- Influence of large hiatus hernia on cardiac volumes. A prospective observational cohort study by cardiovascular magnetic resonance. [Journal Article]
- IJInt J Cardiol 2018 May 09
- CONCLUSIONS: The global heart function was significantly impaired by a standardized meal in the presence of a LHH. Restoration of the cardiac physiological status and improvement of clinical symptoms were noted after surgery. A multidisciplinary evaluation and CMR with a challenge meal may be added to routine pre-operative testing to select symptomatic patients for surgical hernia repair.
- Clinical Approach to Patients with Palpitations. [Review]
- CECard Electrophysiol Clin 2018; 10(2):387-396
- Palpitations are among the most common symptoms that prompt patients to consult a physician. In the diagnostic workup of patients with palpitations, the initial evaluation involves history, physical ...
Palpitations are among the most common symptoms that prompt patients to consult a physician. In the diagnostic workup of patients with palpitations, the initial evaluation involves history, physical examination, and 12-lead electrocardiogram. These investigations yield a prognostic stratification of the patients, and a definitive suspected diagnosis of the cause of symptoms in a good proportion of cases. When the initial evaluation results are negative and the patient is suffering from heart disease, or if the palpitations are frequent or poorly tolerated and with a high probability of an arrhythmic origin, ambulatory electrocardiogram monitoring and/or electrophysiological study should be undertaken.
- High Prevalence of Clinically Important Echocardiographic Abnormalities in Patients with a Normal Electrocardiogram Referred for Transthoracic Echocardiography. [Journal Article]
- JAJ Am Soc Echocardiogr 2018 May 16
- CONCLUSIONS: Clinically important TTE abnormalities in patients with a normal ECG are common, suggesting that normal ECG results should not routinely preclude TTE imaging to identify structural heart disease. However, recognition of common clinical indications and application of the appropriate use criteria may identify patients with a normal ECG in whom TTE imaging is of very low yield.
- Symptom Burden of Atrial Fibrillation and Its Relation to Interventions and Outcome in Europe. [Journal Article]
- JAJ Am Heart Assoc 2018 May 18; 7(11)
- CONCLUSIONS: A higher symptom burden, in particular palpitations, predicted interventions to restore sinus rhythm. The score itself had limited predictive value, but its individual components were related to different and specific clinical events, and may thus be helpful to target patient management.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- History of Present Illness: A 33-year-old Caucasian female presents after admission to the general medical/surgical hospital ward with a chief complaint of shortness of breath on exertion. She report...
History of Present Illness: A 33-year-old Caucasian female presents after admission to the general medical/surgical hospital ward with a chief complaint of shortness of breath on exertion. She reports that she was seen for similar symptoms previously at her primary care physician’s office six months ago. At that time, she was diagnosed with acute bronchitis and treated with bronchodilators, empiric antibiotics, and a short course oral steroid taper. This management did not improve her symptoms, and she has gradually worsened over six months. She reports a 20-pound intentional weight loss over the past year. She denies camping, spelunking, or hunting activities. She denies any sick contacts. A brief review of systems is negative for fever, night sweats, palpitations, chest pain, nausea, vomiting, diarrhea, constipation, abdominal pain, neural sensation changes, muscular changes, and increased bruising or bleeding. She admits a cough, shortness of breath, and shortness of breath on exertion.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Anemia is a common sign found in both inpatient and outpatient management. Although it is routinely listed as a "freestanding" diagnosis, it is a sign (like tachycardia or rash) that needs to be work...
Anemia is a common sign found in both inpatient and outpatient management. Although it is routinely listed as a "freestanding" diagnosis, it is a sign (like tachycardia or rash) that needs to be worked up and further elucidated. Anemia is a prevalent condition that by some estimates is under-recognized and undertreated. It has both the obvious, primary, direct, negative consequences of diminished tissue oxygenation and a secondary indirect negative consequence of complicating the progression of many coexisting diseases. Despite the gravity of the diagnosis of the sign anemia, there remains clinical discordance in both the formal definition of anemia and in the protocols to screen for it. Symptoms of anemia include fatigue, weakness, lightheadedness, headache, pallor/jaundice, tachycardia/palpitations, chest pain, dyspnea, and cold distal extremities, and claudication. These symptoms can be quite limiting and are primary negative consequences of anemia. The cause of the anemia modulates the presence and magnitude of these symptoms. The greater the lethal underlying pathology, the more dramatic the symptomatology. The presence of anemia in conjunction with other pathology adds additional concern. Anemia frequently complicates diabetes, various cancers, chronic kidney disease, cardiovascular disease, hepatitis C, HIV/AIDS, inflammatory bowel disease, rheumatoid arthritis and, despite compensatory polycythemia, chronic obstructive pulmonary disease (COPD). It is universally agreed that anemia is a decrease in the relative number of circulating erythrocytes (red blood cell mass) with a consequent diminished ability to deliver oxygen to tissues. Opinions diverge on the subject of absolute numbers and concentrations to diagnose individuals of various genders, ethnicities, and ages as being anemic. In addition, opinions differ on who is to be routinely screened for anemia and who is to be tested on a "need to know" basis. Finally, the threshold for treatment and the final targets of treatment are subject to variation according to discipline and medical condition. The World Health Organization anemia standard of 2010 is a Hb less than 12 g/dl in premenopausal females and 13 g/dl in postmenopausal females and men of all ages. The Journal Blood disagreed citing the paucity of WHO data and methods and set down standards divided by race, gender and decade of life. Their standards concluded that the standard in white men from 20 to 60 years of age was 13.7 g/dl and after 60 declined to 13.2 g/dl and women of all ages were considered anemic at 12.2 g/dl. This noted a significant difference in Hb in black men and women but did not cite standards. At this point, the majority of the literature utilizes the WHO standards for consistency. There is similar discordance concerning screening for anemia between the US Preventative Services Task Force, and various individual medical academies and, what is done in the day-to-day practice of medicine. For example, the USPTF issued a statement on screening for iron deficiency anemia in asymptomatic children 6 to 24 months of age. The conclusion was that there was insufficient evidence on the benefits and harms of screening for anemia in children of this age. At the same time, the American Academy of Family Practice released their position statement: "Universal screening for anemia should be performed at 12 months of age, with measurement of hemoglobin levels and an assessment of risk factors associated with iron deficiency and iron deficiency anemia." The issue of screening in pregnant women presented a similar discordance. "The USPTF concludes that the evidence of the effect of routine screening for iron deficiency anemia in asymptomatic pregnant women on maternal health and birth outcomes is insufficient...and the balance of benefits and harms cannot be determined." The American Academy of Family Practice voiced agreement with the USPSTF. The American College of Obstetrics and Gynecology in Practice Bulletin No. 95 issued the position statement, "all pregnant women should be screened for anemia and treated if necessary." At present, there are no recommendations for routine anemia screening of non-gravid, well adults.
