Diagnosis of endocarditis is usually based on clinical, microbiologic, and echocardiographic findings. Treatment involves antimicrobial therapy targeted to the identified organism. Surgical indications include heart failure, uncontrolled infection, and prevention of embolic events. The latest article in our Clinical Practice series reviews diagnosis and treatment options for infective endocarditis. Infective endocarditis has an estimated annual… Read More…
In the latest Case Record of the Massachusetts General Hospital, an 18-year-old man suddenly became weak, with slurred speech. Dysarthria and ataxia were noted. Head CT was normal. The next day, he became unresponsive, with extensor posturing. A diagnostic procedure was performed. Up to 14% of all strokes occur in children and young adults. The… Read More…
In a study of Danish women, oral contraceptive pills containing estrogen and progestin were associated with increased risks of stroke and myocardial infarction (MI). Variations in risk according to estrogen dose and progestin type were modest. The risk of thromboembolic complications with the use of hormonal contraception is an important issue scientifically and is relevant… Read More…
Patients with stroke are at high risk for subsequent vascular events, including recurrent stroke (highest risk), myocardial infarction, and death from vascular causes. The latest article in our Clinical Practice series reviews recommended strategies to reduce the risk of a subsequent stroke in patients with a history of transient ischemic attack (TIA) or stroke. Worldwide,… Read More…
To get some protection against stroke in atrial fibrillation, we, along with our patients have been living with the hassles of warfarin, because we have to. But warfarin may not be our only choice for much longer. In this week’s NEJM, the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE)… Read More…
In the ROCKET-AF trial, 14,264 patients with atrial fibrillation were randomly assigned to receive either rivaroxaban or warfarin. In a perprotocol, as-treated analysis, rivaroxaban was noninferior to warfarin with respect to the primary end point of stroke or systemic embolism. The use of vitamin K antagonists is highly effective for stroke prevention in patients with nonvalvular… Read More…
In this week’s NEJM, tablets once again trump technology in the treatment of obstructive atherosclerosis; this time in the brain. Many of the advances in the treatment of ischemic stroke have followed on the heels of similar advances in the treatment of ischemic coronary disease. From thrombolysis in acute stroke, to stenting for symptomatic extracranial… Read More…
The latest article in our Clinical Therapeutics series, Intravenous Thrombolytic Therapy for Acute Ischemic Stroke, comes from Dr. Lawrence Wechsler at the University of Pittsburgh Medical School. An 81-year-old man presents to the ER with an acute ischemic stroke; IV thrombolytic therapy is recommended. Administered as a therapeutic agent within 4.5 hours after stroke, tissue… Read More…
Carotid-artery atherosclerosis is an important cause of ischemic stroke. Carotid endarterectomy has been established as effective treatment for both symptomatic patients and asymptomatic patients. Carotid-artery stenting is another option for treatment. In a randomized comparison by Brott et al. of stenting and endarterectomy as treatment for carotid-artery stenosis, no significant difference was found in the… Read More…
