Podcasts about Angina

This week, Dr. Prather talks about how Aerobic Exercise and External CounterPulsation (ECP) Therapy are treatments that benefit every patient and all types of Cardiovascular Disease.  In this episode, you'll find out:—Why Dr. Prather calls ECP Therapy and Aerobic Exercise "the panacea for Cardiovascular Disease".—The amount of Aerobic Exercise each person needs to prevent or reverse Cardiovascular Disease.  (And why everyone reading this probably does not measure up!)—The story of how ECP Therapy was designed by Harvard decades ago to do Aerobic Exercise for patients who couldn't even walk across the room without losing their breath.  Plus, how long-distance runners are using ECP to help set new records. —How Dr. Prather called the FDA to ask if it would be OK for him to offer ECP Therapy to his patients and was actually encouraged by them to do this therapy in his office.—The "amazing" safety record of ECP Therapy that has NEVER had a single injury reported in decades of use.—The screening Dr. Prather does on patients prior to ECP Therapy for potential contraindications to ensure patient safety.—Why Cardiologists refer for ECP Therapy after everything else has been tried.  And how everyone who has been referred to Dr. Prather for it has lived.—The conditions that benefit from ECP Therapy, including:  Angina, Congestive Heart Failure, Atherosclerosis, Hypertension, Kidney Disease, Restless Leg Syndrome, Diabetes, Cognitive Brain Function, and Erectile Dysfunction. —How Natalie and John came to see Dr. Prather without an appointment after leaving two different hospitals.  And how Dr. Prather was able to provide John relief from pain that very first day.—The details about Dr. Prather's upcoming free educational seminar, "Diabetes Decoded:  A Holistic Look At Type 1 and Type 2 Diabetes" on Wednesday, June 25th at 6:30 p.m.http://www.TheVoiceOfHealthRadio.com

An update about my journey

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I'm a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. In this podcast, Dr. Warrick Bishop, a cardiologist, discusses heart health, particularly focusing on conditions affecting women, with interventional cardiologist Dr. Fiona Foo. They explore angina and ischemia in women who have non-obstructive coronary artery disease, explaining that many women experience chest pain without visible blockages in large arteries. This phenomenon, referred to as Anoca (angina with non-obstructive coronary arteries) and Inoca (ischemia with non-obstructive coronary arteries), highlights issues at the microvascular level that are often overlooked.

In this standout episode of Next Steps 4 Seniors: Conversations on Aging, we’re bringing back an audience favorite: our eye-opening interview with Nurse Practitioner Liz Jackson from Henry Ford Hospital. Liz breaks down the B.E.F.A.S.T. method for spotting stroke symptoms early, dives into the different types of strokes, and explains why timing is everything when it comes to treatment. We also tackle the red flags of heart attacks, the sneaky signs of vascular disease (yes, even leg cramping!), and how managing conditions like high blood pressure and diabetes can be game-changers. Early detection = lives saved. This episode is packed with info that could protect you or someone you love. Listen now on your favorite podcast platform! Follow us on Facebook and Instagram @ConversationsOnAging Visit nextsteps4seniors.com and our foundation at nextsteps4seniorsfoundation.org Questions or ideas? Call 248-651-5010 or email hello@nextsteps4seniors.com Sponsorship inquiries: marketing@nextsteps4seniors.com Sponsored by Aeroflow Urology: You could qualify to receive incontinence supplies at no cost through insurance—discreetly delivered to your door. Visit aeroflowurology.com/ns4s to check eligibility. (*Some exclusions apply.)Learn more : https://nextsteps4seniors.com/See omnystudio.com/listener for privacy information.

In this episode of Next Steps 4 Seniors: Conversations on Aging, we sit down with Nurse Practitioner Liz Jackson from Henry Ford Hospital to discuss life-saving information on strokes, heart attacks, and vascular health. We break down the B.E.F.A.S.T. method for identifying stroke symptoms early, explore the different types of strokes, and highlight the urgency of seeking immediate medical attention. Elizabeth also shares insights on recognizing heart attack warning signs, managing key risk factors like high blood pressure and diabetes, and understanding how leg cramping may indicate vascular disease. Early detection and fast action can save lives—tune in to learn how you can protect yourself and your loved ones.

Commentary by Dr.  Jian'an Wang

Mirza Umair Khalid, MD, social media editor of JACC: Cardiovascular Interventions, and Amir Lerman, MD, discuss the phase II study examining coronary sinus reducer for treatment of microvascular dysfunction.

Sinto dor no peito, será do coração? Esta é a pergunta-chave e que serve de ponto de partida para outras como: quais são as possíveis causas da dor no peito? Quais os sinais de alarme? Já ouviu falar em Angina de Peito? Neste episódio do podcast de Cardio da Vida, os cardiologistas José Ferreira Santos e Hélder Dores falam de forma clara e acessível sobre tudo o que está relacionado com o aparecimento de dores no peito e o seu significado! ​ ​Ouça o episódio, recomende aos seus familiares e amigos e partilhe a sua opinião e possíveis dúvidas connosco! Links úteis: https://cardiodavida.pt/angina-de-peito/ https://cardiodavida.pt/enfarte-agudo-do-miocardio/ https://cardiodavida.pt/a-importancia-de-praticar-atividade-fisica-regular/

Host: Emer Joyce Guest: Filippo Crea Want to watch that extended interview? Go to: https://esc365.escardio.org/event/1797?resource=interview Disclaimer ESC TV Today is supported by Bristol Myers Squibb. This scientific content and opinions expressed in the programme have not been influenced in any way by its sponsor. This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. Declarations of interests Stephan Achenbach, Filippo Crea, Emer Joyce and Nicolle Kraenkel have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, BiAL, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, GSK, Lilly, Novartis, Pfizer, Sanofi, Servier, Takeda, Tecnimede. Davide Capodanno has declared to have potential conflicts of interest to report: Bristol Myers Squibb, Daiichi Sankyo, Sanofi Aventis, Novo Nordisk, Terumo. Steffen Petersen has declared to have potential conflicts of interest to report: consultancy for Circle Cardiovascular Imaging Inc. Calgary, Alberta, Canada. Emma Svennberg has declared to have potential conflicts of interest to report: Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Johnson & Johnson.

