Cardiology

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 therapeutic options?

 A randomized, placebo controlled study of …

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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

Congestive heart failure (CHF) is a clinical syndrome …

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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 down with you, but one of …

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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 agitated saline contrast study (“Bubble Study”) was …

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Is Vasopressin Indicated in the Management of Cardiac Arrest?

February 2, 2011
Is Vasopressin Indicated in the Management of Cardiac Arrest?

By Brandon Oberweis, MD

Faculty Peer Reviewed

Case Report:

A 65-year-old male with a past medical history significant for NYHA class IV heart failure was found by his wife to be unresponsive.  Emergency Medical Services was subsequently called and upon arrival, initiated chest compressions and defibrillation for cardiac arrest secondary to ventricular fibrillation.  Intravenous access was obtained and despite two episodes of defibrillation, the patient remained in ventricular fibrillation.  The patient was given one dose of 40 U of vasopressin followed by 1 mg …

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Anthracycline Induced Cardiotoxicity

January 14, 2011
Anthracycline Induced Cardiotoxicity

By Ami Jhaveri, PGY-3

Faculty Peer Reviewed

Clinical Case:

K.M. is a 61-year-old woman with hypertension diagnosed with non-Hodgkin’s lymphoma 1 month ago.  Her only medication is hydrochlorothiazide.  She is about to undergo treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone).  Her oncologist explains that doxorubicin may affect the heart and that she needs to obtain a Multi Gated Acquisition scan (MUGA)before proceeding with her treatment.  Her oncologist recently read a study describing benefits of beta-blockers and ACE inhibitor therapy in patients receiving treatment …

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Meeting Perspectives: American Heart Association Scientific Sessions 2010

January 12, 2011
Meeting Perspectives: American Heart Association Scientific Sessions 2010

By Steven Sedlis, MD

The 2010 Scientific Sessions of the American Heart Association were held on November 13-17 in Chicago, IL. Details of all the late breaking trials including presentation slides and commentary are available on the newly redesigned and user friendly meeting web site: http://scientificsessions.americanheart.org/portal/scientificsessions/ss/. The cardiology fellows stayed at the W in the Loop and had a raucous party Monday night hosted by Barry Rosenzweig and Glenn Fishman to which the faculty was invited. There was plenty to celebrate. Two of the fellows …

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Early Repolarization: Not as Innocent as Once Thought!

January 5, 2011
Early Repolarization: Not as Innocent as Once Thought!

By Rachel Bond, MD PGY-2

Faculty Peer Reviewed

For many years, the electrocardiogram, a seemingly simple transthoracic interpretation of the electrical activity of the heart captured and externally recorded, has fascinated healthcare professionals.  An aspect of the electrocardiogram which has piqued curiosity consist of an interesting pattern referred to as “early repolarization.”  Early repolarization is a slurring or notching producing a hump-like feature called a J wave, typically found at the junction at the end of the QRS complex and the beginning of the ST …

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Does Vitamin D Supplementation Reduce the Risk of Cardiovascular Events?

October 6, 2010
Does Vitamin D Supplementation Reduce the Risk of Cardiovascular Events?

By Karina Vivar, MS4

Faculty Peer Reviewed

Vitamin D deficiency is highly prevalent in the U.S. and worldwide, and the problem appears to be worsening.  By definition, vitamin D deficiency is a serum 25-hydroxyvitamin D (25-OH D) level of less than 20 ng/mL.  Vitamin D insufficiency is defined as a serum 25-OH D level from 20 to 30 ng/mL.  Unless there is a high risk for fracture and a clinical suspicion of deficiency, it is not routine to screen for vitamin D deficiency, due to …

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Does Heyde Syndrome (The Association Between Aortic Stenosis And Intestinal Angiodysplasia) Exist?

September 29, 2010
Does Heyde Syndrome (The Association Between Aortic Stenosis And Intestinal Angiodysplasia) Exist?

By Lara Dunn, MD

Faculty Peer Reviewed

In 1958, EC Heyde published 10 cases of aortic stenosis (AS) and arteriovenous malformations (AVMs) of the gastrointestinal tract in the New England Journal of Medicine .  Thus, the association between aortic stenosis and intestinal angiodysplasia became known as Heyde Syndrome.  Yet the existence of this syndrome has been controversial.

Contrasting conclusions have been obtained by studies conducted to evaluate this association.  In a prospective study, Bhutani and colleagues did not find an increased prevalence of AS in …

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Pass the Salt? A Look at Population-Based Sodium Reduction Interventions

September 24, 2010
Pass the Salt? A Look at Population-Based Sodium Reduction Interventions

By Ryan Macht, MS4

Faculty Peer Reviewed

On January 11th, the New York City Health Department announced its plans for the National Salt Reduction Initiative, a public health proposal designed to decrease sodium consumption throughout the country. High levels of dietary sodium have frequently been associated with increased rates of hypertension and adverse cardiovascular events. The mean salt intake in the United States is extremely high in all age groups and well above the current recommendations of 5.8 g (2300 mg sodium) for those under …

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The Heart in Acromegaly

September 1, 2010
The Heart in Acromegaly

By Ari Pollack, MD

Faculty Peer Reviewed

The onset of acromegaly is subtle, and its progression is usually very slow. In fact, the usual interval from the onset of symptoms until diagnosis is about twelve years. The manifestations of acromegaly result from excessive secretion of growth hormone (GH), which targets the liver, resulting in stimulation of hepatic secretion of insulin-like growth factor-1 (IGF-1), which causes many of the clinical manifestations of acromegaly.  The most common cause of acromegaly is a functional pituitary adenoma. The effects …

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