Risultati per: La gestione del paziente depresso da parte del medico di medicina generale: case reports

Circulation, Volume 150, Issue Suppl_1, Page A4135265-A4135265, November 12, 2024. Residents care for patients with a vast array of cardiovascular (CV) diagnoses in settings ranging from primary care clinic to the cardiac intensive care unit. However, the resources available are mainly intended for advanced cardiology trainees. We created a resident-driven, case-based reference for residents to serve as a companion to traditional CV medicine educational resources.Methods:We surveyed residents, fellows, and cardiology attendings to identify topics within CV care for which residents are responsible. We recruited residents from multiple ACGME-accredited Internal Medicine residency programs to write a chapter on each identified topic that would be published on a central website. The chapters included a topic overview with key learning points, a case presentation, review questions, attending pearls, and high-yield articles for further reading. Chapters were reviewed for accuracy and completeness by cardiology fellows, pharmacologists, and attendings. The chapters were sent out to residents weekly via email and through social media platforms. Website analytics were used to track usage and monitor engagement. Each chapter concluded with a brief survey regarding learning gains, comprehension, and if the reader would recommend the resources to others.Results:A total of 52 cases were submitted by resident contributors from four residency programs. Topics included management of arrhythmias, structural heart disease, ischemia, cardiogenic shock, and post-procedure complications. Within the first two months of publication, the website was being accessed throughout 30+ states and 6 countries with more than 2,500 views and 1,500 unique visitors. Topics with high traffic included chapters regarding arrhythmias and post-procedural complications. The website was viewed throughout the entire day with no specific time pattern; however, there were significantly more views on days when each chapter was released via email and social media. Preliminary survey results show that residents and other trainees find this resource useful, and many want to get involved and help create more content.Conclusion:Our resident-created and cardiologist reviewed website is a unique resource created for residents caring for patients with CV disease. Using email and social media marketing has allowed this resource to be widely accessible to a large global audience. Survey feedback suggests the importance of this resource and need for continued CV resources for trainees.

Circulation, Volume 150, Issue Suppl_1, Page A4147178-A4147178, November 12, 2024. Background:Loeffler endocarditis is a rare and clinically challenging presentation of hypereosinophilic syndrome (HES). Early detection and treatment are critical for this disease that otherwise carries a high risk of morbidity and mortality. We present a complex case of a patient with HES and sequelae.Case:A 41-year-old male with history of asthma presented with cough, dyspnea on exertion, orthopnea, and right arm pain. He noted a 15-pound weight loss in the past few months. In addition to right upper superficial vein thrombus, he was initially diagnosed with pneumonia, but labs were concerning for significant leukocytosis (WBC 54.23 103/uL) and hypereosinophilia (45%), as well as anemia and thrombocytopenia. Cardiology was consulted for evidence of cardiac involvement with high sensitivity troponin 480 ng/L and BNP 399 pg/mL. Transthoracic echocardiography and cardiac MRI showed mild apical biventricular dilatation with moderate apical hypokinesis. There was nonenhancing T2 hypointense eccentric signal in both apices, suggestive of organized thrombus. Circumferential mid-cavity subendocardial delayed enhancement in the left ventricle and right ventricular apex was noted. Systolic function was preserved, but there were signs of pulmonary arterial hypertension. These findings were consistent with Loeffler endocarditis. He underwent bone marrow biopsy, which confirmed diagnosis of FIP1L1-PDGFRA+ HES.The presence of the FIP1L1-PDGFRA mutation is correlated with an increased risk of cardiac involvement in patients with HES and is also associated with worse prognosis. Following an interdisciplinary discussion between the hematology, rheumatology, and cardiology teams, he was started on imatinib, methylprednisolone followed by prednisone taper, and apixaban. His symptoms and blood counts have since drastically improved, and he is being monitored closely for resolution of the thrombi and for any signs of heart failure.Conclusion:HES complicated by Loeffler endocarditis is a unique presentation of infiltrative disease causing inflammatory, thrombotic, and fibrotic cardiac sequelae. It can portend deadly complications, including valvular involvement, thromboembolic events, and heart failure. A high clinical suspicion is required due to the multitude of possible symptom presentations. Multimodality imaging and interdisciplinary management with early accurate diagnosis and treatment are necessary to slow disease progression and reduce morbidity risk.

