Podcasts about Circulation

Guerre au Moyen-Orient: Trump a-t-il tiré un trait sur l’opinion publique? | Le prix de l’essence continue de grimper en flèche | Une mère de six enfants à la rue à cause… d’une friteuse à air | Violence sans nom à Repentigny: le maire commente la troublante vidéo | Les constructions neuves sont-elles de moins bonne qualité qu’autrefois? | Un nouveau spectacle d’André Sauvé Dans cet épisode intégral du 9 mars, en entrevue : Nathalie Sinclair-Desgagné, candidate du Bloc Québécois pour l'élection partielle dans la circonscription de Terrebonne. Audrey Petitbois, mère de 6 enfants. Leur maison a été complètement détruite après un incendie déclenché dans le airfryer. Nicolas Dufour, maire de Repentigny. Yvan Cliche, fellow et spécialiste en énergie au Centre d’études et de recherches internationales de l’Université de Montréal (CERIUM). Danny McNicoll, propriétaire de Inspection DMI et Inspecteur en bâtiment agréé. André Sauvé, humoriste. Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

durée : 00:03:12 - Les suites de l'incendie du quartier du château à Pau - La circulation va rester coupée jusqu'à la semaine prochaine rue Bordenave d'Abère, et rue du Château, après l'incendie qui a ravagé la toiture de deux immeubles ce jeudi soir. Trois personnes ont dû être relogées. Vous aimez ce podcast ? Pour écouter tous les autres épisodes sans limite, rendez-vous sur Radio France.

Le français est-il prioritaire dans nos milieux professionnels? | Décès de Jacques Martel : Sylvain Cossette lui rend hommage | La Ronde rachetée: il faut que le parc d'attractions redevienne… attractif! | Les champignons magiques, le prochain médicament? | Illustrer un moment sombre de notre histoire: la nouvelle BD de Christian Quesnel | Changement d’heure: tempête dans un verre d’eau? Dans cet épisode intégral du 6 mars, en entrevue : Benoît Dubreuil, commissaire à la langue française. Sylvain Cossette, auteur-compositeur-interprète. Roger Laroche, historien spécialiste des expositions universelles et internationales. Jean-François Stephan, médecin de famille. Christian Quesnel, auteur de bande dessinée et illustrateur. Dre Maude Bouchard, neuropsychologue et directrice de la recherche et développement à la clinique virtuelle du sommeil HALEO. Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

Les autochtones parfois TROP privilégiés? | Le coût EXORBITANT du changement d’heure dans le monde | Aucune chance pour l’Iran | L’Ozempic contre la migraine? | Zelensky est allé trop loin! Dans cet épisode intégral du 6 mars, en entrevue : Hanieh Ziaei, spécialiste du monde iranien contemporain, attachée à la Chaire Raoul-Dandurand, UQAM Dre Marzieh Eghtesadi, médecin au Centre hospitalier de l'université de Montréal (CHUM) Marine Larrivaz, doctorante en primatologie et spécialiste de la sexualité des primates, à l’Université de Montréal Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

