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13 episodes with ecgs
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6 episodes with ecgs
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3 episodes with ecgs
2 episodes with ecgs
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Hundreds of approved devices use artificial intelligence to help physicians diagnose patients faster and more accurately. Brooke & Associates is a legal and regulatory advisory firm that helps medical device makers get AI-powered devices through FDA pre-market approval.In Episode #40 of the MedTech Speed to Data podcast, Key Tech's Andy Rogers and Lei Zong speak with the firm's managing member, Jason Brooke, about the FDA's latest guidance to medical device developers for integrating AI into their products.Need to knowAI's role in MedTech — AI identifies otherwise undetectable data patterns that humans can apply in clinically meaningful ways.FDA's AI staffing surges — The agency accelerated hiring to develop internal AI applications and support pre-market reviews of new AI-powered devices.Radiological imaging leads the pack — More than half of 900+ FDA-approved AI-based products are in radiological imaging.Other fields are catching up — Cardiology and neurology applications are more recent entrants in AI-powered devices, but their numbers are growing.The nitty-grittyThe FDA published “Artificial Intelligence-Enabled Device Software Functions: Lifecycle Management and Marketing Submission Recommendations” in early 2025 to explain how it will address AI's adaptive nature in medical device regulation.“This guidance is really focused on a total product lifecycle approach,” Brooke explains.Good management practices govern traditional medical device development, so documenting the development process in pre-market submissions is not as critical. AI model development is different because the model can evolve once in service.“There's a level of information that's necessary in submissions for AI-based technologies that we haven't had to provide to the FDA before,” Brooke says. “They want a lot of information,” Brooke says. “That's an area I think may be problematic because a lot of that is somewhat trade secret.”AI-specific guidance touches almost every aspect of a company's submission, from risk assessment to labeling to cybersecurity. Brooke highlighted how the FDA's approach to AI data management could change development practices to ensure the independence of training and validation data sets. For example, companies must separate their clinical sites geographically and temporally.“This guidance gets into the weeds,” Brooke says. “It's important for companies to understand this if they're developing an AI-based product.”Data that made the difference:In addition to discussing the FDA's proposed AI regulations, Brooke discusses the challenges companies face in bringing AI-powered medical devices to market.“If you take away anything from this podcast,” Brooke says, “it's that there's a lot of burden associated with developing an AI-based medical device. If you don't need to, then I wouldn't recommend doing it.”Slow and steady wins the race. Do your homework, plan for the FDA review, and then engage the agency at the right time to get them on board.Thoroughly characterize your data sources. Devices like ECGs can vary by vendor, model, site location, patient, and many other factors. The FDA wants to know how this variability could affect the downstream AI model.Develop a strong clinical validation plan. The FDA will limit claims and require disclosures when a device that performs well overall underperforms among certain patient groups.
Podcast summary of articles from the April 2025 edition of the Journal of Emergency Medicine from the American Academy of Emergency Medicine. Topics include ECGs in cardiac arrest, strep toxic shock syndrome, diabetic ketoacidosis, chest pain work ups, exertional heat stroke, and pulmonary embolism controversies. Guest speaker is Dr. Matthew Carvey.
The JournalFeed podcast for the week of April 21-25, 2025.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Wednesday Spoon Feed:This preplanned subgroup analysis of the TOMAHAWK Trial of patients with ROSC after OHCA found no EKG findings (excluding STEMI) that predicted the presence of coronary artery lesions.Thursday Spoon Feed:In this substudy of the Canadian TIA Score cohort, researchers found score utilization with subsequent MRI imaging could improve the outcome of patients suffering from TIA or stroke, particularly in the medium-risk category, scoring between 4-8 points.
