Podcasts about cardiovascular physiology

Denis Noble is Emeritus Professor and co-Director of Computational Physiology who held the Burdon Sanderson Chair of Cardiovascular Physiology at the University of Oxford. He is one of the pioneers of systems biology and developed the first viable mathematical model of the working heart. He is also a philosopher of biology, and his books The Music of Life and Dance to the Tune of Life challenge the foundations of current biological sciences, question the central dogma, its unidirectional view of information flow, and its imposition of a bottom-up methodology for research in the life sciences. Raymond Noble is Honorary Associate Professor at the Institute for Women's Health, University College London. He held a Rockefeller Senior Research Fellowship with a joint appointment in Physiology and Obstetrics and Gynaecology at University College London, where he became Deputy Dean of Life Sciences and Graduate Tutor in Women's Health and where he also taught medical ethics in reproductive health. He is a Fellow of the Royal Society of Biology and a chartered biologist, writing extensively on biological theory and philosophy, working extensively on how organisms sense their environment and make choices. TIMESTAMPS: (0:00) - Introduction (2:45) - Consciousness & the Mind-Body Dichotomy (12:50) - Biology's Evolution & the Importance of Stochasticity (18:00) - The Gene Delusion (25:35) - Arguments Against Richard Dawkins' "Selfish Gene" (35:45) - Moral/Philosophical Implications of The Selfish Gene (39:19) - Purposive Explanations of Life & Understanding Living Systems (45:40) - Ecological Intelligence (56:05) - Consciousness & the Self (1:05:07) - Biological Evolution from a Physiological Perspective (1:21:18) - The Music of Life (Unselfish Gene) (1:29:00) - Free Will & Dogma (1:36:03) - The Story of Noble Brothers (Differences & Similarities) (1:42:24) - When Two Became One (1:50:45) - Teleology & The Purpose of Life (Final Thoughts) (1:56:40) - Conclusion EPISODE LINKS: - Denis: https://tinyurl.com/7uzjuxxm - Ray: https://tinyurl.com/25z9jnk5 - Books: https://tinyurl.com/bdcpwetj - Denis' Publications: https://tinyurl.com/yr3es4ht - Ray's Publications: https://tinyurl.com/yunnfjc5 CONNECT: - Website: https://tevinnaidu.com - Podcast: https://creators.spotify.com/pod/show/mindbodysolution - YouTube: https://youtube.com/mindbodysolution - X: https://twitter.com/drtevinnaidu - Facebook: https://facebook.com/drtevinnaidu - Instagram: https://instagram.com/drtevinnaidu - LinkedIn: https://linkedin.com/in/drtevinnaidu ============================= Disclaimer: The information provided on this channel is for educational purposes only. The content is shared in the spirit of open discourse and does not constitute, nor does it substitute, professional or medical advice. We do not accept any liability for any loss or damage incurred from you acting or not acting as a result of listening/watching any of our contents. You acknowledge that you use the information provided at your own risk. Listeners/viewers are advised to conduct their own research and consult with their own experts in the respective fields.

We're joined by Dr. Denis Noble, Professor Emeritus of Cardiovascular Physiology at the University of Oxford, and the father of 'systems biology'. He is known for his groundbreaking creation of the first mathematical model of the heart's electrical activity in the 1960s which radically transformed our understanding of the heart. Dr. Noble's contributions have revolutionized our understanding of cardiac function and the broader field of biology. His work continues to challenge long-standing biological concepts, including gene-centric views like Neo-Darwinism. In this episode, Dr. Noble discusses his critiques of fundamental biological theories that have shaped science for over 80 years, such as the gene self-replication model and the Weissmann barrier. He advocates for a more holistic, systems-based approach to biology, where genes, cells, and their environments interact in complex networks rather than a one-way deterministic process. We dive deep into Dr. Noble's argument that biology needs to move beyond reductionist views, emphasizing that life is more than just the sum of its genetic code. He explains how AI struggles to replicate even simple biological systems, and how biology's complexity suggests that life's logic lies not in DNA alone but in the entire organism. The conversation covers his thoughts on the flaws of Neo-Darwinism, the influence of environmental factors on evolution, and the future of biology as a field that recognizes the interaction between nature and nurture. We also explore the implications of his work for health and longevity, and how common perspectives on genetics might need rethinking. All the topics we covered in the episode: -The critique of Neo-Darwinism and the future of evolutionary theory. -Systems biology: Understanding life beyond the gene. -The complexity of biology: Why reductionism falls short. -Evolution and inheritance: The role of environment in shaping species. -Health implications of Dr. Noble's work: Longevity, lifestyle, and the limits of genome-based predictions. Join us for a thrilling discussion on the future of biology, evolution, and the practical implications for health and science. Follow our host, Waheed Rahman (@iwaheedo), for more updates on tech, civilizational growth, progress studies, and emerging markets. Timestamps: (00:00) - Intro (03:04) - Why Was The Last 80 Years of Biology Wrong? (08:17) - Where does Logic come from? (13:03) - Is Evolution Truly Random or Driven by Purpose? (22:05) - Is Nurture more important than Nature? (29:06) - Denis Noble calls for a rewrite of all Biology textbooks (32:48) - Is Neo-Darwinism Just a Model? Understanding the Difference Between Evolution and the Creationism Debate (39:22) - Natural Selection vs. Lamarckian Evolution: How Darwin Changed Our Understanding of Survival Traits (46:03) - Reductionism vs. Integrationism in Science: How the 'Third Way' Challenges Neo-Darwinism (49:43) - What Does Epigenetics Mean for the Average Person? How Denis Noble's Paradigm Shift Impacts Everyday Health and Life? (69:29) - Is Western Science Facing a Paradigm Shift? Rethinking How We Determine Truth and Health in Light of Eastern and Western Influences (75:21) - Why Reductionism Dominates Science: The Political and Practical Challenges of Embracing a Systems Biology Approach (82:49) - Can We Trust AI to Behave Ethically? The Need to Connect Philosophy with Technology in AI Development (86:46) - Outro

Michael adds a plank into his exercise routine and is surprised to learn of its huge benefits to our physical health.Dr Jamie O'Driscoll, a Reader of Cardiovascular Physiology at Canterbury Christ Church University, reveals how the plank is a form of isometric exercise, where muscles are held still, neither stretching nor contracting. Jamie shares his research that found these exercises, including the plank and the wall-squat, could massively reduce our blood pressure.Michael also explores how the plank can even be better than crunches or sit ups for your abs and core muscles. Our volunteer Penelope takes on the plank, excited to learn that this small addition to her fitness regime could yield great results. Series Producer: Nija Dalal-Small Science Producer: Catherine Wyler Researcher: Sophie Richardson Researcher: Will Hornbrook Production Manager: Maria Simons Editor: Zoe Heron A BBC Studios production for BBC Sounds / BBC Radio 4.

In this episode of Causes or Cures, Dr. Eeks chats with Dr. Jamie O'Driscoll and Jamie Edwards about their research recently published in the British Journal of Sports Medicine on what is the best exercise for maintaining a healthy resting blood pressure. In the podcast, they explain how they conducted their study, their results, and the theories behind why one exercise did significantly better than others at lowering blood pressure. They will  tell you how you can do the best exercise right now and also offer advice on how their findings should impact current exercise guidelines when it comes to high blood pressure, a serious health problem that affects millions of people! Dr. O'Driscoll is a researcher in Cardiovascular Physiology at Canterbury Christ Church University and a Clinical Scientist in Cardiology. You can learn about him here. Jamie Edwards is a PhD student at Canterbury Christ Church University. You can contact Dr. Eeks at bloomingwellness.com.Follow Dr. Eeks on Instagram here.Or Facebook here.Or Twitter.Subcribe to her newsletter here!Support the show

Biology against determinism!Looking for a link we mentioned? Find it here: https://linktr.ee/philosophyforourtimesWe all feel like we have free will. That our decisions are our own and that we could have chosen otherwise. But today, many prominent figures argue free will is an illusion. Join groundbreaking biologist Denis Noble as he argues that, in fact, our bodies hold the key to our freedom.Denis Noble is a renowned physiologist and one of the pioneers of Systems Biology. He is Emeritus Professor of Cardiovascular Physiology at Oxford University. Noble is known in his field for developing the first viable mathematical model of the working heart in 1960.There are thousands of big ideas to discover at IAI.tv – videos, articles, and courses waiting for you to explore. Find out more: https://iai.tv/podcast-offers?utm_source=podcast&utm_medium=shownotes&utm_campaign=free-will-is-not-an-illusionSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

