Primary care
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Elevated levels of blood lipids are well-documented risk factors for cardiovascular disease. Current classification schemes and treatment levels for hyperlipidemia are based on the National Cholesterol Education Panel's Adult Treatment Program-3 (ATP-III) guidelines. Extensive research over the past decade has raised the question whether or not ATP-III guidelines are sufficiently aggressive. New guidelines from ATP-IV are expected to be released in the near future, but in the meantime physicians are faced with uncertainty about how low to target low-density lipoprotein cholesterol, whether to pharmacologically treat high-density lipoprotein cholesterol and triglyceride levels, and how best to achieve target goals.
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Heart failure (HF) often presents as dyspnea either with exertion and/or recumbency. Patients also experience dependent swelling and fatigue. ⋯ Cardiac defibrillators and biventricular pacemakers can also improve outcomes in selected patients with a decreased LVEF. The authors provide a guide for therapeutic decisions based on the inclusion criteria of the major clinical trials.
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This article describes the risk factors, diagnostic tools, and therapeutic approaches for venous thromboembolism (VTE), which includes primarily deep vein thrombosis and pulmonary embolism, as well as VTE occurring at other sites. Outpatient management strategies are emphasized.
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Heart valve disease is often characterized by a prolonged asymptomatic period that lasts for years and presents primary care physicians with an opportunity to detect disease before irreversible heart failure or other cardiac complications develop. Acute valvular disease can masquerade as respiratory illness or present with nonspecific systemic symptoms, and an astute examination by a primary care physician can direct appropriate care. Therefore, an understanding of the common pathologies and presentations of valvular heart disease is critical. This review focuses on the 2 most common valve lesions, aortic stenosis and mitral regurgitation, and provides an overview of other valve disease topics.