Podcasts about Coronary

Just because something can be measured doesn't mean it deserves equal weight when you're thinking about your health. Episode #277

This episode is part of our comprehensive Decipher the Guidelines Series covering the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. The following question refers to Section 4.3 of the 2025 ACS Guidelines. The question is asked by Thomas Jefferson medical student and CardioNerds Academy Intern Dr. Grace Qiu, answered first by Cleveland Clinic interventional and structural cardiology fellow and member of the CardioNerds Interventional Cardiology Council Dr. Eunice Dugan, and then by expert faculty Dr. Binita Shah. Dr. Binita Shah is an associate professor of medicine, interventional cardiologist, Director for research in Interventional Cardiology, and Director of the Department of Medicine Clinical Investigator Track at NYU. She is also an associate director of interventional cardiology and director of the transcatheter valve program at the VA New York Harbor Healthcare System. She was a member of the 2025 ACS Guidelines writing committee. Question #5 A 64-year-old woman with NSTE-ACS is taken to the cardiac catheterization laboratory. She is P2Y12 inhibitor-naive as she was unable to tolerate oral intake due to severe nausea and vomiting. Coronary angiography reveals a high-grade, thrombotic lesion in the mid-Right Coronary Artery. The interventionalist decides to initiate an intravenous P2Y12 inhibitor before proceeding with PCI. Which of the following is the most appropriate management strategy? A Administer Cangrelor as a 30 mcg/kg IV bolus followed by a 4 mcg/kg/min infusion for at least 2 hours or the duration of PCI, whichever is longer. B Administer Eptifibatide (GP IIb/IIIa inhibitor) as a routine double-bolus followed by an infusion to replace the need for P2Y12 inhibition. C Delay the procedure for 2 hours to allow for the administration and absorption of 600 mg of oral Clopidogrel. D Administer Cangrelor as a 180 mcg/kg bolus followed by a 2 mcg/kg/min infusion for exactly 1 hour. Answer #5 Explanation The correct answer is A.  Cangrelor is the only intravenous P2Y12 inhibitor currently available. It is a direct-acting, intravenous antagonist of the P2Y12 receptor characterized by rapid and potent platelet inhibitory effects, with restoration of platelet function occurring within 1 hour of drug discontinuation. It also has a very short half-life (3–6 minutes). Among patients with ACS undergoing PCI who have not received a P2Y12 inhibitor, intravenous cangrelor may be reasonable to reduce periprocedural ischemic events (Class 2B; LOE B-R). Dosing Strategy: Bolus: 30mcg/kg IV bolus administered rapidly (under 1 minute) before PCI begins. Infusion: 4 mcg/kg/min IV infusion. Duration: The infusion must run for at least 2 hours or for the duration of the PCI, whichever is longer. Transition to Oral Therapy: Ticagrelor: 180mg can be given at any time (during or after the infusion). Prasugrel/Clopidogrel: loading dose must be given immediately after the infusion is stopped. Giving these earlier can lead to a drug-drug interaction where the Cangrelor prevents the active metabolite from binding to the receptor. In the CHAMPION PHOENIX trial, cangrelor was studied versus clopidogrel in patients undergoing PCI for acute or stable coronary syndromes. Cangrelor was administered as an intravenous bolus prior to PCI followed by an infusion for at least 2 hours or for the duration of the procedure, whichever was longer. In the control arm, clopidogrel was administered as a 600- or 300-mg loading dose immediately before or after PCI. At 48 hours, the primary endpoint of all- cause death, MI, ischemia-driven revascularization, or stent thrombosis was significantly reduced with cangrelor, with similar effects observed among those presenting with NSTE-ACS or STEMI. Glycoprotein IIb/IIIa receptor inhibitors are parenterally administered drugs that block platelet aggregation by preventing platelet cross-linking via fibrinogen or von Willebrand factor binding to the glycoprotein IIb/IIIa receptor. Routine administration of GP IIb/IIIa inhibitors before PCI is not recommended and is associated with increased bleeding without improving ischemic outcomes. (Class 3 – No Benefit). In current practice, the role of glycoprotein IIb/IIIa receptor inhibitors is largely limited to adjunctive use at the time of PCI in patients with large thrombus burden or as “rescue” or “bailout” therapy in patients with PCI complications such as no-reflow or persistent or recurring thrombus at the lesion. B is incorrect. Routine “upstream” or periprocedural use of GP IIb/IIIa inhibitors (GPI) is Class 3 (No Benefit) for most patients. Large trials (like EARLY-ACS) showed that routine GPI use significantly increases major bleeding without a proportional decrease in ischemic events compared to modern P2Y12 inhibitors.  C is incorrect. In patients with NSTE-ACS or STEMI who are already in the lab, delaying the procedure to wait for oral drug absorption is not recommended.  D is incorrect. The correct bolus is 30mcg/kg. Cangrelor must be infused for at least 2 hours or the duration of the PCI, whichever is longer. Stopping at 1 hour would leave a “gap” in platelet inhibition before an oral agent can take effect. Because Cangrelor’s half-life is only 3–6 minutes, a premature stop increases the risk of acute stent thrombosis. Main Takeaway Cangrelor may be reasonable among patients with ACS undergoing PCI who have not received a P2Y12 inhibitor to reduce periprocedural ischemic events (Class 2b, LOE B-R). Guideline Loc. Section 4.3.3-4.3.4

My 35 years of involvement with CT heart scans that generate coronary calcium scores has provided many important lessons on how to put this measure to use. Unfortunately, many misconceptions surround this technology due to incomplete understanding. I therefore provide the rationale and evidence on how to make the most with this important measure. Support the showYouTube channel: https://www.youtube.com/@WilliamDavisMDBlog: WilliamDavisMD.comMembership website for two-way Zoom group meetings: InnerCircle.DrDavisInfiniteHealth.comBooks:Super Gut: The 4-Week Plan to Reprogram Your Microbiome, Restore Health, and Lose WeightWheat Belly: Lose the Wheat, Lose the Weight and Find Your Path Back to Health; revised & expanded ed

As soon as I take my blood pressure meds, I get tired and lack energy for the rest of the day.  What gives?I'm 77 and have Sjögren's syndrome.  Can I take carnitine?  How much should I take?Are there cardiac side effects to berberine?  Both my husband and I take it for blood sugar.What types of protein are most helpful for osteoporosis and weight gain?The coronary artery inflammation controversy

