Podcasts about Circulation

Credits: 0.75 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-500 Overview: To celebrate our 500th episode, each member of our team revisits a popular topic from the podcast's earlier installments—GLP-1s, cervical and breast cancer screening, diet and exercise, contraception, hypertension, and lipid management—to trace how the evidence and guidelines have changed since it was first covered. Whether you're catching up or reinforcing what you know, this milestone episode helps you bring the latest evidence into everyday patient care. Guest: Robert Baldor, MD, Alan Ehrlich, MD, Susan Feeney, DNP, FNP-BC; FAANP, Jillian Joseph, PA, Mariyan L. Montaque, DNP, FNP-BC, Jill Terrien PhD, ANP-BC, FAAN   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  Episode resource links:  Zhou H et al.  Evaluation and Comparison of the PREVENT and Pooled Cohort Equations for 10‐Year Atherosclerotic Cardiovascular Risk Prediction. Journal of the American Heart Association Volume 14, Number 4 Goff DC et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2014;129:S49–S73. Circulation. 2018 Jul 24;138(4):345-355.  eClinicalMedicine 2025: 103741. Curry, J. (2018). Screening for cervical cancer: US Preventive Services Task Force Recommendation Statement. JAMA.320(7):674-686. doi:10.1001/jama.2018.10897 https://www.ncbi.nlm.nih.gov/pubmed/30140884  Perkins RB, Wolf AMD, Church TR, et al. Self-collected vaginal specimens for human papillomavirus testing and guidance on screening exit: An update to the American Cancer Society cervical cancer screening guideline. CA Cancer J Clin. 2026;e70041. doi:10.3322/caac.70041   Screening for Cervical Cancer (2026). Obstetrics & Gynecology, 148(1), e63-e67. https://doi.org/10.1097/AOG.0000000000006257  Jad Zeitouni, Nosayaba Osazuwa-Peters, Yusuf Dundar, Gregory Zimet, Mark A. Varvares. (2025). Two decades of the HPV vaccine: its promise, progress, prospects, projections, and posterity, The Lancet Regional Health - Americas, (51), https://doi.org/10.1016/j.lana.2025.101243 Diabetes, Obesity and Metabolism 28, no. 6 (2026): 5043–5057, https://doi.org/10.1111/dom.70698.  Relationship of early rapid weight loss to efficacy and safety of tirzepatide and semaglutide for obesity: SURMOUNT-5 post hoc analysis. Am J Med. 2026 Jul;139(7):913-921. doi: 10.1016/j.amjmed.2026.03.010 US Preventive Services Task Force; Nicholson WK, Silverstein M, Wong JB, et al. Screening for breast cancer: US Preventive Services Task Force recommendation statement. JAMA. 2024;331(22):1918–1930.  Trentham-Dietz A, Chapman CH, Jayasekera J, et al. Collaborative modeling to compare different breast cancer screening strategies: a decision analysis for the US Preventive Services Task Force. JAMA. 2024;331(22):1931–1946. Giaquinto AN, Sung H, Miller KD, et al. Breast cancer statistics, 2022. CA Cancer J Clin. 2022;72(6):524–541.  Qaseem A, Harrod CS, Balk EM, et al. Screening for breast cancer in asymptomatic, average-risk adult females: a guidance statement from the American College of Physicians (Version 2). Ann Intern Med. 2026.:  American Cancer Society. Breast Cancer Facts & Figures 2022–2024. Atlanta, GA: American Cancer Society, 2022.  Hu X, Chehal PK, Kaplan C, et al. Racial differences in patient-reported symptoms and adherence to adjuvant endocrine therapy among women with early-stage, hormone receptor-positive breast cancer. JAMA Netw Open. 2022;5(8):e2225485.  Torres JM, Sodipo MO, Hopkins MF, Chandler PD, Warner ET. Racial differences in breast cancer survival between Black and White women according to tumor subtype: a systematic review and meta-analysis. J Clin Oncol. 2024;42(35):4225–4234.  Bailey ZD, Krieger N, Agénor M, Graves J, Linos N, Bassett MT. Structural racism and health inequities in the USA: evidence and interventions. Lancet. 2017;389(10077):1453–1463. Hypertension. 2026;83:00–00. DOI: 10.1161/HYPERTENSIONAHA.125.25787 Allen RH, Bartz D. Opill: The Over-the-Counter Contraceptive Pill. Obstet Gynecol. 2024;143(2):184-188. doi:10.1097/AOG.0000000000005455  Cahill EP, Kaur S. Advances in contraception research and development. Curr Opin Obstet Gynecol. 2020;32(6):393-398. doi:10.1097/GCO.0000000000000666  Charles DN, Nagarsheth M, Oshman L. Pain Management for IUD Insertion in Primary Care. Am Fam Physician. 2025;111(4):299-301.  Chen, C., Strasser, J., Banawa, R., Luo, Q., Bodas, M., Castruccio-Prince, C., Das, K., & Pittman, P. (2022). Who is providing contraception care in the United States? An observational study of the contraception workforce. American journal of obstetrics and gynecology, 226(2), 232.e1–232.e11. https://doi.org/10.1016/j.ajog.2021.08.015  Diedrich,J., Klein, D. Peipert, J.(2017). Long-acting reversible contraception in adolescents: a systematic review and meta-analysis, Am J Ob Gyn, April 2017. http://dx.doi.org/10.1016/j.ajog.2016.12.024  Li RHW, Lo SST, Gemzell-Danielsson K, Fong CHY, Ho PC, Ng EHY. Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial. Lancet. 2023;402(10405):851-858. doi:10.1016/S0140-6736(23)01240-0  Mørch LS, Meaidi A, Corn G, Hargreave M, Wessel Skovlund C. Breast Cancer in Users of Levonorgestrel-Releasing Intrauterine Systems. JAMA. 2024;332(18):1578–1580. doi:10.1001/jama.2024.18575  Nguyen AT, Curtis KM, Tepper NK, et al. U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recomm Rep. 2024;73(4):1-126. Published 2024 Aug 8. doi:10.15585/mmwr.rr7304a1  Paradise SL, Landis CA, Klein DA. Evidence Based Contraception: Common Questions and Answers. American Family Physician. 2022. https://www.aafp.org/afp/2022/0900/contraception The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Credits: 0.25 AMA PRA Category 1 Credit™   CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-499 Overview: Stay in the know with this breakdown of the latest American College of Cardiology (ACC)/American Heart Association (AHA) recommendations for lipid testing and management. New approaches to evaluating hyperlipidemia, as well as limitations of the updated guidelines, are discussed to provide you with practical strategies for tailoring treatment decisions to individual patient risk. Episode resource links: Writing Committee Members, Blumenthal RS, Morris PB, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(17):e1154-e1276.  Guest: Alan M. Ehrlich, MD, FAAFP   Music Credit: Matthew Bugos Thoughts? Suggestions? Email us at FranklySpeaking@pri-med.com  The views expressed in this podcast are those of Dr. Domino and his guests and do not necessarily reflect the views of Pri-Med.

Does lower cholesterol equal less plaque? The answer may surprise you. On this episode of Vitality Radio, Jared explores emerging research on nattokinase, a systemic enzyme derived from fermented soybeans, and its potential role in supporting cardiovascular health. He reviews a 2017 clinical trial comparing nattokinase with a commonly prescribed statin, discusses why imaging studies of arterial plaque may offer a different perspective than cholesterol markers alone, and explains how fibrin may influence plaque structure. Jared also breaks down the importance of dosage, why many studies suggest higher amounts may produce different results than standard servings, and how systemic enzymes fit into a broader heart health strategy. As always, he encourages listeners to understand the research, ask better questions, and work with qualified healthcare professionals when making decisions about their cardiovascular health.Products:NattokinaseFibrenza Systemic EnzymesSun Nutrition Vascular Defense Systemic Enzyme & N.O. BlendVisit the podcast website here: VitalityRadio.comYou can follow @vitalitynutritionbountiful and @vitalityradio on Instagram, or Vitality Radio and Vitality Nutrition on Facebook. Join us also in the Vitality Radio Podcast Listener Community on Facebook. Shop the products that Jared mentions at vitalitynutrition.com. Let us know your thoughts about this episode using the hashtag #vitalityradio and please rate and review us on Apple Podcasts. Thank you!Just a reminder that this podcast is for educational purposes only. The FDA has not evaluated the podcast. The information is not intended to diagnose, treat, cure, or prevent any disease. The advice given is not intended to replace the advice of your medical professional.This podcast is produced by DrTalks.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://drtalks.com/podcast-service/

CardioNerds (Drs. Dr. Natalie Marrero, Dr. Ritika Tuli, and Dr. Rafael Toro Manotas) discuss multimodality imaging for risk stratification, evaluation, and management of chronic coronary artery disease with Dr. Panithaya Chareonthaitawee. Audio editing by CardioNerds intern Iman Razeghian. This episode was produced as part of the CardioNerds Academy curriculum by House Taussig under the guidance of House Chief, Dr. Natalie Marrero and Academy Program Director, Dr. Gurleen Kaur. A matching review article will be published in US Cardiology Review, the official journal of CardioNerds. This discussion was planned in collaboration with the Mayo Clinic Cardiovascular Board Review Course. In this episode, we discuss the pathophysiology and risk stratification of chronic coronary artery disease (CAD), as well as the current landscape of non-invasive evaluation of this condition. CAD remains a leading cause of morbidity and mortality despite advances in pharmacological and non-pharmacological strategies for the prevention and treatment of atherosclerotic disease. The concept of chronic CAD has shifted from the traditional model of stable, obstructive, flow-limiting disease, toward the current understanding of a dynamic process that extends beyond obstructive epicardial lesions to include non-obstructive plaque, diffuse atherosclerosis, and microvascular disease. Similarly, the imaging modalities used to evaluate CAD have evolved, and clinicians now have an extensive menu of options, each with distinct advantages and limitations, that must be selected carefully to maximize diagnostic accuracy and optimize treatment guidance, while also considering resource availability, local expertise, and high-value care. By the end of the episode, listeners will understand the pathophysiology of chronic CAD, risk-stratify patients with suspected CAD, recognize the advantages and pitfalls of each non-invasive diagnostic modality, and select the most appropriate diagnostic tool for a given clinical scenario. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls: Chronic CAD is a complex process that extends beyond obstructive epicardial stenosis to include non-obstructive disease, dynamic plaque burden and ischemia, diffuse atherosclerosis, microvascular dysfunction, vasospasm, among others. When evaluating patients with suspected CAD, the diagnostic process should be guided by a specific and appropriate clinical question before ordering any tests. The current diagnostic tool arsenal is broadly divided into anatomic and functional imaging modalities. These are complementary, each with distinct properties and limitations, addressing different clinical questions and assessing different aspects of disease. Local availability and expertise, along with patient-specific considerations and contraindications, determine the choice of diagnostic modality. No single test is best for every patient. INOCA and coronary microvascular dysfunction represent a common and increasingly recognized entity that is diagnosable and treatable; initial evaluation includes non-invasive testing such as stress PET and stress CMR. References Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021;144(22):e368-e454. doi:10.1161/CIR.0000000000001029 https://pubmed.ncbi.nlm.nih.gov/34709879/ Vrints C, Andreotti F, Koskinas KC, et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur Heart J. 2024;45(36):3415-3537. doi:10.1093/eurheartj/ehae177 https://pubmed.ncbi.nlm.nih.gov/39210710/ Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation. 2023;148(9):e9-e119. doi:10.1161/CIR.0000000000001168 https://pubmed.ncbi.nlm.nih.gov/37471501/ Edvardsen T, Asch FM, Davidson B, et al. Non-Invasive Imaging in Coronary Syndromes: Recommendations of The European Association of Cardiovascular Imaging and the American Society of Echocardiography, in Collaboration with The American Society of Nuclear Cardiology, Society of Cardiovascular Computed Tomography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2022;35(4):329-354. doi:10.1016/j.echo.2021.12.012 https://pubmed.ncbi.nlm.nih.gov/35379446/ Douglas PS, Hoffmann U, Patel MR, et al. Outcomes of anatomical versus functional testing for coronary artery disease. N Engl J Med. 2015;372(14):1291-1300. doi:10.1056/NEJMoa1415516 https://pubmed.ncbi.nlm.nih.gov/39210710/ Sharma A, Coles A, Sekaran NK, et al. Stress Testing Versus CT Angiography in Patients With Diabetes and Suspected Coronary Artery Disease. J Am Coll Cardiol. 2019;73(8):893-902. doi:10.1016/j.jacc.2018.11.056 https://pubmed.ncbi.nlm.nih.gov/30819356/ SCOT-HEART Investigators, Newby DE, Adamson PD, et al. Coronary CT Angiography and 5-Year Risk of Myocardial Infarction. N Engl J Med. 2018;379(10):924-933. doi:10.1056/NEJMoa1805971 https://pubmed.ncbi.nlm.nih.gov/30145934/ Li Z, Xu T, Wang Z, et al. Prognostic Significance of Computed Tomography-Derived Fractional Flow Reserve for Long-Term Outcomes in Individuals With Coronary Artery Disease. J Am Heart Assoc. 2025;14(2):e037988. doi:10.1161/JAHA.124.037988 https://pubmed.ncbi.nlm.nih.gov/39791423/ Bateman TM, Al-Mallah MH, et al. Clinical indications for positron emission tomography myocardial perfusion imaging and myocardial blood flow quantification: An American Society of Nuclear Cardiology position statement. J Nucl Cardiol. 2026;57:102619. doi:10.1016/j.nuclcard.2025.102619 https://pubmed.ncbi.nlm.nih.gov/41482140/ Taqueti VR, Di Carli MF. Coronary Microvascular Disease Pathogenic Mechanisms and Therapeutic Options: JACC State-of-the-Art Review. J Am Coll Cardiol. 2018;72(21):2625-2641. doi:10.1016/j.jacc.2018.09.042 https://pubmed.ncbi.nlm.nih.gov/30466521/ Taqueti VR, Hachamovitch R, Murthy VL, et al. Global coronary flow reserve is associated with adverse cardiovascular events independently of luminal angiographic severity and modifies the effect of early revascularization. Circulation. 2015;131(1):19-27. doi:10.1161/CIRCULATIONAHA.114.011939 https://pubmed.ncbi.nlm.nih.gov/25400060/ Mehta PK, Huang J, Levit RD, Malas W, Waheed N, Bairey Merz CN. Ischemia and no obstructive coronary arteries (INOCA): A narrative review. Atherosclerosis. 2022;363:8-21. doi:10.1016/j.atherosclerosis.2022.11.009 https://pubmed.ncbi.nlm.nih.gov/36423427/ Kunadian V, Chieffo A, Camici PG, et al. An EAPCI Expert Consensus Document on Ischaemia with Non-Obstructive Coronary Arteries in Collaboration with European Society of Cardiology Working Group on Coronary Pathophysiology & Microcirculation Endorsed by Coronary Vasomotor Disorders International Study Group. EuroIntervention. 2021;16(13):1049-1069. doi:10.4244/EIJY20M07_01 https://pubmed.ncbi.nlm.nih.gov/32624456/

Contributor: Taylor Lynch, MD Educational Pearls:  CPR is an important life-saving measure designed for anyone to perform. Chest compressions works by two mechanisms:  Cardiac pump: Direct squeezing of the heart Thoracic pump: Increasing intrathoracic pressure, causing increased blood flow Proper hand placement per current AHA guidelines:  Hands are placed in the center of the chest, on the lower half of the sternum A recent study challenged this approach, using TEE during chest compressions to visualize the cardiac structures being compressed. They found that when hands were placed ~1cm to the left of the sternum, this compressed the left ventricular outflow tract, potentially restricting forward blood flow. Hand placement ~4cm to the left of the sternum resulted in more effective compression of the left ventricle. While this is not yet reflected in AHA guidelines, the study presents an interesting finding that may influence how CPR is performed in the future.  Key takeaway: Always prioritize administering high quality compressions. References:  American Heart Association. 2025 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2025;152(23_suppl_1). doi:10.1161/CIR.0000000000001378. Chu S, Cheng C, Chang C, et al. Transesophageal echocardiography during CPR in patients with out-of-hospital cardiac arrest: the EXECT-CPR randomized clinical trial. JAMA Intern Med. 2026;186(5):557-566. doi:10.1001/jamainternmed.2026.0102.   Summarized by Ashley Lyons, OMS4 | Edited by Ashley Lyons & Ahmed Abdel-Hafiz, NREMT-P   Donate: https://emergencymedicalminute.org/donate/   Join our mailing list: http://eepurl.com/c9ouHf

Low-fat dairy shown to confer no weight, cholesterol benefits over full-fat dairy; FDA and USDA to define ultra-processed foods for first time—but what are they really? Newly discovered tick-borne Bourbon virus can be fatal—but is it more pervasive than we think? Thorne supplement maker—sold 3 years ago for $700 million—acquired by Procter & Gamble for $3.8 billion. Those dark skin blotches—are they melasma, or just age spots? Is low-mercury salmon a hype? That fishy smell—does it mean your seafood is spoiled?

