Previously the subject of much debate, there is now consensus that diastolic heart failure (DHF) represents a distinct form of heart failure. Epidemiologic data indicate that DHF is common. Indeed, there is evidence that, among elderly persons, DHF is more common than systolic heart failure (SHF). Like SHF, DHF is associated with significant morbidity, mortality, and cost; however, few clinical trials focusing on isolated DHF have been completed. Much of the treatment of DHF is based on current concepts of the pathophysiology of DHF, small clinical studies, and experience gained from treating patients with SHF. The diagnosis of DHF is clinical; data supporting the establishment of a diagnosis of DHF are limited. Differences exist in prognosis and treatment between diastolic and systolic heart failure. This article reviews diastolic heart failure with emphasis on evidence-based management, aimed at primary care physicians who routinely provide care to patients with DHF. (J Am Board Fam Pract 2005;18:189 -98.)

Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes?

A 28-year-old right-handed man tripped down a flight of stairs, landing on his outstretched right hand. He developed immediate pain, swelling, and stiffness but did not seek medical attention. After 1 week without relief, he went to see his primary care provider. The patient did not have numbness or tingling, and he reported no previous injuries to the wrist. X-rays were obtained (figure 1), and the patient was referred to an orthopedist for further evaluation.

No abstract