Branch of medicine dealing with the heart
This is Coronavirus 411, the latest on Omicron and other COVID variants and new hotspots for December 6th, 2021.At least 12 U.S. states have now identified Omicron cases, but US health officials remain more concerned about Delta. It's accounting for 99.9% of all new infections and those infections are going up. Results from studies to gauge the severity and transmissibility of Omicron are expected in a few weeks. Cases of Omicron remain mild but that is not true of Delta. In Brussels, Belgium, police turned water cannons and tear gas on protesters against the tightening of COVID restrictions that aim to counter a surge of coronavirus infections. Thousands participated after the government tightened rules for the third week in a row. But an avalanche of new cases has strained the country's health services.The company's President says Moderna could have a vaccine booster shot that targets the Omicron variant ready for authorization by March. Although the drumbeat of messaging has been that the existing vaccines protect fine against Omicron, he told the Financial Times he thinks the existing vaccines will be less effective against it than they've been against Delta and they've already started work on a new booster.A new analysis in The American Journal of Cardiology has revealed a possible link between the vaccines and elevated risk of Myopericarditis, an inflammation of the heart muscle. The CDC had almost 2,000 reports of the condition just in 2021 in people who got the vaccine. This is mostly happening in men 25 to 44, but most cases with clinical symptoms seem to resolve within six days.Speaking of men and COVID, a study out of Colorado State suggests men spread coronavirus particles more frequently than women or children. The study was originally to see how the performing arts could safely return to the stage. After doing things like making subjects sing “Happy Birthday” over and over, they learned singing spreads more virus than instruments, adults emit more particles than kids, people who talk loud emit more virus, and men emit more than women, theoretically because they have bigger lungs. In the United States cases were up 19%, deaths are up 5%, and hospitalizations are up 18% over 14 days. The 7-day average of new cases has been trending up since November 29. The five states that had the most daily deaths per 100,000 are Wyoming, Montana, Kentucky, Michigan, and West Virginia. There are 9,637,520 active cases in the United States.The five states with the greatest increase in hospitalizations per capita: Delaware 62%, Connecticut 60%, Rhode Island 55%, Indiana 49%, and Illinois 45%.The top 10 counties with the highest number of recent cases per capita according to The New York Times: Allen, KS. Bennington, VT. Koochiching, MN. Sullivan, NH. Jackson, IA. Benton, MN. Waseca, MN. Mille Lacs, MN. St. Clair, MI. And Socorro, NM. There have been at least 788,363 deaths in the U.S. recorded as Covid-related.The top 3 vaccinating states by percentage of population that's been fully vaccinated: Vermont at 73.5%, Rhode Island at 73.3%, and Maine at 72.9%. The bottom 3 vaccinating states are Wyoming at 46%, Alabama at 46.4%, and Mississippi at 47.1%. The percentage of the U.S. that's been fully vaccinated is 59.6%.Globally, cases were up 13% and deaths were up 2% over 14 days, with the 7-day average trending up since October 15. There are once again over 21 million active cases around the world, at 21,146,420.The five countries with the most new cases: The U.K. 43,992. France 42,252. Germany 35,983. The United States 35,065. And Russia 32,602. There have been at least 5,255,544 deaths reported as Covid-related worldwide. For the latest updates, subscribe for free to... See acast.com/privacy for privacy and opt-out information.
This week we turn to a recent work from the group at Texas Children's Hospital about IV sotalol and the treatment of junctional ectopic tachycardia (JET). How did sotalol fair in comparison to IV amiodarone for the treatment of this potentially lethal postoperative arrhythmia? What differences were observed? How should IV sotalol be dosed and who is or is not a candidate? We speak with the first author of this work, Assistant Professor of Pediatrics at The Children's Hospital at Montefiore, Dr. Ellis Rochelson. doi: 10.1016/j.hrthm.2021.11.021
Welcome to episode 258 of the Sexology Podcast! Today I am delighted to welcome Robyn Goldberg to the podcast. In this episode, we discuss the relationship between food and sexuality, looking at food addiction and the issues it can cause and why Robyn decided to write her new book, The Eating Disorder Trap. Robyn Goldberg is a registered dietitian nutritionist, certified eating disorder registered dietitian supervisor, certified intuitive eating counselor and a Health at Every Size® (HAES) clinician. Robyn has spent years learning from some of the best in the industry and continues to seek professional mentoring, attends innovative conferences and stays abreast with the most current literature. Robyn began her career at Cedars-Sinai Medical Center in Los Angeles as the in-patient dietitian in the Department of Cardiology. For the last 23 years, Robyn Goldberg has had a private practice in Beverly Hills, CA, where she specializes in medical conditions, eating disorders, disordered eating, dual diagnosis, pre-pregnancy nutrition and women seeking fertility treatment. Robyn consistently educates professionals, students, and RDNs about how to best incorporate intuitive eating and Health at Every Size® approaches into their work and lives. She teaches nutrition classes on a wide array of topics for the Motion Picture Industry's Wellness Program. Actively involved in the nutrition and body positive community, Robyn is also a member of organizations including: Association of Size Diversity and Health (ASDAH), Academy of Eating Disorders (AED), International Association of Eating Disorder Professionals (iaedp) and the International Federation of Eating Disorder Dietitians (IFEDD). She also serves as a Nutrition Consultant for the Celiac Disease Foundation. Robyn also leads several body image and eating disorder groups in sober living settings in the Los Angeles Area. Robyn is a nationally renowned contributing author registered dietitian nutritionist. She has been quoted as an expert in various publications including The New York Times, The Huffington Post, Diabetes Forecast, Shape Magazine, Fitness, Oxygen, Life & Style, Natural Solutions, Beverly Hills Weekly and Today's Dietitian. In addition, Robyn has also served as an eating disorder specialist on the nationally televised show “The Insider” and an expert on The Associated Press (AP). In this episode, you will hear: How is our relationship between food and sexuality related? Why it's important to look at the relationship between food and sexuality How our hormones can change if we restrict them for a long time Looking at food addiction and the issues it can cause Who is at risk of developing an eating disorder? What to do if you don't like your body Connecting with your partner on this issue to improve your sex life Looking at how Robyn works with people to feel better within their own bodies How dieting can have a negative impact on eating disorders Why Robyn decided to write her book, The Eating Disorder Trap Find Robyn Goldberg Online https://theeatingdisordertrap.com Sex Quiz for Women https://oasis2care.com/sexquiz Podcast Produced by Pete Bailey - http://petebailey.net/audio
Today we dive into virus fears and family life with Dr. Jack Wolfson who is a board-certified cardiologist and a fellow of the American College of Cardiology. He has emerged as one of the worlds leading holistic natural cardiologists and was a Natural Choice Award Winner in the Holistic MD category from Natural Awakenings Magazine. His ideas have been featured by NBC and CNN and covered in publications like the USA Today and The Wall Street Journal. If you're looking for some supplements you and your family can take, you can check out Glutathione Pro: https://auraroots.com/products/glutathione-pro-60-c, Vitamin C Tonic: https://auraroots.com/products/vitamin-c-tonic, and Pure Omega: https://auraroots.com/products/pure-omega-60-ct If you're looking to work with us to get to the root cause of your symptoms, you can reach out to us at evanbrand.com/free.
In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Dr Pamela Brown, consultant cardiologist from the James Cook Hospital, Middlesbrough, UK. They discuss the issues surrounding becoming a consultant, and Dr Brown shares plenty of tips from her own journey, including choosing what type of job to apply for, agreeing on a job plan, managing workload and trying not to drown in email! If you enjoy the show, please subscribe to the podcast to get episodes automatically downloaded to your phone and computer. Also, please consider leaving us a review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2
In this episode of Fight Back, we discuss the latest innovations in treating all types of cardiovascular disease.We welcome our special guest Dr. Laith Alshawabkeh. Dr. Laith is a board-certified cardiologist specializing in caring for adults with congenital heart disease, an abnormality in the heart present at birth. He leads the Adult Congenital Heart Disease Program at UC San Diego. An assistant professor in the Department of Medicine at UC San Diego School of Medicine, Dr. Laith is the lead investigator on multiple studies that impact the care of adults with congenital heart disease. The top medical journals, including the Journal of the American Medical Association, Journal of the American College of Cardiology, and Journal of the American Heart Association, have featured his work.Dr. Laith covers in-depth a variety of topics surrounding cardiovascular disease, including the advancements in the treatment of heart disease—valve replacements, stents, pacemakers, heart transplants—the long-term effects of COVID, how to live a heart-healthy lifestyle, and more.