À l'occasion de sa revue de presse, vendredi, Paul Arcand commente un dossier de La Presse qui révèle qu'entre 2020 et 2024, le nombre de femmes en situation d'itinérance ayant perdu la vie a bondi de plus de 200% dans la province. Ces chiffres, qui proviennent d'une étude de l'Université de Sherbrooke, indiquent également que plus du tiers des personnes qui sont décédées durant ces quatre années se trouvaient en situation d’«itinérance cachée» au Québec. Ces données alarmantes, basées sur le dépouillement des dossiers du Bureau du coroner, ne brossent toutefois qu'un portrait partiel de la réalité. Les chercheurs rappellent que leurs travaux se concentrent uniquement sur les morts violentes ou suspectes, laissant présager un bilan réel encore plus lourd. Autres sujets abordés Les promesses électorales; Vincent Guzzo est accusé de voies de fait; Ce sera le bordel en circulation à Montréal pendant tout le mois de septembre. Voir https://www.cogecomedia.com/vie-privee pour notre politique de vie privée

CardioNerds (Dr. Apoorva Gangavelli, Dr. Cory Sejo, and Dr. Joseph Kassab), discuss tricuspid regurgitation evaluation and management with Dr. Sunil Mankad. This episode was produced as part of the CardioNerds Academy curriculum by House Einthoven under the guidance of House Chief, Dr. Apoorva Gangavelli and Academy Program Director, Dr. Gurleen Kaur. A matching review article will be published in US Cardiology Review, the official journal of CardioNerds. This discussion was planned in collaboration with the Mayo Clinic Cardiovascular Board Review Course.  Audio editing by CardioNerds intern Emma Winakur. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Key Points: Tricuspid regurgitation is common and associated with increased mortality at every stage, regardless of etiology. Outcomes are worse with worsening severity, so accurate grading is critical. Etiology is critical to guide treatment decisions. Etiology includes primary vs secondary (atrial or ventricular) vs CIED-related TR. 3D echocardiography can be very helpful in determining TR etiology, especially in CIED-related TR. Diuresis with the goal of euvolemia is step one. Additionally, underlying contributory conditions (eg. pulmonary HTN, HFrEF, atrial fibrillation) should be addressed, if appropriate, and then TR severity reassessed. The choice between T-TEER and TTVR hinges on anatomy, RV function, pulmonary hypertension, and the ability to tolerate anticoagulation. T-TEER is generally first line in atrial functional TR with appropriate anatomy, in patients with poor RV function who cannot tolerate a sudden increase in RV afterload, or in patients who cannot tolerate the necessary anticoagulation with TTVR. TTVR is preferred with wide coaptation gaps and CIED-related TR. This is a team sport. Multidisciplinary discussions utilizing imaging (TTE/TEE, CT), risk scores (TRI-SCORE or TRIO), patient preference, and prior institutional experience are essential for the effective treatment of severe TR. Notes: What is the clinical importance of tricuspid regurgitation? TR is very common with approximately 4% of people over 75 having moderate or greater severity. TR (even mild) is associated with increased mortality. Those outcomes worsen as the TR severity worsens, and this phenomenon is independent of the mechanism of regurgitation. What is unique about the tricuspid valve compared to the other cardiac valves? It is at an anterior location which allows it to be imaged well with transthoracic echocardiography It is the largest valve and composed generally of 3 leaflets (but very often can have 4+ leaflets). Importantly, the RV is compliant and changes size and shape readily based on loading conditions. The TV annulus similarly changes size and shape based on hemodynamic conditions such as preload. What is a good framework for approaching the causes of tricuspid regurgitation? Determine the presence and define the severity of TR. Using TTE, we want to measure the right atrial size, the RV size, and any other concomitant valvular lesions.  Use TTE (2D and 3D) to characterize leaflet anatomy and characteristics. Subtypes of TR mechanisms (many times etiology is mixed). Primary: primary leaflet abnormality, occurs in ~10% of cases. Look for prolapse, flail, endocarditis, etc. Secondary/functional: leaflets normal but surrounding structures are abnormal. Atrial: RA and tricuspid annular dilation but normal RV size/shape, and can be related to arrhythmias like atrial fibrillation. Ventricular: RV dilated and/or dysfunctional with leaflet tethering. Can be related to pulmonary hypertension or primary RV disease. Cardiac implantable electronic device (CIED): Related to device (usually pacemakers or ICD) interaction with TV leaflets. Includes perforation, entanglement in subvalvular apparatus, impingement, etc. 3D TTE particularly helpful to evaluate How do we grade TR severity? It is very important to grade the severity of TR, and this is generally done with echocardiography. There are both quantitative and qualitative methods which use Doppler and various equations to estimate TR severity. Current recommendations have expanded TR severity beyond mild/moderate/severe to include “massive” and “torrential” categories. The most important parameters measured/calculated are vena contracta width, regurgitant volume, regurgitant fraction, and effective regurgitant orifice area. Helpful qualitative metrics include hepatic venous flow reversal. When should additional studies beyond transthoracic echocardiography, such as transesophageal echocardiography (TEE), cardiac computed tomography (CT), and cardiac magnetic resonance imaging (MRI) be pursued? TEE is particularly helpful if TTE views are poor. Since TEE is used during transcatheter intervention, a pre-procedure TEE to define anatomy, determine procedure candidacy, and plan for the procedure is critical.  CT is also helpful for procedure planning and has particular strengths in defining annulus size and geometry. A CT is required prior to transcatheter tricuspid valve replacement (TTVR). MRI is helpful for measuring RV volumes and function, but is not generally used to assess TR severity.  What is the approach to the treatment for severe tricuspid regurgitation? The first step is to try to determine the etiology. For secondary TR, treating the underlying condition is indicated. For example, pulmonary vasodilators for pulmonary HTN or guideline therapy for heart failure with reduced ejection fraction. Diuretics are the mainstay for treatment, with the goal to obtain euvolemia. This may require inpatient admission to optimize volume status and medication regimen. Once reversible etiologies are addressed, if the patient is still symptomatic from TR, additional therapies can be considered. What is the role of right heart catheterizations (RHC) in patients with severe TR? RHC is very helpful for many reasons. We use it in TR to help determine volume status, cardiac output, and RV function. Additionally, identifying and characterizing pulmonary hypertension (with pulmonary artery pressures and calculating pulmonary vascular resistance) is an important factor when choosing future therapies.  With severe tricuspid regurgitation, when should we refer for intervention (either with surgery or transcatheter repair or replacement)? Once reversible etiologies are addressed and euvolemia has been achieved, if the patient is still symptomatic from TR despite aggressive medical optimization, additional therapies can be considered. Once euvolemic, a repeat TTE should be ordered to reassess the severity of the TR. Use calculators (for example, either the TRI-SCORE or TRIO score) to predict operative mortality for isolated TR surgery. What are our transcatheter treatment options in severe tricuspid regurgitation, and how do we choose between them? The primary approved transcatheter treatment options for severe TR include transcatheter tricuspid edge-to-edge repair (T-TEER) and transcatheter tricuspid valve replacement (TTVR), of which the Edwards EVOQUE valve is the only one currently approved by the FDA. There are other TTVR device under investigation. These decisions should be made with a multi-disciplinary team including representation from cardiac imaging, interventional cardiology, and cardiothoracic surgery. Factors that go into the decision between T-TEER and TTVR include anatomy (annulus width, coaptation gap, leaflet length), RV reserve, pulmonary hypertension presence, ability to tolerate anticoagulation, patient preference, and institutional experience.  T-TEER is generally the first line with atrial functional and suitable anatomy. It is successful at reducing TR but does not generally eliminate it.  TTVR with EVOQUE is preferred in certain anatomic considerations like a large coaptation gap or when there is CIED-related TR (as this was excluded in T-TEER trials). Patients must be suitable for anticoagulation to receive TTVR as there is risk of leaflet thrombosis without it. If moderate/severe pulmonary hypertension is present, or there is poor RV function, TTVR may be avoided as the sudden elimination of TR causes a sudden increase in RV afterload which may not be tolerated. What is the role in advanced metrics for evaluating RV function? Advanced metrics like RV/PA coupling are under investigation but have not made it into the guidelines. The clinical utility is not yet known.  Assessing the RV function is important as stated above. Dr. Mankad prefers using 3D TTE to calculate an RVEF, or tracking RV longitudinal free wall strain. If you do encounter CIED-related TR, how do you treat it? Evaluate with TTE or TEE. 3D is very helpful to identify relative anatomy and leaflet-device interactions. There is no clear consensus about treatment if CIED-related TR is the primary mechanism of severe TR. If recently implanted, repositioning may be a valid option, but requires discussions with multiple teams including electrophysiology, advanced cardiac imaging, CT surgery, and interventional cardiology. References O’Gara PT, Lindenfeld J, Hahn RT, et al. 10 Issues for the Clinician in Tricuspid Regurgitation Evaluation and Management: 2025 ACC Expert Consensus Decision Pathway. J Am Coll Cardiol. 2025;S0735-1097(25)07047-0. O’Gara PT, Little SH, Badhwar V, et al. Operator and Institutional Recommendations and Requirements for Tricuspid Interventions: 2026 ACC/AHA/ASE/HRS/STS Expert Consensus Systems of Care Document. J Am Coll Cardiol. 2026;S0735-1097(26)05481-1. Hahn RT. Tricuspid Regurgitation. N Engl J Med. 2023;388(20):1876-1891. Davidson LJ, Tang GHL, Ho EC, et al. The Tricuspid Valve: A Review of Pathology, Imaging, and Current Treatment Options: A Scientific Statement From the American Heart Association. Circulation. 2024;149(22):e1223-e1238.

Seu paciente treina pesado, tem exames "impecáveis" e quase nunca fala sobre uso de atalhos químicos.Até o dia em que chega ao pronto-socorro. Quanto você realmente sabe sobre o paciente que usa anabolizantes?Neste episódio, William Batah e Fernanda Justo recebem a Dra. Luciana Oliveira, endocrinologista pela UFPR, mestre pela UNIFESP e preceptora do ambulatório de endocrinologia do exercício, para destrinchar um tema que a cardiologia não pode mais ignorar. Luciana também lidera uma plataforma de notificação de complicações do uso indevido de hormônios e implantes no Brasil, o que dá ao episódio uma visão rara de quem lida com as consequências reais desse uso na prática.

durée : 00:05:13 - Les Matins de France Culture - par : Marie Dorcet - Le 8 août 2026, un adolescent de 14 ans a perpétré une fusillade dans un lycée près de Bangkok. Le Premier ministre annonce des mesures pour mieux contrôler les armes à feu dans un pays qui en compte 10 millions en circulation. Vous aimez ce podcast ? Pour écouter tous les épisodes sans limite, rendez-vous sur Radio France

656.Can increased muscle mass improve circulation of blood lymph? Find Get-Fit Guy on Facebook and Twitter, or subscribe to the newsletter for more fitness tips.Get-Fit Guy is a part of Quick and Dirty Tips.Links:https://www.quickanddirtytips.comhttps://www.facebook.com/GetFitGuyhttps://twitter.com/GetFitGuy Hosted on Acast. See acast.com/privacy for more information.

CardioNerds (Dr. Apoorva Gangavelli, Dr. Rebecca Garber, and Dr. Tina Reddy), discuss pre-pregnancy risk stratification and counseling with Dr. Katy Young across a range of risks.  This episode was produced as part of the CardioNerds Academy curriculum by House Einthoven under the guidance of House Chief, Dr. Apoorva Gangavelli and Academy Program Director, Dr. Gurleen Kaur. A matching review article will be published in US Cardiology Review, the official journal of CardioNerds. This discussion was planned in collaboration with the Mayo Clinic Cardiovascular Board Review Course. Audio editing by CardioNerds intern, Dr. Patrick Pekyi-Boateng. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Notes:  Why is pregnancy considered a “physiologic stress test,” and why does risk extend beyond delivery? Blood volume, heart rate, and cardiac output rise while systemic vascular resistance falls, peaking in the late second/early third trimester; underlying (even undiagnosed) heart disease can be unmasked or worsened. Postpartum (“fourth trimester”) is a high-risk period, not a safe zone – fluid shifts, rising SVR, and bleeding risk can precipitate decompensation in patients with heart failure, pulmonary hypertension, valvular disease, or aortopathy. Adverse pregnancy outcomes (hypertensive disorders, gestational diabetes, preterm birth, fetal growth restriction, peripartum cardiomyopathy) are markers of future cardiovascular risk and warrant long-term preventive follow-up. What is the practical framework for approaching pre-pregnancy cardiovascular risk? Four broad categories: (1) patients who may need cardiac screening before pregnancy, (2) patients needing risk-factor/medication optimization, (3) known cardiovascular disease where pregnancy is reasonable with structured risk stratification, and (4) high-risk disease where pregnancy may need to be delayed, modified by intervention, or discouraged. Testing should be targeted, not blanket – reserved for symptoms, abnormal exam, concerning family history, or reduced functional capacity. How is risk stratified in patients with known cardiovascular disease? Use a combination of tools per 2025 ESC guidelines: mWHO 2.0 (broad maternal risk category), CARPREG II (additional predictors of maternal cardiac events), and ZAHARA (useful in congenital heart disease). Key lesion-specific factors: aortic size/growth, valve severity, ventricular function, symptoms, blood pressure, and family history of dissection. Translate risk into practical terms for patients rather than leading with a numerical score. Which cardiovascular medications require review before conception? ACE inhibitors, ARBs, and ARNIs should be transitioned off before pregnancy; statins, MRAs, and SGLT2 inhibitors also need review. DOACs are contraindicated in pregnancy and lactation; mechanical valve anticoagulation requires individualized shared decision-making, as no strategy is risk-free for mother and fetus. Medication changes are best made proactively, before conception, rather than reactively. This is not an exhaustive list! The medication list needs to be reviewed carefully. Which conditions carry high or prohibitive risk in pregnancy? Pulmonary arterial hypertension, Eisenmenger syndrome, severe ventricular dysfunction, prior peripartum cardiomyopathy with residual LV dysfunction, severe left-sided obstructive valve disease (e.g., severe mitral stenosis), mechanical valves, significant aortopathy, cyanotic congenital heart disease, and Fontan physiology. Common theme: limited cardiovascular reserve and high risk of decompensation, thrombosis, arrhythmia, heart failure, aortic dissection, or death. These patients need expert multidisciplinary evaluation before pregnancy. Severe mitral stenosis is poorly tolerated because tachycardia shortens diastolic filling time and raises left atrial pressure, risking pulmonary edema and decompensation. When should genetic testing or counseling be offered? Consider when a diagnosis may be inherited or affect the patient, pregnancy, or family members: inherited cardiomyopathies, aortopathies, channelopathies, select congenital heart disease, and some pulmonary hypertension syndromes. Recurrence risk of congenital heart disease in offspring is roughly 6-10% when the mother has CHD; fetal echocardiography should be offered. How should contraception be approached in high-risk cardiac patients? Frame contraception as part of the cardiac care and reproductive safety plan to prevent unplanned high-risk pregnancy. Long-acting reversible contraception is often preferred; progestin-only methods are generally safer than estrogen-containing options with thrombosis risk, pulmonary hypertension, or mechanical valves. What are key delivery-planning considerations for cardiac patients? Vaginal delivery is preferred unless there is an obstetric indication for cesarean or a specific cardiac reason (e.g., unstable maternal status, therapeutic INR) to avoid labor. Planning should address delivery location, anesthesia involvement, telemetry needs, fluid management, and postpartum monitoring, clearly communicated across the multidisciplinary team in advance. How should clinicians counsel patients when pregnancy is discouraged but strongly desired? Acknowledge the patient’s goals and the emotional weight of the conversation; separate the goal (family building) from the timeline (safety now vs. after optimization). If pregnancy remains prohibitively risky, discuss alternatives for family building and ensure adequate patient support. What are the key gaps and future directions in cardio-obstetric risk stratification? Current risk tools (mWHO, CARPREG II, ZAHARA) provide common language but do not fully capture functional status, prior pregnancy history, or how risk evolves over time. Future direction: individualized, dynamic risk prediction incorporating imaging, biomarkers, exercise capacity, and social drivers of health, with better long-term links between pregnancy complications and cardiovascular prevention. References 1. European Society of Cardiology. 2025 ESC Guidelines for the management of cardiovascular disease and pregnancy. 2. Mehta LS, et al. Cardiovascular Considerations in Caring for Pregnant Patients: A Scientific Statement From the American Heart Association. Circulation. 2020;141:e884-e903. PMID: 32362133. doi:https://doi.org/10.1161/CIR.0000000000000772 3. ACOG Practice Bulletin No. 212. Pregnancy and Heart Disease. Obstet Gynecol. 2019;133(5):e320-e356. PMID: 31022123. doi:https://doi.org/10.1097/AOG.0000000000003243