Circulation, Volume 150, Issue Suppl_1, Page A4145478-A4145478, November 12, 2024. Introduction:Pericarditis is an inflammation of the pericardium, a thin sac-like membrane surrounding the heart, which can progress to life threatening cardiac tamponade. It can be caused by infections (viral, bacterial, fungal, or parasitic), autoimmune conditions, injuries, or underlying medical conditions. Common symptoms include chest pain, fever, shortness of breath, and fatigue. In the case presented, the patient suffered from a severe form of pericarditis caused by a rare infectious etiology, leading to the development of cardiac tamponade.Case Summary:A 29-year-old female with type II diabetes and hypothyroidism presented with a week of shortness of breath, chest pain, lightheadedness, and loss of consciousness. Workup showed WBC (20.6), CRP (283), and ESR (85). Echocardiogram revealed a large pericardial effusion with right ventricular collapse, indicating cardiac tamponade. She underwent pericardiocentesis, draining 400 ml of exudative fluid. Unfortunately, the effusion rapidly re-accumulated, requiring a pericardial window procedure with drainage of fibrinous, loculated fluid over 2 days, improving her symptoms. She was discharged on colchicine and NSAIDs, however she returned 5 days later with recurrent symptoms and fever. The culture of the previous fluid showed Cutibacterium acne. Histopathology of pericardial biopsy revealed fibrinoid pericarditis. She was treated with ceftriaxone, and transitioned to doxycycline for 14 days, along with 14 days of ibuprofen and 3 months of colchicine. At 3-month follow-up, she was asymptomatic with no effusion recurrence.Conclusion::As bacterial pericarditis cases rise, the initial work-up should include investigating bacterial etiology. This raises the question of antibiotic coverage for patients presenting with pericardial effusion until bacterial etiology is excluded and also advocate for elective pericardiocentesis in bacterial effusions without tamponade physiology.

Circulation, Volume 150, Issue Suppl_1, Page A4135212-A4135212, November 12, 2024. Background:Takotsubo cardiomyopathy (TC) can cause dynamic left ventricular outflow tract (LVOT) obstruction leading to cardiogenic shock. Due to differential wall-motion abnormalities, flow acceleration in the LVOT can lead to systolic anterior motion (SAM) of the mitral valve which worsens LVOT obstruction and leads to hemodynamic compromise. We present a case of overlap between TC and hypertrophic obstructive cardiomyopathy (HOCM) with worsening LVOT obstruction leading to cardiogenic shock.Case:A 76-year-old female presented with typical chest pain, nausea, and worsening shortness of breath. On examination, she was hypotensive and cold to touch. EKG showed T-wave inversions in lateral leads with elevated cardiac troponins. Coronary angiogram showed non-obstructive coronary artery disease, and right heart catheterization revealed elevated filling pressures. Transthoracic echocardiogram (TTE) showed septal hypertrophy and SAM of the mitral valve causing dynamic LVOT obstruction (Figure 1) and ejection fraction (EF) of 20%. TTE with contrast showed apical ballooning consistent with TC (Figure 2).Decision Making:Initially with diuresis, she became hypotensive so it was stopped and she received controlled intravenous fluids along with phenylephrine to reduce LVOT obstruction. Her blood pressure improved and she was started on low-dose metoprolol succinate along with ivabradine to reduce heart rate. She tolerated this therapy and hemodynamics stabilized.Conclusion:Cardiogenic shock can be a severe complication of TC. Early detection of LVOT obstruction in cardiogenic shock is important as traditional management strategies of increased inotropy and reduction of afterload can be fatal in these cases. The treatment strategy focuses on reducing the LVOT gradient and includes fluid administration to increase preload, beta-blockers to increase diastolic filling time, and vasopressors to raise afterload.

Universal screening of syphilis in emergency departments (EDs) could increase case detection, a recent investigation in Open Forum Infectious Diseases suggests.

Iss, “servono di bimbi sani o con sindrome di Rett fino a 6 mesi”

Iss, “servono di bimbi sani o con sindrome di Rett fino a 6 mesi”

New England Journal of Medicine, Volume 391, Issue 17, Page 1633-1641, October 31, 2024.

New England Journal of Medicine, Volume 391, Issue 17, Page 1663-1663, October 31, 2024.