With Lavanya Kondapalli, University of Colorado School of Medicine, Aurora - USA & Tomas Neilan, Massachusetts General Hospital, Boston - USA Link to paper Link to editorial
Allan Sniderman is a highly acclaimed Professor of Cardiology and Medicine at McGill University and a foremost expert in cardiovascular disease (CVD). In this episode, Allan explains the many risk factors used to predict atherosclerosis, including triglycerides, cholesterol, and lipoproteins, and he makes the case for apoB as a superior metric that is currently being underutilized. Allan expresses his frustration with the current scientific climate and its emphasis on consensus and unanimity over encouraging multiple viewpoints, thus holding back the advancement of metrics like apoB for assessing CVD risk, treatment, and prevention strategies. Finally, Allan illuminates his research that led to his 30-year causal model of risk and explains the potentially life-saving advantages of early intervention for the prevention of future disease. We discuss: Problems with the current 10-year risk assessment of cardiovascular disease (CVD) and the implications for prevention [4:30]; A primer on cholesterol, apoB, and plasma lipoproteins [16:30]; Pathophysiology of CVD and the impact of particle cholesterol concentration vs. number of particles [23:45]; Limitations of standard blood panels [29:00]; Remnant type III hyperlipoproteinemia—high cholesterol, low Apo B, high triglyceride [32:15]; Using apoB to estimate risk of CVD [37:30]; How Mendelian randomization is bolstering the case for ApoB as the superior metric for risk prediction [40:45]; Hypertension and CVD risk [49:15]; Factors influencing the decision to begin preventative intervention for CVD [58:30]; Using the coronary artery calcium (CAC) score as a predictive tool [1:03:15]; The challenge of motivating individuals to take early interventions [1:12:30]; How medical advancement is hindered by the lack of critical thinking once a “consensus” is reached [1:15:15]; PSK9 inhibitors and familial hypercholesterolemia: two examples of complex topics with differing interpretations of the science [1:20:45]; Defining risk and uncertainty in the guidelines [1:26:00]; Making clinical decisions in the face of uncertainty [1:31:00]; How the emphasis on consensus and unanimity has become a crucial weakness for science and medicine [1:35:45]; Factors holding back the advancement of apoB for assessing CVD risk, treatment, and prevention strategies [1:41:45]; Advantages of a 30-year risk assessment and early intervention [1:50:30]; More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/AllanSniderman Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.
In this week's special 'fellow takeover episode', Dr. Sarah Pradhan, sometime co-host of Pediheart and third year cardiology fellow at Cincinnati Children's Hospital, speaks with Professor Roberta Williams of USC about her long and illustrious career as a pioneer in both echocardiography as well as pediatric cardiac critical care. Prepare for a lot of wisdom about career and life from this giant in the field of pediatric cardiology. An inspirational episode to end the month of November, 2021.
This week on the CodeCast podcast, Terry gets back to specialty coding with her cardiology coding tips for the Cath Lab and discusses what Medicare means by MUE's. Listen in to this week's episode. Subscribe and Listen You can subscribe to our podcasts via: Apple Podcasts – https://podcasts.apple.com/us/podcast/codecast-medical-billing-coding-insights/id1305926627 Google Podcasts – https://play.google.com/music/listen#/ps/Ia47t6quqphhsanlzpajk37yiga Spotify – https://open.spotify.com/show/1lA69Q7EnjSMuVr3sXVWlX Stitcher […] The post Cardiology Coding Tips appeared first on Terry Fletcher Consulting, Inc..
In this episode, Tamara McCleary, CEO at Thulium, sits down with Prof. Dr. Norbert Frey, Medical Director, Department of Cardiology, Angiology, and Pneumology at Heidelberg University Hospital, and Michael Byczkowski, Global Vice President, Head of Healthcare Industry at SAP, to talk with us about implementing a data management platform that improved bed and equipment management across a network of hospitals and very likely saved lives. They will also discuss ongoing improvements for healthcare logistics and medical data management today and in the future.
With Kevin C Maki, Indiana University School of Public Health, Bloomington - USA & Carl E Orringer, University of Miami Miller School of Medicine, Miami - USA Link to paper Link to editorial
The CardioNerds are thrilled to launch The Cardiac Critical Care Series! The series Co-Chairs – Dr. Mark Belkin (Advanced Heart Failure FIT, U Chicago), Dr. Yoav Karpenshif (FIT, U Penn), Dr. Eunice Dugan (CardioNerds Academy Chief Fellow and FIT, Cleveland Clinic), and Dr. Karan Desai (CardioNerds Academy Editor and FIT, U Maryland) - join CardioNerds Co-Founders, Amit Goyal and Daniel Ambinder to delve into high-yield topics in critical care cardiology. We kickstart this series with one of the early pioneers and national leaders in cardiac critical care – Dr. Jason Katz, Director of Cardiovascular Critical Care and Co-Director of Mechanical Circulatory Support and the CICU at Duke University Medical Center. In this episode, we learn about Dr. Katz's career path and what motivated him to train in Critical Care Cardiology. He shares early struggles, notable changes in this field's nascent period, and ongoing challenges in training and practice. We discuss collaboration with other cardiac and non-cardiac specialties and their importance in comprehensive care. Furthermore, we discuss how to advance critical care research, including the Critical Care Cardiology Trials Network and future randomized controlled trials to inform our practice and develop standardized protocols. In this small but rapidly growing field, we learn there is much to discover together. Audio editing by CardioNerds Academy Intern, Hirsh Elhence. Claim free CME for enjoying this episode! Disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes “I think it's really important not to be afraid of change in order to potentially succeed [...] it's okay to not entirely know what you want to do.” - Dr. Katz when sharing his non-direct career path in a novel field.“There is no greater team sport in cardiology than Cardiac Critical Care” and “I oftentimes think of the Critical Care Cardiologist as sort of the conductor that helps to orchestrate [the team]...” - Dr. Katz when discussing the importance of multidisciplinary teams and need to collaborate with other cardiac and non-cardiac sub-specialties.Many general surgical or medical residency/fellowship graduates are not comfortable caring for patients in the critical care setting. There is a need to revamp critical care training without significantly prolonging training time in order to complement and enhance our current workforce to care for complex, critically ill cardiac patients.“I don't think there's necessarily a one size fits all model, and I think we should be malleable or adaptable to the needs of our trainees and the needs of our patients.” - Dr. Katz when discussing training pathways in Critical Care Cardiology or combining Critical Care with other subspecialties like Interventional Cardiology or Advanced Heart Failure.Dr. Katz suggests that when choosing a Critical Care Cardiology training program: “consider geography, the flexibility of the curriculum, the overall fellowship and social experience, and the clinical setting. Everything that's really important to choosing a cardiology fellowship is more important in my mind than if they actually have a standardized, cardiac critical care pathway.” Show notes 1. What are some recent changes in the field of Critical Care Cardiology? Compared to even just a decade ago, there is a growing interest from medical students to young faculty in pursuing a career in critical care cardiology.At the same time there is evidence that the patient demographics in our CICUs are changing, including more multi-organ dysfunction and many non-cardiac diagnoses. In a recent paper from the Critical Care Cardiology Trials Network (CCCTN),
In AHA 2021 Part 1, John Mandrola, MD, reports on selected sessions from the virtual American Heart Association meeting. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - AVATAR - Early SAVR Tops Watchful Waiting in Severe, Asymptomatic Aortic Stenosis: AVATAR https://www.medscape.com/viewarticle/962904 - Aortic Valve ReplAcemenT versus Conservative Treatment in Asymptomatic SeveRe Aortic Stenosis: The AVATAR Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057639 - Early Surgery or Conservative Care for Asymptomatic Aortic Stenosis https://www.nejm.org/doi/full/10.1056/NEJMoa1912846 II - TCV Repair - Concomitant Tricuspid-Mitral Surgery Beneficial but With a Tradeoff https://www.medscape.com/viewarticle/962899 - Concomitant Tricuspid Repair in Patients with Degenerative Mitral Regurgitation https://www.nejm.org/doi/full/10.1056/NEJMoa2115961 III - PALACS - Procedure Reduces Postop AF After Cardiac Surgery: PALACS https://www.medscape.com/viewarticle/962907 - Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial https://doi.org/10.1016/S0140-6736(21)02490-9 IV - Left Main CAD - Left-Main PCI, CABG Mortality Similar; Choice Remains Complex https://www.medscape.com/viewarticle/963198 - Percutaneous coronary intervention with drug-eluting stents versus coronary artery bypass grafting in left main coronary artery disease: an individual patient data meta-analysis https://doi.org/10.1016/S0140-6736(21)02334-5 Features: - Questions Remain on Tricuspid Repair at Time of Mitral Surgery https://www.medscape.com/viewarticle/962902 - Despite Positive Trials, Early Surgery in Asymptomatic AS Should Wait https://www.medscape.com/viewarticle/962926 - Can New Meta-analysis of PCI vs CABG for Left Main CAD Settle the Debate? https://www.medscape.com/viewarticle/963295 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact email@example.com
CardioNerds Tommy Das (Program Director of the CardioNerds Academy and cardiology fellow at Cleveland Clinic) and Rick Ferraro (Director of CardioNerds Journal Club and cardiology fellow at the Johns Hopkins Hospital) join Dr. Erin Michos (Associate Professor of Cardiology at the Johns Hopkins Hospital and Editor-In-Chief of the American Journal of Preventative Cardiology) for a discussion about the effect of DHA and EPA on triglycerides and why DHA/EPA combinations may have exhibited limited benefits in trials. This episode is part of the CardioNerds Lipids Series which is a comprehensive series lead by co-chairs Dr. Rick Ferraro and Dr. Tommy Das and is developed in collaboration with the American Society For Preventive Cardiology (ASPC). Relevant disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Lipid Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls The best intervention for heart disease is prevention! The InterHeart trial showed that 9 modifiable risk factors (dyslipidemia, smoking, hypertension, diabetes, abdominal obesity, dietary patterns, physical activity, consumption of alcohol, and psychosocial factors) predict 90% of acute myocardial infarction. So many acute events can be prevented1.Atherosclerotic vascular disease events increase across a range of triglyceride levels, even from 50-200mg/dL. So even in a relatively normal range, lower triglycerides seem to be better. Over ¼ of US adults have triglycerides over 150.While 8% of US adults take fish oil supplements, multiple meta-analyses have failed to show any benefit to the use of dietary omega-3 supplementation2. Dietary supplements these are not meant for medical use and are not studied or regulated as such! Show notes 1. What are DHA and EPA? DHA, or docosahexaenoic acid, and EPA, or eicosapentaenoic acid, are n-3 polyunsaturated fatty acids, also known as omega-3 fatty acids. These compounds have been of considerable interest for over two decades given observed association of high dietary omega-3 fatty acid intake with reduced cardiovascular events3. As both are important omega-3 fatty acids, trials on the benefits of DHA and EPA have often focused on the two compounds in combination. 2. What was the GISSI-Prevenzione Trial and why was it Important? GISSI-Prevenzione trial (Lancet 1999), was one of the earliest trials to study DHA and EPA4. In this trial, the authors evaluated the effect of omega-3 supplementation as a combination pill of DHA and EPA on cardiovascular events and death in patients with recent myocardial infarction (the last three months). Over a 3.5-year follow-up period, participants treated with DHA/EPA combination experienced a significant reduction in death, nonfatal MI, and stroke.As this was an early trial, patients were largely not on statins, as these were not supported at the time of study initiation (Only 5% were on cholesterol-lowering medications at baseline, and only 45% were on cholesterol-lowering therapy at study completion). The benefits seen in this trial may not extend to modern practice with patients on contemporary background therapy.The trial participants were also not representative of our modern patients for a variety of other reasons. 85% of participants in the trial were men. 42.2% of patients in EPA/DHA arm were current smokers, and 35.4% were prior smokers. Only 14.2% of patients had diabetes and 14.7% with BMI >30.Notably, the decrease in triglycerides in this trial was only 3%, implying that triglyceride lowering did not entirely explain the benefit in cardiovascular events seen. 3. What about the data after the GISSI-Prevensione Trial? After this positive trial for DHA/EPA in combination, subsequent trial data in support of DHA/EPA has been less robust.