Sign up for my free newsletter/1 page action plansIn this episode of Live Long and Well, Dr. Bobby looks at the evidence behind breakfast—not as a slogan, but as a real-life question: what problem is breakfast solving?For some people, breakfast may help with blood sugar, protein intake, morning exercise, or avoiding late-day overeating. For others, skipping breakfast may work perfectly well. And for many adults, “breakfast” may really mean coffee—which can improve alertness and exercise performance, but is not the same as food, protein, fiber, or fuel.Dr. Bobby also explores where the breakfast slogan came from, including its ties to cereal companies, health reformers, and early public relations campaigns. The episode then compares breakfast, lunch, and dinner through three practical questions:Does this meal help my body and health?Weight, blood sugar, disease risk, protein, and muscle.Does this meal help me perform today?Exercise, energy, focus, cognition, and school performance.Does this meal help me live well?Family rhythm, connection, and the social meaning of meals.The conclusion: there is probably no single “most important meal” for everyone. The best meal is the one that helps you live the day you are actually trying to live.In this episodeWhy “breakfast is the most important meal” may be more marketing than medical factWhat observational studies suggest about breakfast skipping and heart disease riskWhy healthy-user bias makes breakfast research trickyWhat randomized trials show about breakfast, skipping breakfast, weight loss, and metabolismHow chrononutrition raises a better question: are we eating too much too late?Why coffee may help you skip breakfast—but does not replace breakfast nutritionallyWhen eating before morning exercise mattersWhat we know about breakfast, cognition, and school performance in childrenWhy “hangry” may be realHow breakfast, lunch, and dinner each serve different rolesHow to decide whether breakfast matters for youKey takeawaysBreakfast does not magically turn on your metabolism.Randomized trials do not show that simply adding breakfast leads to meaningful weight loss.Skipping breakfast is not automatically harmful.It may work well for some people, especially if it reduces total calories without causing overeating later.The observational data are complicated.Breakfast skippers often look less healthy in long-term studies, but they may also smoke more, sleep less, exercise less, work irregular schedules, or eat more late at night.Chrononutrition gives breakfast its strongest argument.The body may handle calories better earlier in the day than late at night. The issue may be less “everyone must eat breakfast” and more “be careful about pushing most calories to the evening.”Coffee is not breakfast.Coffee may improve alertness and exercise performance, and it may reduce appetite for a while. But it is not protein, fiber, or fuel.Kids are different.For a hungry child, breakfast may matter for learning readiness, behavior, and attention.Exercise changes the answer.For a short, easy workout, coffee and water may be enough. For a long run, long ride, intervals, or race-like effort, food or carbohydrate may help.Dinner may win the connection argument.Shared meals are strongly linked with well-being. Dinner may not be best for blood sugar, but it may be powerful for family, friendship, and decompression.Lunch deserves more respect.Lunch may be the underrated meal that prevents the 3 p.m. slump and the 9 p.m. snack attack.A practical experimentRather than adopting a slogan, try a personal experiment.For two weeks, eat a real breakfast with protein, fiber, and minimal added sugar. Track your hunger, mood, exercise quality, afternoon energy, evening snacking, and sleep.Then, if it is safe for you, try two weeks of delaying or skipping breakfast while keeping your coffee/caffeine routine consistent.Ask yourself:Do I feel better or worse?Do I eat less overall—or make it up later?Are my workouts better or worse?Am I sharper or more irritable?Does skipping breakfast lead to a chaotic dinner?Am I still getting enough protein?The question is not whether breakfast works in theory. The question is whether breakfast works for you.Who should be more cautious about skipping breakfast?Be more careful with breakfast skipping if you are a child or adolescent, pregnant, diabetic, prone to low blood sugar, have a history of eating disorders, do long or intense morning workouts, or struggle to get enough protein—especially as an older adult.Dr. Bobby's bottom lineFor me, breakfast is not the most important meal most days.If I have a long workout ahead, I eat breakfast. Coffee alone is not enough.If I am just writing, reading, or working in the morning, coffee may be enough until I am actually hungry.And if I am eating with family or friends, breakfast matters for a different reason. Sometimes the table matters more than the eggs.Maybe breakfast is not the most important meal of the day.Maybe it is the most marketed.The most important meal is the one that helps you live the day you are actually trying to live.

On today's episode Mike Farley is joined by guest Hunter Gary of H2 Outdoor Living from Middle Tennessee, to discuss how Hunter entered pool design and launched his design firm three years ago and a newer build/GC arm. They focus on why detailed construction and hydraulic plans matter to prevent costly, hard-to-fix underground plumbing problems and to ensure apples-to-apples bidding. The epsiode outline homeowner red flags and checkpoints, including clean, well-laid-out equipment pads, photo documentation, flow meters, and builders who can explain pump curves and turnover rates. They emphasize larger plumbing, variable-speed pumps, cartridge filters, proper circulation, quieter systems, safety/entrapment avoidance, Venturi skimmers, in-floor returns/cleaning, and correct design of perimeter overflows and vanishing-edge basins, including surge capacity and filtration/sanitation.   Discover more and connect: https://h2outdoorliving.com/ https://www.farleypooldesigns.com/ https://www.youtube.com/@MikeFarleyDesigns https://www.instagram.com/farleydesigns/ https://www.instagram.com/luxuryoutdoorlivingpodcast/   Watch episodes on YouTube: https://www.youtube.com/@MikeFarleyDesigns/podcasts   00:00 Podcast intro 01:17 Meet Hunter Gary 02:07 How He Started 03:44 From Service to Design 07:41 Million Dollar Challenge 08:43 Launching His Company 10:20 Design Process Explained 12:41 Why Working Drawings Matter 15:41 Hydraulics Intro 17:54 Equipment Pad Clues 20:14 Photos and Hydraulic Plans 24:40 Circulation and Filtration 29:23 Pipe Sizing and Efficiency 34:15 Noise and Suction Lines 36:58 Pumps for Water Features 39:58 Turnover and Flow Meters 41:11 Flow Meters and Turnover 42:35 Venturi Skimmers Explained 43:49 Main Drains vs Skimmers 44:51 Service Knowledge Pitfalls 48:12 Hydraulics Are Just Math 50:22 Perimeter Overflow Returns 52:51 In Floor Circulation Systems 54:31 Vanishing Edge Basin Design 58:17 Equipment Pad and Expansion 59:40 Elevation and Split Equipment 01:01:29 Entrapment Safety and Drains 01:04:20 Budgeting and Spare Lines 01:08:27 Personal Q and A Wrap Up 01:12:06 Final Thanks and Mission    

Is your pool service business making money this summer, or is the summer running your business? In Episode #313 of the Pool Nation Podcast, Edgar and John "JJ Flawless" break down the 5 mid-season checks every pool professional should be making right now to protect their customers, employees, equipment, routes, and most importantly, their profits. August is one of the toughest months in the swimming pool industry. Water temperatures are climbing, chlorine demand is increasing, equipment is working harder, technicians are battling extreme heat, customers are using their pools more, and chemical, fuel, labor, and operating costs can quietly destroy your margins. This episode is a mid-season business checkup for pool service companies. Edgar and John break down five critical areas: • Water & Chemistry → Why the chemistry strategy that worked in May may not work in August, how higher water temperatures accelerate demand, and why pool pros have to stay ahead of problems instead of reacting to them. • Pool Equipment & Filtration → Pumps, filters, salt systems, automation, plumbing, seals, circulation, and other equipment are under maximum stress during the summer. Learn what you should be watching before a small issue becomes an emergency call. • Route Efficiency → Driving all over town costs more than time. Poor route density, unnecessary drive time, fuel costs, and inefficient scheduling can quietly destroy the profitability of your pool route. • Your Team → Your technicians are dealing with the same summer heat and pressure you are. Edgar and John discuss workload, heat, burnout, employee retention, leadership, and why taking care of your team becomes even more important during peak season. • The Profit Check → The check almost nobody wants to do. Are your pools actually profitable? Increased chemical usage, overtime, fuel, callbacks, filter neglect, equipment issues, and extra service time can turn what looks like a profitable account into a pool that is quietly costing you money every week. They also dive deep into one of the most overlooked parts of summer pool maintenance: filtration. Putting off filter cleanings doesn't just create water problems. It can lead to increased chemical consumption, algae, callbacks, unhappy customers, longer service stops, lost filter-cleaning revenue, employee frustration, and ultimately lost customers. John shares a real-world example of how his company has prioritized filter cleanings during peak season and how properly maintaining filtration can create additional revenue while making the route easier to manage. The bigger lesson? Summer exposes the weaknesses in your pool service business. Your systems. Your pricing. Your routes. Your equipment. Your leadership. Your customer service. And your profitability. If you own or operate a pool service company, pool cleaning business, pool repair company, pool maintenance route, or swimming pool business, this episode will help you identify the problems that could be costing you money before the season is over. Edgar and John also share a personal Pool Nation update as Zac "The Pool Boy" Nicholas steps away from Pool Nation to focus on the continued growth of The Pool Boys, his family, employees, and business. The guys reflect on Zac's contribution to Pool Nation and why sometimes business growth requires making difficult decisions and focusing on the opportunity directly in front of you. Plus, Pool Nation gives an update on upcoming industry training and a major announcement coming August 14 at 4:00 PM Central Time. TIMESTAMPS 00:00 → Welcome to the Pool Nation Podcast 01:00 → The 5 Mid-Season Checks Every Pool Pro Should Make 02:00 → Surviving Extreme Summer Heat 05:00 → Pool Nation's August 14 Major Announcement 06:00 → Pool Nation Women's Summit & Upcoming Events 07:00 → Upcoming Hands-On Pool Industry Training 11:00 → A Personal Update About Zac "The Pool Boy" Nicholas 16:00 → The Pool Nation Mission Moving Forward 17:00 → Is Your Business Running You This Summer? 20:00 → Protecting Pool Technicians During Extreme Heat 22:00 → Growth, Experience & Surviving Peak Pool Season 23:00 → Why Summer Is the Best Time to Grow Your Pool Route 27:00 → The 5-Part Mid-Season Pool Business Checkup 30:00 → The Profit Check Every Pool Company Needs to Make 33:00 → What August Heat Does to Pool Water Chemistry 36:00 → Why Summer Pool Chemistry Is Harder 38:00 → Sponsor Break 43:00 → Summer Pool Equipment Problems 46:00 → Circulation, Pumps & Equipment Stress 47:00 → Why Filter Cleaning Matters More in Summer 49:00 → The Expensive Mistake Pool Pros Make With Filters 52:00 → How Filter Neglect Costs Your Pool Business Money 54:00 → The Hidden Revenue Opportunity in Filter Cleaning 57:00 → Sponsor Break 1:02:00 → Mid-Season Checkup Recap & What's Coming Next 1:03:00 → The August 14 Pool Nation Announcement 1:04:00 → Final Thoughts 1:06:00 → Closing THANK YOU TO OUR VISIONARY PARTNERS The Pool Nation Podcast would not be possible without the companies that continue to support Pool Nation, professional education, and the swimming pool industry. Thank you to: SPPA BluRay XL AquaStar Pool Products Natural Chemistry Raypak Heritage Pool Supply Hayward Pool Products OnCore Filtration Poolside Tech Pool Brain Nidec / U.S. Motors Encore Brands Your continued support helps Pool Nation provide education, training, resources, events, and conversations designed to help pool professionals Master the Business and Perfect the Craft. ABOUT THE POOL NATION PODCAST The Pool Nation Podcast is built for swimming pool professionals who want to build better businesses, become stronger leaders, improve their technical knowledge, and become more profitable. From pool service and repair, water chemistry, filtration, pumps, heaters, automation, and equipment to pricing, leadership, employees, route efficiency, customer retention, business growth, and profitability, Pool Nation is committed to helping pool pros build businesses and lives they are proud of. It's all pool talk, and we ain't talking about netting and jetting or splashing and dashing. We're talking about becoming a Nation of Pool Pros. Master the Business. Perfect the Craft.

This week, please join Brad and Mercedes as they welcome Deputy Editor Ryan J. Tedford and they discuss the advance of SGLT-2, non-steroidal MRA, and GLP-1 therapies that provide clinicians options to treat patients and HFpEF comorbidities. Then, Associate Editor Mark Chandy joins the podcast to discuss highlights from the recent BCVS Scientific Sessions in Boston, as well as how he prioritizes different types of basic and scientific manuscripts at Circulation. For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260810.584625

[REDIFF] Tu veux que je te raconte l'histoire du rond-point sans route? Alors attrape ta brosse à dents, ton dentifrice, et c'est parti!

Ryan Pineda and Brian Davila sit down with longevity expert John Jubilee to explore his 88-day cellular hydration protocol, the science and claims behind brain and body optimization, and the daily habits he believes can dramatically improve long-term health and performance.⁣⁣Connect with John - ⁣https://www.energizedhealth.com/⁣https://www.instagram.com/johnjubilee/⁣https://www.instagram.com/energized.health/⁣__________⁣If you'd like my team to run your marketing & sales department to scale your business apply here https://www.pinedapartners.com⁣⁣Join our private mastermind for elite business leaders who golf. https://www.mastermind19.com⁣⁣Want to be featured on the Wealthy Way Podcast? Apply here https://www.wealthyway.com⁣⁣If you want to start your real estate investing business, we'll give you 1:1 coaching, seller leads, software, & everything you need. https://www.wealthyinvestor.com⁣⁣Tired of paying so much in taxes every year? We'll give you strategy, tax prep, and accounting all in one place. https://www.taylor-tax.com⁣⁣Join free Bible studies and workshops for Christian business leaders. https://www.tentmakers.us⁣__________⁣Chapters:⁣00:00 - Perfect Health & Hydration⁣01:44 - Bench Press Record & Biblical Principles⁣08:50 - Testimonials & Health Turnarounds⁣15:01 - Brain Fog & Failed Diets⁣16:59 - Cellular Hydration Discovery⁣19:06 - 12-Step Hydration Protocol⁣30:04 - Follow the Money⁣30:32 - TRT, GLP-1s & Hydration⁣36:24 - Inflammation & Forgiveness⁣45:08 - Forgiveness & Healing⁣47:36 - Spiritual Strongholds & Freedom⁣50:40 - Knowledge & Cellular Healing⁣1:00:09 - Diet & Moderation⁣1:00:48 - Supplements & MSM⁣1:04:45 - Movement & Circulation⁣1:15:12 - Marriage, Family & COVID⁣1:16:29 - Online Coaching & Growth⁣1:18:41 - Longevity & Elite Performance

Pastor Brandon returns to start a brand new series called "Kardia", which is the greek word for heart. As this series is all about the very core of our beings. Our heart represents the innermost character, thoughts, and emotions of who we are. And our foundational concept to root our mindset during this series is that our heart is essential to life because it is the soil in which every decision in life grows. Which is an echo of Proverbs 4:23, "Above all else, guard your heart, for everything you do flows from it." One of the things we can pay attention to in the transformation of our hearts is that our mouths are an indicator and an activator for growth. And to cultivate a healthy heart, we need to speak our heart. You also need to remind yourself of God's faithfulness. And ultimately, you have to remember that your heart hears what your heart says. - Key Verses // Proverbs 4:23, Luke 6:45 - For Sermon Notes, the Connect Card, and our other online resources: https://linktr.ee/Celebrationchurchlive

Each week, join Editor-in-Chief Brad Maron, along with cohosts Mercedes Carnethon and Jane Wilcox for the new iteration of Circulation on the Run. This week, please join Brad and Jane as they welcome author Zahra Raisi-Estabragh as the three discuss her review article regarding 10 Years of Scientific Discovery with the UK Biobank CMR Imaging Study. Then, Brad and Jane chat with Specialty Associate Editor Betty Raman as she discusses her Clinician Lighthouse, a new article type at Circulation, and what prospective authors should consider when submitting their own Clinician Lighthouse manuscript to Circulation. For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260803.13306

In this episode of Resiliency Radio with Dr. Jill, Dr. Jill Carnahan welcomes Eric Fernandez, Senior Director of Hyperice's Rehab Division, for an exciting conversation about the science behind recovery, circulation, and nervous system regulation. From elite athletes to individuals living with chronic illness, they explore how technologies like Normatec compression therapy are transforming recovery, improving circulation, reducing inflammation, and supporting long-term health. Together they discuss the growing role of compression therapy in performance, lymphatic health, dysautonomia, longevity, and everyday wellness. Whether you're looking to recover faster, optimize performance, improve circulation, or simply age more gracefully, this episode offers practical, science-backed strategies to help your body recover and thrive.

