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Specialty: General Medicine
Source: The American Journal of Medicine
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Total 259 results found since Jan 2013.
On Hoofs and Zebras – Struma Ovarii
A 75-year-old mother of ten suffering from a urinary tract infection developed macrohematuria and therefore an abdominal ultrasound was performed, followed by a CT scan when an unexpected large pelvic mass was discovered. Past history included hypertension, paroxysmal atrial fibrillation, and remote history of minor stroke (on candesartan, dabigatran, bisoprolol); bilateral chronic lymphedema; and hysterectomy due to prolapse at the age of 40. Imaging revealed nephrolithiasis and a prominent left adnexal mass suspected as ovarian cancer.
Source: The American Journal of Medicine - July 20, 2023 Category: General Medicine Authors: Ami Schattner, Ina Dubin, Livnat Uliel, Daniela Dick-Necula Tags: Clinical Communication to the Editor Source Type: research
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
Racial and Ethnic Disparities in Stroke Prevention for Atrial Fibrillation
Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting around 2% of the population (1,2) and increasing the risk of stroke by 4 to 5 times (3). Anticoagulation with Vitamin K antagonists (VKAs) such as Warfarin (4) or the newer Direct Oral Anticoagulants (DOACs) (4,5) reduces this risk by up to 60%. AF-related strokes also tend to be more severe and disabling (6).
Source: The American Journal of Medicine - December 7, 2022 Category: General Medicine Authors: Peter Calvert, Kamala Tamirisa, Amin Al-Ahmad, Gregory Y H Lip, Dhiraj Gupta Tags: Review Source Type: research
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
Erratum to ‘Blood Pressure Trajectories and Outcomes for Veterans Presenting at VA Medical Centers with a Stroke or Transient Ischemic Attack’ The American Journal of Medicine (2022) Volume 135, Issue 7, 889-896.e1
The publisher regrets that the following affiliations were incorrect at the time the article was published; however these have now been corrected.
Source: The American Journal of Medicine - November 22, 2022 Category: General Medicine Authors: Greg Arling, Anthony Perkins, Laura J. Myers, Jason J. Sico, Dawn M. Bravata Tags: Erratum Source Type: research
Starry Eye
A 73-year-old female with a past medical history of stroke, hypertension, end stage renal disease on hemodialysis presents to the emergency department for altered mental status and slurred speech. On physical examination, she had a right pupillary defect in a star-like pattern with initial concern for a blown pupil (see image) raising suspicion for acute stroke. Her initial blood pressure was 230/110 mmHg and neuroimaging were unremarkable for stroke. She was admitted for hypertensive emergency.
Source: The American Journal of Medicine - November 6, 2022 Category: General Medicine Authors: Cameron Kahn, Azeem Rathore, Jeffrey House Tags: Clinical Communication to the Editor Source Type: research
Catch Me If You Can: ECG Artifacts
An 83-year-old female with prior stroke and hypertension presented to the emergency department with right arm pain following a mechanical fall. She denies any associated prodromal symptoms, presyncope, or syncope. On admission, she was afebrile with a regular heart rate of 86 beats per minute, elevated blood pressure (190/87 mm Hg), and 96% oxygen saturation on room air. A physical examination was notable for a right humerus fracture, confirmed on the right arm X-ray.
Source: The American Journal of Medicine - September 20, 2022 Category: General Medicine Authors: Golda Harvatin, Jalaj Garg, Dmitry Abramov, Diane Tran, Purvi Parwani Tags: ECG Image of the Month Source Type: research
Inflammatory bowel disease and cardiovascular diseases
Inflammatory Bowel Disease is comprised of two major subtypes: Crohn's disease and ulcerative colitis, characterized by chronic inflammation of the gastrointestinal tract with extraintestinal manifestations that can involve a number of systems.1 There were estimated to be 7 million cases of inflammatory bowel disease globally in 2017, and at the national level, the United States had the highest age-standardized prevalence rate (464.5 per 100,000 population) of inflammatory bowel disease.2 Atherosclerotic cardiovascular diseases is defined as a history of acute coronary syndrome, myocardial infarction, stable or unstable an...
Source: The American Journal of Medicine - September 1, 2022 Category: General Medicine Authors: Bing Chen, Lauren V Collen, Craig Mowat, Kim L. Isaacs, Siddharth Singh, Sunanda V. Kane, Edward V. Loftus, Francis A. Farraye, Scott Snapper, Hani Jneid, Carl J Lavie, Chayakrit Krittanawong Tags: Clinical Research Study 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 Bleeding on Myocardial Infarction, Stroke, and Death During 12 Months Dual Antiplatelet Therapy After Acute Coronary Syndrome
Bleeding remains a complication during dual antiplatelet therapy (DAPT) for acute coronary syndrome (ACS). Some data suggest a link between bleeding and worsened vascular outcomes. However, this association is unclear, due to omitting of minor bleedings when applying conservative scales. In contrast, the Platelet Inhibition and Outcomes (PLATO) trial classification used broad realistic capturing of all bleedings.
