Clinical question of the week: "Arrhythmia" patient with palpitations, dyspnoea, and dark stools
A 75-year-old male with a prior history of hypertension, diabetes and treatment for “arrhythmia” presented to the emergency department complaining of palpitations and dyspnea on exertion over the last two days. The patient also reported dark stools over the last two days. No other symptoms were reported. Current medications included atenolol 50 mg qD, warfarin 5 mg qD, metformin 850 mg BiD. The patient did not remember his last INR result, but reported no blood tests over the last two months. On examination the heart rate was 140, irregular, BP was 90/70, respiratory rate 22, SatO2: 94%. The patient was pale, lungs were clear, and no other abnormalities were noted. The EKG is below:
DiscussionGiven the multiorgan system potential adverse side effects of prednisone, proving noninferiority of an alternate regimen would be sufficient to make the alternative compare favorably to standard dose steroids. This is the first ever clinical trial in cardiac sarcoidosis and thus in addition to the listed goals of the trial, we will also establish a multi-center, multinational cardiac sarcoidosis clinical trials network. Such a collaborative infrastructure will enable a new era of high quality data to guide physicians when treating cardiac sarcoidosis patients.
Conclusions. Complex hernia repairs using bioabsorbable mesh were conducted in a small cohort of high-risk patients. These data demonstrate good outcomes with limited morbidity and mortality. There were no recurrences. PMID: 31617453 [PubMed - as supplied by publisher]
iRhythm and Verily announced a partnership last month to “co-develop solutions intended to provide early warning, diagnosis and management for patients, particularly for those with silent or undiagnosed AF.” We spoke with iRhythm CEO Kevi...
Conclusion: Results show that ThuLEP could be a better option in high-risk patients with BPH.
ConclusionsA high incidence of CV events, with no apparent correlation with CV comorbidities or risk factors, was observed. Prompt identification and treatment of CV events allowed most pts to complete the treatment with FP.Clinical trial identificationNCT02665312.Legal entity responsible for the studyThe authors.FundingHas not received any funding.DisclosureM. Aglietta: Advisory / Consultancy: Bristol-Myers Squibb; Advisory / Consultancy: Merck; Advisory / Consultancy: Roche. All other authors have declared no conflicts of interest.
Hypertension affects about 103 million Americans, according to the American Heart Association (AHA). Atrial fibrillation (AFib), which is often associated with hypertension and could affect up to 6 million people perÂ CDCÂ statistics, can be asymptomatic, so patients may be unaware they have it. The CDC also reports that more than 600,000 Americans die each year from heart disease, and coronary artery disease is the most common type of such disease. Also impacting the heart is diabetesâand more than 100 million Americans suffer from it, the CDC reported. âHeart dise...
Conclusions: Multidisciplinary approaches are necessary from obstetricians, cardiologists, anesthesiologists and perinatologists for pregnancy monitoring and delivery outcomes. PMID: 31569595 [PubMed - in process]
Abstract Cardiovascular diseases (CVDs) are the leading cause of premature death and disability in humans and their incidence is on the rise globally. Given their substantial contribution towards the escalating costs of health care, they also generate a high socio-economic burden in the general population. The underlying pathogenesis and progression associated with nearly all CVDs is predominantly of atherosclerotic origin that leads to the development of coronary artery disease, cerebrovascular disease, venous thromboembolism and, peripheral vascular disease, subsequently causing myocardial infarction, cardiac ar...
CONCLUSIONS: C allele and CC genotype of rs4968309 inMYL4were associated with AF onset and recurrence. Moreover, the A allele of rs1515751 had a significant association with AF onset. The polymorphisms ofMYL4can predict AF onset and prognosis after ablation in AF patients without structural heart disease. PMID: 31406021 [PubMed - as supplied by publisher]
Conclusions: Patients with ≥1 risk factor had a 30% higher risk for arrhythmia recurrence after ablation, but no differences in risk for repeat ablations, adverse events or death.This article is protected by copyright. All rights reserved