Epidemiology of comorbidities in patients with hypertension.

Purpose Of Review: Hypertension affects an enormous number of people and uncommonly presents in isolation. This review aims to summarize contemporary data that is relevant to the epidemiology of specific comorbidities occurring frequently in individuals with hypertension.

Recent Findings: Hypertension is invariably diagnosed along with multiple comorbidities, particularly diabetes mellitus, obesity, chronic kidney disease, coronary artery disease, and heart failure.

Characteristics, quality of care, and in-hospital outcomes of Asian-American heart failure patients: Findings from the American Heart Association Get With The Guidelines-Heart Failure Program.

Background: Because little was previously known about Asian-American patients with heart failure (HF), we compared clinical profiles, quality of care, and outcomes between Asian-American and non-Hispanic white HF patients using data from the American Heart Association Get With The Guidelines-Heart Failure (GWTG-HF) program.

Methods: We analyzed 153,023 HF patients (149,249 whites, 97.5%; 3774 Asian-Americans, 2.

Regional differences in use and outcomes of left ventricular assist devices: Insights from the Interagency Registry for Mechanically Assisted Circulatory Support Registry.

Background: We examined whether characteristics, implant strategy, and outcomes in patients who receive continuous-flow left ventricular assist devices (CF-LVAD) differ across geographic regions in the United States.

Methods: A total of 7,404 CF-LVAD patients enrolled in the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) from 134 participating institutions were analyzed from 4 distinct regions: Northeast, 2,605 (35%); Midwest, 2,210 (30%); West, 973 (13%); and South, 1,616 (22%).

Results: At baseline, patients in the Northeast and South were more likely to have INTERMACS risk profiles 1 and 2.

Short- and long-term rehospitalization and mortality for heart failure in 4 racial/ethnic populations.

Background: The degree to which outcomes following hospitalization for acute heart failure (HF) vary by racial and ethnic groups is poorly characterized. We sought to compare 30-day and 1-year rehospitalization and mortality rates for HF among 4 race/ethnic groups.

Methods And Results: Using the Get With The Guidelines-HF registry linked with Medicare data, we compared 30-day and 1-year outcomes between racial/ethnic groups by using a multivariable Cox proportional hazards model adjusting for clinical, hospital, and socioeconomic status characteristics.

Echocardiographic Evaluation of Hemodynamics in Patients With Systolic Heart Failure Supported by a Continuous-Flow LVAD.

Background: Hemodynamics assessment is important for detecting and treating post-implant residual heart failure, but its accuracy is unverified in patients with continuous-flow left ventricular assist devices (CF-LVADs).

Objectives: We determined whether Doppler and 2-dimensional transthoracic echocardiography reliably assess hemodynamics in patients supported with CF-LVADs.

Methods: Simultaneous echocardiography and right heart catheterization were prospectively performed in 50 consecutive patients supported by using the HeartMate II CF-LVAD at baseline pump speeds.

A simplified echocardiographic technique for detecting continuous-flow left ventricular assist device malfunction due to pump thrombosis.

Background: Malfunction of a continuous-flow left ventricular assist device (CF-LVAD) due to device thrombosis is a potentially life-threatening event that currently presents a diagnostic challenge. We aimed to propose a practical echocardiographic assessment to diagnose LVAD malfunction secondary to pump thrombosis.

Methods: Among 52 patients implanted with a CF-LVAD from a single center who underwent echocardiographic pump speed-change testing, 12 had suspected pump thrombosis as determined by clinical, laboratory, and/or device parameters.

Racial/Ethnic differences in B-type natriuretic peptide levels and their association with care and outcomes among patients hospitalized with heart failure: findings from Get With The Guidelines-Heart Failure.

Objectives: This study sought to determine if there were differences in B-type natriuretic peptide (BNP) levels across racial/ethnic groups and in their association with quality of care and in-hospital outcomes among patients with heart failure (HF).

Background: It remains unclear whether BNP levels and their associations with quality of care and prognosis vary by race/ethnicity among patients hospitalized with HF.

Methods: Using Get With The Guidelines-Heart Failure (GWTG-HF), patient characteristics and BNP levels at admission were compared among 4 racial/ethnic populations: white, black, Hispanic, and Asian.

Management of ACCF/AHA Stage C heart failure.

ACC Stage C heart failure includes those patients with prior or current symptoms of heart failure in the context of an underlying structural heart problem who are primarily managed with medical therapy. Although there is guideline-based medical therapy for those with heart failure with reduced ejection fraction (HFrEF), therapies in heart failure with preserved ejection fraction (HFpEF) have thus far proven elusive. Emerging therapies such as serelaxin are currently under investigation and may prove beneficial.

Increased right-to-left ventricle diameter ratio is a strong predictor of right ventricular failure after left ventricular assist device.

Background: Predictors of right ventricular failure (RVF) in patients with left ventricular assist devices (LVADs) have not been fully elucidated and are comprised mostly of clinical variables. We evaluated echocardiographic parameters associated with adverse outcomes in this population.

Methods: Transthoracic echocardiograms (TTEs) before continuous-flow LVAD implantation were analyzed in 109 patients.