Joining us this week on the Faculty Factory Podcast is Garima Sharma, MD. Dr. Sharma shares with us a recent paper she worked on in the Journal of the American College of Cardiology regarding toxic workplace culture in cardiology, and its broader implications in medicine. With Johns Hopkins Medicine, Dr. Sharma serves as Assistant Professor in the Division of Cardiology and Associate Vice Chair for Women's Careers in Academic Medicine. Learn more: https://facultyfactory.org/garima-sharma/
The Pediatric Acute Care Cardiology Collaborative (PAC3) is an initiative that strives to help children hospitalized with heart conditions achieve better outcomes through traditional research and quality improvement science. Dr. Madsen, the new Chief of Cardiology and Executive Director of PAC3, shares details in this episode.
This week we move into the realm of public health for congenital heart care when we review a recent report on a novel approach to tackling the daunting task of enhancing access to care for congenital heart disease to all who need it in a limited resource region. We speak with Ms. Bistra Zheleva of Children's HeartLink and Professor Krishna Kumar of Amrita Institute in Cocchin, India about a recent report on how a large group of professionals have used a private/public cooperative approach based on education and novel modern methods to rapidly care for children with congenital heart disease, resulting in meaningful reductions in infant mortality as well as improvements in care throughout the congenital heart patient lifespan. Prepare to be inspired by this extraordinary tale. DOI: https://doi.org/10.5334/gh.1034
Welcome to this audio presentation of our recent "Rip's Rescue" event which focused exclusively on men's health and dispelling the outdated myth that real men need meat to thrive. When Rip was a firefighter in Austin, Texas, he spent his days on the rescue squad, responding to fires and medical emergencies. For this presentation, he assembled a brigade of experts to join him in helping people rescue themselves. How? With a fire hose of evidence-based information and simple steps to eating more plants and saving yourself from the flames of chronic lifestyle disease and erectile dysfunction. Joined by notable physicians, Drs. Aaron Spitz and Brian Asbill, Rip and his crew of experts shared vital intel every man should know to help men rescue their health and learn information that can help avoid the constant care of a physician. And good news! You don't have to turn in your man card when you swap t-bones for tofu. We're torching that stereotype right now. Topics covered included: Symptoms you should never ignore How to avoid needing the little blue pill PSA Tests and Numbers- What do I need to know? Can too little sex increase my risk of prostate cancer? The canary in the coal mine for men's health Important screenings every man should have How a plant-based lifestyle can strengthen your odds against chronic disease About Dr. Aaron Spitz Dr. Aaron Spitz is a nationally recognized expert on men's health, a lead delegate of America's Urologists to the American Medical Association, and the author of The Penis Book. He was also prominently featured in The Game Changers for one of the most eye-popping scenes that left audiences howling and men and women wanting to know more! Dr. Spitz discusses "the canary in the coal mine" for men, symptoms that must be treated urgently, and how to preserve sexual longevity while warding off taking the little blue pill. About Dr. Brian Asbill Dr. Brian Asbill is a cardiologist and the first physician in the world to be certified in lifestyle medicine by the American College of Lifestyle Medicine. Dr. Asbill will discuss how lifestyle can fight back against heart disease, the important screenings every man should request from his provider, and the warning signs that a cardiac event is likely. Episode and PLANTSTRONG Resources: Video Version of this Episode PLANTSTRONG Episode Page Dr. Brian Asbill Website - Ruckus Health Dr. Aaron Spitz - The Penis Book Download our Free PLANTSTRONG Holiday Meal Guide PLANTSTRONG Website with all of our Resources to live PLANTSTRONG Join the free PLANTSTRONG Community Theme Music for Episode
Dr. Nancy Sweitzer, Director of the University of Arizona Sarver Heart Center and Chief of Cardiology at the University of Arizona Health Services, joined the podcast to share insights on academic cardiology and advice for being a successful leader today.
