Cardiology

A shortage of contrast material has made weighing value an urgent aspect of imaging decisions and provided a stark example of the consequences of low-value imaging for public health and health equity.

A 17-year-old boy was admitted to the pediatric ICU with chest pain, syncope, electrocardiographic abnormalities, and elevated creatine kinase and troponin T. He had been well until 5 days earlier, when fever, nausea, diarrhea, muscle aches, and chest pain developed.

Cold injury is a combination of direct cellular damage from freezing and cellular ischemia from vasospasm and small-vessel thrombosis. The severity is related to the degree to which frozen tissues are reperfused on thawing.

This interactive feature about an incidentally discovered inferior vena cava filter offers a case vignette accompanied by two essays, one supporting removal of the inferior vena cava filter and the other supporting deferring removal unless complications arise.

A 27-year-old man presented to the dermatology clinic with an asymptomatic rash on his back, arms, and hands that had developed 1 week earlier. Pink-yellow papules were seen on examination. A blood sample was grossly lipemic.

A 34-year-old woman presented with a 4-year history of progressive skin lesions and 3-month history of weight loss. Physical examination showed a symmetric distribution of clusters of pink-yellow papules that merged into branching projections on the trunk, buttocks, and all four limbs.

Tranexamic acid is an antifibrinolytic drug that reduces bleeding in patients undergoing cesarean section or cardiac surgery. In this randomized trial involving patients undergoing noncardiac surgery, the risk of bleeding was lower with tranexamic acid than with placebo, but noninferiority with respect to cardiovascular complications was not established.

A 67-year-old man presented with a 1-month history of dyspnea and diarrhea. Thickened, stiff tricuspid-valve leaflets and tricuspid regurgitation were seen on transthoracic echocardiography (shown in videos), and abdominal imaging showed liver masses.

Gliflozins — sodium–glucose cotransporter 2 inhibitors — lower blood glucose and glycated hemoglobin in patients with type 2 diabetes without causing hypoglycemia. The agents also improve cardiac function in patients who have heart failure with or without type 2 diabetes and improve renal function, with few adverse effects.

The number of adults who undergo major noncardiac surgery is increasing worldwide,¹ including older patients with more coexisting conditions and increased risks of bleeding and thrombotic events.² Although perioperative bleeding is an important complication that leads to excess morbidity and mortality,³ few therapies have...

In light of the recent clinical cases of pig-to-human kidney and heart transplantation, taking stock of progress in xenotransplantation can help us set realistic expectations for clinical adoption of this promising technology.

In this study, childhood cardiovascular risk factors including BMI, systolic blood pressure, lipid levels, and smoking were correlated with cardiovascular events in adulthood after a mean follow-up of 35 years. Childhood risk factors and the change in risk score between childhood and adulthood were associated with midlife cardiovascular events.

A 61-year-old man presented with a 2-day history of left upper back pain. Computed tomographic angiography revealed aneurysmal dilatation of the ascending aorta, aortic arch, and descending thoracic aorta.

Children almost never have myocardial infarctions or other adverse cardiovascular (CV) events, yet there has long been evidence that atherosclerosis may be found on postmortem examination of youths who have died accidently.^1-3 Indeed, cohort studies such as the Cardiovascular Risk in Young Finns Study, the Bogalusa Heart Study,...

This case report describes a patient in Sweden who had an out-of-hospital cardiac arrest and received defibrillation with an automated external defibrillator delivered by a drone (shown in a video).

Preeclampsia complicates 2 to 4% of all pregnancies and accounts for about 46,000 maternal deaths and 500,000 fetal or newborn deaths each year. Antihypertensive agents and magnesium sulfate can help control the systemic manifestations of preeclampsia, which is usually resolved by delivery of the placenta.

Pregnant women with mild chronic hypertension were randomly assigned to receive medication targeting a normal blood pressure (<140/90 mm Hg) or to receive no treatment unless severe hypertension (>160/105 mm Hg) developed. The incidence of adverse maternal and neonatal outcomes was significantly lower in the active-treatment group, without an increase...

The latest data from the National Center for Health Statistics indicate that in 2019 more than 83,000 pregnant women in the United States had chronic hypertension that antedated their pregnancies.¹ This number represents 2.2% of the more than 3.7 million births that were recorded that year. The rate...

A 74-year-old man with end-stage kidney disease and coronary artery disease presented with decreased responsiveness, anorexia, and generalized weakness. Computed tomography of the chest showed intramural gas in the ascending and descending aorta.

A 56-year-old man presented in early autumn with a 1-month history of myalgias and fever. His heart rate was 48 beats per minute. An electrocardiogram showed sinus bradycardia and complete heart block; cardiac imaging showed inflammatory changes in the epicardial fat abutting the noncoronary sinus of the aortic valve. A...