AI and ECGs, novel ways to treat hypertension, combined lipid-lowering therapy after myocardial infarction, PFA and silent stroke, a move toward accountability in AF ablation, and pacing issues in TTVR 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 Help with ECGs in the ED AI Shows Promise for Rapid NSTEMI Diagnosis https://www.medscape.com/viewarticle/ai-shows-promise-rapid-nstemi-diagnosis-2025a10009pw Buscher et al https://doi.org/10.1093/eurheartj/ehaf254 II A Novel way to Treat HTN A Pacemaker to Control BP Gets FDA Breakthrough Designation https://www.medscape.com/viewarticle/pacemaker-control-bp-gets-fda-breakthrough-designation-2025a10009t3 JAHA paper https://www.ahajournals.org/doi/10.1161/JAHA.120.020492 Backbeat https://clinicaltrials.gov/study/NCT06059638 III Type of PFA may matter for Silent Cerebral Lesions Paper https://www.ahajournals.org/doi/10.1161/CIRCEP.125.013719 IV Accountability coming to US AF ablation Heart Rhythm Society Releases a Document on Establishing Centers of Excellence for AF ablation -- Press Release https://www.hrsonline.org/news/new-white-paper-on-atrial-fibrillation-centers-of-excellence/ V Pacing in Patients with Undergoing Transcatheter Tricuspid Valve Replacement Paper https://doi.org/10.1016/j.hrthm.2025.02.004 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
A whistleblower snitched on an allegedly cheating MA plan, leading to a huge negotiated settlement, in our Medicare Advantage Minute. EKGs, ECGs and how Medicare covers them is the subject of our tribute to: "Your Medicare Benefits 2024" The balance of the episode is given over to an analysis of the recorded and requested Medicare supplement rate increases. Conclusion? Medical inflation is still with us and Medicare supplement rate increases exceeding historical averages will plague the industry for the foreseeable future. Contact me at: DBJ@MLMMailbag.com (Most severe critic: A+) Visit us on: BabyBoomer.ORG Inspired by: "MEDICARE FOR THE LAZY MAN 2025; Simplest & Easiest Guide Ever!" on Amazon.com. Return to leave a short customer review & help future readers. Official website: https://www.MedicareForTheLazyMan.com.
To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam.If you don't normally monitor patients as part of your job, I suggest two things:1. Find a system for ECG interpretation that works well for you; and2. Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.Characteristics of first degree heart block.Characteristics of third degree (complete) AV block.Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block.The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn
Mark Goddard, Vice President of Clinical Services at InfoBionic.Ai, a leading authority in cardiac remote monitoring. A registered nurse with over 20 years of experience in clinical electrophysiology, Mark has pioneered service lines across ambulatory ECG, cardiac event monitoring, mobile telemetry and heart failure management in hundreds of institutions. He's also a certified Clinical Cardiac Device Specialist with deep knowledge of subcutaneous monitoring and AI-assisted diagnosticsIn this episode, we explore how AI and real-time ECG data are revolutionising arrhythmia detection, heart failure prediction and patient engagement especially for high-risk groups like those with A-Fib. Mark shares practical insights from the front lines of cardiac care, how to tell genuine innovation from AI hype and why the future of diagnostics may lie beyond traditional heart monitoring. We also cover clinical implementation challenges, device design for older populations and the fine line between wellness tracking and medical-grade careTimestamps:[00:00:27] AI-Powered ECG: From Novelty to Necessity[00:03:28] How Clinicians Are Separating Hype from Reality[00:05:07] Why Near Real-Time Beats Traditional ECG Monitoring[00:08:49] A-Fib and the Global Data Gap[00:11:36] When Good Tech Goes Bad: Early Pacemaker Mistakes[00:13:30] Hospitals, Homes and the Future of Cardiac Care[00:19:59] AI vs Machine Learning: What's the Real Difference?Get in touch with Mark - https://www.linkedin.com/in/mark-goddard-035ab427/ Get in touch with Karandeep Badwal - https://www.linkedin.com/in/karandeepbadwal/ Follow Karandeep on YouTube - https://www.youtube.com/@KarandeepBadwalSubscribe to the Podcast
HeartSciences is a medical technology company focused on applying innovative AI-based technology to ECGs to expand and improve ECG clinical utility. Millions of ECGs are performed every week. Working to improve healthcare by making it a far more valuable ECG, particularly in frontline or point-of-care clinical settings. With one of the largest libraries of AI-ECG algorithms, the company intends to provide these AI-ECG algorithms on a device agnostic cloud-based solution as well as a low-cost ECG hardware platform. Working with clinical experts, HeartSciences ensures that all solutions are designed to work within existing clinical care pathways, making it easier for clinicians to use AI-ECG technology to improve their patients' care and lead to better outcomes.
