Atrial Fibrillation

NEWCASTLE UPON TYNE, England, June 5 -- An interim analysis of the 4,447-patient RECORD trial did not confirman increased risk of myocardial infarction or cardiac death in patients taking rosiglitazone (Avandia) for treatment of type 2 diabetes, although the data suggest an increased risk of heart failure. So reported the New England Journal of Medicine online today, one day before a Congressional hearing on the safety of rosiglitazone.

ABSTRACT: Atypical clinical presentations in the quality, intensity, and radiation of pain are common in patients with acute coronary syndromes. Women with an acute myocardial infarction (AMI) are more likely to have atypical symptoms, such as dyspnea, than men. A history of acute anxiety or a psychiatric diagnosis does not preclude the possibility of an acute coronary event in a patient with chest pain. The clinical response to a GI cocktail, sublingual nitroglycerin, or chest wall palpation does not reliably identify the source of pain. Over-reliance on tests with poor sensitivity, such as the ECG, or on the initial set of cardiac biomarkers will miss many patients with MI. Serial troponin levels obtained at 3- to 6-hour intervals are recommended to evaluate the extent of myocardial damage. Coronary angiography that detects mild non-obstructive disease does not exclude the possibility of sudden plaque rupture and acute coronary occlusion.

Torsades de pointes, or polymorphic ventricular tachycardia, seen on ECG includes wide complex QRS morphology tachycardia, axis deviation of the QRS complexes around baseline.

abstract: Inflammatory bowel disease (IBD) can have a variety of extraintestinal manifestations, including pulmonary disease. Bronchial involvement is the most common, but other manifestations include upper airway disease; parenchymal involvement, such as bronchiolitis obliterans with organizing pneumonia (BOOP) and interstitial lung disease; and serositis, including pleural effusions and pericarditis. Patients with BOOP may present with fever, dyspnea, cough, and pleuritic chest pain. Chest radiographs show bilateral patchy airspace opacities or a diffuse process; CT scans often demonstrate the opacities to be pleural-based. Corticosteroids appear to be effective in the management of certain pulmonary manifestations of IBD, such as BOOP and pulmonary infiltrates with eosinophilia. (J Respir Dis. 2007;28(6):227-234)

WINSTON-SALEM, N.C. -- A simple exercise test measuring the ratio of oxygen consumption to carbon dioxide production can predict mortality risks in systolic heart failure, said researchers here.

PHILADELPHIA -- More than half of patients with atrial fibrillation are also likely to have obstructive sleep apnea, investigators suggested here.

PHILADELPHIA -- The most obvious clinical feature of obstructive sleep apnea may be weariness of mind, but this breathing disorder also slowly and silently wears down the heart, according to researchers.

SAN FRANCISCO -- A daily protocol to bring ICU patients out of a drug-induced coma and breathing on their own gets them home four days faster, researchers said here.

SAN FRANCISCO -- Sleep apnea may increase the risk of heart disease and mortality risk 40%, researchers said here.

LYNCHBURG, Va. -- Televalgelism pioneer Jerry Falwell, the founder of Moral Majority and a stalwart of the Christian right wing of the GOP, died today after collapsing in his office here. Falwell was 73 and had suffered in recent years from congestive heart failure and pneumonia.

SANTA MONICA, Calif. -- Women are less likely to achieve good control of both heart disease and diabetes than men because they get lower quality care, researchers here reported.

SEATTLE -- Gastric acid suppression with proton pump inhibitors appears to hold no excess risk of pneumonia in hospitalized older adults, researchers reported here.

ABBOTT PARK, Ill. -- A heart failure drug called levosimendan (Simdax), which has been in clinical trials, has been withdrawn from development by Abbott Laboratories and Finnish partners.

SAN FRANCISCO -- A successful once-a-year drug to treat postmenopausal osteoporosis, even though administered by an IV infusion, may be welcomed by women who dislike a weekly or monthly pill, researchers here reported.

