September 17th 2024
New data shows that favorable CV health in the first trimester is associated with a 35% to 62% lower risk of HDP regardless of level of genetic risk.
How to Treat Hypertension in Type 2 Diabetes
June 4th 2010A 68-year-old African American man presents for a checkup. He has had type 2 diabetes mellitus for the past 5 years but has no nephropathy and no history of cardiovascular disease. He is currently taking atorvastatin, 80 mg/d, and his low-density lipoprotein cholesterol level is 80 mg/dL. His blood pressure was 148/98 mm Hg at the last visit and is now 150/98 mm Hg. What is the best treatment for him?
Nonarteritic Anterior Ischemic Optic Neuropathy
May 5th 2010A 43-year-old white man presented to the emergency department with dyspnea, abdominal bloating, fever with chills, night sweats, decreased oral intake, and myalgia of 1 week's duration. He was found to have heart failure caused by systolic dysfunction. Viral myocarditis was the presumptive diagnosis after investigation for other causes.
Diabetes and Cardiovascular Disease: Does Lowering Hemoglobin A1c Help or Harm?
November 3rd 2009Case 1: Mr A. is a 55-year-old man who comes to your office for a routine physical examination. He is a traveling salesman and has recently gained weight. He does not exercise much and is a frequent visitor to fastfood establishments. His father had “a touch of diabetes” and died of a myocardial infarction (MI) at age 59.
Pheochromocytoma and Papillary Carcinoma in a Man With Hypertension and Acute Cholecystitis
August 19th 2009A 77-year-old man of Japanese ancestry with a history of well-controlled hypertension was seen in the morning for a routine examination. His blood pressure was normal as were the results of a complete blood cell count and liver function tests. About 6 hours later, he presented to the emergency department with acute abdominal pain accompanied by nausea, vomiting, fever, and chills. He denied headaches, palpitations, and diaphoresis.
Evolving Therapy for Type 2 Diabetes Complications
August 18th 2009The past 3 decades have seen a profound paradigmatic shift in the treatments available for type 2 diabetes mellitus. Because the disease is complicated by a variety of macrovascular and microvascular pathologies, interventions must be broad-based (tight glycemic and blood pressure [BP] control, serum lipid and urinary protein reductions). This "multifactorial" approach has proven successful.
Chemical Colitis From Hydrogen Peroxide Enema
August 6th 2009A 61–year–old man presented to the emergency department with diffuse lower abdominal pain, nausea, and severe diarrhea (20 episodes within the past 12 hours). His symptoms began the night before and had gradually worsened. He denied fever. His medical history was significant for hypertension.
Herniation of a Lung Bulla Through a Thoracostomy Site
May 9th 2009For 3 months, a 63-year-old man had experienced progressively worsening dyspnea. He denied fever, weight loss, and hemoptysis. Eight months earlier, he had had a right thoracotomy to drain a right empyema. Comorbidities included morbid obesity, type 2 diabetes mellitus, hypertension, and obstructive sleep apnea. However, he did not have any intrinsic lung disease.
Is Chronic Kidney Disease Also an Affair of the Heart?
May 8th 2009The 1990s were an exciting decade for the treatment of chronic kidney disease (CKD). The addition of angiotensin-converting enzyme inhibitors (ACEIs) and then angiotensin receptor blockers to the antihypertensive armamentarium helped preserve renal function and decrease proteinuria in patients with CKD.
Chronic Heart Failure:When to Consider Device Therapy
May 1st 2009In the United States, an estimated 5 million people have heart failure and about 550,000 new cases occur each year.1 The incidence is rising as more patients survive what were once fatal myocardial infarctions (MIs). Coronary artery disease (CAD) and hypertension are the most common causes of heart failure. The less frequent causes include diabetes; viral infections; valvular heart disease; drugs (eg, doxorubicin); and postpartum, alcoholic, and familial cardiomyopathies.2,3
What caused this intensely pruritic eruption?
May 1st 2009For 1 month, a 54-year-old woman has had an intensely pruritic eruption on her abdomen, arms, and anterior thighs. She has long-standing hypertension and type 2 diabetes mellitus, which are treated with an angiotensin-converting enzyme inhibitor/diuretic and an oral hypoglycemic agent.
Retinal Vein Occlusions:5 Cases That Run the Gamut
April 2nd 2009A 58-year-old man sought medical attention because of the recent sudden onset of blurred vision in his left eye. His vision had not improved over several days. The patient had hypertension and had recently sustained a myocardial infarction. He was taking metoprolol, 25 mg/d, and aspirin, 81 mg/d.
Multiple Myeloma With a Gastric Plasmacytoma
April 2nd 2009Two weeks after being treated for a fracture of the left humerus and several palpable breast lesions, a 63-year-old African American woman was hospitalized for generalized weakness and confusion. She had a history of type 2 diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, and low-grade B-cell lymphoma (which had been in remission for 2 years).
Renal Artery Stenosis: When Is Revascularization Warranted?
February 2nd 2009Q:My patient is a 66-year-old man with long-standing hypertension and atherosclerotic heart disease. During a recent coronary arteriogram, the cardiologist performed renal artery screening, which revealed a left renal artery stenosis. Renal artery angioplasty and stenting were recommended. Is this appropriate?