Cardio Buzz

Is low blood pressure hindering your heart failure treatment? How do you balance life-saving medications with hypotension? We explore the definitions, causes, and practical solutions to optimize patient care. Learn how to navigate ARNI, beta-blockers, SGLT2 inhibitors, and MRAs effectively.

In this episode of Cardio Buzz, we explore the intriguing concept of the 'legacy effect' of medications like those used in treating diabetes, hypertension, hypercholesterolemia, and chronic kidney disease. We'll delve into landmark studies like the UKPDS, Steno-2, and more, examining the lasting impacts of medications such as Repatha, Candesartan, and Empagliflozin. Learn how these drugs contribute to disease regression, modify genes, and prevent non-fatal events to grant long-term protective effects. 00:00 Introduction: The Challenge of Lifelong Medication 00:57 Exploring the Legacy Effect of Medications 01:33 Diabetes Medications: Long-Term Benefits 03:15 Hypertension Medications: Persistent Effects 03:58 Cholesterol Medications: Lasting Impact 04:49 Kidney Disease Medications: Prolonged Benefits 06:12 Understanding the Legacy Effect Mechanism 09:13 Implications and Final Thoughts

"This week, we delve into the complexities of Familial Hypercholesterolemia (FH) diagnosis and challenge the conventional Dutch Lipid Clinic Network Score.

Join us in this episode of Cardio Buzz as we bring you the latest updates from the European Society of Cardiology conference held in London. Discover groundbreaking clinical trials and new guidelines that promise to reshape the practice of cardiology. We will break down the ten most impactful clinical trials and four new guidelines on hypertension, chronic coronary disease, atrial fibrillation, and peripheral/aortic diseases. Stay ahead in your field with our concise and insightful analysis. Subscribe, like, and hit the notification bell to stay informed on all cardiology advancements. 00:00 Introduction to the European Society of Cardiology Conference 00:59 Top 10 Late-Breaking Clinical Trials 04:41 New Guidelines Overview 05:38 Hypertension Guidelines 09:30 Chronic Coronary Artery Disease Guidelines 15:08 Peripheral Arterial and Aortic Disease Guidelines 20:33 Atrial Fibrillation Guidelines 23:58 Conclusion and Next Steps

In this episode of Cardio Buzz, the discussion focuses on the potential of stem cell therapy to transform cardiology. Host Dr. Hussain interviews Dr. Yahya Kiwan, an experienced cardiologist and stem cell research advocate. They explore the application of stem cells in treating advanced heart conditions, including post-myocardial infarction and chronic heart failure. The episode covers the sources of stem cells, their harvesting and injection techniques, clinical trial results, and success stories. Dr. Kiwan addresses the ethical considerations and the future of regenerative medicine, emphasizing the need for greater awareness and education in the field. The episode concludes with information on upcoming educational opportunities and fellowships in regenerative cardiology. 00:48 The Promise of Stem Cells in Cardiology 01:31 Interview with Dr. Yahya Kiwan 04:13 Sources and Types of Stem Cells 05:55 Stem Cell Therapy Techniques 10:45 Current Applications and Success Stories 17:18 Future Perspectives and Ethical Considerations 19:38 Learning More About Regenerative Medicine 21:20 Conclusion and Next Steps

In this episode of CardioBuzz, host Dr. Hussien discusses advanced CPR techniques and challenges from a cardiologist's perspective, featuring Dr. Naeem Toosy, a consultant in emergency medicine. The conversation delves into critical aspects like when to stop resuscitation, use of mechanical circulatory support devices, and the effectiveness of mechanical chest compression devices. Dr. Tusi outlines the significance of early recognition, the role of the public in initiating CPR, and the potential benefits of ECMO during CPR. He underscores the need for national-level education on CPR and the importance of the Good Samaritan law in encouraging public intervention during cardiac arrests. 00:00 Introduction to CardioBuzz 00:08 Overview of CPR Challenges 00:33 Introducing Dr. Naeem Toosy 01:36 Importance of Brain Resuscitation 03:11 When to Stop Resuscitation 06:20 Mechanical Chest Compression Devices 07:49 ECMO in CPR 13:04 National Strategies to Reduce Cardiovascular Mortality 18:04 Conclusion and Final Thoughts

In this episode of Cardio Buzz, host and guest Dr. Daniel Jones discuss contrast nephropathy, a kidney injury caused by contrast agents used in medical imaging, and a promising intervention to reduce its incidence. Dr. Jones explains that inorganic nitrates, which are naturally found in green leafy vegetables, have shown significant potential in preventing contrast-induced nephropathy and associated acute kidney injuries in a recent study. This study involved 640 high-risk patients and demonstrated that inorganic nitrates reduced kidney injuries by 60% and improved long-term cardiovascular outcomes. The episode concludes with a conversation about the practical implications and future research plans for this intervention.