What are the problems that come from aging and what can we do about them? What is the importance of staying active in old age? What is autophagy and how does it relate to the aging process? Why is it that cancer often recurs? Are herbal remedies legitimate? What do we need to know about cholesterol? What is the importance of community on our health?Thank you to our sponsors:Timeline Nutrition — our favorite supplement for cell support and mitochondrial function. Listeners receive 10% off your first order of Mitopure with code AGEIST at TimelineNutrition.com/AGEIST. LMNT Electrolytes — our favorite electrolytes for optimal hydration. Listeners receive a free 8-serving sample pack with their purchase at DrinkLMNT.com/AGEIST. InsideTracker — the dashboard to your Inner Health. Listeners get 20% off on all products atInsideTracker.com/AGEIST.Denis Noble, 86, is an innovator, scientist, musician, ballroom dancer, and Oxford University Emeritus Professor of Cardiovascular Physiology. He joins us to discuss how to increase our healthspans and our lifespans, what we need to know about the aging process and how it impacts our health, the importance of community, and more. “As you get into long life but very unhealthy life, you're having a big burden on society. I'm not blaming people. I'm saying that this is what we're now seeing and I think we have to do something about it. I don't think we should accept that there is nothing you can do about it.” “There is absolutely no doubt that the biggest thing you can do to remain healthy in old age is to keep active even if it's difficult, it's best to keep active. You use it or you lose it.” “The aging population suffers from these multifactorial diseases with many genes involved and that will not yield to just more sequencing of people's genomes.”“When you attack a late-stage cancer, you may, hopefully, kill it off enough for a permanent cure. But that's, unfortunately, rarer than we once imagined it would be. Very often what happens is it produces a period of several years, which is good, when the cancer has retreated but it will then come back in an even more virulent form.”“To the degree you can do it, a healthy lifestyle in terms of diet is a good thing to go for. It's obvious also to tell your listeners that smoking is a no-no if yuo want to look after yourself in old age.” “You can't go run a marathon on a big full stomach and there's a good reason for that. The blood supply during digestion is attracted to the intestines. They need the blood supply in order to do the work that is necessary to digest the food that you've eaten.”“It's very important to try to arrange your life so that you're not alone, you do interrelate with people, and that's a huge health benefit to be with people and find ways in which you can communicate with others.”“We are designed, effectively, to be social people.” Listen to the SuperAge podcast wherever you get your pods.Connect with Denis Noble:Website

On this week's episode Dr. Ashley Scarlett (Dr Scarlett Smash) has Rhea Storlund is a PhD candidate studying cardiovascular anatomy and function in diving behaviors.

Licy Yanes Cardozo expands on her research exploring the role of androgens on cardiovascular physiology in cis and transgender patients.

Licy Yanes Cardozo expands on her research exploring the role of androgens on cardiovascular physiology in cis and transgender patients.

Video for this podcast: https://mehlmanmedical.com/audio-qbank-hy-usmle-q-563-cardiovascular-physiology Main website: https://mehlmanmedical.com/ Instagram: https://www.instagram.com/mehlman_medical/ Telegram private group: https://mehlmanmedical.com/subscribe/ Telegram public channel: https://t.me/mehlmanmedical Facebook: https://www.facebook.com/mehlmanmedical Podcast: https://anchor.fm/mehlmanmedical Patreon: https://www.patreon.com/mehlmanmedical

My guest on this weeks episode is Dr Aamer Sandoo, Professor of Cardiovascular Physiology at Bangar University. In this episode of the podcast we chat about some the fascinating adaptations to our heart and body that we get from aerobic training. We look at why implementing this type of training is essential for overall health and how these changes are distinct to this form of training. We discuss how to implement this type training into your plan (no matter what your fitness level), key considerations to take into account and training mistakes you need to avoid. We also touch on the other key aspects of a balanced training program (weight training and interval training) that we need to include for optimal results. This was an amazing chat and I have no doubt you will enjoy this one. -If you liked this episode please share on social media, rate and leave us a review. It's a massive help to the podcast so we can continue to grow and deliver you this information. If you have any questions feel free to email sean@livelongperformance.com For more information on our coaching services and free resources heard over to our website www.livelongperformance.com

Drs. Kirk and Kimberly Milhoan are an amazing physician couple with a unique combination of expertise in Pediatric Cardiology and Pediatric Anesthesia. They have experienced what happens when  speaking out against the status quo on Covid therapeutics , and what that cost is. Kirk tells of how he became subject to investigation by the Hawaii Board of Medicine for a conversation he had regarding Covid therapies.  Throughout the pandemic they began to question the evolving push of vaccines over outpatient therapies. Kirk also has concerns with what is happening to children's cardiac health as a result of using an emergency use injection therapy in our young, with no long term data.  They have been actively involved in Global Covid Summit and proponents of the sanctity of the physician-patient relationship, recognizing natural immunity from Covid and avoidance of doing more harm than good with Covid mRNA technologies. Kirk Milhoan has a BA in Biology and Chemistry and a PhD in Cardiovascular Physiology and Pharmacology, focusing on cellular mechanisms of cardiac inflammation, specifically the role of platelet activating factor in activating the myocardial inflammation process. He received his medical degree, Magna Cum Laude, from the Jefferson Medical College of the Thomas Jefferson University. He completed his pediatric residency at David Grant Medical Center at Travis Air Force Base and pediatric cardiology fellowship at San Diego Children's Hospital/UCSD. He is a Diplomate of the American Board of Pediatrics in Pediatrics and Pediatric Cardiology, and a Fellow of the American College of Cardiology and American Academy of Pediatrics. He served thirteen years in the United States Air Force as a pediatric cardiologist and flight surgeon.  Kim is a graduate of Stanford University, with a B.A. in Human Biology, with a concentration in Public Health and Health Administration. She worked as a health care management consultant for American Practice Management before obtaining her medical degree.  She completed her anesthesiology residency, as chief resident, at the University of Health Science Center in San Antonio. She is a Diplomate of the American Board of Anesthesiology in Anesthesiology and Pediatric Anesthesiology, and a Fellow of the American Society of Anesthesiology, with a specialty in Pediatric Anesthesia. She and Kirk co-founded  For Hearts and Souls, a non-profit specializing in the international care of children with congenital heart disease. Kirk serves as medical director and diagnostic cardiologist for the organization, and they have voluntarily served the needs of tens of thousands of children with heart defects throughout the world. The organization has performed over 700 invasive pediatric cardiac procedures internationally.  Kirk is also the Senior Pastor of Calvary Chapel South Maui.  He and his wife have treated many patients with COVID-19 through their federally recognized free mobile medical clinic in Maui.   LINKS:  Global Covid Summit Maui -an alliance of physicians and scientists committed to thinking globally and acting locally regarding COVID-19 public health policy and information. Sponsor:  Thanks to our sponsor MR Insurance! Please reach out to Michael Relvas' team, where their goal is to assist physicians in obtaining the most comprehensive coverage available to fit their unique situation. Click here! www.mr-disability-insurance.com/bsfreemd Our Advice! Everything in this podcast is for educational purposes only. It does not constitute the practice of medicine and we are not providing medical advice. No Physician-patient relationship is formed and anything discussed in this podcast does not represent the views of our employers.  The Fine Print! All opinions expressed by the hosts or  guests in this episode are solely their opinion and are not to be used as specific medical advice.  The hosts,  May and Tim Hindmarsh MD, BS Free MD LLC, or any affiliates thereof are not under any obligation to update or correct any information provided in this episode. The guest's statements and opinions are subject to change without notice. Thanks for joining us! You are the reason we are here.  If you have questions, reach out to us at doc@bsfreemd.com or find Tim and I on Facebook and IG. Please check out our every growing website as well at  bsfreemd.com (no www)  GET SOCIAL WITH US! Instagram:: https://www.instagram.com/bsfreemd/ Facebook: https://www.facebook.com/bsfree