This episode is part of our comprehensive Decipher the Guidelines Series covering the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes.  The following question refers to Section 3.2 of the 2025 ACS Guidelines. The question is asked by Thomas Jefferson medical student and CardioNerds Academy Intern Dr. Grace Qiu, answered first by Cleveland Clinic interventional and structural cardiology fellow and member of the CardioNerds Interventional Cardiology Council Dr. Eunice Dugan, and then by expert faculty Dr. Binita Shah. Dr. Binita Shah is an associate professor of medicine, interventional cardiologist, Director for research in Interventional Cardiology, and Director of the Department of Medicine Clinical Investigator Track at NYU. She is also an associate director of interventional cardiology and director of the transcatheter valve program at the VA New York Harbor Healthcare System. She was a member of the 2025 ACS Guidelines writing committee. Question #3 A 55-year-old woman is brought to the Emergency Department after an out-of-hospital cardiac arrest. She had a witnessed collapse with an initial shockable rhythm. Return of Spontaneous Circulation (ROSC) was achieved after 15 minutes of Advanced Cardiac Life Support (ACLS). Her post-resuscitation ECG shows diffuse ST-segment depression but no ST-segment elevation. She remains comatose. Which of the following is the most appropriate next step in her management regarding coronary angiography? A Immediate emergency coronary angiography (within 2 hours) should be performed. B Routine emergency coronary angiography is not recommended in the absence of ST-segment elevation or hemodynamic instability. C Coronary angiography should be delayed for at least 72 hours to allow for neurological recovery. D Fibrinolytic therapy should be administered immediately if the patient cannot reach a cath lab within 90 minutes. Answer #3 Explanation The correct answer is B. In resuscitated patients who are comatose after cardiac arrest, electrically and hemodynamically stable, and without evidence of STEMI, immediate angiography is not recommended due to lack of benefit (Class 3: No Benefit; LOE A) Patients who have been resuscitated after cardiac arrest and are noncomatose or who are comatose with favorable prognostic features and with evidence of STEMI, should undergo PPCI to improve survival. (Class 1; LOE B-NR). For patients such as this one, a delayed or selective approach should be taken once the patient is stabilized. Early angiography should not be denied solely based on a comatose state, but it should be deferred if there are clear non-cardiac causes for the arrest or if the patient’s overall prognosis is futile. A is incorrect because recent evidence shows no benefit to “emergency” PPCI for stable patients without ST-elevation. C is incorrect because while we wait for stability, we don’t necessarily have a fixed 72-hour “mandatory” delay for the heart if ischemia is suspected. D is incorrect, as fibrinolysis is generally not indicated for post-arrest patients without clear STEMI and carries risks in a post-CPR setting due to potential trauma. The MIRACLE2 Score is a tool for neuroprognostication. It helps clinicians estimate the likelihood of a poor neurological outcome at 6 months. A high score suggests that the benefit of an invasive procedure may be outweighed by the severity of the brain injury. Components of MIRACLE2: M – Missed (unwitnessed) arrest I – Initial non-shockable rhythm R – Reactive pupils at ROSC A – Age (points increase significantly at >60 and >80) C – Rhythm change (e.g., VF to PEA) L – Low pH (pH < 7.20) E – Epinephrine (any dose given) Clinical Threshold: A score of >5 indicates a high risk of poor neurological recovery, which may lead a Heart Team to favor stabilization over immediate emergency angiography in patients without ST-elevation. Early recognition of STEMI in resuscitated patients and direct transfer to a PCI-capable center is associated with improved survival. Survival-to-hospital discharge in the patient who is comatose with out-of-hospital cardiac arrest is

Commentary by Dr. Jian'an Wang.

Commentary by Dr. Jian'an Wang.

Editor's Summary by Linda Brubaker, MD, and Preeti Malani, MD, MSJ, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from August 29-September 4, 2026.

Broadcast from KSQD, Santa Cruz on 8-27-2026: Preparing for extreme heat requires a few days of controlled hyperthermia to boost blood plasma volume and trigger heat shock protein production. Dr. Dawn cites research showing that daily 40-minute treadmill sessions in an 80-degree room followed by 40-minute hot baths for six days—or simply an hour daily in a 40°C bath for four days—produces 75-80% of full acclimatization before a heat-zone trip. Five red flags warrant an ER trip for abdominal pain: pain worsening with coughing or car bumps (peritonitis), lack of gas passage with nausea (bowel obstruction) especially with dark green bilious vomiting, yellowing whites of eyes (bile duct obstruction with sepsis risk), tarry black shiny stool (bleeding ulcer versus coffee-ground vomit), and dizziness with pain (possible leaking aortic aneurysm). Dr. Dawn urges any man who has smoked over 100 lifetime cigarettes to request the Medicare-covered abdominal ultrasound screening for aortic aneurysm, noting only 4% of eligible men currently receive it. Quaternary ammonium compounds (QACs) fill nearly half of disinfectants, surface sanitizers, and cleaning wipes, with use surging after 2016 FDA antimicrobial bans and the COVID pandemic. A 2023 Environmental Science and Technology review documented reproductive toxicity, hormone mimicking, dermal and respiratory irritation, and disruption of mitochondrial oxidative phosphorylation. Dr. Dawn recommends apple cider vinegar and water as a safe household cleaner and directs listeners to EWG.org for QAC-free product listings. A UK Biobank study of 65,000 people born in the 1940s-50s exploited WWII sugar rationing (eight ounces weekly through 1953) as a natural experiment. Those exposed to less sugar before age two had 20% lower dementia risk with 2.5-year delayed onset, and protection held even for those whose low-sugar exposure was purely in utero—underscoring the importance of avoiding added sugars in baby foods during the first 1,000 days. A Coast Guard rescuer's suicide following years of headaches and mood swings prompted his teenage daughter's high school survey of 77 surfmen, most of whom described the same TBI symptoms. Repeated boat impacts hitting waves at 6G at the deck translate to roughly 60G at the sailor's head—more violent than car crashes—prompting the Coast Guard's first official acknowledgment of the wave-pounding brain injury problem. Anopheles stephensi, a hardy South Asian malaria vector that thrives in urban environments and survives dry seasons, has spread from Djibouti (2012) through Yemen, Ethiopia, Sudan, and Kenya. Genomic analysis reveals distinct genetic clusters as it advances, all largely resistant to standard mosquito-control chemicals used in netting and sprays. Dr. Dawn ties this to broader arthropod-borne disease expansion in the U.S. from climate warming, and defends deer culling as tick-vector reduction. Dr. Dawn recommends the PREVENT calculator (using blood pressure, cholesterol, age, sex) as the starting point for coronary risk assessment. Coronary calcium scores are most useful for those in the borderline/intermediate range (3-9% ten-year risk)—a score above age-normal warrants reconsidering statin therapy—but add little value at high risk (where zero calcium doesn't rule out non-calcified plaque) or in older patients. An update on shingles vaccination and dementia: Geldsinger's 2025 Welsh natural-experiment study (exploiting birthday-based Shingrix rollout cutoffs) showed a 20% dementia reduction, since replicated in Canada, Australia, and Scotland. New Hebrew University data suggests giving Shingrix four weeks apart (Dr. Dawn cautions against this shortened interval) may stabilize cognition in existing Alzheimer's patients. The proposed mechanism involves boosting regulatory T-cells that dampen chronic neuroinflammation—also explaining why BCG (400% dementia reduction in bladder cancer patients) and flu vaccines show similar protective effects. An oral KRAS-inhibiting drug, daraxonrasib, doubled median survival in 500 patients with metastatic pancreatic cancer from about six months to 13.2 months by blocking proteins produced by the historically undruggable KRAS gene—the first major advance for a cancer where metastatic diagnosis has meant near-immediate death sentence.

Editor's Summary by Linda Brubaker, MD, and Preeti Malani, MD, MSJ, Deputy Editors of JAMA, the Journal of the American Medical Association, for articles published from August 22-28, 2026.