Join Yvonne Brandenburg, RVT, VTS SAIM and Jordan Porter RVT, LVT, VTS SAIM as we talk with: H. Edward Durham Jr., CVT, LATG, VTS (Cardiology) once again about the hole in the heart after a fetus is born, which we learn is truly a vessel hole and not a hole in the heart. Join us this week as we learn all about the Patent ductus arteriosus. Question of the Week Have you seen a reverse PDA? Leave a comment at https://imfpp.org/episode105 Resources We Mentioned in the Show Cardiology for Veterinary Technicians and Nurses. H. Edward Durham Jr. 30 June 2017. Thanks so much for tuning in. Join us again next week for another episode! Want to earn some RACE approved CE credits for listening to the podcast? You can earn between 0.5-1.0 hour of RACE approved CE credit for each podcast episode you listen to. Join the Internal Medicine For Vet Techs Membership to earn and keep track of your continuing education hours as you get your learn on! Join now! http://internalmedicineforvettechsmembership.com/ Get Access to the Membership Site for your RACE approved CE certificates Sign up at https://internalmedicineforvettechsmembership.com Get Access to the Technician Treasure Trove Sign up at https://imfpp.org/treasuretrove Thanks for listening! – Yvonne and Jordan
In this TCT 2021 episode of Parallax, Dr Ankur Kalra's guest is Prof Mamas Mamas, Consultant Interventional Cardiologist at University Hospitals of North Midlands NHS Trust (UHNM), Professor of Cardiology at Keele University and Senior Clinical Editor of TCTmd. Ankur invites Mamas to talk about the clinical relevance of some of the top studies presented at TCT 2021. Mamas summarises the studies, some of their salient features and the findings. Ankur and Mamas discuss the strategies they currently apply in their US and UK based practices and share how they think the novel data will guide their decision-making. What are the questions that emerged from the new data? What are the controversies? How do these trials challenge our current practice? Trials covered in detail include: FAME 3: A Randomized Trial of FFR-Guided Stenting Compared With CABG EROSION III: A Randomized Trial of OCT-Guided Intervention in STEMI Patients With Early Infarct Artery Patency OPTIMUM: Early Outcomes From a Prospective Registry of PCI in Patients at Prohibitive Risk for CABG Questions and comments can be sent to “firstname.lastname@example.org” and may be answered by Ankur in the next episode. Guest @mmamas1973 hosted by @AnkurKalraMD. Produced by @RadcliffeCARDIO. Brought to you by Edwards: www.edwardstavr.com
With Martha Gulati, University of Arizona College of Medicine - Phoenix - USA & Anastasia Mihailidou, Royal North Shore Hospital, Sydney - Australia Link to paper Link to editorial
Left atrial appendage closure vs DOACs, TAVR vs SAVR, renal denervation, and an AHA 2021 preview are the topics John Mandrola, MD, discusses in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - LAAC - PRAGUE-17: LAA Closure Holds Up Against DOACs Out to 4 Years https://www.medscape.com/viewarticle/962608 - LAAO vs DOAC: PRAGUE-17 Falls Short https://www.medscape.com/viewarticle/933641 - Left Atrial Appendage Closure versus Non-Warfarin Oral Anticoagulation in Atrial Fibrillation: 4-Year Outcomes of PRAGUE-17 https://www.jacc.org/doi/10.1016/j.jacc.2021.10.023 - Does Percutaneous Left Atrial Appendage Closure Stand the Test of Time? https://www.jacc.org/doi/10.1016/j.jacc.2021.10.022 II - SURTAVI (TAVR vs SAVR) - SURTAVI at 5 Years Reinforces TAVR but Was It Long-term Enough? https://www.medscape.com/viewarticle/962484 - Surgical or Transcatheter Aortic-Valve Replacement in Intermediate-Risk Patients https://www.nejm.org/doi/full/10.1056/NEJMoa1700456 III - Renal Denervation - Renal Denervation Adds Clout to BP Meds in Resistant HTN: RADIANCE-HTN TRIO https://www.medscape.com/viewarticle/962508 - Renal Denervation Remains Only Promising in Meta-Analysis https://www.medscape.com/viewarticle/962369 - Renal Denervation for Hypertension: A Systematic Review and Meta-Analysis of Randomized, Blinded, Placebo-Controlled Trials https://doi.org/10.1016/j.jcin.2021.09.020 IV - AHA Preview - AHA 2021 Puts Scientific Dialogue, Health Equity Center Stage https://www.medscape.com/viewarticle/962524 - Mandrola Previews the Virtual AHA 2021 https://www.medscape.com/viewarticle/962468 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact email@example.com
Cardiovascular disease is the #1 cause of death in America and indeed the whole world.The conventional approach to heart health, where doctors rely only on pills and procedures, isn't leading to better outcomes.But there is hope, and there is a better approach to a healthier life.And just like we do in other episodes, we have invited the nation's number one natural heart health doctor to shed more light on this topic.Dr. Jack Wolfson is a board-certified cardiologist and author of Amazon's best-selling book, The Paleo Cardiologist: The Natural Way to Heart Health, and five-time winner of the Natural Choice Award as a Holistic M.DHe uses in-depth testing and targeted nutrition to prevent and treat cardiovascular disease at his integrative cardiology practice.Dr. Wolfson is a believer in finding and eliminating the cause of disease rather than managing symptoms.This is a great conversation that will enlighten you on the common sense approach to health, which ultimately leads to a healthy heart and a long, happy life.Tune in to hear from the world's foremost natural heart health doctor!Key Takeaways- Major contributing factors to heart disease (05:00)- Cholesterol is king (10:48)- The markers for cardiovascular disease (14:43)- Why the statin approach is wrong (16:59)- The complicating factor of fear (20:58)- The best nutrition for your heart (23:37)- Your skin is a solar panel- embrace the power of the sun (25:39)- Efficacy of natural approaches to cardiovascular disease (33:08)- Common sense approach to heart health (34:44)Additional ResourcesGet The Paleo Cardiologist book FREEDr. Jack Wolfson Website---------ditchthequickfix.com/Do you want to improve your physical health? Learn More Here---------You can find the podcast on Apple, Google, Spotify, Stitcher, or wherever you listen to podcasts.If you haven't already, please rate and review the podcast on Apple Podcasts!
Rob Benedict, Gareth Reynolds and Erin Foley are back together again (aka "The Complicated Dads Club") to break down the latest episode of The Bachelorette! HIPPA Violations! Matching Jumpsuits! Tepid baths! - Arden has birthday party fever and is already planning out her mullet dress! - Gareth is going to come to the live show as Dracula! - Rob wrote a song about Arden being a unicorn! - Erin is not feeling Nayte ! All that plus........TWEET OF THE WEEK! Learn more about your ad-choices at https://www.iheartpodcastnetwork.com
This week we delve into the world of EP when we review a recent work from the team at Rady Children's Hospital on length of treatment for infant SVT. Is there an optimal length of therapy for the infant with SVT? Are there predictors of recurrence that might suggest benefit to a longer course of medical therapy? We speak with Director of Pacing at Rady Children's Hospital, Dr. Matthew R. Williams who is the senior author of this week's work. doi: 10.1007/s00246-020-02534-5
In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd, is joined by Dr James Howard from Imperial College, London. They discuss two papers published in Heart that dive into artificial intelligence and machine learning in cardiology. If you enjoy the show, please subscribe to the podcast to get episodes automatically downloaded to your phone and computer. Also, please consider leaving us a review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 Link to published paper: https://heart.bmj.com/content/early/2021/07/23/heartjnl-2020-318686 https://heart.bmj.com/content/106/5/399
Join Yvonne Brandenburg, RVT, VTS SAIM and Jordan Porter RVT, LVT, VTS SAIM as we talk about: The big CHF, or congestive heart failure. We learn so much from this episode and Ed Durham, and hope everyone else does too. Question of the Week What large breed dogs have you seen with CHF? Leave a comment at https://imfpp.org/episode104 Resources We Mentioned in the Show Cardiology for Veterinary Technicians and Nurses. H. Edward Durham Jr. 30 June 2017. EPIC (Evaluation of Pimobendan In dogs with Cardiomegaly) Study: https://www.epictrial.com Efficacy of pimobendan in the prevention of congestive heart failure or sudden death in Doberman Pinschers with preclinical dilated cardiomyopathy (the PROTECT Study): https://pubmed.ncbi.nlm.nih.gov/23078651/ Thanks so much for tuning in. Join us again next week for another episode! Want to earn some RACE approved CE credits for listening to the podcast? You can earn between 0.5-1.0 hour of RACE approved CE credit for each podcast episode you listen to. Join the Internal Medicine For Vet Techs Membership to earn and keep track of your continuing education hours as you get your learn on! Join now! http://internalmedicineforvettechsmembership.com/ Get Access to the Membership Site for your RACE approved CE certificates Sign up at https://internalmedicineforvettechsmembership.com Get Access to the Technician Treasure Trove Sign up at https://imfpp.org/treasuretrove Thanks for listening! – Yvonne and Jordan
With Perry Elliott, University College London - UK and Alexandros Protonotarios, UCL Institute of Cardiovascular Science London - UK Link to paper Link to editorial