This inaugural episode of the CardioNerds Pulmonary Embolism (PE) Series explores the evolution of acute PE care. Dr. Ibrahim Zahid, Dr. Dinu Balanescu, and Dr. Billy Joe Mullinax join guest expert Dr. Kenneth Rosenfield to discuss the shifting landscape of PE management. Pulmonary embolism (PE) remains a leading cause of cardiovascular mortality and a frequent diagnostic challenge, often masquerading as myocardial infarction or a benign illness. Over the past decade, PE care has evolved from anticoagulation-only strategies to nuanced, risk-stratified, multidisciplinary management. Modern approaches integrate hemodynamics, biomarkers, and advanced imaging to guide therapy, including catheter-directed interventions and large-bore thrombectomy. The Pulmonary Embolism Response Team (PERT) model addresses historical gaps by coordinating rapid, multispecialty decision-making and standardizing care pathways. The PERT Consortium further advances PE care through education, research, and the world's largest PE registry, while fostering leadership and research opportunities for trainees. Despite advances, long-term outcomes and post-PE syndromes remain important areas for future investigation. Audio editing by CardioNerds Academy intern, student doctor, Pace Wetstein. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls PE is a “master masquerader”—maintain suspicion for atypical presentations like myocardial infarction, heart failure, flu, or anxiety. Multidisciplinary management mediated through pulmonary embolism response teams improves outcomes and standardizes care. Risk stratification integrates hemodynamics, biomarkers, and imaging. Advanced therapies have expanded beyond anticoagulation. Long‑term follow‑up and post‑PE syndrome need more research. Notes Notes: Notes drafted by Dr. Ibrahim Zahid. 1. How has the clinical approach to PE changed over the past decade? PE is the third leading cause of cardiovascular death and historically under‑recognized. Symptoms mimic MI, HF, asthma, syncope, and more.PE is a silent killer, and it should be recognized more as a cause of spontaneous cardiac arrest. Where life threatening disease like stroke which is owned by neurological specialists and MI is primarily managed by cardiac specialists, PE is an entity without a professional home. The PERT Consortium brings the specialties together for PE care. 2. Ten years ago, a 58-year-old patient with a large bilateral PE, RV dilation, and positive biomarkers might have been managed with anticoagulation and close observation alone. Today, with evolving—but still uneven—data on advanced therapies, PE care feels far more nuanced and highly dependent on where you practice. What are the major gaps in traditional PE management that clinicians should recognize, and what care pathways should they be aware of across different hospital systems? Care has shifted from anticoagulation‑only to multidisciplinary approaches like catheter directed thrombectomy. Risk‑based pathways and the use of CT angiogram has improved early recognition. Risk stratification tools must be used as tools for early recognition of intermediate risk PE. Untreated PE leads to chronic complications like chronic thromboembolic disease and chronic thromboembolic pulmonary hypertension, which requires long term clinic follow up. 3. What is the role of risk stratification tools such as PeSI, sPeSI scores, cardiac biomarkers, and imaging findings in PE, and how do they guide treatment decisions in real world practice? Integrate vitals (blood pressure and heart rate), biomarkers (troponin, pro-BNP), RV/LV ratio assessment, acid‑base status, and scores. Tools include PESI, sPESI, BOVA, HESTIA, FAST, Geneva, NEWS, shock index. Vitals, lactate, acid-base status, and tools like NEWS or shock index track clinical evolution. PESI/sPESI estimate 30-day mortality and help identify low-risk patients who may be candidates for early discharge or outpatient therapy. Clinical judgment matters—scores don't fully capture clot burden, trajectory, or bleeding risk. 4. How was the pulmonary embolism response team created, and since its creation, what evidence or outcome data became available to support the PERT model? Originated after a sentinel case at MGH: A young, pregnant woman in her 30s, who collapsed at home, underwent thrombectomy, and had to be on ECMO for a few days. The case brought cardiology, cardiac surgeons and critical care physicians together for planning and improvement in her health, which was rewarding. Thereby, it was decided to bring specialties involved in PE care together to create a response team. The name of the team, Pulmonary Embolism Response Team (PERT), was coined by Richard Channick in the first meeting. Posters were set up all over the hospital to call a centralized line when an acute PE is recognized A meeting was held to present the concept of putting together a consortium, with development of action items and a PERT database. Enabled rapid multidisciplinary input using early teleconferencing tools. 5. Given concerns about having too many ‘cooks in the kitchen' during the initial PE call—especially with rotating teams—how can institutions reconcile workflow complexity with standardized pathways in a way that meaningfully supports and justifies the added burden on frontline clinicians? Every hospital's PERT is different, catering to their needs and workflow At least two disciplines are needed to make a PERTData is currently being collected to guide further on how the workflow can be standardized Most importantly, the team brings in resources that were not available prior to PERT formation. 6. What are the main goals of the PERT consortium, and how does it support clinicians and institutions involved? To improve care and improve outcomes for patients with PE Expand education, refine algorithms, standardize care with Centers of Excellence. Maintain the largest PE registry for research and outcomes improvement. 7. Beyond global networking, shared learning from successful systems, and the pathway toward Center of Excellence designation, what additional benefits can clinicians and health systems gain by participating in the PERT Consortium? The ability to learn from other systems, the ability to share experiences. Allow people to develop their professional careers like leadership experience, becoming a member of the trainee council Initiate projects and receive funding for your ideas 8. For trainees interested in pulmonary embolism care, how can a trainee be a champion at their institution? Does PERT provide assistance and how can they really contribute meaningfully even before becoming a fellow/attending? Medical students and residents interested in PE should reach out to the consortium and the consortium will hook you up with the correct mentors who can nurture you along. Listen to the podcasts. Participate with your local PERT team PERT wants involvement of people who are social media savvy to help spread the word on PE. Top three take-away points from this episode Acute PE care has advanced and multiple treatment modalities for acute PE including catheter directed therapy, large bore thrombectomy, are becoming standard of care. Multidisciplinary models like PERT improve coordination and outcomes. Trainees play a vital role in advancing PE care through involvement, research, and education References Konstantinides SV, Meyer G, Becattini C, Bueno H, Geersing GJ, Harjola VP, Huisman MV, Humbert M, Jennings CS, Jiménez D, Kucher N, Lang IM, Lankeit M, Lorusso R, Mazzolai L, Meneveau N, Ní Áinle F, Prandoni P, Pruszczyk P, Righini M, Torbicki A, Van Belle E, Zamorano JL; ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur Heart J. 2020 Jan 21;41(4):543-603. doi: 10.1093/eurheartj/ehz405. PMID: 31504429. https://pubmed.ncbi.nlm.nih.gov/31504429/ Rosovsky R, Zhao K, Sista A, Rivera-Lebron B, Kabrhel C. Pulmonary embolism response teams: Purpose, evidence for efficacy, and future research directions. Res Pract Thromb Haemost. 2019 Jun 9;3(3):315-330. doi: 10.1002/rth2.12216. PMID: 31294318; PMCID: PMC6611377. https://pmc.ncbi.nlm.nih.gov/articles/PMC6611377/ Rosenfield K, Bowers TR, Barnett CF, Davis GA, Giri J, Horowitz JM, Huisman MV, Hunt BJ, Keeling B, Kline JA, Klok FA, Konstantinides SV, Lanno MT, Lookstein R, Moriarty JM, Ní Áinle F, Reed JL, Rosovsky RP, Royce SM, Secemsky EA, Sharp ASP, Sista AK, Smith RE, Wells P, Yang J, Whatley EM; Pulmonary Embolism Research Collaborative (PERC) Attendees. Standardized Data Elements for Patients With Acute Pulmonary Embolism: A Consensus Report From the Pulmonary Embolism Research Collaborative. Circulation. 2024 Oct;150(14):1140-1150. doi: 10.1161/CIRCULATIONAHA.124.067482. Epub 2024 Sep 12. PMID: 39263752; PMCID: PMC11698503. https://pubmed.ncbi.nlm.nih.gov/39263752/ Sharifi M, Awdisho A, Schroeder B, Jiménez J, Iyer P, Bay C. Retrospective comparison of ultrasound facilitated catheter-directed thrombolysis and systemically administered half-dose thrombolysis in treatment of pulmonary embolism. Vasc Med. 2019 Apr;24(2):103-109. doi: 10.1177/1358863X18824159. Epub 2019 Mar 5. PMID: 30834822. https://pubmed.ncbi.nlm.nih.gov/30834822/ Pandya V, Chandra AA, Scotti A, Assafin M, Schenone AL, Latib A, Slipczuk L, Khaliq A. Evolution of Pulmonary Embolism Response Teams in the United States: A Review of the Literature. J Clin Med. 2024 Jul 8;13(13):3984. doi: 10.3390/jcm13133984. PMID: 38999548; PMCID: PMC11242386. https://pubmed.ncbi.nlm.nih.gov/38999548/ Rivera-Lebron B., McDaniel M., Ahrar K., Alrifai A., Dudzinski D.M., Fanola C., Blais D., Janicke D., Melamed R., Mohrien K., et al. Diagnosis, Treatment and Follow Up of Acute Pulmonary Embolism: Consensus Practice from the PERT Consortium. Clin. Appl. Thromb. Hemost. 2019;25:1076029619853037. doi: 10.1177/1076029619853037.https://pubmed.ncbi.nlm.nih.gov/31185730/

Un registre des délinquants sexuels dangereux serait… inconstitutionnel | Bernard Drainville veut réduire l’aide sociale pour les demandeurs d’asile et met les points sur les I: il ne se retirera pas de la course à la chefferie | Est-ce mieux d’acheter ou de louer votre véhicule? | Un trou béant dans une route de Châteauguay: le maire est sous le choc | Sébastien Delorme débarque sur TikTok avec une série exclusive Dans cet épisode intégral du 5 mars, en entrevue : Patrick Taillon, professeur et codirecteur du centre d’études en droit administratif et constitutionnel (CEDAC) de la faculté de droit de l’Université Laval. Bernard Drainville, candidat à la chefferie de la CAQ. Louis-Philippe Dubé, chroniqueur au Guide de l’Auto. Eric Allard, maire de Châteauguay. Sébastien Delorme, comédien. Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

Des proches du régime iranien au Canada?? | Chasse à l'OVNI en Californie | Un fraudeur québécois coincé Dubai | PSPP, offensif! | JiC est tanné, le CH a pas fait ce qu’il fallait Dans cet épisode intégral du 5 mars, en entrevue : Élie Cantin-Nantel, ancien attaché politique conservateur et journaliste pour The Hub. Paul St-Pierre Plamondon, chef du Parti québécois Beryl Wajsman, rédacteur-en-chef du Suburban Newspaper Group et fondateur et président de l'Institut des affaires publiques de Montréal Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

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Send a textMorning Prayer (Steadfast Love Of The Lord; People With Heart/Vascular/Circulation Issues; Praise) #pray #prayer #Jesus #love Thank you for listening, our heart's prayer is for you and I to walk daily with Jesus, our joy and peace aimingforjesus.com YouTube Channel https://www.youtube.com/@aimingforjesus5346 Instagram https://www.instagram.com/aiming_for_jesus/ Threads https://www.threads.com/@aiming_for_jesus X https://x.com/AimingForJesus Tik Tok https://www.tiktok.com/@aiming.for.jesus