N Engl J Med 2009;360:2503-2515Background: Type 2 diabetes increases the risk of cardiovascular events and death. Previous trials comparing revascularization versus medical therapy included patients with diabetes, however, a large-scale trial specifically focusing on patients with type 2 diabetes was lacking.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.The Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial sought to assess the optimal treatment strategy for patients with type 2 diabetes and stable coronary artery disease.Patients: Eligible patients had type 2 diabetes and stable coronary artery disease. Coronary artery disease was defined as a stenosis in a major coronary artery of 50% or more and a positive stress test or 70% or more and classic angina. Patients had to be candidates for percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) without further specification.Patients were excluded if they had left main disease, prior PCI or CABG within 12 months, class III or IV heart failure, hepatic dysfunction, creatinine> 2 mg/dL or glycated hemoglobin> 13%.Baseline characteristics: The trial randomized 2,368 patients – 1,176 randomized to the revascularization arm and 1,192 to the medical therapy arm. Among the 1,176 patients in the revascularization arm, 32% were planned to undergo CABG and 68% planned to undergo PCI.The average age of patients was 62 years and 70% were men. The mean glycated hemoglobin was 7.7% and the mean duration of diabetes was 10.4 years. Approximately 32% had prior myocardial infarction, 7% had congestive heart failure and 24% had peripheral artery disease. Approximately 18% had no angina or angina equivalent. Angina class within 6 weeks was 1-2 in 43% of the patients and 3-4 in 9%.The mean left ventricular ejection fraction was 57%. Approximately 31% had three-vessel disease and 13% had proximal left anterior descending artery disease.Baseline characteristics were well balanced between the revascularization arm and the medical therapy alone arm. However, patients who were in the CABG stratum had more three-vessel disease (52% vs 20%) and more proximal left anterior descending artery disease (19% vs 10%).Procedures: The trial was a 2 x 2 factorial design and patients were randomly assigned to two treatment strategies. The first was randomization to revascularization or medical therapy. The second was randomization to insulin-sensitization therapy or insulin-provision therapy. Randomization was stratified based on the method of revascularization (PCI vs CABG) which was determined by the treating physician.In this review, we will focus on the first strategy of revascularization vs medical therapy.For patients randomized to the revascularization arm, the procedure was to be performed within 4 weeks after randomization. Patients in the medical arm could receive revascularization on follow up for any of the following: Progression of angina, acute coronary syndrome or severe ischemia.Patients were seen monthly for the first 6 months and every 3 months thereafter.Endpoints: The primary endpoint was death from any cause. Secondary end point was a composite of death, myocardial infarction, or stroke.Analysis was performed based on the intention-to-treat principle. The original sample size of 2,800 patients was not met, and therefore, the average follow up time was increased by 1.5 years to become 5.3 years. Using the new follow up duration, the study had 88% power to detect a 33% relative risk reduction of death (from 14.0% to 9.8%), and a 95% power to detect a 25% relative risk reduction in the secondary composite endpoint (from 24.0% to 18.0%).Results: Among the patients randomized to the revascularization arm, 95.4% underwent revascularization at 6 months compared to 13.0% of the patients randomized to the medical arm. At 5-years, 42.1% of the patients randomized to the medical arm had undergone revascularization. Among patients who underwent PCI in the revascularization arm, procedures were attempted on average of 1.5 lesions and 56.0% received a bare metal stent. Among patients who underwent CABG in the revascularization arm, 94.2% received an internal mammary artery graft and the mean number of distal anastomoses was 3.0.The average follow up time was 5.3 years.There was no significant difference in the primary outcome of all-cause death. Survival was 88.3% in the revascularization arm and 87.8% in the medical arm (difference: 0.5%; 95% CI: −2.0 - 3.1; p=0.97). There was also no significant difference for the secondary composite endpoint. Freedom from events for the secondary endpoint was 77.2% in the revascularization arm and 75.9% in the medical arm (difference: 1.3%; 95% CI, −2.2 - 4.9; p=0.70).Survival was not significantly different between both treatment strategies in the CABG stratum (86.4% with revascularization vs 83.6% with medical therapy; p= 0.33). However, patients in the CABG stratum had more freedom from the secondary composite endpoint (77.6% vs 69.5%; p= 0.01).In the PCI stratum, revascularization did not improve survival (89.2% with revascularization vs. 89.8% with medical therapy; p= 0.48) or freedom from the secondary composite endpoint (77.0% with revascularization vs 78.9% with medical therapy; p= 0.15).Conclusion: In patients with type 2 diabetes and stable coronary artery disease, revascularization compared to medical therapy did not improve the primary outcome of all-cause death, or the composite secondary outcome of death, myocardial infarction or stroke over an average follow up time of 5.3 years.The observed benefit of revascularization within the CABG stratum should be viewed as hypothesis-generating rather than conclusive evidence that CABG is superior to PCI in this patient population.One potential limitation of this trial is that the authors included patients who were candidates for either PCI or CABG without providing enough details on what makes someone not a candidate. This lack of clarity limits physicians' ability to fully understand which patients would have been suitable for inclusion.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

This week on Heart Doc VIP, Dr. Kahn delves into two compelling patient cases of angina pectoris, both stemming from severe coronary artery disease. He discusses an insightful new study on Chinese herbal therapy for heart health, reviews traditional treatment options, and explores external counterpulsation (ECP/EECP) as an alternative therapy. In this news-packed episode, Dr. Kahn also covers vitamin K2 for leg cramps, the Prolon diet's impact on kidney function, the potential risks of palm oil for patients with multiple sclerosis, colchicine's surprising lack of success in preventing heart events in a major study, and effective weight-loss strategies.  Join Dr. Kahn for a group Prolon fast beginning Sunday, November 17, 2024. Secure your kit at prolonlife.com/drkahn. Special thanks to igennus.com for sponsoring this episode. Use code DrKahn for a discount on their products.

On this episode of the PTA Elevation Podcast, host Briana Drapp, SPT, PTA, CSCS goes over the important things to know about Angina Pectoris when studying for the NPTE. At the end of this episode, Briana provides and reviews a sample question that helps students get a feel for how this subject will be asked on the NPTE - PTA. Tune in to learn more! Check out our FREE stuff!: https://ptaelevation.com/freebies Website: https://www.ptaelevation.com/ Join our FB group for FREE resources to help you study for the exam!  https://www.facebook.com/groups/382310196801103/ If you're interested in our prep course, check it out here:  https://ptaelevation.com/the-600-plus-system Follow us on our other platforms! https://www.ptaelevation.com/linktree

Oldržich Syrovatka. „Kaip Murklys susirgo angina“. Skaito aktorė Janina Berūkštytė.

