ACP Medicine

Approach to The Cardiovascular Patient Part 2

Dyspnea Background Dyspnea refers to difficulty with breathing and can occur with a wide variety of cardiac, pulmonary, and systemic conditions [see Table 5]. Dyspnea can be classified as occurring (1) at rest, (2) with exertion, (3) during the night, awakening a patient from sleep (paroxysmal nocturnal dyspnea), or (4) during episodes of recumbency (orthopnea). […]

Approach to The Cardiovascular Patient Part 3

Diagnostic tests The ECG is the first step in the diagnostic evaluation of a patient with palpitations [see Figure 3]. A short PR interval and delta wave (Wolff-Parkinson-White syndrome), prolonged QT interval (long QT syndrome), and left bundle branch block (structural heart disease) are notable findings. Certain medications [see Table 7] may result in prolongation […]

Approach to The Cardiovascular Patient Part 4

Claudication Background Claudication is a condition of muscle pain or weakness associated with compromised blood flow to the extremities. It is a common complaint of patients who have peripheral vascular disease (PVD). Claudication is also a common symptom of CAD, a disease that shares risk factors with PVD. PVD is associated with an increased risk […]

Heart Failure Part 1

Definition Heart failure is a clinical syndrome resulting from a structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood to meet the needs of the body. This syndrome, which is a constellation of signs and symptoms, is primarily manifested by dyspnea, fatigue, fluid retention, and decreased […]

Heart Failure Part 2

Diagnosis Stage A The first step in the diagnosis of heart failure is to identify patients who are at risk for developing the syndrome; this concept was part of the reasoning behind the new ACC/AHA staging system.14 Patients in stage A are those with CAD, hypertension, diabetes, a history of alcohol abuse or exposure to […]

Hypertension Part 1

Hypertension is the most common chronic disorder in the United States, affecting 29% of the adult population.1 It is the most common reason adults visit the doctor’s office. In the year 2000, hypertension accounted for more than 1 million office visits to health care providers. The prevalence increases with age: for a normotensive middle-aged person […]

Hypertension Part 2

Physical examination The examination should include at least two standardized measurements of BP with the subject in the seated position. Initially, BP should also be measured in the opposite arm (to identify arterial narrowing, which can cause an inaccurately low reading in one arm) and in the standing position, especially in diabetic patients and older […]

Hypertension Part 3

Lifestyle factors Observational studies have identified several environmental factors associated with hypertension, and prospective studies have demonstrated BP lowering with manipulation of these factors [see Table 8].4849 51,54,55,57-6" In addition to lowering BP, lifestyle recommendations are designed to reduce overall CV risk. These measures should be advised for all patients with BP above the normal […]

Hypertension Part 4

Office Hypertension/Pseudohypertension Office measures of BP may overestimate the usual or average level [see Ambulatory BP Monitoring, above]. Before embarking on further evaluation, the clinician should consider using out-of-office BP readings or ABPM to exclude a white-coat effect. Patients with white-coat hypertension are more likely to be younger (although cases of white-coat ISH do occur […]

Hypertension Part 5

Patients with Acute Stroke The majority of patients presenting with either acute is-chemic or hemorrhagic stroke have hypertension.97 The temporal profile is that of an initial acute rise in BP in the first 24 hours, followed by a slow decline over the next several days. On the whole, observational studies show that high BP at […]

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