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Joseph S. Alpert

How Can We Improve the Management of Patients with Hypertension?

Hypertension continues to be a major health problem in the United States, affecting more than 76 million US citizens. Despite marked improvement in detection and therapy of patients with hypertension over recent decades, substantial morbidity and mortality still occur, especially in the Southeastern United States. Hypertension detection programs are common throughout the country and can […]

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Chest Pain in a 39-Year-Old Man: What Could Be the Underlying Cause?

  A 39-year-old man with unremarkable past medical history, but with a positive family history for coronary artery disease, was admitted to the hospital because of persistent arterial hypertension and sudden-onset chest pain in the mid-substernal region with neck radiation. Assessment Results from physical examination were unremarkable. The 12-lead electrocardiogram and the cardiac biomarkers were […]

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Inside Out: Bone Marrow Necrosis and Fat Embolism

  Neurologic symptoms initially attributed to infection were ultimately the result of a devastating hematologic condition. The patient, a 57-year-old woman, was rushed to the emergency department for somnolence and slurred speech. She had experienced low back pain during the preceding week. Her medical history was notable for a ventriculoperitoneal shunt placed several years ago […]

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The Sweatshirt Sign: Coronary Artery Disease

  In one memorable case, the patient’s attire told physicians more about his health than the initial interview and physical examination. A 65-year-old veteran with a history of dyslipidemia, hypothyroidism, and post-traumatic stress disorder presented for a routine primary care visit and had no symptoms. He specifically denied having any chest pain. Assessment When asked […]

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Significance of Comorbid Psychological Stress and Depression on Outcomes After Cardiac Rehabilitation

  Depression is associated with increased mortality in stable coronary heart disease. Cardiac rehabilitation and exercise training has been shown to decrease depression, psychological stress, and mortality after a coronary heart disease event. The presence of depression at completion of cardiac rehabilitation and exercise training is associated with increased mortality. However, it is unknown if […]

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