Episode 73: Anticoagulation in Afib. When should you start anticoagulation in atrial fibrillation? What medications are appropriate? Virginia Bustamante, Charizza Besmanos and Dr Arreaza discuss this topic. By Charizza Besmanos, MS4; Virginia Bustamante, MS4; and Hector Arreaza, MDCharizza: Hello, welcome to today's episode of Rio Bravo qWeek Podcast. My name is Charizza Besmanos, a 4th year medical student from American University of the Caribbean and I am joined here today by Virginia Bustamante. Virginia: I'm Virginia Bustamante, an incoming 4th year medical student from Ross University. Arreaza: And I'll be here just to make sure that you guys behave during this episode. Charizza: Before we get started on our discussion, I have a quick patient case to share with you. This is a 66-year-old woman who is brought to the ED with sudden onset of severe difficulty speaking and weakness while having breakfast. She has hypertension, hyperlipidemia, severe left atrial enlargement seen on previous ECHO, and is noncompliant with her medications. She is a lifetime nonsmoker and does not drink alcohol. On admission, her blood pressure is 152/90 and pulse is 124/min and irregularly irregular. She is awake and alert but has difficulty finding words while trying to speak. She has severe right lower facial droop and marked weakness and sensory loss in the right arm and mild weakness in right leg. Fingerstick glucose is at 105. ECG shows atrial fibrillation. Acute stroke management is started right away. CT shows occlusion of the left MCA. What management could have prevented this complication? Virginia: This patient clearly has multiple risk factors for thromboembolism events but given her irregularly irregular pulse consistent with atrial fibrillation, she would've warranted long-term anticoagulation to prevent stroke, which she most likely had. Charizza: Exactly. Today's topic is atrial fibrillation, specifically the use of anticoagulation. __________________This is Rio Bravo qWeek, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California. Our program is affiliated with UCLA, and it's sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. __________________ Virginia: Anticoagulation is indicated to decrease the risk of thromboembolic events such as ischemic stroke in patients with atrial fibrillation (A-fib). Not all patients receive anticoagulation. Like most things in medicine, you must decide to start anticoagulation when the benefits of decreasing the risk of stroke outweighs the risk of bleeding. So, for assessing the risk of stroke in A-fib, the American College of Cardiology along with American Heart Association and the Heart Rhythm Society published a guideline in the Journal of the American College of Cardiology in 2014 and was recently updated in 2019 detailing in which patients anticoagulation is recommended. Charizza: Yes, according to the guideline, “high risk patients” are all patients with valvular A-fib, and those with nonvalvular A-fib with a CHADVASC score of >/= 2 in men or >/= 3 in women, and those with nonvalvular Afib and hypertrophic cardiomyopathy. Those with “medium risk” are patients with nonvalvular Afib with CHAD2VASc score of 1 in men or 2 in women. In these patients, anticoagulation is considered but the risk and benefits are discussed with the patient. Those with “low risk” are patients with CHAD2VASc score of 0 in men or 1 in women and anticoagulation is not routinely recommended in these patients. Can you tell us briefly what CHA2DVASc score is? Virginia: CHA2DS2-VASc score is the stroke risk assessment tool of choice by the AHA/ACC/HRS guideline. It is great because it is a mnemonic. Each letter is assignment 1 point except for 2 criteria. C stands for congestive heart failure, H for HTN defined as >140/90, A2 is for or Age>75 which is for 2 points, D for diabetes, S2 is for stroke or TIA and it's for 2 points, V for vascular disease such as MI, A for age 65-74, S for female sex. Charizza: That certainly makes it easy to remember. Not only that, but you can also find CHA2DS2-VASc score of MDCalc to make it even easier. Virginia: Now that we've established which patients should receive anticoagulation, how do we choose which anticoagulant? Charizza: For this discussion today, I would like to focus on nonpregnant patients. There really are 2 main anticoagulants, DOACs (or the direct oral anticoagulants) and warfarin. DOACs are the direct thrombin INH (dabigatran) and the direct factor Xa INH (rivaroxaban, apixaban, and edoxaban). DOAC is recommended as first-line in the long-term management of nonvalvular afib as trials have shown DOACs are more successful at reducing risk of thromboembolic events and have a lower risk of bleeding than warfarin and warfarin requires INR monitoring with dose adjustments. Although, in patients with valvular Afib, warfarin is preferred. Arreaza: All of them are by mouth. Virginia: Dosing of DOACs depends on the kidney function, so it is important to obtain the creatinine clearance. For dabigatran, the direct thrombin INH, the recommended dose for patients with CrCl >30 mL/min is 150mg PO twice daily based on the results from the RE-LY trial (2), which evaluated the efficacy and safety of dabigatran with warfarin in patients with Afib. For patients with CrCl of 15-30 mL/min, the recommended dose is 75mg PO BID. Those with CrCl 1.5, patient who is > 80years old or body weight
FFR-guided PCI, ISCHEMIA trial challenged, QFR, and one of the most important studies of 2021 are discussed by John Mandrola, MD, in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - FFR-Guided PCI - FFR-Guided PCI Falls Short vs CABG in Multivessel CAD: FAME 3 https://www.medscape.com/viewarticle/962274 - Fractional Flow Reserve–Guided PCI as Compared with Coronary Bypass Surgery https://www.nejm.org/doi/full/10.1056/NEJMoa2112299 - The fallacies of fractional flow reserve https://pubmed.ncbi.nlm.nih.gov/31889563/ II - ISCHEMIA-Trial Challenged - How Applicable is ISCHEMIA Trial to US Clinical Practice? https://www.medscape.com/viewarticle/962233 - Comparison of Patients Undergoing Percutaneous Coronary Intervention in Contemporary U.S. Practice With ISCHEMIA Trial Population https://www.jacc.org/doi/full/10.1016/j.jcin.2021.08.047 - The Glass Is at Least Half Full https://www.jacc.org/doi/10.1016/j.jcin.2021.08.054 - Initial Invasive or Conservative Strategy for Stable Coronary Disease https://www.nejm.org/doi/full/10.1056/nejmoa1915922 III - QFR - FAVOR III China: QFR-Guided PCI Shows Advantage Over Angiography https://www.medscape.com/viewarticle/962328 - Angiographic quantitative flow ratio-guided coronary intervention (FAVOR III China): a multicentre, randomised, sham-controlled trial https://doi.org/10.1016/S0140-6736(21)02248-0 Features: - The MI–Mortality Mismatch: When Lowering MI Doesn't Extend Life https://www.medscape.com/viewarticle/962276 - Assessment of Nonfatal Myocardial Infarction as a Surrogate for All-Cause and Cardiovascular Mortality in Treatment or Prevention of Coronary Artery Disease https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2785560 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact firstname.lastname@example.org
This week we review a recent important work from Germany about the coronary perfusion in patients with HLHS and possible relations between this flow and clinical outcomes. What factors are associated with abnormalities in microvascular coronary flow in the HLHS patient? What anatomical substrate is more concerning for these sorts of problems? Are there factors that might be modifiable that could possibly improve outcomes due to coronary microvascular flow problems in the HLHS patient? How practically easy are CMR studies to assess microvascular coronary flow in the HLHS patient? These are amongst the questions posed this week to Professor Carsten Rickers of University Heart and Vascular Center at the University Hospital Hamburg-Eppendorf. DOI: 10.1161/CIRCIMAGING.121.012468
ESUS, CAC 0, Takotsubo syndrome, and chest pain are the topics John Mandrola, MD, covers in today's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I – ESUS Anticoagulation May Benefit Stroke Patients With LV Dysfunction https://www.medscape.com/viewarticle/961815 - Left Ventricular Dysfunction Among Patients With Embolic Stroke of Undetermined Source and the Effect of Rivaroxaban vs AspirinA Subgroup Analysis of the NAVIGATE ESUS Randomized Clinical Trial https://jamanetwork.com/journals/jamaneurology/article-abstract/2785030 - Rivaroxaban for Stroke Prevention after Embolic Stroke of Undetermined Source https://www.nejm.org/doi/10.1056/NEJMoa1802686 - Dabigatran for Prevention of Stroke after Embolic Stroke of Undetermined Source https://www.nejm.org/doi/10.1056/NEJMoa1813959 II – CAC CAC Score 0 Unreliable to Rule Out Stenosis in Younger Patients https://www.medscape.com/viewarticle/961801 - Association of Age With the Diagnostic Value of Coronary Artery Calcium Score for Ruling Out Coronary Stenosis in Symptomatic Patients https://jamanetwork.com/journals/jamacardiology/fullarticle/2785586 - The Case Against Coronary Artery Calcium Scoring for Cardiovascular Disease Risk Assessment https://www.aafp.org/afp/2019/1215/p734.html III – Takotsubo Cardiomyopathy Broken Heart Syndrome: On the Rise, Especially in Women 50-74 https://www.medscape.com/viewarticle/961307 - Sex‐ and Age‐Based Temporal Trends in Takotsubo Syndrome Incidence in the United States https://www.ahajournals.org/doi/10.1161/JAHA.120.019583 IV- Chest Pain Guidelines AHA/ACC Issues First Comprehensive Guidance on Chest Pain https://www.medscape.com/viewarticle/961806 - 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines https://www.jacc.org/doi/10.1016/j.jacc.2021.07.052 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact email@example.com
This week we replay an episode reviewing a large administrative database study from Sweden on risk for cancer amongst patients with CHD. Why are cancer rates different in the CHD patient? What are the most important factors? What actions should be taken by cardiologists caring for ACHD patients in order to properly screen for cancer? We discuss these issues with Assistant Professor of Pediatrics, Harvard Medical School, Dr. Michelle Gurvitz. doi:10.1001/jamanetworkopen.2019.6782
In this episode of the Heart podcast, Digital Media Editor, Dr James Rudd is joined by EP specialist Dr Bhargava from the Cleveland Clinic. They discuss his Education in Heart paper on PVCs, covering assessment, drugs and ablation. If you enjoy the show, please subscribe to the podcast to get episodes automatically downloaded to your phone and computer. Also, please consider leaving us a review at https://itunes.apple.com/gb/podcast/heart-podcast/id445358212?mt=2 Link to published paper: https://heart.bmj.com/content/early/2021/07/13/heartjnl-2020-318628
Join Yvonne Brandenburg, RVT, VTS SAIM and Jordan Porter RVT, LVT, VTS SAIM as we talk about: Cardiology basics with the one and only H. Edward Durham Jr., CVT, LATG, VTS (Cardiology). Let's get our physical exam on. Want to know what you should be listening for? This episode is perfect for you. Resources We Mentioned in the Show "Basic Cardiac Anatomy and Physiology" by Nancy Braudis for OPENPediatrics - Bing video Cardiology for Veterinary Technicians and Nurses. H. Edward Durham Jr. 30 June 2017. Littmann Library of Sounds: http://www.3m.com/healthcare/littmann/mmm-library.html Thanks so much for tuning in. Join us again next week for another episode! Want to earn some RACE approved CE credits for listening to the podcast? You can earn between 0.5-1.0 hour of RACE approved CE credit for each podcast episode you listen to. Join the Internal Medicine For Vet Techs Membership to earn and keep track of your continuing education hours as you get your learn on! Join now! http://internalmedicineforvettechsmembership.com/ Get Access to the Membership Site for your RACE approved CE certificates Sign up at https://internalmedicineforvettechsmembership.com Get Access to the Technician Treasure Trove Sign up at https://imfpp.org/treasuretrove Thanks for listening! – Yvonne and Jordan
