When to Consider Coronary Revascularization for Stable Coronary Artery Disease
Revascularization is an effective adjunct to medical therapy for some patients with chronic coronary disease. Despite numerous randomized trials, there remains significant uncertainty regarding if and how to revascularize many patients. Coronary artery bypass grafting is a class I indication for patients with significant left main stenosis or multivessel disease with ejection fraction ≤ 35%. For other patients, clinicians must carefully consider the potential benefits of symptom improvement and reduction of future myocardial infarction or CV death against the risk and cost of revascularization. Although guidelines pro...
Source: Medical Clinics of North America - December 18, 2023 Category: Primary Care Authors: Andrew M. Cheng, Jacob A. Doll Source Type: research
Medical Decision-Making and Revascularization in Ischemic Cardiomyopathy
Ischemic cardiomyopathy (ICM) is the most common underlying etiology of heart failure in the United States and is a significant contributor to deaths due to cardiovascular disease worldwide. The diagnosis and management of ICM has advanced significantly over the past few decades, and the evidence for medical therapy in ICM is both compelling and robust. This contrasts with evidence for coronary revascularization, which is more controversial and favors surgical approaches. This review will examine landmark clinical trial results in detail as well as provide a comprehensive overview of the current epidemiology, diagnostic ap...
Source: Medical Clinics of North America - December 18, 2023 Category: Primary Care Authors: Alex J. Chang, Yilin Liang, Steven A. Hamilton, Andrew P. Ambrosy Source Type: research
Optimal Medical Therapy for Stable Ischemic Heart Disease in 2024
Given the prevalence of chronic coronary disease, efforts should be made toward risk factor modification. Cardiac rehabilitation is a secondary prevention program consisting of tailored exercise and lifestyle counseling and has been shown to not only reduce cardiovascular morbidity and mortality but also improve quality of life and exercise capacity. Despite the benefits, it remains underutilized. Efforts should be made to increase referral for patients with chronic coronary disease to aid in symptom management and reduction of cardiovascular risk factors. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - December 15, 2023 Category: Primary Care Authors: Sherrie Khadanga, Tanesha Beebe-Peat Source Type: research
Diagnosing Coronary Artery Disease in the Patient Presenting with Stable Ischemic Heart Disease
There are unique advantages and disadvantages to functional versus anatomic testing in the work-up of patients who present with symptoms suggestive of obstructive coronary artery disease. Evaluation of these individuals starts with an assessment of pre-test probability, which guides subsequent testing decisions. The choice between anatomic and functional testing depends on this pre-test probability. In general, anatomic testing has particular utility among younger individuals and women; while functional testing can be helpful to rule-in ischemia and guide revascularization decisions. Ultimately, selection of the most appro...
Source: Medical Clinics of North America - December 14, 2023 Category: Primary Care Authors: Michelle D. Kelsey, Anita M. Kelsey Source Type: research
CME Accreditation Page
(Source: Medical Clinics of North America)
Source: Medical Clinics of North America - November 10, 2023 Category: Primary Care Source Type: research
Adolescent Undiagnosed and Rare Diseases
MEDICAL CLINICS OF NORTH AMERICA (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - November 10, 2023 Category: Primary Care Authors: Heather Toth, Robert Kliegman, Brett J. Bordini Source Type: research
Copyright
ELSEVIER (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - November 10, 2023 Category: Primary Care Source Type: research
Forthcoming Issues
Sexually Transmitted Infections (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - November 10, 2023 Category: Primary Care Source Type: research
Contributors
JACK ENDE, MD, MACP (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - November 10, 2023 Category: Primary Care Source Type: research
Contents
Jack Ende (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - November 10, 2023 Category: Primary Care Source Type: research
Sexually Transmitted Infections: Medicine in Its Fullest
As far back as ancient times, sexually transmitted infections (STIs) have been part of the human condition. Records from ancient Egypt, Greece, and Rome depict outbreaks of gonorrhea and syphilis. The Middle Ages saw epidemics of both these diseases, which, of course, were untreatable then, leading to stigmatization, isolation, and shame, accompaniments of STIs that persist to this day. As populations became more mobile, initially with ocean voyages in the time of Christopher Columbus, and all the way up to modern times with air travel, STIs spread in both senses of the word: from patient to patient and from continent to c...
Source: Medical Clinics of North America - November 2, 2023 Category: Primary Care Authors: Jack Ende Tags: Foreword Source Type: research
Proctitis
is an inflammatory condition of the distal rectum that can be associated with common sexually transmitted infections (STIs), such as gonorrhea, chlamydia, and syphilis. For persons presenting with ulcerative findings on examination, in addition to syphilis, Mpox, lymphogranuloma venereum, and herpes simplex virus should be in the differential. Providers should also be aware that there are evolving data to support a role for Mycoplasma genitalium in proctitis. Performing a comprehensive history, clinical evaluation including anoscopy, and rectal nucleic amplification STI testing may be useful in identifying the cause of pr...
Source: Medical Clinics of North America - November 1, 2023 Category: Primary Care Authors: Candice J. McNeil, Luis F. Barroso, Kimberly Workowski Source Type: research
On The Horizon
Rates of sexually transmitted infections (STIs), especially cases of infectious and congenital syphilis, are increasing in the United States. Novel strategies for STI prevention are being explored and include doxycycline post-exposure prophylaxis and the potential utility of vaccines against gonorrhea. Self-collection of samples and point of care testing for STI are increasingly being employed in a variety of settings. Both can improve uptake of screening and lead to earlier detection and treatment of incident STI in target populations. Overcoming existing regulatory issues and optimizing implementation of current evidence...
Source: Medical Clinics of North America - November 1, 2023 Category: Primary Care Authors: Chase A. Cannon, Stephanie E. McLaughlin, Meena S. Ramchandani Source Type: research
Taking a Sexual History
Recognizing the holistic definitions of sexual health, health-care providers must approach sexual health history taking with sensitivity, inclusivity, and a trauma-informed perspective. Many versions of what a sexual history should look like exist but certain principles are commonly found. Education of health-care providers on sexual history taking can involve reviewing the components of the sexual history but should also include the importance of using nonstigmatizing language, having a patient-centered approach, and practicing trauma-informed and culturally sensitive care. (Source: Medical Clinics of North America)
Source: Medical Clinics of North America - October 31, 2023 Category: Primary Care Authors: Donald Hong, Joseph Cherabie, Hilary E. Reno Source Type: research
Sexual Health and Well-Being
Although the acceptance of sex positivity centering pleasure and justice has grown, clinical and public health strategies for sexually transmitted infection management have remained focused on risk and adverse outcomes. To promote sex-positive health care practice in clinical settings and beyond, health care practitioners should use an integrated, patient-centered approach to sexual health. These strategies include initiating discussions, continued sexual health education, providing informative material for patients, and knowledge of different communication strategies. Patient –provider interactions might be enhanced by ...
Source: Medical Clinics of North America - October 31, 2023 Category: Primary Care Authors: Keosha T. Bond, Asa E. Radix Source Type: research
