{"title":"Should I start anticoagulation in my patient newly diagnosed with pulmonary hypertension?","authors":"Tark Abou-Elmagd, Shraddha Narechania","doi":"10.3949/ccjm.92a.24083","DOIUrl":"https://doi.org/10.3949/ccjm.92a.24083","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 6","pages":"339-343"},"PeriodicalIF":3.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Direct oral anticoagulants (DOACs) are preferred to vitamin K antagonists for treating venous thromboembolism and nonvalvular atrial fibrillation, primarily because of comparable efficacy, consistent dosing, and fewer drug-drug interactions. However, major trials that led to the approval of DOACs excluded subsets of patients who are challenging to treat in the primary care setting, including patients with extreme body weight, advanced kidney disease, and advanced cirrhosis, and those who have undergone bariatric surgery. The authors review the available evidence and outline current recommendations to help guide the appropriate use of DOACs in these patients.
{"title":"Direct oral anticoagulants: Challenging prescribing scenarios in everyday practice.","authors":"Syed Bukhari, Mohamed Ghoweba, Syed Zamrak Khan, Ammar Saati, Marcelo Gomes","doi":"10.3949/ccjm.92a.24061","DOIUrl":"https://doi.org/10.3949/ccjm.92a.24061","url":null,"abstract":"<p><p>Direct oral anticoagulants (DOACs) are preferred to vitamin K antagonists for treating venous thromboembolism and nonvalvular atrial fibrillation, primarily because of comparable efficacy, consistent dosing, and fewer drug-drug interactions. However, major trials that led to the approval of DOACs excluded subsets of patients who are challenging to treat in the primary care setting, including patients with extreme body weight, advanced kidney disease, and advanced cirrhosis, and those who have undergone bariatric surgery. The authors review the available evidence and outline current recommendations to help guide the appropriate use of DOACs in these patients.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 6","pages":"353-361"},"PeriodicalIF":3.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Allopurinol hypersensitivity is rare, bad, and partially avoidable, but allopurinol can still be used effectively.","authors":"Brian F Mandell","doi":"10.3949/ccjm.92b.06025","DOIUrl":"https://doi.org/10.3949/ccjm.92b.06025","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 6","pages":"326-328"},"PeriodicalIF":3.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maximilian C Volk, Bianca Honnekeri, Joanna Ghobrial, Mazen Hanna, Sanjeeb Bhattacharya, Lee Kirksey, J Emanuel Finet, Heba Wassif
High-output heart failure can be a complication of having an arteriovenous fistula (or graft) for hemodialysis access. This review details the pathophysiology, diagnosis, and management of this serious but underdiagnosed condition.
{"title":"High-output heart failure from arteriovenous dialysis access: A structured approach to diagnosis and management.","authors":"Maximilian C Volk, Bianca Honnekeri, Joanna Ghobrial, Mazen Hanna, Sanjeeb Bhattacharya, Lee Kirksey, J Emanuel Finet, Heba Wassif","doi":"10.3949/ccjm.92a.24114","DOIUrl":"https://doi.org/10.3949/ccjm.92a.24114","url":null,"abstract":"<p><p>High-output heart failure can be a complication of having an arteriovenous fistula (or graft) for hemodialysis access. This review details the pathophysiology, diagnosis, and management of this serious but underdiagnosed condition.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 6","pages":"362-371"},"PeriodicalIF":3.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nitrogen: The unsung hero of vascular physiology.","authors":"Adam J Brown","doi":"10.3949/ccjm.92a.24120","DOIUrl":"https://doi.org/10.3949/ccjm.92a.24120","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 6","pages":"344-346"},"PeriodicalIF":3.4,"publicationDate":"2025-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144207822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Do I need to treat supine hypertension in my hospitalized patient?","authors":"Katherine Sherman, Robert Lichtenberg","doi":"10.3949/ccjm.92a.24092","DOIUrl":"https://doi.org/10.3949/ccjm.92a.24092","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 5","pages":"285-289"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143970930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pulmonary embolism (PE) has a significant impact on right-sided heart function. Clinical presentation can range from no involvement of the right ventricle to right ventricular dysfunction, cardiogenic shock, and even cardiac arrest. The authors explore the pathophysiology of PE-induced right ventricular failure, emphasizing the mechanisms by which PE contributes to dysfunction, current diagnostic tools for risk stratification, and the importance of timely diagnosis. The primary focus is on strategies for managing right ventricular failure secondary to PE, including medical, percutaneous interventional, and surgical options. Recent advances in the field are also noted, including emerging therapies and evolving treatment algorithms.