Please join author Jonathan Newman and Associate Editor Sandeep Das as they discuss the article "Outcomes of Participants With Diabetes in the ISCHEMIA Trials." Dr. Carolyn Lam: Welcome to circulation on the run, your weekly podcast, summary, and backstage pass to the journal and its editors. We're your co-hosts; I'm Dr. Carolyn Lam, Associate Editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, Associate Editor, Director of the Pauley Heart Center at VCU health in Richmond, Virginia. Well, Carolyn, this week's feature, a couple of weeks ago, we had that feature forum on the ischemia trial. Now we're going to explore some of the outcomes in patients with diabetes, from the ischemia trial in the feature discussion today. But, before we get to that, let's grab a cup of coffee and start in on some of the other articles in this issue. So, how about if I go first, this time? This particular paper, Carolyn, we're going to start on one of your topics. I know you're a fan of diet related interventions. So high intake of added sugar is linked to weight gain and cardio-metabolic risk. And in 2018, the U S National Salt and Sugar Reduction Initiative proposed government supported voluntary national sugar reduction targets. Dr. Greg Hundley: This intervention's potential health and equity impacts and cost effectiveness are unclear. And so Carolyn, these authors, led by Dr. Renata Micha from Tufts University, incorporated a validated micro-simulation model - CVD Predict coded in C++, and used it to estimate incremental changes in type two diabetes, cardiovascular disease, quality adjusted life years, cost and cost effectiveness of this national policy. The model was run at the individual level and the model incorporated national demographic and dietary data from the National Health and Nutrition Examination Survey across three cycles spanning from 2011 to 2016, added sugar related diseases from meta-analysis and policy costs and health-related costs from established sources and a simulated nationally representative us population was created and followed until age 100 years or death with 2019 as the year of intervention start and findings were evaluated over 10 years and a lifetime from healthcare and societal perspectives. Dr. Carolyn Lam: Ooooh, You so got my attention, Greg, a very important topic and so, what did they find? Dr. Greg Hundley: Right, Carolyn. So achieving the NSRI sugar reduction targets could prevent 2.48 million cardiovascular death related events, 0.5 million cardiovascular disease deaths, and three quarters of a million diabetes cases, gain 6.7 million quality adjusted life years, and save $160.8 billion in net cost from a societal perspective over a lifetime. The policy became cost-effective, defined as less than $150,000 for quality adjusted life years at six years and highly cost-effective at seven years with a cost savings noted at nine years. And therefore, Carolyn, implementing and achieving the NSSRI sugar reformation targets could generate substantial health gains, equity gains, and cost savings. Dr. Carolyn Lam: Wow, thanks Greg. So, moving from a very publicly health focused paper to this paper that really focuses on hypoplastic left heart syndrome with very, very scientifically significant findings. Now, first, we know hypoplastic left heart syndrome is the most common and severe manifestation within the spectrum of left ventricular outflow tract obstruction defects occurring in association with ventricular hypoplasia. The pathogenesis is unknown, but hemodynamic disturbances are assumed to play a prominent role. Authors led by Doctors Moretti and Laugwitz from Technical University of Munich in Germany, as well as Dr. Gruber from Yale University School of Medicine, and their colleagues combined whole exome sequencing of parent offspring, trios, transcriptome profiling of cardiomyocytes from ventricular biopsies and immuno-pluripotent stem cell derived cardiac progenator or cardiomyocyte models of 2D and 3D cardiogenesis, as well as single cell gene expression analysis to decode the cellular and molecular principles of hypoplastic left heart syndrome phenotypes. Dr. Greg Hundley: Wow, Carolyn, there is a lot of data, very complex preclinical science here. So what did they find? Dr. Carolyn Lam: Indeed, Greg. As I said, scientifically incredible and rigorous, and they found that initial aberrations in the cell cycle unfolded protein response, autophagy hub led to disrupted cardiac progenator lineage commitment, consequently, impaired maturation of ventricular cardiomyocytes limited their ability to respond to growth cues. Resulting in premature cell cycle exit and increase apoptosis under biomechanical stress in 3D heart structures. Together, these studies provide evidence that the hypoplastic left heart syndrome pathogenesis is not exclusively of hemodynamic origin, and they revealed novel potential nodes for rational design of therapeutic intervention. Dr. Greg Hundley: Wow, Carolyn, we really need research in this topic and this is great preclinical science that we're getting here in our journal. Congratulations to the authors and what a great presentation of that by you. Well, Carolyn and my next paper there remain major uncertainties regarding disease activity within the Retain Native Aortic Valve, as well as bioprosthetic valve durability, following transcatheter aortic valve implantation. And these authors led by Doctor Jacek Kwiecinski, from the Institute of Cardiology, aimed in a multi-center cross-sectional observational cohort study to assess native aortic valve disease activity and bioprosthetic valve durability in patients with TAVI in comparison to subjects with bioprosthetic surgical aortic valve replacement or SAVR. Dr. Carolyn Lam: Oh, very interesting. And what were the results? Dr. Greg Hundley: An interesting comparison, Carolyn. So in patients with TAVI, native aortic valves demonstrated 18 F sodium fluoride uptake around the outside of the bioprosthesis that showed a modest correlation with the time from TAVI. Next, 18 sodium fluoride uptake in the bias prosthetic leaflets was comparable between SAVR and TAVI groups. Next, the frequencies of imaging evidence of bioprosthetic valve degeneration at baseline were similar on echo cardiography 6 and 8% respectively, CT, 15 and 14% respectively, and with PET scanning. Next, baseline 18 F sodium fluoride uptake was associated with subsequent change in peak aortic velocity for both TAVI and SAVR. And on multi-variable analysis, the 18 F sodium fluoride uptake was the only predictor of peak velocity progression. And so Carolyn, therefore, in patients with TAVI, native aortic valves demonstrate evidence of ongoing active disease and across imaging modalities, TAVI degeneration is of similar magnitude to bioprosthetic SAVR suggesting comparable midterm durability. Dr. Carolyn Lam: Very nice, important stuff. Dr. Carolyn Lam: Well, thanks, Greg. Let's tell everyone about the other papers in today's issue. There's an exchange of letters between Doctors Baillon and Blaha regarding the article very high coronary artery, calcium and association with cardiovascular disease events, non-cardiovascular outcomes and mortality from MESA. There's an ECG challenge from Dr. Bell Belhassen on a left bundle branch block, tachycardia following transcatheter aortic valve replacement. And On My Mind paper by Dr. Neeland on cardiovascular outcomes trials for weight loss interventions, another tool for cardiovascular prevention, another Research Letter by Dr. Nakamura on clinical outcomes of Rivaroxaban Mono therapy in heart failure, patients with atrial fibrillation and stable coronary artery disease. So insights from the AFIRE trial, and finally, a Research Letter from Dr. Kumoro three-dimensional visualization of hypoxia induced, pulmonary vascular remodeling in mice. Dr. Greg Hundley: Great, Carolyn, and I've got an in-depth piece from Professor Jia Sani entitled breadth of life, heart disease, linked to developmental hypoxia. Dr. Greg Hundley: Well, Carolyn, how about we get onto that feature discussion and learn more about results from the ischemia trial? Dr. Carolyn Lam: Let's go Greg. Dr. Carolyn Lam: Well, we all know how important diabetes is as a risk factor for atherosclerotic coronary disease. And we know it's a very common comorbidity among patients with chronic coronary disease, but the question is do patients with diabetes and chronic coronary disease on top of guideline directed medical therapy and lifestyle interventions, of course, do they derive incremental benefit from an invasive management strategy of their coronary disease? Well, we are going to try to answer that question today in our feature discussion. Thank you so much for joining us today. The first author and corresponding author of today's feature paper, which tells us about results from the ischemia trials. And that's Dr. Jonathan Newman from New York university Grossman School of Medicine. We also have associate editor Sandeep Das from UT Southwestern. So welcome both of you. And if I could please start with Jonathan reminding us, perhaps, what were the ischemia trials and then what you tried to answer and do in today's paper, Dr. Jonathan Newman: Of course, Carolyn, and thank you so much for having me and for the discussion with Sandeep. It's a pleasure to be here. So sure has a little bit of background, as you indicated, the ischemia trials basically enrolled and for the purposes of this discussion and this analysis, I'm referring to both the main ischemia trial and the ischemia chronic kidney disease trials. So ischemia CKD under the umbrella of the ischemia trials. Ischemia stands for the international study of comparative health effectiveness with medical and invasive approaches. And the purpose of the trial was to test to see whether a routine invasive approach on a background of intensive guideline directed medical therapy for high risk patients with chronic coronary disease and at least moderate ischemia and obstructive coronary disease documented on a blinded CCTA or computed coronary tomography angiography prior to randomization was associated with benefits for a cardiovascular composite. And we looked in this analysis at whether or not there was appreciable heterogeneity of treatment effect or a difference in treatment effect for patients compared without diabetes in the ischemia trials, in ischemia and ischemia CKD. Dr. Carolyn Lam: Great, thanks for lining that up so nicely. So what, Dr. Jonathan Newman: So the results of our analysis really highlighted a couple of things that I think you touched upon initially, the first thing that I would highlight is that diabetes was very common in this high risk cohort with chronic coronary disease, over 40% of participants in the ischemia trials, 43% with obstructive coronary disease and moderate to severe, you may have had diabetes. Perhaps not surprisingly patients with diabetes had higher rates of death or MI than those without diabetes. And the rates were highest among those patients that required insulin, had insulin treated diabetes, but using really robust methods to assess for heterogeneity using a Bassen assessment of heterogeneity of treatment effect accounting for violation of proportional hazards. The fact that there was an upfront hazard and a late benefit, we really saw no difference in death or MI, between the invasive or conservative strategies for patients with, or without diabetes over about three years of follow-up. Dr. Jonathan Newman: And the results importantly were consistent for ischemia and ischemia CKD and provided the rationale for us when we started by looking to see if the distribution of