Cardiovascular Features Archive

Case Study: Chest pain radiating into the neck

Case Study: Chest pain radiating into the neck

A 44-year-old man presents to his local urgent care clinic for chest pain radiating up into his neck that is gradually getting worse.

Resumption of antithrombotic therapy after gastrointestinal bleeding in patients with atrial fibrillation

Resumption of antithrombotic therapy after gastrointestinal bleeding in patients with atrial fibrillation

Resuming antithrombotic therapy with in patients with atrial fibrillation and a serious gastrointestinal bleed results in better overall mortality outcomes.

Adherence and hypertension in the geriatric patient

Adherence and hypertension in the geriatric patient

Addressing factors that lead to lack of adherence to antihypertensive 
therapy in elderly patients is crucial to improving outcomes.

In patients without 
CVD or diabetes, pooled cohort equations may underestimate risk for CV event if other risk factors are present

In patients without 
CVD or diabetes, pooled cohort equations may underestimate risk for CV event if other risk factors are present

Accurate prediction of cardiovascular disease risk is crucial for the success of preventive measures.

Monitoring for pulmonary hypertension

Monitoring for pulmonary hypertension

Doctors must assess for the presence of pulmonary hypertension in patients with lung disease, COPD, or emphysema, among other conditions.

Monitoring pregnant women with nonsevere hypertensive disorders

Monitoring pregnant women with nonsevere hypertensive disorders 


Hypertensive disorders are the most common medical complications of pregnancy, affecting 5-8% of all pregnancies in the U.S.

Integrative medicine treatments 
for hypertension

Integrative medicine treatments 
for hypertension

A number of evidence-based, 
nonpharmacologic approaches are 
available for patients with hypertension.

Astragalus may help treat cancer, heart failure

Astragalus may help treat cancer, heart failure

Research is being done on the use of astragalus root for the treatment of cancer and congestive heart failure.

Dietary fiber: The prebiotic connection

Dietary fiber: The prebiotic connection

Adequate fiber intake is critical for maintaining good health, but only 5% of Americans consume the recommended daily amount.

A mnemonic device for use in cardiology care

A mnemonic device for use in cardiology care

Use the acronyms PASS and PAID to remember important murmurs

What PCPs need to know about heart disease in men and women

What PCPs need to know about heart disease in men and women

What do NPs and PAs working in primary care need to know about the different path that heart disease takes in men and women?

Percutaneous closure of left atrial appendage may decrease mortality, hemorrhagic stroke risk

Percutaneous closure of left atrial appendage may decrease mortality, hemorrhagic stroke risk

Antithrombotic therapy is consistently recommended for most patients with atrial fibrillation and until recently warfarin, a vitamin K antagonist, has been the antithrombotic of choice.

Extending duration of dual antiplatelet therapy in patients with drug-eluting stents yields mixed results

Extending duration of dual antiplatelet therapy in patients with drug-eluting stents yields mixed results

Extending the duration of DAPT may decrease the risk of stent thrombosis, but evidence on the efficacy of DAPT for greater than one year has been inconsistent.

Preventing and treating periodontitis

Preventing and treating periodontitis

NPs and PAs must work in collaboration with oral health clinicians to effectively educate patients in the prevention of periodontal disease.

Consider glucomannan for obesity treatment

Consider glucomannan for obesity treatment

Glucomannan can help treat obesity and comorbid conditions of type 2 diabetes, heart disease, and early mortality.

A recurring, itchy, burning rash in a patient taking beta-blockers

A recurring, itchy, burning rash in a patient taking beta-blockers

Beta-blockers are known to induce or aggravate psoriasis and should be avoided in these patients whenever possible.

Inflamed foot in a patient with diabetes

Inflamed foot in a patient with diabetes

A patient diagnosed with type 2 diabetes, hypertension, hyperlipidemia presents to the foot clinic after one month of swelling, redness, and warmth in the left foot.

Yellow lights, digoxin toxicity

Yellow lights, digoxin toxicity


A woman complaining of seeing yellow lights is diagnosed with digoxin toxicity.

Managing type 2 diabetes in an outpatient setting

Managing type 2 diabetes in an outpatient setting

How would you help maximize this patient's diabetes therapy, hypertension management, and reduce leg cramps?

A different look at lipids

A different look at lipids

The first step in reducing the risk of cardiovascular disease is for health-care professionals to get a full understanding of a patient's risk.

Preoperative management in a patient with type 2 diabetes

Preoperative management in a patient with type 2 diabetes

After a patient's elective surgery was postponed due to glucose readings, an assessment of his medical profile and history were evaluated to manage his type 2 diabetes mellitus complications.

