Cardiology

The Role of Fish Oil in Arrhythmia Prevention

July 29, 2015
The Role of Fish Oil in Arrhythmia Prevention

By Steven Bolger

Peer Reviewed

Omega-3 fatty acids were first identified as a potential agent to prevent and treat cardiovascular disease through several epidemiologic studies of the Greenlandic Inuit in the 1970s suggesting that high consumption of fish oil was associated with a decreased risk of cardiovascular disease . Fish oil contains two omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), that have been shown to be beneficial in treating hypertriglyceridemia and in the secondary prevention of cardiac events .

The GISSI-Prevenzione trial, …

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A Primer on CRP and Cardiovascular Risk

July 22, 2015
A Primer on CRP and Cardiovascular Risk

Cindy Fei, MD

Peer Reviewed

A 63-year-old woman with hypertension presents to your clinic for routine follow-up. She came across an online article regarding C-reactive protein and its purported link to heart disease, and she asks you whether she should be tested for it. She is an otherwise asymptomatic non-smoker without a family history of heart disease. Her only medication is hydrochlorothiazide. Her blood pressure measured in the office is 128/81 mmHg, her low-density lipoprotein is 110 mg/dL, and her high-density lipoprotein is 54 mg/dL. …

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Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate

July 10, 2015
Neurologic Complications In Infective Endocarditis: To Anticoagulate Or Not To Anticoagulate

By Shannon Chiu, MD

Peer Reviewed

The annual incidence of infective endocarditis (IE) is estimated to be 3 to 9 cases per 100,000 persons in developed countries . Neurologic complications are the most severe and frequent extracardiac complications of IE, affecting 15-20% of patients . They consist of 1) ischemic infarction secondary to septic emboli from the valvular vegetation, which can eventually undergo hemorrhagic transformation; 2) focal vasculitis/cerebritis from septic emboli obstructing the vascular lumen, which can then develop into brain abscess or meningoencephalitis; 3) …

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Unraveling The Mysteries of Prinzmetal’s Angina: What Is It And How Do We Diagnose It?

October 8, 2014
Unraveling The Mysteries of Prinzmetal’s Angina: What Is It And How Do We Diagnose It?

By Anjali Varma Desai, MD

Peer Reviewed

Mr. Q is a 55-year-old male smoker who presents with recurrent chest pain in the mornings over the past several months. The patient reports being awakened from sleep at approximately 5:00 a.m. each morning with the same diffuse chest “pressure.” The pain typically lasts on the order of minutes, resolves, and then recurs at five-minute intervals in the same fashion for a total duration of two hours. The pain always occurs at rest and is never precipitated by …

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From the Bellevue Wards: Wellens’ Syndrome Revisited

September 18, 2014
From the Bellevue Wards: Wellens’ Syndrome Revisited

By Matthew Shou Lun Lee, MD

Peer Reviewed

Clinical Questions

-How common are elevated cardiac enzymes during Wellens’ syndrome?

-Can the EKG changes in Wellens’ syndrome be found with other causes?

Background

This post represents a follow-up to the 2009 article in Clinical Correlations by Dr. Erin Ducharme .

Wellens’ syndrome refers to a distinctive combination of clinical and EKG findings in unstable angina associated with high-grade lesions of the left anterior descending artery (LAD) . Initially described in 1982, the criteria has undergone minor …

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Caffeine and the Risk of Atrial Fibrillation

June 6, 2014
Caffeine and the Risk of Atrial Fibrillation

By Joshua Michael Lader, MD

Peer Reviewed

As physicians, we are frequently asked to weigh-in on dinnertime discussions about topics that, despite their relevance to everyday life, were never formally addressed in our medical training. For example, at a recent family gathering the conversation turned to a 78 year-old uncle who was recently diagnosed with atrial fibrillation. While this uncle had longstanding and likely poorly controlled hypertension, he would also typically drink 4 to 5 cups of coffee between breakfast and lunch. The debate then …

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New Cholesterol Guidelines: How Safe Are High-Potency Statins?