Charles Berde, MD, PhD, is the Sara Page Mayo Chair in Pediatric Pain Medicine and a Professor of Anaesthesia at Harvard Medical School. As a co-founder of the Pain Treatment Center at Boston Children's Hospital, he has spent decades at the forefront of pediatric analgesic pharmacology and the development of novel local anesthetics. His extensive translational research focuses on local anesthetic mechanisms and prolonged-duration formulations, making him a preeminent authority on the physiological impacts and safety profiles of these agents in neonates and children. A recipient of the Myron Yaster Lifetime Achievement Award from the Society for Pediatric Anesthesia, Dr. Berde brings unparalleled expertise to the discussion of managing and preventing local anesthetic systemic toxicity (LAST) within the high-stakes environments of the PICU and pediatric operating rooms.Guest Conflicts of Interest (COI)Algavita Bio: Collaborator/Developer of novel, prolonged-duration local anesthetics.Quiver Bioscience: Unpaid Scientific Advisor and co-PI on an NINDS-HEAL grant focused on rare disease pain treatments.Latigo Biotherapeutics: Scientific Advisor and recipient of past research support for novel analgesics development.Algos: Scientific Advisor for non-opioid analgesics development.Learning Objective: By the end of this podcast, listeners should be able to discuss an evidence-based and expert-guided approach to the management of local anesthetic systemic toxicity (LAST) in children.References:Patient and Doctor Reconcile for Greater GoodBerde CB. Toxicity of local anesthetics in infants and children. J Pediatr. 1993 May;122(5 Pt 2):S14-20. doi: 10.1016/s0022-3476(11)80004-1.McMahon K, Paster J, Baker KA. Local anesthetic systemic toxicity in the pediatric patient. Am J Emerg Med. 2022 Apr;54:325.e3-325.e6. doi: 10.1016/j.ajem.2021.10.021. Epub 2021 Oct 25. Lavonas et al. 2023 American Heart Association Focused Update on the Management of Patients With Cardiac Arrest or Life-Threatening Toxicity Due to Poisoning: An Update to the AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2023 Oct 17;148(16):e149-e184. doi: 10.1161/CIR.0000000000001161. Epub 2023 Sep 18. Questions, comments or feedback? Please send us a message at this link (leave email address if you would like us to relpy) Thanks! -Alice & ZacSupport the showHow to support PedsCrit:Please complete our Listener Feedback SurveyPlease rate and review on Spotify and Apple Podcasts!Donations are appreciated @PedsCrit on Venmo , you can also support us by becoming a patron on Patreon. 100% of funds go to supporting the show.Please remember that all content during this episode is intended for educational and entertainment purposes only. It should not be used as medical advice. The views expressed during this episode by hosts and our guests are their own and do not reflect the official position of their institutions. If you have any comments, suggestions, or feedback-you can email us at pedscritpodcast@gmail.com.  You can also check out our website at http://www.pedscrit.com. Thank you for listening to this episode of PedsCrit!

Each week, join Editor-in-Chief Brad Maron, along with cohosts Mercedes Carnethon and Jane Wilcox for the new iteration of Circulation on the Run. This week, join Mercedes and Brad as Fatima Rodriguez joins the podcast for a discussion on the recently released CKM Guidelines. Then, Mercedes welcomes Deputy Editor Tiffany Powell-Wiley as they discuss the Clinician's Corner article type and what prospective authors should consider when submitting a manuscript for this article type. For the episode transcript, visit:  https://www.ahajournals.org/do/10.1161/podcast.20260727.885623

If you reach for a caffeine-filled drink first thing every morning, you've probably heard conflicting advice over the years. Caffeine is good for you, caffeine is bad for you. So which is it? A new scientific review published in the journal Circulation suggests we've been asking the wrong question. Instead of asking whether caffeine is healthy, we should be asking what the caffeine comes packaged with. Your morning coffee and an energy drink might contain similar amounts of caffeine, but they are not the same when it comes to your heart. Studying caffeine sounds simple, give people caffeine and see what happens. The problem is that researchers usually aren't studying caffeine in isolation, they're studying coffee. And coffee isn't simply a caffeine delivery system, it's a remarkably complex drink containing hundreds of biologically active compounds, including antioxidants and anti-inflammatory molecules that appear to have health effects of their own. Rather than conducting one new experiment, researchers reviewed decades of evidence, bringing together large population studies involving hundreds of thousands of people, randomised controlled trials, genetic research and laboratory experiments to build the clearest picture yet of caffeine and heart health. The findings were reassuring for coffee drinkers. For most healthy adults, consuming up to 400 milligrams of caffeine a day (3-4 cups of regular coffee) appears to be safe. Surprisingly people who drank moderate amounts of coffee (even decaf) consistently showed lower risks of heart disease, stroke, heart failure and Type 2 diabetes. Scientists think those benefits may have less to do with caffeine itself and more to do with the antioxidants in coffee which appear to improve blood vessel function, increase insulin sensitivity and even influence the bacteria living inside our gut. Coffee isn't just delivering caffeine; it's delivering an entire chemical cocktail that may help offset some of caffeine's effects. Energy drinks contain similar amounts of caffeine to coffee, but they also contain ingredients such as taurine that may increase how quickly caffeine is absorbed. Unlike coffee, these highly concentrated caffeine drinks were associated with: increased blood pressure abnormal heart rhythms cardiovascular problems, even in otherwise healthy young adults. The caffeine molecule may be identical, but the delivery system isn't. Ever wondered why one person can drink an espresso after dinner and sleep perfectly, while someone else lies awake after a lunchtime coffee? Researchers estimate that 30–50 percent of the differences in how people tolerate caffeine are inherited. Much of that comes down to variations in a liver enzyme called CYP1A2, which controls how quickly caffeine is broken down. Fast metabolisers clear caffeine quickly, slow metabolisers can experience stronger and longer-lasting effects, even after drinking exactly the same cup of coffee. That's why there is no universal "safe" amount that works for everyone. Finally, how you brew your coffee matters. Unfiltered coffee, including French press, Turkish coffee and some espresso preparations contains higher amounts of a compound called cafestol, which can raise LDL ("bad") cholesterol. Paper filters remove most of it meaning your brewing method may influence your heart health just as much as the amount of coffee you drink. This study doesn't suggest everyone should start drinking coffee, but instead, highlights that foods are more than the sum of their ingredients. Coffee delivers caffeine alongside hundreds of naturally occurring compounds that may work together to produce health benefits. Energy drinks often deliver concentrated caffeine alongside ingredients that appear to amplify cardiovascular stress. The stimulant may be the same, but the biology isn't. LISTEN ABOVESee omnystudio.com/listener for privacy information.

CardioNerds (Drs. Apoorva Gangavelli, Jenna Skowronski, and Hannah Every) discuss the continuum of prevention and heart failure with Drs. Anu Lala and Martha Gulati. Grounded in a clinical case of a 55-year-old woman with uncontrolled hypertension, type 2 diabetes, and obesity who is on the trajectory toward heart failure, this episode unpacks a paradigm-shifting framework from a joint HFSA/ASPC Scientific Statement. The discussion explores how prevention should not be siloed from heart failure management but rather integrated across a patient’s lifespan—from primary prevention in at-risk individuals, to secondary prevention in those with established heart failure, to tertiary prevention in patients with advanced therapies such as LVADs and heart transplantation. The experts highlight the importance of aggressive risk factor management, biomarker-guided screening, the AHA’s Life’s Essential 8, and the need for multidisciplinary collaboration and systems-level change to shift heart failure care from reactive to proactive. Audio editing for this episode was performed by CardioNerds Intern, Dr. Julia Marques Fernandes. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Prevention PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Systemic inflammatory diseases are associated with an elevated CVD risk that has significant implications for early detection, risk Heart failure prevention is a continuum, not a checkpoint. Prevention applies at every stage—from at-risk (Stage A) through advanced/post-transplant care—and every clinical encounter is an opportunity to intervene. The AHA’s Life’s Essential 8 (diet, physical activity, nicotine exposure, sleep, BMI, blood lipids, blood glucose, blood pressure) forms the foundation at every stage. Hypertension carries the highest population-attributable risk for heart failure of any modifiable risk factor. In the Framingham Heart Study, 91% of patients with newly diagnosed HF had pre-existing hypertension. The SPRINT trial demonstrated a 38% reduction in HF incidence with intensive blood pressure targets (30 ng/L or NT-proBNP >125 ng/L) identify individuals at heightened risk for progression to symptomatic HF. The ACC/AHA/HFSA guidelines give a Class IIa recommendation for natriuretic peptide screening in at-risk patients. Urine albumin-to-creatinine ratio (UACR) is an underutilized screening tool that provides additional insight into CKM risk. The heart failure label does not close the prevention window—it accentuates it. Secondary prevention through GDMT optimization (quadruple therapy in HFrEF) and continued risk factor management remains critical. Tertiary prevention extends to post-LVAD and post-transplant patients, where hypertension, diabetes, obesity, and CKD management remain essential to long-term outcomes. Show notes For a comprehensive review, please review the full HFSA/ASPC Joint Scientific Statement: Lala A, Beavers C, Blumer V, et al. The Continuum of Prevention and Heart Failure in Cardiovascular Medicine. J Card Fail. 2026;32:75-105. doi:10.1016/j.cardfail.2025.06.013 1. What is the “continuum of prevention” framework, and how does it differ from traditional approaches to heart failure prevention? Historically, prevention and heart failure management have been treated as separate disciplines—primary prevention handled by preventive cardiologists and treatment managed by heart failure specialists. This joint HFSA/ASPC Scientific Statement reframes prevention as a dynamic, continuous process that spans a patient’s entire lifespan, regardless of HF stage or ejection fraction. The framework maps onto the ACC/AHA HF staging system: Primary prevention targets Stage A (“at risk”) and Stage B (“pre-HF”) patients to reduce the burden of incident HF. Secondary prevention targets Stage C (symptomatic) and Stage D (advanced) patients to reduce the impact of established HF through GDMT optimization and ongoing risk factor management. Tertiary prevention encompasses risk factor management in patients with LVADs or heart transplants—populations where hypertension, diabetes, and obesity still drive outcomes. The Central Figure of the statement illustrates that Life’s Essential 8 (blood pressure and lipid control, diabetes management, exercise, sleep, smoking cessation, weight management, and diet/nutrition counseling) forms the foundation at every stage, with pharmacologic and device-based therapies layered on top as disease progresses (Figure) 2. How do traditional risk factors drive heart failure, and what should clinicians prioritize? Hypertension carries the greatest population-attributable risk for HF. In the Framingham Heart Study (N=5,143), HTN was associated with a 2- to 3-fold increased risk of HF, with a population-attributable risk of 39% in men and 59% in women. The SPRINT trial showed a 38% reduction in HF incidence and 25% reduction in the primary composite outcome with intensive BP targets (30 ng/L or NT-proBNP >125 ng/L) are associated with heightened risk for progression to symptomatic HF. In the ARIC study, incorporating NT-proBNP reclassified 20% of older adults without HF into Stage B. Factors that affect interpretation include age, sex, obesity (lower values), and CKD (higher values). High-sensitivity cardiac troponin (hs-cTn): Concentrations above the 99th percentile are now included in the definition of Stage B HF. Troponin testing may complement natriuretic peptides, particularly when BNP/NT-proBNP values are ambiguous. Risk scores: The PCP-HF equation predicts 10-year HF risk using traditional risk factors plus QRS duration. The AHA PREVENT score incorporates HF risk calculation and includes markers of kidney function (albuminuria, eGFR), though it may underestimate risk in men and Black adults. The CKM syndrome staging framework (Stages 0–4) provides a holistic approach to assessing systemic cardiovascular-kidney-metabolic risk. 4. What are the key nontraditional risk factors and cross-cutting themes in heart failure prevention? Genetics: Pathogenic cardiomyopathy variants exist in ~1 in 200 individuals in the general population. The HFSA and ACMG recommend cascade testing to identify at-risk family members. Polygenic risk scores for dilated cardiomyopathy show a 3.8-fold risk for DCM in the top 10th percentile compared with the median. Sex-specific considerations: Women have 2.8 times the odds of developing HFpEF, while men have similarly increased odds of HFrEF. A complete obstetric/gynecologic history is essential—preeclampsia is associated with a 4-fold increased risk of HF. Peripartum cardiomyopathy requires intentional screening in high-risk populations. Cardiotoxic exposures: Clinicians should be aware of medications that cause direct myocardial toxicity (e.g., anthracyclines, trastuzumab, tyrosine kinase inhibitors). A team-based approach with pharmacists can help optimize medication selection and risk factor modification. Social determinants of health: Environmental exposures (air pollution, arsenic, lead, cadmium), food insecurity, financial instability, and limited healthcare access contribute to HF risk and progression. Equity-focused, risk-based prevention strategies are needed. Psychological health: Depression is common in HF and independently associated with worse outcomes. Screening with brief questionnaires (e.g., PHQ-2) is recommended. Meditation, spirituality, and holistic wellness approaches remain underutilized. 5. What systems-level and policy changes are needed to move the needle on heart failure prevention? Multidisciplinary HF prevention clinics that bring together preventive cardiologists, HF specialists, endocrinologists, nephrologists, dietitians, pharmacists, exercise physiologists, and genetic counselors are advocated by the statement. EHR-embedded risk stratification could proactively flag patients on a trajectory toward HF—analogous to sepsis alerts or fall risk flags—enabling earlier intervention, particularly for patients who may not reach a cardiologist. Cardiac rehabilitation remains underutilized, particularly in HFrEF (Class 2b recommendation) and HFpEF (not yet covered by Medicare). The HF-ACTION trial showed quality-of-life benefits, and the REHAB-HF trial showed particular benefit in older patients with HFpEF. Policy priorities include expanding insurance coverage for preventive screening and novel therapies (SGLT2i, GLP-1 RAs, nsMRAs), reducing clinical inertia through team-based care models with closer follow-up intervals, and ensuring equitable access to evidence-based therapies across diverse populations. Digital health and AI hold promise for personalized risk prediction, remote monitoring (e.g., wearable devices, implantable PA pressure monitors), and virtual cardiac rehabilitation to overcome access barriers. Figure  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. J Card Fail. 2026;32(1):75-105. doi:10.1016/j.cardfail.2025.06.013) References Key references are bolded. 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. J Card Fail. 2026;32(1):75-105. doi:10.1016/j.cardfail.2025.06.013 Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(18):e895-e1032. doi:10.1161/CIR.0000000000001063 Lloyd-Jones DM, Allen NB, Anderson CAM, et al. Life’s Essential 8: updating and enhancing the American Heart Association’s construct of cardiovascular health: a presidential advisory from the American Heart Association. Circulation. 2022;146(5):e18-e43. doi:10.1161/CIR.0000000000001078 SPRINT Research Group, Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med. 2015;373(22):2103-2116. doi:10.1056/NEJMoa1511939 Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure. JAMA. 1996;275(20):1557-1562. doi:10.1001/jama.1996.03530440037034 Major outcomes in high-risk hypertensive patients randomized to angiotensin-converting enzyme inhibitor or calcium channel blocker vs diuretic: the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT). JAMA. 2002;288(23):2981-2997. doi:10.1001/jama.288.23.2981 Yusuf S, Sleight P, Pogue J, et al. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. N Engl J Med. 2000;342(3):145-153. doi:10.1056/NEJM200001203420301 Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med. 2015;373(22):2117-2128. doi:10.1056/NEJMoa1504720 Anker SD, Butler J, Filippatos G, et al. Empagliflozin in heart failure with a preserved ejection fraction. N Engl J Med. 2021;385(16):1451-1461. doi:10.1056/NEJMoa2107038 Solomon SD, McMurray JJV, Claggett B, et al. Dapagliflozin in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2022;387(12):1089-1098. doi:10.1056/NEJMoa2206286 Filippatos G, Anker SD, Agarwal R, et al. Finerenone reduces risk of incident heart failure in patients with chronic kidney disease and type 2 diabetes: analyses from the FIGARO-DKD trial. Circulation. 2022;145(6):437-447. doi:10.1161/CIRCULATIONAHA.121.057983 Solomon SD, McMurray JJV, Vaduganathan M, et al. Finerenone in heart failure with mildly reduced or preserved ejection fraction. N Engl J Med. 2024;391(16):1475-1485. doi:10.1056/NEJMoa2407107 Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med. 2023;389(24):2221-2232. doi:10.1056/NEJMoa2307563 Deanfield J, Verma S, Scirica BM, et al. Semaglutide and cardiovascular outcomes in patients with obesity and prevalent heart failure: a prespecified analysis of the SELECT trial. Lancet. 2024;404(10454):773-786. doi:10.1016/S0140-6736(24)01498-3  Kosiborod MN, Abildstrøm SZ, Borlaug BA, et al. Semaglutide in patients with heart failure with preserved ejection fraction and obesity. N Engl J Med. 2023;389(12):1069-1084. doi:10.1056/NEJMoa2306963 Ndumele CE, Neeland IJ, Tuttle KR, et al. A synopsis of the evidence for the science and clinical management of cardiovascular-kidney-metabolic (CKM) syndrome: a scientific statement from the American Heart Association. Circulation. 2023;148(20):1636-1664. doi:10.1161/CIR.0000000000001175 Khan SS, Matsushita K, Sang Y, et al. Development and validation of the American Heart Association’s PREVENT equations. Circulation. 2024;149(6):430-449. doi:10.1161/CIRCULATIONAHA.123.067626 Khan SS, Ning H, Shah SJ, et al. 10-year risk equations for incident heart failure in the general population. J Am Coll Cardiol. 2019;73(19):2388-2397. doi:10.1016/j.jacc.2019.02.057 Bozkurt B, Fonarow GC, Goldberg LR, et al. Cardiac rehabilitation for patients with heart failure: JACC expert panel. J Am Coll Cardiol. 2021;77(11):1454-1469. doi:10.1016/j.jacc.2021.01.030 Packer M. Leptin-aldosterone-neprilysin axis: identification of its distinctive role in the pathogenesis of the three phenotypes of heart failure in people with obesity. Circulation. 2018;137(15):1614-1631. doi:10.1161/CIRCULATIONAHA.117.032474 Lala A, Tayal U, Hamo CE, et al. Sex differences in heart failure. J Card Fail. 2022;28(3):477-498. doi:10.1016/j.cardfail.2021.10.006 Bozkurt B, Coats AJS, Tsutsui H, et al. Universal definition and classification of heart failure. Eur J Heart Fail. 2021;23(3):352-380. doi:10.1002/ejhf.2115 Hershberger RE, Givertz MM, Ho CY, et al. Genetic evaluation of cardiomyopathy—a Heart Failure Society of America practice guideline. J Card Fail. 2018;24(5):281-302. doi:10.1016/j.cardfail.2018.03.004 Levine GN, Cohen BE, Commodore-Mensah Y, et al. Psychological health, well-being, and the mind-heart-body connection: a scientific statement from the American Heart Association. Circulation. 2021;143(10):e763-e783. doi:10.1161/CIR.0000000000000947 Ezekowitz JA, Colin-Ramirez E, Ross H, et al. Reduction of dietary sodium to less than 100 mmol in heart failure (SODIUM-HF): an international, open-label, randomised, controlled trial. Lancet. 2022;399(10333):1391-1400. doi:10.1016/S0140-6736(22)00369-5

