Cardiology

From The Archives: How to interpret troponins in renal disease?

March 15, 2012
From The Archives: How to interpret troponins in renal disease?

Please enjoy this post from the archives first posted on October 21, 2009.

By Ivan Saraiva MD

Case: A 68-year-old man, with a history of stable angina and end-stage renal disease treated by hemodialysis for the past three years, presents to the hospital with leg swelling and shortness of breath. He also complains of intermittent chest pain unrelated to exertion. Physical exam reveals bilateral pitting lower extremity edema, pulmonary crackles, and an elevated jugular venous pressure. Initial electrocardiogram is notable for some nonspecific repolarization abnormalities.…

Read more »

Cardiac Murmur Websites: An Internet Review of Common Cardiac Auscultation Websites

February 29, 2012
Cardiac Murmur Websites: An Internet Review of Common Cardiac Auscultation Websites

By Rachel Bond, MD

Faculty Peer Reviewed

In the field of medicine including the art of physical diagnosis, there is nothing more nerve provoking then having to master the art of cardiac auscultation. Imagine the concern of medical students, residents, internists and freshly starting cardiologists all alike who are asked by patients time and time again, “does my heart sound okay?!” With the advancement in technology and the rapid surge of echocardiogram usage, the use of a stethoscope has not been very provocative. However, being…

Read more »

The Diagonal Earlobe Crease: Historical Trivia or a Useful Sign of Coronary Artery Disease?

November 2, 2011
The Diagonal Earlobe Crease: Historical Trivia or a Useful Sign of Coronary Artery Disease?

Nicholas Mark, MD & Sarah Buckley, MD

Faculty Peer Reviewed

Background

Publius Aelius Hadrianus, better known as Hadrian, emperor of Rome (117-138 CE), traveler, warrior, and lover of all things Greek, fell ill at the age of 60. He developed progressive edema and episodic epistaxis, fell into a depression soothed by rich food and drink, and succumbed to death within 2 years. The exact cause of Hadrian’s death–whether by heart failure, glomerulonephritis, or even hereditary hemorrhagic telangiectasia–has been a topic of debate among paleopathologists. It was…

Read more »

Should Women Be Screened For Abdominal Aortic Aneurysms?

October 26, 2011
Should Women Be Screened For Abdominal Aortic Aneurysms?

By Michael Boffa

Faculty Peer Reviewed

Laura K. sits in the office of her cardiologist waiting for the results of her follow-up aorto-iliac duplex scan. Six months ago, Laura had an endostent placed in her abdominal aorta after a 5.2 cm x 5.4 cm abdominal aortic aneurysm (AAA) was discovered.  Though she has recently quit, Laura, now 70, smoked for a large portion of her life. Her advanced age and smoking put her at increased risk of suffering a potentially life-threatening aortic aneurysm rupture. …

Read more »

Systemic Lupus Erythematosus and Premature Coronary Artery Disease

July 14, 2011
Systemic Lupus Erythematosus and Premature Coronary Artery Disease

Please enjoy this post from the Clinical Correlations archives first posted June 17, 2009

Ishmeal  Bradley MD

Faculty Peer Reviewed

Ms. W is a 35 yo woman with a history of systemic lupus erythematosus diagnosed 10 years ago. Her only medications are hydroxychloroquine and prednisone for occasional disease flares. She is otherwise healthy. She has no known personal or family history of cardiac disease or stroke, but does smoke ½ pack of cigarettes per day. Currently, she denies any chest pain, shortness of breath, urinary…

Read more »

Do Soft Drinks Cause Hypertension?

July 8, 2011
Do Soft Drinks Cause Hypertension?

By Ivan Saraiva, MD

Faculty Peer Reviewed

Sugared soft drinks are among the most heavily consumed drinks in the US. Carbonated soft drinks were first invented as a way to make “healthier” water that looked like natural carbonated waters that were found in European spas in the mountains. The name soda came from the use of bicarbonate of soda, which was used to produce carbonation (for an excellent review of the history of beverages, refer to Wolf et al..  Unfortunately, we no longer…

Read more »

Red Yeast Rice: Nature’s Statin?

June 30, 2011
Red Yeast Rice: Nature’s Statin?

By Joshua Farhadian

Faculty Peer Reviewed

M. K.  is a 61-year-old female with hypercholesterolemia who presents to clinic complaining of muscle pain and weakness.  She reports that one month after beginning statin therapy she developed myalgias and immediately stopped taking her medication.  She states that she wants to control her cholesterol level, since both of her parents died of heart disease; however, she is hesitant to take a prescription medication due to the side effects she experienced.  She asks you about red yeast rice (RYR).…

Read more »

How Does Alcohol Affect Hypertension?

June 24, 2011
How Does Alcohol Affect Hypertension?

By Benjamin Kenigsberg

Faculty Peer Reviewed

Alcoholic beverages have been part of human culture for thousands of years and cross nearly every political and demographic boundary. Despite this long history, the interaction between alcohol and human health is still poorly understood. This confusion is particularly true with regard to blood pressure, as multiple studies have debated the association between alcohol intake and the development or management of hypertension.  For this discussion, in America a standard drink is defined as 12 ounces of regular beer, 5…

Read more »

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

May 25, 2011
Fast Hearts and Funny Currents, Part 2: Is Tachycardia Part of the Problem in Heart Failure?

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.  What are his…

Read more »

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

May 18, 2011
Fast Hearts and Funny Currents: Is Tachycardia Part of the Problem in Heart Failure? Part 1

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 the Failing Heart

Read more »

An Intern In The ER

April 1, 2011
An Intern In The ER

By Demetrios Tzimas, MD

New York City.  Bellevue Hospital Center.  July 17, 2009.  1:53 pm.  Intern Year. Long Call.

“Go down to the ER.  There’s a guy with chest pain for the past three days, EKG shows some non-specific changes, vitals stable.  First set of labs negative.  CXR clear.  They gave him a full-dose aspirin.  This sounds like a rule out chest pain, and since it’s Friday, he’ll go to medicine and not the chest pain unit.  I’d go…

Read more »

Stroke Prevention in the Setting of a Patent Foramen Ovale: A “Hole” in the Evidence

March 9, 2011
Stroke Prevention in the Setting of a Patent Foramen Ovale: A “Hole” in the Evidence

Brandon Oberweis, MD

Faculty Peer Reviewed

 Case Report:

A 48-year old gentleman with no significant past medical history presents to the emergency department with new-onset left upper extremity hemiparesis, visual field deficits, and decreased level of consciousness.  A non-contrast CT scan was performed and revealed right-sided focal hypoattenuation in the middle cerebral artery distribution.  Following acute management of this patient, further studies were conducted to elucidate the underlying etiology of the cerebrovascular accident.  An echocardiogram with an…

Read more »