Case 1: A 73-year-old man with good past health presented to the emergency department with a few days’ history of involuntary low-amplitude unpredictable movements of his left arms and legs.
Case 2: An 84-year-old man with a few years’ history of type 2 diabetes mellitus was admitted with 2 days’ history of involuntary flinging movements of his right arm and leg.
In this case report, we present the challenges encountered by physicians and cardiologists managing patients with advanced HF, and highlight the broadening spectrum of medical therapies and pathways that comprise contemporary practice.
Dr Paul Chiam, a senior consultant cardiologist at The Heart & Vascular Centre, Mount Elizabeth Hospital, Singapore, and an Adjunct Associate Professor at the National University of Singapore, shares his insights with Pearl Toh on diagnosing and managing hypertension in the primary care setting.
Dr. Kelvin Ki-Wan Chan, Dr. Chun-Ka Wong, 20180710000000
Case 1: Madam A became pregnant at 38 years of age. She carried a class IV risk under the modified WHO classification of maternal cardiovascular risk, for which pregnancy was contraindicated. Termination of pregnancy was repeatedly suggested, but the couple opted to continue with the pregnancy.
Case 2: Madam B had had hypertension since early adolescence. Apart from being obese with a Body Mass Index of 34 kg/m2and fatty liver disease, extensive investigations were unrevealing. Her family history was unremarkable. She was then lost to follow-up. At 24 years of age, madam B was referred back to our hospital for a high-risk pregnancy situation during her first trimester.
Ruptured aneurysms can be one of the most fatal medical emergencies and are dubbed as a “silent killer” given their lack of symptoms. Audrey Abella speaks with Dr Julian Wong Chi Leung, Senior Consultant at the Department of Cardiac, Thoracic and Vascular Surgery at the National University Heart Centre, Singapore, on how this potentially life-threatening condition can be aptly diagnosed and prevented in the primary care setting.
Dr. Michael Sze, Dr. Tammy Ma, Dr. Yui-Ming Lam, 20180409000000
A 47-year-old gentleman with a known history of mitral valve prolapse (MVP) and mild-to-moderate mitral regurgitation since his 30s presented to Queen Mary Hospital with sudden onset of chest pain and palpitations for 1 day.
Adjunct Assistant Prof Tang Tjun Yip, Consultant Vascular & Endovascular Surgeon, Department of Vascular Surgery, Singapore General Hospital, shares clinical pearls on how GPs can manage varicose veins and chronic venous insufficiency in the primary care setting.
Dr. Michael Kwan-Lung Ko, Dr. Siu-Yin Wong, 20170710000000
Case 1: A 79-year-old male patient presented initially with acute coronary syndrome and newly diagnosed myeloproliferative neoplasm with high white blood cell and platelet counts. He was stabilized and subsequently discharged with dual antiplatelet therapy (DAPT) (aspirin plus clopidogrel) and hydroxyurea.
Case 2: A 62-year-old female patient with a history of decompensated cryptogenic cirrhosis presented with acute variceal haemorrhage with haematemesis. Emergency OGD revealed three columns of grade 3 oesophageal varices with fibrin clot noted on one of them.
Case 3: A 51-year-old female patient with a history of systemic lupus erythematosus and hyperlipidaemia was referred to our hepatology clinic for evaluation of deranged liver function.
An 82-year-old lady with hypertension and hyperlipidaemia presented with 2 weeks’ history of increasing breathing difficulty. She had flu-like illness 2 weeks ago with some residual dry cough. Physical examination showed low-grade fever of 37.8°C with mildly elevated jugular venous pressure and mild pedal oedema. There was no obvious murmur, and chest auscultation revealed bilateral basal crepitations. Her blood pressure was 130/80 mm Hg. She required oxygen 1 L/min to maintain blood oxygen saturation level (SpO2) of 94 percent.
Dr. Yiting Fan, Yiqun Zhang, Dr. Xingwei Zhang, Dr. Alex Pui-Wai Lee, 20160812000000
A 74-year-old man with a history of paroxysmal non-valvular atrial fibrillation (AF) and transient ischaemic attack (TIA) despite oral anticoagulation was referred for catheter-based left atrial appendage (LAA) occlusion.
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A trial assessing the implantable CardioFit® device designed to stimulate the parasympathetic nervous system in heart failure patients failed to meet its primary endpoints – reducing the rate of hospitalization due to heart failure or death by any cause.
The use of spot urine appears to be unhelpful in estimating 24-hour urinary sodium excretion at the individual level due to its poor performance with regard to misclassification, according to a recent study.