Today, we're diving into the captivating world where cardiology meets cutting-edge technology. Ever wondered how your smartwatch could potentially save your life or how wearable tech is revolutionizing heart rhythm monitoring? You're in for a treat! Joining us is Dr. Yaariv Khaykin, an internationally renowned expert in rhythm disorders. He's a self-proclaimed "heart electrician" with a knack for gadgets and tech, and he's here to guide us through the intersection of traditional cardiology and modern advancements. From exploring the 100-year-old ECG technology to discussing breakthrough wearable devices, this episode is packed with insights that will transform the way you think about heart health. So whether you're a medical professional, a tech enthusiast, or someone just curious about how wearables could benefit your health, stay tuned for a fascinating conversation that proves science fiction is quickly becoming present-day medicine.Episode HighlightsWearables Catch Fleeting Symptoms Wearables effectively detect fleeting health symptoms that traditional monitors might miss, especially heart rhythm abnormalities.ECG's Long-Standing Role ECGs have been crucial in cardiology for over 100 years, providing insight into heart's electrical activity.Technology Elevates Heart Monitoring Advanced tech offers multi-channel monitoring, improving safety and precision in diagnosing heart conditions like arrhythmias.Smartwatches: Medical Utility Evolving Smartwatches like Apple Watch are now FDA-approved for heart monitoring, offering reliable data for clinical decisions.Data in Wearables: Double-Edged Sword While empowering users, wearables can increase anxiety without proper context. Interpretation is key.Improving Life Through Wearables Devices encourage healthy behaviors, tracking sleep, steps, and exercise to guide lifestyle choices for longevity.Heart Rate Variability's Importance High heart rate variability indicates fitness and longevity, while low variability can signal health issues.Non-Invasive Monitoring Innovations Textile-based ECGs provide comfort, easy use, and continuous heart monitoring without traditional discomforts.Bridging Clinical and Consumer Tech The integration of wearables in daily life advances proactive healthcare, offering diagnostic-level insights easily accessible to all.Episode Timestamps00:00 - Ditch the Lab Coat Podcast06:09 - AI enhances ECG interpretation07:03 - Advanced cardiac mapping vest10:30 - Wearables revolutionize heart monitoring14:39 - Wearables' role in health monitoring18:58 - Assessing Apple Watch for heart rhythms21:00 - Atrial fibrillation detection limitations23:49 - Wearable limitations in symptom detection28:41 - Wearable ECG tech achieves 99.9% accuracy29:46 - Medical device risk and standards34:38 - "Tech bros & longevity obsession"38:17 - Wearables: balancing peace and anxiety42:32 - Heart rate variability explained46:02 - Heart tech: ECGs and innovation47:20 - Future of wearable cardiac technologyDISCLAMER >>>>>> The Ditch Lab Coat podcast serves solely for general informational purposes and does not serve as a substitute for professional medical services such as medicine or nursing. It does not establish a doctor/patient relationship, and the use of information from the podcast or linked materials is at the user's own risk. The content does not aim to replace professional medical advice, diagnosis, or treatment, and users should promptly seek guidance from healthcare professionals for any medical conditions. >>>>>> The expressed opinions belong solely to the hosts and guests, and they do not necessarily reflect the views or opinions of the Hospitals, Clinics, Universities, or any other organization associated with the host or guests. Disclosures: Ditch The Lab Coat podcast is produced by (Podkind.co) and is independent of Dr. Bonta's teaching and research roles at McMaster University, Temerty Faculty of Medicine and Queens University.
Medicus Pharma CEO Dr. Raza Bokhari joined Steve Darling from Proactive to share updates on the ongoing SKNJCT-003 clinical study, which is being conducted at nine sites across the United States and aims to randomize 60 patients. An interim analysis conducted after enrolling more than half of the targeted participants has shown encouraging results. The study reports a clinical clearance rate exceeding 60%, with the investigational therapy demonstrating strong tolerability across both tested dosage levels. Notably, no dose-limiting toxicities (DLTs) or serious adverse events (SAEs) have been observed, and there have been no systemic effects or clinically significant abnormalities in laboratory results, ECGs, vital signs, or physical exams. These promising findings will be submitted to the U.S. Food and Drug Administration (FDA) as part of a Type C meeting request in Q2 2025. In parallel, the company is advancing its clinical initiatives for non-invasive basal cell carcinoma treatment with a newly proposed study. This randomized, double-blind, placebo-controlled, multi-center trial has been submitted for approval to the UAE Department of Health. The study aims to enroll up to 36 patients at prominent medical institutions, including Cleveland Clinic Abu Dhabi, Sheikh Shakbout Medical City, Burjeel Medical City, and the American Hospital of Dubai. Participants will be assigned in a 1:1:1 ratio to receive either a placebo or one of two dosage levels of the experimental treatment. This expansion into the UAE represents a significant step forward in the company's mission to develop innovative, non-invasive therapies for skin cancer, broadening its global clinical footprint and reinforcing its commitment to advancing patient care. #proactiveinvestors #nasdaq #mdcx #tsxv #mdcx #pharma #Biotech #CancerTreatment #ClinicalTrials #FDAApproval #SkinCancer #HealthcareInnovation #Investing #MedicalResearch
Post-Cardiac Ablation Atrial Arrhythmia Monitoring Guest: Suraj Kapa, M.D. Host: Anthony H. Kashou, M.D. In this episode of the segment "ECG Making Waves," the listener will learn to identify the right monitoring approach for a given patient's arrhythmia considerations around ablation. They will also learn how to list specific considerations when reviewing and interpreting post-ablation arrhythmia ECGs. Topics Discussed: What specific aspects of the ECG and ECG monitoring are important to look for after cardiac ablation? How do you approach rhythm monitoring discussions with your patients after ablation? What are potential benefits and pitfalls of different monitoring approaches for atrial arrhythmias after ablation? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.