EDINBURGH, Scotland -- When acute coronary syndrome guidelines get used, patients have had significant reductions in rates of heart failure, myocardial infarction, stroke, and death according to the multinational GRACE study.

abstract: Pulmonary alveolar proteinosis (PAP) is characterized by the accumulation of lipoproteinaceous material in the alveoli. The most common symptoms are dyspnea on exertion and nonproductive cough. Weight loss, fatigue, chest pain, and hemoptysis have also been reported. Chest radiographs typically show bilateral, symmetrical airspace disease with an ill-defined nodular or confluent pattern, which gives a "bat wing" appearance, as is seen in heart failure. Pulmonary function tests usually demonstrate mild restrictive disease. Findings on examination of sputum specimens or bronchoalveolar lavage fluid can suggest the diagnosis; however, open lung biopsy is the diagnostic gold standard. Whole lung lavage remains the standard of care for PAP and is warranted in patients with severe dyspnea and hypoxemia. Subcutaneous human recombinant granulocyte-macrophage colony-stimulating factor appears to be a promising alternative to whole lung lavage for symptomatic patients. (J Respir Dis. 2007;28(5):177-184)

Patients with congenital heart disease and pulmonary arterial hypertension (PAH) are at risk for severe deterioration during pregnancy and delivery. We discuss the case of a 38-year-old woman who presented to the emergency department complaining of dyspnea 6 days after giving birth to her first child via cesare- an section. When PAH is untreated, maternal mortality may exceed 50%, but aggressive PAH treatment offers improved outcomes. Moreover, initial improvement in functional status made with parenteral prostanoids can be maintained with combination oral therapy.

ABSTRACT: Patients who experience an acute myocardial infarction (MI) are at very high risk for recurrent cardiovascular events. Both site-supervised and home-based cardiac rehabilitation programs can effectively reduce all-cause and cardiovascular mortality. Start risk factor reduction as soon as possible; pharmacotherapy is best initiated while patients are still in the hospital. All patients who have had an MI should receive aspirin, an angiotensin-converting enzyme inhibitor, and a ß-blocker, unless these agents are contraindicated or are not tolerated. Prescribe aggressive lipid-lowering therapy to bring patients' low-density lipoprotein cholesterol levels to below 70 mg/dL. For smokers, quitting is the single most important change they can make to reduce future risk of MI.

What is "normal" blood pressure (BP)? Is it different from optimal BP?

COLORADO SPRINGS, Colo. -- For prospective gastric bypass patients, surgeons may have a better tool to help gauge the risk of mortality from the procedure, researchers said here.

BOSTON -- The anti-angina drug ranolazine (Ranexa) is safe in patients with non-ST elevation acute coronary syndromes (ACS), but it doesn't reduce the occurrence of cardiovascular events.

A 24-year-old woman presents to the emergency department (ED) withgeneralized weakness, headache, and muscle cramping that have progressivelyworsened over the past week. Recently, she has also had nauseaand vomiting. She denies chest pain, palpitations, dyspnea, cough, fever,chills, diarrhea, and urinary symptoms. She has a history of type 1 renaltubular acidosis.

A 29-year-old sailor presented with a painless, enlarging, reddish, mobile lump under his left nipple. Four months earlier, while on deployment in the South Pacific, he had his nipples pierced on a whim.

SEATTLE -- Nearly a third of Americans with type 2 diabetes have chronic kidney disease, and about 20% have diabetic eye disease and foot problems, a surveillance report shows.

MONTRÉAL -- Restless legs syndrome may boost nocturnal blood pressure and exacerbate cardiovascular disease risks, particularly among older patients, investigators here suggested.

KUOPIO, Finland -- Intravenous hydrocortisone after cardiac surgery led to a 37% lower relative risk of post-op atrial fibrillation compared with placebo, researchers here reported.

NEW ORLEANS -- The potential impact of the COURAGE trial -- the headline-making study that matched medicine to stenting in patients with chronic stable angina -- appears to be in the eye of the clinical beholder.

NEW YORK -- When low-dose aspirin is taken for cardiovascular risk reduction and ibuprofen for the pain of osteoarthritis, the heart may be the loser, found investigators here.

NEW ORLEANS -- Nurse-led education and counseling in disease-management programs may improve outcomes for heart failure patients, but setting and patient age may be determining factors, according to separate studies.

The role of anticoagulation in the treatment of patients who have been permanently immobilized as a result of neurological impairments is unique. Patients with spinal injuries have been comprehensively studied, and the data are very clear: the risk of DVT falls sharply 4 to 6 months after the injury and onset of immobility.