Self pulse-monitoring may prevent second stroke

Self pulse-monitoring may prevent second stroke

Patients were taught to identify atrial fibrillation by measuring the peripheral pulse at the radial artery to prevent a second stroke.

Cardiovascular risk factors may dictate psoriatic arthritis severity

Cardiovascular risk factors may dictate psoriatic arthritis severity

Half of the patients in the study were newly diagnosed with four or more symptoms of metabolic syndrome.

Identifying obstructive sleep apnea

Identifying obstructive sleep apnea


Airflow disturbances during sleep need to be recognized and evaluated before harm comes to the patients themselves or those around them.

Nuts may lower heart, diabetes risks

Nuts may lower heart, diabetes risks

Patients who ate nuts regularly had reduced diabetes, fatal and nonfatal ischemic heart disease.

Vitamin D may lower hypertension risk

Vitamin D may lower hypertension risk

Every 10% increase in serum 25-hydroxyvitamin D concentration was associated with a 0.24-mmHg decrease in diastolic blood pressure.

Magnesium for treating CVD, T2D, and asthma

Magnesium for treating CVD, T2D, and asthma

Magnesium is a common component of lightweight metals and is the fourth most abundant mineral in the body.

The case for vegetarianism in the fight against heart disease

The case for vegetarianism in the fight against heart disease

Multiple studies show that just about any low-meat or no-meat diet reduces almost all controllable risk factors for cardiovascular disease.

Listening saved a life

Listening saved a life

After listening to a patient, this clinician urged an in-person visit that led to an ED admission for atrial fibrillation and heart failure.

High cholesterol may spell low fertility

High cholesterol may spell low fertility

The longest time to achieve pregnancy occurred in couples in which both partners had high cholesterol levels.

Early clopidogrel essential after stenting

Early clopidogrel essential after stenting

A delay in filling the first clopidogrel prescription may lead to myocardial infarction or even death.

Some BP meds may affect vision

Some BP meds may affect vision

Of the patients, 19.1% of those using vasodilator medication developed early-stage AMD, compared with an estimated 8.2% of persons not taking such drugs.

Azithromycin pros beat cons in pneumonia

Azithromycin pros beat cons in pneumonia

Although azithromycin is usually first-line treatment, recent evidence has linked the drug with an increased risk of cardiovascular events.

Dyspnea and cough in an elderly woman with diabetes and CHF

Dyspnea and cough in an elderly woman with diabetes and CHF

Our patient had an extensive medical history, but were her new-onset symptoms the result of poor compliance?

Self-monitoring for HTN awareness

Self-monitoring for HTN awareness


CT assesses plaque in diabetes

CT assesses plaque in diabetes

Only about one-third of the coronary plaque detected showed calcification.

Subtle signs of a failing heart

Subtle signs of a failing heart

Complaints about lack of sleep and postnasal drip may describe worsening heart failure.

The effect of statins on antihypertensive meds

The effect of statins on antihypertensive meds

How do statins interact with calcium channel blockers?

Benefits of newer drug-eluting stents in women with CAD

Benefits of newer drug-eluting stents in women with CAD

Newer-generation drug-eluting stents reduce MI risk, target revascularization in women with coronary artery disease.

What does a pleural rub sound like?

What does a pleural rub sound like?


A straightforward simile to help young clinicians learn what to listen for when auscultating a patient.

Detecting abnormal heart sounds

Detecting abnormal heart sounds

Picking up such low-pitched heart sounds can be difficult. Read this tip for clearer listening.

New therapy 
for adults 
with PAH

New therapy 
for adults 
with PAH

Opsumit is indicated for treatment of pulmonary arterial hypertension to delay disease progression.

The facts and fictions of chelation therapy

The facts and fictions of chelation therapy

Originally used to treat lead poisoning and hypercalcemia, chelation has shown promise among individuals with heart disease and other conditions.

What aortic stenosis sounds like

What aortic stenosis sounds like


Differentiating systolic heart murmurs can be challenging.

Treating ­hypertension in older patients

Treating ­hypertension in older patients

In those older than age 65 years, high BP heightens risk for various forms of heart disease as well as for chronic kidney disease and diabetes mellitus.

Difficulty lifting the right arm drives a young man to seek help

Difficulty lifting the right arm drives a young man to seek help

An adolescent presented with persistent upper-extremity pain, redness, and 
axillary swelling upon lifting weights.

Recognizing stroke warning signs in an ESL patient

Recognizing stroke warning signs in an ESL patient

Listening beyond a nonnative English speaker's words helped diagnose and treat a medical emergency.

Severe hemorrhaging after eclampsia and stroke

Severe hemorrhaging after eclampsia and stroke

A family faces a life and death decision when a patient is given a poor prognosis after experiencing a major stroke from eclampsia.