Host: Perry Elliott Guest: Christiaan Vrints Want to watch that extended interview? Go to: https://esc365.escardio.org/event/1793?resource=interview Disclaimer ESC TV Today is supported by Bristol Myers Squibb. This scientific content and opinions expressed in the programme have not been influenced in any way by its sponsor. This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. Declarations of interests Christiaan Vrints has declared to have no potential conflicts of interest to report. Perry Elliott has declared to have potential conflicts of interest to report: consultancies for Pfizer, BMS, Cytokinetics, AstraZeneca, Forbion.

ESC TV Today brings you concise analysis from the world's leading experts, so you can stay on top of what's happening in your field quickly. This episode covers: Cardiology This Week: A concise summary of recent studies Optimal management of angina Artificial sweeteners and cardiovascular risk Statistics Made Easy: Network meta-analyses Host: Perry Elliott Guests: Carlos Aguiar, Christiaan Vrints, Marco Witkowski Want to watch that episode? Go to: https://esc365.escardio.org/event/1793 Disclaimer ESC TV Today is supported by Bristol Myers Squibb. This scientific content and opinions expressed in the programme have not been influenced in any way by its sponsor. This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. Declarations of interests Stephan Achenbach, Antonio Greco, Nicolle Kraenkel, Christiaan Vrints and Marco Witkowski have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, BiAL, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, GSK, Lilly, Novartis, Pfizer, Sanofi, Servier, Takeda, Tecnimede. Davide Capodanno has declared to have potential conflicts of interest to report: Sanofi Aventis, Novo Nordisk, Terumo. Perry Elliott has declared to have potential conflicts of interest to report: consultancies for Pfizer, BMS, Cytokinetics, AstraZeneca, Forbion. Steffen Petersen has declared to have potential conflicts of interest to report: consultancy for Circle Cardiovascular Imaging Inc., Calgary, Alberta, Canada. Emma Svennberg has declared to have potential conflicts of interest to report: Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Johnson & Johnson.

N Engl J Med 2023;389:2319-2330Background: Percutaneous coronary intervention (PCI) does not reduce mortality or myocardial infarction as seen in COURAGE, FAME 2, ISCHEMIA and ISCHEMIA-CKD. However, unblinded studies have indicated that revascularization may improve symptoms, which is a key factor in driving PCI decisions for many patients. ORBITA was the first blinded, placebo-controlled trial of PCI for stable angina and found no significant improvement in exercise time with PCI. The trial had a high use of anti-anginal medications, with an average of 3 medications per patient  pre-randomization. However, this level of medication use is not always achievable in clinical practice due to side effects and challenges with adherence.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.The ORBITA-2 trial sought to test the hypothesis that PCI improves symptoms in patients with stable angina who are not receiving background antianginal medications.Patients: Eligible patients had angina or angina equivalent, severe coronary stenosis of 70% or more in at least one coronary artery and evidence of ischemia on non-invasive testing or by invasive pressure wire assessment.Main exclusion criteria were acute coronary syndrome within 6 months, previous CABG, left main disease, chronic total occlusion of target vessel, and left ventricular ejection fraction of 35% or less.Baseline characteristics: The trial randomized 301 patients – 151 randomized to PCI and 150 to placebo PCI.The average age of patients was 64 years and 79% were men. Approximately 63% had hypertension, 28% had diabetes, 72% had hyperlipidemia, and 62% were current or previous smokers. Left ventricular systolic function was normal in 96% of the patients.Angina class based on the Canadian Cardiovascular Society (CCS) angina grade was 2 in 58% of the patients and 3 in 39%. Approximately 80% had single vessel disease, 17% had 2-vessel disease and 2% had 3-vessel disease. Left anterior descending coronary artery was the target vessel in 55% of the patients.Procedures: Patients initially underwent coronary angiogram and invasive physiologic assessment was performed in each vessel with 50% or more stenosis. Patients underwent the coronary angiography while wearing headphones with music playing for auditory isolation throughout the procedure. Patients who had evidence of ischemia in at least one territory were then randomized in a 1:1 ratio to PCI or placebo PCI. Patients were sedated until they were unresponsive to verbal and tactile stimuli. In the PCI group, all target vessels were treated during the index procedure. Patients in the placebo group did not receive intervention and were kept sedated for at least 15 minutes after randomization.The recovery room staff and all subsequent medical providers were unaware of the treatment assignments. The operator and research staff who were present during the randomization procedure had no further contact with the patients.Anti-anginal medications were stopped at enrollment. Antihypertensive medications that has antianginal properties were replaced with different agents.Patients were followed up for 12 weeks during which they reported daily angina symptoms using a smart phone application. New anti-anginal medications or increase in the dose of anti-anginal medications were also tracked. At the end of the 12 weeks, patients completed symptom and quality-of-life questionnaires, had an assessment of CCS class, and underwent a treadmill exercise test and dobutamine stress echocardiography. After all of these were completed, patients and medical staff were unblinded.Endpoints: The primary endpoint was an angina symptom score calculated based on the number of angina episodes that a patient reported on a given day and the number of units of antianginal medication prescribed on that day. In this score, each episode of angina on a particular day counts as 1 point for a maximum of 6 points per day (0 points given to no angina), and each unit of anti-anginal medications counts as 7 points (0 points given for no antianginal medications prescribed that day). In supplement table 3, authors provided what counted as one unit of anti-anginal medications. For example, atenolol 25 mg counted as 1 unit and amlodipine 2.5 mg counted as one unit.Secondary endpoints included frequency of angina, use of ant-anginal medications, exercise time on treadmill test and symptoms questionnaires.Analysis was performed based on the intention-to-treat principle. The estimated sample size to achieve 80% power at 0.05 alpha was 284 patients. This is based on assumed standard deviation of 6 angina symptom score units and a difference of 2 units between PCI and placebo.Results: Data were available on 99.7% of the total patient-days.Compared to placebo, PCI reduced the mean angina symptom score (2.9 vs 5.6, OR: 2.2, 95% CI: 1.4 - 3.5; p

