April 1st 2025
Semaglutide 2.4 mg significantly lowered the risk of MACE and mortality in patients with ASCVD and overweight or obesity but without diabetes, researchers reported.
Chronic Disease in African Americans: The Scope of the Disparity
December 31st 2006The incidence of hypertension, diabetes, certain types ofcancer, and other chronic diseases is disproportionatelyhigher in African Americans than in white Americans. Thestatistics presented in the Table illustrate the magnitudeof this disparity. For other diseases, such as breast cancer,the incidence is lower but mortality is higher in AfricanAmericans.
Ambulatory BP Monitoring: Time for an Expanded Role in Office Practice?
December 31st 2006Twenty-four-hour ambulatory blood pressure (BP) monitoringis a more accurate predictor of stroke and myocardialinfarction than office BP measurement, according tothe results of the recent Office Versus Ambulatory BloodPressure Study. This prospective trial followed 1963 patientswith treated hypertension for 5 years.
Cold Weather Dermatoses: How to Recognize and Treat
December 31st 2006Prolonged exposure to coldtemperatures can have a profoundeffect on the skin.When tissues are exposed toabove-freezing temperatures,localized vasoconstriction and increasedblood viscosity reduce bloodflow and decrease the amount ofoxygen available to tissues. Whentissues are exposed to freezing temperatures,water within those tissueschanges into ice crystals; this resultsin either intracellular or extracellulardamage and tissue necrosis.
Central Retinal Artery Occlusion in a 70-Year-Old Man
December 31st 2006A 70-year-old man complains of a sudden, painless loss ofvision in the left eye that occurred several hours earlier. He denies traumaand previous visual disturbances. His history is significant for peripheralvascular disease and type 2 diabetes mellitus.
Acute Dx: What Cause of Sudden Illness?
December 31st 2006A 60-year-old woman reportsthat she has felt intermittent“fullness” in her face for the past day.This sensation is present when sheis supine on the examination table.She denies shortness of breath, dysphagia,and chest discomfort. Thepatient has a 25 pack-year history ofcigarette smoking.
Near-Syncope in an Elderly Woman
December 31st 2006An 84-year-old woman with hypertension and type 2 diabetes mellitus isbrought to the emergency department (ED) after an episode of nearsyncope.When emergency medical service personnel initially assessed her,blood pressure was 96/60 mm Hg and heart rate was “slow”; however, shehad no symptoms.
Older Man With Exertional Dyspnea and Leg Swelling
December 31st 2006A 74-year-old man with a history ofatrial fibrillation presents to hisprimary care physician with dyspneaof 4 days’ duration. The dyspnea developedwhile he was walking as partof his recovery from back surgery forspinal stenosis 1 month earlier. Hebecame progressively short of breathand was unable to carry out his exerciseprogram.
Middle-Aged Man With Newly Detected Atrial Fibrillation
December 31st 2006A 56-year-old man with insulin-dependent type 2 diabetes is hospitalized foroperative debridement of an ulcer on his left heel. During the preoperativeevaluation, atrial fibrillation (AF)-with a ventricular rate of 130 beats perminute-is detected.
A Photo Quiz to Hone Dermatologic Skills
December 31st 2006During the past few weeks, a 14-year-old boy has noticed blood on the proximalnail folds of the second and third fingers of his dominant hand. He deniesany pain or pruritus. The patient is otherwise healthy and takes no prescriptionmedications.
Acute, Severe Dyspnea in an Older Man With COPD
December 31st 2006An 82-year-old man suddenly became extremely short of breath while helpinghis wife wash dishes. The dyspnea was not accompanied by pain, and it was notrelieved by sitting. He was taken to the emergency department after diaphoresisand cyanosis developed.
Diagnostic Images, Treatment Issues
December 31st 2006A39-year-old man is brought to theemergency department (ED)after his car struck a tree. He experienceda transient loss of consciousnesswith a 3-minute episode of retrogradeamnesia at the scene of the accident,despite wearing a seat belt andshoulder harness. He was disorientedto date and place.