In-stent restenosis presents a challenge on coronary CTA. Bryce Saba, MD, discusses the multicenter study by Xu et al. exploring a super-resolution deep-learning reconstruction method for stent evaluation. Full article: Comparison of Super-Resolution Deep-Learning Reconstruction and Hybrid Iterative Reconstruction for Coronary Stent Assessment on CTA: A Prospective Multicenter Study  Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social

What if everything you've been told about your health is wrong? Most men don't realize their testosterone has been declining since their 30s — and by the time 40 arrives, burnout, weight gain, and low drive feel like the new normal. Dr. Stephen Sanders, MD, MPH, founder of Whole Men's Health, lived that reality and chose to fight back. He went from burned out, overweight, and running on empty in his late 30s to a complete physical, hormonal, and mindset transformation — and now he's guiding thousands of men through that same journey. In this episode of A Swift Kick in the Ass, host John W. Curren sits down with Dr. Sanders for a no-filters conversation about what it actually means to be a healthy, whole man today. They break down the science behind testosterone decline, which now begins around age 30 and has dropped by roughly 30% in modern men compared to previous generations. They explore the hidden role of environmental toxins, the neurochemical impact of pornography on dopamine and drive, and the compounding effects of burnout and chronic stress on hormonal health. Dr. Sanders and John get into the specifics: personalized elimination diets, dairy intolerance and inflammation, hitting approximately 1 gram of protein per pound of ideal body weight, and why creatine and peptide supplementation deserve serious consideration. They cover the critical importance of muscle mass — particularly glute strength — for injury prevention and long-term longevity. Dr. Sanders also makes a compelling case for coronary calcium scans and establishing baseline lab work starting in your 20s before problems arise. The conversation closes with something deeper — emotional resilience, mindfulness, and a reimagined definition of masculinity built on purpose rather than performance. This is not just a health conversation. It is a blueprint for becoming a whole man. - KEY TOPICS - - Dr. Sanders' personal burnout and transformation story - Testosterone decline starting at 30 and what drives it in modern men - Environmental toxins and their impact on male hormones - Pornography's neurochemical effect on dopamine and drive - Elimination diets, dairy intolerance, and personalized nutrition - Protein targets, creatine, and peptide supplementation - Muscle mass and glute strength for longevity and injury prevention - Coronary calcium scans and baseline labs in your 20s - Mindfulness, emotional resilience, and breaking male silence - Redefining masculinity with purpose and intention - CONNECT WITH DR. STEPHEN SANDERS - Website: wholemenshealth.com Instagram: @drstephensanders (105.7K followers) YouTube: @drstephensanders TikTok: @drstephensanders LinkedIn: Stephen Sanders, MD, MPH Linktree: linktr.ee/drstephensanders Book a consult: 850-660-8348 Locations: Santa Rosa Beach, FL | Dothan, AL | Birmingham, AL | Nationwide Telehealth (all 50 states) - ABOUT THE PODCAST - A Swift Kick in the Ass, hosted by John W. Curren, is bold conversations on mindset, men's health, resilience, and living life on your own terms. Subscribe wherever you get your podcasts. - DISCLAIMER - This episode is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making health decisions.

Our hearts are restless, says Saint Augustine, until they find their rest in God. The biological science and the spiritual metaphor are in agreement here. Over the course of billions of beats, our hearts never stop to rest.  Your magnificent heart exchanges or pumps your entire blood volume, just over a gallon, every single minute. (Athlete hearts can pump up to 10 gallons per minute!) In this episode, Mark Labberton discusses matters of the heart with his close friend Dr. David Anderson, a cardiologist of four decades who trained at Johns Hopkins and helped launch one of the first interventional cardiology programs in San Francisco. Anderson reflects on the medical science of cardiology, the profound life-saving medical advances over the past forty years, heart disease versus coronary artery disease, how the brain and the heart communicate, and what happens during a heart attack. In the second half of their conversation, they move from physiology to spirituality of the heart: Pharaoh's hardened heart, "out of the heart the mouth speaks," and the human need to find somewhere to locate the self. Anderson closes with what a cardiologist would tell anyone worried about their own heart, and with a case for medicine as a noble profession. Episode Highlights "When I first began in cardiology, if your heart was damaged, imagining that the heart could actually improve its function was like imagining someone could grow back a new arm." "One of the distinctive things about the heart is unlike other muscles, it doesn't have a time to rest. When it gets insufficient blood supply, it can't just say, 'Whoa, I'm gonna stop here.' It asks you to slow down because it starts hurting." "I think that's part of the intrigue of the heart, that it is inside us … but in some ways it's apart from us. It's responding to environmental things that we're not really even aware of. … I think it's this sense of detachment of the heart from us—but yet its centrality—that has led people to posit the soul or the will or the passions or almost anything that you would think was the real you. "Atherosclerosis … I would describe as it's like having a pimple inside your artery." "First of all, know yourself. That is, it's not a time to be fatalistic because your father had a heart attack in his fifties or your brother just had a heart attack. It's a time to be proactive." About David Anderson David Anderson is a cardiologist who practiced for more than four decades before retiring. He studied at Stanford as an undergraduate and earned his medical degree at Johns Hopkins University School of Medicine. He stayed at Hopkins for residency, then trained in San Francisco at the dawn of interventional cardiology, helping to build an angioplasty program in the early 1980s. Helpful Links and Resources Alta Bates Summit Medical Center, Sutter Health, the Oakland hospital Anderson thanks by name: https://www.sutterhealth.org/about-us/our-hospitals/alta-bates-summit-medical-center DeWood et al., "Prevalence of Total Coronary Occlusion during the Early Hours of Transmural Myocardial Infarction," the 1980 study that identified clot as the cause of heart attack: https://www.nejm.org/doi/full/10.1056/NEJM198010163031601 Waagstein et al., "Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy," the Swedish beta-blocker work behind the recovery he describes: https://pubmed.ncbi.nlm.nih.gov/1191416/ What Is Atherosclerosis, National Heart, Lung, and Blood Institute: https://www.nhlbi.nih.gov/health/atherosclerosis Warning Signs of a Heart Attack, American Heart Association: https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack Angina (Chest Pain), American Heart Association, on the exertional pain he describes at the close: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain Show Notes The impact of family gene pool, lifelong heart awareness How David Anderson got into medicine, and cardiology in particular A Hopkins autopsy elective, a teenager dead in a parking lot, a mentor who followed From internists interested in the heart to interventionists inside it Catheters, pressures, and the arrival of echocardiography Seeing a beating heart inside a living body for the first time, as a senior resident A colleague's heart attack in 1979 The 1980 angiography study that identified clot as the trigger Spring 1983: an artery occludes, the cath lab opens it, pain gone in fifteen minutes Bypass surgery before that: elective, scheduled, never mid-attack Prevention running under the technology: blood pressure, smoking, the lipid theory Fixing one artery and never having to fix another Coronary artery disease versus disease of the muscle itself Plasticity, not regeneration Adrenaline as an emergency system built for days, not decades Moving from technological advances to molecular-based understanding of heart problems Understanding of the pathophysiology of atherosclerosis and its prevention Beta blockers, ejection fraction, and hearts that came back The heart as a muscle with no rest The heart's own electrical center, and the backup pacemakers below it Your heart doesn't rely on you or your consciousness to beat Why the ancients may have located the self in the heart organ Jeremiah's pounding heart, Pharaoh's hardened one Pascal, the soul, and needing somewhere to put "the real you" Maintaining an appropriate degree of separation from the patient and their family in order to care properly and effectively The difficulty of delivering bad news to patients and their familes Digging for a shared history to call on in a crisis "Medicine is a noble profession." Heart care advice from a cardiologist: First, know yourself. Heart health checklist: cholesterol, blood pressure, weight, knowing your own history The pain that warrants a phone call #Conversing #MarkLabberton #Cardiology #Heart #MedicalScience #HeartHealth #Biology #ChristianHumanism Production Credits Conversing is produced and distributed in partnership with Comment magazine and Fuller Seminary.