The Lancet Volume 391, Issue 10115, 6–12 January 2018, Pages 31-40Background:  For decades, cardiologists commonly used percutaneous coronary intervention (PCI) for the relief of angina. It made sense because PCI resulted in near complete resolution of blood flow through a stenosed vessel. The problem facing evidence-based clinicians was that no previous trial had compared PCI to a placebo (sham) procedure. Instead, previous trials had compared PCI (a procedure) to tablets. In the absence of blinding, a procedure will exert a larger placebo effect than tablets.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The Objective Randomized Blinded Investigation with optimal medical Therapy of Angioplasty in stable angina (ORBITA) trial was designed to assess the effect of PCI versus placebo on exercise time in patients with stable ischemic symptoms.ORBITA met ethical criteria because previous trials, primarily the COURAGE trial, had found that PCI in addition to medical therapy did not reduce hard outcomes, such as myocardial infarction or death due to cardiovascular causes, compared to medicine alone. In other words, PCI in patients with stable coronary artery disease was not a disease-modifying therapy; it was used to relieve symptoms.Patients:  Patients had to have single-vessel coronary artery disease (≥ 70% stenosis) that was appropriate for PCI and angina or equivalent symptoms. The authors published in the appendix pictures of every patient enrolled in the trial. Exclusion criteria included acute coronary syndrome, previous bypass surgery, left main stenosis, chronic total occlusions, severe valvular disease or left ventricular dysfunction, moderate or severe pulmonary hypertension, or life-expectancy less than 2 years.  Baseline Characteristics: The mean age of patients was 65 years. More than 79% were male. Almost 90% had normal left ventricular function. Canadian Cardiovascular Society class included about 60% with class 2 symptoms and nearly 40% with class 3 symptoms. Angina had been present for a mean of 9 months. Trial Procedures: ORBITA had two phases. First was a 6-week medical optimization phase wherein patients were optimally treated with medical therapy. They had a questionnaires, dobutamine stress echo, and a cardiopulmonary exercise test.  They then had the blinded procedure with either PCI or placebo.All PCI was done with drug-eluting stents. The procedure included measures to insure blinding, such as headphones during the procedure, sedation and a measure of hemodynamics such as fractional flow reserve. The second phase was a 6-week period of blanking in which patients underwent follow-up assessment. Testing procedures were similar to the pre-procedure protocol.At all times, the staff were blinded to the procedural data. This included procedural details as well as post-procedural assessment. The recovery staff were well rehearsed in their role of maintenance of blinding. Patients and subsequent medical caregivers were also blinded to treatment allocation. The study physicians present during the procedure had no further contact with the patient during the study.By the time of randomization, in the PCI group, 103 (98%) of 105 patients were taking aspirin, 103 (98%) were taking a second antiplatelet, and 99 (94%) were taking a statin, compared to 93 (98%), 94 (99%), and 91 (96%) of 95 patients, respectively, in the placebo group. At the same timepoint, in the whole study population, 156 (78%) of 200 patients were taking β blockers and 182 (91%) were taking calcium channel antagonists.The mean number of antianginal medications in the PCI group was 0·90 (SD 0·8) at enrollment, 2·8 (1·2) at pre-randomization, and 2·9 (1·1) at follow-up, compared to the placebo group in which the mean number of medications was 1·0 (0·9; p=0·357), 3·1 (0·9; p=0·097), and 2·9 (1·1; p=0·891), respectively.Endpoints: The primary endpoint of ORBITA was the difference between PCI and placebo groups in the change in treadmill exercise time. The power calculation relied on previous trials wherein PCI had resulted in a 48-55 second increase in exercise time over medicine. ORBITA authors designed the trial to detect a 30 second increase in exercise time.They estimated that a sample size of 100 patients per group had more than 80% power to detect a between-group difference in the increment of exercise duration of 30 seconds, at the 5% significance level, using the two-sample t test of the difference between groups. This calculation assumed a between-patient standard deviation of change in exercise time of 75 s. Since there had been no previous placebo-controlled trials of PCI, the authors initially allowed for a one-third dropout rate in the 6-week period of medical optimization between enrollment and randomization and therefore planned to enroll 300 patients. But the dropout rate was much lower, so only 230 patients had to be enrolled. The primary endpoint was continuous, and it was calculated as a difference between groups. They also measured secondary endpoints, including measures of angina severity and quality of life.Results: A total of 368 patients were screened for eligibility, and 200 were randomly assigned. Most were excluded from randomization because they declined to participate. There were 105 allocated to PCI (all but one had PCI) and 95 to placebo (4 patients had PCI due to a procedural complication).Across all patients, the mean area stenosis by quantitative coronary angiography was 84·4% (SD 10·2), mean FFR was 0·69 (0·16), and mean iFR was 0·76 (0·22). 57 (29%) patients had FFR greater than 0·80 and 64 (32%) had iFR greater than 0·89.The median length of stent implanted was 24 mm (IQR 18–33). After PCI, the mean FFR improved to 0·90 (SD 0·06; p

Ischemic heart disease is a leading cause of morbidity and mortality. While atherosclerotic coronary artery disease (CAD) is the focus of most outpatient and inpatient evaluations for cardiovascular symptoms, up to two thirds of patients suffer from myocardial ischemia with non-obstructive coronary arteries (INOCA). Patients with INOCA have unique symptoms and are more likely to have functional limitation and repeat presentations for cardiovascular evaluation. While there has been increasing recognition of INOCA there is no specific functional status measure, limiting our ability to evaluate the course of illness or effectiveness of therapies. In this presentation, Dr. Samit Shah, interventional cardiologist at Yale New Haven Hospital who recently gave grand rounds recently to the Mayo Clinic Department of Emergency Medicine, reviews the causes of ischemic heart disease, challenges with current symptom assessment, and proposes a new path for better diagnosis and treatment of heart disease.   CONTACTS X - @AlwaysOnEM; @VenkBellamkonda; @SamitShahMD YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com

No episódio de hoje Rapha Rossi e Diandro recebem um convidado mais que especial: Dr. Andé Gerhardt, assistente do ambulatório de Coronariopatias do Instituto Dante Pazzanese. Nesta semana discutimos as mais variadas apresentacões de sintomas anginosos, desmistificando inclusive os incompreendidos casos de INOCA. Devo intervir? Mantenho tratamento clínico? Vai mudar a sobrevida? Todas estas questões e muito além só aqui so seu podcast semanal de cardiologia favorito!

