Cardiology

Breaking News: A Disappointment for Zetia

January 15, 2008
Breaking News: A Disappointment for Zetia

Commentary by Alana Choy-Shan MD, NYU Chief Resident

The highly anticipated results of the ENHANCE trial will likely be presented at the American College of Cardiology meeting in March, but the preliminary results already have everyone talking. ENHANCE was a multinational, double-blind randomized controlled trial sponsored by Merck and Schering-Plough (the manufacturers of the combination ezetimibe/simvastatin pill). A total of 720 patients who were heterozygotes for Familial Hypercholesterolemia were randomized to treatment with either ezetimibe/simvastatin 10/80mg or simvastatin 80mg. The primary endpoint was change in…

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Evaluation of Asymptomatic Wolff-Parkinson-White EKG Morphology

January 3, 2008
Evaluation of Asymptomatic Wolff-Parkinson-White EKG Morphology

Commentary by David Steckman MD, PGY-2 and William Slater MD, Associate Professor of Medicine, Division of Cardiology

Case: A 42 year-old man presents to clinic for routine follow-up. He is found to be hypertensive for the second consecutive clinic appointment. On routine EKG, you find a shortened PR interval and what looks to be a delta wave in V1-V3. The patient does not report any history of syncope, chest pain, palpitations or shortness of breath. In addition to treating his hypertension, what…

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Vagally-induced Atrial Fibrillation

November 7, 2007
Vagally-induced Atrial Fibrillation

Case by: Alana Choy-Shan, Chief Resident

Commentary by William Slater MD, Associate Professor of Medicine, Division of Cardiology

Following Thanksgiving dinner, a 36 year-old healthy man developed palpitations and heart racing. He was evaluated in the emergency room and was noted to be in atrial fibrillation with rapid ventricular response. All of his other vital signs were within normal limits. He was treated with a beta-blocker for rate control and was started on anticoagulation. Within a few hours, he spontaneously converted to normal…

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Targeting Triglycerides

October 31, 2007
Targeting Triglycerides

Commentary by Josh Remick MD, PGY-3

Hypertriglyceridemia is defined by the NCEP guidelines for treatment as a fasting triglyceride level greater than 200 mg/dL after the target LDL-C level has been achieved (1). When triglyceride levels are greater than 1000 mg/dL, the risk of pancreatitis increases and treatment with fibrates should be started immediately. Many physicians would also argue for treatment of a triglyceride level greater than 500mg/dL. However, it is the triglyceride level between 200 and 500 mg/dL that is a bit more difficult to…

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Atrial Fibrillation Part 2: Additional Words of Wisdom

August 3, 2007
Atrial Fibrillation Part 2: Additional Words of Wisdom

Commentary by William Slater, MD Associate Professor of Medicine, Divsion of Cardiology

The vast majority of patients with persistent AF can be rendered asymptomatic with AV nodal blocking drugs and don’t require ablation. Digitalis is underused but is often of major benefit, either
alone, or in combination with beta blockers or calcium channel blockers.

Of paroxysmal fibrillators, most can be managed by reassurance that the episodes are harmless with a normal heart and of minimal risk if brief even in context of…

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Management and Consequences of Atrial Fibrillation

August 2, 2007
Management and Consequences of Atrial Fibrillation

Commentary by Timothy Wong, MD

A group of short articles focusing on the consequences and management of atrial fibrillation (AF) recently appeared in the July 7th issue of the Health section of the New York Times. In brief, the articles highlighted the risks of thromboembolism, the lack of very successful medical therapies, and the growing demand for catheter-based atrial fibrillation ablation procedures.

As a cardiology fellow on the consultation service at a teaching hospital in western Pennsylvania, I find that atrial fibrillation…

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Statin Pleiotropy: Unique Roles for a Common Medication

April 26, 2007
Statin Pleiotropy: Unique Roles for a Common Medication

By: Melissa Freeman, MD, PGY1

For over a decade now, statins, or 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, have facilitated millions of patients in the management of their atherosclerosis. Statins are known for their ability to reduce hepatic lipoproteins, up-regulate hepatic LDL receptors, and increase apoprotein E- and B-containing lipoproteins. They have become a household name in the genre of lipid-lowering and a touted hero in cardiovascular risk reduction amongst physicians. Excitingly, research has found that statins may be valuable in disease…

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Meeting Perspectives: The 2007 American College of Cardiology Scientific Session

April 5, 2007
Meeting Perspectives: The 2007 American College of Cardiology Scientific Session

Commentary By: Steven Sedlis, MD Associate Professor of Medicine, Chief, Division of Cardiology Manhattan Veterans Administration Medical Center

The 56th annual scientific session of the American College of Cardiology was held in New Orleans on March 24-27.  The site of the meeting had been selected before hurricane Katrina; the ACC re-affirmed its commitment last year when the devastation caused by the storm was still fresh and when future prospects for southern Louisiana were still uncertain. The ACC meeting was by far the largest…

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First Direct Renin Inhibitor Approved for Hypertension

March 29, 2007
First Direct Renin Inhibitor Approved for Hypertension

Commentary By: Josh Olstein, PGY-3

Earlier this month the FDA approved Tekturna (aliskiren) the first drug in a novel class of antihypertensives that work by directly inhibiting renin. While Novartis has yet to release pricing information, don’t expect to see this new addition on the Bellevue or VA formulary any time soon.

The idea of treating hypertension by blocking the actions of renin has been toyed with by pharmaceutical companies for over twenty years with little success. Aliskiren is the first agent…

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The COURAGE Trial: PCI is not superior to medical therapy in patients with stable coronary disease

March 27, 2007
The COURAGE Trial:  PCI is not superior to medical therapy in patients with stable coronary disease

Commentary by Cara Litvin, PGY-3

The results of one of the more remarkable studies from the meeting of the American College of Cardiology were presented on Monday, along with the simultaneous early publishing of the study online in the New England Journal of Medicine. As a result the study results captured a front page article in today’s New York Times.

The COURAGE (Clinical Outcomes Utilizing Revascularization and Aggressive Drug Evaluation) trial was a randomized trial involving 2287 patients with stable but significant coronary artery disease…

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How Do You Approach A Patient with a Non-Ischemic Cardiomyopathy

March 7, 2007
How Do You Approach A Patient with a Non-Ischemic Cardiomyopathy

A 26 year old woman developed uncontrolled hypertension peripartum 5 years prior to this presentation After diagnosis she was intermittently compliant with her medication although remained asymptomatic. She now presents with new onset congestive heart failure. On admission, she was in mild respiratory distress. Her physical exam was notable for tachycardia with a blood pressure ranging from 160/100-200/110. She had a jugular-venous pressure of 8cm, +S4, crackles were present bilaterally 1/2 way up, but no peripheral edema. Labs were notable only for renal insufficiency…

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Bedside Rounds #1: Why is a pulsus paradoxus not a paradox?

February 1, 2007
Bedside Rounds #1: Why is a pulsus paradoxus not a paradox?

Welcome to our inaugural Bedside Rounds a new regular feature of Clinical Correlations.  Here you will learn not only practical physical diagnosis pearls, but also the historical context in which these findings were discovered.

Commentary By: Judith Brenner MD, Associate Program Director, NYU Internal Medicine Residency Program

When you take a deep breath in, what happens? Because of an increase in the negative intrathoracic pressure, blood is sucked into the right side of the heart. Temporarily, a filled right ventricle can bulge…

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