Coronary revascularization in patients undergoing TAVI: an IPD meta-analysis of four randomized trials

Dr. Daniel Chong has spent years helping patients understand their true cardiovascular risk and take meaningful action to prevent heart attacks and strokes.In this episode, Rip and Dr. Chong dig into the confusing, often polarizing world of cholesterol and heart disease. Is LDL cholesterol really important? How low should it go? Is ApoB a better marker? What about calcium scores, lipoprotein(a), statins, saturated fat, and the growing noise around keto and carnivore diets?Dr. Chong offers a grounded, practical, and highly nuanced perspective. He explains why standard LDL cholesterol is only part of the picture, why ApoB and LDL particle number may provide a clearer view of risk, and why cardiovascular disease is never about one single factor. Instead, it is about the full internal environment: inflammation, endothelial function, blood flow, plaque stability, lifestyle, and diet.Rip and Dr. Chong also explore the limits of coronary artery calcium scores, the risks of relying on a “zero” score too early in life, and why soft plaque can still pose a serious threat even when calcified plaque is not detected.They also discuss saturated fat, heme iron, blood viscosity, hydration, testosterone therapy's potential effect on red blood cell count, and the fascinating protective layer inside our blood vessels known as the glycocalyx.This conversation is a reminder that cardiovascular prevention is about building a body that supports vitality from the inside out.You'll Learn:LDL cholesterol matters, but ApoB and LDL particle number may offer a more precise picture of cardiovascular risk.The longer LDL particles remain elevated, the greater the potential risk over time.Saturated fat can interfere with the body's ability to clear LDL particles from the bloodstream.Coronary artery calcium scores can be useful, but they do not detect soft, non-calcified plaque.A calcium score of zero does not always mean “clean arteries,” especially in younger people.Lipoprotein(a), or Lp(a), is an important marker to test at least once.Dr. Chong recommends looking at a broader cardiovascular panel, including lipids, ApoB, Lp(a), A1C, and hs-CRP.Heme iron from red meat is absorbed differently than non-heme iron from plants and may contribute to oxidative stress when elevated.Blood viscosity — or how “thick” your blood is — can influence endothelial function and plaque formation.Hydration, plant foods, and, in some cases, blood donation may help support healthier blood viscosity.The glycocalyx is a delicate, hair-like protective layer that supports endothelial function.A whole food, plant-based lifestyle remains one of the most powerful foundations for vascular health.Learn More About our 2026 Live PLANTSTRONG Events: https://plantstrongevents.com/ Let Us Help Your PLANTSTRONG JourneyLearn More About Our Corporate Wellness Program: https://liveplantstrong.com/corporate-wellness/ COMPLEMENT: Use code PLANTSTRONG for 30% off at https://lovecomplement.com/pages/plantstrong-special-offer Follow PLANTSTRONG and Rip Esselstynhttps://plantstrong.com/ https://www.facebook.com/GoPlantstrong https://www.instagram.com/goplantstrong/https://www.instagram.com/ripesselstyn/ Follow the PLANTSTRONG Podcast and Give the Show a 5-star RatingApple PodcastsSpotifyWatch on YouTubeEpisode Webpage

Can one exercise help lower blood pressure naturally? Discover a simple exercise that can help support healthy blood pressure and cardiovascular health.

Commentary by Dr. Kenichi Sakakura.

Approximately 95% of SCAD cases (spontaneous coronary artery dissection) occur in women--even young women who do not have typical cardiovascular risk factors. Guests Eileen Handberg, PhD, ANP-BC, FAHA, FACC, FPCNA, and Maggie Teliska describe SCAD from both a clinical and patient standpoint: symptoms, diagnosis and misdiagnosis, treatments, advocating for yourself, and the importance of the SCAD registry in moving the science forward.Related resources:scadalliance.orgwomenheart.orgHeberden's symptom description from 1800s: https://pmc.ncbi.nlm.nih.gov/articles/PMC2989494/PCNA Article: Cardiovascular Health in Women: https://pcna.net/news/cardiovascular-health-in-women-beyond-the-basics/See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Heart disease kills one person every 40 seconds. That number hasn't changed in 30 years. Dr. John Osborne, a preventive cardiologist with two doctorates and 29 years in practice, has spent his career on a single question: why do we screen for cancers that kill a few percent of us and do nothing for the disease that kills 40%? In this episode, Jeremy and Jason sit down with Dr. Osborne to get the real story on cardiac CT with AI — the imaging technology that can detect, quantify, and track arterial plaque at sub-millimeter resolution, years before symptoms appear. If you track your bloodwork, wear a fitness device, or consider yourself health-forward — this is the conversation that fills the gap nobody warned you about.(Note: This episode was originally published March 16th, 2026)Guest Link:https://clearcardio.com/Key Moments:00:00 — Dr. Osborne's case for preventive cardiology: why heart disease is the most under-screened killer02:43 — How cardiac CT evolved from "iPhone 0.5" to the 2026-era AI-powered tool he uses today05:35 — Why he gave up stress tests and heart caths in 2005 and never looked back08:16 — What AI actually adds: seeing and quantifying plaque invisible to the human eye, down to 0.1 cubic millimeters10:13 — When insurance pays for cardiac CT — and when it doesn't (the preventive gray zone)14:50 — The “cardiac colonoscopy” concept: the case for screening before symptoms, not after18:11 — Coronary artery calcium score: the accessible $100 starting point, and what it can and can't tell you31:54 — Lifestyle essentials: the 50% of risk that's modifiable regardless of genetics35:00 — Family history decoded: why your sibling's heart history matters more than your parents'36:12 — Nicotine myth-busting: Dr. Osborne on the "health guru" nicotine fad and why he thinks it's dangerous38:05 — Supplements under scrutiny: natokinase, fish oil, red yeast rice — what the actual RCT data says

In the final episode, Salvatore Brugaletta explores the future of percutaneous coronary intervention, including AI-assisted decision-making, personalised device selection, and next-generation coronary therapies. Discover how innovation could further improve outcomes for patients with coronary artery disease.  Timestamps:  0:50 – 10 years from now  2:17 – AI  3:47 – Personalised medicine  5:34 – Breakthroughs   7:02 – Salvatore's vision

Salvatore Brugaletta joins host Catherine Glass to explore how intracoronary imaging has transformed modern percutaneous coronary intervention (PCI). From intravascular ultrasound and optical CT to stent optimisation, vascular dysfunction, and AI-enhanced image interpretation, this episode examines the technologies improving procedural precision and patient outcomes.  Timestamps:  0:55 – IVUS and OCT  2:58 – Endothelial recovery  4:55 – Stent failure mechanisms  6:19 – Barriers to adoption  8:18 – Innovations in imaging 

Send us Fan MailHello Fellow Airgun Geeks,In this episode of The Airgun Geeks Podcast, Bill Ruehl and Patrick Schmitz sit down for one of the most personal and important episodes we've ever recorded. Bill shares the story of a near-fatal coronary issue that almost claimed his life, what happened, how close it really was, and why he's grateful to still be here talking airguns with the community.But this episode is not only about Bill's health scare. We also dig into major updates from the competitive airgun world, including what's happening in field target, benchrest, precision airgun shooting, and the growing world of organized airgun competition. If you follow PCP airguns, pellet guns, slug guns, airgun matches, or the broader airgun industry, this episode covers a lot of ground.Bill and Pat also talk about new airgun announcements, upcoming gear, industry movement, and what airgunners should be paying attention to as the sport continues to grow. We also share the current plans for the Airgun Geeks Shooting Team, including what Bill and Pat are working toward, future competitions, team goals, and how we plan to represent the Airgun Geeks community on the firing line.Whether you're a competitive shooter, backyard plinker, PCP airgun owner, hunter, field target competitor, benchrest shooter, or just part of the Airgun Geeks family, this episode is packed with real talk, airgun news, personal perspective, and the kind of conversation that reminds us why this community matters. Like this video if you support Bill, Pat, and the Airgun Geeks Shooting Team. Drop a comment below: Have you had a wake-up call that changed how you look at life, shooting, or competition? Subscribe to The Airgun Geeks Podcast for airgun news, PCP airgun talk, product announcements, competition coverage, and conversations with the people shaping the sport.Some links may be affiliate links. Purchases made through those links may support the channel at no additional cost to you. Thank you for helping us keep the Airgun Geeks Podcast going.Suggested Hashtags#AirgunGeeks #AirgunPodcast #PCPAirguns #CompetitiveAirgun #AirgunCompetition #FieldTarget #BenchrestShooting #AirgunNews #PelletGun #AirgunCommunitySupport the show