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Angina⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Cardiovascular section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets Linkedin: https://www.linkedin.com/company/medbullets

For full review of the trials, please visit https://cardiologytrials.substack.com/ Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

King and I | S5 E2 | The Evolution of Angina Treatment

Lancet 1982;320:1173-1180Background: The first coronary artery bypass graft surgery (CABG) was performed in 1964 and by the 1970's it was commonly used for relief of angina. However, whether it improved survival was unknown. The European Coronary Surgery Study (ECSS) sought to test the hypothesis that CABG compared to medical therapy improved survival at 5 years.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Note to readers: Several preliminary reports of ECSS results were published at earlier time points (2 and 3-5 years). We are reporting the 5-year results since this was the prespecified hypothesis the investigators sought to test.Patients: Men under 65 years of age with angina pectoris of more than 3 months duration, a left ventricular ejection fraction >50%, and angiographic obstruction of >/=50% in at least 2 major coronary vessels with at least 1 vessel suitable for grafting. Patients with severe angina that could not be controlled with medical therapy were excluded.Baseline characteristics: No information is provided in the main paper on the number or characteristics of individuals screened to enrolled. There were 768 patients enrolled in the study. They were recruited from September, 1973 to March, 1976. The average age of patients was 50 years and the left ventricular ejection fraction was 65%. Approximately, 46% had a previous heart attack, 43% smoked, 35% had a high cholesterol, 15% had hypertension and 6% had diabetes. In terms of coronary anatomy, 53% had 3-vessel disease, 40% had 2-vessel disease, and 7% had left main disease.Procedures: Patients were randomly assigned to receive medical or surgical treatment. Medical measures varied based on location. The authors reported that strict standardization was not felt to be practical or necessary. Surgical treatment was either with saphenous-vein graft or internal mammary artery and was performed as soon as possible following randomization. The average time from randomization to surgery was approximately 4 months.Follow-up evaluations were performed 6 months after randomization and annually thereafter. Graft angiography was planned at 6 and 12 months after operation.Endpoints: The primary endpoint was all-cause death. The prespecified minimum follow-up time, set at the start of the trial, for all patients was 5 years. At the time of this report, some patients had been followed up to 8 years. A strict hypothesis was not tested (i.e., CABG would reduce death by X% compared to medical therapy). The primary analysis was a traditional intention to treat analysis and medical patients who crossed over to surgery and surgical patients who died prior to receiving surgery or refused surgery after randomization were retained within their original groups.Results: There were 767 patients included in the final analysis; 373 patients in the medical group and 394 in the surgical group (1 patient was lost from the surgical group immediately following randomization and was not counted in the group). At 5 years, 90 patients (24%) of the medical group had crossed over to surgery and 26 (7%) of the surgical patients were not operated on. An average of 1.9 grafts per patient were performed in the 2-vessel disease subgroup and 2.4 grafts per patient in the 3-vessel disease subgroup. The graft patency rate was 90% within 9 months and 77% between 9 and 18 months.Compared to medical therapy, surgery significantly reduced death at 5 years by 53% (7.6% vs 16.4%; p=0.00025). Operative (in-hospital) mortality was 3.6% for a total of 494 operations and 7.7% for 26 reoperations. Seven of 27 prespecified variables recorded at the time of randomization were found to be associated with significant treatment effect heterogeneity. They included: (i) extent of disease; (ii) location of lesion(s) in the proximal third of the left anterior descending artery (proximal LAD); (iii) resting ECG suggestive of previous possible or probable myocardial infarction and/or with other specified abnormalities (iv) ischemic ST-segment response predominantly in lead V5 during maximum level of a multistage symptom/sign-limited bicycle exercise test; (v) history of peripheral arterial disease; (vi) age; and (vii) mode of treatment.Subgroup analysis on the basis of coronary anatomy supported a significant advantage of surgery for patients with left main disease (14.3% vs 32.1%; p=0.11) and 3-vessel disease (6% vs 17.6%; p=0.003) but not in 2-vessel disease (8.8% vs 11.8%; p>0.20). The left main subgroup could have had 2- or 3-vessel disease and the p-value was insignificant due to the small sample size.Surgery significantly reduced death in patients with proximal LAD disease (7.3% vs 18%; p=0.0004) but not in those without it (6.7% vs 7.9%; p>0.20). In the subset of patients with 2-vessel disease and without proximal LAD disease, surgery caused a numerical increase in death at 5 years, attributed to operative mortality.Surgery significantly reduced death in patients with >/= 1.5mm exertional ST depression on bicycle testing (8.3% vs 21%; p=0.003) but not in those without it (5.1% vs 9.7%; p>0.20).Angina and exercise performance were significantly improved in the surgery group compared to medicine. Conclusions: Compared to medical therapy, bypass surgery using internal mammary arteries and saphenous vein grafts significantly reduced mortality at 5 years in men under 65 years of age with normal left ventricular function. Approximately 11 men would need to be treated with CABG to prevent 1 death. This represents a large benefit for bypass surgery in well-selected patients at the time the study was undertaken. Contemporary caveats to this interpretation include improvements in medical therapy since the publication of ECSS mainly involving aspirin and cholesterol lowering drugs for patients with CAD as well as an improvement in the general management of conditions like hypertension and diabetes. Also, smoking rates have significantly declined at the population level.Despite the impressive benefit of bypass surgery seen in this study, important treatment effect heterogeneity was identified for certain lower risk patient groups including those with 2-vessel disease, absence of proximal LAD disease, and minimal ST depression on symptom limited bicycle testing. Theoretically, such patients would be expected to benefit from bypass surgery even less today given the improvements in medical therapy mentioned above.Finally, it is worth pointing out the difference in treatment effects seen in this study compared to the Veterans Administration Cooperative Study that we reviewed earlier this week, which was a negative trial. In the Veterans Administration Cooperative Study, coronary bypass was performed primarily with saphenous vein grafting whereas ECSS used internal mammary arteries and saphenous vein grafts. Internal mammary arteries are superior conduits compared to vein grafts. They have improved long-term patency rates, which is attributed to their striking resistance to the development of atherosclerosis. Furthermore, they are used almost exclusively on the LAD, which is the most important vessel.In conclusion, ECSS demonstrated that CABG surgery dramatically reduced death at 5 years compared to medical treatment; however, we should be aware of the caveats mentioned above and appreciate that the trial was limited to highly selected male patients under the age of 65.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Audio Commentary by Dr. Valentin Fuster, Emeritus Editor in Chief