Today on Moments of Clarity, I speak to Dr Andrew Hattam. Andrew is an advanced trainee in Vascular Surgery with interests in trauma and transplant surgery. He holds a Bachelor of Biomedical Science in which he trained in lab-based research, and obtained his honours in epidemiology from the University of Melbourne. He studied Medicine in Cairns and holds a graduate diploma in applied anatomy by dissection. He also holds a PhD in Cardiovascular Physiology from the University of Melbourne. Andrew is passionate about medical and surgical education and sits on the Australian and New Zealand Association for the Surgery of Trauma education committee. He is also a founding member of the faculty of the Anatomy of Surgical Exposure Course in Cairns, helping to develop the curriculum and textbook. If you would like to follow some of Andrew's work he is on Twitter @andrewhattam.    In Part 1 of today's podcast, we discuss Andrew's unique position working as a surgeon in major hospitals in both Melbourne and Sydney at the height of each city's Covid-19 outbreak. This first-hand perspective is a real eye opener and well worth the listen. I am in awe of our health care workers and am proud of all Australians who have done the right thing through this pandemic to ensure they feel supported and valued at this difficult time.   My discussion with Andrew was recorded in late November 2021, so a lot of the Covid talk is pre-omicron. On that note, I hope everyone is safe and healthy. Book in your booster if you haven't already and let's get on top of this thing.    In Part 2 of the podcast, Andrew explains vascular surgery, the daily life of a surgeon and how he got into the profession. Andrew's alternative pathway into the medical field is an inspiring one and illustrates that not everyone has to take the same road and sometimes all we need is someone to believe in us.    Part 3 of the podcast delves into some of the experiences that make Andrew the surgeon he is today, including some incredible stories from his time in a trauma hospital in South Africa.   Thank you for listening.   Time Stamps Introduction: 0:00 - 3:08 Part 1: 3:09 - 27:51 Part 2: 27:52 - 62:52 Part 3: 62:53 - 91:02 Conclusion: 91:03 - 91:42   Moments of Clarity Instagram: @momentsofclaritypodcast Facebook: @momentsofclaritypodcast Twitter: @BarneyMOC Email: momentsofclaritypodcast@gmail.com   Podcast by Matthew Sortino Music by Christian Prochilo Artwork by Michael Chrisanthopoulos  

Derek Hockaday interviews David Paterson, physiologist and Professor of Cardiovascular Physiology, 8 January 2019. Topics discussed include: (00:00:09) coming from Western Australia to Oxford for doctoral studies; (00:01:58) switching from breathing to the heart and focus on cardiac electrophysiology; (00:03:35) comparison of initially coming as a tutorial fellow to teaching now at Oxford; (00:07:51) administration and divisionalisation; (00:09:51) interactions between clinicians and pre-clinicians past and present; (00:12:24) how funding has changed (not just for Oxford but for Briitsh science); (00:14:13) changes in subjects and information being taught at Oxford; (00:15:00) teaching using HoloLens; (00:18:15) role as professor and head of department; (00:20:30) undergraduate medical students and funding; (00:23:34) admissions to Oxford medical school; (00:28:48) decisions on clinical placements; (00:31:06) work outside of Oxford including editor-in-chief of the Journal of Physiology; (00:33:40) moving from Otago to Western Australia; (00:40:22) comparing medical schools in the United States.

Here is cardiovascular (CVS) physiology part 2 classifiedIf you would like to support us please do via our Patreon account. https://www.patreon.com/anaesthesiaAnd best thing is that all proceeds will go to a reputable charity!Effect of standing due to hydrostatic pressure Compensation is Global-       Baroreceptoro   A reduction in mean arterial pressure is sensed by the baroreceptors. They decrease their rate of firing which results in an increase in SNS discharge and decreased PNS discharge causing:o   increased HRo   increased myocardial contractility ® increased CO ® increased MAPo   peripheral vasoconstriction ® increased TPR ® increased MAP (greater effect on resistance vessels than on capacitance vessels)o   venoconstriction ® increased venous return ® increased CO -       Atrial stretcho   Over an extended period of time, decreased blood volume will be sensed by the cardiopulmonary receptors as decreased stretch and decreased firing of the A and B receptors will stimulate:o   release of angiotensin, aldosterone and ADH (­ Na+/H2O reabsorption, restoration of blood volume)o   increased SNS activity in the kidney (vasoconstriction, ¯ GFR and ¯ urine flow) -       Venous flow o   Skeletal muscle pumpo   Valveso   Thoracic pump-       Microcirculation changes  Local -       Cerebral autoregulaton -       Myogenic mechanism-       Metabolic -       Increase O2 extraction Please rate, post a review and subscribe!Check out www.anaesthesiacollective.com and sign up to the ABCs of Anaesthesia facebook group https://www.facebook.com/groups/2082807131964430and check you the ABCs of Anaesthesia YouTube channel for more contenthttps://www.youtube.com/c/ABCsofAnaesthesiaAny questions please email Lahiruandstan@gmail.com  Disclaimer: The information contained in this podcast is for medical practitioner education only. It is not and will not be relevant for the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this video. You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant.You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode' Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewing The information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia. The information presented here does not represent the views of any hospital or ANZCA. These podcasts are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements. This disclaimer was created based on a Contractology template available at http://www.contractology.com. 

If you would like to support us please do via our Patreon account. https://www.patreon.com/anaesthesiaAnd best thing is that all proceeds will go to a reputable charity!In this episode we cover categorisation of core cardiovascular topicsHere is a brief summary:HypotensionPreloadRate RhythmContractilityAfterloadOr ShockHypovolaemiaCardiogenicDistributiveObstructiveO2 supply demand  Supply= o2 flux or delivery to heartCBF x o2 content (Hb, sats, PO2)CVR and CPPCVResistance = metabolic, myogenic, neural, physical compression, viscosity, pathologyCPP = Cor Pressure – RAP or LVP.O2 extraction.High basal extraction of 55-65%other tissues only 25%so O2 demand is met by increasing CBFDemandDepends on Metabolic rate and myocardial workWall tension – PL and ALContractilityHRRhythmsWall thicknessBasal rateType of work (pressure > volume work)Electrical activationWhen this is unbalanced = ischaemiaDeterminants of coronary vasc resistanceResistance = pressure difference / flow = corPP/ CBF= 8nl/Pi R4. (n = eta)RadiusNeuralPhysical – compression, HR,PathologyAutoregulation            Metabolic            Myogenic ViscosityCoronary blood flow= CPP/CVRNeuralPhysical-       CompressionHRViscosityAutoreg-       Metabolic-       Myogenic: A myogenic response refers to the intrinsic tendency of vascular smooth muscle to contract in response to increased distending pressure and to relax in response to decreased distending pressure.Please rate, post a review and subscribe!Check out www.anaesthesiacollective.com and sign up to the ABCs of Anaesthesia facebook group https://www.facebook.com/groups/2082807131964430and check you the ABCs of Anaesthesia YouTube channel for more contenthttps://www.youtube.com/c/ABCsofAnaesthesiaAny questions please email Lahiruandstan@gmail.com  Disclaimer: The information contained in this podcast is for medical practitioner education only. It is not and will not be relevant for the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this video. You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant.You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode' Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewing The information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia. The information presented here does not represent the views of any hospital or ANZCA. These podcasts are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements. This disclaimer was created based on a Contractology template available at http://www.contractology.com. 

This weeks episode is part two of my lengthy conversation with Dr Greg duManoir. Who is a tenure track instructor within the School of Health and Exercise Sciences at the University of British Columbia Okanagan. Dr duManoir is a specialist in cardiovascular physiology and he helps unpack the science behind different types of energy system development, the determinants of endurance performance, and why it is hugely beneficial to have different types of cardiorespiratory training in your arsenal to improve metabolic flexibility. If you haven't already, I suggest you head over and take a listen to part one prior to indulging in part two. If you already have or if scrambled is more your style, then let dive right in

In this week's episode, we dive into the science behind exercise, or more specifically, the science behind cardiovascular physiology with our guest, Dr. Greg duManoir. Dr. duManoir is a tenure track instructor within the School of Health and Exercise Sciences at the University of British Columbia Okanagan. He holds a B.Sc. (Kinesiology) and a M.Sc. from the Faculty of Physical Education and Recreation at the University of Alberta and a PhD from the University of Western Ontario. Dr. duManoir has held several teaching-related positions including Sessional Instructor at the University of Alberta and College Professor in the Human Kinetics Diploma Program at Okanagan College. While his training is in cardiovascular physiology, he has a wide breadth of knowledge on the interaction and response of human physiology during exercise. Greg and I discussed the role of altitude training, the efficacy of training masks, the different adaptations that occur within the body as a result of different stimuli as well as several other topics. I learned a lot during our discussion and was also reminded about how much I have forgot since my years in undergrad, so I know there will be a lot of practical information for you as well. In his free time, Dr duManoir enjoys wine, hitting the slopes, and long bike rides down muddy mountain trails. Without any further adieu, let's dive right in.

