Cardiology

A 40-year-old previously healthy woman had progressively worsening dyspnea on exertion and lower extremity edema for a duration of 4 months.

A 75-year-old former dentist was admitted to our department for evaluation of chronic angina pectoris.

A 62-year-old woman presented to the emergency department with chest pain.

A 50-year-old woman with angina pectoris, hyperlipidemia, and hypertension was admitted to our clinic because of a possible transient ischemic attack.

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 72-year-old woman with symp­toms of palpitations and fatigue for the past several months was seen in the outpatient department.

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.

A 62-year-old white man weighing 78 kg was referred to our cardiac catheterization laboratory for evaluation and percutaneous treatment of suspected ischemic coronary artery disease.

A 61-year-old man was admitted to the hospital for increasing shortness of breath, weight gain, and orthopnea.

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

An asymptomatic 65-year-old woman with a 10-year history of well-controlled diabetes mellitus, hyperlipidemia, and hypertension was referred for preoperative cardiac evaluation before noncardiac surgery.

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

A 45-year-old man with no significant medical history presents for a new-patient evaluation at your office.

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

Patient #1 was a 64-year-old woman with chest discomfort provoked by exertion and emotional stress.

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 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.