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Above the threshold time of coagulation: delayed diagnosis of acquired hemophilia A
A man in his 80 ’s presented to our hospital's emergency department with left hip pain after falling while transferring from a wheelchair on a visit day. He had been taking clopidogrel for> 10 years after atherothrombotic stroke and apixaban 2.5 mg b.i.d. for 2 years since he was diagnosed with deep vein thrombosis. The patient had no coagulation abnormalities when he started apixaban therapy and had never experienced bleeding events. His medical history included cervical spondylosis surgery, right femoral neck fracture, hypertension, and benign prostatic hypertrophy.
Source: The American Journal of Medicine - February 23, 2023 Category: General Medicine Authors: Mayu Kikuchi, Yukinori Harada, Ayano Hamai, Sachi Takaoka Tags: Diagnostic dilemma Source Type: research

Integrated care for atrial fibrillation management: The role of the pharmacist
Within Europe and the Asia-Pacific, the Atrial Fibrillation Better Care (ABC) pathway is the gold standard integrated care strategy for atrial fibrillation management. Atrial fibrillation diagnosis should be Confirmed and Characterized (CC) before implementation of ABC pathway components: (1) ‘A’- Anticoagulation/Avoid stroke; (2) ‘B’- Better symptom management and (3) ‘C’- Cardiovascular and other co-morbidity optimization. Pharmacists have the potential to expedite integrated care for atrial fibrillation across the healthcare continuum -hospital, community pharmacy and gene ral practice.
Source: The American Journal of Medicine - August 20, 2022 Category: General Medicine Authors: Leona A Ritchie, Peter E Penson, Asangaedem Akpan, Gregory YH Lip, Deirdre A Lane Tags: Review Source Type: research

Impact of Atrial Fibrillation on In-Hospital Mortality and Stroke in Acute Aortic Syndromes
Acute aortic syndromes may present with a number of cardiovascular complications, including atrial fibrillation. We assessed the prevalence of atrial fibrillation in patients presenting with acute aortic syndromes and evaluated atrial fibrillation's association with in-hospital mortality and stroke.
Source: The American Journal of Medicine - July 6, 2021 Category: General Medicine Authors: Umberto Campia, Samantha M. Rizzo, Julia E. Snyder, Mariana A. Pfefferman, Ruth B. Morrison, Gregory Piazza, Samuel Z. Goldhaber 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

Twenty-Five-Year (1986-2011) Trends in the Incidence and Death Rates of Stroke Complicating Acute Myocardial Infarction
The occurrence of a stroke after an acute myocardial infarction is associated with increased morbidity and mortality rates. However, limited data are available, particularly from a population-based perspective, about recent trends in the incidence and mortality rates associated with stroke complicating an acute myocardial infarction.The purpose of this study was to examine 25-year trends (1986-2011) in the incidence and in-hospital mortality rates of initial episodes of stroke complicating acute myocardial infarction.
Source: The American Journal of Medicine - May 3, 2018 Category: General Medicine Authors: Essa Hariri, Mayra Tisminetzky, Darleen Lessard, Jorge Yarzebski, Joel Gore, Robert Goldberg Tags: Clinical Research Study Source Type: research

Intracranial Calcification Due to Hypoparathyroidism
A 70-year-old Japanese man with a history of idiopathic hypoparathyroidism presented to the Emergency Department of our hospital owing to weakness in his right leg. Although his primary care doctor had prescribed activated vitamin D analogues, his serum calcium level was slightly low at 8.0  mg/dL. Owing to suspicions of stroke, he underwent radiographic imaging of the head. Computed tomography revealed bilateral and symmetrical calcifications in the basal ganglia, cerebellum, and at the gray-white junction in the axial image and the sagittal image (Figure).
Source: The American Journal of Medicine - January 16, 2018 Category: General Medicine Authors: Ko Harada, Tatsuya Fujikawa Tags: Clinical Communication to the Editor Source Type: research

Falls and Delirium: Platypnea-Orthodeoxia Syndrome
An 85-year-old woman's inability to remain standing was ultimately connected to an undiagnosed congenital defect. The patient was admitted to the geriatric unit of a university hospital for new frequent falls and subacute delirium, both of which began a month before presentation. Her medical history included ischemic stroke 10 years earlier, mild neurocognitive impairment, and Von Recklinghausen neurofibromatosis with isolated skin involvement.
Source: The American Journal of Medicine - November 20, 2017 Category: General Medicine Authors: A. Putot, C. Laborde, M. Fichot, P. Brunel, M. Deidda, H. Guepet, P. Manckoundia Tags: Diagnostic Dilemma Source Type: research

