October 2007

A 52-year-old man was admitted to the emergency department with a 2-hour history of typical ischemic chest pain.

Postpartum cardiomyopathy is a serious disorder that can present from the third trimester to up to 5 months after pregnancy. Although spontaneous resolution of cardiac function occurs in more than half of patients (over a period of 6-12 months), the balance is left with persistent cardiac dysfunction. Cardiac dysfunction results in signs and symptoms of left heart failure, formation of apical or left ventricular thrombi, and arrhythmias and requires management similar to that in patients with nonischemic dilated cardiomyopathy.

According to results of the Atorvastatin for Reduction of Myocardial Damage During Angioplasty-Acute Coronary Syndromes (ARMYDA-ACS) trial, short-term pretreatment with high-dose atorvastatin prior to percutaneous coronary intervention improves clinical outcome in subjects with unstable angina and non-ST-segment elevation myocardial infarction. These findings support the upstream administration of high-dose statins in subjects with acute coronary syndrome treated with an early invasive strategy.

The use of statins to treat hyperlipidemia is well established.

We evaluated trends in the treatment and mortality of patients with and without diabetes mellitus and acute myocardial infarction over the last decade. Despite improvements in the provision of evidence-based care, patients with diabetes did not derive improvements in long-term survival.

Two trends have collided in the last 10-20 years: 1) there is no question that both the prevalence and incidence of type 2 diabetes mellitus are on the increase; 2) conversely, the morbidity and mortality associated with acute coronary syndromes— especially myocardial infarction (MI)—are definitely declining.

We assessed the prognostic value of the 6-minute walk test (6-MWT) among 1592 subjects with differing degrees of left ventricular systolic dysfunction (LVSD). We found that the 6-MWT was an independent predictor of mortality, particularly among patients with more than mild LVSD. The 6-MWT provides less prognostic utility in patients with mild or lesser LVSD, however.

Heart failure affects approximately 5 million Americans, and more than 500 000 new cases are diagnosed each year.

We hypothesized that atherosclerotic renovascular disease (ARVD) might account for a growing proportion of end-stage renal disease in the United States because of shared risk factors and the aging of the population. We tested this hypothesis through an evaluation of 146 973 older patients starting dialysis therapy in the United States between 1996 and 2001.

The incidence of end-stage renal disease (ESRD) has nearly doubled in the United States between 1991 and 2000 and has been projected to increase by 50% by 2015.