September 2008

A 39-year-old mother of 2 teenage boys, who was also a nurse, became permanently aphasic because of a stroke.

A 75-year-old woman who experienced chest discomfort that caused her to awaken and persisted as retrosternal pain was admitted to the emergency department.

A 64-year-old white woman presented to a nearby emergency department after experiencing abrupt, intense chest pressure while playing tennis.

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

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.

Percutaneous closure of the patent foramen ovale (PFO) can be accomplished within 15 minutes using only fl uoroscopy for guidance. Local anesthesia and femoral vein puncture in the groin with a 9 French catheter can achieve about a 90% complete closure rate when the Amplatzer® PFO Occluder is used. Complications are extremely rare and physical restrictions are unnecessary starting a couple of hours after the intervention. Aspirin and clopidogrel (Plavix) are typically prescribed for a few months after the procedure, and the therapy concludes with transesophageal echocardiography at follow-up approximately 6 months later.

Migraines, including those with aura, are common and generally benign, affecting between 10% and 15% of the population.

The AMIS (Acute Myocardial Infarction in Switzerland) Plus prospective cohort study compared treatment and in-hospital outcomes between men and women with acute coronary syndrome (N = 26,452) admitted to Swiss hospitals between 1997 and 2007. The study reached several important conclusions: women had different baseline characteristics than men at admission, were treated with different drug regimens, and were significantly less likely to undergo percutaneous coronary intervention. After adjusting for these differences, researchers found no significant difference in the rates of in-hospital mortality between men and women, except for women aged 51 to 60 years, who were more likely to die in-hospital.

More than 1 million percutaneous coronary interventions (PCIs) are performed annually in the United States.

Although multivessel coronary artery disease (CAD) is commonly encountered in patients with acute coronary syndrome (ACS), no randomized controlled trials have evaluated the effi cacy of singlevessel percutaneous coronary intervention (PCI) versus multivessel PCI.