In this episode, I interview Alis Bonsignore, R.Kin and Exercise Physiologist at Cleveland Clinic Canada. Ms. Bonsignore obtained her Bachelor of Science in Kinesiology from the University of Guelph-Humber. While there, she discovered cardiac rehab during a placement and was inspired by the way that exercise and nutrition could alter the state of a disease on a physiological level and help individuals with chronic condition achieve better health outcomes. She went on to complete her Master of Science at the University of British Columbia in Cardiovascular Physiology and Oncology. A lifelong learner, she is currently pursuing her PhD from the University of Toronto in an emerging field of “cardio-oncology. In this episode, Alis tells us the number one thing to learn if you want to go into this field, imagining Kinesiologist's in a health liaison role and how you don't need to be working as a front-end therapist to be an R.Kin. SHOW NOTES 02' - College as a good foundation 03' - Heart failure in women with breast cancer 08' - Exercise Physiologist vs Clinical Kinesiologist 09' - R.Kin in hospital setting required. 11' - Exercise physiologist's in Pre- and Post- COVID world 13' - Number one thing to learn if you want to go into this field 15' - Define your role early on 19' - Volunteer ALOT 22' - Starts at education level - Master's Kin degree required for an R.Kin? 23' - R.Kin as a Health liaison 29' - Pick your area of Kinesiology you enjoy and stick through it 30' - Network and Continuing Education 31' - Don't need to be front line therapist 32' - Find programs that specialize you in a specific population LINKS Spencer's LinkedIn: https://www.linkedin.com/in/spennyraposo/ Making Kinnections Facebook: https://www.facebook.com/MakingKinnectionsPodcast/ Making Kinnections LinkedIn: https://www.linkedin.com/showcase/making-kinnections/ Making Kinnections Instagram: https://www.instagram.com/makingkinnectionspodcast/ Alis LinkedIn: https://www.linkedin.com/in/alis-bonsignore-msc-phd-c-r-kin-82641926/ Cleveland Clinic Bio: https://my.clevelandclinic.org/canada/staff/bonsignore-alis Episode Sponsor Continuing Education for Kinesiologists and COKO Exam Prep Kinformation: https://kinformation.teachable.com/

Dr. Chastity Bradford completed her undergraduate studies at Spelman College (an HBCU) earning a B.S. in Biology. While there she was a Microbiology Scholar, received a Howard Hughes Fellowship (Loyola University, Chicago, IL), and made Spelman College's Honor Society as well as the Dean's List. Chastity started her graduate studies in the Department of Cellular and Molecular Physiology at the University of Alabama at Birmingham (UAB). Her research area focused on Cardiovascular Physiology in Dr. Pamela A. Lucchesi's Lab. Her dissertation work focused on The Role of the Renin-Angiotensin System in Extracellular Matrix Remodeling During the Progression of Hypertension and the Development of Cardiac Fibrosis Currently, Dr. Bradford is an Associate Professor of Biology in the College of Arts and Science at Tuskegee University (an HBCU). As the Principal Investigator of her own lab, the Bradford Lab, she uses hemodynamic, molecular, biochemical, and immunohistological analyses to determine if ACE2 overexpression prevents Angiotensin-II induced HTN and rescues Pulmonary Hypertension. --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Denis Noble, CBE, Ph.D., FRS, the celebrated and outspoken British biologist, physiologist, and prolific author, discusses his incredible, noteworthy career in biology, exciting concepts in genetics, and the level of causation in biology.  Podcast Points: What is the current state of evolutionary theory? What do we know about cells and how they work? Issues regarding the genome and how diseases might originate British biologist, Noble has long been a major voice in modern biology. Dr. Noble was the Burdon Sanderson Chair of Cardiovascular Physiology at the University of Oxford for more than two decades. He was later named Professor Emeritus. Additionally, Dr. Noble was appointed the Co-Director of Computational Physiology. Dr. Noble is one of the earliest researchers in systems biology and he played an integral role in the development of the first mathematical model of the human heart. His thoughts on evolutionary theory have been part of a growing movement, a sort of revolution in evolutionary biology. Dr. Noble discusses his background and talks about what got him interested in his areas of research and study. As a self-described ‘card-carrying reductionist scientist,' Dr. Noble was interested in the concept of a privileged level of causation. And as he states, it was really always about, and is about, simply molecules. He recounts some early experiments he engaged in, attempts to reproduce the rhythm of the heart, with differential equations representing the molecular event. Which molecules are involved? This was an important question for the research. After much experimentation and study, he came to the conclusion that the cell itself is partially causing what happens. Rhythm only occurs by something that is constrained by the cell membrane. He explains the complex details of how the process works and how differential equations will not lead to answers unless the appropriate information is added into the mix.  The research scientist discusses how DNA is produced, and how cells have mechanisms for controlling errors. Cells, in short, have great control over what happens within systems. Dr. Noble goes on to discuss other important experiments, in the nervous system and other systems such as the immune system. Continuing, the Ph.D. expert talks about the genome. He discusses the origin of diseases and the fact that we know very little about biology above the level of the genome, in contrast to what we know about molecular biology in general. But remarkably, we still don't know exactly how cells work. 

Bioenergetics and Cardiovascular Physiology

Denis Noble, CBE, PhD, FRS, the famed British biologist, delivers an interesting overview of his life's work studying the intricate details of biology and what new developments can mean for the treatment of disease. As a celebrated British biologist, Noble held the Burdon Sanderson Chair of Cardiovascular Physiology at the University of Oxford for two decades and was later bestowed the honor of Professor Emeritus and appointed Co-Director of Computational Physiology. Noble's work has been groundbreaking and he is one of the earliest pioneers of systems biology who developed the very first useful mathematical model of the heart, back in 1960. Noble talks in detail about extracellular vesicles (EVs), which are lipid bilayer-delimited particles—naturally released from a cell but, unlike a cell, they cannot replicate. He discusses the interior of cells, and explains how extracellular vesicles occur, touching on DNA and RNA, and the processes utilized by cells. As he explains, we “used to think that the cells were more or less cut off from each other,” but Noble states that this is just not true. Cells are actually exchanging information all the time, and the extracellular vesicles are little packets that contain information for exchange. The celebrated biology expert goes on to discuss how Darwin saw the potential significance of transgenerational information being passed on. Noble explains that we can use the expanding information to develop tools to diagnose and treat diseases earlier on, which will be incredibly beneficial of course to patients. Noble continues, and talks about how digital intelligence and AI can help to organize information and opportunities. He explains how intelligence is created, and discusses his theories on the topic. As one of the world's preeminent biologists and evolution scientists, Noble continues to lead some of the most pertinent discussions in the scientific community regarding life, genetics, and cellular processes.

In this episode, we cover practice questions for the NSCA's CSCS Exam. Concepts covered include programming, Endocrine, Cardiovascular Physiology, Aerobic Training, and How to get started in the Strength and Conditioning Field.  Bryce is a full time Online Personal Trainer and Prep Coach. He discusses his methods of training and his experience working in the field of Strength and Conditioning.  Join our Facebook group "Strength and Conditioning Study Group" for more information and helpful educational videos. 

Is it possible for preclinical researchers to improve the quality of their cardiac and metabolic animal studies by incorporating protocols and strategies aimed at reducing bias? Listen as Deputy Editor Merry L. Lindsey (University of Nebraska Medical Center) interviews lead author Julie R. McMullen (Baker Heart & Diabetes Institute) and content expert Lisandra de Castro Brás (East Carolina University) about the study by Weeks et al., the latest article in the AJP-Heart and Circulatory Physiology Cores of Reproducibility in Physiology series. McMullen and co-authors conducted a short survey of preclinical research colleagues about how animal studies were being performed, with a focus on blinding, randomization and allocation concealment. The survey was followed by skills training aimed at improving practices, such as computer-generated methods for randomization and de-identifying drugs and interventions. Why take on this project? By providing basic scientists with tools to correctly randomize animals, and rationale to pre-specify inclusion and exclusion criteria, pre-specify endpoints, and appropriately address negative data, McMullen and collaborators hope to equip investigators with tools and knowledge to remove unconscious bias. This includes the encouragement of team science among smaller labs to allow for improvements in experimental design such as allocation concealment, which requires more personnel. Listen now to learn more.   Kate L. Weeks, Darren C. Henstridge, Agus Salim, Jonathan E. Shaw, Thomas H. Marwick, Julie R. McMullen CORP: Practical Tools for Improving Experimental Design and Reporting of Laboratory Studies of Cardiovascular Physiology and Metabolism Am J Physiol Heart Circ Physiol, published July 26, 2019. DOI: doi.org/10.1152/ajpheart.00327.2019

