Cardiovascular Disease

Plants of the genus Digitalis are the source of digoxin. Historical evidence of pharmacological use of purple foxglove (Digitalis purpurea) is documented as early as 1250, when it was used as a recipe for headache. Its topical form was used in 1466 for wound healing. In 1785, Dr. William Withering, an English physician and botanist, analyzed approximately 200 cases, mostly with “dropsy” in his An Account of the Foxglove and Some of its Medical Uses: With Pract

One of the major health concerns for older persons is their potential risk for serious cardiovascular events, a risk that rises dramatically with increasing age.1,2 For example, the average annual rate of first major cardiovascular events rises from 7 per 1000 men at ages 35-44 years to 68 per 1000 men at ages 85-94; comparable rates occur in women 10 years later in life.3

Coronary heart disease (CHD) is more prevalent in the elderly, with over 83% of cardiovascular disease deaths in the United States occurring in individuals age 65 years or older.4 Individuals in the sixth decade of...

INTRODUCTION
Hypertension has been associated with an increased risk of stroke, vascular dementia, and Alzheimer’s disease.1-10 Cerebral infarcts, lacunae, and white matter changes are implicated in the pathogenesis of vascular dementia, but also may lead to the development of Alzheimer’s disease.11 Microcirculatory disorders and endothelial dysfunction also may cause a deterioration in cognitive function in persons with hypertension.11 The Epidemiology of Vascular Aging study showed that hypertension is a major risk factor for severe white matter hyperin

CASE PRESENTATION
A 62-year-old functional but cachectic male, who was able to ambulate with a walker, presented to the emergency department (ED) with a temperature of 102.3 degrees F, and neck and low back pain. The patient reported having had subjective fever and chills at home starting 1 week prior to the hospital visit. He also reported generalized fatigue, occasional shortness of breath, and a 20-pound weight loss over 2 weeks. There were no reported changes in mental status. The patient did have a recent history of having had a left carotid sinus takedown with removal of the opt...

CME ARTICLE
ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should c...

CME ARTICLE

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should ...

ACCREDITATION
The Johns Hopkins University School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Johns Hopkins University School of Medicine takes responsibility for the content, quality, and scientific integrity of this CME activity.

CREDIT DESIGNATION STATEMENT
The Johns Hopkins University School of Medicine designates this educational activity for a maximum of 1.0 category 1 credit toward the AMA Physician’s Recognition Award. Each physician should claim only those ho...

Older persons are more likely to have hypertension and isolated systolic hypertension. They are also more likely to have target organ damage and clinical cardiovascular disease, and to develop cardiovascular events. Finally, the reality is that they are also less likely to have their hypertension controlled. Consequently, the need for antihypertensive treatment in this patient population remains crucial. The use of such drug therapy results in a reduction of coronary events, stroke, and heart failure in older persons.

This article examines the evidence supporting the incidence and p...

Case Presentation

A 67-year-old man visits his primary care physician with the chief complaint of erectile dysfunction (ED). He has a two-year history of inability to achieve and maintain an erection adequate for vaginal penetration. He has a decrease in the frequency of nocturnal and early morning erections. He has tried sildenafil 50 mg on several occasions without any improvement in his sexual performance. He also reports lethargy, a decrease in his libido, and falling asleep after meals.

He has a history of borderline hypertension and elevated total cholesterol. He is a sm...