Double the Trouble: Acute Coronary Syndrome and Ischemic Stroke in Polycythemia Vera
Vague symptoms turned out to be life-threatening conditions. A 50 year-old man with a history of polycythemia vera, presented to hospital with epigastric discomfort and clumsiness of the right hand for 5 days. Polycythemia vera was diagnosed 1 year prior with good control of hematocrit by intermittent phlebotomy. He did not have any other medical history, and was not taking any medications. He denied chest pain, shortness of breath, nausea, headache, vision change, or speech difficulty.
Source: The American Journal of Medicine - March 12, 2017 Category: Journals (General) Authors: Hitomi Hosoya, Jeffrey J. Levine, David H. Henry, Sheldon Goldberg Tags: Diagnostic Dilemma Source Type: research

The Reply
Arunachalam suggests that describing the reasons for readmissions might help in determining how to improve patient care. We agree, and this was our rationale for determining diagnosis syndromes for each patient.1 Overall, the increases in readmissions were observed across all diagnoses and accentuated for patients with stroke or delirium (Figure). This means that hospital admissions may also be influenced by other determinants of health.
Source: The American Journal of Medicine - February 17, 2017 Category: Journals (General) Authors: Christopher J. Yarnell, Steven Shadowitz, Donald A. Redelmeier Tags: AJM online Source Type: research

Future of the Palliative Care Workforce: Preview to an Impending Crisis
The specialty of palliative care has experienced remarkable acceptance over the last decade, with teams present in 85% of medium/large hospitals in the United States.1 For many serious illnesses like cancer, advanced heart disease, stroke, and chronic obstructive pulmonary disease, routine integration of palliative care is considered standard of care.
Source: The American Journal of Medicine - September 25, 2016 Category: Journals (General) Authors: Arif H. Kamal, Janet H. Bull, Keith M. Swetz, Steven P. Wolf, Tait D. Shanafelt, Evan R. Myers Tags: Editorial Source Type: research

Improving medication adherence in patients with hypertension: a randomized trial
and Purpose: In patients with hypertension, medication adherence is often suboptimal, thereby increasing the risk of ischemic heart disease and stroke. In a randomized trial, we investigated the effectiveness of a multifaceted pharmacist intervention in a hospital setting to improve medication adherence in hypertensive patients. Motivational interviewing was a key element of the intervention.
Source: The American Journal of Medicine - August 21, 2015 Category: Journals (General) Authors: Ulla Hedegaard, Lene Juel Kjeldsen, Anton Pottegård, Jan Erik Henriksen, Jess Lambrectsen, Jørgen Hangaard, Jesper Hallas Tags: Clinical Research Study Source Type: research

Totally one-sided: painless unilateral proptosis
An 88-year-old woman’s startling ophthalmologic symptoms were wrongly attributed to infection during an outpatient examination. When treatment offered no improvement, she presented to Johns Hopkins Hospital, where she reported progressive left eye swelling of 2 weeks’ duration. Seven years earlier, she had undergone mastectomy, chemotherapy, and radiation for breast cancer. Her medical history was also significant for a prior stroke, hypertension, and dementia.
Source: The American Journal of Medicine - January 5, 2015 Category: Journals (General) Authors: Bharati Kochar, Shannon J.C. Shan, Gobind Anand, S. James Zinreich, Allan C. Gelber Source Type: research

Antiphospholipid syndrome: an important differential diagnosis for culture-negative endocarditis
Sometimes the initial diagnosis proves secondary to an illness that is diagnosed later. This was the case when a 37-year-old woman presented to the hospital with sudden-onset persistent left-sided weakness. While she reported pain in the right maxilla, lethargy, and malaise in the month prior to presentation, she denied headache, sensory change, visual disturbances, fever, chills or weight loss. Hypertension was her only cardiovascular risk factor, but she took no regular medications. She had no history of stroke, ischemic heart disease, deep vein thrombosis, pulmonary embolism, or miscarriage, and she had no family histor...
Source: The American Journal of Medicine - November 26, 2014 Category: Journals (General) Authors: Louis W. Wang, Baptiste Noël, Elodie Descloux, David W. Baron Source Type: research

Early Invasive Versus Initial Conservative Treatment Strategies in Octogenarians with UA/NSTEMI
Abstract: Background: Previous studies have demonstrated improved outcomes with an early invasive strategy in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI). However, there are limited data for patients ≥80 years of age in these studies.Methods: We used the 2003-2010 Nationwide Inpatient Sample databases to identify all patients ≥80 years of age (octogenarians) with UA/NSTEMI. Multivariable logistic regression was used to compare in-hospital outcomes in octogenarians with UA/NSTEMI undergoing early invasive (coronary angiography within 48 hours of admission, with or without revasculari...
Source: The American Journal of Medicine - November 27, 2013 Category: Journals (General) Authors: Dhaval Kolte, Sahil Khera, Chandrasekar Palaniswamy, Marjan Mujib, Gregg C. Fonarow, Ali Ahmed, Diwakar Jain, William H. Frishman, Wilbert S. Aronow Tags: Clinical research studies Source Type: research