The Heart: Cardiovascular Physiology

Human Body Cardiovascular Physiology Overview Lesson 6b

Just around the corner is the publication of Exosomes in Health and Disease, an enormous compilation of data on exosomes and their role in almost every disease you can imagine. What's an exosome, you might ask? At just a fraction of the size of even the smallest bacteria, exosomes are tiny vesicles communicating with and carrying information to cells anywhere in the body. We've known about them for decades, but a recent discovery holds huge implications for our understanding of epigenetics, epigenetic inheritance, and the causes of diseases. Denis Noble, physiologist, researcher, and former Chair of Cardiovascular Physiology at the University of Oxford joins the podcast today to offer a fascinating conversation about the presence of epigenetic data within exosomes, their ability to control the genome of other cells by simply communicating with them, and the profile components that could indicate cancer or a particular disease state. He also discusses the techniques used to extract such small vesicles from blood plasma and the challenges that this process has brought about, the transmission of epigenetic information by exosomes through the germline, symbiogenesis, and more. Tune in for all the details.

Dr. Paul Wang:                Welcome to the monthly podcast, On The Beat for Circulation: Arrhythmia, and Electrophysiology. I'm Dr. Paul Wang, Editor in Chief, with some of the key highlights from this month's issue. We'll also hear from Dr. Suraj Kapa, reporting on new research from the latest journal articles in the field.                                            This month's issue of Circulation: Arrhythmia, and Electrophysiology has a number of groundbreaking and fascinating articles. Let's start with the first article by Christopher Andrews and Associates on the novel use of noninvasive electrocardiographic imaging in patients with arrhythmogenic right ventricular cardiomyopathy.                                            The authors compared 20 genotyped arrhythmogenic right ventricular cardiomyopathy patients to 20 control patients using electrocardiographic imaging, ECGI, a method for noninvasive cardiac electrophysiology mapping. They found that ARVC patients had a longer ventricular activation duration, with a mean of 52 milliseconds versus 42 milliseconds with a p-value of 0.007, as well as a prolonged mean epicardial activation recovery interval, a surrogate for local action potential duration with a median of 275 milliseconds versus 240 milliseconds with a p-value of 0.014.                                            In addition, the authors observed abnormal epicardial activation breakthrough locations with regions of nonuniform conduction and fractionated electrograms. These abnormal activation patterns correlated with late gadolinium enhancement using cardiac magnetic resonance scar imaging. This study suggests that electrocardiographic imaging may be a promising tool for the diagnosis and follow-up of patients with ARVC.                                            In the next article, Thomas Fink and Associates report the results of the prospective randomized Alster-Lost AF trial, comparing ablation strategies in patients with symptomatic persistent or long-standing persistent atrial fibrillation. The study compared standalone pulmonary vein isolation, the PVI-only approach, with a stepwise approach of PVI followed by complex fractionated atrial CFAE ablation and linear ablation, the substrate modification approach. Patients were randomized one-to-one to each study group. The primary study endpoint was freedom from recurrence of any atrial tachyarrhythmia at 12 months after a 90-day blanking period. 118 of 124 enrolled patients were analyzed. 61 in the p-value only group and 57 in the substrate modification group. The pulmonary vein isolation only group had a one-year freedom from arrhythmia recurrence of 54%, which was similar to the 57% recurrence rate in the substrate modification group, p = 0.86. Thus, this study confirms in a population of persistent and long-standing persistent atrial fibrillation that there is no significant benefit to the addition of CFAE ablation to pulmonary vein isolation only.                                            In the next paper, John Papagiannis and associates studied AV nodal reentrant tachycardia in patients with congenital heart disease. In this multi-centered, retrospective study, the authors compared catheter ablation of AV nodal reentrant tachycardia in 51 patients with complex congenital heart disease, with 58 patients with simple congenital heart disease.                                            There was no significant difference between the groups in terms of growth parameters, the use of 3D imaging, or type of ablation, radio frequency versus cryoablation. The procedure times, fluoroscopy times were longer in the complex group compared to the simple group. There were also significant differences between the groups in terms of acute success of ablation, 82% versus 97%; the risk of AV block, 14% versus 0%; and the need for chronic pacing, all significant in favor of the simple congenital heart disease group. There were no permanent AV block observed in patients who underwent cryoablation.                                            After a mean, 3.2 years of follow up, the long-term success was 86% in the complex group, and 100% in the simple group, p = 0.004. Thus, the authors concluded that the complexity of congenital heart disease affects the outcome of AV nodal reentrant tachycardia catheter ablation.                                            In the next paper, Moloy Das and associates studied whether the presence of abnormal intra-QRS peaks would indicate altered activation and might predict ventricular arrhythmias in cardiomyopathy patients. The authors examined the 99 patients with ischemic or nonischemic cardiomyopathy undergoing primary prevention ICD implantation, with a mean left ventricular ejection fraction of 27%. After a median follow up of 24 months, 20% of patients had arrhythmic events. Using a multivariate, Cox regression model that included age, left ventricular ejection fraction, QRS duration, and QRS peaks, only QRS peaks was an independent predictor of arrhythmic events with a hazard ration of 2.1. ROC analysis revealed that a QRS peak value of greater than or equal to 2.25 identified arrhythmic events with a greater sensitivity than QRS duration, 100% versus 70%, with p < 0.05, and a negative predictive value of 100%, compared to 89% for QRS duration, p < 0.05. Thus, the authors concluded that this novel QRS morphology index may be a promising additional tool in sudden death risk stratification.                                            In our next paper, Yoshiyasu Aizawa and associates studied J wave changes during atrial pacing in patients with and without idiopathic ventricular fibrillation. In eight patients with idiopathic ventricular fibrillation, and 17 patients without idiopathic ventricular fibrillation, having J waves, the J wave amplitude was measured before, during and after atrial pacing. All of the patients with ventricular fibrillation did not have any structural heart disease. The idiopathic ventricular fibrillation patients were younger than the non-idiopathic ventricular fibrillation patients, and had larger J waves with more extensive distribution. The J wave amplitude decreased from 0.35 millivolts to 0.22 millivolts when the R-R intervals shortened, a decrease of greater than, equal to 0.005 millivolts in the J wave amplitude was observed in six of eight idiopathic ventricular fibrillation patients while the J wave amplitudes were augmented in nine out of 17 non-idiopathic ventricular fibrillation subjects. The authors therefore concluded that the different response patterns of J waves to rapid pacing suggested different mechanisms that is early repolarization in idiopathic ventricular fibrillation patients, and conduction delay in non-idiopathic ventricular fibrillation patients.                                            Our final paper of the month was written by Jim T. Vehmeijer and colleagues, who examined the utility of recent guidelines and consensus documents for ICD implantation for sudden death protection in adults with congenital heart disease. The authors examined an international, multi-center registry, having 25,790 adult congenital heart disease patients, and identified all sudden cardiac death cases, which were then matched to living controls by age, gender, congenital defect and surgical repair. They used conditional logistic regression models to calculate odds ratios, and receiver operating characteristic curves. In their first analysis, they identified 124 cases and 230 controls. In total, 41% of sudden cardiac death cases, and 17% of controls had an ICD recommendation based on the 2014 consensus statement on arrhythmias in adult congenital heart disease, with an odds ratio of 5.9. A similar analysis of the 2015 European Society of Cardiology guidelines showed that 35% of cases and 14% of controls had an ICD recommendation, respectively with an odds ratio of 4.8. The authors concluded that a minority of sudden cardiac death cases had an ICD recommendation according to these guidelines, while the majority of sudden cardiac death victims remained under-recognized, emphasizing the need for continued critical, clinical reasoning when deciding on ICD implantation in adult congenital heart disease patients.                                            And now, here with the review of the highlights from the articles from journals throughout the world, in the past month is Dr. Suraj Kapa. Dr. Suraj Kapa:                 Thank you, Paul. Today we'll be discussing hard-hitting articles that have been published within the last month across the electrophysiologic literature. First, we'll be focusing on the topical area of atrial fibrillation, with an initial foray into the realm of anticoagulation. The first article we will be focusing on was published by Yao, et al., in the Journal of the American College of Cardiology in volume 69, entitled Non-Vitamin K Antagonist Oral Anticoagulant Dosing in Patients with Atrial Fibrillation and Renal Dysfunction. In the study, Yao, et al, demonstrated that the dosing of direct oral anticoagulants in a real world patient sample, with preexisting renal dysfunction was inappropriately dosed in as many as 43% of patients. Specifically, in these patients, there was overdosing of the direct oral anticoagulants. Moreover, as many as 13% of patients were underdosed.                                            The overdosing of these patients led to increased bleeding risks, without an incremental stroke benefit compared with cohorts that were appropriately dosed. In turn, underdosing led to increased stroke risk without an incremental reduction in bleeding risk. These results are provocative in that they indicate, in a real life sample of patients, frequent inappropriate dosing of direct oral anticoagulants. This identifies the need for better guidelines, or better adherence to guidelines, in management of these patients to improve clinical outcomes.                                            In another article with the realm of anticoagulation management of atrial fibrillation patients, was published by Labovitz, et al. in Stroke, in volume 48, entitled Using Artificial Intelligence to Reduce the Risk of Nonadherence in Patients on Anticoagulation Therapy. They demonstrated in a small randomized study that a smart phone based artificial intelligence program could be used to monitor anticoagulation adherence, and in fact, improve it. The program utilized features available on all smart phones to identify the patient, the medication, and active ingestion of the medication by the patient in real time.                                            