The American journal of medicine
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Lower extremity peripheral artery and upper extremity artery disease are significant vascular conditions with distinct clinical presentations and diagnostic and therapeutic approaches. The lower extremity peripheral artery is associated with worse major adverse cardiovascular events compared with coronary artery disease, but often remains underdiagnosed and undertreated. ⋯ This review aims to synthesize existing knowledge on both conditions, encompassing risk factors, clinical manifestations, diagnostic modalities, and treatment options. Improved awareness and early intervention can mitigate complications and enhance patient outcomes for lower extremity peripheral artery and upper extremity artery disease.
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Review
Interpreting the Coronary Artery Calcium Score - Critical Information for the Practicing Physician.
Coronary artery calcium scanning is a routine test for assessing the severity of atherosclerosis in asymptomatic individuals. This inexpensive, noninvasive test quantifies the calcium deposition in the 4 principal coronary arteries. Correct interpretation is important to the physician (for recommending therapy) and to the patient (for determining his or her lifetime risk of a cardiovascular event). ⋯ One-third of individuals with scores greater than 1000 will have a cardiovascular event within 3 years. For all elevated calcium scores, aggressive treatment is warranted, including significant lifestyle changes and medications to reduce low-density lipoprotein cholesterol. Understanding the importance of the coronary artery calcium score will result in improved therapy and patient compliance.
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Randomized Controlled Trial
Machine Learning Predicting Atrial Fibrillation as an Adverse Event in the Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial.
Atrial fibrillation and heart failure commonly coexist due to shared pathophysiological mechanisms. Prompt identification of patients with heart failure at risk of developing atrial fibrillation would allow clinicians the opportunity to implement appropriate monitoring strategy and timely treatment, reducing the impact of atrial fibrillation on patients' health. ⋯ The use of machine learning can prove useful in identifying novel cardiac risk factors. Our analysis has shown that "social factors," such as living alone, may disproportionately increase the risk of atrial fibrillation in the under-represented non-White patient group with heart failure, highlighting the need for more studies focusing on stratification of multiracial cohorts to better uncover the heterogeneity of atrial fibrillation.
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Right heart thrombus is a rare but serious form of venous thromboembolic disease that may be associated with pulmonary embolism. The prognosis of patients with right heart thrombus presenting without a concomitant pulmonary embolism remains ill-defined. ⋯ Patients with right heart thrombus and pulmonary embolism had a more severe clinical presentation, required more advanced therapies, and had reduced survival compared with those without a concomitant pulmonary embolism. Important variables associated with development of concomitant pulmonary embolism include thrombus mobility and size. Right heart thrombus in the setting of acute pulmonary embolism represents a unique clinical entity that is associated with worse prognosis compared with right heart thrombus only.