Microplastics are small pieces of plastic less than five millimeters in size that result from the degradation of larger plastic items. Derived from synthetic materials such as polyethylene and polyvinyl chloride, plastics are known for their durability and low cost but pose significant environmental and health risks due to their inability to biodegrade. Microplastics, including even smaller nanoplastics, are found everywhere - in our food, water, air, and even within the human body, where they can be ingested, inhaled, or absorbed through the skin. Italian researchers published their work in March 2024, found microplastics in the atherosclerotic plaques of patients with carotid artery stenosis. This presence of micro and nanoplastics was associated with higher levels of inflammation and an increased risk of heart attacks and strokes. While this finding indicates a correlation rather than causation, it raises concerns about the potential health impacts of microplastics. We provide practical advice on minimizing exposure to microplastics, such as avoiding single-use plastics, choosing products with minimal or no plastic packaging, and opting for natural fibers over synthetic ones.   00:00 Introduction to Plastics: Types and Properties 00:26 The Environmental and Health Impact of Microplastics 01:39 Investigating Microplastics in Human Arteries: A Groundbreaking Study 02:25 Study Findings: Microplastics in Atherosclerotic Plaques 03:12 Implications of the Study: Association vs. Causation 03:44 Practical Steps to Minimize Microplastic Exposure 04:47 Conclusion: The Challenge of Avoiding Microplastics  

With #diabetes projected to affect 783 million patients globally, understanding its connection to #coronary disease, #heartfailure , and #kidneydisease is crucial. We explore the latest guidelines from the European Society of Cardiology and break down the essentials, from diabetes diagnosis to cardiovascular risk assessment, lifestyle modifications, glucose-lowering medications, and other topics.  #heart #healthcare #medicine #doctor #nurse #medical #coronavirus #covid19 #healthylifestyle #hospital #mentalhealth #dentistry #pharmacy #surgery #healthtips #weightloss #fitness #workout #diet #nutrition #exercise #wellness #selfcare #prevention #disease #treatment #research

لدينا جميعاً شعور أن حالات الموت المفاجئ ☠️ دون سابق إنذار قد زادت  بين أوساط الشباب والرياضيين

في قديم الزمان ، كان البشر يعتقدون أن أقدارهم محددة في النجوم والأفلاك والكواكب ولايزال الكثير ممن أعرفهم يعتقدون أن أبراجهم الفلكية ترسم شخصياتهم وتحدد مصيرهم في الحياة  أما في الطب الحديث، وبدلاً من رسم خرائط الأبراج الفلكية ، يمكننا رسم خرائط للجينات.  وقد خريطة الجينات هذه على التنبؤ بمن سيمرض ومتى سيمرض وبأي مرض سيصاب.  ولكن أيهما أكثر تأثير على خطر الإصابة بأمراض القلب؟ جودة الجينات أم جودة العادات؟  هل يمكن إن وَرّثنا آباؤنا طفرات جينية واقية أن تحمينا من أثر العادات الصحية السيئة؟  وعلى العكس هل يمكن لنمط الحياة الصحي أن يحد من تأثير الطفرات الجينية المؤذية الموروثة؟

Welcome to ESC this year from Amsterdam, the city known of charming canals, cycling, and attractive architecture. There were 5 new guidelines, tens of session and 30 late-breaking clinical trials. In this episode, I've handpicked just seven trials. The choice was made based on the importance of the topics, the ability of the results to shake up the practice and challenge some cardiology dogmas. Some of the trials were positive, others were negative, but we learn in both cases. I'll be presenting the trials in ascending order of importance, saving the most impactful one for last. Here we go...

هل يجب أن نتناول الأسبرين بعد سن الأربعين لمنع النوبات القلبية والسكتات الدماغية أم لا؟ هل هو مفيد أم مضر؟

تستوستيرون هو هرمون الذكورة الذي يمنح الرجال القوة والدافع والعزيمة لتحقيق الأهداف. انخفاض مستويات التستوستيرون يؤدي الى فتور الرغبة الجنسية وضعف الانتصاب والإرهاق وضعف العضلات والاكتئاب والدوار وانخفاض كثافة العظام.  هل يؤثر ذلك على صحة القلب؟ ماذا يحدث إذا قمنا بتصحيح نقص التستوستيرون باستخدام التستوستيرون الخارجي؟ هل سيؤذي القلب أم يشفيه؟ ماذا تخبرنا أحدث الأبحاث عن تعويض التستوستيرون وتأثيره على القلب؟

Hypertension affects one third of humans. Untreated hypertension, shortens life expectancy by five years because it's a major cause of heart failure, renal failure, strokes, and coronary disease. The mortality due to hypertension has increased  more than 30% in the last three decades. And the sad fact is that hypertension is uncontrolled in the majority of hypertensive patients, but it seems there's a breakthrough treatment. Angiotensinogen is a protein, it's mainly produced by the liver. If we stop the production of Angiotensinogen in the liver, then the whole. Renin angiotensin system will be silenced. And we have the results of the study on DNA silencing available. 

Testosterone is the primal essence of manhood. Testosterone is the gift that gives men the strength, the drive, and the resolve to achieve goals. It's part of what makes man a man.   But what happens when testosterone levels drop? Does that affect the heart's health? What happens if we correct testosterone deficiency with exogenous testosterone? Will it damage the heart or heal it?  What does the latest research on testosterone replacement tell us? 