N Engl J Med 2013;368:1379-1387Background In 2013, it had been established that primary PCI for STEMI was the preferred strategy. Yet many patients did not have prompt access to primary-PCI capable hospitals and transfer delays could impact outcomes. The vast majority of patients with STEMI who present to non-PCI facilities do not subsequently get primary PCI within recommended times.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Delays led to the development of prehospital care, such as ECGs in the ambulance, and pre-hospital delivery of fibrinolysis. The Strategic Reperfusion Early after Myocardial Infarction (STREAM) study evaluated whether a fibrinolytic-therapy approach consisting of prehospital or early fibrinolysis with contemporary antiplatelet and anticoagulant therapy, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary PCI in patients with STEMI who present early after symptom onset.Patients Eligible patients had a) STEMI within three hours, b) could not have primary PCI within one hour of first medical contact. No formal exclusion criteria were listed in the main manuscript.Baseline Characteristics A total of 1892 patients underwent randomization in 1:1 fashion. The mean age of patients was 59 years. Less than 15% of both groups were older than 75 years. Females were 20%. More than 90% of patients were Killip class 1. Less than 10% of enrolled patients had had prior CHF, MI, or PCI.Procedures Patients were randomized in a 1:1 ratio to fibrinolysis followed by timely coronary angiography or primary PCI. All patients were transferred to a PCI-capable hospital; for all non-PCI community hospitals participating in the study, a well-developed hub-and-spoke relationship with a PCI-capable site was required.The fibrinolytic strategy included early use of concomitant antiplatelet and anticoagulant medications, as well as additional discretionary glycoprotein IIb/IIIa antagonists. Tenecteplase was administered in a weight-based dose and was combined with low-molecular-weight enoxaparin, weight and age adjusted.Antiplatelet therapy consisted of clopidogrel in a 300-mg loading dose (omitted for patients ≥75 years of age) followed by 75 mg daily and aspirin (150 to 325 mg) immediately followed by 75 to 325 mg daily. Urgent coronary angiography in the fibrinolysis group was permitted at any time in the presence of hemodynamic or electrical instability, worsening ischemia, or progressive or sustained ST-segment elevation requiring immediate coronary intervention, according to the investigator's judgment.Endpoints The primary end point of the trial was a 30-day composite of death from any cause, shock, congestive heart failure, or reinfarction. Single efficacy end points as well as safety end points consisting of ischemic stroke, intracranial hemorrhage, nonintracranial bleeding, and other serious clinical events were recorded.The statistical analysis plan was complicated. A sample size of 1000 patients per study group was planned, and the rate of the primary end point in the primary PCI group was projected to be 15.0%. After one-fifth of patients had been enrolled, trialists amended the protocol to reduce the dose of tenecteplase by 50% in patients older than 75 years because of excess ICH. ECG criteria for inferior MI was also changed to require at least 3 mm (up from 2) of ST elevation in two contiguous leads.This trial was designed as a proof-of-concept study. All statistical tests were of an exploratory nature.Results The median time delay from the onset of symptoms to first medical contact and randomization was similar in the two groups ( 61-62 minutes). The median times between symptom onset and start of reperfusion therapy (bolus tenecteplase or arterial sheath insertion) were 100 minutes and 178 minutes, respectively (P