Un sondage qui fait TRÈS mal à la CAQ, qui doit donner beaucoup d’espoir à Charles Milliard et le PQ doit se mordre les doigts | Iran : le conflit au Moyen-Orient pourrait-il faire augmenter le taux directeur? | Des Canadiens coincés au Moyen-Orient | Les Québécois veulent-ils réellement de la souveraineté? Dans cet épisode intégral du 4 mars, en entrevue : Benoit Therrien, président de Truck Stop Québec. Daniel Gobeil, président des Producteurs de lait du Québec. Jasmin Guénette, vice-président des affaires nationales à la Fédération canadienne de l'entreprise indépendante (FCEI). Charles Milliard, chef du Parti libéral du Québec. Camille Goyette-Gingras, présidente des OUI Québec. Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

Les libéraux sont de retour | Crise en Iran | Droit spatial: à qui appartient l’espace? | Fin du PEQ : une citoyenne française vit un pur cauchemar | Vive Heated Rivalry! Dans cet épisode intégral du 4 mars, en entrevue : Vincent Correia, codirecteur de l'Institut de droit aérien et spatial de l’université McGill. Stéphane Dion, ex-ministre fédéral et ancien ambassadeur du Canada en Allemagne et en France. Il devient le premier « diplomate en résidence » de l'histoire de l'Université de Montréal. Tiffany Corti, Française arrivée au Québec en 2023 Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

Les extraterrestres sont-ils déjà venus nous voir? | Un enfant de 6 ans meurt après un drame tragique | De la misogynie et de l’homophobie dans les écoles | Une semaine de relâche causerait… une hausse des vols?? | Le pronostics osé de JiC pour le match du CH de ce soir Dans cet épisode intégral du 3 mars, en entrevue : Francis Choinière, co-propriétaire d’ATMA Classique Julien Garon-Carrier, journaliste indépendant et fondateur de Indocile Média. Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

Conflit au Moyen-Orient : des avions américains descendus… par accident | Une autre tuile s’abat sur la tête des premiers acheteurs: vers une autre hausse du prix médian des maisons au Québec | Renvoi à cause du signe religieux : les femmes musulmanes sont-elles bien représentées dans le milieu de l’éducation? | Equifax: un citoyen a vécu l’enfer (et il n’est pas le seul) Dans cet épisode intégral du 3 mars, en entrevue : Éric Sauvé, ancien officier des Forces canadiennes et consultant en sécurité et défense. Isabelle Demers, VP développement stratégique affaires publiques et innovation pour l’APCHQ. Fatima Aboubakr, directrice de garderie. Thibault Rehn, cofondateur de Vigilance OGM. Solomon Abudarham, qui est derrière le recours collectif contre Equifax et tribune téléphonique. Jean-Michel Anctil, humoriste et acteur. Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

This week, join author Enrico Ammirati and Associate Editor Justin Ezekowitz as they discuss their article "Natural History of Patients With Histologically Proven Acute Eosinophilic Myocarditis." For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260302.497755

Conflits au Moyen-Orient : des Québécois pris à l’étranger, des femmes iraniennes soulagées, des questionnements quant à l’intervention du président Trump | Le TGV rappelle de mauvais souvenirs aux expropriés de l’aéroport de Mirabel | Le marché du pétrole est de nouveau sous pression après les frappes d’Israël et des États-Unis contre l’Iran | Duels à La Voix : la participante Roxanne Garceau a été sauvée Dans cet épisode intégral du 2 mars, en entrevue : Nimâ Machouf, militante iranienne. Sylvie Bigeault, Québécoise en voyage à Dubaï. Ils sont actuellement confinés à leur hôtel. Roxanne Therrien, mairesse de Mirabel. Carol Montreuil, vice-président Est du Canada et Économie à l'Association canadienne du carburant. Roxanne Garceau, participante à La Voix dans l’équipe de France D’Amour. Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

Quel rôle pour le Canada dans le conflit en Iran? | Avenir radieux pour le PQ? | La crise au Moyen-Orient: Mauvaise nouvelle pour le Canada | Témoignage GLAÇANT d’un lanceur d’alerte | Nouveau féminicide au Québec Dans cet épisode intégral du 2 mars, en entrevue : Jocelyn Coulon, ancien conseiller politique du ministre des Affaires étrangères. Luc Sabourin, lanceur d'alerte au sein de l'Agence de service frontalier du Canada. Mandana Javan, militante politique pour la laïcité et pour les droits des femmes. Une production QUB Mars 2026Pour de l'information concernant l'utilisation de vos données personnelles - https://omnystudio.com/policies/listener/fr

1 - Uccelli - Flicker 2 - Steve Parry - Freeze 3 - Quivver - Moonlight Pools (Cruz Vittor Remix) 4 - Circulation, Cass (UK) - Nuke the Site From Orbit (Cass Skunkworks Remix) 5 - Gai Barone - Macula (Extended Mix) 6 - Thaddeus X - Life in Wave (Noel Barbeito Edit) 7 - UNWA - Lonely (Katrin Souza Remix) 8 - Nick Stoynoff - Strawberry Fields 9 - Calcou - Closer 10 - HVOB - The Blame Game (Roman & Juan Ibáñez Bootleg) Download episode on MP3 (Right click, save link as...) Help me support NGO Alegría Intensiva, Hospital Clown, in Argentina. Donate now by clicking here!!! Donar desde Argentina haciendo click aquí!!!

Send a textIn this Friday 5 episode of The Autoimmune RESET Podcast, I'm talking about something that many people with autoimmune conditions experience, but that isn't always discussed in enough depth — hand health.For many individuals, the hands are one of the first places symptoms show up. Cold fingers, colour changes, stiffness, pain, weakness, or reduced dexterity can all reflect deeper processes happening in the body, including circulation instability, nervous system dysregulation, connective tissue vulnerability, or immune-driven inflammation. Conditions such as Raynaud's phenomenon, inflammatory arthritis, hypermobility syndromes, and autoimmune connective tissue disorders often manifest visibly in the hands long before other symptoms fully develop.In this episode, I share both clinical insights and personal observations, alongside five practical strategies that can make a meaningful difference. We explore how stabilising circulation supports tissue health, why nervous system regulation plays a central role in blood flow, and how connective tissue and joint support influence long-term hand function. I also discuss the importance of warmth, sensory stimulation, and daily micro-practices that help maintain mobility and comfort.This conversation emphasises that supporting hand health is not only about external measures — creams, braces, or heat — but also about addressing internal physiology, including nutrient status, inflammation, and nervous system balance.As always, the goal is not perfection, but consistency. Small daily practices layered over time can create significant improvements.If you experience persistent pain, colour changes, numbness, or reduced function in your hands, it is always worth investigating underlying drivers rather than simply accepting symptoms as inevitable.Key TakeawaysThe hands are often an early indicator of immune and connective tissue issues.Circulation stability is fundamental for tissue health and comfort.Nervous system regulation directly influences blood flow to the extremities.Supporting connective tissue and joints improves strength and resilience.Warmth and sensory stimulation can significantly improve microcirculation.Consistent daily care matters more than occasional interventions.Persistent symptoms should prompt deeper investigation.Chapters00:00 Introduction to Hand Health and Autoimmune Clues 02:25 Stabilising Circulation 05:49 Nervous System Regulation 07:49 Supporting Connective Tissue and Joints 10:41 Keeping Hands Warm 12:07 Sensory Tools for Microcirculation 14:24 Final Thoughts and Support→ I personally use and recommend Shakti, because it's one of the simplest ways to shift out of “fight or flight” and into a calmer state — supporting relaxation, body awareness, and better sleep quality over time.Use my code: VJ10 for 10% off at checkout: https://www.shaktimat.co.uk/vj