What is the difference between cholesterol and LDL cholesterol?  What evidence do we have that link cholesterol and heart disease? How convincing is that evidence? Is it a myth created by the drug industry or is it a fact backed by science? Let's answer all of these questions in this episode

 I've got several questions and comments all related to the cause of atherosclerosis. Most of the questions and comments were skeptical and  doubting the causal effect of cholesterol atherosclerosis. In this episode we elaborate more on how modern science arrives at conclusions on the cause of diseases, especially chronic degenerative diseases like atherosclerosis.

Vaping, or electronic cigarette use, is becoming increasingly popular, especially among youth and young adults. While it is perceived as safer than tobacco cigarettes, the exact composition of the liquids used in e-cigarettes is not publicly known, making it difficult to predict the health effects. E-cigarette contents include nicotine, flavors, chemical additives, and a solvent. Studies have shown that vaping can have negative effects on cardiovascular health, such as higher arterial stiffness, impaired endothelial function, and increased blood pressure. However, clinical studies were inconclusive, and long-term trials were not available. It is also unclear if e-cigarettes can be effectively used for smoking cessation. We reviewed the contents of the vape, the latest literature, and the statement from the American heart association on electronic cigarettes, and here are the facts.

Lipoprotein a is a molecule produced by the liver, similar to LDL in structure, with a peculiar protein that gives it wide variability.Elevated lipoprotein little (a) is causal of atherosclerotic disease, recurrent strokes, and aortic calcification. Smaller forms of LPa are riskier. LPa is not a risk factor for venous thromboembolismThe levels are determined genetically with minimal impact from lifestyle.Normal values are 125 nmol/L)Levels should not be converted from mg to mmol or vice versaLevels should be measured once in the lifetimeThe excess risk of LPa elevation can be mitigated by additional LDL lowering and tighter CV risk factor control.PCSK9i(s) reduces the levels by 25%, but they are not approved for this indication.Aspirin may be beneficial as primary prevention in individuals with genetic variants that elevate LPa.Specific therapies are being developed to lower LPA by >70% and may be released three years from now.

Sleep is the single most effective way to reset our brain and body health each day. Sleep is a foundational element of human biology and is a requirement for life. We spend roughly one-third of our lives asleep. A famous quote is, “Happiness is nothing more than getting enough sleep”. Sleep disturbance is a common condition in modern society, with evidence showing that people sleep on average 1.5 hr less than a century ago. one-third of the general population suffers from sleep-related problemsAnd now, we better understand the relationship between poor sleep and poor health, especially cardiovascular health. Just a couple of months ago, the American heart association added Sleep to the essential pillars of cardiovascular health. And in this episode, we will discuss sleep and heart health, what is good sleep, what is bad sleep, what's the risk of poor sleep, and we will end up with some advice on how to improve your sleep for a stronger heart. First, is there a relationship between the number of hours slept and CV health?Yes, we have clear data on this relationshipSleeping for less than six hours is associated with a 70% increase in mortality Sleeping 5 hr or less per night had a 2.3-fold greater risk of AMISleeping for less than four hours is associated with a 2.8 times increase in mortality Sleeping for nine hours or more was also associated with a 70% increase in mortality The ideal duration of sleep is between seven hours and eight hours because this has been associated with the best survival.During normal, healthy sleep, blood pressure drops by around 10-20%. This is known as nocturnal dipping, and research highlights its role in cardiovascular health. When we sleep, the blood pressure comes down, and the heart rate also goes down. This helps to unload the circulatory system and give rest to the heart. Poor sleep, whether from a lack of sleep or sleep disruptions, is associated with non-dipping, meaning that a person's blood pressure doesn't go down at night. Studies have found that elevated nighttime blood pressure is related to overall hypertension (high blood pressure). Not only hypertension but sleep disruption is also associated with an increased risk of diabetes, coronary atherosclerosis, and myocardial infarction. Add to that obesity risk; we can remember that we are more likely to feel hungry when we don't get enough sleep. All these conditions are increased with sleeping less than six hours or with sleeping more than nine hours. It is a U-shaped relation.We've understood the impact of sleep quantity on health, but what is the impact of poor sleep quality on health?We also know that difficulty falling asleep, nightmares, easily awakening from sleep, use of sleeping pills, and walking up tired are markers of poor sleep.Poor sleep quality was associated with subclinical cardiovascular disease and increased risk of cardiovascular disease. Sleep apnea, where there is airway obstruction resulting in loud snoring and apnea, is a well-established risk for resistant hypertension, heart failure, coronary disease, and atrial fibrillation.What's the mechanism linking sleep and poor cardiometabolic health?There are several potential mechanisms. Data show that a lack of sleep may increase sympathetic nervous system activity the next day; sleep deprivation also results in an inflammatory state and in increased salt intake, elevated cortisol levels, and insulin resistance. These changes all culminate in poor cardiometabolic health resulting in a cascade or a package of cardiovascular diseases. How to improve your sleep?First: Identify your ideal sleep durationThe general rule is 7-8 hours of daily sleep. But because this may vary, you can measure your own needed sleep hours this way… Try to get into bed at the time where you fall asleep within about 15 minutes, and wake up without an alarm clock, feeling rested, and having enough energy to carry you through the day. On average, the amount of sleep you get this way is probably the right amount of sleep for you. The American heart association elected to add sleep duration as an eighth metric to the formal definition of CVH. Metric: Average hours of sleep per night Scoring:
Points Level 100 7–

How can wearables and smartwatches guide the diagnosis and management of serious arrhythmias like atrial fibrillation and ventricular tachycardia?