May 14, 2014
New Cholesterol Guidelines: How Safe Are High-Potency Statins?

By Molly Anderson

Peer Reviewed

Managing hyperlipidemia is a mainstay of cardiovascular risk reduction. The 2013 ACC/AHA guidelines no longer target specific low-density lipoprotein (LDL)-cholesterol levels, but recommend lipid-lowering therapies of varying intensity based on the predicted risk of cardiovascular events . Adoption of the new guidelines would result in millions more Americans receiving high-potency statins; it is therefore important to investigate potential dangers associated with aggressive therapy and the long-term implications for patients.

Many studies have shown that strict adherence to lipid-lowering medications improves …

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The Yolk Or The Egg

February 27, 2014
The Yolk Or The Egg

By Nicole A. Lamparello, MD and Molly Somberg, MD, MPA

Peer Reviewed

You hear it wherever you eat, whether at the deli ordering a breakfast sandwich or at the diner for Sunday brunch, “Egg whites only, please.” For the last decade, there has been a strong movement toward avoiding egg yolks; instead people are opting for only the ‘healthier’ egg white when ordering or cooking their breakfast.

However, are egg whites truly ‘healthier’ than eating whole eggs? What is the basis for this decision being …

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Should Beta-Blockers Be Used In The Setting Of Cocaine-Related Chest Pain?

February 5, 2014
Should Beta-Blockers Be Used In The Setting Of Cocaine-Related Chest Pain?

By Matthew A. Haber

Peer Reviewed

The following is a hypothetical example of a classic exam question that one might come across as a medical student:

A 50-year-old male presents to the emergency department with severe chest pain. His past medical history is significant for congestive heart failure and stent placement. His vitals are significant for a blood pressure of 220/110 and a heart rate of 170. On physical exam he appears to be profusely sweating, and his pupils are markedly dilated. Troponin I is …

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How Much Do We Know About HDL Cholesterol?

January 29, 2014
How Much Do We Know About HDL Cholesterol?

By Gregory Katz, MD

Peer Reviewed

As levels of HDL cholesterol increase, rates of heart disease go down. It’s this fact that has given HDL its reputation as the “good cholesterol,” serving a crucial role in reverse cholesterol transport. According to our models, HDL ferries cholesterol away from our arteries – where its buildup leads to heart disease and stroke – and back towards our liver, safely out of harm’s way. The epidemiology backs this up: people with higher levels of HDL tend to have …

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From The Archives: Fast Hearts and Funny Currents, Part 2: Is Tachycardia Part of the Problem in Heart Failure?

January 9, 2014
From The Archives: Fast Hearts and Funny Currents, Part 2: Is Tachycardia Part of the Problem in Heart Failure?

Please enjoy this post from the archives dated May 25, 2011

By Santosh Vardhana

Faculty Peer Reviewed

Please review Part 1 of this article here.

Mr. M is a 63-year old man with a history of coronary artery disease and systolic congestive heart failure (ejection fraction 32%) on lisinopril, metoprolol, and spironolactone who presents to the Adult Primary Care Center complaining of persistent dyspnea with exertion, two-pillow orthopnea, and severely limited exercise tolerance. His vital signs on presentation are T 98.0˚F, P 84, BP 122/76. …

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From The Archives: Fast Hearts and Funny Currents: Is Tachycardia Part of the Problem in Heart Failure? Part 1

December 12, 2013
From The Archives: Fast Hearts and Funny Currents: Is Tachycardia Part of the Problem in Heart Failure? Part 1

Please enjoy this post from the archives dated May 18, 2011

By Santosh Vardhana

Faculty Peer Reviewed

Mr. M is a 63-year-old man with a history of coronary artery disease and systolic CHF (ejection fraction 32%) on lisinopril, metoprolol, and spironolactone who presents to Primary Care Clinic complaining of persistent dyspnea with exertion, two-pillow orthopnea, and severely limited exercise tolerance. His vital signs on presentation are T 98.0º F, BP 122/76, HR 84 bpm. What are his therapeutic options?

A Race Against Time: Tachycardia in …

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