With Liemena Harold Adrian, Syarifah Ambami Rato Ebu General Academic Hospital, Surabaya - Indonesia and Shelley Zieroth, St. Boniface Hospital, Winnipeg - Canada.  In this episode, Liemena Harold Adrian and Shelley Zieroth discuss heart failure in post–myocardial infarction patients, covering how myocardial infarction leads to the development of heart failure despite advances in reperfusion and acute care. The conversation addresses the epidemiology and underlying pathophysiology, approaches to early prevention and screening, diagnostic tools, as well as key interventions in the acute and early post-MI phases that may alter heart failure trajectories. They outline management with guideline-directed medical therapy, review current studies on heart failure–modifying therapies (such as the DAPA-MI and EMPACT-MI trials), and address indications for advanced therapies in post-MI populations. The episode also highlights the importance of early diagnosis, prompt recognition, and key evidence gaps in the field. Recommended readings: Akhtar KH, Khan MS, Baron SJ, et al. The Spectrum of Post-Myocardial Infarction Care: From Acute Ischemia to Heart Failurehttps://doi.org/10.1016/j.pcad.2024.01.017. Prog Cardiovasc Dis. (2024); 82: 15-25. DOI: 10.1016/j.pcad.2024.01.017. Butler J, Hammonds K, Talha KM, et al. Incident Heart Failure and Recurrent Coronary Events Following Acute Myocardial Infarctionhttps://doi.org/10.1093/eurheartj/ehae885. Eur Heart J (2025); 46: 1540-50. DOI: 10.1093/eurheartj/ehae885. Butler J, Jones WS, Udell JA. Empagliflozin after Acute Myocardial Infarction. N Engl J Med (2024); 390: 1455-66. DOI: 10.1056/NEJMoa2314051. Fioretti F, Butler J, Udell JA, et al. Empagliflozin after myocardial infarction with or without diabetes and chronic kidney disease: Insights from EMPACT-MI. ESC Heart Failure (2025); 12: 3940-3952. DOI: 10.1002/ehf2.15393. Hernandez AF, Udell JA, Jones WS. Effect of Empagliflozin on Heart Failure Outcomes After Acute Myocardial Infarction: Insights From the EMPACT-MI Trial. Circulation (2024); 149: 1627–1638. DOI: 10.1161/CIRCULATIONAHA.124.069217. Jenca D, Melenovsky V, Stehlik J, et al. Heart Failure after Myocardial Infarction: Incidence and Predictors. ESC Heart Failure (2021): 8: 222-237. DOI: 10.1002/ehf2.13144. Lala A, Beavers C, Blumer V, et al. The Continuum of Prevention and Heart Failure in Cardiovascular Medicine: A Joint Scientific Statement from the Heart Failure Society of America and The American Society for Preventive Cardiology. Journal of Cardiac Failure (2026); 32: 75-105. Petrie MC, Udell JA, Anker SD, et al. Empagliflozin in Acute Myocardial Infarction in Patients with and without Type 2 Diabetes: A Pre-specified Analysis of the EMPACT-MI Trial. Eur J of Heart Fail. (2025): 27: 577-588. DOI: 10.1002/ejhf.3548. Zieroth S, Rizi SS. Time Is of the Essence. JACC: Heart Failure (2023): 11(6): 713-714. DOI: 10.1016/j.jchf.2023.03.022 "This 2026 HFA Cardio Talk podcast series is supported by Bayer in the form of unrestricted financial support. The discussion has not been influenced in any way by its sponsors."