To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: 1. Find a system for ECG interpretation that works well for you; and2. Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting. Donations at Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated and will help ensure others can benefit from these tips as well.Good luck with your ACLS class!Helpful Listener Links:Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/*FREE to anyone in the U.S. Save $$ on prescription medications for you and your pets with National Drug Card - https://nationaldrugcard.com/ndc3506 *Indicates affiliate links. I may get paid a small commission if you purchase products or memberships using my link. It doesn't affect the price you pay.Practice ECGs at Dialed Medics: https://dialedmedics.com/
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Se trata de un "gadget" de alta gama que realiza electrocardiogramas (ECGs) completos (existe una versión para ECGs simples, más barata). No permite anticipar infartos, pero sí monitorizar de forma óptima una posible taquicardia y el nivel de pulsaciones de una persona. Las infirmaciones se archivan en la aplicación del teléfono móvil que regula su funcionamiento y se pueden descargar en PDF para su envío al médico de forma inmediata. Tiene un funcionamiento sencillo y, por encima de todo, ayuda a no angustiarse en caso de dudas por un malestar pasajero. Muy recomendable para personas con taquicardias debidas a cualquier circunstancia médica o anímica. ENLACE: https://www.alivecor.es/?accid=6457972212&cid=10912623026&agid=134861589833&gad_source=1&gclid=Cj0KCQiAyc67BhDSARIsAM95QztBFdFewrd1EUx71rcya3pi9DWMKbXTrJ4rC1GeqhDpRurpP2LIhsEaAu5hEALw_wcB Podcast recomendado: LATIENDO de ZIGOR MADARIA : https://go.ivoox.com/sq/1511203 Más y mejores podcast en la RED SOSPECHOSOS HABITUALES: https://feedpress.me/sospechososhabituales ¡SALUD!
Se trata de un "gadget" de alta gama que realiza electrocardiogramas (ECGs) completos (existe una versión para ECGs simples, más barata). No permite anticipar infartos, pero sí monitorizar de forma óptima una posible taquicardia y el nivel de pulsaciones de una persona. Las infirmaciones se archivan en la aplicación del teléfono móvil que regula su funcionamiento y se pueden descargar en PDF para su envío al médico de forma inmediata. Tiene un funcionamiento sencillo y, por encima de todo, ayuda a no angustiarse en caso de dudas por un malestar pasajero. Muy recomendable para personas con taquicardias debidas a cualquier circunstancia médica o anímica. ENLACE: https://www.alivecor.es/?accid=6457972212&cid=10912623026&agid=134861589833&gad_source=1&gclid=Cj0KCQiAyc67BhDSARIsAM95QztBFdFewrd1EUx71rcya3pi9DWMKbXTrJ4rC1GeqhDpRurpP2LIhsEaAu5hEALw_wcB Podcast recomendado: LATIENDO de ZIGOR MADARIA : https://go.ivoox.com/sq/1511203 Más y mejores podcast en la RED SOSPECHOSOS HABITUALES: https://feedpress.me/sospechososhabituales ¡SALUD!
In this episode of the Heart podcast, Digital Media Editor, Professor James Rudd, is joined by Dr Rohan Khera from Yale, USA. They discuss the idea of image derived AI insights from ECGs and more widely AI in cardiovascular practice. If you enjoy the show, please leave us a podcast review wherever you get your podcast - it's very helpful to us! Link to published paper: https://heart.bmj.com/content/110/17/1065 https://www.jacc.org/doi/epdf/10.1016/j.jacc.2024.05.003
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In this podcast, Dr. Valentin Fuster discusses a groundbreaking study on using artificial intelligence (AI) in electrocardiograms (ECGs) to assess left ventricular diastolic function and predict outcomes in patients with significant mitral regurgitation. The study demonstrates that AI-driven ECGs can offer comparable prognostic value to traditional echocardiography, identifying high-risk patients and potentially revolutionizing cardiovascular diagnostics, though challenges around sensitivity, specificity, and patient selection remain.
