Cardiology

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.

Multiple imaging modalities were used to assess left ventricular function in a 64-year-old patient with prior inferior myocardial infarction.

A 37-year-old man was referred for assessment and treatment of syncope by his family doctor.

A 62-year-old man was admitted for spontaneous constrictive, intense chest pain.

An 80-year-old woman with hypertension, diabetes, and osteoarthritis experienced an episode of atrial fibrillation 1 year earlier, causing presyncope accompanied by palpitations, but no other symptoms.

A 58-year-old woman with a longstanding history of hypertension presented with numbness on the right side of the body and drooping of the right side of the face. The episode lasted about 30 minutes, after which there was a significant improvement of symptoms... Read the rest of the case report inside and take the quiz!

We compared the rates of cardiac catheterization in 2136 non–ST-segment elevation acute coronary syndrome patients who were stratified according to their baseline thrombolysis in myocardial infarction (TIMI) risk score. Higher-risk patients were referred for catheterization at a similar rate as low-risk patients. The main reasons why physicians did not make referrals included (1) clinical trial evidence did not support an early invasive approach and (2) 68% of patients were thought not to be at high enough risk; however, 59% of these patients were found to be higher risk when their baseline TIMI risk scores were recalculated. Patients who were referred for catheterization had better in-hospital and 1-year outcomes. Our findings indicate that a significant opportunity remains to improve upon accurate risk stratification and adherence to an early invasive strategy for higher-risk patients.

A 59-year-old Indian man with a medical history significant for orally controlled diabetes presented to the emergency department after experiencing a witnessed seizure.

Despite contemporary management, patients with acute coronary syndrome (ACS) remain at risk of recurrent adverse cardiovascular events.