Middle-aged Man With Chest Pain After Exercise
December 31st 2006A42-year-old man with a history of hypertension presents to an outpatientclinic with chest pain that began the day before, after he had worked outat his health club. The discomfort increases when he walks and worsenssomewhat with inspiration. No associated symptoms are noted. Results of aphysical examination are normal; no chest wall tenderness is evident. Becausecertain features of the presentation suggest an acute coronary syndrome, a12-lead ECG is obtained, which is shown here.
Two Cases of ST-Segment Elevation
December 31st 2006A 51-year-old man with hypertension, type 2 diabetes mellitus, and hypercholesterolemiapresents with a 1-hour history of substernal chest discomfort anddyspnea. He was given sublingual nitroglycerin in the emergency department,but his symptoms did not resolve.
Older Man With Morning Stiffness and Achiness in His Shoulders and Hips
December 31st 2006A 78-year-old man complains that he has not “felt well” for several months. Hismajor symptom is profound morning stiffness and achiness, especially in theshoulders and hips. In addition, he has little energy and has difficulty in completingeven routine daily activities.
CHD Prevention and Current CHD Prevention and Current Is Lower Better?
December 31st 2006A major controversyin cardiologytoday iswhether loweringthe level oflow-density lipoprotein cholesterol(LDL-C) to substantiallybelow 100mg/dL-the current NationalCholesterol EducationProgram goal for patientswith existing coronaryheart disease1-willfurther reduce the incidenceof cardiovascularmorbidity and mortality.
Elderly Woman With Severe, Worsening Dyspnea
December 31st 2006An 88-year-old woman is admitted for severe dyspnea thathas worsened over the past month. Dyspnea on exertionis now elicited by everyday activities, even walking acrossthe room. Orthopnea and paroxysmal nocturnal dyspneahave progressed to the point that she has been unable tosleep at all the past several nights. She also tires very easilyand thinks her ankles are more swollen than previously.She denies chest pain or pressure.
A Photo Quiz to Hone Dermatologic Skills
December 31st 2006For 3 months, a 57-year-old woman has had a persistent green nail that is occasionallyslightly sore; the nail plate has lifted. Another physician prescribed a7-day course of levofloxacin for a suspected Pseudomonas infection; the treatmenthad no effect on the nail. A subsequent 7-day course of norfloxacin wasalso unsuccessful. The patient is otherwise healthy.
Do You Recognize These Nail Disorders?
December 31st 2006During a routine skin examination,periungual erythema and increasedcurvature of the nail plate are notedin a 78-year-old man. The patient hasemphysema and a smoking historyof more than 50 pack-years. Currently,he requires oxygen support forregular daily activity.
Rightward Shift in Axis or Right Axis Deviation?
December 31st 2006In their “Photoclinic” case of a patient with acute pulmonary embolism(CONSULTANT, December 2003, page 1741), Drs Tapas Bandyopadhyay andIsmael Martin state that the patient’s 12-lead ECG (which accompanies the casediscussion) exhibits right axis deviation.
Young Man With Cough and Dyspnea
December 31st 2006A 22-year-old man presents to theemergency department with a2-week history of a worsening nonproductive,irritating dry cough andexertional dyspnea. The patient hasbeen otherwise healthy. He deniesfever, rigors, night sweats, hemoptysis,chest pain, palpitations, orthopnea,paroxysmal nocturnal dyspnea,ankle edema, and lymphadenopathy.
Diagnostic Images, Treatment Decisions
December 31st 2006For 3 days, a 42-year-old man has had episodic dullchest pain. The anterior precordial and retrosternalpain intensifies with inspiration and movement. He has nohistory of recent viral infection, hypertension, coronaryartery disease, cardiac surgery, diabetes mellitus, or hyperlipidemia.There is no family history of cardiovasculardisease.
Chest “Tightness” in an Elderly Woman
December 31st 2006A 76-year-old woman presents with chest pain-which she describes as“muscle tightness”- that began when she awoke in the morning. Thepain is constant, exacerbated by deep inspiration, and accompanied by asubjective sense of slight dyspnea; she rates its severity as 3 on a scale of1 to 10. She denies pain radiation, nausea, diaphoresis, palpitations, andlight-headedness. Her only cardiac risk factors are hypertension and a distanthistory of smoking.