This week listen in as Kate, Mark, Gary and Henry discuss antiviral treatment for infant RSV, colonoscopy competence by specialty, oral minoxidil for hair loss in men, and artificial intelligence performance on interpreting electrocardiograms . RSV medication: https://www.nejm.org/doi/full/10.1056/NEJMoa2313551#ap2 and https://pubmed.ncbi.nlm.nih.gov/39321361/ Colonoscopy by specialty https://pubmed.ncbi.nlm.nih.gov/38588561/ https://aapce.wildapricot.org/ Minoxidil:https://pubmed.ncbi.nlm.nih.gov/38598226/ AI for ECGs:https://www.ncbi.nlm.nih.gov/pubmed/39096711
To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things:Find a system for ECG interpretation that works well for you; andPractice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II.Characteristics of first degree heart block. Characteristics of third degree (complete) AV block.Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!Practice ECGs at Dialed Medics: https://dialedmedics.com/
An AI-ECG Algorithm for Left Ventricular Diastolic Dysfunction Guest: Jae Oh, M.D. Host: Anthony H. Kashou, M.D. Diastolic function assessment is crucial in diagnosing, managing, and predicting outcomes in various cardiac conditions. It provides insight into heart health, particularly in diagnosing heart failure. Shortness of breath, a common patient complaint, often indicates elevated diastolic filling pressure if linked to a cardiac condition. Echocardiography is the primary method for assessing diastolic function, but it is operator-dependent and not always available. In contrast, ECGs are standardized and widely accessible. Although subtle changes in ECGs are not easily detectable by the human eye, artificial intelligence can identify specific conditions reflected in the ECG. By training an AI model with labeled ECGs based on diastolic function determined through echocardiography, researchers achieved high accuracy in detecting diastolic dysfunction. AI-enhanced ECGs can significantly impact the identification of both asymptomatic and symptomatic cardiac conditions, potentially streamlining diagnostic strategies and reducing costs. Future developments may enable patients to monitor their heart health using simple wearable devices, enhancing the management of heart failure and other conditions. Topics Discussed: Your special clinical academic interest is echocardiography. Why are you interested in ECG AI in diastolic function? What is diastolic function and why is it important to assess diastolic function in clinical practice? Why did you decide to create AI-ECG for diastolic function assessment? What did you find and how do you envision AI ECG for diastolic function be used in clinical practice? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.
America Out Loud PULSE with Dr. Peter McCullough and Malcolm – I find myself without a candidate -- with the looming possibility that our elections could be theater... I do get tight-chested and get irregular beating, but my ECGs and EKGs are fine. Should I worry?... How long does the spike protein from the vax last in the body?... The vaccine exhausts the T-cells and makes the body IGg4 tolerant, but is this true for everyone?
America Out Loud PULSE with Dr. Peter McCullough and Malcolm – I find myself without a candidate -- with the looming possibility that our elections could be theater... I do get tight-chested and get irregular beating, but my ECGs and EKGs are fine. Should I worry?... How long does the spike protein from the vax last in the body?... The vaccine exhausts the T-cells and makes the body IGg4 tolerant, but is this true for everyone?
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In this episode, we explore the history and development of ECG algorithms with a leading expert in the field. We'll cover the early days of ECG interpretation, the hurdles in creating automated algorithms, and how this essential technology has evolved. Our guest, with decades of experience, will discuss his role in establishing an ECG Core Laboratory for clinical trials and epidemiological studies. We'll also look at the globally used Glasgow ECG algorithm, which aids thousands of clinicians in interpreting 12 lead ECGs. Joining me is Professor Peter Macfarlane, Emeritus Professor and Honorary Senior Research Fellow at the University of Glasgow. His team's work, including the Glasgow ECG interpretation program, is renowned worldwide. Peter's research has focused on ECG variations across age, gender, and ethnicity, influencing international guidelines for diagnosing acute myocardial infarction. He founded an ECG Core Laboratory for both national and international clinical trials and studies. A Fellow of the Royal Society of Edinburgh, Macfarlane received a DSc in 2000, the 1998 Rijlant International Prize in Electrocardiology, and a CBE in January 2014 for his contributions to healthcare. to see more on the Glasgow ECG Program Research, see here: https://www.gla.ac.uk/schools/healthwellbeing/research/robertsoncentreforbiostatistics/electrocardiology/glasgowecgprogram/ Some of the publications mentioned in the interview can be seen here: https://www.sciencedirect.com/science/article/abs/pii/S0022073606000628 https://www.gla.ac.uk/schools/healthwellbeing/research/robertsoncentreforbiostatistics/electrocardiology/publications/#clinicaltrialsandstudies This podcast is sponsored by Wel Medical. Wel Medical are a leading provider of life saving medical equipment. Known for their cutting-edge defibrillators, including the widely trusted iPAD SP1, Wel Medical is dedicated to making emergency tools accessible in public spaces, schools, and businesses. Their defibrillators are designed for ease of use, with clear voice prompts and visual aids, empowering anyone to help in a cardiac emergency. Wel Medical also offers a comprehensive range of first aid supplies and provides expert training, ensuring that organizations are well-prepared for any emergency. With a strong focus on customer support, they are passionate about helping people feel confident in saving lives. Tune in to learn how Wel Medical is making a difference in emergency preparedness. For more information, visit welmedical.com and discover how you can make your environment and workplace safer today.