Deciphering a stroke patient's message

Deciphering a stroke patient's message

A patient is visibly frustrated after a stroke results in expressive aphasia.

A patient recalls details from a cardiac arrest

A patient recalls details from a cardiac arrest

Responding to a crisis inspires a clinician to pursue opportunities to improve nursing skills.

Do antipsychotics increase the risk of pulmonary embolism?

Do antipsychotics increase the risk of pulmonary embolism?

Is there any evidence that psychiatric medications contribute to a greater risk of pulmonary emboli?

Extended apixaban, dabigatran cuts recurrent VTE

Extended apixaban, dabigatran cuts recurrent VTE

Extended anticoagulation with apixaban or dabigatran reduces recurrent VTE and mortality without increasing major bleeding.

Craving ice may signal anemia

Craving ice may signal anemia

Ask patients who present with fatigue about abnormal cravings for ice.

Prevent DVT in patients with folic-acid deficiency

Prevent DVT in patients with folic-acid deficiency

Detecting deep vein thrombosis early can aid prevention efforts.

High-sensitivity troponin T assay reduces time to MI diagnosis

High-sensitivity troponin T assay reduces time to MI diagnosis

Measuring cardiac troponin T levels using a high-sensitivity assay twice, one hour apart can diagnose and rule out MI in most patients with chest pain.

First steps when treating atrial fibrillation

Medication, ablation or rate control for a patient with first onset of atrial fibrillation?

Nursing protocols may reduce dependence after acute stroke

Nursing protocols may reduce dependence after acute stroke

Nursing protocols for fever, hyperglycemia, and swallowing management in patients with acute stroke may reduce dependence.

Evaluation and treatment of acute cerebral ischemia

Evaluation and treatment of acute cerebral ischemia

To ensure that therapeutic interventions begin in time, providers must be able to recognize the clinical presentation of an acute ischemic stroke.

Communicating Concerns About Nonspecific Changes on ECG

Communicating Concerns About Nonspecific Changes on ECG

Exercise caution when a patient presents with acute chest pain. The ability to explain the situation as clearly as possible is essential.

Controlling geriatric hypertension

Controlling geriatric hypertension

Many older patients take many medications, making contraindications a concern when trying to control hypertension.

Updated standards for CCHD screening: Pulse-oximetry pearls and statewide protocols, Part 3

Updated standards for CCHD screening: Pulse-oximetry pearls and statewide protocols, Part 3

Improved pulse-oximetry standards translate into more sensitive critical congenital heart disease screening.

The effects of exercise on LDL

The effects of exercise on LDL

As LDL goals become more aggressive, therapeutic lifestyle changes are increasingly important in achieving recommended lipid levels.

Incorrect 
triage caused critical delay

Incorrect 
triage caused critical delay

A woman in her early 60s presented with chest pain and was miscategorized in the emergency department.

CCHD screening guidelines: Implementation of standardized protocols, Part 2

CCHD screening guidelines: Implementation of standardized protocols, Part 2

Taking the pulse of neonatal screening for critical congenital heart disease.

What's causing elevated creatine levels?

What's causing elevated creatine levels?

A patient has elevated creatine and fasciculations. Could an electrolyte imbalance be the cause?

No benefit with imaging plus exercise testing for initial CAD diagnosis in women

No differences in major cardiac adverse events or hospitalization for chest pain among women who underwent exercising plus MPI vs. exercising alone.

No CRT benefit for HF with moderate QRS interval prolongation

No significant differences observed in overall HF risk among patients with moderately prolonged QRS intervals who receive cardiac resynchronization therapy.

Detection of hypoxemia: 
Visual observation 
versus pulse oximetry, Part 1

Detection of hypoxemia: 
Visual observation 
versus pulse oximetry, Part 1

Early diagnosis is essential to providing treatment in infants with critical congenital heart disease.

Polishing off a sticky situation

Polishing off a sticky situation

Patients often complain they have a difficult time completely removing the adhesive from ECG pads. Pass on this simple tip for painless removal.

Minimize admissions for heart failure

Minimize admissions for heart failure

The need to educate patients and help them make difficult lifestyle changes requires clinicians to think differently and offer novel treatment approaches.

Plumbing for atherosclerosis

Using plumbing as an analogy for atherosclerosis can help improve treatment adherence.

Niacin: An antioxidant and nutrition supplement

Niacin: An antioxidant and nutrition supplement

While niacin is well known for preventing pellagra, it is only in the past 15 to 20 years that other medicinal uses for this common vitamin have emerged.

Tart cherry: A superfruit with antiinflammatory and cardiac benefits

Tart cherry: A superfruit with antiinflammatory and cardiac benefits

A growing body of evidence has linked the tart cherry to substantial anti-inflammatory benefits, including reduced arthritic and gout pain, and several cardiac benefits.

