Impact of Preadmission Beta-blocker Use on Cardiac Abnormalities and In-hospital Mortality in Patients with Aneurysmal Subarachnoid Hemorrhage

Introduction: Various cardiac abnormalities, including dysrhythmias, left ventricular (LV) dysfunction, and myocardial injury, are commonly seen after subarachnoid hemorrhage (SAH). In patients taking a beta-blocker (BB) chronically, the medication is generally discontinued after hospitalization due to the concern of compromising cerebral perfusion. We hypothesized that sudden BB discontinuation might inadvertently lead to an increased incidence of composite cardiac abnormalities and higher in-hospital mortality in patients presenting with nontraumatic SAH

Ampere Hour as a Predictor of Cardiac Resynchronization Defibrillator Pulse Generator Battery Longevity: A Multicenter Study

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/122444/1/pace12831_am.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/122444/2/pace12831.pd

From the Editors

We are proud to publish the 11th version of the Medicine Forum. Over the years, theforum has served as an opportunity for medical students and housestaff to pursue scholarly activities alongside learning clinical medicine. This peer-reviewed journal has also served as a platform for rising residents to gain invaluable experience with the editing process as well

The Role of Implantable Cardioverter Defibrillators for the Prevention of Ventricular Arrhythmia in Left Ventricular Assist Device Recipients

Advanced heart failure represents a significant strain on our health care system and is associated with increased morbidity and mortality. New device therapies, including left ventricular assist device (LVAD) implantation, have transformed management as both a destination therapy and as a bridge to transplantation. Although LVADs have improved patient outcomes, arrhythmias represent a significant and costly complication of this therapy. In recent years, implantable cardioverter-defibrillators (ICDs) have been developed to reduce the incidence of lethal arrhythmia. However, a gap in the literature exists for both guidelines in prevention of early ventricular arrhythmia (VA) in LVAD recipients and the effectiveness of ICDs when paired with various LVADs. Here, we clarify these guidelines and show that ICD selection should be tailored to the type of LVAD. We also show that subcutaneous ICDs represent an attractive alternative option for certain cohorts of patients, although transvenous ICDs remain a first-line choice at this time. Ultimately, understanding the various management options that affect outcomes in heart failure patients is important for treatment and clinical decision-making in an ever-growing population

Hemoptysis as a Presenting Symptom for Metastatic Pancreatic Cancer

Introduction Approximately 32,000 pancreatic neoplasms are diagnosed in theUnited States annually. Currently, carcinoma of the pancreas isthe fourth most common cause of cancer death in both menand women in this country, after cancers of the lung, breast/prostate, and colon. The most common presenting symptomsof pancreatic cancers are epigastric pain, obstructive jaundice,and weight loss. However, since pancreatic cancer is frequentlymetastatic when diagnosed, it may uncommonly present withfindings characteristic of the site of spread

Evaluation of Echogenic Material on Transvenous Leads by Transesophageal Echocardiography in Patients with and without Lead-associated Endocarditis

Echogenic material (EM) on non-infected leads in patients with cardiac implantable device is common on transesophageal echocardiography (TEE). Although several morphologic characteristics of EM are more commonly seen in transvenous lead-associated endocarditis, these characteristics alone are not diagnostic for lead-associated endocardiatis. Lead-associated EM on TEE should be interpreted within the overall clinical context

65-Year-Old Man with Weight Loss, Anorexia, and Distal Extremity Numbness

Case Report A 65-year-old Caucasian male with no significant pastmedical history presented to the emergency department with an unintentional 44-pound weight loss over a four-month period. The weight loss was preceded by fatigue and anorexia,which had been increasing for approximately eight months.In addition, he noted numbness and tingling of his hands and feet that began over the same time period. The patient was initially treated for depression with sertraline by his primarycare physician. However, his symptoms persisted without significant improvement. An initial workup at outside hospital one month prior to presentation included an abdominal CTscan, which revealed a mass in the pancreatic head suggestive of a pseudocyst. He was also treated for Lyme disease with a course of doxycycline based on a rash finding on his left thigh.Lyme serologies were negative. He denied fever, chills, nightsweats, changes in bowel habits or stool character, dysphagia,odynophagia, abdominal pain, cough, or shortness of breath.He also denied focal weakness, changes in speech, or changes invision. He has no known drug allergies. Medications included sertraline for depression, zolpidem and diphenhydraminefor sleep. He denied tobacco or illicit drug use. He drinks alcohol occasionally. Family history was non contributory, with no history of malignancy, neurodegenerative or endocrine disorders

Patient Characteristics and Predictors of Mortality Associated with Pericardial Decompression Syndrome

Pericardial decompression syndrome is a rare complication of pericardiocentesis and surgical drainage of pericardial effusion with a high morality rate. The minimum amount of drained effusion in our serious was 450 ml. Surgical drainage was associated with a higher mortality rate

Subcutaneous cardiac rhythm monitors: state of the art review

INTRODUCTION: Subcutaneous cardiac rhythm monitors (SCRMs) provide continuous ambulatory electrocardiographic monitoring for surveillance of known and identification of infrequent arrhythmias. SCRMs have proven to be helpful for the evaluation of unexplained symptoms and correlation with intermittent cardiac arrhythmias. Successful functioning of SCRM is dependent on accurate detection and successful transmission of the data to the device clinic. As the use of SCRM is steadily increasing, the amount of data that requires timely adjudication requires substantial resources. Newer algorithms for accurate detection and modified workflow systems have been proposed by physicians and the manufacturers to circumvent the issue of data deluge. AREAS COVERED: This paper provides an overview of the various aspects of ambulatory rhythm monitoring with SCRMs including indications, implantation techniques, programming strategies, troubleshooting for issue of false positive and intermittent connectivity and strategies to circumvent data deluge. EXPERT COMMENTARY: SCRM is an invaluable technology for prolonged rhythm monitoring. The clinical benefits from SCRM hinge on accurate arrhythmia detection, reliable transmission of the data and timely adjudication for possible intervention. Further improvement in SCRM technology is needed to minimize false positive detection, improve connectivity to the central web-based server and devise strategies to minimize data deluge