The controversy over cocaine use and beta-blockade continues to brew

Cocaine Abuse Epidemiology Cocaine is the second most commonly used illicit drug and the most frequent cause of drug-related deaths in the United States. Approximately 24 million people in the United States have used cocaine at least once, and five million abuse cocaine on a regular basis. Its use is associated with acute and chronic complications affecting many organ systems, the most common being the cardiovascular system

Man with flu-like symptoms

Case Presentation A 69 year-old male presents to the Emergency Department with complaints of malaise, myalgias, rhinorrhea, increased congestion, and occasional fevers for one week. The symptoms have gradually worsened over the past week, and Tylenol has minimally alleviated his symptoms. He denies exacerbating factors. He denies any trauma, shortness of breath, chest pain, or recent weight change. He has no sick contacts or recent travel history

A Woman With Chest Pain, Syncope, and Transaminitis

Case Presentation The patient is a 49 year-old female with past medical history ofanxiety and hyperlipidemia who presented to an outside hospitalwith complaints of five hours of substernal chest pain followed bythree episodes of syncope witnessed by her son. At presentationin the emergency department the patient denied any currentchest pain or shortness of breath. She received 325 mg of aspirinen route to the hospital by EMS. Her vital signs were temperature100° Fahrenheit, heart rate 60 beats/minute, blood pressure101/50 mm Hg, respiratory rate 20 breaths/minute, and a pulseoxygenation of 98% on room air. The patient’s EKG showed STelevations in the inferior leads. The patient’s laboratory studieswere: white blood cell (wbc) count 14 B/L, hemoglobin 13.2 g/dL, platelets 153 B/L, CKMB 32 U/L, troponin 8.27 ug/L, andCK 24.5 U/L. The patient was started on intravenous heparinand integrillin drips and transferred to Jefferson for emergentcardiac catheterization

Chest Pain as a Presenting Symptom for Gastric Phytobezoar

Introduction Chest pain is a common chief complaint of patient presentation to the emergency room. It also presents itself as one of the most challenging symptoms for clinicians to manage. The differential diagnosis for chest pain involves a multitude of organ systems. Failure to recognize potentially serious life-threatening causes such as acute ischemic heart disease, aortic dissection, tension pneumothorax, or pulmonary embolism can lead to serious morbidity and mortality. At the same time, overly conservative management of low-risk patients leads to unnecessary hospital admissions, studies and procedures.1 The following case illustrates the need to broaden the differential diagnosis for chest pain once life-threatening causes have been ruled out

Congestive Heart Failure and Vitamin D Deficiency

Introduction Congestive heart failure (CHF) is a chronic medical condition whoseincidence is rising. The prevalence of CHF is approximately 1% to3% in Western countries. Despite innovations in medical therapy,CHF is associated with high morbidity and mortality rates. CHF patients commonly experience muscle weakness and fatigueas two major symptoms. An altered intracellular handling ofionized calcium has been suggested to play a vital role in impairedmyocardial contraction. In isolated myocytes from patientswith end stage heart failure, systolic ionized calcium levelswere markedly decreased, while diastolic levels were elevated ascompared to healthy controls. In addition, digitalis and betablockermedical therapy is frequently used in CHF patients andis known to increase myocardial ionized calcium levels

Severe Heart Failure and Large Left Ventricular Thrombus Following Acute Myocardial Infarction

Case Presentation A 58 year-old man who recently underwent a left superficialfemoral artery thrombectomy presented with a three-day historyof worsening exertional dyspnea and bilateral pedal edema. Hispast medical history is significant for coronary artery disease,myocardial infarction, and insulin dependent diabetes mellitus.The patient initially presented to an outside hospital where hedeveloped ventricular tachycardia that warranted cardioversionthree times. Initial electrocardiogram showed inferior lead STsegment elevations and lateral lead ST depression

From the editors

Every day our House Staff strive to deliver the most advanced and compassionate healthcare possible. Our clinical perspectives are constantly being challenged, prompting new avenues of inquiry and information to further our insight into the state of the human condition

From the Editors

Argentina, California, Kenya, Alaska — these are just a fewof the places visited by our internal medicine residents andcaptured in breathtaking photographs that are exhibitedthroughout this issue of The Jefferson Medicine Forum. It iseasy to appreciate the beauty of nature when taking in thesepictures of stunning aerial views and colorful landscapes.Their display in this journal is fitting amongst the academicarticles that speak to the intellectual curiosity of our residentsand the diversity of pathology seen at Thomas JeffersonUniversity Hospital

From the Editors

As the Jefferson Forum embarks on its 11th issue a number of additions have beeninstituted. First, we are proud to announce new faculty collaborators with Dr. StevenHerrine, Dr. Danielle Duffy, Dr. Daniel Frisch, Dr. Anjali Avadhani, Dr. JosephDesimone and Dr. Edward Ruby. Our faculty has helped us with creating a new section of outstanding articles thatwe introduce in this issue. The “Best Of” designation allows us to highlight articlesthat were chosen by peer and faculty review as the best example of academic worksubmitted in each field of medicine. We hope that this addition will inspire moreresidents and faculty to get involved with the journal