Latest Articles
- Noninvasive risk assessment after myocardial infarction
BACKGROUND Mortality from acute myocardial infarction is substantially less than it was two and even one decade ago. This improvement in both short-term and postdischarge outcome results both from early interventions to restore myocardial perfusion and mitigate expansion and remodeling, and from later assessment and management of functional status at the time of hospital discharge.
OBJECTIVE Recent studies suggest that invasive evaluation of the patient who has had a myocardial infarction (MI) should not be recommended on a routine basis. This review provides an approach to the noninvasive assessment of the patient.
DISCUSSION Stress testing to ascertain post-MI ischemia, ejection fraction determination to evaluate ventricular volumes and function, and ambulatory electrocardiographic monitoring, electrophysiologic study, and signal-averaged electrocardiography to assess presence and type of ventricular ectopy are discussed.
CONCLUSION The approach to the post-MI patient offered herein is felt to be medically sound and cost-effective. Refinement and alterations in this approach will be necessary as outcomes in specific patient groups, such as thrombolysis patients, women, and the elderly, become clearer.
- Potential molecular therapy for acute renal failure
As more is learned about renal epithelial cell regeneration and differentiation, exogenously administered growth promoters seem a likely intervention.
- Cardiopulmonary exercise testing in patients with chronic obstructive pulmonary disease
Defining the etiology of dyspnea, evaluating impairment, and assessing the response to therapy are among the current indications.
- Efficacy of beta blockade, thrombolytic therapy, and coronary angioplasty in diabetic patients with coronary artery disease
Determining the effectiveness of these interventions in diabetic patients has received little attention, despite the association of diabetes with increased mortality from coronary artery disease.
- Cushing’s syndrome: easy to see, tricky to diagnose
The difficulty lies in determining whether the syndrome has a pituitary or nonpituitary cause.