CURRENT Essentials of Medicine, Fourth Edition (LANGE by Lawrence Tierney, Sanjay Saint, Mary Whooley

By Lawrence Tierney, Sanjay Saint, Mary Whooley

The right quickly reference at the wards and within the medical institution! The well-known "one illness in keeping with web page" layout! present necessities of drugs is a realistic, point-of-care pocket instruction manual that provides "nutshell" info at the prognosis and therapy of greater than 500 scientific problems noticeable in either fundamental care and clinic settings. ideal as a short reference at the wards or in a hectic health center, this is often the single pocket advisor to supply illness necessities in a one-disease-per-page bulleted structure. useful pearls, for which the authors are renowned, are provided for the majority stipulations. positive aspects To-the-point details at the prognosis and remedy of greater than 500 of the most typical illnesses visible in scientific perform handy one-disease-per web page presentation Bulleted facts for every disorder protecting necessities of prognosis, Differential prognosis, remedy, Pearl, and Reference Encompasses either ambulatory and inpatient drugs contains inner medication, plus specialties equivalent to obstetrics/gynecology, surgical procedure, and pediatrics up-to-date medical manifestations, diagnostic exams, and remedy issues all through

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Reference Schneider DJ, Moore JW. Patent ductus arteriosus. Circulation 2006;114:1873. [PMID: 17060397] 1 28 Current Essentials of Medicine Prinzmetal’s Angina 1 ■ Essentials of Diagnosis • • • • • • ■ Differential Diagnosis • • • • • • • • • ■ Caused by intermittent focal spasm of an otherwise normal coronary artery Associated with migraine, Raynaud’s phenomenon The chest pain resembles typical angina, but often is more severe and occurs at rest Affects women under 50, occurs in the early morning, and typically involves the right coronary artery Electrocardiography shows ST-segment elevation, but enzyme studies are normal Diagnosis can be confirmed by ergonovine challenge during cardiac catheterization Typical angina pectoris; myocardial infarction; unstable angina Tietze’s syndrome (costochondritis) Cervical or thoracic radiculopathy, including pre-eruptive zoster Esophageal spasm or reflux disease Cholecystitis Pericarditis Pneumothorax Pulmonary embolism Pneumococcal pneumonia Treatment Statins, smoking cessation, nitrates, and calcium channel blockers acutely effective and are the mainstay of chronic therapy • Prognosis excellent given absence of atherosclerosis • ■ Pearl In its classic iteration, vasospasm of the right coronary artery, mostly women, nonexertional, no atherosclerosis, ST elevation at the same time of the day; in 2010, consider cocaine or methamphetamine use.

Adenosine versus intravenous calcium channel antagonists for the treatment of supraventricular tachycardia in adults. Cochrane Database Syst Rev 2006;(4):CD005154. [PMID: 17054240] Chapter 1 Cardiovascular Diseases 27 Patent Ductus Arteriosus ■ Essentials of Diagnosis Caused by failure of closure of embryonic ductus arteriosus with continuous blood flow from aorta to pulmonary artery (ie, left-to-right shunt) • Symptoms are those of left ventricular failure or pulmonary hypertension; many cases are complaint-free • Widened pulse pressure, a loud S2, and a continuous, “machinery” murmur loudest over the pulmonary area but heard posteriorly • Echo Doppler helpful, but contrast or MR aortography is the study of choice • ■ Differential Diagnosis In patients presenting with left heart failure: • Mitral regurgitation • Aortic stenosis • Ventricular septal defect If pulmonary hypertension dominates the picture: • Primary pulmonary hypertension • Chronic pulmonary embolism • Eisenmenger’s syndrome ■ Treatment Pharmacologic closure in premature infants, using indomethacin or aspirin • Surgical or percutaneous closure in patients with large shunts, symptoms, or previous endocarditis; controversial in other settings • ■ Pearl Patients usually remain asymptomatic as adults if problems have not developed by age 10 years.

ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2006;114:e84. [PMID: 16880336] 1 24 Current Essentials of Medicine Multifocal Atrial Tachycardia 1 ■ Essentials of Diagnosis • • • • • ■ Differential Diagnosis • • • • ■ Classically seen in patients with severe COPD; electrolyte abnormalities (especially hypomagnesemia or hypokalemia) occasionally responsible Symptoms include those of the underlying disorder, but some may complain of palpitations Irregularly irregular heart rate Electrocardiography shows at least three different P-wave morphologies with varying PR intervals Ventricular rate usually between 100 and 140 beats/min; if < 100, rhythm is wandering atrial pacemaker Normal sinus rhythm with multiple premature atrial contractions Atrial fibrillation Atrial flutter with variable block Reentry tachycardia with variable block Treatment Treatment of the underlying disorder is most important Verapamil particularly useful for rate control; digitalis ineffective Intravenous magnesium and potassium administered slowly may convert some patients to sinus rhythm even if serum levels are within normal range; be sure renal function is normal • Medications causing atrial irritability, such as theophylline, should be avoided • Atrioventricular nodal ablation with permanent pacing is used in rare cases that are highly symptomatic and refractory to pharmacologic therapy • • • ■ Pearl Multifocal atrial tachycardia is the paradigm COPD arrhythmia, electrocardiographically defined and increasingly treated electrophysiologically.

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