The American journal of the medical sciences
-
Case Reports
Cardiac papillary fibroelastoma presents as an acute embolic stroke in a 35-year-old African American male.
This is an interesting case of a young patient suffering an acute embolic stroke in the middle cerebral artery distribution, who was later found to have a papillary fibroelastoma on the mitral valve. The mass was first recognized by transesophageal echocardiography and eventually resected surgically. The retrieved specimen had classic histologic findings of a papillary fibroelastoma. A thrombus was noted on the tip of the specimen, supporting the theory that these masses are risks for strokes secondary to damage along the endothelial lining predisposing to subsequent fibrin deposition and mural thrombus formation.
-
The Brugada syndrome is an inherited arrhythmogenic and nonstructural heart disease associated with an increased risk of sudden cardiac death from ventricular fibrillation. There are conflicting data about its prevalence and prognosis. Particularly, population-based studies are lacking in the United States and other countries. ⋯ Brugada-type electrocardiograms among middle-aged or elderly Japanese-American men are uncommon and are not associated with increased risk of either sudden death or total mortality.
-
Metformin-associated lactic acidosis (MALA) is a rare but serious clinical entity. It is almost always seen in patients with a serious underlying medical disorder, most often a degree of renal impairment or other factors that are known to predispose to the lactic acidosis. ⋯ Early recognition of this condition and initiation of treatment are important. Bicarbonate hemodialysis is the treatment of choice.
-
The metabolic syndrome is an aggregation of biochemical and physical conditions that presage the development of atherosclerotic cardiovascular disease. The history of the metabolic syndrome is rooted in the recognition of adipose tissue as a heterogeneous, biologically active organ, as well as in the concepts of insulin resistance and its consequences. Establishment of the metabolic syndrome as a disease entity has been hindered by non-uniform criteria for its diagnosis.
-
The metabolic syndrome is a common disorder characterized by central obesity, impaired glucose tolerance, hypertension, and atherogenic dyslipidemia (including the combination of hypertriglyceridemia, low levels of high-density lipoprotein cholesterol, and a preponderance of small, dense low-density lipoprotein particles). In this manuscript, we review the pathogenesis and significance of dyslipidemia in the metabolic syndrome, the role of nonpharmacologic therapy with therapeutic lifestyle changes, and drug therapies, including statins, fibrates, nicotinic acid, and omega-3 fatty acids or fish oils, alone or in drug combinations, to improve lipids and reduce the chance of subsequent cardiovascular disease events.