Contributor: Taylor Lynch MD Educational Pearls: Overview: Sympathomimetic drugs mimic the fight or flight response, affecting monoamines such as dopamine, norepinephrine, and epinephrine Limited therapeutic use, often abused. Types: Amphetamines: Methamphetamine, Adderall, Ritalin, Vyvanse MDMA (Ecstasy) Cocaine (Both hydrochloride salt & free based crack cocaine) Theophylline (Asthma treatment) Ephedrine (For low blood pressure) BZP, Oxymetazoline (Afrin), Pseudoephedrine (Sudafed) MAO Inhibitors (treatment-resistant depression) Mechanisms: Act on adrenergic and dopaminergic receptors. Cocaine blocks dopamine and serotonin reuptake. Methamphetamines increase stimulatory neurotransmitter release MAO Inhibitors prevent neurotransmitter breakdown. Symptoms: Agitation, tachycardia, hypertension, hyperactive bowel sounds, diuresis, hyperthermia. Severe cases: Angina, seizures, cardiovascular collapse. Diagnosis: Clinical examination and history. Differentiate from anticholinergic toxidrome by diaphoresis and hyperactive bowel sounds. Tests: EKG, cardiac biomarkers, chest X-ray, blood gas, BMP, CK, coagulation studies, U-tox screen. Treatment: Stabilize ABCs, IV hydration, temperature monitoring, benzodiazepines. Avoid beta-blockers due to unopposed alpha agonism. Whole bowel irrigation for body packers; surgical removal if packets rupture. IV hydration for high CK levels. Observation period often necessary. Recap: Mimic sympathetic nervous system. Key symptoms: Diaphoresis, hyperactive bowel sounds. Treatment: Supportive care, benzodiazepines. Use poison control as a resource. References: Costa VM, Grazziotin Rossato Grando L, Milandri E, Nardi J, Teixeira P, Mladěnka P, Remião F. Natural Sympathomimetic Drugs: From Pharmacology to Toxicology. Biomolecules. 2022;12(12):1793. doi:10.3390/biom12121793 Kolecki P. Sympathomimetic Toxicity From Emergency Medicine. Medscape. Updated March 11, 2024. https://emedicine.medscape.com/article/818583-overview Williams RH, Erickson T, Broussard LA. Evaluating Sympathomimetic Intoxication in an Emergency Setting. Lab Med. 2000;31(9):497-508. https://doi.org/10.1309/WVX1-6FPV-E2LC-B6YG Summarized by Steven Fujaros | Edited by Jorge Chalit, OMSIII  

Coronary Sinus Reducer for the Treatment of Refractory Angina: A Randomized, Placebo-Controlled Trial (ORBITA-COSMIC)

An Impella update, another TAVI vs SAVR trial, two studies on angina and PCI, another null substudy from REVIVED-BCIS, and semaglutide are the topics John Mandrola, MD, covers in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I. Impella Update CHRIP BCIS 3 https://classic.clinicaltrials.gov/ct2/show/NCT05003817 Danger-Shock Podcast https://www.medscape.com/viewarticle/1000675 II. TAVI vs SAVR Notion 2 Trial EHJ https://doi.org/10.1093/eurheartj/ehae331 DEDICATE-DZHK6 III. Angina and PCI Orbita 2 Sub-analysis Orbita Star https://www.jacc.org/doi/10.1016/j.jacc.2024.04.001 IV. Complete Revascularization Main REVIVED trial https://www.nejm.org/doi/full/10.1056/NEJMoa2206606 JACC Substudy https://www.jacc.org/doi/10.1016/j.jacc.2024.04.043 V. Semaglutide Semaglutide CV Benefits Irrespective of Weight Loss: 4-Year SELECT Data https://www.medscape.com/viewarticle/semaglutide-cv-benefits-irrespective-weight-loss-4-year-2024a100095z Nature Med substudy https://www.nature.com/articles/s41591-024-02996-7 SELECT Main paper https://www.nejm.org/doi/full/10.1056/NEJMoa2307563 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Acute Angina, what the hell is it? Do we have it or have had it? Headlines with anger over bogo croissants involving guns and what not Sports with Brock Purdy doubling his salary by having a great season