The newest AHA and ACC guidelines for treating dyslipidemia are here — and according to Dr. Kim Williams, they mark a powerful shift toward prevention, earlier testing, and whole-food, plant-based nutrition as the foundation of cardiovascular care.Rip welcomes back Dr. Kim Williams, past president of the American College of Cardiology, for a practical and deeply encouraging breakdown of what these updated cholesterol guidelines mean for everyday people.Dr. Williams explains why cardiovascular risk is no longer just about one cholesterol number. Instead, clinicians are being encouraged to look at the whole picture: LDL cholesterol, ApoB, Lp(a), inflammation, blood pressure, blood sugar, kidney function, family history, lifestyle, and coronary artery calcium when appropriate.The most exciting part for the PlantStrong community? Lifestyle optimization is now treated as the clinical foundation — and Dr. Williams is clear about what that means: a whole-food, plant-based diet built around beans, grains, nuts, seeds, fruits, vegetables, and mushrooms, along with exercise, sleep, mindfulness, strong social connections, and avoidance of tobacco, alcohol, and other harmful substances.This conversation also tackles statins, PCSK9 inhibitors, Lp(a), coronary calcium scoring, and the new philosophy of treating risk lower, earlier, and longer — always with food first, and medication when needed.Key TakeawaysThe new cholesterol guidelines emphasize lifestyle first, not lifestyle as an afterthought.Dr. Williams says a whole-food, plant-based diet should be built around beans, grains, nuts, seeds, fruits, vegetables, and mushrooms.LDL cholesterol is still important, but it is no longer the only number that matters.ApoB may give a clearer picture of risk in some people, especially those with diabetes, high triglycerides, or central obesity.Lp(a) is largely genetic and should be measured at least once in adulthood; the 2026 guideline includes updated recommendations for elevated Lp(a).Coronary artery calcium scoring can help personalize risk and guide LDL targets.Dr. Williams emphasizes that the goal is not “plants versus statins.” It is whole plant foods first, medications when needed.The overall prevention philosophy is: lower, earlier, longer.Watch the Episode on YouTube: https://youtu.be/6cD8tGpsAggLearn More About our 2026 Live PLANTSTRONG Events: https://plantstrongevents.com/ Let Us Help Your PLANTSTRONG JourneyLearn More About Our Corporate Wellness Program: https://liveplantstrong.com/corporate-wellness/ COMPLEMENT: Use code PLANTSTRONG for 30% off at https://lovecomplement.com/pages/plantstrong-special-offer Follow PLANTSTRONG and Rip Esselstynhttps://plantstrong.com/ https://www.facebook.com/GoPlantstrong https://www.instagram.com/goplantstrong/https://www.instagram.com/ripesselstyn/ Follow the PLANTSTRONG Podcast and Give the Show a 5-star RatingApple PodcastsSpotify

This episode is part of our comprehensive Decipher the Guidelines Series covering the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes.  The following question refers to Section 5.2.1 of the 2025 ACS Guidelines. The question is asked by Thomas Jefferson medical student and CardioNerds Academy Intern Dr. Grace Qiu, answered first by Henry Ford Interventional cardiology fellow and member of the CardioNerds Interventional Cardiology Council Dr. Li Pang, and then by expert faculty Dr. Michelle O'Donoghue. Dr. O'Donoghue is a cardiologist, senior investigator with the TIMI Study Group, and Associate Professor of Medicine at Harvard Medical School who holds the McGillycuddy-Logue Endowed Chair in Cardiology at Brigham and Women's Hospital. She was the Vice Chair of the Writing Committee for the 2025 ACS Guidelines. Question #2 A 63-year-old woman presented to the emergency room for chest pain. She described having exertional chest pain for the past two months and had an episode of severe pain after dinner 3 days ago. She went to bed and slept it off.  She told her children today at a family gathering, and was immediately brought to the ED by her daughter. She has a history of hypertension and hyperlipidemia. She was asymptomatic and normotensive in the ED. Labs show a down-trending troponin and an elevated NT-proBNP but are otherwise unremarkable. Her ECG showed Q waves with ST elevation in V2-V4. She was treated with aspirin and heparin drip, and taken to the cath lab. Coronary angiogram showed complete proximal LAD occlusion with right-to-left collaterals, without significant residual disease elsewhere. She remains asymptomatic and is stable, both hemodynamically and electrically. What is the next best step with regard to reperfusion and anti-thrombotic management? A Proceed with primary PCI to LAD  B Medical management with aspirin and enoxaparin  C Medical management with aspirin and clopidogrel D Medical management with aspirin and ticagrelor   Answer #2 Explanation  The Correct answer is D In patients who are stable with STEMI and have a totally occluded infarct-related artery >24 hours after symptom onset and are without evidence of ongoing ischemia, acute severe HF, or life-threatening arrhythmia, PPCI should not be performed due to lack of benefit. (Class 3, LOE B-R) The benefit of PPCI begins to diminish after >12 hours from symptom onset, but there appears to be continued benefit through approximately 24 hours.  In stable asymptomatic patients with an occluded artery >48 hours after symptom onset, routine PCI has not been shown to be beneficial in the absence of ongoing ischemia. The relative utility of routine PCI for asymptomatic patients with STEMI between 24 and 48 hours from symptom onset is less rigorously tested. PCI is not recommended for an occluded infarct-related artery if the patient is asymptomatic and has a completed infarct. MACE outcomes were similar in those with an occluded infarct-related artery who underwent medical therapy versus those who underwent PCI 3 to 28 days after an MI (Occluded Artery Trial [OAT]), and results were no different at 7-year follow-up. Similar findings were noted in the DECOPI (Desobstruction Coronaire en Post-Infarctus) trial, which enrolled patients with an occluded artery and Q waves on the ECG presenting 2 to 15 days after symptom onset. However, coronary revascularization should be considered for patients with late presentations with continued signs and symptoms of ischemia, including cardiogenic shock, acute severe HF, persistent angina, and life-threatening arrhythmias.  Main Takeaway In patients who are stable with STEMI who have a totally occluded infarct-related artery >24 hours after symptom onset and are without evidence of ongoing ischemia, acute severe HF, or life-threatening arrhythmia, PPCI should not be performed due to lack of benefit. Guideline Loc. Section 5.2.1 