Athletes also can have heart disease and can collapse in the field.How can wearable digital devices help an athlete who has suspected arrhythmia?

Smart gadgets are all around, in TVs, phones, cameras, cars, kitchens, and also on our skin! Bands, watches, rings, earbuds, and even shirts can monitor our bodies and give insights into our health and disease.The global Wearable Technology Market size was worth about 115.8 (USD billion) in 2021 and is predicted to grow to around 380.5 (USD billion) by 2028Wearables can measure the pulse and can even tell the heart rhythm. How can wearable technology's ability to monitor rate and rhythm help in medicine? How accurate are they? Can physicians rely on them in the diagnosis and treatment of abnormal heart rhythms (arrhythmia)? The European heart rhythm association (EHRA) has recently released a practical guide on the use of digital devices to detect and manage arrhythmia and we are here to review it.I will not discuss medical devices such as Holter monitors or implantable devices that can deliver therapy such as pacemakers and life vests as they are well established, are prescribed and used by a physician, and fall outside the scope of this episode. We will give an overview of Devices that anyone can buy and use outside the hospitals; types and advantages of eachClinical application to evaluate palpitation

How to tailor medicine for each and every individual person? Mixing clinical variables, genetic variants, and molecular profiles, all into Artificial Intelligence can lead to "Precision Medicine"...Interviewing Prof Maha Saber-Ayad, Professor of Pharmacology at Sharjah University on Pharmacogenomics and the quest for precision medicine.

Paris is not only the city of light, love, and culture but it is also the home of the biggest interventional cardiology meeting Paris Course on Revascularization PCR. Last week, the meeting was back in person after two years of COVID-imposed virtual attendance. Eight thousand attendees inside the “Palais de Congress”, tens of sessions, live cases, and industry stands. This version of Euro PCR celebrated 30 years of radial cath and 20 years of transcatheter aortic valve interventions (TAVI). I had the chance to attend, meet the experts, and present my cases. And I am here bringing to the cardio buzz audience, who couldn't make it to the conference, the hot topics, and the latest breaking trials from Paris.7. Robots invade the cath lab6 Simulate before you operate5 Leaving nothing behind4 Fewer wires in, more data out3 How long will the valve live?2 Snuff boxers punched in the DISCO1 A Patch to Stop Bleeding

Drawing a map of genes might help us predict who will get sick and when we will get sick of heart disease or cancer. And we have seen Angelina Jolie, the famous actress, going for a preventive mastectomy because she had a faulty gene for breast cancer. But Is it the inevitable destiny, or can we change it? Do genes decide who will have heart disease? Who is to be blamed for heart disease? The genes we inherit, or the environment where we grow and live?Can your good genes protect you from your unhealthy lifestyle? Can a good lifestyle buffer our faulty genes?Watch it

With all its health benefits, cheap, and with few side effects, Aspirin is in every house. Aspirin reduces mortality in acute myocardial infarction. It is intuitive to use it for prevention, not only for treatment. Some studies supported that practice.But in the 21st century, we realize that aspirin is a gastric irritant and can cause bleeding. We got better pain killers and more potent platelet inhibitors, and we started questioning aspirin's protective effect compared to other drugs. So what's the truth about Aspirin? Should people above 40 with no heart or vascular disease take Aspirin to prevent heart attacks and strokes or not? LinkedIn articleYouTube VideoAspirin Use to Prevent Cardiovascular Disease: US Preventive Services Task Force Recommendation Statement.” JAMA 327, no. 16 (April 26, 2022): 1577–84. https://doi.org/10.1001/jama.2022.4983https://www.cvriskcalculator.comhttps://www.uspreventiveservicestaskforce.org/uspstf/recommendation-topics

The new heart failure guidelines were released this month. Last week, we summarized staging, classification, and diagnostic workup points. You can find the contents of the first part as an audio in the last week of cardio buzz or on the Cardio Buzz Youtube channel.This week we will summarize the management of heart failure. Bring in your coffee because, again, this article will be rich in information and will need all our attention.Guidelines Full Text 

The AHA, ACC, and HFSA have all joined efforts and just released the latest guidelines on heart failure. If you are a clinician, a nurse, or a healthcare provider involved in the care of patients with HF then these guidelines are for you. The full text comes in a big document of 138 pages. I will summarize the main points here over two episodes. The first episode will be on staging, classification, clinical assessment, and diagnostic workup. The second episode will describe the basics of treatment. So bring in your coffee because the episode will be rich in information and will need all our attention.https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063