DISCLAMER >>>>>>    The Ditch Lab Coat podcast serves solely for general informational purposes and does not serve as a substitute for professional medical services such as medicine or nursing. It does not establish a doctor/patient relationship, and the use of information from the podcast or linked materials is at the user's own risk. The content does not aim to replace professional medical advice, diagnosis, or treatment, and users should promptly seek guidance from healthcare professionals for any medical conditions.                                                  >>>>>> The expressed opinions belong solely to the hosts and guests, and they do not necessarily reflect the views or opinions of the Hospitals, Clinics, Universities, or any other organization associated with the host or guests.                                                                                  Disclosures: Ditch The Lab Coat podcast is produced by (Podkind.co) and is independent of Dr. Bonta's teaching and research roles at McMaster University, Temerty Faculty of Medicine and Queens University. Welcome back to "Ditch the Labcoat," where today we debunked heart health myths with the remarkable Dr. Michael Ward. Did you know stress can literally break your heart? Dr. Ward broke down the realities of Takatsubo cardiomyopathy, stressed the importance of timely intervention in heart attacks, and shared his insights on the Mediterranean diet for cardiac wellness. Plus, we got a glimpse into the high-stakes world of interventional cardiology—straight from the operation room. Stay heart-smart and catch the full episode for a deep dive into the art and science of keeping your ticker ticking! Remember, a healthy heart is a healthy start. Don't miss it!00:00:03 Understanding Takotsubo Cardiomyopathy and Broken Heart Syndrome with Dr. Michael WardDr. Mark Bonta discusses Takotsubo cardiomyopathy, also known as broken heart syndrome, with Dr. Michael Ward. They explore how the condition is often triggered by emotional stress, such as the loss of a loved one, leading to acute heart failure.00:01:03 Discussion on the Heart as a Muscle and Cardiac ConditionsDr. Michael Ward discusses the heart as a muscle that pumps and the various cardiac conditions patients may face, such as heart attacks, heart failure, and heart rhythm problems. The conversation emphasizes the importance of understanding the basic function of the heart for better management of cardiac health.00:02:26 Discussion with Dr. Michael Ward on Interventional Cardiology and Hypertrophic CardiomyopathyDr. Michael Ward is an expert in interventional cardiology who helps people prevent and recover from heart-related issues. He also focuses on hypertrophic cardiomyopathy, a genetic condition affecting the heart. With a background in both medicine and research, he is a valuable asset at Western University in London, Ontario.00:03:50 Interview with Dr Michael Ward, Interventional CardiologistDr. Michael Ward, an interventional cardiologist with both an MD and a PhD, discusses his background in cell-based gene therapy and his interest in cardiovascular medicine. He shares insights on heart health, the importance of vacations for mental health, and his balanced lifestyle.00:07:18 Insight into the Fascinating Aspects of the Heart from an Interventional Cardiology PerspectiveDr Mark Bonta, an interventional cardiologist, shares his perspective on the intricate nature of the heart, highlighting how it responds to various stimuli and stressors. He emphasizes the role of the cardiovascular system in determining life and death outcomes and the potential for improving quality of life through cardiology interventions.00:11:14 Discussion on Interventional CardiologyDr. Mark Bonta discusses their work in interventional cardiology, including responding to emergencies like heart attacks and performing procedures in the catheterization laboratory. They describe the challenges faced by patients with heart conditions and the range of cases they handle.00:13:26 Understanding Cardiovascular System with Dr. Michael WardDr. Michael Ward talks about atherosclerosis as the accumulation of plaque in the arteries, which can lead to heart issues like angina and heart attacks. The discussion also touches on the difference between chronic accumulation of plaque and acute blockages causing heart attacks.00:18:01 Understanding Acute Heart Attacks and Plaque Ruptures in ArteriesAcute heart attacks can occur when plaque ruptures inside an artery, leading to a clot that blocks the artery and causes the heart attack. Platelets play a crucial role in responding to the rupture and forming clots to heal the affected area.00:19:44 Importance of Timely Intervention in Heart AttacksDuring a conversation between Dr. Mark Bonta and Dr. Michael Ward Interventional Cardiology, they discussed the critical importance of timely intervention in heart attacks. Dr. Bonta mentioned that when a heart attack occurs, time is of the essence as the muscle of the heart is deprived of blood flow. Historically, patients were given aspirin and blood thinners but no interventional procedures were done immediately.00:21:20 Advanced Cardiac Care Protocols in CanadaIn Canada, there are advanced protocols in place for managing ST-elevation myocardial infarction (STEMI) cases, including direct ambulance transportation to hospitals with cath labs. Time is crucial in treating cardiac emergencies to minimize heart muscle damage.00:23:51 Patient Experience in the Cath Lab: What to ExpectThe patient experience in the cath lab involves inserting a needle with a wire into their arteries, either through the wrists or groin. Patients may not feel much during the procedure, but there might be some sensations of discomfort or awareness of the procedure taking place.00:26:56 Understanding the Process of Opening Blocked Heart VesselsIn the conversation between Dr Mark Bonta and Dr Michael Ward Interventional Cardiology, they discuss the process of opening blocked heart vessels during angioplasty procedures. They talk about using topical lidocaine for anesthesia and how temporary discomfort may be felt when the blockage is being opened up. Dr Ward explains that a stent is not a rigid pipe but a meshwork that is placed in the living system of the coronary artery.00:29:41 Understanding Interventional Cardiology and StentingInterventional cardiology involves using contrast dye and x-ray cameras to map arteries and identify blockages. Stents are used to provide support and prevent arteries from narrowing, improving blood flow to the heart muscle. The decision to place a stent is based on the degree of blockage and the impact on blood flow.00:34:10 Discussion on Heart Health Interventions and Medical ManagementThe conversation between Dr. Mark Bonta and Dr. Michael Ward Interventional Cardiology delves into the topic of heart health interventions and the importance of medical management in cardiac care. They discuss the limitations of interventions like stents in treating moderate blockages and emphasize the significance of lifestyle changes and medications in preventing heart attacks and strokes.00:38:32 Preventing Cardiovascular Disease Through Exercise and MedicationsDr. Mark ...

For resources to help you master Cardiac topics we have a FREE Cheatsheet Download at  NURSING.com/heart.   At NURSING.com you can learn everything you need to know as a nurse about agina including: angina symptoms, anginal pharmacology, the difference between stable and unstable angina, and more.     We also cover key concepts for NCLEX for angina nursing.       Excerpt:    ". . . it wasn't my patient that I should have been worried about When my patient's son said he wasn't feeling right, it would have been easy to assume it was because of the stress he was under.  He was visiting his sick mom . . . in the ICU nonetheless.     But something just didn't feel right"  

For resources to help you master Cardiac topics we have a FREE Cheatsheet Download at  NURSING.com/heart.   At NURSING.com you can learn everything you need to know as a nurse about agina including: angina symptoms, anginal pharmacology, the difference between stable and unstable angina, and more.     We also cover key concepts for NCLEX for angina nursing.       Excerpt:    ". . . it wasn't my patient that I should have been worried about When my patient's son said he wasn't feeling right, it would have been easy to assume it was because of the stress he was under.  He was visiting his sick mom . . . in the ICU nonetheless.     But something just didn't feel right"  

For resources to help you master Cardiac topics we have a FREE Cheatsheet Download at  NURSING.com/heart.   At NURSING.com you can learn everything you need to know as a nurse about agina including: angina symptoms, anginal pharmacology, the difference between stable and unstable angina, and more.     We also cover key concepts for NCLEX for angina nursing.       Excerpt:    ". . . it wasn't my patient that I should have been worried about When my patient's son said he wasn't feeling right, it would have been easy to assume it was because of the stress he was under.  He was visiting his sick mom . . . in the ICU nonetheless.     But something just didn't feel right"  

For resources to help you master Cardiac topics we have a FREE Cheatsheet Download at  NURSING.com/heart.   At NURSING.com you can learn everything you need to know as a nurse about agina including: angina symptoms, anginal pharmacology, the difference between stable and unstable angina, and more.     We also cover key concepts for NCLEX for angina nursing.       Excerpt:    ". . . it wasn't my patient that I should have been worried about When my patient's son said he wasn't feeling right, it would have been easy to assume it was because of the stress he was under.  He was visiting his sick mom . . . in the ICU nonetheless.     But something just didn't feel right"  

For resources to help you master Cardiac topics we have a FREE Cheatsheet Download at  NURSING.com/heart.   At NURSING.com you can learn everything you need to know as a nurse about agina including: angina symptoms, anginal pharmacology, the difference between stable and unstable angina, and more.     We also cover key concepts for NCLEX for angina nursing.       Excerpt:    ". . . it wasn't my patient that I should have been worried about When my patient's son said he wasn't feeling right, it would have been easy to assume it was because of the stress he was under.  He was visiting his sick mom . . . in the ICU nonetheless.     But something just didn't feel right"  

