Cardiology

The questions asked in this article can assist candidates prepare for the Maintenance of Certification Exam in Cardiovascular Disease.

Cardiogenic shock continues to be a major complication of acute myocardial infarction, with in-hospital mortality approaching 70% to 80% for patients who are managed medically.

The authors report an unusual case of a patient presenting with such severe intermittent vasospastic constriction of the brachial artery that it resulted in symptoms of decreased blood supply.

The last 2 decades have seen enormous strides in the identifi cation and modification of cardiovascular disease (CVD) risk factors. Many large, population-based studies, led by the Framingham Heart Study, have been invaluable in identifying these risk factors.

Reforming healthcare often took center stage during the presidential campaign. Having won the election, President Obama continues to tout healthcare reform as one of the top issues he wants addressed his first year in office.

A 64-year-old woman with a history of atrial fibrillation, hypertension, and sarcoidosis presented to the emergency department with chest pain. After a positive stress test, a coronary angiogram was performed, which showed normal coronary arteries except for an anomalous take-off of the left circumflex artery from the right coronary cusp.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia, occurring in over 2% of the general population.

Researchers recently announced that they have discovered a "novel gene mutation among the Old Order Amish population that significantly reduces the level of triglycerides in the blood and appears to help prevent cardiovascular disease."

This editorial was stimulated one morning when I saw a patient with congestive heart failure and rapid atrial fibrillation (AF).

Treatment of type 2 diabetes should achieve and maintain euglycemia, thereby preventing complications from this progressive disease. Current antidiabetic therapies should be a part of a multimodal management program that includes diet, exercise, and blood pressure and lipid control. Oral antidiabetic drugs are still first-line therapy for type 2 diabetes, but intensification of therapy, including starting insulin, should occur every 2 to 3 months as needed to achieve euglycemia. The first insulin added is typically a basal insulin, which is effective in lowering fasting plasma glucose (FPG). A persistently elevated glycated hemoglobin (HgbA1C) level despite near or complete normalization of FPG, however, indicates postprandial hyperglycemia. In these cases, the addition of bolus insulin is required to reduce postprandial glucose (PPG). Several approaches to initiate and titrate insulin can be used based on FPG, PPG, HgbA1C, and patient factors.

A 43-year-old man with a strong family history of diabetes mellitus presented to his primary care physician requesting interventions to decrease his cardiovascular risk.

A 61-year-old man presented to his primary care physician for a routine physical examination.

A 72-year-old man presented with angina, dynamic ST-segment depression, and increased troponin and creatine kinase-myocardial band (CK-MB) levels above the institutional upper limits of normal (ULN).

An 84-year-old woman was admitted to the hospital because of fever, wheezing, and shortness of breath.

A 72-year-old physically active man with a history of coronary artery disease and wellcontrolled hypertension developed gradual shortness of breath, initially with outdoor exertional physical activities and later with more usual activities. He also developed mild ankle and leg edema during the same time.

A 62-year-old man with paroxysmal atrial fibrillation (AF) presents to his physician’s office for a discussion of treatment options for his AF.

A 70-year-old woman presented to the emergency department with acute onset of shortness of breath that awakened her from sleep.

A 40-year-old previously healthy woman had progressively worsening dyspnea on exertion and lower extremity edema for a duration of 4 months.

After an anterior acute myo­cardial infarction 7 years ago, a 74-year-old man had re­ceived treatment with aspirin, simvastatin (Zocor), and a beta blocker.

A 68-year-old man with increasing shortness of breath during moderate physical exertion consulted his family physician.

A 77-year-old man with atrial fibrillation of more than 10 years duration was admitted to the neurology department with left-sided hemiparesis and aphasia.