CardioNerds (Dr. Jenna Skowronski [Heart Failure Council Chair], Dr. Shazli Khan, and Dr. Josh Longinow) are joined by renowned leaders in the field of AHFTC (Advanced Heart Failure and Transplant Cardiology) and mechanical circulatory support, Dr. Jeff Teuteberg and Dr. Mani Daneshmand to continue the discussion of advanced heart failure therapies by taking a deep dive into the world of durable LVADs (Left Ventricular Assist Devices). In this episode, we will review the history of ventricular assist devices, the basics of LVAD function, selection criteria for LVAD therapy, and surgical nuances of LVAD implantation. Audio Editing by CardioNerds intern, Joshua Khorsandi. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Heart Success Series PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls There have been significant advances in the field of MCS/LVAD therapy since the first implanted LVAD in the 1960s, to the first FDA approved device in the early 2000's, to now the HM3 LVAD, with the most important change being a centrifugal flow/magnetically levitated design that led to minimized hemocompatibility-related adverse events (HRAE's) (MOMENTUM 3 trial comparing HM2 and HM3).  The REMATCH trial in 2001 was a pivotal trial for LVAD therapy, demonstrating that in a population of patients with advanced HF (70% IV inotrope dependent), LVAD therapy significantly improved survival at both 1 and 2 years as compared to medical therapy alone.    MOMENTUM 3 trial was a landmark trial for the HM3 device, showing that in a population of end stage HF patients (86% inotrope dependent, 32% INTERMACS 1-2, and 60% DT strategy), 5-year survival with HM3 was 58% and HM3 had lower HRAE's compared with HM2.  There are both patient-specific factors and surgical considerations when it comes to candidacy for LVAD therapy.  RV function prior to LVAD is a key determinant for success post-LVAD  Many patients being considered for LVAD may not have robust RV function, however, predicting RV failure after LVAD is exceedingly difficult.   In general, it doesn’t matter how bad the RV may look on imaging; we care more about the pre-LVAD hemodynamics (look at the PAPi and RA/wedge ratio).   What happens in the OR may be the most important determinant of how the RV will do with the LVAD!  Notes Notes drafted by Dr. Josh Longinow.  1. Historical background of heart pumps and LVADs  LVAD Evolution   FDA approval year  2001  2008  2012  2017  Pump  HeartMate XVE   HeartMate II  Heartware HVAD  HeartMate III  Flow/Design Features  Pulsatile Technology   Continuous flow Axial design  Continuous flow  Centrifugal design  Continuous flow   Full MagLev + Centrifugal design  The 1960's ushered in the first ‘LVADs', when the first air-powered ‘LVAD' was implanted. It kept the patient alive for four days before the patient expired.   The first generation of LVADs were pulsatile pumps   The first nationally recognized, FDA approved LVAD was the HeartMate XVE (late 1990s to early 2000s, REMATCH trial). The XVE pump used compressed air (pneumatically driven) to power the pump.   Prior to the XVE, OHT was the standard of care for patients with advanced, end-stage heart failure.   The second and third generations of LVADs were non-pulsatile, continuous flow devices and included the HVAD, HM2, and HM3 devices.   MOMENTUM 3 was a landmark trial for the HM3 device, showing that in a population of sick patients with end stage HF (86% inotrope dependent, 32% INTERMACS 1-2, and 60% DT strategy), 5-year survival with HM3 was 58% and HM3 had lower HRAE's compared with HM2.   The only pump that is currently FDA approved for implant is the HM3, although other pumps are in clinical trials (BrioVAD system, INNOVATE Trial).  2. What are LVADs, and how do they work?   In simplest terms, the LVAD is a heart pump comprised of several key mechanistic components:   Inflow cannula  Mechanical pump   Outflow cannula  Driveline  Controller/Power source  The HM3 differs from its predecessors (HM2 and HVAD) in several key ways;   HM3 is placed intrapericardial whereas the HM2 was placed pre-peritoneal.   Perhaps most importantly, the HM3 is a fully magnetically levitated, centrifugal flow pump, whereas the HM2 is an axial flow device.  Axial flow pumps are not magnetically levitated, leading to more friction produced between the ruby bearing's contact with the pump rotors, and higher rates of hemocompatibility related adverse events (HRAEs, i.e. pump thrombosis) and the HM2 was ultimately discontinued in favor of the HM3 (MOMENTUM 3 trial).  3. What do the terms ‘Destination Therapy' (DT) or ‘Bridge to Transplant' (BTT) mean when it comes to LVADs?   When LVADs first came on the stage, EVERYONE was a BTT; these early pumps weren't designed for long term use (I.e. REMATCH Trial, Heartmate XVE)  Destination therapy means the LVAD was placed in leu of transplant because there are contraindications to transplant   REMATCH trial brought about the concept of “Destination therapy”, comparing outcomes in patients (with contraindications for transplant) who received an LVAD vs optimal medical therapy  Bridge to transplant means we are placing the LVAD in a patient who may not be a transplant candidate at this moment in time (is too sick, or conversely, not sick enough), but may be down the line   Bridge to recovery is another term used when the LVAD is being placed for a patient we think may have a recoverable cardiomyopathy  4. What are some factors we should consider when assessing a patient’s candidacy for LVAD, in general, and from a surgical perspective?   Patient factors   Older age might push us towards thinking LVAD rather than transplant  In general, age > 70 is the cutoff for transplant, but this is not a hard cut off and varies institution to institution    In general, think about things that help predict recovery after a major surgery; Frailty and Nutritional status are important, we try to optimize these prior to LVAD implant   Right ventricular function remains the Achilles heel of LV support  We know that needing temporary RV support post LVAD puts you on a different survival curve than patients who don’t need RVAD support  Studies have not been able to successfully predict who will develop RV failure after LVAD implantation  What happens in the time between when the patient goes to the OR and when they get back to the ICU is an important determinant who might develop RV failure post LVAD   Surgical techniques such as implanting the HM3 in the intra-thoracic cavity, rather than intra-pericardial may help maintain LV/RV geometry to help optimize the RV post LVAD   Surgical considerations for LVAD candidacy  Small, hypertrophied LV: HM3 inflow cannula is small, but small hypertrophied ventricles tend towards chamber collapse during systole causing suction, needing to run slower with lower flow rates  Chest size/diameter: pumps have gotten so small now, that for adults, these have become less of a consideration  BMI: low BMI used to be more of a concern with the older pumps due to where they were placed, and the relative size of the pump itself, not so much now with the smaller HM 3 pumps  Calcified LV apex: would increase risk of stroke, bleeding   Driveline tunneling becomes a concern in the super obese population, higher risk for driveline infections (might tunnel these driveline's shorter, and to a less fatty region of the abdomen, could even tunnel out the thoracic cavity in the super obese to limit skin motion)    5. Is there a role for MCS (i.e. temporary LVAD such as Impella) in pre-habilitation of patients prior to LVAD surgery?   The theory of being able to improve systemic perfusion, decongest the organs, and make the patient feel better prior to surgery makes sense, but becomes problematic due to the lack of a hard end point/time for prehabilitation which might risk delays in surgery   More likely that it can lead to delay in the surgery, with less-than-optimal benefit; you don't want to prolong the wait for surgery and increase the risk for complications prior to surgery    An Impella 5.5 is currently FDA approved for 2 weeks of support, not 2 months so timing is important to keep in mind  It’s unlikely that you will take a patient and convert them from a malnourished, cachectic person in 2 weeks’ time   6. Is there a role for LVAD therapy in the younger patient population? Should we be thinking of LVAD up front for these patients, with the goal of transplanting down the line?   Recovery may be more likely in certain populations, particularly younger females with smaller LV's; in those populations, perhaps bridge to recovery should be the focus, optimizing them on GDMT etc.   The replacement of transplant, with MCS (LVAD) in young patients has become a topic of discussion, because these pumps have become better and better, with the thinking that an LVAD could bridge a patient for 10 years or so, and they could get a transplant later   It is still a big unknown, but several concerns exist  Patients who get LVADs might end up with complications that become contraindication to transplant down the line (stroke, sensitization etc)   Patients and providers are more hesitant because of the more recent iteration for the UNOS criteria for OHT listing which no longer gives patients with an uncomplicated LVAD higher priority, and therefore they could end up waiting a longer time for a heart after undergoing LVAD  References Rose EA, Gelijns AC, Moskowitz AJ, et al. Long-term use of a left ventricular assist device for end-stage heart failure. N Engl J Med. 2001;345(20):1435-1443. doi:10.1056/NEJMoa012175  Mehra MR, Uriel N, Naka Y, et al. A Fully Magnetically Levitated Left Ventricular Assist Device – Final Report. N Engl J Med. 2019;380(17):1618-1627. doi:10.1056/NEJMoa1900486  Mancini D, Colombo PC. Left Ventricular Assist Devices: A Rapidly Evolving Alternative to Transplant. J Am Coll Cardiol. 2015;65(23):2542-2555. doi:10.1016/j.jacc.2015.04.039  Mehra MR, Goldstein DJ, Cleveland JC, et al. Five-Year Outcomes in Patients With Fully Magnetically Levitated vs Axial-Flow Left Ventricular Assist Devices in the MOMENTUM 3 Randomized Trial. JAMA. 2022;328(12):1233-1242. doi:10.1001/jama.2022.16197  Rose EA, Moskowitz AJ, Packer M, et al. The REMATCH trial: rationale, design, and end points. Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure. Ann Thorac Surg. 1999;67(3):723-730. doi:10.1016/s0003-4975(99)00042-9  Kittleson MM, Shah P, Lala A, et al. INTERMACS profiles and outcomes of ambulatory advanced heart failure patients: A report from the REVIVAL Registry. J Heart Lung Transplant. 2020;39(1):16-26. doi:10.1016/j.healun.2019.08.017  Mehra MR, Netuka I, Uriel N, et al. Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure: The ARIES-HM3 Randomized Clinical Trial. JAMA. 2023;330(22):2171-2181. doi:10.1001/jama.2023.23204  Mehra MR, Nayak A, Morris AA, et al. Prediction of Survival After Implantation of a Fully Magnetically Levitated Left Ventricular Assist Device. JACC Heart Fail. 2022;10(12):948-959. doi:10.1016/j.jchf.2022.08.002  Bhardwaj A, Salas de Armas IA, Bergeron A, et al. Prehabilitation Maximizing Functional Mobility in Patients With Cardiogenic Shock Supported on Axillary Impella. ASAIO J. 2024;70(8):661-666. doi:10.1097/MAT.0000000000002170 

