Introduction: Intramural esophageal hematoma is a rare condition presenting with dysphagia, nausea and mid epigastric or retrosternal chest pain. We present a unique case of spontaneous esophageal hematoma in a patient anticoagulated with apixaban for atrial fibrillation. Case presentation: An 88-year-old woman with history of hypertension, hypothyroidism, persistent atrial fibrillation on apixaban presented to emergency department with sudden onset epigastric pain, dysphagia and nausea without vomiting while having dinner. Physical examination was unremarkable except for mild tenderness in the epigastric region. Initial workup including complete blood count, complete metabolic panel, lipase, troponin was unremarkable. EKG showed atrial fibrillation with no ischemic changes. CT chest showed abnormal hyperdense mass-like thickening approximately 4 x 3 x 12 cm involving the mid/distal thoracic esophagus with possible differentials being food bolus, esophageal hematoma or mass. Prothrombin complex concentrate (Kcentra) was given as patient was on apixaban and gastroenterology was consulted for upper endoscopy which showed a large hematoma occupying most of the esophageal lumen at the entire length of esophagus. After family discussion on stroke-versus-bleeding risk with anticoagulation, cardiology recommended holding anticoagulation for at least a month and future evaluation for WATCHMAN device. With stable hemoglobin and gradual advancement to a soft diet, patient was discharged home with repeat endoscopy planned in two weeks. Conclusion: Spontaneous esophageal hematoma, although rare in incidence, should be identified as a differential diagnosis in a patient on anticoagulation presenting with chest pain. Literature shows a higher incidence of this complication in women. Timely diagnosis and management along with discontinuing anticoagulation can significantly lower morbidity and mortality and overall has favorable prognosis.
Introduction: Increasing the prevalence of the ideal cardiovascular health (CVH) phenotype over the coming decades would likely result in dramatic improvements in healthy longevity and reductions in healthcare costs. Therefore, it is of paramount importance to understand the global prevalence and trends of the ideal CVH behaviors and factors for monitoring progress and providing evidence to support policy efforts. Hypothesis: We aim to describe the prevalence of CVH for the AHA defined metrics of tobacco use, body mass index, total cholesterol, blood pressure and glucose levels, and estimate its trends worldwide. Methods: We used data from people aged > 20 years who participated in 68 national health examination surveys from 1983 to 2017 in 18 countries: Australia, Czech Republic, Denmark, Germany, Greece, Ireland, Italy, Malaysia, Mexico, Poland, Seychelles, Slovakia, South Korea, Spain, Sweden, Turkey, the UK, and the USA. We calculated age-standardized prevalence of ideal CVH (no current smoking, BMI < 25 kg/m2, untreated TC < 200 mg/dL, untreated BP < 120 / < 80 mmHg, and absence of diabetes mellitus). Additionally, we examined the trends of the ideal CVH for countries that had at least two individual-level national surveys in two different decades (2000-2009 vs 2010-2019). Results: With the exception of Australia and South Korea, age-standardized prevalence of idea CVH was lower than 10% in women and lower than 5% in men across all countries. Older individuals had a lower prevalence of Ideal CVH than younger ones. Those over 65 years of age had a prevalence almost equal to zero. In ages 35-64 years, ideal CVH prevalence ranged from 3.6% to 25.4% among women, and from 0.6% to 7.1% among men. For the 10 countries where trends were estimated by age-sex groups, ideal CVH prevalence did not change or declined in the selected middle-income countries and increased in the selected high-income countries except for South Korea, where it plateaued for men and declined for women. Conclusions: Prevalence of ideal CVH worldwide is low and is declining for adults in middle-income countries in recent decades.
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