Dr. Pregerson talks all about the guidelines for reading ECGs, how to minimize interruptions while you're reading them, and ways to build your skills, only in this month's podcast. Read more in the Show Notes.
The JournalFeed podcast for the week of Sept 9-13, 2024.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:There are an increasing number of water bead related injuries in children, with the majority occurring in children less than five. While most cases can be treated and released from the ED, water bead injury can be serious and even deadly.Friday Spoon Feed:These researchers developed and trained a deep ensemble artificial intelligence (AI) model to classify ECGs as STEMI versus non-STEMI. The AI performed well in both accuracy and in improving sensitivity.
To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: 1. Find a system for ECG interpretation that works well for you; and 2. Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II. Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block.The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@Pass-ACLS-Podcast on LinkedInGive Back & Help Others: Your support helps cover the monthly cost of software and podcast & website hosting so that others can benefit from these ACLS tips as well. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Make a difference in the fight against breast cancer by donating to my Men Wear Pink fundraiser for the American Cancer Society (ACS) at http://main.acsevents.org/goto/paultaylor Every dollar helps in the battle with breast cancer.Good luck with your ACLS class!Practice ECGs at Dialed Medics: https://dialedmedics.com/
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Understanding ECG Waveforms: Normal vs. Abnormal Guest: Dr. Peter van Dam Host: Anthony H. Kashou, M.D. The ECG interpretation is majorly driven by event detection, i.e. QRS onset and end, QT time, P wave etc. From these we can determine the normal heart rhythm, and some performance measures, like heart rate etc. The ECG waveforms, however, are much less understood. This is a pity, as ECG waveforms, provide instantaneous information on the electrophysiological and structural function of the heart. In this respect it is interesting to know if there is something like a normal ECG waveform or normal PathECG (CineECG). This latter technique is a vector-based method to estimate the electrical position of a moving vector within the heart. Similar normal distributions can be created to compare to the normal ECGs. Topics Discussed How can we define a normal ECG waveform? (ECGs from healthy normal people for different age groups, I used about 6000 normal ECGs, correction for heart rate by resampling to standard QT time (400 ms for instance, these ECGs can be used to create a distribution of amplitudes and derived signals (CineECG) to compare an ECG too) What is needed for an accurate waveform comparison? (Good baseline correction, not filtering, but baseline correction) What is the onset and end of the P-wave, QRS and T wave?) Are normal ECGs waveforms different from abnormal ECG waveforms? (Of course they overlap, describe left bundle branch block, or ischemia, with long QRS or deviating ST segment ) Did you use this method to classify ECGs as normal or abnormal? (results from our study (manuscript in preparation) that any QRST sequence in an ECG can be classified as abnormal with an accuracy (AUC) of more than 81%. In our study population 15% of the patients had only atrial related abnormal ECGS) Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.
It was a huge pleasure to sit down with Steve Smith, a name synonymous with ECG expertise. Steve, renowned worldwide for his influential ECG blog, has been a pivotal figure in advancing our understanding of ECGs. Many of us have honed our ECG skills thanks to Steve's insights. I had the opportunity to meet Steve about a decade ago at one of the SMACC conferences. Today, we delve into the fascinating world of occlusive myocardial infarction (OMI) and its comparison to STEMI (ST-elevation myocardial infarction), and explore the promising future of artificial intelligence in ECG interpretation. A comprehensive blog post with references is available here
To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: 1. Find a system for ECG interpretation that works well for you; and 2. Practice reading ECGs every day for a few weeks before your class. Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II. Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back & help others. Your support will help cover the monthly cost of software and podcast & website hosting. Donations made via Buy Me a Coffee at https://buymeacoffee.com/paultaylor are appreciated.Good luck with your ACLS class!Visit Dialed medics for online practice ECGs at: https://dialedmedics.com/