We all know that heart disease is the number 1 killer worldwide. And patients die either because of acute coronary syndromes (myocardial infarction) or because of left ventricular dysfunction (heart failure). And, as an interventionist, being trapped with both evils; severe coronary stenosis and left ventricular dysfunction is scary. The only solution then is usually revascularization but it also comes with risks of myocardial injury and impaired organ perfusion. There is already an entire system with bypass surgery that perfuses the organs while the heart is paralyzed, the bypass machine. Unfortunately, surgery is not always available, many patients refuse surgery, and others may be declined by the surgeons because of their high risk. Here, cath interventions are the only hope. In addition to the gadgets available to handle the coronary occlusions, there is a need for devices to support the circulation and blood pressure during cardiogenic shock or when the heart is stunned during complex coronary intervention. The last thing we want is to have a patient crashing on-table or shortly after.And to review these devices that support the heart and the circulation in complex PCI (I call them the guardian in the cath lab), I am glad to host today one of the International experts on complex coronary interventions and mechanical circulatory support. Dr. Lorenzo Azzalini. Dr. Azzalini is the Director of the Complex Coronary Interventions Program and associate professor of medicine at Virginia Commonwealth University, in Richmond, VA. Before joining VCU he was co-director of the chronic total occlusion program at San Raffaele Hospital in Milan, Italy. And San Rafaelle was one of the centers of excellence in Europe. Dr. Azzalini's clinical and research expertise is represented by chronic total occlusion PCI, atherectomy, mechanical circulatory support, and acute kidney injury after PCI. He has over 170 international publications, more than 3700 citations, has received numerous international awards, is a member of the editorial board of the Canadian Journal of Cardiology, Eurointervention, Cardiovascular Revascularization Medicine, and Minerva Cardiology and Angiology, and is a guest reviewer for other twenty journals. And he is a wiz inside the cath lab. I had the chance to work with him several times in the cath lab and I would describe his skills as amazing. 

Washington was calm, cold, and rainy in the first days of Ramadan but it was totally worth it because the American college of cardiology ACC meeting was back in person after two years of virtual attendance.In this episode of cardio buzz, we are bringing you, what we think are, the best late-breaking trials announced in the ACC meeting last week. More than 20 trials were announced as late-breaking as well as another bunch of featured clinical research. I decided to choose only 5 trials to present here. Choosing the top 5 articles was challenging. I chose the ones that I felt will have a bigger impact on your practice, bring in newer concepts, or change our views on medicine in general.Let's start the count downNumber 5; PROMPT-HFElectronic medical records changed the way we practice medicine. They have obvious advantages but I can't hide the fact that it makes us spend more time with screens than with patients. However, these electronic systems can prove useful in other aspects. By nudging the doctors, we might improve our prescription habits and overcome our inertia in prescribing medications or up titrating them. And one of the domains in which inertia is clear is heart failure. GDMT is under-prescribed in patients with heart failure. We usually don't prescribe the 4 essential medications and we rarely up titrate them to the maximum tolerable dose. And the PROMPT-HF trial was not a study on patients, it was a study on doctors. 100 healthcare providers, caring for patients with HFrEF in the outpatient were randomized to either an alert or usual care. one-third of them were not physicians. The alert started working at the moment of prescribing medications. It highlighted the patients' creatinine, potassium, blood pressure, eGFR, heart rate, and EF. The system notified providers of missing medications and the need to build up the dose. The electronic alerts increased GDMT prescription by >40% and were highly significant for beta clockers. 79% of alerted doctors agreed that the alert was effective at enabling improved prescription of medical therapy for HF. This low-cost intervention can be rapidly integrated into clinical care and accelerate the adoption of high-value therapies for heart failure. So next time, don't be angry when the system alerts you to the need of increasing the beta-blocker dose.Number 4 CHAP trial Treating mild chronic hypertension during pregnancy.We know that treating hypertension does prevent strokes, MI, and heart failure but the situation in pregnancy is more complicated. Unless hypertension is severe and complicated by eclampsia, we did not have evidence that treating hypertension can improve pregnancy outcomes given the potential hazards of the drugs on the fetus. The CHAP trial enrolled 2,408 women with mild chronic hypertension (

