JAAPA : official journal of the American Academy of Physician Assistants
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Takotsubo cardiomyopathy, also known as broken heart syndrome, apical ballooning syndrome, or stress cardiomyopathy, occurs when a stressful emotional or physical event causes the left ventricle of the heart to dilate, leading to acute heart failure. The syndrome was first described in Japan in 1990. Signs and symptoms of Takotsubo cardiomyopathy are similar to acute myocardial infarction. ⋯ Treatment is largely supportive. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blockers (ARBs) may reduce the likelihood of recurrent episodes. Overall, the prognosis is very good, with about 95% of patients making a full recovery.
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Religious objections to vaccines are in the news, but clinician engagement with patients' underlying religious objections has been minimal, presumably because clinicians lack tools to respectfully address these objections while honoring patient autonomy. This article introduces a four-step framework for exploring and responding to a patient's stated religious objections to vaccination, culminating in suggested approaches for respectful and collaborative discussions to encourage optimum patient protection consistent with informed consent and patient belief systems. Three hypothetical situations are presented and evaluated.
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Pericarditis is the most common form of pericardial disease and may be associated with significant morbidity and mortality. Management of idiopathic pericarditis includes pharmacologic therapies, non-pharmacologic therapies, and surgery. This article describes the diagnosis and management of idiopathic causes of pericarditis, incorporating recommendations included in the European Society of Cardiology guidelines.
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Calciphylaxis is a rare disease that typically presents in patients with end-stage renal disease on dialysis or those who have received a renal transplant. Nonuremic calciphylaxis leads to ischemia and subsequent necrosis of subcutaneous tissue. Diseases associated with nonuremic calciphylaxis include primary hyperparathyroidism, connective tissue disease, malignancy, and alcoholic liver disease. Due to its high mortality, early identification and an aggressive multidisciplinary treatment approach is necessary to improve patient outcomes.
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Inhaled nitrous oxide (N2O) has been used worldwide for over 100 years as labor analgesia but has not gained widespread use in the United States. Nitrous oxide provides a noninvasive option for laboring women. This article outlines its efficacy and safety as an analgesic compared with epidural and IV pain medications.