risk and characteristics allowed the trials to be combined. The study really confirms this higher risk of death or a MI for chronic coronary disease patients who have diabetes extends these findings for those patients with moderate or severe ischemia. And I think really notably also adds information about chronic coronary disease patients with diabetes and CKD. That's sort of the overall findings. And I'm happy to talk in more detail about that. Dr. Carolyn Lam: I love the way you explain that Jonathan and especially, going into detail on what was so different about the paper and the really important statistical methods that made these findings robust, very important and impactful findings. If I could ask Sandeep to share your thoughts. Dr. Sandeep Das: Thanks, Carolyn. You know, I am just a big fan of everything that's come out of the ischemia group. One of the things that I really most enjoy as a consumer of the literature is when well done studies give me results that are unexpected. And I know it's become fashionable now to say that everybody knew that all along that this is what going to be the result. But honestly, I think we all sort of are many of us thought that there's going to be a subgroup somewhere that's really going to benefit from an invasive approach in terms of preventing heart outcomes. I think the key here that really jumped out at me was that this is identifying what we typically think of is a very high risk subgroup. You know, patients with diabetes patients with multi-vessel coronary disease patients with insulin dependent diabetes. Dr. Sandeep Das: And we did see the association with mortality across the increased disease severity and the increased severity of diabetes as expected. But really we didn't see a signal that revascularization, routinely revascularizing patients, even the higher risk patients led to clinically relevant heart outcome benefits. So I thought that that was a really interesting top line finding and really that's kind of. I mean, it would have been interesting if it was the other way too, but it was, it really was kind of the hook that got me into the paper. Dr. Sandeep Das: I actually have a question for Jonathan, one of the things that I think we spend a lot of time as an editorial group thinking about and talking about, and we bounce back and forth with the authors a few times was the idea that relatively few of these patients with multi-vessel CAD ended up having CABG. So, you would typically think of diabetes multi-vessel CAD as being a pretty strong signal for patients that may benefit in terms of mortality from having bypass surgery. And here it was a relatively small group about a third, or maybe even less than a third. And I realized up front, they excluded the left main and the patients that had angina had a CTA, et cetera. But what I'd be curious as to your thoughts about, the benefits of bypass surgery and diabetes, which have been established in other trials. Dr. Jonathan Newman: It's a great question. And I think we really appreciated the questions from you and from the editors to try and get at some of the nuance with this issue. As you indicated in the ischemia and ischemia CKD trials overall, and the patients in the invasive treatment arm, it was about 25% or so 26% and 15% were revascularized with CABG. Part of the issue here is that it gets a little tricky with the use of CCTA of pre randomization CTA to define coronary artery severity, which was not required in the CKD population due to impaired renal function. But what we can say is among the patients with diabetes and multi-vessel coronary disease, 29% were revascularized surgically in their combined analysis, which is comparable to the 30% in Bery 2d that were revascularized via bypass surgery, as we've discussed. And as you know, the decision for surgical versus percutaneous revascularization in ischemia, as in Barry 2d was non-randomized though we might want to, we really tried to be very, very cautious in terms of comparing revascularization strategies on outcomes for patients with diabetes and multi-vessel CAD, which has you suggested. Dr. Jonathan Newman: And as we pointed out, the proportion with multi-vessel CAD was more common amongst in patients with diabetes compared with those patients without diabetes. The other thing I would sort of say in the framework of, the revascularization and strategies for revascularization, comparing, let's say ischemia to Barry 2d or to freedom. Basically we have very little data about revascularization approaches for those patients with creatinine with impaired renal function and, patients with the crediting greater than two were excluded from Barry 2d. So while we had about 15% or so that had severe CKD. So in the GFR, less than 30 are on dialysis. And we know that's an extremely high risk group of patients with diabetes and chronic coronary disease. And we don't have great evidence on which strategy for revascularization if at all provides additional benefit. So I think it's a really a tough question to answer, and we tried to be as judicious as possible in our comments about revascularization approaches, given the nature of the trial design. Dr. Carolyn Lam: Gee, thanks so much, Jonathan, for explaining that. So, well, I actually have a related question now, referring to the medical therapy. Can I, sort of ask you about the fact that, these days that the rage is all about GLP one receptor agonist, for example, that are known to reduce the risk of atherosclerotic cardiovascular disease and diabetes. So these ischemic trials, I assume, did not have a high usage of these medications. And what do you think would be the impact, if anything, I suppose even more for guideline directed medical therapy. Huh? Dr. Jonathan Newman: Yeah. So it's a great question, Carolyn. As you know, in strategy trials and clinical trials in general, that take a while it's always a real challenge to keep the trial contemporary with current clinical practice, whether it's revascularization strategies or changes in medical therapy. And as you indicated, the real revolution and glucose lowering therapies with profound cardiovascular benefit for patients with diabetes, we worked hard to try and stay up to date and encourage sites around the world with the use of best SGLT2 inhibitors and GLP ones. The rates were very, very low and we don't actually given the fact that the ischemia trials were conducted a real multinational and is really an international trial is over 330 sites worldwide. So we really had to balance the data that we could get from sites with the reality of collecting and running this trial across the whole world. Dr. Jonathan Newman: So we don't actually know. We know insulin use or non-use or oral medication use or non-use or no medication use or non-use, but not much more than that. From what, as, you know, unfortunately, even after now, six going on seven years of impressive data for the benefit of these agents, uptake remains low for patients with diabetes, whether it's with coronary disease or heart failure. And there was certainly the case with the trial, which started back in 2015, or sorry, before 2015, even before the results of EMPA-REG. So the rates of those agents were low. I would expect as you indicated that if we did have greater use of these beneficial therapies. Medical therapy may have performed even better and potentially given an added boost potentially for our high risk, even higher risk subgroups that we'd looked at that were available in these trials. Dr. Carolyn Lam: Oh, thanks again. I wish we could go on forever, but we've got just a little bit of time left. So I'd like to ask you both for your quick take home messages for the audience. Could I start with Sandeep and then Jonathan? Dr. Sandeep Das: Yeah. You know, I think a key take home from this is that, although it may be naively intuitive that a very aggressive invasive strategy would be superior, especially in high risk patients. You know, the data are very, very convincing that it's not. And so therefore I think in an absolute minimum, you have plenty of time and ability to think about these patients carefully, to select who, if anybody would be a great candidate for revascularization, more aggressive therapy and more invasive therapy, but the most patients will do well with conservative management. Dr. Sandeep Das: And I think that that's the, that's a real key take home here. And I think that the points that Jonathan raised about, you know, poor uptake of GLP one RAs and SGLT 2 inhibitors in the community as they're so far are key, right? So we have great medicines that we just under used, and that to me is the other sort of clarion call here is that if in the context of a nice trial, that you can see similar result for invasive conservative approaches, then lets, let's get our medical therapy where it needs to be to provide our patients the best outcomes we can Speaker 3: Love it, Jonathan. Dr. Jonathan Newman: Yeah. So I'm really glad that Sandeep brought up the issue of medical therapy in the trial. And maybe I can take a minute to sort of frame what San kind of build off of what Sandeep just said, you know, we, in the context of this clinical trial, you know, Dr. Judy Hawkman, the study chair and Dr. David Marin, the co-chair and I, we worked very hard with optimizing medical therapy across the trials, for all participants. So really getting patients on the maximum tolerated doses of high-intensity statins, lowering patient's LDL as aggressively as possible evolving our systolic blood pressure targets. And it was extremely challenging. And at the end of the day, we see that patients with diabetes were more likely than those without to get to our LDL goal. We used a threshold problematic concept that that still may be to some extent, but they were less likely to achieve their systolic blood pressure goals. Dr. Jonathan Newman: And I think Sandeep was exactly right. We have a way to go with implementing existing therapies, existing medical therapy. There may be a benefit for as demonstrated in Dr. S. for patients that remain highly symptomatic to derive symptom benefit with revascularization. The other context I would sort of add with the medical therapy issue is that despite really aggressive medical therapy, and we really did as much as we could, patients with diabetes still had, a 40, 50% greater risk of death or MI than those without diabetes. So there's still this idea of kind of residual risk. And these were patients with diabetes that were very well managed from a medical and glycemic control perspective. So we still have a lot of work to do. And I think understanding ways we can benefit our patients is really that challenge. Speaker 3: Thanks so much, Jonathan, and thank you Sandeep for joining us today. Speaker 3: And thank you audience for listening from Greg and I. This has been "Circulation On The Run", please tune in again. Next week. Dr. Greg Hundley: This program is copyright of the American Heart Association, 2021. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association for more visit AHJjournals.org.