Each week, join Editor-in-Chief Brad Maron, along with cohosts Mercedes Carnethon and Jane Wilcox for the new iteration of Circulation on the Run. This week, join Brad on location at BCVS Scientific Sessions in Boston as he sits down with the new BCVS Council Chair, Sean Wu. Brad and Sean discuss the priorities for BCVS, the standards for high-quality and actionable science in the era of multi-omics, how cardiovascular science can adapt to growing emphasis on acquired determinants of disease, and finally, find ways to improve the clinical translational relevance of basic science. For the episode transcript, visit:  https://www.ahajournals.org/do/10.1161/podcast.20260717.271223

For 22 years, I predicted death for life insurance companies. One pattern showed up in file after file: most "genetic" conditions have no gene behind them. Ask your doctor which gene causes your blood pressure, your autoimmune condition, or your ADHD, and most can't answer, because it doesn't exist. What actually runs in your family is a nutrient deficiency, not a disease, and once your body gets what it's missing, the disease often clears on its own. This isn't medical advice, so bring this to your own doctor before you assume anything is permanent. CLICK HERE TO BECOME GARYS VIP!: https://bit.ly/4ai0Xwg Thank you to our partners A-GAME: “ULTIMATE15” FOR 15% OFF: http://bit.ly/4kek1ij AION: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4h6KHAD AIRES: "ULTIMATE20 " FOR 20% OFF: https://bit.ly/4a3Duze BAJA GOLD: "ULTIMATE10" FOR 10% OFF: https://bit.ly/3WSBqUa BODYHEALTH: “ULTIMATE20” FOR 20% OFF: http://bit.ly/4e5IjsV COLD LIFE: THE ULTIMATE HUMAN PLUNGE: https://bit.ly/4eULUKp CYMBIOTIKA: "ULTIMATE20" FOR 20% OFF: https://bit.ly/4tjyluP  GENETIC METHYLATION TEST (UK ONLY): https://bit.ly/48QJJrk GENETIC TEST (USA ONLY): ⁠https://bit.ly/3Yg1Uk9 GOPUFF: GET YOUR FAVORITE SNACK!: https://bit.ly/4obIFDC H2TABS: “ULTIMATE10” FOR 10% OFF: https://bit.ly/4hMNdgg HEALF: 10% OFF YOUR ORDER: https://bit.ly/41HJg6S PEPTUAL: “TUH10” FOR 10% OFF: https://bit.ly/4mKxgcn SNOOZE: LET'S GET TO SLEEP!: https://bit.ly/4pt1T6V WHOOP: JOIN & GET 1 FREE MONTH!: https://bit.ly/3VQ0nzW Watch  the “Ultimate Human Podcast” every Tuesday & Thursday at 9AM EST: YouTube: https://bit.ly/3RPQYX8 Podcasts: https://bit.ly/3RQftU0 Connect with Gary Brecka Instagram: https://bit.ly/3RPpnFs TikTok: https://bit.ly/4coJ8foX: https://bit.ly/3Opc8tf Facebook: https://bit.ly/464VA1H LinkedIn: https://bit.ly/4hH7Ri2 Website: https://bit.ly/4eLDbdU Merch: https://bit.ly/4aBpOM1 Newsletter: https://bit.ly/47ejrws Ask Gary: https://bit.ly/3PEAJuG Timestamps 00:00 - Intro of Show 01:57 - 22 Years Predicting Mortality 03:00 - Medical Error and Misdiagnosis 07:40 - Idiopathic Hypertension Explained 09:59 - Autoimmune of Unknown Origin 11:00 - Presence of Oxygen, Two Promises 14:07 - The Methylation Pathways Map 16:00 - Attention Overload, Not Deficit 19:00 - MTHFR Gene and Folic Acid 22:00 - What Anxiety Actually Is 26:50 - COMT Gene and B12 Forms 29:00 - Serotonin and the SSRI Problem 33:00 - Dana White's Blood Pressure Story 37:00 - Circulation, Homocysteine, and TMG 43:00 - Blood Sugar and Insulin Resistance 57:15 - The Truth About LDL Cholesterol 59:00 - The Only Diet Rule That Matters 01:01:31 - Community and Faith as Medicine 01:04:00 - Molecular Hydrogen Explained 01:08:00 - Morning Routine: Sun and Breath 01:13:37 - Q&A: Thyroid and Selenium 01:18:51 - Q&A: Autoimmune and Heavy Metals 01:22:00 - Q&A: Neuropathy and Circulation  Disclaimer: This podcast is for informational purposes only and does not provide medical advice. It is not intended for diagnosing or treating any health condition. Always consult a licensed healthcare professional before making health or wellness decisions.  Gary Brecka is the owner of Ultimate Human, LLC which operates The Ultimate Human podcast and promotes certain third-party products used by Gary Brecka in his personal health and wellness protocols and daily life and for which Ultimate Human LLC and / or Gary Brecka directly or indirectly holds an economic interest or receives compensation.  Accordingly, statements made by Gary Brecka and others (including on The Ultimate Human podcast) may be considered promotional in nature. Learn more about your ad choices. Visit megaphone.fm/adchoices

James is Associate Professor of Religious Studies at Northwestern University. He is the author of five books, most recently "Materializing the Bible: Scripture, Sensation, Place." His current research focuses on the secondhand circulation of Christian material culture.I spoke with James about his path into studying material religion and why materiality is essential for understanding religious practice. We discussed the Bible as a powerful object, how creativity functions in the context of literal interpretations of Scripture, and the ways religious artifacts circulate, gaining new meanings and values. James shared insights on the remixing of objects, the journey of the Gauchi brothers' Holy Land model, and the ethics of collecting and selling Christian items. We also talked about how we can be surprised by  material culture, the role of intentionality, and how secondhand spaces reveal both the endurance and transformation of Christianity in everyday life, especially in relation to popular culture.

On this week's episode of Circulation on the Run, join Editor-in-Chief Bradley Maron and Deputy Editor Mercedes Carnethon as they welcome Circulation's Executive Editor, Karen E. Joynt Maddox.  Karen discussed health services and health care policy, and what prospective authors should consider when submitting manuscripts to Circulation. Then, Brad and Mercedes welcome authors Marc Humbert and Jason Weatherald as they discuss their review article regarding pulmonary arterial hypertension in the July 14th issue of Circulation. For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260713.392409

You have a wedding, a vacation, a babymoon, a reunion, or a big shoot in about two months, and you want to walk in glowing. In this episode I give you my full 8 week glow up protocol, the same one I build for my one on one clients, and it is all from the inside out. I break down what glow actually is on a physiological level: collagen, glycation, inflammation and puffiness, gut health, circulation and lymph, and body composition. Then I walk you through the labs to run, my three pillars of nutrition, lifestyle, and supplements, and the peptides I reach for when a client wants skin, hair, tan, and fat loss support. I close with budget tiers so you can start whether you have $100 or $5,000 a month. If you want me to build this protocol with you, work with me one on one for peptides, hormones, longevity, and a full lab review.   I TALK ABOUT: 00:00 Welcome and the 8 week glow up premise 04:16 What glow really is: collagen as your scaffolding 09:52 Glycation, AGEs, and how sugar ages your skin 11:11 Inflammation, puffiness, and what actually drives bloat 18:56 The gut skin axis 20:34 Circulation, lymph, and de-puffing 24:09 Muscle tone, body composition, and hormones 28:46 The labs to run first 35:45 Pillar 1: Nutrition (protein, collagen, electrolytes) 50:03 Pillar 2: Lifestyle and biohacks 58:39 Pillar 3: Supplements 1:02:25 Peptides for skin, hair, tan, and fat loss 1:17:32 Budget tiers from $100 to $5,000 and how to start   WORK WITH ME: 1:1 longevity and peptide consults for women My Peptide Source Guide Her Stack Planner Join The LongHer Life   WHAT I MENTIONED IN THIS EPISODE: Labs: Function Health, SiPhox Health (code BRITTANY20), and NiaHealth for Canada. Skincare, SPF, and gua sha: OneSkin, code BIOHACKINGBRITTANY. Protein: Vega Sport. Electrolytes and pre workout: Baja Gold Salt Company, Tidal, code BIOHACKINGBRITTANY. Movement: Booty by Bret. Sleep tracking: Oura Ring. Everything I use, with my codes, is in my shop.   LET'S CONNECT: Instagram: @biohackingbrittany TikTok: @biohacking Facebook: Biohacking Brittany Website: biohackingbrittany.com   This episode is for educational purposes only and is not medical advice.

CardioNerds co-chairs Dr. Dinu Balanescu and Dr. Billy Joe Mullinax, along with FIT lead Dr. Shiavax Rao, discuss the evolving landscape of randomized controlled trials in pulmonary embolism with Dr. Jay Giri, interventional cardiologist, Associate Professor of Medicine, and Director of the Cardiovascular Catheterization Laboratories at the Hospital of the University of Pennsylvania. This episode examines the historical evidence behind systemic thrombolysis, the emergence of catheter-directed therapies and mechanical thrombectomy, and the landmark RCTs – STORM-PE, PEERLESS, HI-PEITHO, and PEERLESS II – that are reshaping intermediate-risk PE management. The discussion highlights challenges in PE trial design, the critical importance of clinical deterioration as an endpoint, and why this era represents an unprecedented wave of evidence generation in PE. Audio editing for this episode was performed by CardioNerds Intern, Dr. Julia Marques Fernandes. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   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: Systemic thrombolysis in intermediate-risk PE reduces hemodynamic decompensation but at the cost of ~1.5–2% intracranial hemorrhage risk – a near-zero net benefit that has driven the search for safer catheter-based alternatives. “Focus on clinical deterioration, not mortality” – Due to crossover design in contemporary PE RCTs, control-arm patients who decompensate are rescued with advanced therapies, biasing mortality toward the null. Clinical deterioration is the most informative endpoint to watch in HI-PEITHO, PRAGUE-26, and PEERLESS II. HI-PEITHO is the first large RCT to demonstrate that catheter-directed fibrinolysis plus anticoagulation significantly reduces the composite of PE-related death, cardiorespiratory decompensation, or PE recurrence versus anticoagulation alone (RR 0.39; 95% CI 0.20–0.77; P=0.005), with no intracranial hemorrhage in either arm. The four major upcoming/recently reported PE RCTs (HI-PEITHO, PRAGUE-26, PEERLESS II, PE-TRACT) enroll progressively different risk populations – from the most enriched (HI-PEITHO) to the most permissive (PE-TRACT, which includes intermediate-low risk patients) – enabling a nuanced understanding of which patients benefit most from intervention. PE device clearance follows a fundamentally different FDA pathway than structural heart devices (single-arm safety/efficacy studies vs. mandated RCTs), yet market forces and clinical need have ultimately driven industry and government to sponsor large-scale RCTs – a lesson in how evidence development can evolve organically alongside regulatory frameworks. Notes: Notes drafted by Dr. Shiavax Rao. Question #1: What is the current evidence behind advanced PE therapies? Systemic thrombolysis: Sixteen RCTs over 40 years (1972–2014) enrolling nearly 2,000 patients have studied systemic thrombolysis in intermediate-risk PE. The landmark PEITHO trial (n=1,006) showed that tenecteplase reduced the composite of death or hemodynamic collapse (2.6% vs. 5.6%; P=0.015), driven primarily by reduced hemodynamic decompensation (1.6% vs. 5.0%; P=0.002). However, this came at the cost of increased major bleeding (6.3% vs. 1.5%; P

Dragon Breathing Level 1 is one of the most important practices I've developed over the years, and it's become a foundational part of the Sexual Kung Fu system.This guided practice is designed to help you open the microcosmic orbit, cultivate earth energy through the feet, and learn how to circulate energy through the body in a way that builds vitality, pleasure, and deep relaxation.The goal isn't to force anything or visualize complicated energy pathways. It's to become more sensitive to your body, connect with the ground beneath you, and gradually train your nervous system to experience greater levels of energy and full-body awareness.In this guided session you'll learn:• How to practice Dragon Breathing Level 1• The role of foot breathing and earth energy• How to circulate energy through the body naturally• Why grounding is essential for sexual vitality• How this practice supports ejaculation control and full-body pleasure• Ways to integrate Dragon Breathing into qigong, meditation, and sexual cultivationI recommend practicing this regularly for at least a few weeks before moving on to more advanced methods.Consistency is the key.Let me know in the comments what you experience from this practice and how it unfolds for you over time.Get my FREE Ebook - 3 Techniques for Legendary Ejaculation Control:

Tu veux que je te raconte l'histoire du rond-point sans route? Alors attrape ta brosse à dents, ton dentifrice, et c'est parti!