- A Case Series of Two Patients Presenting With Pericardial Effusion as First Manifestation of Non-Small Cell Lung Cancer With BRAF Mutation and Expression Of PD-L1. [Journal Article]
- WJWorld J Oncol 2018; 9(2):56-61
- Lung cancer is the number one cause of cancer-related deaths in the United States. Involvement of pericardium occurs once cancer has progressed to stage IV which can cause massive effusion in the per...
Lung cancer is the number one cause of cancer-related deaths in the United States. Involvement of pericardium occurs once cancer has progressed to stage IV which can cause massive effusion in the pericardial sac. This can lead to cardiac tamponade which can be fatal very quickly if untreated. The following is a two patient case series in which both patients presented with large pericardial effusion. The first patient sought medical attention due to new onset palpitations and was found to have hemorrhagic pericardial effusion and pulmonary embolism (PE). The second patient presented with shortness of breath. Investigations revealed that she had pericardial and pleural effusions along with multiple metastases throughout the body. Both patients ended up with a diagnosis of non-small cell lung cancer (NSCLC) with BRAF mutation. One patient had V600E mutation; other patient had a variant p.D594N mutation. Both patients also had expression of PD-L1.
- Pharmacotherapy for postural tachycardia syndrome. [Review]
- ANAuton Neurosci 2018 May 04
- Postural tachycardia syndrome (POTS) is a disorder characterized by the presence of orthostatic symptoms (including lightheadedness, palpitations, nausea, dyspnea, and tremulousness) as well as exces...
Postural tachycardia syndrome (POTS) is a disorder characterized by the presence of orthostatic symptoms (including lightheadedness, palpitations, nausea, dyspnea, and tremulousness) as well as excessive upright tachycardia. POTS predominantly affects women of childbearing age. Treating POTS involves a multi-faceted approach using non-pharmacological and pharmacological interventions. There are no pharmacological treatments that are currently United States Food and Drug Administration (FDA) approved for POTS due to lack of randomized controlled trials. Yet, several medications can improve POTS symptoms and are supported by small prospective studies or retrospective case series. Drugs that are most commonly used for POTS target the following mechanisms 1) blood volume expansion, 2) reduction of heart rate, 3) peripheral vasoconstriction and 4) sympatholysis. Pharmacological approaches can also be used to target specific symptoms including "brain fog," fatigue, sleep, and depression. This review outlines pharmacological approaches for treating POTS and summarizes evidence supporting each treatment approach.
- Alexithymia and Somatosensory Amplification Link Perceived Psychosocial Stress and Somatic Symptoms in Outpatients with Psychosomatic Illness. [Journal Article]
- JCJ Clin Med 2018 May 10; 7(5)
- CONCLUSIONS: The results suggested that the association between psychosocial stress and reported somatic symptoms is mediated by alexithymia and somatosensory amplification in psychosomatic patients.
New Search Next
- T wave inversions in a young athlete. [Journal Article]
- HHeart 2018 May 10
- A 21-year-old black athlete presented for a preparticipation medical examination prior to playing collegiate basketball. He had no exercise limitations, syncope, dizziness or palpitations. He took no...
A 21-year-old black athlete presented for a preparticipation medical examination prior to playing collegiate basketball. He had no exercise limitations, syncope, dizziness or palpitations. He took no medications. There was no family history of coronary artery disease, cardiomyopathy, sudden cardiac arrest, drowning or seizures. Physical examination revealed a tall, well-appearing young man with an athletic build. Blood pressure was 119/61 mm Hg. Cardiac examination was unremarkable with no murmurs. A screening ECG is shown in Figure 1.heartjnl;heartjnl-2018-313088v2/F1F1F1Figure 1Resting 12-lead ECG performed in clinic. Patient was asymptomatic at the time of acquisition.