It is the first day of Ramadan, the holy blessed month observed by 1.8 billion Muslims around the world. This is a month with a mix of religious rituals, historical traditions, and family gatherings. It happens also to be an occasion for big meals, TV serials, and commercials! So I must say to all of you… Ramadan KareemBut when patients ask me “doctor, what should I do in Ramadan” I get a bit anxious. The answer to that question involves and mix of science and religious teachings. Even if you are a devout Muslim doctor, the answer won't come easy as you need to be balancing from both the religious aspect, respecting the patient's desire to fast, and the health aspect to avoid potential harm to your cardiac patient. And to make it worse, we don't have enough randomized or observational studies to guide us on what to do exactly in different cardiac conditions. So most of the advice we gave to patients was based on our own personal views which is not exactly called “science”What we know is that fasting as a concept is useful. The benefits of intermittent fasting on cardiovascular health are proven and Ramadan fasting was shown to reduce systolic and diastolic BP and was even associated with improved anginal symptoms in patients with chronic ischemic coronary syndromes. But Ramadan fasting is different from intermittent fasting; there is no water and no medicines. There is always the risk of hypotension, dehydration, and thrombotic tendency during the long fasting hours, especially in the summertime and in frail elderly patients. Dehydration may increase the risk of arrhythmia like ventricular ectopics, and atrial fibrillation and is very risky in patients with long QT syndrome, Brugada syndrome, or patients taking digoxin or class I antiarrhythmic drugs. Also in one multi-center study, patients who undertook Ramadan fasting within 3 months of percutaneous coronary intervention had a higher incidence of significant cardiac events than those who did not undertake Ramadan fasting. Moreover, if fasting times are more than 12 hours, then twice daily dosed medications will be disrupted with a potential for overdosing and under-dosing. Patients receiving two times per day DOACs were noted to be more likely to change their anticoagulation administration and more likely to be admitted to the hospital as a consequence of their changes, for example, bleeding or stroke. And the habits in the middle east of food consumption after sunset breakfast “Iftar” are far from the essence of intermittent fasting. This meal can get heavy with lots of dates, sugary drinks, and full-loaded oriental sweets are made special in celebration of the holy month. This is a major disruption of blood sugar control in diabetic patients. And I would like to refer you to the nice scoring developed by Diabetes and Ramadan DAR group which guides patients and physicians on who can fast and who shouldn't. You can also check the previous episode of cardio buzz where our nephrology expert provided guidance on fasting for renal patients.So who can fast Ramadan and who should not fast? There is a good consensus document from a group of British doctors in the NHS, published in Heart open journal last May. And I think it came on time. The link to the article is in the description. The eight authors scanned the literature for trials on fasting and cardiovascular disease and added their personal insights, and the work was supported by the British Islamic Medical Association. https://www.daralliance.org/daralliance/idf-dar-practical-guidelines-2021/https://heart.bmj.com/content/108/4/258

Lots of interactions between the kidneys and the heart. Cardiometabolic medicine is evolving with exciting news for both cardiac and renal patients.Should a patient with kidney disease fast in Ramadan or not.All these questions were answered in this interview with Dr. Nizar Atallah.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2788582We are in March, a month that marks international women's day and also mothers' day in the middle east, some African countries, and many European countries. Speaking of women's health, we tend to focus emotionally on depression, breast cancer, and osteoporosis. Whereas in fact, cardiovascular disease is the leading cause of death in women with roughly one out of every five deaths being due to CV disease.And we are familiar with the classic risk factors for coronary artery disease are diabetes, hypertension, dyslipidemia, smoking, etc but other factors can also modify the development of atherosclerotic and thrombotic disease. Nontraditional risk factors like social background, ethnicity, race, income, education, social support, etc. And we are exposed to social stresses throughout life. But as people grow older, life changes; retirement, deaths of family members and friends, and decreasing activities of daily living. These life changes contribute to decreasing social network size. And women, particularly older ladies, tend to experience more social isolation than men because they are more likely to be widowed, live alone, and get lower incomes.Today I chose a paper published in the JAMA open last February. The paper tested the impact of two, potential social determinants of disease; namely loneliness and social isolation. And we need to differentiate the two. Social isolation is the objective measure of social interactions and relationships, loneliness is the subjective feeling of being socially isolated. The researchers looked at 57,825 healthy American ladies 65 years old and above. None of them had any coronary disease or stroke. This was part of the investigation called the women's health initiative extension II. They followed those old but healthy ladies for 8 years from 2011 until 2019They measured a social isolation index score based on marital status, living situation, and frequency of social activities. Participants answered questions about being married or not, living alone, how often do you meet family and friends or call them by phone, how frequently do you go out to religious places, cinema, eat outside or go shopping. A higher score meant worse social isolation. They also measured loneliness using a scale based on questions that reflected feelings of isolation, lack of companionship, and being left out. Again, a higher score meant more loneliness. They also looked at other variables like diabetes, depression, the level of social support, the quality of the diet, and the level of physical activity. Women with the (higher) worst loneliness scores have a 14% higher chance of cardiovascular disease. Women with worse social isolation scores also had an 18% higher chance of cardiovascular disease. So now, social isolation and loneliness can be considered risk factors for coronary artery disease. What's the explanation? Over time, the experiences of social isolation and feelings of loneliness disturb autonomic function, increase systolic blood pressure control, and evoke an inflammatory response. These may lead to hypertension and atherosclerosis. The study has limitations, of course. It was just an observational study. But it highlights the need for further research to evaluate the effectiveness of whatever interventions to reduce social isolation and loneliness and see if they can mitigate CVD risk or not. But what we are sure of is that we need to measure social isolation and loneliness in primary care. Maybe we also need to increase referrals for mental health assessments which can be done aided by AI. But the bottom line is loneliness and social isolation are bad for your mothers' heart. So, no matter what, don't leave your mom alone!