Aspirin for primary prevention, induced hypothermia, half-dose DOAC, and social media, are the topics John Mandrola, MD, discusses in this week's podcast. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I - ASA for Primary Prevention - USPSTF Rules Out Aspirin for Over 60s in Primary CVD Prevention https://www.medscape.com/viewarticle/960745 - Aspirin Use to Prevent Cardiovascular Disease: Preventive Medication https://www.uspreventiveservicestaskforce.org/uspstf/document/draft-evidence-review/aspirin-use-to-prevent-cardiovascular-disease-preventive-medication - Use of aspirin to reduce risk of initial vascular events in patients at moderate risk of cardiovascular disease (ARRIVE): a randomised, double-blind, placebo-controlled trial https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31924-X/fulltext - Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus https://www.nejm.org/doi/full/10.1056/nejmoa1804988 - Effect of Aspirin on Cardiovascular Events and Bleeding in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/NEJMoa1805819 - Effect of Aspirin on All-Cause Mortality in the Healthy Elderly https://www.nejm.org/doi/full/10.1056/nejmoa1803955 II - Induced Hypothermia - No Benefit From Lower Temps for Out-of-Hospital Cardiac Arrest https://www.medscape.com/viewarticle/961191 - The CAPITAL CHILL Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2785263 - Targeted Temperature Management at 33°C versus 36°C after Cardiac Arrest https://www.nejm.org/doi/10.1056/NEJMoa1310519 - Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest https://www.nejm.org/doi/full/10.1056/NEJMoa2100591 III - Half-dose DOAC - Half-Dose DOACs Cut Bleeding, Thrombus Risk Post-Watchman LAA Closure https://www.medscape.com/viewarticle/960974 - Half-Dose Direct Oral Anticoagulation Versus Standard Antithrombotic Therapy After Left Atrial Appendage Occlusion https://www.jacc.org/doi/full/10.1016/j.jcin.2021.07.031 IV - Social Media - Navigating Benefits, Pitfalls of Social Media as a Female Doctor https://www.medscape.com/viewarticle/961150 - Gender Differences in Physician Use of Social Media for Professional Advancement https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2779868 Features: - USPSTF Statement on Aspirin: Poor Messaging at Best https://www.medscape.com/viewarticle/961118 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact firstname.lastname@example.org
The practice of Cardiology has undergone a massive transition over the last couple of decades. At the forefront of this transition is my guest today, Dr. Stephen Sinatra.He is a pioneer in the field of integrative cardiology. From introducing metabolic cardiology to recognizing the healing power of food, he has radically changed cardiac medicine.Having been in functional cardiac medicine for so long, Dr. Sinatra shares one dirty secret the pharmaceutical industry doesn't want you to know about cholesterol and statins. In addition, we talk about the exciting subject of vibrational living and why he thinks that earthing is a vital health discovery. We discuss the impact of earthing on chronic inflammation and heart health.In this episode, we talk about:- The secrets to heart health- Best foods for your heart- The great cholesterol myth- High vibrational living- And much moreThis is an inspiring conversation that you don't want to miss! Tune in to learn of the best ways you can lower your risk of heart disease and protect your patients and your loved ones. Key Takeaways- The secrets to heart health (02:12)- Best foods and supplements for your heart (03:25)- The great cholesterol myth (06:20)- Medicine of the present and the future (11:14)- Why environment trumps hereditary genetics (16:59)- Sugar is the enemy of the heart (19:47)- High vibrational living (22:59)Additional ResourcesGet Cardiologist Chosen, All organic, 100% natural heart-healthy foods and Olive Oils: Vervana.com - Use Code Damon20 to get 20% off -------Connect with Dr. Stephen Sinatra:Website-------ditchthequickfix.com/Do you want to improve your physical health? Learn More Here---------You can find the podcast on Apple, Google, Spotify, Stitcher, or wherever you listen to podcasts.If you haven't already, please rate and review the podcast on Apple Podcasts!
This week we delve into the world of heart transplantation and echocardiography to review a recent work on non-invasive assessment of the pediatric heart transplant patient. Can stress echo and real time myocardial contrast echo identify coronary vasculopathy in this patient group? How do the results compare to coronary angiography? How difficult is this form of imaging and can it be done by pediatric echo techs and staff physicians? Professor Jonathan N. Johnson of the Mayo Clinic shares his insights this week. DOI: 10.1016/j.echo.2020.12.009
Dr. Jit Choudhuri is the founder and CEO of MediCardia Health, a digital health platform that aggregates and visualizes healthcare data, and applies intelligence and automation at the clinician-patient interface, to drive value for patients, providers, practices, and payers. By using technology to deliver big wins to all stake holders, MediCardia is developing the healthcare platform of tomorrow, to drive digital transformation today, starting with Cardiology and Cardiovascular disease. Jit is a Cardiac Electrophysiologist and Electrical Engineer, and today has more than 10 years experience in Clinical Operations, applied Value-based Care and population health, and cardiovascular Informatics. Here are some key insights from this week's show: The vision of success is to transition healthcare from being one of the least digitized industries to one in which digitization is at the center of how we maintain and act upon data. Digital transformation and data driven healthcare is the true solution that will enable transition into value based care. Digital care doesn't mean impersonal care. Always challenge a simple premise. A solution should never be a compromise. Prefer to watch the video? Watch it here: https://youtu.be/wtLJlzGynhw
Going to the Doctor is no fun, but when patients walk in to see Dr. Columbus Batiste, they are met with compassion, understanding, and genuine empathy. Not only does he work with his patients with a team-based collaborative approach, but he also meets patients where they are at and explains health in a way that makes sense. As an Interventional Cardiologist (or “Plumber for the Heart” as he affectionately refers to himself), Doctor Batiste naturally treats disease with medical and surgical interventions, but he also works with his patients from a mental and emotional standpoint - emphasizing nutrition, stress reduction, and overall well-being. Today's episode includes a description of real-life patient case studies and Dr. Batiste provides his initial assessments and recommendations for treatment. Perhaps you recognize yourself or a loved one in one of the patient profiles. If so, appreciate the feedback and advice and, as he says, ask yourself, "What is your want and desire? What are you willing to do or not do in order to improve your health? The key takeaway from Dr. Batiste? It's OK to be S.E.L.F.I.S.H. in your desire for good health. Ready to feel a little selfish? We hope so! About Dr. Columbus Batiste, MD, FACC, FSCAI Columbus Batiste, MD, FACC, FSCAI, is the Chief of Cardiology at Kaiser Permanente Riverside and Moreno Valley Medical Centers. He completed his residency in Internal Medicine and fellowship in Cardiovascular Disease at Loma Linda University Medical Center. He is also known as the “Healthy Heart Doc” and he endorses a holistic approach to health care, emphasizing nutrition, stress reduction, and exercise. Episode Resources PLANTSTRONG Community PLANTSTRONG Website and Resources PLANTSTRONG Meal Planner - If you'd like to try our meal planner free for 14-days, use the code BACKTOSCHOOL to enjoy two weeks of free access. After the trial ends, membership is just $1.90 a week! Dr. Batiste Website and Resources Theme Music for Episode
Dr. Peter McCullough is a distinguished internist, cardiologist, and epidemiologist who has been front and center speaking against the policies and medical flaws in official actions to deal with the covid pandemic. For many he has become regarded as one of the world's experts on Covid-19. Dr. McCullough is also the Chief Medical Advisor for the Truth for Health Foundation, president of the Cardiorenal Society of America Editor in Chief of the peer reviewed journal Reviews in Cardiovascular Medicine and a senior associate editor of the American Journal of Cardiology. In addition to his internal medicine practice, he also manages common infectious diseases as well as cardiovascular complications associated with viral infection and injuries following Covid-19 vaccination. Since the time the pandemic was declared, Dr. McCullough took a lead in the medical response. He published the first synthesis of sequenced multi-drug treatment for ambulatory patients infected with the SARS-2 virus in the American Journal of Medicine. He has now published 46 peer-reviewed papers on the infection, reviewed thousands of reports, and has published an additional 700 papers and studies. You can keep up with Peter's reports and analyses on the website AmericaOutLoud.com
This week we delve into the world of cardiovascular surgery to review a recent work on outcomes of arch reconstruction in the newborn and small child. We speak with Dr. Ramana Dhannapuneni, lead cardiac surgeon of Alder Hey Children's Hospital in Liverpool, UK. How often in the present era is re-operation or reintervention required? How common is the recurrent laryngeal nerve or phrenic nerve injured or affected by surgery? Dr. Dhannapuneni provides us with the surgical perspective to this complex surgery this week. doi: 10.1017/S1047951121003747