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Review Article
Current Concepts: The Autosomal Recessive Cerebellar Ataxias
The autosomal recessive cerebellar ataxias are a group of little known and often neglected diseases that are best understood by following a practical, multidisciplinary approach that focuses on clinical rather than molecular considerations. This review focuses on the main forms in which cerebellar…
- CME
- Video
Original Article
Truncations of Titin Causing Dilated Cardiomyopathy
Gene mutation is an important cause of cardiomyopathy. Mutations in eight sarcomere-protein genes cause hypertrophic cardiomyopathy, detected in 40 to 70% of patients. Variations in more than 40 genes, most of which encode components of the sarcomere, the cytoskeleton, or the nuclear lamina, have…
Original Article
Cardiac Arrest during Long-Distance Running Races
Participation in long-distance running races has increased annually in the United States. In 2010, there were approximately 2 million participants in marathon and half-marathon races, as compared with fewer than 1 million participants in 2000. This increase has been driven in part by heightened…
- CME
Case Records of the Massachusetts General Hospital
Case 36-2011 — A 93-Year-Old Woman with Shortness of Breath and Chest Pain
Presentation of Case. Dr. Pooja Agrawal (Emergency Medicine): A 93-year-old woman was seen in the emergency department at this hospital because of chest pain and shortness of breath. The patient had been in her usual state of health, with hypertension and chronic renal insufficiency, until the…
- Video
Correspondence
Reversible Cardiomyopathy Associated with Sunitinib and Sorafenib
To the Editor: Tyrosine kinase inhibitors with potent properties against vascular endothelial growth factor (VEGF) signaling pathway (VSP inhibitors) are effective antitumor agents in metastatic renal-cell carcinoma and are now increasingly used in the treatment of other tumors. Although VSP…
- Free Full Text
Original Article
Brief Report: Inflammatory Skin and Bowel Disease Linked to ADAM17 Deletion
Inflammatory disorders of the skin and gut, including eczema, psoriasis, and celiac disease, have been linked to changes in barrier function and immune responses, by means of genetic and functional studies. Large case–control studies combined with genomewide association studies have identified…
Case Records of the Massachusetts General Hospital
Case 29-2011 — A 66-Year-Old Woman with Cardiac and Renal Failure
Presentation of Case. Dr. Jason E. Faris (Medicine): A 66-year-old woman was admitted to this hospital because of cardiac and renal failure. The patient had been well until approximately 6 months earlier, when dyspnea on exertion and leg edema developed. A diagnosis of congestive heart failure was…
- CME
Correspondence
Eosinophil Granule Protein Localization in Eosinophilic Endomyocardial Disease
To the Editor: A 70-year-old man with chronic renal disease, splenomegaly, and eosinophilia presented with transient weakness in the left arm, visual disturbances, disequilibrium, and anomia. Magnetic resonance imaging of the brain showed findings consistent with numerous, small embolic strokes.…
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Clinical Therapeutics
Antitrypanosomal Therapy for Chronic Chagas' Disease
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
- CME
Review Article
Mechanisms of Disease: Inherited Cardiomyopathies
Inherited cardiomyopathies are a major cause of heart disease in all age groups, often with an onset in adolescence or early adult life. Not only the patients but also their families can be severely burdened by these illnesses. More than 20 years ago, the first "disease gene" for hypertrophic…
Original Article
Myocardial Viability and Survival in Ischemic Left Ventricular Dysfunction
Coronary artery disease is an important contributor to the rise in the prevalence of heart failure and in associated mortality and morbidity.– It has not been clearly established whether coronary-artery bypass grafting (CABG) has a role in improving the symptoms and the rate of survival of…
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- CME
Original Article
Coronary-Artery Bypass Surgery in Patients with Left Ventricular Dysfunction
It is estimated that 5.8 million patients in the United States and 15 million in Europe have heart failure. Coronary artery disease is the most common substrate for heart failure in industrialized nations. However, the role of coronary-artery bypass grafting (CABG) in the treatment of patients with…
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- CME
Editorial
Underestimating Medical Therapy for Coronary Disease . . . Again
The question of how best to treat patients with multivessel coronary artery disease and left ventricular dysfunction has challenged physicians for years. Although most clinicians are comfortable recommending revascularization when there is angina, extensive coronary disease, and a left ventricular…
Case Records of the Massachusetts General Hospital
Case 11-2011 — A 47-Year-Old Man with Systemic Lupus Erythematosus and Heart Failure
Presentation of Case. Dr. Caroline L. Sokol (Medicine): A 47-year-old man with systemic lupus erythematosus (SLE) and progressive cardiac failure was transferred to this hospital after a cardiac arrest. One year before admission, dyspnea, leg edema, and abdominal distention gradually developed, and…
- Video
Case Records of the Massachusetts General Hospital
Case 6-2011 — A 77-Year-Old Man with Dyspnea, Weakness, and Diaphoresis
Presentation of Case. Dr. Gyanprakash A. Ketwaroo (Medicine): A 77-year-old man with a history of ischemic cardiomyopathy was admitted to this hospital in midspring because of increasing dyspnea, weakness, and diaphoresis. The patient had been in his usual state of health until 3 days before…
Clinical Therapeutics
Iron-Chelating Therapy for Transfusional Iron Overload
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
- CME
- Interactive/Multimedia
Clinical Implications of Basic Research
Reprogramming Fibroblasts into Cardiomyocytes
A deficiency of cardiomyocytes underlies most cases of heart failure, and scientists have long sought to repopulate the heart with new cardiomyocytes. Most attempts at remuscularization have been based on the transplantation of stem cells or their derivatives, and success has been modest to date. A…
Clinical Problem-Solving
A Heavy Heart
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 73-year-old man presented with a…
- CME
Original Article
Myocardial Fibrosis as an Early Manifestation of Hypertrophic Cardiomyopathy
Hypertrophic cardiomyopathy is caused by mutations in genes encoding sarcomere proteins. With a prevalence of approximately 1 case per 500 persons in the general population, hypertrophic cardiomyopathy is the most common monogenic cardiac disorder. The clinical diagnosis depends on the…
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Clinical Problem-Solving
Thinking Inside the Box
Foreword. In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows. Stage. A 62-year-old woman presented to a…
- CME