It was back in the 19th century, exactly in the year 1816, Rene Laënnec, a French doctor was walking alone in the Louvre Palace in Paris. The 35-year-old physician and surgeon, observed two children playing by sending signals to each other using a long piece of solid wood and a pin. One child scratched a pin on a side of the wooden piece and the other child placed his ear on the opposite end of the wooden piece and received the amplified sound of the pin. Laennec loved the idea as he was a gifted musician who used to make and play on flutes.Shortly after, Laënnec who was known to be shy was called to see a lady with suspected heart disease. The lady was young and chubby, and so the bashful Laënnec was reluctant to stick his ears directly to her chest, which was the only way to listen to heart sounds at that time. In his moment of embarrassment, Laënnec recalled his observation of the children's wooden sound transmission. That observation inspired his invention of the device which is now the symbol of physicians “the stethoscope”The first generation was a rolled tube to funnel where one end was on the patient's chest and another side on the doctor's ear. He called it the “stethoscope” derived from the Greek words stethos, meaning chest, and skopein, meaning to explore. For 200 years, the stethoscope was essential to any physical examination with dedicated cardiology types and pediatric types. However, the importance of the stethoscope has declined dramatically in favor of more sophisticated technologies. Clinical skills in general are dwindling. There has been a constant decline in practitioners' ability to correctly identify heart sounds through auscultation, the accuracy of 22% in American trainees and slightly higher in fellows. No surprise as we are counting more on echo, angiography, CT, and MRI. We and patients trust these more than the good old stethoscope.But now, we are in the age of smart tools. We have smartphones, smart bags, smart lamps, and smart homes. How about a smart stethoscope? What would that look like and how useful would it be? Can it revive the dying stethoscope? Can it compete against the echo for example?https://doi.org/10.1016/S2589-7500(21)00256-9

https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-22/salt-and-hypertension-current-viewsWhen you hear the word “salt”      What's the first thing that comes to the mind White crystals that give food its taste, pickles, potatoe chips, snacks, high blood pressure and low blood pressure…Whatever came across your mind, we must admit that salt is deeply rooted in our culture. In the roman times, it was called the white gold. A famous roman saying “Trust no one unless you have eaten much salt with him”. We say we have eaten bread and salt so we will remain faithful forever.But when it comes to medicine, many questions need to be answered. What's the relation between salt and hypertension or hypotension? How much salt do we need to take to stay healthy? Which foods have high salt content and which foods are free of salt? Hello and welcome. My name is Hussien Heshmat, professor of cardiology, and this is my Cardio Buzz my weekly podcast where we provide updates on cardiology news, research, conferences, and products. These questions on salt were answered in a recent review article in the European society of cardiology E journal of clinical practice. I am placing a link to that nice and comprehensive review. And I am glad to interview today Prof Ghada Sayed, associate professor of cardiology at Cairo University, my colleague for almost 20 years. Dr Ghada has done lots of research on hypertension epidemiology including salt surveys, she shared in writing Egyptian hypertension guidelines in 2014, she moderate specialized hypertension clinics in Egypt, and she is also of course the author of the ESC review on salt and hypertension. 

You probably recognize the minions. Those tiny yellow characters featured in three motion pictures. I personally love them. Capsule-like small creatures with wide eyes, blue overalls and peculiar cheerful funny laughs and squawks. And I share with them their love for bananas!Kevin, Stuart, Dave and Bob are four of the most familiar minions. Individually they are small but each one has a special talent and when they work together they can create marvelous tools and solve the most difficult problems for the film's main character.Speaking of difficult problems, hypertension is one problem that affects billions of people. Most of us, if we live to our eighties, will become hypertensive. And the control rates are poor in the developed countries. The traditional treatment is based on giving one drug in the standard dose or combining two of those two also in standard doses to lower the blood pressure.But, how about combining four (mini doses) minions of antihypertensives in one pill! Would that pill do better than a standard dose of a single good antihypertensive?This question was tackled by a trial called QUARTET trial was presented at the ESC Congress last August then published in the Lancet last September.The trial was a multicentre, double-blind randomised, trial of 571 Australian adults with hypertension, who were untreated or receiving monotherapy. Patients were randomly assigned to either quadpill  or a mono therapy. The quad pill (contained 4 medications, each in one fourth of the standard dose; irbesartan 37·5 mg instead of 150, amlodipine at 1·25 mg not 5, indapamide at 0·625 mg not 2.5, and bisoprolol at 2·5 mg not 10 or even 5) or an indistinguishable monotherapy control (irbesartan 150 mg). If blood pressure was not at target, additional medications could be added in both groups. The researchers looked at BP control, safety and tolerability a 12 weeks then 12 months. And guess who won?SBP was about 7mmHg lower in the quadpil (allow me to call it the minion group) and control rates were 30% higher compared to the monotherapy group without difference in adverse events. The better BP control was sustained at one year with minions. Significantly less patients in the minion group) required additional BP medications compared to the mono therapy groupI consider this one of the key research papers in hypertension. I can think of several future implications of this conceptNumber 1: This is a further step in combination therapies for HTN. Not just two as recommended in many guidelines. With four mini doses, multiple pathophysiologic pathways tackled in one pill; sympathetic , RAS, sodium overload, vasoconstriction in small doses with less adverse effects. This can overcome physicians inertia and improve patients adherence to treatment.Number 2: Polypill is revived. Expect to see trials combining not just several BP medications, but also with statins and aspirin. NEJM trial on polypill in socioeconomic classes, cheap, more compliance, better BP and LDL reduction.Number 3: I expect the idea may be adopted by the pharma to manufacture different doses and different combinations not only triple combinations as we currently haveNumber 4: Boost to personalized medicine. Think of the tens of permutations that could come from different doses of four medications. Maybe in the future, the local pharmacist can add tailor your minion pill combinations; more beta blocker for the young, less diuretics for an elderly…etc