Circulation on the Run welcomes Circulation's new Editor-in-Chief, Bradley A. Maron, MD. Join Brad Maron, along with cohosts Mercedes Carnethon and Jane Wilcox for the new iteration of Circulation on the Run. This week join Brad, Mercedes and Jane as they first welcome Vice Chair Pamela B. Morris as she discusses the 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Then join author Hertzel Gerstein as he discusses his article "Cardiovascular Risk Reduction with GLP-1 RA Drugs." Besides gaining insight about leading science research, learn more about the scientific researchers in Circulation on the Run's newest feature, "Get to Know Our Guests." Don't miss this newly revamped podcast! For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260706.284480

 CardioNerds (Drs. Apoorva Gangavelli, Rebecca Garber, and Tina Reddy discuss INOCA with Dr. Claire Raphael. Audio editing by CardioNerds Academy intern, student doctor Pacey Wetstein. This episode was produced as part of the CardioNerds Academy curriculum by House Einthoven under the guidance of House Chief, Dr. Apoorva Gangavelli, and Academy Program Director, Dr. Gurleen Kaur. A matching review article will be published in US Cardiology Review, the official journal of CardioNerds. Non-obstructive coronary artery disease (CAD) is more common than often recognized, particularly in women and individuals with risk factors like diabetes or hypertension. Conditions such as INOCA, ANOCA, and MINOCA can cause ischemia and chest pain despite “clean” angiograms, often due to microvascular dysfunction, coronary spasms, or subtle plaque. Diagnosing these conditions requires advanced imaging or invasive studies to assess blood flow and vessel function. Treatment focuses on reducing cardiovascular risk with aspirin, statins, ACE inhibitors, or ARBs, and managing symptoms with beta-blockers or calcium channel blockers. The key takeaway: A normal angiogram doesn't rule out disease, and these patients need a comprehensive, evidence-based approach to care. 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: When patients present with chest pain but do not have obstructive coronary artery disease, the story does not end there! Other pathologies that must be ruled out include spontaneous coronary artery disease (SCAD), coronary vasospasm, microvascular disease, Takotsubo, and cardiomyopathy. A TTE can help rule out other pathologies. Cardiac MRI can help identify myocardial fibrosis, scarring, or edema that may suggest prior events or alternative diagnoses.  About 60-70% of INOCA cases are in women. However, it is estimated that about half of the patients with so-called “normal” angiograms actually have positive stress tests. Patients with elevated troponins are more likely to have recurrent events. Patients with INOCA are more likely to come back to the ER multiple times before getting diagnosed. These patients have a 1.4x increased risk of adverse cardiovascular events (such as HFpEF, MI, and recurrent hospitalizations for cardiac chest pain).  INOCA is a complex condition with a variety of causes, primarily linked to microvascular disease. Within microvascular disease, there are different “endotypes” (types or subcategories) classified by specific characteristics. In centers that conduct microvascular testing, patients are categorized as endothelium-independent or endothelium-dependent, based on their responses to adenosine or acetylcholine during testing. Additionally, microvascular disease can be classified as either structural or functional, depending on the results of tests measuring microvascular resistance. The field is moving towards the term ANOCA, or angina with non-obstructive coronary arteries, to include patients with anginal symptoms without objective ischemia.  The field is moving toward using genotyping and hemodynamic testing to guide first-line therapies for microvascular disease, a heterogeneous condition. Current treatments mostly come from obstructive coronary artery disease, but specialized approaches—like the coronary sinus reducer—may offer unique benefits for microvascular disease. Treatment includes sublingual nitroglycerin, ACE inhibitors/ARBs, and beta-blockers. Remember to also treat any additional comorbidities, such as diabetes, hypertension, and hyperlipidemia. Unfortunately, many of these patients may still have refractory chest pain, so it is important to reassure them. These patients can still exercise, but they may be hesitant to do so for fear of having chest pain. Cardiac rehab may be helpful for these patients as it helps them build up their tolerance. References Lawton JS, Tamis-Holland JE, Bangalore S, et al; Writing Committee Members. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2022;145(3):e18-e114. doi:10.1161/CIR.0000000000001039 Hwang D, Park S, Koo B-K. Ischemia with nonobstructive coronary artery disease. JACC: Asia. 2023;3(2):169-180. doi:10.1016/j.jacasi.2023.01.004 Yukselen Z, Majmundar V, Dasari M, Kumar PA, Singh Y. Chest pain risk stratification in the emergency department: current perspectives. Open Access Emerg Med. 2024;16:29-43. doi:10.2147/OAEM.S419657

This week marks the final Circulation on the Run under Dr. Joseph Hill's tenure. For this episode, please join our current hosts along with former host Carolyn Lam, Executive Editor James de Lemos, and Editor-in-Chief Joseph Hill as they remember the legacy of the podcast started a decade ago, the important scientific research discussed, and fond memories after 520 episodes. For the episode transcript, visit: https://www.ahajournals.org/do/10.1161/podcast.20260629.459176

"Living in a physical world can be challenging. To experience the New Faith Currency in your daily life requires faith, inspired action... and a little Unicorn magic." — Thom and the Golden White Unicorns Inspired by a chapter from Jennifer Ruth Russell's book, Opulence Infusion: A New Faith Currency, this guided meditation invites you into a sacred partnership with the Golden White Unicorns. As you relax and receive their blessings, you'll awaken the circulation of Divine Supply, increase your capacity to receive, and open yourself to greater grace, generosity, synchronicity, and Opulence. If the Golden Unicorns speak to your heart, I warmly invite you to join me for Tea with Mother Mary, held on the first Wednesday of every month, where we explore the wisdom, love, and guidance of Mother Mary and her Heavenly Team. Sign up here: https://www.jenniferruthrussell.com/post/tea-with-mother-mary

CardioNerds (Amit and Dan), Billy Joe Mullinax, and Saahil Jumkhawala discuss the long term management of pulmonary embolism with Dr. Soophia Naydenov.  The episode focuses on the approach to patients who struggle with persistent symptoms like dyspnea and fatigue even after completing the acute phase of anticoagulation. This spectrum of disease, ranging from mild post-PE impairment to chronic thromboembolic pulmonary hypertension (CTEPH), requires a structured follow-up. The discussion covers the critical importance of identifying CTEPH early, the necessary timelines for follow-up, and the appropriate objective screening tools and invasive testing to guide patient care toward full functional recovery. Audio editing by CardioNerds academy intern, Grace Qiu. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   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! Acronyms PE: Pulmonary Embolism PERT: Pulmonary Embolism Response Team CTEPH: Chronic Thromboembolic Pulmonary Hypertension QL: Quality of Life VTE: Venous Thromboembolism DASH: D-dimer, Age, Sex, History of non-provoked PE (a risk score) CPET: Cardiopulmonary Exercise Testing PFTs: Pulmonary Function Tests VQ Scan: Ventilation-Perfusion Scan DOACs: Direct Oral Anticoagulants TPA: Tissue Plasminogen Activator (Thrombolytics) ECMO: Extracorporeal Membrane Oxygenation Pearls: Post-PE “Syndrome” is a Spectrum: It is more accurately a spectrum of disease (sequelae of PE) rather than a single syndrome, ranging from mild fatigue/dyspnea to the most severe form, CTEPH. Structured Follow-up is Mandatory: All PE survivors need a structured follow-up, typically with checkpoints at 3, 6, 12, and 16–24 months, with the primary goal being to detect CTEPH, the deadliest, yet potentially curable, disease on the spectrum. Screening Should Be Objective and Practical: When screening for persistent symptoms, use objective assessment tools like the Post-VTE Functional Status (PVFS) scale or the Modified Medical Research Council (MMR-C) scale, as highly comprehensive but cumbersome tools (like the PE Quality of Life questionnaire) may not be practical for routine clinical use. Recurrence Risk Scores Aid in Anticoagulation Duration: Simple scores like the DASH score or the HERDO2 score (for women) can provide guidance when considering the continuation versus discontinuation of anticoagulation after the initial treatment phase. Invasive Testing for Persistent Symptoms: If a patient remains symptomatic at the 6-month mark despite normal non-invasive testing (chest X-ray, ECG, PFTs, six-minute walk, echo, VQ scan, CPET), consider invasive testing such as Right Heart Catheterization (RHC) at rest or with exercise, or an invasive CPET. Notes: Notes drafted by Saahil Jumkhawala. 1. The Spectrum of Post-PE Disease The term “post-PE syndrome” should be used with caution, as it refers to a spectrum of disease rather than a single entity. This spectrum includes symptoms (sequelae) that exist in a patient’s life following an incidental PE event that they did not have before. On one extreme is Chronic Thromboembolic Pulmonary Hypertension (CTEPH): The definition is clear, but it is the most deadly type, though thankfully rare (2% to 4%). It involves a residual clot and pulmonary hypertension identifiable at rest. In the middle is Chronic Thromboembolic Disease (CTED): Patients may have residual defects seen on a VQ or CT scan, but they do not have pulmonary hypertension. On the other side is a milder disease, which can include fatigue, dyspnea, or a patient’s perceived impairment, where the definitions of CTEPH and CTED are not met, but the patient remains symptomatic. 2. Structured Follow-up and Screening for Post-PE Symptoms Structured follow-up is key for all PE survivors, though the structure may vary based on available resources (PCP, Cardiology, Pulmonary, or multidisciplinary clinic). Recommended Timeline for Follow-up: Data from studies like ELOPE and FOCUS suggest checkpoints at 3, 6, 12, and up to 16 to 24 months. This timeline is designed to identify patients who may develop CTEPH. 88% of patients who develop CTEPH will be identified within about a year. A structured follow-up can reduce the delay in CTEPH diagnosis from 10–12 months to 4–6 months. Personal Practice Note: A quick 2–3 week/30-day check-in is recommended for severely ill patients (e.g., those who had TPA, profound shock, or ECMO support) to ensure medication compliance, manage symptoms, and identify red flags. Screening Tools (Objective Assessment): The first step is an inventory of patient symptoms, leaning toward objective rather than subjective assessment. Recommended Simple Tools: Modified Medical Research Council (MMR-C) for dyspnea evaluation. Post-VTE Functional Status (PVFS) scale. The Pulmonary Embolism Quality of Life (QL) questionnaire is comprehensive but long, making it tedious and better suited for research. Future Utility: Technology (AI/electronic tools) may assist in administering these questionnaires before the clinic visit, presenting the information as a “dashboard” for the provider. 3. Management of Persistent Symptoms and Further Testing Initial Non-Invasive Tests (Often done at 3 months): Echocardiogram VQ Scan Full PFTs Six-minute walk CPET Further Evaluation for Persistent Symptoms (e.g., at 6 months): If non-invasive tests (Chest X-ray, ECG, CPET) are normal but symptoms persist, more invasive testing should be considered as the patient has not returned to baseline. Repeat VQ scan or echocardiogram if symptoms have changed. Right Heart Catheterization (RHC) at rest or with exercise. Invasive CPET. PA gram (Pulmonary Angiogram) to assess vasculature. 4. Recurrence Risk and Anticoagulation Duration The decision to continue or discontinue anticoagulation depends on the patient’s risk factors, the situation of the PE (provoked or unprovoked), presence of active cancer, and patient preference. Recurrence Risk Scores: Simple scores are preferred for practicality. DASH Score. HERDO2 Score (particularly for women). The Vienna Score can be considered if the question is whether to restart anticoagulation after a disruption. Role of D-dimer in Abbreviation: While D-dimer can be used to guide the decision to restart anticoagulation after a planned pause (if D-dimer is high, resume), patient symptoms are preferable to guide management decisions like early abbreviation. 5. Prevention of Post-PE Syndrome Currently, there is no clear tool known to prevent the post-PE syndrome/spectrum of disease. Best Current Advice for Prevention/Recovery: Anticoagulation compliance. Pulmonary rehabilitation, which aids in faster recovery. General precautions, such as smoking cessation and body weight management. Future Research: Ongoing trials are investigating whether acute management strategies (e.g., using thrombolytics in intermediate-risk PE) can prevent long-term sequelae. (The PYTHO trial did not show a reduced rate of CTEPH in intermediate-risk PE patients who received thrombolytics). References: Khan, F., Tritschler, T., Kahn, S. R., & Rodger, M. A. “Venous Thromboembolism.” The Lancet, vol. 398, no. 10294, 2021, pp. 64-77. doi:10.1016/S0140-6736(20)32658-1. Kearon, C., & Kahn, S. R. “Long-Term Treatment of Venous Thromboembolism.” Blood, vol. 135, no. 5, 2020, pp. 317-325. doi:10.1182/blood.2019002364. Kahn, S. R., & de Wit, K. “Pulmonary Embolism.” The New England Journal of Medicine, vol. 387, no. 1, 2022, pp. 45-57. doi:10.1056/NEJMcp2116489. Di Nisio, M., van Es, N., & Büller, H. R. “Deep Vein Thrombosis and Pulmonary Embolism.” The Lancet, vol. 388, no. 10063, 2016, pp. 3060-3073. doi:10.1016/S0140-6736(16)30514-1. Chopard, R., Albertsen, I. E., & Piazza, G. “Diagnosis and Treatment of Lower Extremity Venous Thromboembolism: A Review.” JAMA, vol. 324, no. 17, 2020, pp. 1765-1776. doi:10.1001/jama.2020.17272.

Sometimes V-fib doesn't respond to the shock at all. Sometimes it converts and comes right back. Those are two completely different problems.In this episode, Sarah breaks down the science behind why defibrillation fails, how to recognize the difference between refractory and recurrent V-fib, and respond when shocks aren't working. You'll learn how to start approaching the electrical storm at the bedside — that means understanding transthoracic impedance, optimizing your pad placement, and knowing when to reach for double sequential defibrillation.Topics discussed in this episode:Refractory vs. recurrent V-fibThe physiology of ventricular fibrillation and re-entry tachycardiasMisconceptions about defibrillationTransthoracic impedance and how to reduce itAnterior-lateral vs. anterior-posterior pad placementDouble sequential defibrillation: evidence and objectionsKey findings from the DOSE VF trialAmerican Heart Association. (2025). 2025 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation.Cheskes, S., Dorian, P., Feldman, M., McLeod, S., Scales, D. C., Pinto, R., Turner, L., Morrison, L. J., Drennan, I. R., & Verbeek, P. R. (2020). Double sequential external defibrillation for refractory ventricular fibrillation: The DOSE VF pilot randomized controlled trial. Resuscitation, 150, 178–184. https://doi.org/10.1016/j.resuscitation.2020.02.010D. Hasegawa, A. Sharma, Y. I. Lee, & R. Sato. (2023). A systematic review and meta-analysis of esmolol for refractory ventricular fibrillation and pulseless ventricular tachycardia. Chest, 164(4 Suppl.), A1568. https://doi.org/10.1016/j.chest.2023.07.1077International Liaison Committee on Resuscitation. (2025). 2025 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR).Mentioned in this episode:CONNECT

In this episode, Dr. Brendan McCarthy breaks down one of the most misunderstood topics in hormone replacement therapy: estradiol. Not all estrogen is the same—and how estradiol is delivered can dramatically affect hormone balance, inflammation, clotting risk, testosterone levels, and overall health outcomes. Dr. McCarthy discusses: • Why route of administration matters (oral, patch, injectable, topical, vaginal, pellet) • How oral estradiol converts to estrone • The differences between estradiol (E2), estrone (E1), and estriol (E3) • Estrone's relationship to inflammation and metabolic health • Oral estrogen and clotting risk • Oral estrogen's effect on SHBG and free testosterone • The impact of oral estrogen on IGF-1 and growth hormone signaling • Why informed consent should be central to hormone therapy • Benefits and limitations of pellets, patches, creams, and injections • Estriol and emerging research in autoimmune conditions such as multiple sclerosis At Protea Medical Center, our philosophy is simple: patients deserve complete information so they can make empowered decisions about their health.