Avgas hit 8.85 a gallon, so the $100 hamburger is now a $300 hamburger, and if you're renting, congratulations, it's a $1,000 hamburger. Brian, Ben, and Ted dig into how midlifers actually keep flying when fuel costs go vertical: pull the power back and trade five knots for four gallons an hour, cast a wide net for a safety pilot to split the cost, chase the cheapest fuel 50 miles out, and rediscover this thing called "morning." The feedback bag is stacked this week. The Tuba Guy writes in from the Boston Symphony, 13 years out of the cockpit and finding his way back. Listener Jason followed in Brian's footsteps to Drift Aviation and got hooked on the J-3 Cub. And Cassie, a brand-new private pilot, relies on the show for her weekly "aviation friend fix," which nearly earns her 30 instant pilot friends in Portland whether she wants them or not.Plus a legendary 1 Dull Geek Rant on the the eternal question of where exactly you're supposed to do your run-up. Brian's new VFR cross-country course is at makesmallcorrections.com.Mentioned on the show:* Catherine Cavagnaro: https://aceaerobaticschool.com/* Justin Tidwell, Flywell Aviation: https://www.flywellaviation.com/aboutus* AC Super Decathlon: https://en.wikipedia.org/wiki/American_Champion_Decathlon* Coronary artery disease: https://en.wikipedia.org/wiki/Coronary_artery_diseaseiep141* Getting a medical with coronary artery disease: https://www.faa.gov/ame_guide/media/Coronary_Heart_Disease_Disposition_Table.pdf* Episode 141 - Every pilot is creative somehow: https://podcasts.apple.com/us/podcast/ep141-every-pilot-is-creative-somehow-tim-lien-from/id1591463789?i=1000721686629* Bill Burr- helicopter bit: https://www.youtube.com/watch?v=S9ZSzuj1UpA* The Ultimate Guide to Becoming a Midlife Pilot- second edition! https://midlifepilotpodcast.com/#guide* Lambert's throwed rolls: https://throwedrolls.com/* RYY airport diagram: https://www.aopa.org/ustprocs/20260611/SE-4/ryy_airport_diagram.pdf* Brian's "the long way" ground course: https://makesmallcorrections.com/Support the show! www.midlifepilotpodcast.com

Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Associations of Central Adiposity With Subclinical Coronary Calcification and Disease Progression: Meta-Analysis of 68,629 Participants.

Heart disease often develops silently for decades before symptoms ever appear, which is why early detection can be one of the most powerful tools for protecting long-term health and longevity.     On today's show, I break down the Coronary Artery Calcium (CAC) Score, also known as the Agatston Score, and why it may be one of the most important cardiovascular screening tools for adults over 40.     We'll explore what this scan measures, how the scoring system works, and what different score ranges may reveal about your future heart disease risk.     I'll also explain the limitations of the test, why plaque buildup can begin long before symptoms arise, and how lifestyle, inflammation, blood sugar balance, and other health markers all play a role in cardiovascular health.     Most importantly, you'll learn why prevention and early awareness matter so much, and how foundational health habits may help support long-term heart health and healthy aging.     So join me on today's Cabral Concept 3772 as we take a closer look at the CAC Score and what it may reveal about your cardiovascular health and longevity.   - - - For Everything Mentioned In Today's Show: StephenCabral.com/3772 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

Heart disease often develops silently for decades before symptoms ever appear, which is why early detection can be one of the most powerful tools for protecting long-term health and longevity.     On today's show, I break down the Coronary Artery Calcium (CAC) Score, also known as the Agatston Score, and why it may be one of the most important cardiovascular screening tools for adults over 40.     We'll explore what this scan measures, how the scoring system works, and what different score ranges may reveal about your future heart disease risk.     I'll also explain the limitations of the test, why plaque buildup can begin long before symptoms arise, and how lifestyle, inflammation, blood sugar balance, and other health markers all play a role in cardiovascular health.     Most importantly, you'll learn why prevention and early awareness matter so much, and how foundational health habits may help support long-term heart health and healthy aging.     So join me on today's Cabral Concept 3772 as we take a closer look at the CAC Score and what it may reveal about your cardiovascular health and longevity.   - - - For Everything Mentioned In Today's Show: StephenCabral.com/3772 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

Commentary by Dr. Jian'an Wang.

In this episode of The Atrium, host Dr. Alice Copperwheat speaks with Dr. Elan Burton, clinical associate professor in the Department of Cardiothoracic Surgery at the Stanford University School of Medicine and Section Chief for Stanford Medicine Affiliates, about distal coronary anastomosis. Chapters  00:00 Intro  01:08 Why CT Surgery?  03:01 Overview & History  05:02 Geometric Planning & Hemodynamics  10:40 Sequential & Composite Configurations  16:23 Y or T Grafts  21:21 Step-by-Step, Suturing  30:37 Endarterectomy  36:37 Intraop Quality Assurance  40:29 Failed Mechanisms & Pitfalls  43:18 Future Trends  45:54 Summary  47:03 Surgery Training Advice  They discuss the history of distal coronary anastomosis, geometric planning, and hemodynamics, as well as sequential grafting and composite configurations, including Y and T grafts. The conversation also covers arteriotomy, suturing techniques, and the continuous parachute method. Additionally, they delve into the traction technique, open direct vision, and intraoperative quality assurance, including pulsatility index. Furthermore, they examine failure mechanisms such as graft kinking and explore future trends. The Atrium is a monthly podcast presenting clinical and career-focused topics for residents and early career professionals across all cardiothoracic surgery subspecialties. Keep an eye out for next month's episode. Disclaimer The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.

With Edoardo Conte and Daniele Andreini, Galeazzi-Sant'Ambrogio Hospital IRCCS, Milan - Italy and Gal Tsaban, Mayo Clinic, Rochester - USA. Link to paper Link to editorial

This week we review a recent work from the CT group at NY Presbyterian assessing the impact of phenylephrine during pediatric congenital CT scans to lower heart rate. Why is a lower heart rate better for CCT's? Should this agent be routinely employed for this indication during CT scans in children? Dr. Yosef Cohen, pediatrics resident at the Children's Hospital at Montefiore shares his insights from a recent work he co-authored. doi: 10.1093/ehjimp/qyag023. eCollection 2025 Aug.

In this sponsored episode from Novartis Pharmaceuticals Corporation, a leading preventive cardiologist walks through the 2026 cholesterol guideline update and what it means in practice. Seth J. Baum, a Columbia-trained preventive cardiologist, founder of Flourish Research, chairman of the Family Heart Foundation, and past president of the American Society of Preventive Cardiology, breaks down the major changes in the March 2026 ACC and AHA guideline release. You will hear why LDL targets are explicit again after nearly a decade, why universal lipoprotein A screening is now recommended, why a coronary calcium score above 300 places a patient in the highest-risk treatment tier, and why apolipoprotein B measurement can refine risk assessment when LDL is at goal. Baum also covers the alternatives available when a patient cannot tolerate a statin, including ezetimibe, PCSK9 inhibitors, inclisiran, and bempedoic acid, along with practical framing for the statin-hesitant patient. You will also hear his approach to discussing cholesterol with patients, from the science of lipoprotein physiology to the case for earlier and more aggressive lipid-lowering treatment. Dr. Baum was not compensated for his participation in today's episode. The opinions expressed are his alone and do not represent the opinions of Novartis Pharmaceuticals Corporation. At Novartis, our mission is to ensure no heart is lost too soon. We envision a world where preventable CV deaths are no longer part of our lives. We're proud of the positive impact we've made over the past 40 years and remain dedicated to tackling the most challenging problems in CVD. Through cutting-edge science and technology, we are focusing on areas of high unmet need, including scaling our xRNA platform across multiple risk factors and pioneering breakthroughs for genetically driven CVD risk factors and common heart conditions, including atrial fibrillation. We also work with patients, healthcare professionals, and organizations around the world to improve CV care beyond medicine alone. Together, we can help people with CVD enjoy longer, healthier lives and more time with their loved ones. Learn more here: https://Novartis.us/cardiovascular-disease VISIT SPONSOR → https://Novartis.us/cardiovascular-disease SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

