"Broken heart syndrome": catecholamine surge or aborted myocardial infarction?

Takotsubo cardiomyopathy, also called transient left ventricular apical ballooning or "broken heart syndrome", is a cardiac condition that mimics the clinical presentation of acute coronary syndrome but without any evidence of obstructive atherosclerotic coronary artery disease. An episode of intense emotional or physiologic stress, serving as the nidus for a catecholamine surge, has been reported prior to presentation and is presumed to be the triggering factor playing the pathogenic role. We report a unique case of Takotsubo cardiomyopathy without any known precipitating factors. After reviewing multiple case reports and review articles, the evidence supporting a "catecholamine surge" is empirically plausible; however, our case calls this theory into question. The "aborted MI" hypothesis is more convincing as an all-inclusive nidus for the pathogenesis and clinical presentation described in Takotsubo syndrome. More detailed studies and research are needed to ascertain the pathogenesis and optimal management of this syndrome.

Dyslipidemia in South Asian patients.

South Asians around the globe have the highest rates of coronary artery disease (CAD). These rates are 50% to 300% higher than other populations, with a higher risk at younger ages. These high rates of CAD are accompanied by low or similar rates of major traditional risk factors. The prevalence of diabetes is three to six times higher among South Asians than Europeans, Americans, and other Asians but does not explain the "South Asian Paradox." A genetic predisposition to CAD, mediated by high levels of lipoprotein(a), markedly magnifies the adverse effects of traditional risk factors related to lifestyle and best explains the South Asian Paradox. Although the major modifiable risk factors do not fully explain the excess burden of CAD, they are doubly important and remain the foundation of preventive and therapeutic strategies in this population. A more aggressive approach to preventive therapy, especially dyslipidemia, at an earlier age and at a lower threshold is clearly warranted.

Towards automatic augmentation of electronic medical records with MEDLINE citations.

The adoption of Electronic Medical Records (EMR)is increasing every year even though the rate of adoption is slow. MEDLINE is adding thousands of new citations every day. It may be possible to enrich an EMR system with relevant information from NLM resources. During my elective at NLM I was assigned to evaluate the preliminary stages in designing and building a system, which automatically augment a patient's EMR with pertinent information from NLM resources. Clinical informatics experiments using content from real EMR is necessary to achieve the ultimate goal of automatic augmentation of the EMR with MEDLINE.

eHand-offs: An IBM Lotus Domino application for ensuring patient safety and enhancing resident supervision in hand-off communications.

Reliable communication of patient information among physicians during shift changes is an important patient safety parameter. The Joint Commission on Accreditation of Healthcare Organizations [JCAHO] recognized the pitfalls in hand off communications by including standardized hand-offs as a National Patient Safety Goals. We are presenting an electronic application called eHand-offs to address this problem in our residency program. Residents can use this application to hand-off patient information during admissions, transfers, and discharges. eHand-offs also functions as a surveillance tool for administrators to track patient hand offs, ensuring added patient safety and enhancing resident supervision and training.