I sit down with nutrition scientist Dr. Luke Bucci to explore the powerful connection between blood flow, nitric oxide, mitochondrial health, and healthy aging. We discuss why circulation impacts nearly every function in the body, what causes energy levels to decline with age, and how nutrition, exercise, and targeted supplementation may help support long-term vitality. Dr. Bucci also explains the science behind nitric oxide, blood sugar regulation, and the role mitochondria play in keeping us energized and resilient throughout life.Dr. Luke Bucci, PhD, CNS, CCN is the Chief Scientific Officer of Juvenon and a biomedical scientist with more than 40 years of experience in nutrition, dietary supplements, and clinical laboratory science. He earned his PhD in Biomedical Sciences from the University of Texas Health Science Center at Houston and has helped develop numerous patented nutritional products used worldwide. A recognized authority in healthy aging, sports nutrition, omega-3s, probiotics, and dietary supplement science, Dr. Bucci has authored scientific books, taught university-level courses, and received multiple industry awards for his contributions to nutrition and health innovation.Links mentioned during this episode:Juvenon: https://juvenon.com/Free Initial Consultation with Dr. Megan: https://p.bttr.to/3a9lfYkLyons' Share Instagram: www.instagram.com/thelyonsshareJoin Megan's newsletter: www.thelyonsshare.org/newsletter

Scientists have made a new scientific breakthrough in the study of the human body.Researchers in the United States have discovered something amazing: a third circulatory system within the human body.Alongside the previously known cardiovascular and lymphatic systems, this interstitium system (as it's being called) appears to allow the different organs of the human body to pass things along to one another.Which in-and-of-itself is an amazing discovery, but it's made even more exciting by the fact that this newly discovered system maps very well onto the model of the human body that's been used in traditional Eastern medicine for thousands of years (in practices like acupuncture, for instance).Meaning, this discovery might very well be the missing link between Western and Eastern medicine.Let's go through the details together.

Listener feedback, transcatheter tricuspid valve replacement, a new metabolic disease called CKM, the ARISE-FLUIDS Trial, the BIHCA trial, and temporal trends in ICD therapies are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback LOSE-AF Trial https://jamanetwork.com/journals/jama/fullarticle/2849335 ARREST-AF Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2840225 POP-AF Trial https://doi.org/10.1093/eurheartj/ehaf689 PRAGUE-25 Trial https://www.jacc.org/doi/10.1016/j.jacc.2025.04.042 II Transcatheter Tricuspid Valve Replacement TRISCEND Cost Study https://doi.org/10.1016/j.shj.2026.101049 TRISCEND II Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2401918 III More Disease Creation – the CKM Syndrome ACC/AHA Release First-Ever Guideline for CKM Syndrome https://www.medscape.com/viewarticle/acc-aha-release-first-ever-guideline-ckm-syndrome-2026a1000jbs CKM Guideline in Circulation https://www.ahajournals.org/doi/10.1161/CIR.0000000000001447 IV Two Trials That Teach Important EBM Lessons ARISE-FLUIDS Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2516225 Dr Josh Farkas Post on X https://x.com/PulmCrit/status/2065064796270022845?s=20   V  Bicarbonate for Inpatient Cardiac Arrest –The BIHCA trial BIHCA Trial https://jamanetwork.com/journals/jama/fullarticle/2850405 VI The Decline of VT in Heart Failure Trends and Outcomes in ICD Recipients: 15-Year Analysis https://doi.org/10.1093/europace/euag110 Declining Risk of Sudden Death in HF https://www.nejm.org/doi/full/10.1056/NEJMoa1609758 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

The March 2026 ACC/AHA Guideline on the Management of Dyslipidemia made a major pivot regarding Lipoprotein(a) by establishing a formal recommendation for universal screening in adults. This 2026 guideline, published in the Journal of the American College of Cardiology, issued a Class 1 recommendation stating that every adult should have their Lp(a) measured at least once in their lifetime. Because Lp(a) levels are genetically determined and remain highly stable throughout a person's life, a single lifetime check is sufficient for the vast majority of the population to establish their baseline risk. Well, that's great for Family medicine or internal medicine, but how does that affect us in women's health? Well, it's complicated: lipoprotein(a) has been associated with an increased risk of VTE and has also been associated, in some studies, with FGR, preeclampsia, and preterm birth! So, can these patients receive oral contraceptives? What about Perioperative and postop care? Do these patients require anticoagulation? What about pregnancy- is LDA recommended here? And lastly, what about TXA use in patients with HMB? This podcast topic comes from one of our podcast family members who is an OBGYN military personnel caring for our wonderful troops overseas. Listen in for details!16% OFF TONA ACTIVE WEAR PROMO: https://tonaactive.com/discount/CHAPANOSPINOBG1. Ezzat, D., Lopez, D. M., Claggett, B. L., Li, L., Mohammadnia, N., Schuermans, A., Hemeryck, J., Chang, A., Murillo, S., O'Donoghue, M. L., Bikdeli, B., Yu, Z., Natarajan, P., Patel, A. P., Pabon, M. A., & Honigberg, M. C. (2026). Lipoprotein(a) and incident venous thromboembolism in pre- and postmenopausal women, and in men. European Heart Journal, ehag252. https://doi.org/10.1093/eurheartj/ehag2522.ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Dyslipidemia Writing Committee. (2026). 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia. Circulation, 153, e1155–e1300. https://doi.org/10.1161/CIR.00000000000014233. CDC MEC 4. Prevention of Venous Thromboembolism in Gynecologic Surgery: ACOG Practice Bulletin, Number 232. Obstetrics and Gynecology. 2021. Committee on Practice Bulletins—Gynecology5. Sofi F, Marcucci R, Abbate R, Gensini GF, Prisco D.Lipoprotein(a) as a Risk Factor for Venous Thromboembolism: A Systematic Review and Meta-Analysis of the Literature.Seminars in Thrombosis and Hemostasis. 2017. Dentali F, Gessi V, Marcucci R, et al. Lipoprotein (A) and Venous Thromboembolism in Adults: The American Journal of Medicine. 2007.

This is my personal favorite topic, but probably your least favorite: strength training.  Before you run away, hear me out! Because whether you’re bed-bound, housebound, or just convinced your body can’t handle it right now, this episode is for you. I’m breaking down exactly WHY resistance and strength training isn’t just helpful for vestibular disorders—it’s essential.  You Have to Move Your Body to Manage Your Dizziness From the dizzy-anxious-dizzy cycle to blood sugar regulation to better sleep to reduced inflammation, strength training touches virtually every struggle vestibular warriors face. I’m not letting anyone off the hook, but I am meeting you exactly where you are. Starting with 3 minutes? That counts.  Walking to the mailbox and back? That counts too.  Because the goal here is progress, not perfection. And you know I have the science to back every single word of it! In this episode, we'll dig into: Why strength training is non-negotiable for vestibular disorder management How exercise helps break the dizzy-anxious-dizzy cycle “In the moment” vs. “hangover” dizziness and how to adjust your approach Why EDS, HSD, or MCAS makes building muscle even more critical The truth about the fear of getting “bulky” How to start exercising when you’re bedbound or couch-bound What physical activity guidelines actually say, and where most people fall short How functional movements like the deadlift directly support vestibular patients How Vestibular Group Fit makes strength and resistance training accessible Whether you start with 3 minutes or 30, the most important thing is that you start. Because your vestibular system, your mood, your balance, and your future self are all counting on it. Links Mentioned: Vestibular Group Fit (code GROUNDED at checkout for 15% off!): https://thevertigodoctor.com/vestibular-group-fit Free Resources: ⁠The 4 Steps to Managing Vestibular Migraine: https://thevertigodoctor.myflodesk.com/cb5js0y78n ⁠The PPPD Management Masterclass⁠: https://thevertigodoctor.myflodesk.com/new-pppd ⁠What your Partner Should Know About Living with Dizziness⁠: https://thevertigodoctor.myflodesk.com/partnership ⁠The FREE Mini VGFit Workout⁠: https://thevertigodoctor.myflodesk.com/minifit ⁠The FREE POTS – safe Workouts⁠: https://thevertigodoctor.myflodesk.com/pots Connect with Dr. Madison (@TheVertigoDoctor): https://instagram.com/thevertigodoctor Work with Dr. Madison: For 1:1 Vestibular Rehabilitation Therapy, email madison@thevertigodoctor.com Otherwise, I'll see ya in Vestibular Group Fit! Connect with Dr. Jenna (@dizzy.rehab.therapist): https://www.instagram.com/dizzy.rehab.therapist/ Learn about the Oak Method: http://thevertigodoctor.com/why-vestibular-group-fit Citations: Adriano Oliveira, Andressa Fidalgo, Paulo Farinatti, Walace Monteiro,Effects of high-intensity interval and continuous moderate aerobic training on fitness and health markers of older adults: A systematic review and meta-analysis,Archives of Gerontology and Geriatrics,Volume 124,2024,105451,ISSN 0167-4943,https://doi.org/10.1016/j.archger.2024.105451.(https://www.sciencedirect.com/science/article/pii/S0167494324001274) Yu Y, Wang J, Xu J. Optimal dose and type of exercise to improve cognitive function in patients with mild cognitive impairment: a systematic review and network meta-analysis of RCTs. Front Psychiatry. 2024 Sep 12;15:1436499. doi: 10.3389/fpsyt.2024.1436499. PMID: 39328348; PMCID: PMC11424528. Zhang Y, Zhou M, Yin Z, Zhuang W, Wang Y. Relationship between physical activities and mental health in older people: a bibliometric analysis. Front Psychiatry. 2024 Oct 21;15:1424745. doi: 10.3389/fpsyt.2024.1424745. PMID: 39497901; PMCID: PMC11532734. Garcia Meneguci, C. A., Meneguci, J., Sasaki, J. E., Tribess, S., & Júnior, J. S. V. (2021). Physical activity, sedentary behavior and functionality in older adults: A cross-sectional path analysis. PloS one, 16(1), e0246275. https://doi.org/10.1371/journal.pone.0246275 Mennitti C, Farina G, Imperatore A, De Fonzo G, Gentile A, La Civita E, Carbone G, De Simone RR, Di Iorio MR, Tinto N, Frisso G, D’Argenio V, Lombardo B, Terracciano D, Crescioli C, Scudiero O. How Does Physical Activity Modulate Hormone Responses? Biomolecules. 2024 Nov 7;14(11):1418. doi: 10.3390/biom14111418. PMID: 39595594; PMCID: PMC11591795. Beavers KM, Brinkley TE, Nicklas BJ. Effect of exercise training on chronic inflammation. Clin Chim Acta. 2010 Jun 3;411(11-12):785-93. doi: 10.1016/j.cca.2010.02.069. Epub 2010 Feb 25. PMID: 20188719; PMCID: PMC3629815.  Chastin, S.F.M., Abaraogu, U., Bourgois, J.G. et al. Effects of Regular Physical Activity on the Immune System, Vaccination and Risk of Community-Acquired Infectious Disease in the General Population: Systematic Review and Meta-Analysis. Sports Med 51, 1673–1686 (2021). https://doi.org/10.1007/s40279-021-01466-1 Hoffman GJ, Malani PN, Solway E, Kirch M, Singer DC, Kullgren JT. Changes in activity levels, physical functioning, and fall risk during the COVID-19 pandemic. J Am Geriatr Soc. 2022 Jan;70(1):49-59. doi: 10.1111/jgs.17477. Epub 2021 Sep 24. PMID: 34536288. Rey-Lopez JP, Rimm EB, Tabung FK, Giovannucci EL. Long-Term Leisure-Time Physical Activity Intensity and All-Cause and Cause-Specific Mortality: A Prospective Cohort of US Adults. Circulation. 2022 Aug 16;146(7):523-534. doi: 10.1161/CIRCULATIONAHA.121.058162. Epub 2022 Jul 25. PMID: 35876019; PMCID: PMC9378548. Hupin D, Roche F, Gremeaux V, Chatard JC, Oriol M, Gaspoz JM, Barthélémy JC, Edouard P. Even a low-dose of moderate-to-vigorous physical activity reduces mortality by 22% in adults aged ≥60 years: a systematic review and meta-analysis. Br J Sports Med. 2015 Oct;49(19):1262-7. doi: 10.1136/bjsports-2014-094306. Epub 2015 Aug 3. PMID: 26238869. Chandrasekaran B, Ganesan TB. Sedentarism and chronic disease risk in COVID 19 lockdown – a scoping review. Scott Med J. 2021 Feb;66(1):3-10. doi: 10.1177/0036933020946336. Epub 2020 Jul 27. PMID: 32718266; PMCID: PMC8685753. Izquierdo M, Merchant RA, Morley JE, Anker SD, Aprahamian I, Arai H, Aubertin-Leheudre M, Bernabei R, Cadore EL, Cesari M, Chen LK, de Souto Barreto P, Duque G, Ferrucci L, Fielding RA, García-Hermoso A, Gutiérrez-Robledo LM, Harridge SDR, Kirk B, Kritchevsky S, Landi F, Lazarus N, Martin FC, Marzetti E, Pahor M, Ramírez-Vélez R, Rodriguez-Mañas L, Rolland Y, Ruiz JG, Theou O, Villareal DT, Waters DL, Won Won C, Woo J, Vellas B, Fiatarone Singh M. International Exercise Recommendations in Older Adults (ICFSR): Expert Consensus Guidelines. J Nutr Health Aging. 2021;25(7):824-853. doi: 10.1007/s12603-021-1665-8. PMID: 34409961; PMCID: PMC12369211. Bunnell E, Stratton MT. The Impact of Functional Training on Balance and Vestibular Function: A Narrative Review. J Funct Morphol Kinesiol. 2024 Dec 3;9(4):251. doi: 10.3390/jfmk9040251. PMID: 39728235; PMCID: PMC11679947. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985 Mar-Apr;100(2):126-31. PMID: 3920711; PMCID: PMC1424733. Warner A, Vanicek N, Benson A, Myers T, Abt G. Agreement and relationship between measures of absolute and relative intensity during walking: A systematic review with meta-regression. PLoS One. 2022 Nov 3;17(11):e0277031. doi: 10.1371/journal.pone.0277031. PMID: 36327341; PMCID: PMC9632890. “Metabolic Equivalent (MET): Pick the Best Exercise for Longevity.” Whyiexercise.com, www.whyiexercise.com/metabolic-equivalent.html. Love what you heard?Consider leaving a review on your favorite podcast platform to help us reach more vestibular warriors like you! This podcast is for informational purposes only and may not be the best fit for you and your personal situation. It shall not be construed as medical advice. The information and education provided here is not intended or implied to supplement or replace professional medical treatment, advice, and/or diagnosis. Always check with your own physician or medical professional before trying or implementing any information read here. ————————————— strength and resistance training, exercises for vestibular disorders, living with vestibular migraine, guidelines of physical activity, anxiety and depression, chronic dizziness, couch bound, bed bound, dizzy-anxious-dizzy cycle, physical therapist

