Cardiology

A 55-year-old man with a history of hypercholesterolemia presented to the emergency department with severe crushing chest pain radiating to the left arm for a duration of 1 hour.

A meta-analysis of 40 previously published studies conducted by Elizabeth Selvin, PhD, MPH, of the Johns Hopkins Bloomberg School of Public Health, and colleagues has found that treatment with the diabetes drug metformin may be associated with a lower risk of death from cardiovascular disease.

Christopher D. Nielsen, MD, Associate Professor of Medicine, Division of Cardiology, Medical University of South Carolina, discusses issues with a patent foramen ovale.

Pamela B. Morris, MD, Director, Preventive Cardiology, Co-Director, Women's Heart Care, Medical University of South Carolina, discusses cardiovascular disease in women.

The following questions are exclusive to CRLive and can assist candidates in preparing for the Maintenance of Certification Exam in Cardiovascular Disease.

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.

Treatment of stable patients with acute coronary syndrome (ACS) is controversial. Until recently, large randomized clinical trials had indicated that an "early" invasive strategy with routine cardiac catheterization reduced the likelihood of recurrent cardiovascular events when compared with a more "selective" approach, in which stable patients were referred to cardiac catheterization based on high-risk features on noninvasive stress imaging or because of a failure in initial medical therapy.

Sudden death in young athletes is shocking because it is unexpected in these seemingly healthy individuals. We present the case of an athlete who was found to have an incidental murmur during a screening physical, which led to a diagnosis of an anomalous origin of the right coronary artery with an intramural course. This congenital anomaly has been well recognized to result in sudden death; thus, it was fortunate that the condition was identified in our patient. We provide a brief overview of the literature, discuss the challenges faced in diagnosing such coronary abnormalities, and review the various management options that are available.

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.

Rates of death and myocardial infarction were assessed for a national sample of acute coronary syndrome patients after stopping clopidogrel. In the first 90 days after stopping treatment, patients experienced a nearly twofold increased risk of adverse events compared with subsequent follow-up intervals for patients treated medically without stents and for patients treated with coronary stents. This suggests a possible clopidogrel rebound effect, but additional studies are needed to support this hypothesis and to identify strategies to reduce early events after clopidogrel cessation.

We performed a systematic review and meta-analysis of all clinical trials comparing routine invasive strategy with selective invasive strategy in patients with non–ST-segment elevation acute coronary syndrome. We did not find either strategy to offer an advantage over the other, even when we excluded trials that did not use coronary stents and glycoprotein IIb/IIIa inhibitors.

The British Medical Journal concluded that their research does "not provide evidence to support the use of aspirin in primary prevention of cardiovascular events and mortality."

Francis Spinale, MD, PhD, MUSC, discusses his research on new techniques for detecting heart remodeling in early heart failure.

From the FDA (Food and Drug Administration) a warning about heparin.

The benefits of intensive glycemic control appear to be confined to microvascular disease, with 3 randomized controlled clinical trials failing to demonstrate a macrovascular benefit with intensive glycemic control in patients with type 2 diabetes.

New research to be presented at the 20th Annual Transcatheter Cardiovascular Therapeutics scientific symposium.

Hypertension may well be the most important public health issue facing society today.

The Unofficial Apple Weblog reports on a new unapproved Apple iPhone application that will "monitor your heart rate."

The latest research from Dr. Costas Karageorghis's 20-year-old program shows that music can increase physical endurance.

The US House of Representatives voted last week to approve the Heart Disease Education, Analysis Research, and Treatment for Women Act, legislation.

The article by Schwartzman and Brener (page 33) has 4 important implications for the treatment of acute coronary syndrome (ACS) patients who are found to have multivessel coronary artery disease (CAD) during diagnostic coronary angiography.

Millions of people in the United States require chronic anticoagulation to prevent thromboembolism secondary to chronic atrial fibrillation (AF), pulmonary hypertension, mechanical valve replacements, and other prothrombotic conditions.