With this approach, they noted the plasma drug concentration levels indicated 100% adherence in the intervention group, namely those using the artificial intelligence program, while in the control group, only 50% of patients had adherence to the medications. Overall, there was an absolute improvement in adherence amongst patients on direct oral anticoagulants by as many as 67%. These findings are provocative given data suggestive of the lack of appropriate adherence to anticoagulant therapy amongst patients.                                            Changing paths from anticoagulation management, the next article we choose to focus on was published within the realm of cardiac mapping in ablation for atrial fibrillation. It was published by Das, et al. in JACC: Clinical Electrophysiology in volume three, entitled Pulmonary Vein Re-Isolation as a Routine Strategy Regardless of Symptoms, The PRESSURE Randomized Controlled Trial. In this randomized trial, Das, et al, demonstrated that aggressive reevaluation of patients undergoing pulmonary vein isolation after index ablation for pulmonary vein reconnection, with the intent to re-ablate, significantly reduced arrhythmia recurrence. In addition, there was a commented improvement in quality of life. It has been well-recognized that even in the absence of clinical recurrence, a large number of patients, after index pulmonary vein isolation, may have pulmonary vein reconnection. However, it has always been unclear whether aggressive reevaluation and re-isolation of reconnected veins holds value, has been unclear. Further study is needed to evaluate the cost effectiveness and the risk-benefit ratio of such an invasive approach to reevaluate pulmonary vein isolation, irrespective of the evidence of clinical atrial fibrillation recurrence, however.                                            Changing gears, with the realm of atrial fibrillation, we will now focus on risk stratification and management. Pathik, et al, in JACC: Clinical Electrophysiology, published in volume three, have progressed to complement their work on the role of risk stratification, and risk factor management in patients with atrial fibrillation, to evaluate the cost-effectiveness and clinical effectiveness of such risk factor management clinics in atrial fibrillation, that they termed the SENSE Study. They demonstrated that there was significant cost and clinical benefits to aggressive risk factor targeting clinics for patients with atrial fibrillation, specifically, utilizing supervised approaches to weight-loss, improvements in fitness and reduction in other clinical risk factors such as diabetes, hypertension, or other risks. The patients had a significantly decreased risk of arrhythmia occurrence. In addition to this, there was an actual incremental cost benefit of $62,000 for quality adjusted life year saved. These findings suggest that such an aggressive risk factor mediated approach to management of patients with atrial fibrillation holds significant promise, not just in the reduction of arrhythmia occurrence, but also in potential healthcare cost savings.                                            Our next article within the realm of risk stratification and management relates to identification of patients with atrial fibrillation, in otherwise normal population-wide cohorts. Krivoshei, et al, in Europace volume 19, studied algorithms applied to information gathered on pulse-wave signals via smartphone-based LED light/camera lens. They demonstrated that using such a tool on patients, atrial fibrillation can be discriminated from sinus rhythm with sensitivity specificity of above 95%. We recognize the critical importance of early detection of atrial fibrillation, particularly in high-risk cohorts for stroke. Early identification of patients may identify those patients for initiation of anticoagulation, even if asymptomatic or minimally symptomatic. Our so-termed subclinical atrial fibrillation patients, which we identify by prior clinical trials, have an increased risk of stroke. However, the main hurdle to implementation of such technology has been the high cost, applied to traditional medical interventions. However, use of ever-advancing ambulatory technologies, such as smartphones or in the future, smart watches, may held the promise to identify atrial fibrillation via cheaper mechanisms.                                            The last article within the realm of atrial fibrillation risk stratification and management that we'll choose to focus on is that by Gaeta, et al, published in Europace in volume 19. They performed a systematic review and meta-analysis of existing trials, regarding whether epicardial fat depot was associated with atrial fibrillation. They demonstrated via their meta-analysis that there is, in fact, a significant association between epicardial fat and atrial fibrillation risk, with more epicardial fat being associated with more persistent, rather than paroxysmal forms of atrial fibrillation, as well as any atrial fibrillation versus none. However, the role of epicardial fat in arrhythmogenesis remains unclear. While many studies suggest an association, causation remains to be proven. A recent review, however, published by Antonopoulos, et al, in the Journal of Physiology in June 2017, has multiple suggestive pathways by which paracrine effects of epicardial fat on the heart and vice versa, may lead to alterations in normal cardiac function. Thus, while this remains an association, there are evolving principles that might further support causation.                                            Changing topics, we'll next focus on four major articles within the realm of ICDs, pacemakers, and CRT managements. Lyons, et al, in JACC: Heart Failure, volume five, studied the impact of current versus previous cardiac resynchronization therapy guidelines on the proportion of patients with heart failure eligible for therapy. They evaluated the effect of changing guidelines based on increased bodies of evidence, related to indications for resynchronization therapy on real world patient samples. They demonstrated that these further refined guidelines would decrease by as many as 15% those patients eligible for cardiac resynchronization therapy. However, while their study demonstrates that fewer patients may qualify, as far as receiving benefit from resynchronization therapy, at least two studies published in the same month have demonstrated that even amongst patients who meet guidelines, there is severe under-utilization/under-referral for such devices. These studies by Marzec, et al, in JAMA Cardiology, as well as by Randolph, et al, in American Heart Journal, demonstrated that there's frequent under-utilization and under-referral of patients meetings indications for resynchronization therapy.                                            Keeping on the same topic in resynchronization therapy, Barra, et al, in Heart, volume 103, looked at sex-specific outcomes with addition of defibrillation to resynchronization therapy in patients with heart failure. They demonstrated in a multi-central observational cohort study that the addition of defibrillator resynchronization therapy in patients meeting primary prevention indications for device implant, primarily conferred benefit in men, rather than women. In the same month, Randolph, et al, in the American Heart Journal, demonstrated that resynchronization therapy offered potential greater benefits in women over men. Interestingly, this study by Barra, et al, conversely demonstrates that the concomitant addition of defibrillator therapy does not necessarily further improve outcomes on women, with the primary benefit being conferred to men. Whether this differential is effected by relative rates of arrhythmogenic myopathy is in men versus women remains unclear. However, the findings are provocative.                                            Keeping within the realm of appropriateness of defibrillator therapies, Luni, et al, performed a meta-analysis of randomized controlled trials published in the Journal of Cardiovascular Physiology, in volume 28, on the mortality effect of ICDs in primary prevention in nonischemic cardiomyopathies, including six studies that met criteria. They found that while there was an overall significant survival benefit in patients receiving ICDs in the setting of nonischemic cardiomyopathy. Once accounting for those on adequate beta-blockade, and ACE or ARP 00:22:56 therapy, there was no statistical difference conferred by primary prevention ICD use.                                            This complements an article published by Al-Khatib, et al, in JAMA Cardiology, in the same month, which also suggested that the overall mortality benefit was present in nonischemic patients, though in their case, they did not evaluate the granularity of appropriateness based on current management at the time of ICD implant. These findings further previous findings from a Danish study that the survival benefit of primary prevention ICD in nonischemic cardiomyopathy might not be anywhere near the same as those conferred with ischemic cardiomyopathy. However, the perceived lower relative mortality benefit, compared to earlier clinical trials, namely partly due to improvements in the clinical and pharmacologic management of such patients.                                            The final paper we'll choose to focus on within the realm of device therapies was published by Doppalapudi, in the Journal of Cardiovascular Electrophysiology, in volume 28. They looked at the significant discrepancy between estimated and actual longevity in St. Jude Medical implantable cardioverter defibrillators. While amongst a small number of patients of only 40, they demonstrated that up to 74% of these patients had a significant discrepancy between actual and estimated battery life, specifically amongst current or promotes defibrillator devices. This discrepancy was most significant in the 18 months prior to reaching electrical replacement medication. These findings suggest the need for more frequent monitoring of such devices to look for rapid battery depletion.                                            Switching topics away from device therapies, we next focus on the realm of sudden death in cardiac arrest. The first paper we'll focus on was published in Circulation, in volume 135, by Halliday, et al, and focused on the association between mid-wall late gadolinium enhancements, and sudden cardiac death in patients with dilated cardiomyopathy in mild and moderate left ventricular systolic dysfunction. In his publication, Halliday demonstrated that the presence of mid-wall late gadolinium enhancements on MRI identified patients at risk of sudden cardiac death, with a hazard ratio up to 35.9 for border sudden cardiac death, amongst dilated cardiomyopathy patients with such mid-wall dilated enhancements. The incremental value of MRI is evolving in the risk stratification of patients, though it has not quite met inclusion in guidelines for decision making regarding those who most benefit from ICDs. However, studies like this are provocative in the sense of identifying those patients most at risk.                                            Within the realm of cardiac arrest, we next focus on the role of out-of-hospital cardiac arrest, and how to improve management of these patients. Boutilier, et al, published in Circulation, in volume 135, optimization of drone networks to deliver automated external defibrillators. They demonstrated via simulation model that using a drone network system to deliver AEDs to patients suffering sudden cardiac arrest could decrease the time to response by as much as six minutes and 43 seconds compared to traditional approaches, such as 911 in urban areas, or as much as 10 minutes and 34 seconds in rural areas. These findings are highly provocative. However, they need to be applied to clinical real world situations. The first attempt at such was actually published this month as well, by Claesson, et al, in the Journal of the American Medical Association, and demonstrated the feasibility of implementing a drone network within real world case example, and the efficacy of the same. These disruptive technologies have the potential to improve emergency care, and out of hospital cardiac arrest survival.                                            