Cardiology

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 (creatinine …

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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 into the …

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When Should You Order a T Wave Alternans Test?

January 25, 2007
When Should You Order a T Wave Alternans Test?

A 58 year old male is admitted for "presyncope".  He has not had chest  pain and his baseline ECG is unchanged.  The patient has an ischemic cardiomyopathy with an ejection fraction of 39% with mild reversible changes on a stress echo that was done 5 months prior to admission.  On telemetry, the patient has frequent  polymorphic premature ventricular contractions. The cardiology consult recommends a T wave alternans test.  What is the reason for this test?

Commentary By: Neil Bernstein, MD Assistant Professor of Medicine, Cardiology/EPS…

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The First Joint Medical-Surgery Conference

December 21, 2006
The First Joint Medical-Surgery Conference

The first monthly medical/surgery conference was a great success. Attended by resisdents and attendings from both departments the conference was a lively discussion regarding the controversies in caring for a 51 year old man who recently underwent a percutaneous coronary intervention with the placement of a Cypher stent after a non-st elevation myocardial infarction, who soon afterwards was found to have a gall bladder mass that needed to be resected. The complete slide presentation can be found here: Joint Medicine-Surgery Conference Slides
A short summary …

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Pfizer Shutting Lights on ILLUMINATE Study

December 4, 2006
Pfizer Shutting Lights on ILLUMINATE Study

Low HDL is a well known independent risk factor for atherosclerotic disease.  As a result, there have been several attempts to develop medications to raise HDL.  Specific targets include the inhibition of cholesteryl ester transfer protein, which plays an essential role in HDL metabolism by facilitating the transfer of cholesterol esters from HDL cholesterol to apolipoprotein B-containing lipoproteins.

Pfizer created just that drug.  Known as Torcetrapib, it was seen as a promising therapeutic to increase HDL and potentially use in combination with Lipitor. Drug execs …

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Fast Facts-Cardiology

November 20, 2006
Fast Facts-Cardiology

Welcome to Fast Facts-a new feature of Clinical Correlations.  Look for frequent posts summarizing key teaching points from Morning Reports and Noon Conferences from Bellevue, Tisch and the VA.

Bellevue 11/16/08-William Slater M.D.

34 yo female, 4 weeks post-partum, presents with progressive DOE, othopnea, and bilateral pleural effusions on CXR.  Working DDx: Postpartum Cardiomyopathy, PE, Primary Pulmonary HTN TTE with normal EF, right ventricle dilatation, and PAP >50 mmhg..

ECG changes due to PE: The classical S1Q3T3 reflects delayed rightward forces (S1) as well as the…

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NYU’s Dr. Hochman Releases OAT Results

November 16, 2006
NYU’s Dr. Hochman Releases OAT Results

                          Hochman JS et al. for the Occluded Artery Trial Investigators. Coronary intervention for persistent occlusion after myocardial infarction. N Engl J Med 2006 Nov 14; 355.

Reperfusion via thrombolytics or PCI in patients with acute STEMI has been shown to reduce mortality and maximize myocardial salvage.  It has been less clear whether patients with late presentations of MI are afforded the same benefits.  Though there was no official consensus, late revascularization of the infarct vessel was frequently employed.  At the AHA meeting yesterday, Dr Hochman …

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Statins and CHF

November 3, 2006
Statins and CHF

This week’s JAMA has an enormous study that looks at chf patients and the use of statins. Data from ~25,000 patients with chf were analyzed for use of statin in the 120 days prior to the initial chf diagnosis. Mortality risk was significantly lower for statin users than nonusers (hazard ratio 0.79), as was hospitalization (hr 0.80). Findings did not change by etiology of chf or whether the patient had cad. The press is taking this study to mean all patients with chf should be…

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Syncope W/U

November 1, 2006
Syncope W/U

Don’t forget to ask your patients whether they recently attended a screening of Saw III when they are admitted with syncope……

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