Evaluation and EKG Findings with Palpitations – Primary Care RAP

Copied from Primary Care RAP March podcast - an excellent overview of the workup and "red flags" on EKG. Palpitations are a common symptom seen in the outpatient setting. While most are benign, it is important to rule out more serious and potentially deadly causes. A family history of sudden cardiac death and certain EKG… Continue reading Evaluation and EKG Findings with Palpitations – Primary Care RAP

Ankle-Brachial Index

Helpful in diagnosis of peripheral arterial disease Also, decreased ABI associated with high-risk CAD, stroke, TIA, renal insufficiency and all-cause mortality. Normal:  0.9 - 1.3 > 1.3 = calcified, sclerotic vessels < 0.9 if occlusive arterial disease (95% sens, 100% spec) < 0.4 suggestive of multilevel disease (iliac, femoral, tibial) and associated with non-healing ulcers… Continue reading Ankle-Brachial Index

Heart Failure with Preserved Ejection Fraction (HFpEF) – NEJM

Notes from NEJM Review Article:  Redfield MM. (2016), Heart Failure with Preserved Ejection Fraction Case:  73 yo woman seen for hospital f/u after admission for AF with RVR and pulm edema.  She c/o fatigue and DOE. Cr 1.4, eGFR 37, NT-proBNP 300.  Echo EF 70% with nl LV dimensions.  Elevated LA pressure and pulm arterial… Continue reading Heart Failure with Preserved Ejection Fraction (HFpEF) – NEJM

Risk vs Benefits of Post-MI Beta-Blockers in Nursing Home Residents

JAMA Intern Med 2016 Dec 12 Beta-blockers are known to prevent early mortality after an MI, but they are often not prescribed in elderly NH patients due to fear that they can worsen functional decline. Researchers studied linked Medicare claims and NH data on 11,000 NH residents (mean age, 84; mostly white women).  Post-MI patients… Continue reading Risk vs Benefits of Post-MI Beta-Blockers in Nursing Home Residents

New Statin Recommendations for Primary Prevention from USPSTF

USPSTF 2016 recommendations on statin use for primary prevention of CVD Clinical Question:What are the benefits and harms of statin treatment for dyslipidemia in adults 21 years and older?Bottom Line:The United States Preventive Services Task Force (USPSTF) now recommends that adultswithout a history of cardiovascular disease (CVD) use a low- to moderate-dose statin for the… Continue reading New Statin Recommendations for Primary Prevention from USPSTF

Asymptomatic Hypertensive Urgencies Can Be Managed Outpatient

Retrospective study of 59,000 patients presenting to outpatient setting with severe asymptomatic hypertension. No difference between those sent to the ED vs those managed as outpatients in: Major adverse CV events Uncontrolled HTN 6 mos later Only difference - those who went to the ED were hospitalized more often. Take-away:  Asymptomatic severe hypertension can be… Continue reading Asymptomatic Hypertensive Urgencies Can Be Managed Outpatient

Out-of-Hospital Cardiac Arrest – Three Predictors of Death Prior to Discharge

Study of 7000 patient in Paris, France, and Seattle, Washington. Three criteria that predict, with almost 100% PPV, of death prior to hospital discharge: Arrest not witnessed by EMS personnel. Non-shockable rhythm on initial evaluation. No ROSC by 3rd dose of epinephrine 1mg. Of the 2800 patients who met all 3 criteria, only 1 survived… Continue reading Out-of-Hospital Cardiac Arrest – Three Predictors of Death Prior to Discharge