What would I actually do if I had to start over? No brand. No supplements to sell. No trends to chase. No social media theatrics. Just me, in 2026, building my health from the ground up. In this stripped-down solo episode, Darin lays out the foundational pillars he would implement immediately if he were starting fresh today. This is not about extremes. It's not about perfection. It's not about viral biohacks. It's about alignment. Infrastructure. Sovereignty. From water filtration and mineral balance to plant-dominant nutrition, strength training, sleep timing, nervous system regulation, purpose, and community, this is the grounded, research-backed roadmap to a Super Life. In This Episode Why reverse osmosis water filtration is step one The importance of remineralizing filtered water Eliminating PFAS, agrochemicals, and heavy metals from daily exposure Why non-toxic cookware is a non-negotiable A plant-dominant, whole-food strategy backed by longevity research Protein distribution and muscle protein synthesis science The truth about B12, the microbiome and supplementation Why algae-based omega-3s may be smarter than fish oil Resistance training as a longevity lever Why sleep timing consistency may matter more than duration Breathwork, meditation and nervous system training Community as biological medicine Limiting social media for mental health Purpose as a predictor of mortality risk Why you need a functional medical practitioner in your corner Nurturing creativity in a productivity-obsessed culture Chapters 00:00:00 – Welcome to SuperLife 00:00:33 – NAD supplement fraud & the importance of verification 00:02:23 – The question: If I started over in 2026, what would I do? 00:04:08 – No trends, no hype, just grounded science 00:05:15 – Step 1: Clean up your water 00:06:28 – PFAS, heavy metals & agrochemical contamination 00:07:59 – Reverse osmosis as the gold standard 00:08:35 – Re-mineralizing filtered water 00:09:40 – Mineral strategy & electrolyte balance 00:10:35 – Eliminating toxic cookware exposure 00:12:52 – Plant-dominant nutrition as foundational strategy 00:14:45 – Protein distribution & muscle protein synthesis 00:17:22 – Longevity Blue Zones & daily legumes 00:18:06 – B12 nuance & microbiome research 00:20:15 – Omega-3s: chia, flax & algae-based oils 00:22:39 – Strength training as the longevity switch 00:23:05 – Resistance training & reduced all-cause mortality 00:24:24 – Sleep timing consistency & mortality research 00:25:40 – Darkness, eye masks & sleep quality 00:26:20 – Nervous system regulation: meditation & somatic work 00:27:05 – Breathwork protocols & inflammation research 00:28:27 – Community as biological medicine 00:29:05 – Limiting social media & reducing depression risk 00:29:24 – Purpose & lower mortality association 00:30:12 – Functional medicine practitioners vs primary care 00:32:21 – Nurturing yourself in a productivity culture 00:34:22 – Closing: Build alignment, not perfection Thank You to Our Sponsors Our Place – Non-toxic cookware that keeps harmful chemicals out of your food. Get 10% off at fromourplace.com with code DARIN. Tru Niagen – Boost NAD+ levels for cellular health and longevity. Get 20% off with code Darin20 at truniagen.com. Key Takeaway If I were starting today, I wouldn't chase perfection. I would build alignment. Clean water. Plant-dominant nutrition. Strength. Sleep consistency. Nervous system regulation. Community. Purpose. And nurturing creativity. No hacks. No drama. Just infrastructure. That's how you build a Super Life. Bibliography/Sources British Journal of Sports Medicine. (2022). Muscle-strengthening activities and risk of cardiovascular disease, cancer, diabetes, and all-cause mortality: a systematic review and meta-analysis of prospective cohort studies. https://bjsm.bmj.com/content/56/13/757 Sleep. (2023). Sleep regularity is a stronger predictor of mortality risk than sleep duration: A prospective cohort study. https://academic.oup.com/sleep/article/47/2/zsad253/7280431 NIH Office of Dietary Supplements. (2024). Vitamin B12 Fact Sheet for Consumers. Provides guidance on necessary B12 sources for those on plant-based diets. https://ods.od.nih.gov/factsheets/VitaminB12-Consumer/ Nutrients. (2019). Dietary Protein and Amino Acids in Vegetarian Diets—A Review. Authored by Mariotti and Gardner, examining protein adequacy in plant-based eating. https://www.mdpi.com/2072-6643/11/11/2661 Circulation. (2021). Effect of omega-3 fatty acids on cardiovascular outcomes: A systematic review and meta-analysis. https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.055656 Journal of Social and Clinical Psychology. (2018). No More FOMO: Limiting Social Media Decreases Loneliness and Depression. A randomized controlled trial on limiting social media use. https://guilfordjournals.com/doi/10.1521/jscp.2018.37.10.751 NHMRC. (2015). NHMRC Statement on Homeopathy. A comprehensive review of the evidence for the effectiveness of homeopathy. https://www.nhmrc.gov.au/about-us/publications/homeopathy

Après la dermatose nodulaire, la peste porcine africaine continue de se disséminer aux frontières de la France. Deux sangliers, tués par ce virus très transmissible et extrêmement mortel pour les suidés sauvages et domestiques, ont été découverts en Catalogne. Au total, quelque 155 sangliers ont été infectés en trois mois autour de Barcelone. Écoutez l'analyse de Thierry Lefrançois, chercheur en maladies émergeantes et vectorielles. Ecoutez L'invité de 18h20 avec Vincent Parizot du 26 février 2026.Hébergé par Audiomeans. Visitez audiomeans.fr/politique-de-confidentialite pour plus d'informations.

This week, join author Moritz J. Hundertmark and Associate Editor Vlad Zaha as they discuss their article "IMPROVE-DiCE, a 2-Part, Open-Label, Phase 2a Trial Evaluating the Safety and Effectiveness of Ninerafaxstat in Patients With Cardiometabolic Syndromes." For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260223.163027

Dan Dicks just obliterated the veil on this show—Canada's forcing SOGI gender perversion on kindergarten babies, mutilating confused kids through affirmation mills, then herding the broken straight into MAiD government-assisted suicide with over 100,000 already executed since 2016 in this demonic harvest.  

Gareth Icke rips into the Epstein files leak as elite mockery—Jewish-linked globalists parading taped child rape, torture, cannibalism, sacrifices, and transhuman experiments, daring us to either submit or end them for defiling our children.   BitChute's Ray Vahey details dodging Jewish-led globalist assaults—debanked in Europe, slammed by regimes, NGOs, and blacklists—delivering censorship-free video since 2017 with spy-free ops, honest trending, auto-monetization for creators, and a $10K shadowban bounty untouched.