{"title":"Managing right ventricular failure in the setting of pulmonary embolism.","authors":"Sharmeen Sorathia, Anibelky Almanzar, Abhishek Bhandiwad, Phoo Pwint Nandar","doi":"10.3949/ccjm.92a.24069","DOIUrl":"https://doi.org/10.3949/ccjm.92a.24069","url":null,"abstract":"<p><p>Pulmonary embolism (PE) has a significant impact on right-sided heart function. Clinical presentation can range from no involvement of the right ventricle to right ventricular dysfunction, cardiogenic shock, and even cardiac arrest. The authors explore the pathophysiology of PE-induced right ventricular failure, emphasizing the mechanisms by which PE contributes to dysfunction, current diagnostic tools for risk stratification, and the importance of timely diagnosis. The primary focus is on strategies for managing right ventricular failure secondary to PE, including medical, percutaneous interventional, and surgical options. Recent advances in the field are also noted, including emerging therapies and evolving treatment algorithms.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 5","pages":"301-309"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143986020","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Karthik Meiyappan Udayappan, Christopher V Anstine
{"title":"What diagnostic tests should be done after discovering clubbing in a patient without cardiopulmonary symptoms?","authors":"Karthik Meiyappan Udayappan, Christopher V Anstine","doi":"10.3949/ccjm.92a.24052","DOIUrl":"https://doi.org/10.3949/ccjm.92a.24052","url":null,"abstract":"","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 5","pages":"273-276"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Zehra Naseem, Aun Muhammad, Arjun Chatterjee, Alberto Rubio-Tapia
Alpha-gal syndrome is an emerging condition characterized by an immunoglobulin (Ig) E-mediated reaction to galactose-alpha-1,3-galactose (alpha-gal) after consumption of mammalian-derived food products. Identified in the early 2000s, the syndrome is linked to sensitization through tick bites; in the United States, the lone star tick (Amblyomma americanum) is the main vector. Symptoms range from pruritus and hives to severe systemic reactions like anaphylaxis, and typically occur 3 to 8 hours after eating meat. Diagnosis involves a history of consistent symptoms, positive alpha-gal IgE serology, and dietary exclusion trials. Management focuses on avoiding foods and products that contain alpha-gal and preventing tick bites.
{"title":"Alpha-gal syndrome: Recognizing and managing a tick-bite-related meat allergy.","authors":"Zehra Naseem, Aun Muhammad, Arjun Chatterjee, Alberto Rubio-Tapia","doi":"10.3949/ccjm.92a.24072","DOIUrl":"10.3949/ccjm.92a.24072","url":null,"abstract":"<p><p>Alpha-gal syndrome is an emerging condition characterized by an immunoglobulin (Ig) E-mediated reaction to galactose-alpha-1,3-galactose (alpha-gal) after consumption of mammalian-derived food products. Identified in the early 2000s, the syndrome is linked to sensitization through tick bites; in the United States, the lone star tick (<i>Amblyomma americanum</i>) is the main vector. Symptoms range from pruritus and hives to severe systemic reactions like anaphylaxis, and typically occur 3 to 8 hours after eating meat. Diagnosis involves a history of consistent symptoms, positive alpha-gal IgE serology, and dietary exclusion trials. Management focuses on avoiding foods and products that contain alpha-gal and preventing tick bites.</p>","PeriodicalId":10245,"journal":{"name":"Cleveland Clinic Journal of Medicine","volume":"92 5","pages":"311-319"},"PeriodicalIF":3.4,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143955276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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