A 25-year-old pregnant woman presents with a 1-day history of progressive pain and swelling. The foot is cold, pulseless and neurologic function is deteriorating by the hour. Imaging shows a massive iliofemoral DVT. Now both the limb and the pregnancy are threatened. Do you anticoagulate, thrombolyse or operate? Join us as we break down the management and decision making behind this rare but devastating case.Hosts:·      Christian Hadeed -PGY 4 General Surgery, Brookdale Hospital Medical Center·      Paul Haser -Division Chief, Vascular Surgery, Brookdale Hospital Medical Center·      Andrew Harrington, Vascular surgery, Brookdale Hospital Medical Center·      Lucio Flores, Vascular surgery, Brookdale Hospital Medical CenterLearning objectives:-       Recognize the clinical presentation and pathophysiology of phlegmasia cerulea dolens-       Describe how pregnancy affects decision making in patients with phlegmasia and venous thromboembolic disease-       Discuss the goals of treatment for patients with DVT's and identify when operative intervention is indicated-       Describe the sequelae of DVT's and how this relates to post thrombotic syndrome-       Review the indications, risks, and limitations of anticoagulation, catheter-directed thrombolysis, thrombectomy, and fasciotomy in the management of DVT and phlegmasia.-       Explain the role of IVUS in managing venous thromboembolic disease and May Thurner syndromeReferences:-       Vedantham, S., Goldhaber, S. Z., Julian, J. A., Kahn, S. R., Jaff, M. R., Cohen, D. J., Magnuson, E., Razavi, M. K., Comerota, A. J., Gornik, H. L., Murphy, T. P., Lewis, L., Duncan, J. R., Nieters, P., Derfler, M. C., Filion, M., Gu, C.-S., Kee, S., Schneider, J., … Kearon, C. (2017). Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. New England Journal of Medicine, 377(23), 2240–2252. https://doi.org/10.1056/NEJMoa1615066-       Gomes, M. S., Guimarães, M., & Montenegro, N. (2019). Thrombolysis in pregnancy: A literature review. Journal of Maternal-Fetal & Neonatal Medicine, 32(14), 2418–2428. https://doi.org/10.1080/14767058.2018.1438402-       Mangla, A., & Hamad, H. (2023). May-Thurner syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK554377/-       Bates, S. M., Rajasekhar, A., Middeldorp, S., McLintock, C., Rodger, M. A., James, A. H., et al. (2018). American Society of Hematology 2018 guidelines for management of venous thromboembolism: Venous thromboembolism in the context of pregnancy. Blood Advances, 2(22), 3317–3359. https://doi.org/10.1182/bloodadvances.2018024802-       Kahn, S. R., Comerota, A. J., Cushman, M., Evans, N. S., Ginsberg, J. S., Goldenberg, N. A., et al. (2014). The postthrombotic syndrome: Evidence-based prevention, diagnosis, and treatment strategies. Circulation, 130(18), 1636–1661. https://doi.org/10.1161/CIR.0000000000000130 https://pubmed.ncbi.nlm.nih.gov/25246013/Sponsor URL: https://www.goremedical.com/If you liked this episode, check out our recent episodes here: https://behindtheknife.org/listenBehind the Knife Premium: https://behindtheknife.org/premiumOral Board Review: https://behindtheknife.org/oral-boardOral Board Simulator: https://behindtheknife.org/oral-board/simulatorGeneral Surgery Oral Board Review Course: https://behindtheknife.org/premium/general-surgery-oral-board-reviewTrauma Surgery Video Atlas: https://behindtheknife.org/premium/trauma-surgery-video-atlasDominate Surgery: A High-Yield Guide to Your Surgery Clerkship: https://behindtheknife.org/premium/dominate-surgery-a-high-yield-guide-to-your-surgery-clerkshipDominate Surgery for APPs: A High-Yield Guide to Your Surgery Rotation: https://behindtheknife.org/premium/dominate-surgery-for-apps-a-high-yield-guide-to-your-surgery-rotationVascular Surgery Oral Board Review Course: https://behindtheknife.org/premium/vascular-surgery-oral-board-reviewColorectal Surgery Oral Board Review Course: https://behindtheknife.org/premium/colorectal-surgery-oral-board-reviewSurgical Oncology Oral Board Review Course: https://behindtheknife.org/premium/surgical-oncology-oral-board-reviewCardiothoracic Oral Board Review Course: https://behindtheknife.org/premium/cardiothoracic-surgery-oral-board-reviewDownload our App:Apple App Store: https://apps.apple.com/us/app/behind-the-knife/id1672420049Android/Google Play: https://play.google.com/store/apps/details?id=com.btk.app&hl=en_US

In this episode, the we welcome back guest host, Dr. Neelou Weeker, and ED nurse, Leigh Clary, to discuss the critical intersection of language barriers, patient equity, and emergency care. Through two powerful clinical scenarios, the team explores the “gold standards” of medical translation, the challenges of resource-limited community settings, and how TeamSTEPPS tools—specifically closed-loop communication and situational monitoring—can be leveraged to ensure true informed consent and patient safety. The Gold Standard vs. Clinical Reality Providing equitable care means ensuring every patient, regardless of language or culture, fully understands their medical team. While academic centers are often highly resourced, executing communication seamlessly remains a universal challenge. 1. Translation Tools and Hierarchy The Gold Standard: Video- or audio-based professional interpretation tablets allow face-to-face or direct vocal translation. The Secondary Backup: In-house dual-handset “blue phones” connect directly to professional phone lines when tablets experience connectivity issues. The Tertiary Backup: Multilingual staff members can help act as a bridge. Many institutions feature language fluencies on staff ID badges. Note: Staff members should only be used to establish initial rapport or identify the required dialect, not as official medical interpreters. The Danger of Family Interpreters: While family members bring invaluable cultural context and an understanding of the patient’s baseline, studies show they only correctly interpret medical dialogue 19% of the time. The Bottom Line: Always utilize the official route first. When technology fails, do your absolute best—never settle for “good enough” when better communication is possible. 2. Academic vs. Community and Rural Settings Emergency medicine requires extreme adaptability. In resource-limited community or rural hospitals, finding an interpreter for less commonly spoken languages can take upwards of 30 minutes. Physicians must sometimes physically carry translation phones from room to room while managing other patients just to maintain an open line with a rare-dialect interpreter. Applying TeamSTEPPS to Patient Communication We routinely use TeamSTEPPS tools to communicate with our fellow clinicians, but we must remember that the patient is the most important member of the healthcare team. 1. Closed-Loop Communication & The Teach-Back Method To confirm true patient understanding, avoid simple “yes or no” questions, nods, or smiles. Instead, utilize the Teach-Back Method, requiring the patient to repeat the instructions or choices back to you in their own words. How to Phrase It (Taking Responsibility): “I want to make sure that I have been clear in what I’ve said to you. To help me feel reassured that I communicated everything correctly, could you tell me what you understand is going on?” Clinical Value: This is particularly vital for high-stakes decisions and ED discharge instructions. Multimodal Approach: In high-stakes moments, combine professional translation, family context, and teach-back to minimize errors. 2. Situational Monitoring Resuscitative environments are chaotic, and the primary physician trying to run a cod or secure an airway has immense cognitive load. The Team Safety Net: Other team members (nurses, techs, scribes) can help monitor the situation and catch critical communication errors. Reconciling Clinical Urgency with Informed Consent How do you balance the immediate need to save a life with the time-consuming process of formal translation? The ABC Priority: First and foremost, secure Airway, Breathing, and Circulation. If a patient presents to the ED in extremis and cannot communicate, clinicians must operate under the assumption that the patient wants life-saving measures performed. Task Delegation: While the medical team manages the immediate ABCs, immediately task support staff (such as social workers) with finding an official interpreter, locating family members, and gathering background information. Next Steps: Once the ABCs are stable, the team has the time and space to pause, establish formal translation, and dive deeper into informed consent for further procedures. Key Takeaways Acknowledge the Bias of Urgency: Time pressure can tempt us to bypass official translation channels. Guard against this by maintaining an equity-first mindset. Close the Loop with Patients: Ensure they can paraphrase their care plan or consent choices. Protect the Team via Shared Roles: Trust your teammates to monitor the big picture and catch subtle communication gaps during high-stress resuscitations. Do you use TeamSTEPPS or a similar model in your ED? We'd love to hear what has been successful for your team. Hit us up on social media @empulsepodcast or connect with us on ucdavisem.com Host: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Guest Host: Dr. Neelou Tabatabai, Assistant Professor of Emergency Medicine at UC Davis Guest: Leigh Clary, RN, BSN, RN, CEN, ADCES, MICN , ED Nurse and TeamSTEPPS Project Lead at UC Davis Resources: TeamSTEPPS Player of the Month Program, Presentation by Leigh Clary and Jose Metica TeamSTEPPS™: Team Strategies and Tools to Enhance Performance and Patient Safety Heidi B. King, MS, CHE, James Battles, PhD, David P. Baker, PhD, Alexander Alonso, PhD, Eduardo Salas, PhD, John Webster, MD, MBA, Lauren Toomey, RN, BSBA, MIS, and Mary Salisbury, RN, MSN. TeamSTEPPS Pocket Guide – Agency for Healthcare Research and Quality EM Pulse: TeamSTEPPS, September 17, 2021  *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services. Disclaimer: The opinions expressed on this podcast are those of the hosts or guests and do not necessarily reflect the views of UC Davis Department of Emergency Medicine, UC Davis Health, or their parent organizations.  

In this episode, we review key updates from the 2026 ACC-AHA Guidelines on the Management of Dyslipidemia. Key Concepts The PREVENT ASCVD equation is now recommended to calculate ASCVD risk, with thresholds at 3%, 5%, and 10%. The previous 7.5% threshold for statin treatment is now 5%. In addition to the 10-year ASCVD estimate, clinicians should consider the use of Lp(a), "risk enhancers", and coronary artery calcium (CAC) scans as a "tie breaker" with shared decision-making when the decision to treat is not clear. In addition to LDL goals of < 100, < 70, or < 55 (depending on risk), the new guidelines also suggest non-HDL-C and apoB goals once LDL cholesterol is at goal. Many patients will require non-statin therapies to achieve lipid goals. The recommended non-statin therapies include ezetimibe, PCSK9 mAb, PCSK9-interfering RNA, and bempedoic acid. References Writing Committee Members, Blumenthal RS, Morris PB, et al. 2026 ACC/AHA/AACVPR/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Dyslipidemia: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2026;153(17):e1154-e1276. doi:10.1161/CIR.0000000000001423 Wiggins BS, Barac A, Benziger CP, et al. 2026 Dyslipidemia Guideline-at-a-Glance. J Am Coll Cardiol. 2026;87(19):2617-2623. doi:10.1016/j.jacc.2026.02.4872 Superko H, Garrett B. Small Dense LDL: Scientific Background, Clinical Relevance, and Recent Evidence Still a Risk Even with 'Normal' LDL-C Levels. Biomedicines. 2022;10(4):829. Published 2022 Apr 1. doi:10.3390/biomedicines10040829

CardioNerds (Dr. Billy-Joe Mullinax, Dr. Dinu Balanescu, and Dr. Jane Ehret) discuss risk stratification in acute pulmonary embolism with Dr. Stavros Konstantinides, Chair of the 2019 ESC Pulmonary Embolism Guidelines. Using a real-world case, this episode explores how modern PE care has moved beyond “massive” and “submassive” labels toward a dynamic, physiology-based approach. The discussion highlights the limitations of static risk scores, the importance of right ventricular dysfunction and biomarkers, and why normotension does not imply stability. Special emphasis is placed on intermediate-high risk PE, early identification of impending hemodynamic collapse, and the role of lactate, serial reassessment, and PERT teams in guiding escalation of care. Audio editing by CardioNerds intern, Joshua Khorsandi.The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   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 Stable blood pressure does not mean low risk in PEHypotension is a late finding. Patients may have severe RV failure, hypoxia, and tissue hypoperfusion while remaining normotensive — a key concept behind “normotensive shock.” Risk stratification in PE must be dynamic, not staticLegacy scores like PESI and Bova provide a snapshot and predict 30-day mortality, but they do not capture short-term trajectory or impending hemodynamic collapse. Intermediate-high risk PE is a dangerous and heterogeneous groupPatients with RV dysfunction, positive biomarkers, tachycardia, hypoxemia, and elevated lactate may have in-hospital mortality approaching 15%, rivaling STEMI. Lactate is a critical but underutilized marker in PEElevated lactate reflects tissue hypoxia and early circulatory failure and may identify patients at risk for collapse before blood pressure declines. PERT enables physiology-driven, patient-centered PE carePERT teams operationalize continuous reassessment, integrate imaging, labs, and clinical trajectory, and allow timely escalation — shifting PE management from rigid categories to real-time decision-making. Notes Drafted by Dr. Jane Ehret. 1. What is the contemporary framework for risk stratification in acute pulmonary embolism? Modern PE risk stratification prioritizes hemodynamics and right ventricular (RV) function rather than clot burden. The 2019 ESC Guidelines classify PE into high risk, intermediate risk (low vs high), and low risk, based on: Hemodynamic status, RV dysfunction on imaging, and Cardiac biomarkers. This framework emphasizes early mortality risk but requires clinical context to guide escalation decisions. 2. Why is normotension insufficient to define “stability” in PE? Blood pressure is a late marker of circulatory failure in PE. Patients can maintain normal BP through Tachycardia, Increased sympathetic tone, and RV compensation. Many patients with preserved BP may already have shock physiology, including hypoxemia, elevated lactate, and RV failure — sometimes referred to as “normotensive shock.” 3. How should intermediate-risk PE be conceptualized clinically? Intermediate-risk PE is heterogeneous, ranging from patients who do well on anticoagulation to those who deteriorate rapidly. Intermediate-high risk PE is defined by RV dysfunction on imaging and positive cardiac biomarkers. Clinical features such as tachycardia, increasing oxygen requirement, and elevated lactate identify patients at highest risk within this group. 4. What are the strengths and limitations of commonly used PE risk scores? Legacy scores are useful for initial risk categorization but are static and limited in predicting short-term deterioration. Most scores were developed to predict mortality or complications at fixed time points rather than dynamic clinical trajectory. 5. What are the commonly used risk scores and clinical tools in PE, and what is each designed to predict? ESC Risk Stratification Algorithm: Identifies high-risk PE by hemodynamics. Uses PESI or sPESI in normotensive patients to distinguish low-risk from non–low-risk PE. Uses RV dysfunction and biomarkers to differentiate intermediate-low from intermediate-high risk. Forms the basis of many institutional PE pathways. PESI and sPESI: Validated to predict 30-day mortality. Widely used to identify low-risk patients appropriate for outpatient management. Heavily influenced by age and comorbidities. Bova Score: Predicts 30-day PE-related complications in normotensive patients. Composite PE Shock Score (CPES): Predicts normotensive shock in hemodynamically stable PE patients. Pulmonary Embolism Progression (PEP) Score: Predicts progression from intermediate-risk to high-risk PE within 72 hours of diagnosis. PE Short-term Clinical Outcomes Risk Estimation (PE-SCORE): Predicts clinical deterioration or death within 5 days of PE diagnosis. Hestia Criteria: Identifies low-risk PE patients safe for outpatient treatment. Wells' Criteria and Revised Geneva Score: Determine pretest probability for diagnostic triage. PERC Score: Rules out PE in very low-risk patients. 6. What is the role of biomarkers in PE risk stratification? Troponin and natriuretic peptides reflect RV myocardial injury and strain. Current guidelines treat biomarkers as binary (positive vs negative), despite risk being continuous. Biomarkers are most helpful for: Initial risk classification. They are less useful for: Short-interval monitoring and Detecting rapid clinical deterioration. 7. Why is lactate an important physiologic marker in PE? Lactate reflects global tissue hypoxia and impaired perfusion. Elevated lactate may identify patients with: Early circulatory failure and Increased risk of imminent hemodynamic collapse. Lactate is not currently included in ESC risk algorithms but may add important prognostic information in intermediate-risk patients. 8. How does trajectory influence decision-making in PE management? Risk stratification should be viewed as a dynamic process, not a one-time label. Worsening clinical trajectory may include: Rising heart rate, Increasing oxygen needs, Rising lactate, and Progressive RV dysfunction. Serial reassessment is essential for timely escalation of care. 9. What role do Pulmonary Embolism Response Teams (PERT) play in risk stratification? PERT facilitates: Multidisciplinary decision-making and Integration of imaging, biomarkers, and clinical physiology. PERT is most valuable for: Intermediate-risk and high-risk PE and Patients with complex comorbidities or uncertain trajectory. PERT enables a shift from category-based to physiology-driven PE care. References 1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. Published 2019 Oct 9. doi:10.1183/13993003.01647-2019 2. Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med. 2022;11(9):2533. Published 2022 Apr 30. doi:10.3390/jcm11092533 3. Choi WH, Kwon SU, Jwa YJ, et al. The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism. Korean J Intern Med. 2009;24(2):123-127. doi:10.3904/kjim.2009.24.2.123 4. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199 5. Chen X, Shao X, Zhang Y, et al. Assessment of the Bova score for risk stratification of acute normotensive pulmonary embolism: A systematic review and meta-analysis. Thromb Res. 2020;193:99-106. doi:10.1016/j.thromres.2020.05.047 6. Zhang RS, Yuriditsky E, Zhang P, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(8):e014088. doi:10.1161/CIRCINTERVENTIONS.124.014088 7. Zhang RS, Alam U, Sharp ASP, et al. Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(2):e013399. doi:10.1161/CIRCINTERVENTIONS.123.013399 8. Ehret J, Wakefield D, Badlam J, Antkowiak M, Erdreich B. Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study. J Thromb Thrombolysis. 2025;58(2):243-253. doi:10.1007/s11239-024-03051-5 9. Weekes AJ, Raper JD, Lupez K, et al. Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One. 2021;16(11):e0260036. Published 2021 Nov 18. doi:10.1371/journal.pone.0260036 10. Zondag W, Hiddinga BI, Crobach MJ, et al. Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism. Eur Respir J. 2013;41(3):588-592. doi:10.1183/09031936.00030412 11. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010 12. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503-510. doi:10.1016/j.annemergmed.2004.04.002 13. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-171. doi:10.7326/0003-4819-144-3-200602070-00004 14. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-1255. doi:10.1111/j.1538-7836.2004.00790.x 15. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. doi:10.1111/j.1538-7836.2008.02944.x