For resources to help you master Cardiac topics we have a FREE Cheatsheet Download at  NURSING.com/heart.   At NURSING.com you can learn everything you need to know as a nurse about agina including: angina symptoms, anginal pharmacology, the difference between stable and unstable angina, and more.     We also cover key concepts for NCLEX for angina nursing.       Excerpt:    ". . . it wasn't my patient that I should have been worried about When my patient's son said he wasn't feeling right, it would have been easy to assume it was because of the stress he was under.  He was visiting his sick mom . . . in the ICU nonetheless.     But something just didn't feel right"  

For resources to help you master Cardiac topics we have a FREE Cheatsheet Download at  NURSING.com/heart.   At NURSING.com you can learn everything you need to know as a nurse about agina including: angina symptoms, anginal pharmacology, the difference between stable and unstable angina, and more.     We also cover key concepts for NCLEX for angina nursing.       Excerpt:    ". . . it wasn't my patient that I should have been worried about When my patient's son said he wasn't feeling right, it would have been easy to assume it was because of the stress he was under.  He was visiting his sick mom . . . in the ICU nonetheless.     But something just didn't feel right"  

This week, Gary, Kate, Henry and Mark discuss a newly approved medication for major depression in adults, initiation of abortive therapy using ubrogepant during migraine prodrome, the value of PCI for patients with stable angina, and a simple intervention to improve communication with hospitalized patients. And a quiz!

Episode: 1131 John Hunter: idiosyncratic medical pioneer.  Today, the history of medicine provides a strange hero.

On this week's listener series episode, we welcome Valerie. Valerie shares her journey with pregnancy and birth as a Type 1 Diabetic. Everything went smoothly until 2 days after discharge, when Valerie started to feel unwell. She shares how her family navigated a hospital stay postpartum and her second homecoming. What you will hear on this episode:- Pregnancy with Type 1 Diabetes- Preeclampsia diagnosis at 32 weeks- Induction and vacuum birth- Postpartum readmission- Microvascular angina- Postpartum while recovering from complicationsIf you have a birth trauma story you would like to share with us, click this link and fill out the form. For more birth trauma content and a community full of love and support, head to my Instagram at @birthtrauma_mama.Learn more about the support and services I offer through The Birth Trauma Mama Therapy & Support Services.

AHA23 Congress Coverage: PCI for Stable Angina (ORBITA-2 Trial)

Viagra, Cialis, Golf, Angina and Boomer's putter.

Are you worried about your high cholesterol levels and being now at risk for a sudden heart attack or other heart problems? Or, maybe you've had one already and don't know if there will be another one coming. Well, if you're tired of taking all those heart meds and want a solution…without MORE meds or surgery, listen in to the interview I had with my guest, Paul C.   In this interview (Part 1), Paul shares the symptoms and experience he had of a heart attack at just 40 years of age, with another one only two years later. As a result, he had two stent placements and was also placed on multiple meds, including those for cholesterol, angina and blood pressure. Learn what led him to finally make the change to a plant-based diet lifestyle and some of the positive changes he started experiencing as a result, after just 4 months of starting a whole food plant-based diet!   Listening to his story is such a reminder to me of why early recognition of the warning signs of a heart attack is so important, and of having the right rapid diagnosis and subsequent treatment. It's also a reminder that heart attacks can happen at any age, not just in later adult years. Listen in and be inspired by this episode!     Next Steps: Contact -> healthnow@plantnourished.com Learn -> www.plantnourished.com Grow  -> Plant-Powered Life Transformation Course: www.plantnourished.com/ppltcourse Join the FB Community -> www.bit.ly/pbdietsuccess Apply -> Free Rapid Health Transformation Call: https://bit.ly/plantnourished Free Resource -> Quick Start Grocery Guide for Plant-Based Essentials: www.plantnourished.com/groceryguide  

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Angina ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Cardiovascular section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

Full Episode HERE Your 14-Day Jump-Start For Nursing School Success Begins Now!!! Come along for a 14-day series that will push you ahead of the curve, helping you break through the most difficult nursing content with a FREE 10-minute video each day. You can access these lesson videos completely free of charge! Simply set up a password, and you're good to go. Do you know 3 types of Angina? Stable – With exertion. Relieved by nitroglycerin Unstable – At rest. Lasts longer. Unrelieved by nitroglycerin. Variant – Unpredictable. If you answered any of those

Full Episode HERE Your 14-Day Jump-Start For Nursing School Success Begins Now!!! Come along for a 14-day series that will push you ahead of the curve, helping you break through the most difficult nursing content with a FREE 10-minute video each day. You can access these lesson videos completely free of charge! Simply set up a password, and you're good to go. Do you know 3 types of Angina? Stable – With exertion. Relieved by nitroglycerin Unstable – At rest. Lasts longer. Unrelieved by nitroglycerin. Variant – Unpredictable. If you answered any of those

Full Episode HERE Your 14-Day Jump-Start For Nursing School Success Begins Now!!! Come along for a 14-day series that will push you ahead of the curve, helping you break through the most difficult nursing content with a FREE 10-minute video each day. You can access these lesson videos completely free of charge! Simply set up a password, and you're good to go. Do you know 3 types of Angina? Stable – With exertion. Relieved by nitroglycerin Unstable – At rest. Lasts longer. Unrelieved by nitroglycerin. Variant – Unpredictable. If you answered any of those

Follow along while you listen to this show!   Just head over to nclexbook.com to get our Free eBook -  NCLEX Flash Notes, with 77- MUST KNOW NCLEX nursing topics . . . and as a bonus, you'll receive 16 full-color nursing cheatsheet.   www.nclexbook.com Cataracts Flash Notes - The Best Way to Prep for NCLEX  Cataracts is a clouding of the lens in the eye which leads to a decrease in vision. If left untreated can lead to blindness. Master questions on Angina with this clear and concise content that will help you conquer the NCLEX exam. www.nclexbook.com  

Follow along while you listen to this show!   Just head over to nclexbook.com to get our Free eBook -  NCLEX Flash Notes, with 77- MUST KNOW NCLEX nursing topics . . . and as a bonus, you'll receive 16 full-color nursing cheatsheet.   www.nclexbook.com Sinus Tachycardia Flash Notes - The Best Way to Prep for NCLEX  Master questions on Angina with this clear and concise content that will help you conquer the NCLEX exam. www.nclexbook.com