Rev Cardiovasc Med
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Acute myocardial infarction (MI) in the setting of sexual intercourse following the concomitant use of cocaine, alcohol, and sildenafil has not been previously reported. We present a case of a middle-aged patient with no previous history of angina pectoris or coronary artery disease who presents with severe ischemic chest pain and an MI induced by cocaine, alcohol, sildenafil, and sexual intercourse.
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Acute chest discomfort and dyspnea are 2 of the most common nontraumatic symptoms that prompt emergency department evaluations in the United States. The overlap between these presenting symptoms is considerable. In addition, each symptom calls for a broad differential diagnosis that requires rapid refinement according to details in the history, physical examination, blood biomarkers, and radiographic evaluation. This article highlights the epidemiology and the evidence supporting critical decision making, which makes judicious use of the clinical laboratory and diagnostic radiology in the evaluation of the acutely ill patient with chest discomfort and dyspnea.
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Approximately 6 million patients are evaluated annually in US emergency departments for acute chest pain. The delineation of the presence or absence of acute coronary syndromes in these patients must be accurate and efficient in order to prevent missed diagnoses. Coronary computed tomography angiography has great promise as a tool to expedite the triage of patients with acute chest pain to early discharge or further inpatient diagnosis and treatment.
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Obesity is a known risk factor for developing cardiovascular disease, including heart failure. However, the impact of obesity on patients with heart failure is unclear. ⋯ Even more, increases of weight in cachectic heart failure patients might improve survival, although patients with heart failure who are overweight or mildly to moderately obese have better outcomes than patients with heart failure who are at ideal or normal weight. In heart failure patients, weight reduction through diet regulation, moderate exercise, and bariatric surgery can improve quality of life and New York Heart Association functional class, but it is yet unclear if these measures will improve survival.