Illustrating coronary anatomy

A helpful analogy for helping patients understand coronary anatomy.

Aspirin and clopidogrel after coronary bypass surgery

What are the current evidence-based recommendations for aspirin and clopidogrel (Plavix) use following coronary artery bypass graft (CABG) surgery (both on- and off-pump procedures)?

Stat Consult: Hypertensive emergency/
hypertensive 
urgency

Stat Consult: Hypertensive emergency/
hypertensive 
urgency

A quick review of hypertensive emergency and hypertensive urgency using the best global evidence.

Gynecomastia in a patient on dialysis

A 69-year-old man with multiple health conditions develops gynecomastia after hemodialysis. Are the two related?

Severe dizziness, nausea and vomiting prompt an ED visit

Severe dizziness, nausea and vomiting prompt an ED visit

The patient's gait was affected 48 hours after onset and any slight head movement intensified the feeling of imbalance.

"Predisease": A concept whose time has come?

"Predisease": A concept whose time has come?

Treating patients before they develop a disease is tempting, but the old 
adage still applies: First, do no harm.

A practical guide to 
metabolic syndrome

A practical guide to 
metabolic syndrome

With obesity on the rise, more patients are at risk for metabolic 
syndrome, a diagnosis given to a set of simultaneous disorders.

Ice down dyspnea

A nurse offers a surprising, yet effective solution for helping patients catch their breath.

Freezing fish-oil capsules

Advise patients who are bothered by the fishy taste of omega-3 fish oil capsules to freeze the supplements.

Does gender affect statin efficacy?

Is there evidence showing that women taking statins saw little improvement in their lipid levels?

Halting migraine in someone with coronary artery disease

What treatment would you recommend for aborting a migraine in a patient with known coronary artery disease?

Intracranial arterial stenting plus aggressive medical management increases stroke risk

Intracranial arterial stenting plus aggressive medical management increases stroke risk

Current recommendations from the American Heart Association and the American Stroke Association classify percutaneous transluminal angioplasty with stenting (PTAS) as an investigational intervention with unknown utility for patients with transient ischemic attack or stroke.

Intensive-dose vs. moderate-dose statins increase diabetes risk, but lower CVD risk

Statins are widely used for treating elevated cholesterol for both primary and secondary prevention of coronary artery disease. One concern about their use has been the possibility of increasing the risk of diabetes.

A visual hypertension warning

A nurse practitioner offers an easy tip to help increase patient adherence to antihypertensive medication by enabling them to visualize their condition.

Choosing the best inflammation marker

Which serologic measure of inflammation is the most cost-effective and reliable when monitoring inflammatory disease?

How is microalbumin:creatinine ratio interpreted?

How is microalbumin:creatinine ratio interpreted?

When is it appropriate to refer diabetic and hypertensive patients to a renal specialist?

Chest CT before ED discharge to prevent pulmonary embolism

Since 50% of patients admitted to the ED with deep vein thrombosis, should it be common practice to do a chest CT prior to discharge?

Can too much fish oil lead to GERD?

Is there any indication that taking too much fish oil — particularly green-lipped mussel oil — can cause stomach problems in a person with a history of gastroesophageal reflux disease?

Testing for cold intolerance

An elderly man complains of feeling cold all the time, even though the weather is warm.

Sesame oil to lower BP?

Can substituting dietary corn oil with sesame oil reduce blood pressure?

Stopping warfarin before cataract surgery

Does an individual undergoing cataract surgery with standby or local anesthesia need a full workup if he or she has been stable on current medications, regardless of medical history?

Treating elevated triglycerides

If triglycerides are a more significant indicator of cardiovascular disease (CVD) risk in women than in men, is it appropriate to treat even if LDL is normal?

Acute onset of pain and a noncompressible area in the anterior forearm

Acute onset of pain and a noncompressible area in the anterior forearm

After a high-impact fall, a middle-aged 
firefighter presents with ecchymosis and fixed flexion in the right arm and hand.

Evaluating heart risk in 
asymptomatic patients

Evaluating heart risk in 
asymptomatic patients

An evidence-based guideline is available to help primary-care clinicians lower the burden of coronary deaths in this adult population

Quercetin may be a useful complementary therapy for conditions involving oxidative damage

Quercetin may be a useful complementary therapy for conditions involving oxidative damage

Quercetin, a potent antioxidant, is found in red wine, onions, green tea, apples, berries and cruciferous vegetables and is a popular component in the herbal and supplemental marketplace due to it's value in treating and preventing many illnesses.

Preventing drug confusion

Many providers confuse metoprolol tartrate and metoprolol succinate. Learn an easy way to keep them straight.

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