Atrial Fibrillation

DALLAS -- For patients with cardiovascular disease, chronic kidney disease is often a fellow traveler, necessitating more sensitive diagnostic tools than serum creatinine alone.

SAN FRANCISCO -- Even though anticoagulation for atrial fibrillation may boost the chance of an intracranial bleed slightly in older patients, the benefits of the therapy outweigh the risk of a hemorrhage, according to researchers here.

PAMPLONA, Spain -- Severe obstructive sleep apnea more than doubled the risk of a first ischemic stroke in persons over age 70, researchers here reported.

NEW YORK -- Stroke risk trumps age, gender or other history of heart disease in determining which atrial fibrillation patients benefit from anticoagulation, according to revised guidelines issued today by the American College of Cardiology, the American Heart Association, and the European Society of Cardiology.

We describe a case in which a patient received thrombolytic therapy after he presented with a clinical picture consistent with submassive pulmonary embolism (PE). Two months later, a malignant peripheral nerve sheath tumor was diagnosed, and the patient died with metastatic disease. The filling defect in the left main pulmonary artery originally interpreted as PE was in fact a tumor. This case describes an unusual presentation of a rare disease (malignant peripheral nerve sheath tumor) mimicking a submassive PE.

A middle-aged woman is experiencing episodes of chest pain and fatigue. Although stress test results are positive for ischemia, coronary angiography reveals open arteries. What next step would you take?

An 81-year-old Asian woman was at a family function when she briefly complained of a severe headache, then quickly lost consciousness. She was brought to the hospital within 2 hours of symptom onset.

Is the weight gain associated with thiazolidinediones (TZDs) counterproductive to the treatment of diabetes?

A succinct review of hyperkalemia . . . its various causes, clinical manifestations and consequences, ECG findings, and treatment approaches.

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,