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Riesman's sign or Snellen-Riesman's sign is a clinical sign characterized by bruit heard over the closed eye with a stethoscope in Graves' ophthalmopathy (thyroid eye disease or Graves' orbitopathy or thyroid-associated orbitopathy) in thyrotoxicosis. The bruit is audible during systole. , (Copyright © 2021, StatPearls Publishing LLC.)

Peripheral line placement, also referred to as peripheral intravenous (IV) cannulation, is the insertion of an indwelling single-lumen plastic conduit across the skin into a peripheral vein. Such devices may be referred to as peripheral IV (or venous) lines, cannulas, or catheters depending on the country. They allow fluids, medications and other therapies such as blood products to be introduced directly into the cardiovascular system, bypassing other barriers to absorption and reaching most target organs very quickly. Once inserted, a well-functioning line can remain in use for several days if required, obviating the need for repeated needle insertion into the patient should ongoing treatment be needed. Placement of peripheral lines is the most commonly performed invasive procedure in acute healthcare settings with as many as 80% of hospital inpatients requiring intravenous access at some stage during their admission, and worldwide more than 1 billion lines are used annually.[1][2] This article focuses on anatomical landmark-guided techniques for peripheral line placement. Lines may also be placed using real-time ultrasound guidance, which is particularly beneficial for those with suspected difficult access or multiple failed attempts at cannulation.[3], (Copyright © 2021, StatPearls Publishing LLC.)

Endocarditis is an uncommon infection occurring every 3 to 7 per 100000 person-years. Yet, it is also the fourth most common life-threatening infection after sepsis, pneumonia, and intraabdominal abscess, with an estimated inpatient mortality rate between 15 to 30%. When endocarditis was first widely studied in the 1960s, streptococcus viridian was the most commonly identified pathogen. However, the epidemiology has shifted, with Staphylococcus aureus being the most frequently identified pathogen. While this shift is partially attributable to an increased rate of intravenous drug abuse in North America, the healthcare-associated infection has become increasingly common, representing about 30% of all endocarditis cases. The management of endocarditis requires an interprofessional approach by infectious disease, cardiology, and cardiac surgery to manage antimicrobial therapy and assess for possible surgical intervention.[1] Early consultation with cardiothoracic surgery has been shown to improve mortality and is mandatory in patients presenting with complications. Approximately 50% of patients with endocarditis will require some form of surgical intervention.[2] According to the American Heart Association recommendation, a consult with an infectious disease expert should occur before initiating empiric antibiotic therapy due to the many nuances associated with treating endocarditis. Vegetations contain densely packed bacteria interlocked within a biofilm composed of fibrin and platelets, which creates a mechanical barrier limiting antibiotic penetration. Each antibiotic class has differing pharmacological properties which influence the rate of diffusion, distribution, and ability of the antibiotic to penetrate the vegetation, which ultimately determines the bactericidal efficacy. The duration of therapy for successfully eradicating bacteria has its basis in the bactericidal action of the specific antibiotic, minimal inhibitory concentration, pathogen, vegetation burden, and area of involvement. The duration of treatment can range from 2 to 6 weeks. The American Heart Association 2015 Adult Infective Endocarditis guidelines and European Society of Cardiologists 2015 management of infective endocarditis guidelines serve as the basis for the following recommendation.[2][3] The treatment of endocarditis should be pathogen-directed and directed by blood cultures and antibiotic sensitivities. Therefore it is imperative to obtain at least two separate blood cultures (preferably three) from two different venous sites for targeted antibiotic therapy before administering antibiotics. Blood cultures ideally should be repeated every 24 to 48hrs until they are negative. Patients should undergo assessment for clinical response to antibiotics. Most patients become afebrile within 3 to 5 days of appropriate antibiotics. In patients who present with an indolent, uncomplicated course, antibiotic therapy can be delayed until cultures and sensitivities are available. However, in patients with a more acute presentation or features of complicated endocarditis, prompt empiric treatment is often required to reduce the risk of complications. The recommendation is for an Infectious disease consultation when selecting empiric antibiotic therapy as various factors influence the choice of empiric antibiotics, including patients characteristics and risk factors, epidemiological factors, recent administration of antibiotics, whether the infection was healthcare-associated, and severity of presentation., (Copyright © 2021, StatPearls Publishing LLC.)

Hypertensive heart disease refers to a constellation of changes in the left ventricle, left atrium, and coronary arteries as a result of chronic blood pressure elevation. Hypertension increases the workload on the heart inducing structural and functional changes in the myocardium. These changes include hypertrophy of the left ventricle, which can progress to heart failure. Patients with left ventricular hypertrophy have significantly increased morbidity and mortality, but current treatment follows standard hypertension guidelines as the effects of pharmacotherapy on regression of left ventricular hypertrophy has unclear benefits. Hypertensive heart disease is subclassified by the presence or absence of heart failure as the management of heart failure requires more intensive goal-directed therapy. Hypertensive heart disease can lead to either diastolic heart failure, systolic failure, or a combination of the two. Such patients are at a higher risk for developing acute complications such as decompensated heart failure, acute coronary syndrome, or sudden cardiac death. Hypertension disrupts the endothelial system which increases the risk of coronary artery disease and peripheral arterial disease and thus represents a significant risk factor for the development of atherosclerotic disease. However hypertensive heart disease ultimately encompasses all of the direct and indirect sequelae of chronic high blood pressure which include systolic or diastolic heart failure, conduction arrhythmia especially atrial fibrillation, and increased risk of coronary artery disease., (Copyright © 2021, StatPearls Publishing LLC.)