Next, we move on to studies in electrophysiology. The first article we will focus on is by De Jesus, et al, published in Heart Rhythm, volume 14, on antiarrhythmic effects of interleukin 1 inhibition after myocardial infarction. De Jesus, et al, in this study, demonstrated that the use of anakinra and interleukin 1 beta antagonist would improve conduction velocity, calcium handling, spontaneous and inducible ventricular arrhythmias, and action potential duration dispersion, in canine models. These findings of potential antiarrhythmic effects were due to increased expression of connexin 43, and sarcoplasmic reticulum calcium ATPase. While in isolation, this might seem a general article, it complements multiple recent studies that suggest a significant role for targeting inflammatory pathways, not just in infarct pathogenesis, but in arrhythmogenesis.                                            Lazzerini, et al, this month as well, demonstrated in the European Heart Journal, the link between systemic inflammation and arrhythmic risk based on a review of the existing literature. In addition, Yucel, et al, demonstrated in Nature Scientific Reports the relationship between lipopolysaccharides and electrophysiology dysfunction in stem cell direct cardiomyocytes, which they felt partly may be mediated through interleukin pathways. Finally, though as of yet unpublished, a clinically available interleukin 1 beta inhibitor, canakinumab, has been shown in preliminary data to reduce major cardiovascular events in a randomized, double-blind, placebo-controlled trial, when combined with optimal medical therapy in patients with post myocardial infarction. These potential clinical benefits complement translational benefits seen to date. However, whether these are conferred by primary inflammatory pathways, arrhythmogenic pathways, or interactions between both remains to be seen.                                            The next article we will focus on is by Chauveau, et al, published in Circulation: Arrhythmia Electrophysiology, volume 10. They looked at induced pluripotent stem cells derived cardiomyocytes in producing in vivo biological pacemaker function. They demonstrated that in canines with atrioventricular block, injection of such derived cardiomyocytes into the epicardial surface of the heart, demonstrated inherent pacemaker activity with global cardiac activation. In fact, this activation in pacemaker activity increased over time, up to four weeks of maturation, and also demonstrated responsiveness to epinephrine and alterations with day and night variation. However, the intrinsic rates tend to be quite low, in the 50 to 60 beat per minute range. The potential to restore pacemaker activity in patients with severe conduction disease, holds the potential to dynamically progress options in care for patients with electrophysiologic disease. However, even though these findings are promising, significant remaining questions include ensuring the robustness of the heart rate conferred by these biologic pacemakers, the durability of pacemaker activity, and the arrhythmogenic potential of such interventions.                                            Within the realm of cellular electrophysiology, the final article we will choose to focus on was published by Barbic, et al, in American Journal of Physiology, heart and Circulatory Physiology, in volume 312, entitled Detachable Glass Microelectrodes for Recording Action Potentials in Active Moving Organs. They demonstrated that a new glass microelectrode could allow for determinational cellular actional potential duration in actively moving organs. This is a profound potential advance in the physiologic evaluation of both in vitro and in vivo translational cellular models of cardiac activation. Traditional patch clamping action potential studies required immobilization of cells being studied, whether by mechanical or pharmacologic means. However, directed efforts to immobilize cells can alter electrophysiologic parameters. The ability to record cellular action potentials in actively moving cells, for example the beating heart, may offer studies of cellular electrophysiology, that more closely approximate real world physiology.                                            Our next area of focus will be on genetic channelopathies, including long QT syndrome, Brugada, catecholaminergic polymorphic ventricular tachycardia and others. The article we choose to focus on this month, within this realm, was published by Pappone, et al, in Circulation: Arrhythmia and Electrophysiology, volume 10. They focus on electrical substrate elimination in 135 consecutive patients with Brugada syndrome. They demonstrated in this large cohort of patients that the arrhythmogenic electrical substrate associated with the Brugada syndrome primarily localized to the right ventricular epicardium, and an ablation of such region led to normalization of electrocardiogram and non-inducibility ventricular arrhythmias acutely in all patients, and over a long term in all but two patients.                                            These findings complement prior work by Nademanee and others that support a role for targeting substrate in the region of the right ventricular epicardium, in preventing recurrent ventricular arrhythmias in patients with Brugada syndrome, and in normalizing the electrocardiographic Brugada pattern. At the translational level, prior work has demonstrated that the same SCN mutations associated with Brugada syndrome confer accentuated transmittal gradients within the realm of the right ventricle, along with preferential prolongations of action potentials in the right ventricular epicardial myocytes. However, it remains to be seen whether the specific genetic cause of individual patient's Brugada pattern or Brugada syndrome is associated with discreet pathologic and inter-ablation findings and success rates.                                            Next, moving on to the realm of ventricular arrhythmias, we focus on three major articles published in the past month. The first article is published by Vaseghi, et al, in the Journal of the American College of Cardiology, volume 69, entitled Cardiac Sympathetic Denervation for Refractory Ventricular Arrhythmias. They demonstrated that cardiac sympathetic denervation may be an effective therapy in many patients with intractable ventricular arrhythmias, with a greater than 50% reduction in sustained VT, ICD shock, transplant or death over one year follow-up. Not only this but nearly one third of patients no longer required antiarrhythmics. However, bilateral sympathectomy is far superior over left sided only sympathectomy. Furthermore, advanced heart failure and VT cycle length were associated with poor outcomes. These findings suggest a role for bilateral sympathectomy in management of patients presenting with intractable ventricular arrhythmias. However, patient identification and selection in terms of the ideal cohorts for such therapy, and how to identify such cohorts remains to be seen.                                            Our next article regards advances in attaining epicardial access. Di Biase, et al, published in Heart Rhythm, volume 14, the initial international multi-centered human experience with the novel epicardial access needle embedded with a real time pressure frequency monitor to facilitate epicardial access. They looked specifically at feasibility and safety of this novel approach. While in only 25 patients, they did demonstrate that epicardial access can be successfully obtained with only one complication of a delayed pericardial effusion. With evolving indications for epicardial access, including for left atrial appendage occlusion, epicardial ganglia modulation, and ventricular arrhythmia mapping and ablation, development of novel tools to minimize the risks associated with epicardial ablation, particularly in individuals who do not perform it routinely, is critical. However, whether these variable approaches hold significant advances in randomized trials, beyond traditional approaches, remains to be seen.                                            Within the realm of ventricular arrhythmias, the last article we will choose to focus on was published by Acosta, et al, in Europace, volume 19. They looked at the long-term benefit of first line peri-implantable cardioverter-defibrillator implant ventricular tachycardia substrate ablation in secondary prevention patients. This study complemented prior data from SMASH-VT supporting a role for early ablation to reduce future arrhythmia events in patients receiving defibrillators. In their study, they demonstrated that early ablation was associated with a decreased recurrence of ventricular arrhythmias and defibrillary shocks over an average of almost four years. However, it addressed patients with lower ejection fractions, namely less than 35%, received less benefit. Though this was mostly conferred by while having similar frequency of VT recurrence, having an overall lower burden compared to those who did not have ablation. Practice patterns continue to vary in the decision making with regards to performing early ablation in such patients. Furthermore, whether or not a mortality benefit exists with early ablation remains relatively unclear and unproven. However, there's an evolving body of evidence to support the notion that aggressive, early intervention with invasive procedures in patients receiving ICDs, and at high risk for ventricular arrhythmias, may make sense.                                            The final article we will focus on that has been published in the past month, is published by Turagam, et al, in the International Journal of Cardiology, volume 236, entitled Practice Variation in the Re-initiation of Dofetilide: an Observational Study. Turagam, et al, surveyed 347 providers in the U.S. and worldwide, and demonstrate significant practice variability when re-initiating dofetilide. They know that up to 21% of providers always admit patients to the hospital for dofetilide re-initiation, while 37% of physician admit patients less than 10% of the time. Interestingly, the duration off of dofetilide ranging anywhere from three days to more than a year, did not necessarily significantly affect the rate of decision to re-initiate dofetilide, after prior cessation. One key finding of this was the 4% of physicians reporting major adverse events with drug re-initiation in patients. This was despite the vast majority of these patients tolerating de novo initiation. Given the prolific effects of antiarrhythmetic drugs, strategies to reduce those potential risks are critical. In fact, multiple groups such as the Cardiac Safety Research Consortium, within the same month, had sought to publish recommendations for long-term electrocardiographic monitoring, in drug developments. It must be realized the consideration of the impact of antiarhythmetic drug managements may not always be well outlined by existing protocols. And thus, further study is likely required to inform current clinical practice.                                            It was my pleasure to introduce to you some of the major heart hitting articles published in the part month across the electrophysiologic literature. While none of this is really touching on every single major advance, we hope to identify those that hold potential, measure immediate clinical potential, or those that hold potential for future advancements within our field. Thank you. Dr. Paul Wang:                I hope you enjoyed this month's podcast On the Beat, Circulation: Arrhythmia and Electrophysiology. We've had a number of groundbreaking and fascinating studies. See you next month.

