An 89-year-old man presents with worsening heart failure
Clinical introduction An 89-year-old man with a history of heart failure with preserved ejection fraction presented with worsening dyspnoea, reduced exercise capacity and peripheral oedema. His medical history was significant for hypertension, paroxysmal atrial fibrillation (AF), chronic obstructive pulmonary disease and Lyme disease (1983). Admission cardiovascular medications included aspirin 75 mg once a day, perindopril 6 mg once a day, furosemide 40 mg two times a day, flecainide 100 mg two times a day and simvastatin 40 mg one a night. On examination, he was normothermic and clinically in heart failure with raised jugular venous pressure, bibasal pulmonary crepitations and oedema up to abdomen. Cardiac markers were negative. Other laboratory tests demonstrated a normocytic anaemia, C reactive protein 18.7 mg/L (0–7.9), urea 19.4 mmol/L (2.8–7.2) and creatinine 162 µmol/L (72–127), which had trended above a baseline of 110 µmol/L for 4 months. Electrolytes including sodium, potassium, magnesium, corrected calcium and inorganic phosphate were within normal range. His admission...
Optimal medical and lifestyle therapy is vital in providing the best outcomes regarding maintenance of vein graft patency following revascularization procedures. Current recommendations include the use of statins, antiplatelet therapy, and smoking cessation, all of which are supported by strong evidence linking respective therapies to increased graft patency. For example, continued smoking has been linked to a threefold increase in graft failure, and likewise statin therapy has been linked with an approximate threefold decrease in long-term graft failure.
Patients undergoing carotid endarterectomy (CEA) often experience intraoperative and postoperative blood pressure lability and postoperative headache. Postoperative headache and hypertension after CEA are thought to increase the risk of developing postoperative cerebral hyperperfusion syndrome (CHS). Although fortunately rare, CHS spans a wide spectrum of signs and symptoms, with patients usually presenting with an unrelenting ipsilateral headache. Temporary or permanent neurologic deficit, seizures, intracranial hemorrhage, and, sometimes, death can follow the initial headache 3 to 7 days after discharge.
This article reviews some of the physiologic theories for the difference in recommendations and discusses potential complications with race-based treatment algorithms.
Dr Santina Wheat discusses the role and responsibility that family physicians have in preventing/managing hypertension in pregnant patients as well as those of reproductive age who may become pregnant.Medscape Family Medicine
Prevalence ratios for chronic obstructive pulmonary disease increased with ever exposure, high cumulative exposure to pesticides at work
ConclusionMeasuring the CSMA at C3 obtained results equivalent to those obtained by calculating the SMMI at L3, suggesting that direct SMM assessment from C3 is a useful approach to evaluating PCF formation risk after TL.
ConclusionPatients who had OSA had a higher prevalence of stroke compared to non-OSA patients by 16% with almost three times higher odds. The difference was statistically significant in bivariant but not multivariant analysis. The rate of hospitalization, emergency visit, and blood transfusion were not affected by OSA status. Screening for OSA in high-risk patients such as SCD children and early management could prevent the risk of SCD complications.
MANY strokes are preventable, especially as the life-threatening event is preceded by narrowed arteries, symbolic of heart disease. Diet can play a crucial role in the condition.
People with mental health disorders are up to twice as likely to die earlier from chronic conditions such as heart disease and diabetes than those without them, a study published Thursday by PLOS Medicine found.
A Yale study reveals new insights into the cellular causes of Chronic Obstructive Pulmonary Disease. The findings may help identify more targeted treatments.
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