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Paroxysmal AV Block
A 69 year old woman with a history of congestive heart failure and stroke presented to the emergency room with sudden onset lightheadedness leading to a fall at the grocery store and sustaining head trauma. On physical examination, she was alert and in mild distress. Her HR was 72 beats per minute and blood pressure was 196/70. A 12 lead electrocardiogram (ECG) showed normal sinus rhythm, first degree atrioventricular (AV) block and right bundle branch block. She was admitted for management of subdural hematoma which was noted on CT scan.
Source: The American Journal of Medicine - December 7, 2022 Category: General Medicine Authors: Tharian S. Cherian, Amit Thosani Tags: ECG image of the month Source Type: research

Effects of Anticoagulation on Low-Density Lipoprotein-Cholesterol and Ischemic Stroke in Patients with Nonvalvular Atrial Fibrillation
The study by Omelchenko et al1 concluded that, unlike the general population, low-density lipoprotein-cholesterol (LDL-C) levels were not associated with ischemic stroke risk among patients with atrial fibrillation treated with direct oral anticoagulants (DOACs). To arrive at this conclusion, they retrospectively analyzed data of 21,229 patients with a first-time diagnosis of nonvalvular atrial fibrillation treated with DOACs categorized according to the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category, ...
Source: The American Journal of Medicine - September 28, 2021 Category: General Medicine Authors: Zeeshan H. Ismail, Zekarias T. Asnake, Joshua K. Salabei Tags: Letter Source Type: research

Oral Anticoagulation Use in High-Risk Patients Is Improved by Elimination of False-Positive and Inactive Atrial Fibrillation Cases
Multiple registries have reported that>40% of high-risk atrial fibrillation patients are not taking oral anticoagulants. The purpose of our study was to determine the presence or absence of active atrial fibrillation and CHA2DS2-VASc (Congestive heart failure, Hypertension, Age ≥75 y, Diabetes mellitus, prior Stroke [or transient ischemic attack or thromboembolism], Vascular disease, Age 65-74 y, Sex category) risk factors to accurately identify high-risk atrial fibrillation (CHA2DS2-VASc ≥2) patients requiring oral anticoagulants and the magnitude of the anticoagulant treatment gap.
Source: The American Journal of Medicine - December 23, 2020 Category: General Medicine Authors: Gerald V. Naccarelli, Mohammed Ruzieh, Deborah L. Wolbrette, Mauricio Sendra-Ferrer, John van Harskamp, Barbara Bentz, Gregory Caputo, Nathan McConkey, Kevin Mills, Stephen Wasemiller, Jovan Plamenac, Douglas Leslie, Frendy D. Glasser, Thomas W. Abendroth Tags: Clinical Research Study Source Type: research

Peripheral arterial disease in patients with atrial fibrillation: The Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) study.
Atrial fibrillation and peripheral arterial disease are two conditions associated with high risk of cardiovascular and cerebrovascular complications and mortality.1 –5 There is evidence that coexistence of both these clinical conditions can result to an additive risk of adverse events.6 Indeed, atherosclerotic vascular disease has been linked with stroke, thromboembolism and death in subjects with atrial fibrillation and has been therefore included as one of the components of risk scores, such as the CHA2DS2-VASc score (Congestive Heart failure, Hypertension Age> 75 years, DM, Stroke, Vascular disease) in order to strati...
Source: The American Journal of Medicine - September 17, 2020 Category: General Medicine Authors: Antonios Vitalis, Alena Shantsila, Marco Proietti, Rajiv K. Vohra, Mark Kay, Brian Olshansky, Gregory Y.H. Lip Source Type: research

Contemporary Meta-Analysis of Extended Direct Acting Oral Anticoagulant Thromboprophylaxis to Prevent Venous Thromboembolism Among Hospitalized Patients
There are over 36 million medical hospitalizations each year in the United States, with the majority being for acute medical illness.1 Cancer, chronic obstructive pulmonary disease, congestive heart failure, stroke and myocardial infarction are some of the most common indications for hospitalization and are additionally risk factors for venous thromboembolism.2 With over 900,000 patients suffering from venous thromboembolism each year, excess thrombosis causes a large medical and financial burden to patients and the health care system.
Source: The American Journal of Medicine - March 5, 2020 Category: General Medicine Authors: Vikas Bhalla, Olivia F Lamping, Ahmed Abdel-Latif, Meenakshi Bhalla, Khaled Ziada, Susan S. Smyth Tags: Clinical Research Study Source Type: research