Interview With Denis Noble On How To Change Your Limiting Beliefs "Denis Noble (born 16 November 1936) is a British biologist who held the Burdon Sanderson Chair of Cardiovascular Physiology at the University of Oxford from 1984 to 2004 and was appointed Professor Emeritus and co-Director of Computational Physiology. He is one of the pioneers of Systems Biology and developed the first viable mathematical model of the working heart in 1960" (Source: https://en.wikipedia.org/wiki/Denis_Noble) Today I've partnered up with Denis Noble to discuss about the theory of beliefs and how there is much more to that than what we already know. Biology is not what we think we know and, more and more, the scientific community is starting to see more evidence about it. In this video, Denis will show how you can change your beliefs with the power of biology and how it can directly impact your life as a software developer. Interview Perry Marshall: https://www.youtube.com/watch?v=F75GL6_ECc8 Music Of Life Book: https://simpleprogrammer.com/musicoflife Dance To The Tune Of Life Book: https://simpleprogrammer.com/themusicoflife Buy Simple Programmer SHIRT: https://store.simpleprogrammer.com/

Denis Noble is Emeritus Professor of Cardiovascular Physiology at Oxford University. He developed the first viable mathematical model of the working heart. He has been listed as one of the top 100 scientists and a pioneer in the field of Systems biology. His most recent book “The Music of Life” tackles the big issue of how biologists should seek to understand life itself. In this podcast we discuss the rhythms of life itself, the intelligence of evolution and the question of ‘self’. Guest: Connect with Denis Noble by reading The Music of Life - Biology Beyond Genes & Dance to the Tune of Life. Show Notes: • The Blind Watchmaker • Hippocampus • How trees talk to each other • Differential Equation • Rhythms of Life Conference • Oxford Trobadors • Human Genome Project • 23andME.com • The Music of Life - Biology Beyond Genes • Dance to the Tune of Life

The human circulation is a complex system that has evolved over millenia, primarily designed to promptly respond to conditions of stress - the fight and flight response. The traditional physiological approach focuses on the heart as a pump, adapting to changes in volume and metabolic states. These principles are underpinned by the Starling equation and incorporated into an adaptation of Ohm's law. These principles have been maladapted, punctuated by an increasing reliance on surrogate and derived variables that have little to do with teleological haemodyanamic responses.Insights into the central role of the autonomic nervous system are provided by Guytonian theory that in part explain the physiological fallacy germane to many clinical protocols and practices. These fallacies have been amplified by commercial studies directed at short-term physiological improvements that have little to do with patient-centred outcomes in the medium and longer term.Such effects have been demonstrated in recent high-quality RCTs that force a re-appraisal of seductive short-term physiologically-based gratification.

Professor Saltzman talks about electrical conductivity in the heart: that is, the generation and propagation of electrical potential in heart cells. He describes the role of ion channels and pumps in transporting sodium, potassium, and calcium ions to create action potential. This propagation of signal from the sinoatrial node through different tissues, which can be replaced by a pacemaker, eventually stimulates contraction of muscle fibers throughout the heart. Next, he describes the electrocardiograph and how each wave trace corresponds to the events caused by depolarization/repolarization of different heart tissues.

Professor Saltzman describes the blood flow through the systemic and pulmonary circulatory system. More specifically, he describes, with the help of diagrams, the events that lead to blood flow in the body as a function of contraction/relaxation by specific chambers of the heart, and the effect of four valves which help direct flow. Important terms and concepts such as systole/diastole pressures, cardiac output (CO) as a function of heart rate (HR) and ejection volume (EV), and the action potential propagation that stimulates heart muscle contraction are discussed.

Professor Saltzman discusses the biophysics of the circulatory system. He begins by describing the anatomy of different types of blood vessels, and states the relationship between pressure difference (ΔP) as the driving force for fluid flow (Q) in a tube (i.e., blood vessel) with some resistance R (ΔP = RQ). R can be calculated using if dimensions of the tube (L, r) and fluid viscosity (μ) are known: R = 8μL/πr4. Next, Professor Saltzman traces the blood flow through the circulatory system and explains how the body can regulate blood flow to specific regions of the body. Finally, he describes the heart and its function as the pressure generator in the system.

Professor Saltzman talks about electrical conductivity in the heart: that is, the generation and propagation of electrical potential in heart cells. He describes the role of ion channels and pumps in transporting sodium, potassium, and calcium ions to create action potential. This propagation of signal from the sinoatrial node through different tissues, which can be replaced by a pacemaker, eventually stimulates contraction of muscle fibers throughout the heart. Next, he describes the electrocardiograph and how each wave trace corresponds to the events caused by depolarization/repolarization of different heart tissues.

Professor Saltzman describes the blood flow through the systemic and pulmonary circulatory system. More specifically, he describes, with the help of diagrams, the events that lead to blood flow in the body as a function of contraction/relaxation by specific chambers of the heart, and the effect of four valves which help direct flow. Important terms and concepts such as systole/diastole pressures, cardiac output (CO) as a function of heart rate (HR) and ejection volume (EV), and the action potential propagation that stimulates heart muscle contraction are discussed.

Professor Saltzman discusses the biophysics of the circulatory system. He begins by describing the anatomy of different types of blood vessels, and states the relationship between pressure difference (ΔP) as the driving force for fluid flow (Q) in a tube (i.e., blood vessel) with some resistance R (ΔP = RQ). R can be calculated using if dimensions of the tube (L, r) and fluid viscosity (μ) are known: R = 8μL/πr4. Next, Professor Saltzman traces the blood flow through the circulatory system and explains how the body can regulate blood flow to specific regions of the body. Finally, he describes the heart and its function as the pressure generator in the system.