ITEMS IN FPM WITH MESH TERM:
Risk-Assessment Tools for Detecting Undiagnosed Diabetes - Point-of-Care Guides
Abdominal Aortic Aneurysm - Article
ABSTRACT: Most abdominal aortic aneurysms (AAAs) are asymptomatic, not detectable on physical examination, and silent until discovered during radiologic testing for other reasons. Tobacco use, hypertension, a family history of AAA, and male sex are clinical risk factors for the development of an aneurysm. Ultrasound, the preferred method of screening, is cost-effective in high-risk patients. Repair is indicated when the aneurysm becomes greater than 5.5 cm in diameter or grows more than 0.6 to 0.8 cm per year. Asymptomatic patients with an AAA should be medically optimized before repair, including institution of beta blockade. Symptomatic aneurysms present with back, abdominal, buttock, groin, testicular, or leg pain and require urgent surgical attention. Rupture of an AAA involves complete loss of aortic wall integrity and is a surgical emergency requiring immediate repair. The mortality rate approaches 90 percent if rupture occurs outside the hospital. Although open surgical repair has been performed safely, an endovascular approach is used in select patients if the aortic and iliac anatomy are amenable. Two large randomized controlled trials did not find any improvement in mortality rate or morbidity with this approach compared with conventional open surgical repair.
A Tool for Evaluating Hypertension - Improving Patient Care
ABSTRACT: Coronary artery disease is the leading cause of mortality in the United States. In patients who have had a myocardial infarction or revascularization procedure, secondary prevention of coronary artery disease by comprehensive risk factor modification reduces mortality, decreases subsequent cardiac events, and improves quality of life. Options for secondary prevention include medical therapy and surgical revascularization in the form of coronary artery bypass grafting or percutaneous coronary intervention. Medical therapy focuses on comprehensive risk factor modification. Therapeutic lifestyle changes (including weight management, physical activity, tobacco cessation, and dietary modification) improve cardiac risk factors and are universally recommended by evidence-based guidelines. Treatment of hypertension and dyslipidemia reduces morbidity and mortality. Recommendations for persons with diabetes mellitus generally encourage glucose control, but current evidence has not shown reductions in mortality with intensive glucose management. Aspirin, angiotensin-converting enzyme inhibitors, and beta blockers reduce recurrent cardiac events in patients after myocardial infarction. Surgical revascularization by coronary artery bypass grafting is recommended for those with significant left main coronary artery stenosis, significant stenosis of the proximal left anterior descending artery, multivessel coronary disease, or disabling angina. Percutaneous coronary intervention may be considered in select patients with objective evidence of ischemia demonstrated by noninvasive testing.
ABSTRACT: Poorly controlled hypertension is a common finding in the outpatient setting. When patients present with severely elevated blood pressure (i.e., systolic blood pressure of 180 mm Hg or greater, or diastolic blood pressure of 110 mm Hg or greater), physicians need to differentiate hypertensive emergency from severely elevated blood pressure without signs or symptoms of end-organ damage (severe asymptomatic hypertension). Most patients who are asymptomatic but have poorly controlled hypertension do not have acute end-organ damage and, therefore, do not require immediate workup or treatment (within 24 hours). However, physicians should confirm blood pressure readings and appropriately classify the hypertensive state. A cardiovascular risk profile is important in guiding the treatment of severe asymptomatic hypertension; higher risk patients may benefit from more urgent and aggressive evaluation and treatment. Oral agents may be initiated before discharge, but intravenous medications and fast-acting oral agents should be reserved for true hypertensive emergencies. High blood pressure should be treated gradually. Appropriate, repeated follow-up over weeks to months is needed to reach desired blood pressure goals.
Blood Pressure Treatment Targets for Uncomplicated Hypertension - Cochrane for Clinicians
First-Line Treatment for Hypertension - Cochrane for Clinicians
Acutely Swollen Tongue in a Middle-Aged Woman - Photo Quiz
End-stage Renal Disease - Clinical Evidence Handbook