How do you turn your patients' calcium scores into clear, personalized prevention plans? Credit available for this activity expires: 4/28/27 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/episode-two-cracking-code-coronary-artery-calcium-cac-2026a1000clt?ecd=bdc_podcast_libsyn_mscpedu

Paclitaxel-coated Versus Uncoated Balloon For Coronary In-stent Restenosis - Three-year Outcomes Of The Agent Ide Trial

Send us Fan MailIn this episode, we break down everything you need to know about coronary angiography. Written by: Dr. Luke MacLeod. Reviewed by: Drs. Michael Ward and Alison Lai.Support the show

INNOVATION COMPETITION: Retrievable Scaffold Therapy: The Spur Elute Coronary Retrievable Scaffold System

Tom Looby, CEO of Conavi, is focused on developing hybrid intravascular imaging technology that combines two established modalities into a single imaging catheter to provide a comprehensive view of the coronary arteries. This eliminates blind spots when using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT) alone and is driving a shift away from relying solely on traditional angiography toward the use of advanced intravascular imaging to guide coronary procedures. Using AI to analyze dual-stream co-registered data allows interventional cardiologists to more accurately assess lesions, determine the appropriate stent size, and ensure proper placement, thereby reducing cardiac death and blood clots around stents. Tim explains, "So our technology is an imaging catheter. We're unique in that we combine two imaging modalities that are already well established in the market. But because each of them has blind spots, by combining them into a single catheter, we remove those blind spots, and we think we produce the best imaging catheter to help guide coronary interventions."   "It is well known that these strengths and weaknesses occur in both ultrasound and optical imaging. But to set the stage, this is a trend happening in the marketplace. There are four million angioplasty stenting procedures performed each year, and most of them rely solely on traditional angiography. Most of your audience probably knows that angiography is an X-ray that uses a contrast agent, so you're seeing the vasculature around the heart through a secondary image. The detailed view inside the blood vessels is limited when using only angiography, which has restricted the types of procedures doctors have been able to perform over time. Recognizing that intravascular ultrasound, sometimes called IVUS, and separately, OCT—short for optical coherence tomography—were developed independently to examine inside the blood vessel." #Conavi #CardiovascularImaging #InterventionalCardiology #MedicalDevice #HeartHealth #Innovation #IVUS #OCT #AIinHealthcare #CardiacIntervention #HealthTech #Medtech #Cardiology #HybridImaging Conavi.com Download the transcript here  

Tom Looby, CEO of Conavi, is focused on developing hybrid intravascular imaging technology that combines two established modalities into a single imaging catheter to provide a comprehensive view of the coronary arteries. This eliminates blind spots when using either intravascular ultrasound (IVUS) or optical coherence tomography (OCT) alone and is driving a shift away from relying solely on traditional angiography toward the use of advanced intravascular imaging to guide coronary procedures. Using AI to analyze dual-stream co-registered data allows interventional cardiologists to more accurately assess lesions, determine the appropriate stent size, and ensure proper placement, thereby reducing cardiac death and blood clots around stents. Tim explains, "So our technology is an imaging catheter. We're unique in that we combine two imaging modalities that are already well established in the market. But because each of them has blind spots, by combining them into a single catheter, we remove those blind spots, and we think we produce the best imaging catheter to help guide coronary interventions."   "It is well known that these strengths and weaknesses occur in both ultrasound and optical imaging. But to set the stage, this is a trend happening in the marketplace. There are four million angioplasty stenting procedures performed each year, and most of them rely solely on traditional angiography. Most of your audience probably knows that angiography is an X-ray that uses a contrast agent, so you're seeing the vasculature around the heart through a secondary image. The detailed view inside the blood vessels is limited when using only angiography, which has restricted the types of procedures doctors have been able to perform over time. Recognizing that intravascular ultrasound, sometimes called IVUS, and separately, OCT—short for optical coherence tomography—were developed independently to examine inside the blood vessel." #Conavi #CardiovascularImaging #InterventionalCardiology #MedicalDevice #HeartHealth #Innovation #IVUS #OCT #AIinHealthcare #CardiacIntervention #HealthTech #Medtech #Cardiology #HybridImaging Conavi.com Listen to the podcast here  

Full article: https://www.ajronline.org/doi/10.2214/AJR.25.34334  The PET/CT examinations commonly obtained in patients with cancer provide additional information that can be used for nononcologic prognostication. Radhika Rajeev, MD, discusses the AJR article by Kim et al. exploring the role of visual ordinal coronary calcium scoring on routine FDG PET/CT examinations in predicting perioperative outcomes.

Welcome to this podcast from the Medical Journal of Australia. My name is Sally Block, the MJA's news and online editor.  “The MJA acknowledges the Traditional Owners and Custodians of the land on which we live and work across Australia.  This podcast was recorded on the lands of the Gadigal people of the Eora Nation  I pay my respects to their Elders past and present.” The MJA has recently published the Australian Clinical Guideline for Diagnosing and Managing Acute Coronary Syndromes 2025. Professor Garry Jennings AO has a distinguished career as a cardiologist in clinical practice and was previously Director of Cardiology at The Alfred Hospital, Melbourne, and Chair of the Division of Medicine. He is the Heart Foundation's Chief Medical Advisor. Professor Jennings is a co-author of the Guideline and joins me now.

Stephen is a Carnivore & Keto Coac, Specialist Practitioner in Obesity & Diabetes, Personal Trainer, and Qualified Phlebotomist for blood tests

Heart disease kills one person every 40 seconds. That number hasn't changed in 30 years. Dr. John Osborne, a preventive cardiologist with two doctorates and 29 years in practice, has spent his career on a single question: why do we screen for cancers that kill a few percent of us and do nothing for the disease that kills 40%? In this episode, Jeremy and Jason sit down with Dr. Osborne to get the real story on cardiac CT with AI — the imaging technology that can detect, quantify, and track arterial plaque at sub-millimeter resolution, years before symptoms appear. If you track your bloodwork, wear a fitness device, or consider yourself health-forward — this is the conversation that fills the gap nobody warned you about.Guest Link:https://clearcardio.com/Key Moments:00:00 — Dr. Osborne's case for preventive cardiology: why heart disease is the most under-screened killer02:43 — How cardiac CT evolved from "iPhone 0.5" to the 2026-era AI-powered tool he uses today05:35 — Why he gave up stress tests and heart caths in 2005 and never looked back08:16 — What AI actually adds: seeing and quantifying plaque invisible to the human eye, down to 0.1 cubic millimeters10:13 — When insurance pays for cardiac CT — and when it doesn't (the preventive gray zone)14:50 — The “cardiac colonoscopy” concept: the case for screening before symptoms, not after18:11 — Coronary artery calcium score: the accessible $100 starting point, and what it can and can't tell you31:54 — Lifestyle essentials: the 50% of risk that's modifiable regardless of genetics35:00 — Family history decoded: why your sibling's heart history matters more than your parents'36:12 — Nicotine myth-busting: Dr. Osborne on the "health guru" nicotine fad and why he thinks it's dangerous38:05 — Supplements under scrutiny: natokinase, fish oil, red yeast rice — what the actual RCT data says