Source: The American Journal of Medicine - August 14, 2022 Category: General Medicine Authors: Victor L. Serebruany, Jean-Fran çois Tanguay, Wiktor Kuliczkowski, Eric Heidel, Moo Hyun Kim, Dan Atar Tags: Clinical Research Study Source Type: research
Impact of Bleeding on Myocardial Infarction, Stroke and Death During 12-months Dual Antiplatelet Therapy After Acute Coronary Syndrome
One of the largest controversies of modern antithrombotic strategies is the uncertain relation among the potency and duration of dual antiplatelet therapy (DAPT) with associated bleeding rates1-3, and whether or not bleeding impacts mortality, myocardial infarction (MI) and stroke risks4-6. Some data from clinical trials1-5 and registries7,8 suggest that such a link is valid, however, this association is not established partly due to capturing of exclusively major or/and catastrophic events while omitting minor and minimal episodes, and applying restrictive bleeding scales9.
Source: The American Journal of Medicine - August 14, 2022 Category: General Medicine Authors: Victor L. Serebruany, Jean-Francois Tanguay, Wiktor Kuliczkowski, Eric Heidel, Moo Hyun Kim, Dan Atar Tags: Clinical Research Study Source Type: research
Quality of Care Among Patients with Diabetes and Cerebrovascular Disease. Insights from The Diabetes Collaborative Registry
Not only do patients with type 2 diabetes have increased risks of coronary artery disease and peripheral artery disease, but they also have least a two-fold increased risk of experiencing a stroke. Further, patients with type 2 diabetes who have a stroke have worse outcomes compared with those without type 2 diabetes.1 While secondary prevention strategies and the quality of care of patients with type 2 diabetes and concomitant coronary artery disease have been well-studied,2 less is known about the management of patients with type 2 diabetes and cerebrovascular disease (e.g., stroke, transient ischemic attack, carotid artery disease).
Source: The American Journal of Medicine - July 21, 2022 Category: General Medicine Authors: Justin B. Echouffo-Tcheugui, Alexander Turchin, Robert S. Rosenson, Gregg C. Fonarow, Abhinav Goyal, James A. de Lemos, Suzanne V. Arnold Tags: Clinical Research Study Source Type: research
Long-term cardiac monitoring after embolic stroke of undetermined source. Search longer – look harder
Ischemic stroke is a heterogeneous syndrome which may result from several causes such as atherosclerosis, small vessel disease and atrial fibrillation.1 Despite an extensive diagnostic work-up during the acute or chronic phase of the ischemic stroke, the cause of ischemic stroke remains unexplained for 20% of patients, termed cryptogenic stroke. 2 3
Source: The American Journal of Medicine - May 14, 2022 Category: General Medicine Authors: Dimitrios Sagris, Stephanie L Harrison, Benjamin J.R Buckley, George Ntaios, Gregory Y.H Lip Source Type: research
Long-Term Cardiac Monitoring After Embolic Stroke of Undetermined Source: Search Longer, Look Harder
Embolic stroke of undetermined source (ESUS) represents a heterogeneous subgroup of patients with cryptogenic stroke, in which despite an extensive diagnostic workup the cause of stroke remains uncertain. Identifying covert atrial fibrillation among patients with ESUS remains challenging. The increasing use of cardiac implanted electronic devices (CIED), such as pacemakers, implantable defibrillators, and implantable loop recorders (ILR), has provided important information on the burden of subclinical atrial fibrillation.
Source: The American Journal of Medicine - May 14, 2022 Category: General Medicine Authors: Dimitrios Sagris, Stephanie L. Harrison, Benjamin J.R. Buckley, George Ntaios, Gregory Y.H. Lip Tags: Review Source Type: research
Primary Medical Care Integrated with Healthy Eating and Healthy Moving is Essential to Reduce Chronic Kidney Disease Progression
Chronic kidney disease is among the few chronic diseases in the US with increasing prevalence 1, is the ninth leading cause of US mortality 2 and is increasing disability-adjusted life years lost 1, 3. Patients with chronic kidney disease contribute broadly to US mortality because they have increased risks for heart disease 4, cancer for those over age 65 years 5, and stroke 6 which represent, respectively, the first, second, and fifth causes of US mortality 2. Because patients with chronic kidney disease more likely die from these diseases before progressing to end-stage kidney disease 7, their deaths from these non-chron...
Source: The American Journal of Medicine - May 13, 2022 Category: General Medicine Authors: Donald E. Wesson, Vandana Mathur, Navdeep Tangri, Sarah Hamlett, David A. Bushinsky, L. Ebony Boulware Tags: Narrative Review Source Type: research