What if the key to "getting" more in life isn't about trying harder—but about giving more freely? In this episode, we explore the the Law of Circulation and how it shapes everything from our relationships, finances, and even to our overall sense of abundance. Through insights from both science and spirituality, we look at how nature itself models this truth—nothing thrives by holding on, but by allowing energy to move. When we consciously choose to give—whether it's love, attention, generosity, or presence—we create space for something new to flow back into our lives.We also talk about how aligning with these universal laws can transform not just what we experience externally, but who we become internally. How might your life shift if you focused more on what you can contribute rather than what you can get? And what would happen if giving became less about obligation and more about expression? Join us for a heartfelt and practical conversation that invites us to step into a deeper level of abundance, fulfillment, and conscious living—by simply starting with what we already have to give.Chapters00:00 New Beginnings and Updates02:53 The Law of Circulation: Giving to Receive05:47 Nature's Examples of Giving and Receiving08:41 The Importance of Alignment with Universal Laws12:04 Concrete Examples of Giving in Life14:56 Financial Giving and Spiritual Nourishment17:51 Transformative Stories of Giving and Receiving20:47 Recommended Resource: The Go-Giver23:43 Closing Thoughts and Future Directions

Thomas English talks with a guest from the Nevada Public Library about the upcoming teen programs and events through the month of February. The guest is Library Circulation Supervisor of Teen Programs and Outreach Services Kevin Polo. He discusses the next TV Trivia Tuesday theme as well as the D&D events. He highlights some of the teen programs the library has including various craft events. Lastly, he explains how the technology grant has positively benefitted the library since its installment. 

Jake GTV joins Stew Peters live from Puerto Vallarta at Anarchapulco ripping open the Epstein files that nail Bill Gates in direct collusion with Jeffrey Epstein—the pedo financier who bankrolled the entire COVID bioweapon operation—complete with pre-planned depopulation, white fibrous clots yanked from corpses, and skyrocketing deaths that prove this was mass murder, not a pandemic. Max Igan live from Anarchapulco Genesis in Puerto Vallarta dropping hard truth: Trump was Epstein's best buddy sharing the Talmudic, Star of Moloch child-sacrifice fetish of the elite Jewish network running blackmail-free pedo rings, while Rothschild central banks control compliant governments and depopulate the world through wars for Greater Israel.

Aging is inevitable. Being misled about it isn't.In this episode of Plastic Surgery Uncensored, Dr. Rady Rahban breaks down the true biology of aging — and why it's far more complex than just “wrinkles.” Collagen and elastin decline. Fat shifts and disappears. Bone resorbs. Muscle thins. Circulation changes. Then you layer in sun exposure, stress, lifestyle, and genetics. Aging isn't one event — it's a cascade happening simultaneously.Dr. Rahban explains what can realistically slow the process — SPF, medical-grade skincare, retinoids, properly used Botox, disciplined lifestyle choices — and what's mostly marketing noise. He also dives into filler misuse, overpromised devices, social media illusions, and why “doing more” often makes people look worse, not better. Most importantly, he answers the question everyone eventually asks: When is it actually time to consider surgery?This episode is the foundation. If you want to manage aging with clarity instead of hype, start here.✨ If you enjoyed this episode of Plastic Surgery Uncensored:✔️ Subscribe on Apple Podcasts, Spotify, or wherever you listen.✔️ Rate & Review—your feedback helps more people find us.✔️ Follow Dr. Rady Rahban across all platforms for daily insights, behind-the-scenes, and patient education:Instagram: @drradyrahbanTikTok: @radyrahbanMDYouTube: @Rady RahbanFacebook: @Rady Rahban✔️ Share this episode with someone considering plastic surgery—the right knowledge can save a life.

This week, please join guest hosts Sana Al-Khatib and Mercedes Carnethon as first, they briefly introduce Circulation's annual Go Red for Women® issue. Then, our hosts welcome author Emilia Benjamin and Section Editor Maryjane Farr as they discuss the unique challenges women cardiologists have faced in the past and still encounter, and the importance of mentors and mentees in the field of cardiology. Finally, our hosts welcome Ju-Young (Judy) Shin to discuss her article "Association of Statin Discontinuation in Pregnancy With Maternal Cardiovascular Health and Birth Outcomes: A Nationwide Cohort Study." Don't miss this important podcast! For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260213.424527

CardioNerds (Dr. Ramy Doss, Dr. Kelly Arps, and Dr. Naima Maqsood) dive into the nuances of atrial fibrillation (AF) ablation with Dr. Jon Piccini. They provide a high-yield overview of AF ablation, guiding listeners from patient selection through post-procedural management. We review appropriate candidacy for catheter ablation across AF phenotypes, key elements of pre-procedural evaluation including imaging and anticoagulation strategy, and the fundamental procedural steps with pulmonary vein isolation as the cornerstone. The discussion compares lesion set strategies in de novo ablation and reviews currently used energy sources—including radiofrequency, cryoablation, and pulsed-field ablation—highlighting differences in safety and efficacy. They also examine surgical and hybrid approaches for selected patients and outline essential components of post-ablation care, including rhythm monitoring, anticoagulation decisions, and management of complications. This episode integrates contemporary evidence with practical insights to support clinicians delivering comprehensive AF ablation care. Audio editing for this episode was performed by CardioNerds intern Dr. Bhavya Shah. NOTE: This episode was recorded in March 2025. Since then, the OCEAN trial showed that among patients who had had successful catheter ablation for atrial fibrillation at least 1 year earlier and had risk factors for stroke, treatment with rivaroxaban did not result in a significantly lower incidence of a composite of stroke, systemic embolism, or new covert embolic stroke than treatment with aspirin.  Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Atrial Fibrillation PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

