery embolization for refractory thrombocytopenia secondary to hypersplenism.

56-year-old man presents with substernal chest pain, diaphoresis, and weakness of 1 hour's duration. He had taken a sublingual nitroglycerin tablet that had been prescribed for his wife.

A review of the environmental determinants of allergic rhinitis and asthma, including house dust mites, cats, dogs, and cockroaches.

MILAN ? The potent antioxidant Fluimucil (N-acetylcysteine) may prevent contrast-medium-induced nephropathy and preserve kidney function in patients who undergo primary angioplasty after a heart attack.

UPPSALA, Sweden - A nighttime increase in diastolic blood pressure, or blood pressure that fails to dip at night, are significant independent predictors of congestive heart failure, researchers here reported.

HARROW, England - In the face of gathering thunderclouds, it's probably a good idea to shut down that cellphone before moving quickly to shelter. The risk of a working phone drawing a lightning charge is small but real, physicians here warned.

VANCOUVER, British Columbia ? Patients on long-term anticoagulation therapy for atrial fibrillation or heart valve replacement can safely monitor their anticoagulation status at home, and save morbidity, lives, and even money.

CHICAGO-The American Medical Association has added its weight to the many health groups in the country that have long advocated a reduction in salt consumption.

ROCHESTER, N.Y. - Heart failure may be a consequence of a successful reduction in sudden cardiac death for patients given implantable cardioverter defibrillators (ICDs).

HAMILTON, Ontario ? Antiplatelet therapy is a poor alternative to oral anticoagulation for preventing stroke in patients with atrial fibrillation, according to researchers here.

KANSAS CITY ? When considering transplants for patients with heart failure, women may need to be evaluated differently than men,

OAKLAND, Calif. ? Anemia, polycythemia, and chronic kidney disease are independent predictors of outcome for patients with heart failure, researchers here reported.

I have read that the concurrent use of an NSAID and an angiotensin-convertingenzyme (ACE) inhibitor may impair the antihypertensive effect of the ACEinhibitor. What is the mechanism of this interaction?

A 22-year-old woman presents with fever and malaise of1 month’s duration. About 3 weeks earlier she went to theemergency department. Erythromycin was prescribed,and the patient was told to seek medical attention if hercondition did not improve. Since that time, her healthhas worsened, the fever has continued, and she has lostweight. She says she has had painful areas on her handsand feet but no rash.

A 43-year-old woman presents to the emergency departmentwith fatigue, dyspnea, and intermittent chest painof 3 days’ duration. Her symptoms have worsened sinceshe arose, and 2 hours ago palpitations developed. She describesthe chest pain as a heavy pressure under her sternumthat does not radiate; she denies fever, nausea, vomiting,and diaphoresis.

Match each picture with the phrase below that best describes it. The organisms in these pictures might be microscopicor macroscopic, and they can be recovered from skin lesions or clothing by the patient and/or clinician.Answers and discussion appear on the following page.

A 47-year-old African American woman presented to the hospital after a 5-day history of cough and shortness of breath. The patient also described worsening cough with yellow sputum production over that same time but denied any fevers, chills, nausea, vomiting, abdominal pain, and urinary symptoms. Her condition began to rapidly deteriorate on arrival to the emergency department (ED).

Abstract: Failure to recognize heparin-induced thrombocytopenia (HIT) can lead to devastating thrombotic events, including pulmonary embolism and stroke. In most cases, the problem develops within 5 to 14 days after a first-time exposure to heparin. HIT can occur with either unfractionated heparin or low molecular weight heparin (LMWH), but the incidence is much lower with LMWH. When HIT is suspected clinically, a functional assay and immunoassay should be performed. However, treatment should not be delayed while waiting for laboratory confirmation. All forms of heparin should be eliminated, and treatment with an alternative anticoagulant should be initiated to prevent new thromboembolic events. Argatroban and lepirudin are the direct thrombin inhibitors that have been approved for the treatment of HIT. Because of the risk of warfarin-induced venous limb gangrene or skin necrosis, warfarin should be avoided in patients with acute HIT until their platelet counts have recovered and they are improving clinically. (J Respir Dis. 2006;27(6):248-259)

The authors describe a woman who presented with severe pulmonary hypertension. A cardiopulmonary cause was initially sought, but thyrotoxicosis was the underlying cause.

abstract: Pulmonary arterial hypertension (PAH) is 1 of 5 types of pulmonary hypertension (PH). Symptoms may include dyspnea on exertion, fatigue, near-syncope, and palpitations. Physical findings include lower extremity edema, jugular venous distention, and a loud P2. Findings on chest radiography, transthoracic echocardiography, and electrocardiography can suggest the presence of PAH; however, right heart catheterization is the gold standard for confirming the diagnosis and for differentiating PAH from other forms of PH. It is essential to exclude chronic thromboembolic PH, since this can be surgically corrected. The treatment of PAH depends on the severity. In addition to the standard treatments, such as diuretics and anticoagulation, more advanced treatment options include prostaglandin therapy (epoprostenol, treprostinil, and iloprost), endothelin receptor antagonists (bosentan), and phosphodiesterase inhibitors (sildenafil).