Aspirin, Plavix, and Other Antiplatelet Medications: What the Oral and Maxillofacial Surgeon Needs to Know.

Most patients with coronary artery disease and peripheral vascular disease are on long-term antiplatelet therapy and dual therapy. Achieving a balance between ischemic and bleeding risk remains an important factor in managing patients on antiplatelet therapy. For most outpatient surgical procedures, maintenance and continuation of this therapy are recommended.

Prevalence of Metabolic Syndrome in Patients with HIV in the Era of Highly Active Antiretroviral Therapy.

Objectives: Since the introduction of combination antiretroviral therapy (cART) as the standard of care for HIV disease, there has been a precipitous decline in the death rate due to HIV/ AIDS. The purpose of this study was to report the prevalence of metabolic syndrome in HIV infected patients.

Methods: Retrospective, cross-sectional, observational study of 259 patients with HIV infection treated with cART from an urban community hospital.

Prospective chest pain evaluation in the emergency department with use of high-sensitivity C-reactive protein (PROCEED-CRP study).

We evaluated the clinical value of a single measurement of high-sensitivity C-reactive protein (hs- CRP) in patients presenting to the emergency department with chest pain. We screened 408 consecutive patients of whom 292 comprised the final cohort for this study. Hs-CRP measured in the emergency department (ED) in patients presenting with chest pain and admitted for evaluation of acute myocardial infarction was neither sensitive nor specific in predicting acute myocardial infarction, myocardial ischemia on SPECT imaging, need for coronary revascularization, or cardiovascular or all-cause rehospitalization at 30 days.

Isolated left ventricular noncompaction: a review of three different presentations for a rare disease.

Isolated left ventricular noncompaction (ILVNC) is a rare cardiomyopathy with a genetic background characterized by numerous prominent trabeculations and deep intertrabecular recesses. It occurs in the absence of any coexisting congenital lesion or hemodynamic abnormality and is rare in the adult population. Heart failure, ventricular arrhythmias, and embolic events are the three major clinical manifestations of ILVNC.

Long-term outcome of Tako-tsubo cardiomyopathy.

Background: Current data suggest an excellent outcome for patients with Tako-tsubo cardiomyopathy (TC). The objectives of this study were to evaluate the long-term outcome and the prognostic implication of thrombolysis in myocardial infarction myocardial perfusion grade (TMPG) in patients with TC.

Methods: Retrospective analysis of all patients diagnosed with TC at our hospital between 2003 and 2008.

A rare cause of systolic murmur: unruptured right sinus of Valsalva aneurysm with right ventricular outflow tract obstruction and supracristal ventricular septal defect.

Dyspnea and heart murmur are common reasons for referrals in cardiology and both are associated with a broad differential diagnosis. Sinus of Valsalva aneurysms are rare abnormalities of the aortic root that should be considered in the differential diagnosis in young and middle aged patients. Sinus of Valsalva aneurysms are often associated with supracristal ventricular septal defects and can be identified on transthoracic echocardiography.

Endocarditis complicating central venous catheter bloodstream infections: a unique form of health care associated endocarditis.

Background: Endocarditis complicating central venous catheter blood stream infection (CVC-BSI) is a serious complication and is being seen with increasing frequency.

Methods: All patients discharged from our institution with International Classification of Disease (ICD-9) codes of endocarditis and CVC-BSI were identified. The medical records of those meeting our inclusion criteria were reviewed.

Nesiritide in the initial management of acute decompensated congestive heart failure.

Background: In the era of evolving therapy for heart failure (HF), optimal medical therapy has become challenging. Nesiritide is being used for HF therapy but its impact is still controversial.

Methods: Prospective and randomized controlled study of 34 patients who presented to the emergency department (ED) with HF and remained symptomatic despite maximal standard therapy delivered for at least one hour.

Papillary fibroelastoma arising from the pulmonary valve associated with pulmonary embolization.

Cardiac papillary fibroelastomas are rare, usuallybenign tumors that can be detected at autopsy, during open-heart surgery, or with echocardiography. They usually arise from the cardiac valves and more commonly are found on the left side of the heart. Embolization of left-sided and tricuspid valve tumors has been well documented.

Coronary artery aneurysms.

Aneurysmal coronary artery disease is frequently encountered in clinical cardiology practice. Although more commonly associated with atherosclerosis, a variety of other acquired (eg, inflammatory, infectious, iatrogenic) or congenital causes have been identified. Recent research on the pathogenesis of coronary aneurysms has yielded interesting results.

Coronary vasculitis with acute myocardial infarction in a young woman with systemic lupus erythematosus.

Myocardial infarction in patients with systemic lupus erythematosus (SLE) is most commonly a consequence of atherosclerosis. Coronary vasculitis with aneurysms is a rare cause of myocardial ischemia in SLE. We present a case of a 22-year-old woman with a 4-year history of SLE who was admitted with acute onset of chest pain.

Caseous calcification of the mitral valve ring.

Mitral annular calcification (MAC) is found in 10% of patients older than 50 years of age, and represents deposition of calcium between the basal infero-lateral ventricular wall and the posterior leaflet of the mitral valve. Caseous calcification, formed from a mixture of calcium, cholesterol and fatty acids, is an uncommon variant found on echocardiography in 0.6% of patients with MAC.

Intraaortic balloon pump insertion through the subclavian artery. Subclavian artery insertion of IABP.

The intraaortic balloon pump (IABP) is frequently used in the management of cardiac failure in the setting of myocardial infarction or as a bridge for coronary revascularisation surgery. The IABP is usually inserted through the femoral artery. Occasionally severe aorto-iliac occlusive disease prevents the retrograde passage of the balloon, in which case an anterograde route, usually through the ascending aorta is used.

Intramural hematoma of the descending thoracic aorta.

Aortic intramural hematoma (AIH) is part of the acute aortic syndrome together with aortic dissection and penetrating aortic ulcer. AIH represents up to 12% of acute aortic syndrome cases and has a clinical presentation indistinguishable from that of classic aortic dissection. A patient with AIH is presented and the diagnostic, prognostic and therapeutic implications of the disease are discussed.

Patterns of anticoagulation in patients hospitalized with atrial fibrillation: warfarin is underused in paroxysmal atrial fibrillation.

Paroxysmal atrial fibrillation (PAF) has a similar stroke risk when compared with chronic atrial fibrillation (CAF). Our study sought to define the incidence of warfarin use at time of admission and discharge in patients hospitalized with PAF and CAF. Anticoagulation rates upon hospital admission were 89% in the patients with CAF and 38% in patients with PAF, and increased to 100% for patients with CAF and 81% for patients with PAF at the time of hospital discharge.