Clinical
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Echocardiographic Estimation of Left Atrial Pressure in Atrial Fibrillation Patients
A study of patients undergoing catheter ablation for atrial fibrillation with periprocedural echocardiograms and directly measured left atrial pressure (LAP) has shown that mean LAP can be estimated with a high degree of accuracy by a hierarchical algorithm using three Doppler echocardiographic parameters.
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Arrhythmias in the Holiday Heart Syndrome
A small study of continuous electrocardiogram and breath alcohol concentration in young volunteers during acute excessive alcohol consumption has shown that heart rate and ventricular premature beats increased during the drinking period. During recovery (six to 19 hours), significant arrhythmias such as atrial fibrillation occured in 5% of the subjects. The observed changes in heart rate variability and breath alcohol concentration suggest that these effects are the result of increased sympathetic nervous system activity associated with excess blood alcohol concentrations.
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Catheter Ablation for Ischemic Ventricular Tachycardia
A multicenter, randomized trial of initial catheter ablation vs. antiarrhythmic drug therapy for ventricular tachycardia in ischemic cardiomyopathy patients with an implantable cardioverter defibrillator resulted in fewer subsequent ventricular tachycardia episodes with ablation.
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Antiplatelet Therapy for Coronary Stent Patients Undergoing Noncardiac Surgery
A larger randomized controlled trial of aspirin monotherapy vs. no antiplatelet therapy in patients more than one year post-drug-eluting coronary stent placement failed to show a difference in ischemic outcomes or major bleeding, but minor bleeding was more common in the aspirin group.
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Angiography-Based QFR Analysis Falls Short Compared with FFR
In this large, multicenter, randomized trial, use of the angiography-based quantitative flow ratio method to guide revascularization of intermediate coronary stenoses resulted in a higher incidence of major adverse cardiac events at one year compared with pressure wire-based fractional flow reserve.
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Parvovirus and Increasing Danger in Pregnancy and Sickle Cell Disease
The incidence of human parvovirus B19 infection is increasing in the United States, putting vulnerable groups at risk of serious complications.
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Intrauterine Instillation of Mepivacaine at the Time of IUD Placement
In a randomized clinical trial of 151 women, intrauterine instillation of mepivacaine significantly reduced pain with intrauterine device insertion on visual analog scales both before (53.9 mm vs. 67.2 mm, respectively; P < 0.001) and after adjustment for individual provider variability (55.2 mm vs. 77.4 mm, respectively; P < 0.001), compared to placebo.
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Do Warm Compresses Combined with Perineal Massage Reduce Perineal Trauma During Labor?
In this randomized trial, the addition of warm compresses to perineal massage during the second stage of labor showed no significant difference in reducing perineal tears, obstetric anal sphincter injuries, or episiotomies compared to perineal massage alone.
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Interventions for Pain During Office Endometrial Biopsy
In this randomized controlled trial, the use of transcutaneous electric nerve stimulation during endometrial biopsy did not clinically significantly reduce pain compared to placebo (median [interquartile range], 50 mm [20 mm to 80 mm] vs. 60 mm [40 mm to 100 mm]; P = 0.039), but was associated with increased satisfaction with the procedure.
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Flank Pain and ‘Heartburn?’
The electrocardiogram (ECG) in the figure was obtained from a man in his 60s who presented to the emergency department for a suspected kidney stone. The patient also noted some intermittent heartburn in recent weeks. How would you interpret his ECG? Should you activate the cath lab?