Episode 215: Meth-associated HFrEF.   Abishak and Zat (medical students) explain the cardiotoxic effect of methamphetamine and the diagnosis and treatment of heart failure with reduced ejection fraction (HFrEF). Dr. Arreaza adds insight into the reversibility of meth-associated HFrEF.   Written by Abishak Govindarajan, MSIV and Zat Akbar Shaw. American University of the Caribbean. Edits and comments by Hector Arreaza, MD. Welcome Dr. Arreaza: Welcome to Rio Bravo qWeek. My name is Hector Arreaza, family physician, faculty and associate program director of the Clinica Sierra Vista/Rio Bravo Family Medicine Residency Program. Today we will explore heart failure with reduced ejection fraction, a high-yield and clinically relevant topic in medicine. We will discuss the role of methamphetamine use in the development of HFrEF. This is a pressing issue because about 0.8% of the population 12 and older in the US reported using methamphetamine within the past 12 months in 2024 (National Survey on Drug Use and Health, NSDUH), that's about ≈2.4 million people!We are joined by two aspiring physicians who will help explore this topic. By the way, we will refer to methamphetamine in this episode as “meth”. [Abishak and Akbar introduce themselves] Abishak: [Introduce yourself] The role of meth in HFrEF Dr. Arreaza: Meth is a growing problem in many places, including Bakersfield, where we live. Meth is also known as Meth Crystal, Poor man's cocaine, Ice, Glass, Crank, Speed, Chalk, and Tina. How does meth contribute to the development of HFrEF? Abishak: So, first, let's understand how methamphetamine works. It has a chemical structure similar to dopamine and norepinephrine, and it gets taken up through the neuron transporter proteins. Once it enters the synaptic vesicles (storage sacs for neurotransmitters), it displaces and forces the release of large amounts of dopamine, norepinephrine, and serotonin into the synapse (the space between neurons). Additionally, meth blocks the reuptake of those neurotransmitters into the neuron, ensuring they remain in the synapse for a prolonged period. All this causes a downstream effect of increased sympathetic pathways in the body. Diagnosis Dr. Arreaza: The diagnosis starts with collecting a good history and performing a complete physical exam, and then we confirm with an echocardiogram.  Abishak: Yes, diagnosis requires both symptoms consistent with heart failure and objective evidence of reduced ejection fraction. Echocardiography is the primary diagnostic tool. We also measure BNP. In certain cases, cardiac MRI is used to evaluate myocardial fibrosis and exclude infiltrative or inflammatory etiologies. Coronary angiography may be performed if ischemic disease is suspected.Guideline-Directed Medical Therapy Dr. Arreaza: GDMT Guideline-Directed Medical Therapy started around 1987 when ACE inhibitors were proven to improve mortality in patients with heart failure. Then, during the following decades, many medications have been added to GDMT. Until around 2019–2022 we came out with the main 4 groups of medications that we know as GDMT. Let's talk about GDMT. Akbar: There are four core pillars in GDMT. First, an angiotensin receptor-neprilysin inhibitor, such as sacubitril with valsartan (Entresto), is preferred over ACE inhibitors when tolerated. This medication reduces mortality and heart failure hospitalizations. Second, evidence-based beta blockers including carvedilol, metoprolol succinate, or bisoprolol are used to reduce sympathetic overactivity and improve ventricular remodeling. Third, mineralocorticoid receptor antagonists such as spironolactone or eplerenone reduce fibrosis and improve survival. The Fourth pillar is SGLT2 inhibitors such as dapagliflozin or empagliflozin, which provide significant reductions in heart failure hospitalizations and cardiovascular mortality, regardless of diabetes status. Abishak: Other main parts of the treatment are diuretics, which are used for symptom control but do not reduce long-term mortality. Dr. Arreaza: As a recap: The current 4 pillars of GDMT are: ARNI/ACEi + β-blocker + MRA + SGLT2i)  Beta Blocker Considerations Dr. Arreaza: Sometimes we may be concerned about using beta blockers in active meth users. What did you read about it? Abishak: Historically, there was concern about unopposed alpha stimulation. However, in chronic heart failure, beta blockers remain essential. Carvedilol is often favored because it provides both alpha and beta blockade. Careful titration and close monitoring are critical.Reversibility and Remodeling Dr. Arreaza: Regarding meth-associated HFrEF, we have good news for meth users. Tell us about how reversible this condition is.  Akbar: It can be reversible. One of the most important aspects of this condition is that significant reverse remodeling may occur if the patient stops methamphetamine use and adheres to medical therapy. The Left ventricular ejection fraction can improve substantially and, in some cases, normalize. On the other end of the spectrum, continued meth use may lead to progressive fibrosis, ventricular dilation, and potentially irreversible damage, leading to death.Complications of meth-associated HFrEF Abishak: These patients are at increased risk for ventricular arrhythmias, sudden cardiac death, left ventricular thrombus formation, and progressive pulmonary hypertension. If the ejection fraction remains below 35 percent after at least three months of optimized therapy, implantable cardioverter-defibrillator (known as ICD) placement should be considered for primary prevention.Addiction Treatment as Core Therapy Dr. Arreaza: It sounds like GDMT cannot be done without talking about meth use disorder treatment. Akbar: Absolutely. Treating the myocardium without addressing the substance use disorder is ineffective. Primary care providers can be trained to manage addictions, but if resources are available, you can place a referral to addiction medicine, psychiatric support, behavioral therapy, and social support services. This is an essential part of the treatment. Sustained abstinence is the single most powerful predictor of recovery.Prognosis Abishak: Prognosis is highly dependent on abstinence. Patients who stop using methamphetamine often experience meaningful improvement in EF and even return to normal.  Dr. Arreaza: Yes, the key factor is complete abstinence, plus standard heart failure treatment. If the damage is mostly functional and inflammatory, recovery is possible. If there is extensive fibrosis (scar) recovery is less likely. Observational studies have shown that patients with meth-associated cardiomyopathy who stop using meth have significant improvement in EF over 3–12 months, fewer hospitalizations, and lower mortality. Akbar: Absolutely. Not all meth-associated cardiomyopathy behaves the same way. The extent of fibrosis determines recovery potential. Cardiac MRI with late gadolinium enhancement can help us estimate scar burden. Patients with minimal fibrosis often have better improvement with abstinence and medical therapy. Dr. Arreaza: So, MRI can actually help us determine the prognosis. Abishak: Yes, very much so. If MRI shows extensive fibrosis, the likelihood of full EF recovery is lower. That information helps us counsel patients more accurately. Akbar: Another key issue is right ventricular involvement. Methamphetamine can affect both ventricles. When the right ventricle fails, patients may develop severe peripheral edema, ascites, and hepatic congestion. Right ventricular dysfunction also worsens prognosis significantly. Dr. Arreaza: And pulmonary hypertension can also worsen the whole picture.  Akbar: That's correct. Meth is associated with pulmonary arterial hypertension independently of left-sided heart failure. In some patients, you may see a combined picture of both pulmonary vascular disease and right ventricular dysfunction. That can make management more complicated because pulmonary pressures may remain elevated even after EF improves. Dr. Arreaza: Tells us about the role of BNP in monitoring these patients.  Abishak: Serial BNP levels can help track response to therapy. Additionally, troponin may be elevated at times in meth users due to myocardial injury. Monitoring renal function is critical because many heart failure medications affect kidney function and potassium levels. Akbar:Other lifestyle modifications include sodium restriction, regular follow-ups, vaccination, and avoidance of other cardiotoxic substances such as alcohol or cocaine. Sleep disorders, especially OSA, should be evaluated because untreated OSA worsens heart failure outcomes. Dr. Arreaza: WhatIs there any role for wearable devices or remote monitoring? Abishak: Yes, increasingly so. Remote weight monitoring, blood pressure tracking, and symptom reporting can reduce hospitalization. In select patients, implantable hemodynamic monitors may help detect rising filling pressures before symptoms occur. Dr. Arreaza: It was a great discussion. Thank you, Abishak and Akbar for bringing all that valuable information to us. Let's wrap it up.     

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