Episode 212: Managing HFpEFHyo Mun and Jordan Redden (medical students) explain how to manage HFpEF with medications and touch some basics about nonpharmacologic treatments. Dr. Arreaza asks insightful questions to guide the discussion. Written by Hyo Mun, MSIV, American University of the Caribbean; and Jordan Redden, MSIV, Ross University School of Medicine. Comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Treatment of HFpEFArreaza: Mike, if you had to name the one therapy everyone with HFpEF should be on, what is it?Mike: That's easy! SGLT-2 inhibitors. This is the one slam-dunk we have in HFpEF. Empagliflozin (Jardiance) or dapagliflozin (Farxiga) should be started in essentially every patient with HFpEF, and it doesn't matter if they have diabetes or not.Jordan: And that's worth repeating, because people still think of these as “diabetes drugs.” They're not anymore. In HFpEF, SGLT-2 inhibitors reduce heart-failure hospitalizations, improve symptoms, improve quality of life, and even reduce cardiovascular death.Dr. Arreaza: They're also simple. Empagliflozin 10 mg daily or dapagliflozin 10 mg daily. No titration, no drama. The effectiveness of these meds was established around 2019 with DAPA-HF and later with DELIVER. These were trials thatdemonstrated that dapagliflozin reduces worsening heart failure and cardiovascular events across the full spectrum of heart failure, from reduced to preserved ejection fraction, independent of diabetes status.Mike: And the number needed to treat is about 28 to prevent one heart-failure hospitalization. That's excellent for a disease where we historically had almost nothing that worked.Jordan: They're also safe in chronic kidney disease down to an eGFR of about 25, which makes them even more useful in this population.Dr. Arreaza: Alright. We got SGLT-2 inhibitor, what's next?Mike: Volume management. Loop diuretics are still the backbone of symptom control in HFpEF. If the patient is volume overloaded, you diurese, and you diurese aggressively.Jordan: The goal is euvolemia. Dry weight, no edema, no orthopnea, no waking up gasping for air. A lot of these patients end up needing chronic oral loop diuretics to stay there.Dr. Arreaza: Something to remember: HFpEF patients don't tolerate congestion well, and being “a little wet” is not benign. Let's move into RAAS inhibition. Where do ARBs and ACE inhibitors fit in?Mike: Between ARBs and ACE inhibitors, ARBs are the winners in HFpEF. They actually reduce heart failure hospitalizations—drugs like candesartan, losartan, valsartan. ACE inhibitors? Not so much. They showed minimal benefit in older HFpEF patients, which is why we go with ARBs instead.Jordan: But a lot of clinicians get nervous about ACE inhibitors and ARBs because of kidney function, so it's worth talking through how these drugs actually work in the kidney.Dr. Arreaza: Yes, misunderstanding may lead to unnecessary drug discontinuation.Jordan: Under normal conditions, the afferent arteriole brings blood into the glomerulus, and the efferent arteriole is constricted by angiotensin II. That constriction keeps pressure high in the glomerulus and maintains filtration.Mike: Here's what happens with an ACE inhibitor: you block angiotensin II, the efferent arteriole relaxes, glomerular pressure drops, and GFR dips slightly. Creatinine bumps up a little, and that scares people, but that's actually the whole point—that's how you get kidney protection long-term.Jordan: High intraglomerular pressure causes hyperfiltration injury and scarring over time. Lowering that pressure protects the kidney long-term. The short-term GFR drop is the price you pay for long-term benefits.Dr. Arreaza: So let's talk about CKD, because this is where people panic.Mike: Right. ACE inhibitors and ARBs are not contraindicated in chronic kidney disease. In fact, they're recommended even in advanced stages. They reduce progression to kidney failure by about a third.Jordan: The key is how you use them. Start low. Check creatinine and potassium one to two weeks after starting, then periodically. A creatinine rise up to 30% from baseline is acceptable. That's not kidney injury, that's physiology.Dr. Arreaza: And what about potassium creeping up?Mike: You adjust the dose or add a potassium binder. You don't just automatically stop the drug.Dr. Arreaza: Now there is one absolute contraindication everyone needs to know about! (board exam test)Jordan: Bilateral renal artery stenosis. This is the big one. In these patients, the kidneys are completely dependent on angiotensin II–mediated efferent constriction to maintain GFR. Take that away, and GFR collapses.Mike: Creatinine can jump dramatically within days. If you see a creatinine rise of 20% or more shortly after starting an ACE inhibitor, you should be thinking about bilateral renal artery stenosis and stopping the drug immediately.Dr. Arreaza: After revascularization, though, many patients can tolerate ACE inhibitors again, so this isn't always permanent. What about cardiorenal syndrome? That's where things get uncomfortable.Mike: It is uncomfortable, but cardiorenal syndrome isn't a contraindication. These patients have severe heart failure and kidney disease, and their mortality is actually higher than patients with heart failure alone.Jordan: ACE inhibitors still reduce mortality and slow kidney disease progression in this group. Studies show that stopping ACE inhibitors during acute heart-failure admissions increases in-hospital mortality three- to four-fold.Dr. Arreaza: So we are cautious, but we don't avoid it.Mike: Exactly. Start low, titrate slowly, monitor labs closely, accept up to a 30% creatinine rise. You only stop if kidney function keeps worsening, or potassium gets dangerously high.Dr. Arreaza: Alright. Let's move on. What about mineralocorticoid receptor antagonists… MRA?Jordan: Spironolactone or eplerenone might reduce hospitalizations in HFpEF, but the data is mixed. This is more of a “select patients” situation.Mike: And you have to watch potassium and kidney function carefully, especially if they're already on an ACE inhibitor or ARB.Dr. Arreaza: What about sacubitril-valsartan, also known as Entresto®?Mike: Entresto may help patients with mildly reduced EF roughly in the 45 to 57% range. It's not first-line for HFpEF, but in select patients, it's reasonable.Dr. Arreaza: Now let's clarify one of the biggest sources of confusion: beta blockers.Jordan: Beta blockers are not a treatment for HFpEF itself. They're only indicated if the patient has another reason to be on them, like coronary disease or atrial fibrillation.Mike: And timing really matters here. You absolutely do not start beta blockers during acute decompensated heart failure. Their negative inotropic effects can make things worse when patients are volume overloaded.Jordan: But, and this is critical, you also don't stop them if the patient is already taking one. Abrupt withdrawal causes a sympathetic surge and dramatically increases mortality.Dr. Arreaza: If a patient is admitted on a beta blocker, what do we do?Mike: Continue it at the same dose or reduce it slightly if they're really unstable. Once they're euvolemic and stable, you can carefully titrate up.Jordan: And watch for chronotropic incompetence. HFpEF patients often rely on heart-rate response to exercise, and beta blockers can worsen exercise intolerance.Dr. Arreaza: Beyond medications, HFpEF is really about treating comorbidities. Aerobic activity can be an initial strategy to improve exercise intolerance and has evidence of improving aerobic function and quality of life. Sodium restriction: improves symptoms, does not decrease risk of death or hospitalizations.Mike: Hypertension control is huge. For diabetes, the SGLT-2 inhibitors will perform double duty. For obesity, weight loss improves symptoms, and GLP-1 agonists like semaglutide are absolute gamechangers.Jordan: Don't forget sleep apnea, atrial fibrillation, and lifestyle. Exercise improves the quality of life, even if it doesn't change hard outcomes. Lifestyle is the main treatment. Dr. Arreaza: And when should you refer to cardiology?Mike: You should refer when the diagnosis isn't clear; symptoms are not responding to treatment, difficult volume management, end-organ dysfunction, or if you are concerned about advanced heart failure.Dr. Arreaza: So, it has been a great discussion. What is the takeaway?Mike: HFpEF treatment isn't about one magic drug -- it's about volume control, SGLT2 inhibitors, smart use of RAAS blockade, and aggressive management of comorbidities.Jordan: And it's understanding the physiology, so you don't withhold life-saving therapies out of fear.Dr. Arreaza: Well said. If you found this helpful, share it with a friend or colleague and rate us wherever you listen. This is Dr. Arreaza, signing off.Jordan/Mike: Thanks! Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. 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Marking 5 months since Charlie Kirk's execution on Sept 10, 2025, at Utah Valley University, Stew dismantles the Zionist cover-up shielding his killers. JD Sharp joins Stew to discuss the illusion of American democracy exposed by the latest Epstein files drop. Trump shows up over 38,000 times, linked to unspeakable crimes against kids, with survivors naming him directly in assaults.