Cardiovascular Consultations Archive

First steps when treating atrial fibrillation

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

Controlling geriatric hypertension

Controlling geriatric hypertension

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

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?

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)?

Gynecomastia in a patient on dialysis

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

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?

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?

Are high-dose beta blockers safe for patients with pulmonary disease

Is it safe for a patient with chronic obstructive pulmonary disease to be on high doses (e.g., 100 mg b.i.d.) of metoprolol?

Comparing methods of calculating ejection fraction

How does the ejection fraction (EF) calculated during the sestamibi imaging of a cardiac stress test correlate with an EF measured with a two-dimensional cardiogram?

Dialysis access when both arms have shunts

If a patient has a nonfunctional arteriovenous (AV) shunt in one arm and a functional shunt used for dialysis in the other, does the avoidance of an IV access in the arm with the nonfunctional shunt still apply?

Is there one pill to treat hypertension and migraine?

A hypertensive patient with migraines experienced undesirable side effects (irritability and weight gain) while taking the nonselective beta-blockers nadolol (Corgard) and propranolol (Inderal).

Tips for treating elevated homocysteine levels

What are the consequences of elevated homocysteine in young asymptomatic patients with and without comorbidities?

Consider many factors when assessing GI bleed risk

The risk for experiencing a serious GI event rises exponentially with increasing numbers of risk factors.

Etiology of bilateral lower-extremity edema

Did a drug reaction cause bilateral lower-extermity edema in a patient with pityriasis rubra pilaris?

Antihypertensives in a patient with elevated creatinine

At what level is creatinine considered a contraindication to placing a patient on an ACE inhibitor or angiotensin II receptor blocker?

When is it appropriate to order abdominal ultrasound?

Clinician seeks guidelines for ordering abdominal ultrasound to detect asymptomatic abdominal aortic aneurysm in a smoker.

Hyponatremia on the rise

I seem to be seeing a lot more hyponatremia. Some of these patients are taking diuretics, while others have psychogenic polydipsia or syndrome of inappropriate antidiuretic hormone secretion (SIADH). Others have no known cause. Is there an explanation for this increase?

What is causing this patient's syncope and abdominal symptoms?

A white woman aged 53 years has had several episodes of syncope that start with nausea, abdominal cramping, and, often, an urge to defecate.

Blisters on swollen ankles

A black woman aged 52 years developed large (1.5-2.0 cm wide), fluid-filled blisters on her swollen ankles. There were no other symptoms, and the patient's health history was unremarkable except for anemia. What could be the cause?

Aspirin use in a patient at high risk for GI bleed

What treatment would you recommend for this patient at high risk for a recurrent cardiac event?

Taking coenzyme Q10 with lipid-lowering meds

Does research support the addition of coenzyme Q10 for those on lipid-lowering medication?

The role of myofascial trigger points in migraine therapy

What is the relationship between myofascial trigger points and migraine headaches?

Chronic inflammatory conditions and CRP levels

What is the relevance of a cardiac C-reactive protein level in a patient with an underlying inflammatory condition, such as rheumatoid arthritis?

Blisters on swollen ankles

What could be causing blisters in a 52-year old patient with no other symptoms and an unremarkable health history?

Drugs not to take with grapefruit

How important is it for patients to avoid grapefruit/grapefruit juice when taking medication, particularly for cardiovascular disease?

A man who can't stay warm

A 54-year-old man from India with a history of type 2 diabetes, hypertension, and dyslipidemia, has cold hands and feet despite wearing sufficient clothing. A specialist has ruled out Raynaud's disease.

When cholesterol is too low

Is a below-normal cholesterol level dangerous?

Gout prevention tips

Would stopping the diuretic be the first choice before instituting preventive therapy?

Loading dosages of clopidogrel

There are conflicting opinions regarding the timing of steady state as it relates to dosing clopidogrel (Plavix) as well as the role of this agent in acute coronary syndrome and percutaneous coronary intervention (PCI).

Mysterious muscle soreness

Is there any known interaction between glucosamine/chondroitin and atorvastatin?

ARB use in a patient allergic to ACE inhibitors

Would you consider a trial of an angiotensin II receptor blocker (ARB) in a patient who has an ACE inhibitor allergy?

Reliability of Doppler flow data

Is there any clinical correlation between Doppler flow data and the degree of stenosis in arteriovenous (AV) grafts for dialysis access?

Alternatives to insulin

In rural health-care settings, many patients are reluctant to use insulin.

Who should have carotid ultrasound?

More and more offices are performing their own carotid ultrasounds. In light of recent guidelines published by...

Anxiety and cardiac disorders

I have read that anxiety can be an early symptom of cardiac disorders. What screening tests would help clinicians detect...

Anticoagulation in Cardiomyopathy?

Is there a role for anticoagulation in a patient who has nonischemic cardiomyopathy with...

Why does amlodipine lead to edema?

I am unable to find a valid explanation for the edema that develops with amlodipine. Is the cause vascular distension, vessel permeability, or renal hemodynamics? Many patients experience weight gain. Could it be an antidiuretic effect? Is the edema harmful?

Clot Prevention in a Patient with Drug Sensitivity

Would a large dose of vitamin E (1,600-2,400 IU) be an appropriate choice as a platelet inhibitor in a CAD patient who is allergic to aspirin, intolerant of...

Can BP Therapy Worsen Hyperglycemia?

Will using a diuretic with hydrochlorothiazide in a patient with hypertension and type 2 diabetes contribute to worsening of his hyperglycemia?

Incidental Calcium on Statins

Calcium is attached to many statin molecules as a stabilizer. How much calcium will...

Diabetes, Renal Disease, Heart Failure

What is the best oral medication for a diabetic patient in end-stage renal disease (ESRD) and...

Divergent BPs at Home and the Office

If you record a high BP in the office, but the patient says it is normal at home, should the dosage of his antihypertensive medication be adjusted? Is 24-hour monitoring of...

Role of Lipid Lowering in Dementia?

Could overly aggressive lowering of lipid levels in elderly patients interfere with...

Role of Lipid Lowering in Dementia?

Could overly aggressive lowering of lipid levels in elderly patients interfere with...

Surge in Neurocardiogenic Syncope Cases

I have noticed an unusually large number of patients (>20) with neurocardiogenic syncope (all of the...

BE WARY OF BETA-AGONISTS IN CHF PATIENTS

We seem to use beta-agonists for everything that wheezes these days. While these agents are technically for asthma, we routinely use...

Race-specific hypertension treatment

An obese 48-year-old African American woman was sent from the emergency department for follow-up of newly diagnosed asymptomatic hypertension (BP 226/130 mm Hg). She was started on lisinopril/hydrochlorothiazide (Zestoretic) 40/25 mg daily and clonidine 0.2 mg b.i.d. The patient has Wolff-Parkinson-White syndrome and...

STARTING STATINS WHEN LIVER ENZYMES ARE ELEVATED

I have many patients for whom statin therapy is indicated, but I am hesitant to start because of...

Cholesterol goals in diabetes patients

Now that colesevelam (WelChol), a bile acid sequestrant (BAS), has been shown to decrease hemoglobin A1c (HbA1c), should it be the agent of...

When to start low HDL treatment

What is the current recommendation for treating isolated low HDL levels? My patient is a 37-year-old white nonsmoker, whose original total cholesterol was...

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