Behavioral intervention, nutrition, and exercise trials in heart failure.

With the aging of the population and advances in acute treatment of ischemic events and surgical techniques for coronary artery and valvular heart disease, the prevalence of heart failure has been increasing. Lifestyle modifications are an integral part of preventing and treating most pathologic human conditions, and include behavioral modifications, diet, and exercise. Despite advances in medical and device therapy for heart failure, clinicians still hope that patients will adhere to nonpharmacologic interventions, some of which can actually improve symptoms and quality of life.

Treatment of heart failure with preserved ejection fraction: have we been pursuing the wrong paradigm?

Heart failure with preserved ejection fraction (HF-PEF) is the clinical syndrome of heart failure associated with normal or near-normal systolic function. Because inhibition of the adrenergic and renin-angiotensin-aldosterone systems has been so effective in the treatment of systolic heart failure, these same therapies have been the subject of recent clinical trials of HF-PEF. In this review, we examine the current evidence about treatment of HF-PEF, with particular emphasis on reviewing the literature for large-scale randomized clinical studies.

The STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) trial improves outcomes.

Objectives: The goal of this study was to evaluate the impact of the STAT-MI (ST-Segment Analysis Using Wireless Technology in Acute Myocardial Infarction) network on outcomes in the treatment of patients presenting with ST-segment elevation myocardial infarction (STEMI).

Background: Shortening door-to-balloon (D2B) time remains a national priority for the treatment of STEMI. We previously reported a fully automated wireless network (STAT-MI) for transmission of electrocardiograms (ECGs) for suspected STEMI from the field to offsite cardiologists, allowing early triage with shortening of subsequent D2B times.

Optimizing primary PCI beyond "door to intervention time"--are we there yet?

Aim: To assess the effects of shortened door-to-intervention (DTI) time on appropriate clinical decisions regarding the four most critical and costly decisions during primary percutaneous coronary intervention (PCI): cath-lab activation (CLA), use of glycoprotein IIb/IIIa inhibitors (GPI), use of PCI, and deployment of drug-eluting stent (DES).

Background: STEMI PCI patients are frequently subject to decision making based on abbreviated medical encounter and limited medical information.

Methods: Clinical data were prospectively collected in a STEMI registry over 19 months.

A case of spontaneous pneumothorax presenting with high-degree atrioventricular block.

The myocardial electrical conduction is significantly influenced by the sympathetic and parasympathetic nervous systems. Hypervagotonia refers to increased vagal tone leading to sinus bradycardia, sinus pause, or any degree of atrioventricular (AV) block. There are many clinical, electrocardiographic, and electrophysiologic clues that help make the diagnosis of hypervagotonia as the cause of bradyarrhythmias.

Acute myocardial infarction due to left anterior descending coronary artery dissection after blunt chest trauma.

Cardiac complications of chest trauma range from arrhythmias to valvular avulsions to myocardial contusion, rupture, and rarely myocardial infarction. We describe a case of a young patient with blunt chest trauma after a motor vehicle accident in whom the diagnosis of myocardial infarction was established a week later because no electrocardiogram or cardiac biomarkers were obtained on presentation. Retrospective review of contrast-enhanced computed tomography (CT) of the chest done on presentation demonstrated a perfusion defect in the distribution of the left anterior descending artery (LAD).

Vasopressin and vasopressin receptor antagonists in heart failure.

Antidiuretic hormone, also known as arginine vasopressin, is a hormone with a multitude of physiologic activities including the control of urinary free water excretion. Antidiuretic hormone also plays a role in vasoconstriction and has 3 receptors that have been identified. Vasopressin analogs and antagonists have been extensively studied in animal models as well as in humans.

Rituximab-induced acute thrombocytopenia: a report of two cases.

Rituximab use in B-cell malignancies has been widely favored by the acceptable toxicity profile of this drug. Episodes of rituximab-induced neutropenia have been reported in some patients, but severe acute thrombocytopenia is very unusual. Here, we report transient severe acute thrombocytopenia after rituximab infusion in two patients with, one hairy cell leukemia the other with mantle cell lymphomay.

Erysipelas of the upper extremity following locoregional therapy for breast cancer.

Cellulitis is a well-known complication of lymphedema of the lower extremities. Erysipelas of the upper extremity complicating breast cancer therapy has never been reported in the English-language literature. We describe seven breast cancer patients with erysipelas of the upper extremity.

Incidence of urinary tract infection following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon.

Objective: To determine the incidence of urinary tract infections (UTIs) following transrectal ultrasound guided needle biopsy of the prostate (TRUBP) and the bacteriology of these infections.

Design: Retrospective evaluation of the charts and records of all patients who underwent TRUBP between June 1, 2002, and August 31, 2003.

Setting: American University of Beirut Medical Center, a tertiary-care center in Lebanon.