Seafood is a classic heart-healthy food. It is part of the Mediterranean diet that can lower blood pressure. Fish consumption was shown in several studies to lower the risk of death in patients with coronary artery disease. Seafoods are traditionally low in saturated fats, rich in iron, iodine and in omega-3 fatty acids. But also seafoods contain Methyl mercury which is produced by microorganisms in water and soil, and accumulates in fish. Recently, many people choose to limit their seafood consumption because of fear of mercury exposure from seafood. Excessive mercury may adversely affect the nervous system in infants and pregnant ladies and lactating mothers should avoid exposure to mercury because of its effects on the fetus. So what should we do? Consume fish and seafood to get the benefits on the CV system or reduce or intake to avoid exposure to mercury?https://www.fda.gov/food/consumers/advice-about-eating-fish

Surgical revascularization “coronary bypass” known as CABG is the most commonly performed cardiac surgery procedure worldwide with roughly one million procedures annually. We have seen in previous episodes that Cardiac surgery community was not happy the latest ACC revascularization guidelines. However, these guidelines have got lots to say on the performance of cardiac surgery. Let's see what the ACC/AHA guidelines recommend on the optimal performance of coronary bypass graft.Hi everyone my name is Hussain Hishmat I'm an Interventional cardiologist. Welcome to my podcast Cardio Buzz. We provide doctors and anyone who is interested in cardiology a brief and focused update of cardiology trials, products and guidelines. We are still continuing our episodes on ACC AHA guidelines on coronary Revascularization and this episode is about CABG.We will talk about the optimal performance of coronary bypass; the medical aspects and the surgical aspects all in 10 minutes. We will cover antiplatelets, choice of grafts, sternal wound infection, off pump, stroke prevention and other topics. 

The middle east is not only an area of diversity and brisk transformations, it is also a region where cardiovascular diseases are rampant. Traditional risk factors for atherosclerotic disease are more prevalent than most regions around the globe; In the middle east, one in five will have either diabetes, obesity, hypertension, or smoking. Dyslipidemia, which is a recognized cause of atherosclerosis, is even more common. That's why I decided to shed some light on Consensus clinical recommendations for the management of plasma lipid disorders in the Middle East: 2021 update published this month in Atherosclerosis journal.https://doi.org/10.1016/j.atherosclerosis.2021.11.022And there is no better than Dr Hani Sabbour to interview on this indispensable publication. Dr. Sabbour is a colleague and friend. He has six American Board Certifications: Internal Medicine, General cardiology, Electrophysiology, Advanced Heart failure and Transplant Cardiology, Echocardiography and Nuclear Cardiology. He is currently Staff Physician in Cleveland Clinic Abu Dhabi. He is a co-principal investigator in the Gulf Familial Hyperlipidemia Registry and naturally, he is one of the authors of this consensus clinical recommendation.

Fixing coronary blockade without opening the chest is an attractive option to patients and their families… No surprise, Percutaneous coronary intervention PCI growing steadily since 1980s. 4 million PCIs are performed annually round the globe. A market size of 10 billion dollars!! What's the best practice in PCI? Access, Assessment, gadgets, adjunctive medications. Let's see what does the ACC/AHA guidelines recommend….

A big question in revascularization, surgical or percutaneous? In the last decade, advanced technology has granted PCI more of the surgical territories. But what does the evidence say on choosing CABG versus PCI? Let's see what the new ACC AHA guidelines have to tell us.Why the surgical community refused to endorse these guidelines?

Coronary revascularization; the bread and butter of modern cardiology practice and it got new guidelines! Jointly issued by the American Heart Association, American College of cardiology and the sky, and also reviewed by American Association for Thoracic Surgery, the guideline document was published simultaneously in JACC and in circulation less than a month ago. Noteworthy that these are first guidelines on the topic in 10 years. Several practice-changing trials were published in the same period.  This long-waited document comes to replace or retire five guidelines partially or totally, not only 2011 PCI and CABG guidelines, but also will replace sections in STEMI guidelines, ACS guidelines and stable IHD guidelines. So this is a document not to miss!

Big news this week. The FDA approves a new therapy for cholesterol lowering “inclisiran”.  So what is this new therapy? Why did the FDA approve it and to whom? What does it mean for patients and where does the new therapy stand among other similar lipid lowering drugs currently available?

Heart failure is like cancer. The mortality is high and the burden on the economy is huge. We have almost  dozen  medications to treat heart failure and most of them work. So what  combination of drugs  give the best effect in heart failure? A new research suggests a "fantastic four" approach to be the best. Listen here to know the answer!