Take-Home Messages From the Recently Updated AHA/ACC Guidelines for Atrial Fibrillation
Atrial fibrillation and congestive heart failure (CHF) are “growth industries” in 21st-century industrial nations. The rapid growth of the geriatric population in these countries plays an important role in the ever-increasing number of patients seen with these 2 clinical entities. Patients with atrial fibrillation are seen on a daily basis in both the c linic and the hospital. The most devastating complication resulting from atrial fibrillation is cerebral arterial embolism with resultant stroke.
Source: The American Journal of Medicine - August 7, 2019 Category: General Medicine Authors: Joseph S. Alpert Tags: Commentary Source Type: research

AFib in Special Populations
Abstract: For physicians who see and treat patients who present with AFib in routine clinical practice there are 4 important factors to understand and bear in mind when diagnosing and planning treatment strategies: age, gender, prior or incident heart failure, and underlying coronary artery disease (CAD) and acute coronary syndrome (ACS). (online video available at: http://education.amjmed.com/video.php?event_id=445&stage_id=5&vcs=1). This review addresses the clinical characteristics of each of these presentations in order. For all patients with AFib, of either gender or any age, the greatest risk is failure to prescrib...
Source: The American Journal of Medicine - March 24, 2014 Category: Journals (General) Authors: William J. French Tags: CME multimedia activities Source Type: research

CHA2DS2-VASc Score Is Directly Associated with the Risk of Pulmonary Embolism in Patients with Atrial Fibrillation
Conclusions: CHA2DS2-VASc score is directly associated with the incidence of pulmonary embolism in atrial fibrillation.
Source: The American Journal of Medicine - January 1, 2014 Category: Journals (General) Authors: Walid Saliba, Gad Rennert Tags: Clinical research studies Source Type: research

Does CHA2DS2-VASc Improve Stroke Risk Stratification in Postmenopausal Women with Atrial Fibrillation?
Abstract: Background: Risk stratification of atrial fibrillation patients with a congestive heart failure (C), hypertension (H), age ≥ 75 (A), diabetes (D), stroke or transient ischemic attack (TIA) (S2) (CHADS2) score of
Source: The American Journal of Medicine - October 18, 2013 Category: Journals (General) Authors: JoEllyn M. Abraham, Joseph Larson, Mina K. Chung, Anne B. Curtis, Kamakshi Lakshminarayan, Jonathan D. Newman, Marco Perez, Kathryn Rexrode, Nawar M. Shara, Allen J. Solomon, Marcia L. Stefanick, James C. Torner, Bruce L. Wilkoff, Sylvia Wassertheil-Smoll Tags: Clinical research studies Source Type: research

Risk Factors for Aspiration in Community-acquired Pneumonia: Analysis of a Hospitalized UK Cohort
Abstract: Background: There is a move toward finding clinically useful “phenotypes” in community-acquired pneumonia: groups of patients displaying distinct clinical characteristics, microbiology, and prognosis. Aspiration pneumonia is an intuitive clinical phenotype; however, to date there are no recognized diagnostic criteria, and data regarding outcomes in suspected aspiration are limited.Methods: An observational study of 1348 patients hospitalized with community-acquired pneumonia in the United Kingdom examined both short- and long-term outcomes for patients at risk of aspiration pneumonia. Patients were defined as...
Source: The American Journal of Medicine - September 19, 2013 Category: Journals (General) Authors: Joanne K. Taylor, Gillian B. Fleming, Aran Singanayagam, Adam T. Hill, James D. Chalmers Tags: Clinical research studies Source Type: research

CHADS2 Score, Statin Therapy, and Risks of Atrial Fibrillation
This study aimed to evaluate the efficacy of statin treatment for atrial fibrillation prevention in elderly patients with hypertension, and to determine if comorbidity or CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack) score can predict the effectiveness of statin treatment. Methods: Patients aged ≥65 years with hypertension were identified from a National Health Insurance research database (a systemic sampling from 2000 to 2009 with a total of 1,000,000 subjects). Medical records of 27,002 patients were used in this study, in which 2400 (8....
Source: The American Journal of Medicine - January 17, 2013 Category: Journals (General) Authors: Chen-Ying Hung, Ching-Heng Lin, El-Wui Loh, Chih-Tai Ting, Tsu-Juey Wu Tags: Clinical research studies Source Type: research