B-type natriuretic peptides in acute coronary syndromes: implications in an aging population.

B-type natriuretic peptide (BNP) and N-terminal-proBNP (NT-proBNP) are increasingly recognized as prognostic markers in patients with acute coronary syndrome (ACS). The need for novel and more effective tools for risk assessment cannot be more emphasized than in older patients with ACS given their atypical presentation, multiple comorbidities, and higher risk for mortality and morbidity. Accurate interpretation of B-type NP values in older patients with ACS, however, may be confounded by several aging-related physiologic changes.

Care and outcomes of Hispanic patients admitted with heart failure with preserved or reduced ejection fraction: findings from get with the guidelines-heart failure.

Background: Although individuals of Hispanic ethnicity are at high risk for developing heart failure (HF), little is known about differences between Hispanic HF patients stratified by left ventricular ejection fraction (EF). We compared characteristics, quality of care, and outcomes between Hispanic and non-Hispanic white patients hospitalized for HF with preserved EF (PEF) or reduced EF (REF).

Methods And Results: From 247 hospitals in Get With The Guidelines-Heart Failure between 2005-2010, 6117 Hispanics were compared with 71 859 non-Hispanic whites.

Regional differences in clinical profile, quality of care, and outcomes among Hispanic patients hospitalized with acute myocardial infarction in the Get with Guidelines-Coronary Artery Disease (GWTG-CAD) registry.

Background: Although Hispanics constitute the largest minority in the United States, it is unknown whether regional differences in quality of care and outcomes exist among Hispanic patients hospitalized with acute myocardial infarction (MI).

Methods: Using the GWTG-CAD Registry, clinical characteristics, conformity with quality measures, and in-hospital outcomes were assessed among Hispanic patients from different geographic regions admitted for acute MI in participating hospitals.

Results: A total of 11,299 Hispanic patients treated for acute MI at 277 hospitals from 4 regions were included in the study.

Echocardiographic evaluation of hemodynamics in patients with decompensated systolic heart failure.

Background: Doppler echocardiography is currently applied for the assessment of left ventricular and right ventricular hemodynamics in patients with cardiovascular disease. However, there are conflicting reports about its accuracy in patients with unstable decompensated heart failure. The objective of this study was to evaluate the accuracy of the technique in patients with unstable heart failure.

Gigantic coronary sinus associated with concurrent persistent left superior vena cava and right ventricular volume overload.

A 76-year-old women with known atrial fibrillation and congestive heart failure presented with increasing shortness of breath. A 2-dimensional (2-D) transthoracic echocardiogram was performed to assess left ventricular function. An incidental finding of a very large coronary sinus with a diameter of 4.

Multimodality imaging of giant prolapsing left atrial myxoma.

Through a case of a very large left atrial myxoma diagnosed in a 53-year old woman, we feature the complementary value of multimodality imaging. Two-dimensional echocardiography continues to be the principal imaging modality for intracardiac masses due to its accessibility and ability to provide basic information on mass morphology, position, and mobility. Real-time three-dimensional echocardiography offers more precise assessment of tumor size and attachment.

Medical students' perceptions of their teachers' and their own cultural competency: implications for education.

Background: Enhancing the cultural competency of students is emerging as a key issue in medical education; however, students may perceive that they are more able to function within cross-cultural situations than their teachers, reducing the effectiveness of cultural competency educational efforts.

Objective: The purpose of our study was to compare medical students' perceptions of their residents, attendings, and their own cultural competency.

Design: Cross-sectional study.

ST elevation myocardial infarction in a teenager: case report and review of the literature.

In the presence or absence of atherosclerosis, young adults can experience a myocardial infarction. Notably, young patients are at increased risk to be misdiagnosed since they do not frequently have traditional coronary risk factors. We describe a 19-year-old woman with chest pain and ST elevation on electrocardiogram who was initially suspected to have pericarditis.

Heart failure in Hispanics.

Although large-scale heart failure (HF) studies in Hispanic Americans are lacking, some compelling data indicate that they are a particularly vulnerable population and underscore the need for further research. Hispanics comprise the largest and fastest-growing ethnic group in the U.S.

Digoxin: current use and approach to toxicity.

Heralded as the oldest known cardiovascular drug, digoxin remains widely used today in the face of increasing rates in heart failure and atrial fibrillation despite the emergence of newer medications. Its hemodynamic, neurohormonal and electrophysiologic actions make it a suitable adjunctive, evidence-based therapy for the above conditions. Its narrow therapeutic index and its toxicity, however, have become more relevant as aging, comorbid diseases, and polypharmacy make more patients vulnerable.

It's a trap! Clinical similarities and subtle ECG differences between takotsubo cardiomyopathy and myocardial infarction.

We describe a 65-year-old woman with a history of hypertension and smoking who presented with an acute episode of chest pain precipitated by severe emotional stress. Her initial electrocardiogram done in the emergency room showed non-specific T wave changes in the lateral leads and her cardiac troponin levels were mildly elevated. Because of her clinical presentation, she was admitted with a presumptive diagnosis of acute myocardial infarction and managed with antiplatelet and anticoagulant therapy.