Howard H. Weitz

Use of enoxaparin for the chronically anticoagulated patient before and after procedures.

Patients who require chronic anticoagulation and a procedure have been traditionally managed either by stopping warfarin and starting intravenous standard heparin or by adjusted dose subcutaneous standard heparin or taken off all anticoagulation for a week before the procedure. Enoxaparin may be useful as an alternative method of anticoagulation, avoiding hospitalization and the need for frequent monitoring.

Adenosine radionuclide perfusion imaging in the preoperative evaluation of patients undergoing peripheral vascular surgery.

To define the clinical and adenosine test variables that predicted perioperative cardiac events, 122 patients who received adenosine radionuclide perfusion imaging before peripheral vascular surgery were reviewed. Events included pulmonary edema, an ischemic end point of acute myocardial infarction (AMI) or cardiac death. Five patients underwent coronary revascularization before the surgical procedure. Of the 117 remaining patients, 19 had pulmonary edema, 10 had an AMI, and 2 died after peripheral vascular surgery. Most of the patients (78%) were in an intermediate-risk group as indicated by the presence of > or = 1 clinical risk factor as defined by the Eagle criteria. The only predictor of perioperative pulmonary edema was a history of congestive heart failure (33% vs 4%; p = 0.002). No clinical variables predicted AMI or death. The adenosine variables that were univariate predictors of AMI and death were the number of reversible perfusion defects (1.75 +/- 1.84 vs 0.75 +/- 0.90; p = 0.001) and the number of coronary artery distributions with a radionuclide perfusion defect (1.33 +/- 0.64 vs 0.85 +/- 0.67; p = 0.022). The number of reversible perfusion defects was the only multivariate predictor of ischemic events (p = 0.017). The presence of > 1 reversible defect was associated with an increased frequency of ischemic events (68% vs 28%; p = 0.045). The sensitivity and specificity of > 1 reversible defect was 58% and 73%, respectively, with a positive and negative predictive value of 19% and 94%.(ABSTRACT TRUNCATED AT 250 WORDS)

Noncardiac Surgery in the Patient with Heart Disease

Optimal care of the patient with heart disease undergoing noncardiac surgery requires that the members of the surgical team, including anesthesiologist, internist-cardiologist, and surgeon, be familiar with the cardiovascular response to surgery, preoperative cardiac risk stratification, and the unique pathogenesis of cardiac complications that may occur in the perioperative period. Preoperative evaluation and computation of cardiac risk, anesthetic considerations, along with perioperative care of the patient with ischemic heart disease, valvular heart disease, congestive heart failure, arrhythmias and conduction disorders, and hypertension is discussed.

Approach to the patient with palpitations

Palpitations are a common complaint present in up to 16% of outpatients. They are nonspecific and in only 15% of patients do they correlate with a cardiac arrhythmia. The significance of palpitations is related to the presence or absence of underlying cardiac disease, the clinical setting in which palpitations occur, and the characteristics and severity of symptoms. This article presents a concise approach to the evaluation of the ambulatory patient with palpitations.

ACCF/AHA/SCAI 2013 Update of the Clinical Competence Statement on Coronary Artery Interventional Procedures: a Report of the American College of Cardiology Foundation/American Heart Association/American College of Physicians Task Force on Clinical Competence and Training (Writing Committee to Revise the 2007 Clinical Competence Statement on Cardiac Interventional Procedures).

WRITING COMMITTEE MEMBERS John G. Harold,* MD, MACC, FAHA, Chair, Theodore A. Bass, MD, FACC, FSCAI, Vice Chair, Thomas M. Bashore, MD, FACC, FAHA, FSCAI, Ralph G. Brindiss,* MD, MPH, MACC, FSCAI, John E. Brush JR, MD, FACC, James A. Burke, MD, PhD, FACC, Gregory J. Dehmers, MD, FACC, FAHA, FSCAI, Yuri A. Deychak, MD, FACC, Hani Jneids, MD, FACC, FAHA, FSCAI, James G. Jolliss, MD, FACC, Joel S. Landzberg, MD, FACC, Glenn N. Levine, MD, FACC, FAHA, James B. McClurken, MD, FACC, John C. Messengers,* MD, FACC, FSCAI, Issam D. Moussas, MD, FACC, FAHA, FSCAI, J. Brent Muhlestein, MD, FACC, Richard M. Pomerantz, MD, FACC, FSCAI, Timothy A. Sanborn, MD, FACC, FAHA, Chittur A. Sivaram, MBBS, FACC, Christopher J. Whites, MD, FACC, FAHA, FSCAI, Eric S. Williamss,* MD, FACC,

Annals Consult Guys – Pros and Cons of Therapy to Increase Bone Mineral Density

The Guys (Howard and Geno) take on a tough one: Will calcium supplementation increase the risk for cardiovascular disease, and should it be avoided in a patient with aortic stenosis?

Annals Consult Guys - Should Your Patient's Surgery Be Stopped for Hypertension? The Pressure Is On

In this episode of the consultative medicine talk show, the Consult Guys dissect the evidence regarding whether and when surgery should be delayed because of hypertension.

Annals Consult Guys – PE in Pregnancy: What Imaging? What Drugs?

In this episode of the consultative medicine talk show, Geno and Howard address the tricky topic of venous thromboembolism during pregnancy.

Annals Consult Guys – A Stumper: How Much Spent for How Much Prevention?

Howard and Geno challenge us to think about what is known and what is not known about what we might assume to be well-established preventive therapy. Can your team get the right answer?

Annals Consult Guys – Talking to Our Patients About Firearm Injury

Drs. Merli and Weiss (the Consult Guys) and their expert guess address the questions of a viewer who wants to help his patients risks for firearm-related harms but is not sure how to talk about fi...