Listen to ASCO's JCO Oncology Practice essay, “Patient is Otherwise Healthy” by Dr. Scott Capozza, Board Certified Oncology Physical Therapist at Smilow Cancer Hospital Adult Cancer Survivorship Clinic at Yale Cancer Center. The essay is followed by an interview with Capozza and host Dr. Lidia Schapira. Capozza shares his personal experience with the long-term effects of cancer treatment. TRANSCRIPT ‘Patient Is Otherwise Healthy' by Scott J. Capozza, PT, MSPT Let me start by saying: I know I am one of the fortunate ones. Being diagnosed with cancer at any age puts many in a tailspin. I was no different when I was diagnosed with stage II testicular cancer at age 22 years. I was still in graduate school, completing my physical therapy program; suddenly, I had to schedule an orchiectomy, retroperitoneal lymph node dissection, and two cycles of chemotherapy around lectures, laboratory work, and practical examinations. Fast forward 20 years and I have an unbelievably supportive wife who has seen me through so much of my long-term survivorship concerns. Despite my fertility challenges, we are so very fortunate that my wife was able to conceive three healthy, happy, and strong kids (conceived only through the roller coaster that is fertility preservation and reproduction medicine, which so many adolescent and young adult survivors must deal with and is emotionally very challenging, but that is a discussion for another day). I have a great career as a board-certified physical therapist in oncology, where I can help enhance the physical well-being of patients throughout the cancer care continuum. The journey to this path as a survivor was not a straight line, though that also is a discussion for another day. What I do not remember signing up for was all the late and long-term side effects of cancer treatment, or maybe I did sign for them in a sort of deal with the devil so that I could finish PT school on time and return to my precancer life of running and being with my friends. We sign on the dotted line to rid the cancer from our bodies, but just like the mortgage, student loans, and back taxes, we end up having to pay in the end. Unfortunately, paying off this debt comes with a high interest rate (a multitude of adverse effects) heaped on top of the principal balance. And while it would be very easy to blame my hyperlipidemia on my cancer treatments,1 I am pretty sure there is a likely strong genetic component. My grandmother had high cholesterol for as long as I could remember. As your quintessential Italian grandmother, she was 105 pounds soaking wet and ate like a bird (while being insulted if I did not have a 4th helping of her lasagna) but had to take her blasted pills for high cholesterol for all her adult life. She died a month short of her 103rd birthday and was still sharp as a tack until the very end. I will gladly sign on the dotted line for that outcome. My immediate postcancer treatment years were great. I resumed running and ran several marathons, returned to a relatively normal social life, and started along my career. I met my wife, and she was enthusiastically willing to live her life with a cancer survivor. Marriage, house, kids, job…everything was going great. Until things started going downhill. About 10 years postchemotherapy, I noticed that my exercise tolerance was decreasing. It was harder and harder to keep up with friends on our long runs. I felt more fatigued overall. I went from running 10 miles to seven to five to now barely being able to complete two miles. My chest would feel tight as if a vise was clamping down on my ribs. Running up short hills in my neighborhood, which I had routinely done in the past, felt like I was ascending Mount Everest without supplemental oxygen or Sherpa support. When I brought this up to my primary care physician, he looked perplexed. I am young(ish), no family history of heart disease, nonsmoker, healthy weight, and only enjoy a hard cider once a week. He performed an ECG in the office, just to double check to make sure I was not crazy. When my heart rhythms started throwing out inverted T-waves, his eyes got larger. He said that I did not fit the description of someone who should be experiencing these symptoms. “I had cancer, remember?” I remind him although he is very familiar with my medical history and we know each other well. “Oh. Yeah.” My doctor nods…. My doctor thankfully took my concerns seriously and directed me to a series of referrals to cardiac and pulmonary specialists. Through the Pandora's box which is patient access to electronic medical records, I was able to read his postvisit report. He very accurately described the results of the physical examination and our conversation. He did write in his report that he would be placing referrals to cardiology and pulmonology. It was a very thorough evaluation, and I could tell that he was truly listening to me and not dismissing my concerns. What caught my eye, though, was the opening line to his assessment: “Patient is an otherwise healthy 42-year-old male…” Otherwise healthy? I have high cholesterol; had to endure heartache and struggle to have a family because of treatment-induced fertility issues; I wear hearing aids because of cisplatin induced ototoxicity; and now, I have to go for a full cardiopulmonary work-up, all because, I had testicular cancer at age 22 years. To me it did not feel like that I was otherwise healthy. To further work up my symptoms, I was scheduled for cardiac testing. I have a new appreciation for what my own patients go through when they have to get magnetic resonance imaging (MRI) after I had a cardiac stress MRI. I had no idea just how tiny and claustrophobia-inducing an MRI machine is, so now I nod my head in agreement with my patients when they tell me how anxiety-producing it is to get an MRI. I had a treadmill stress test and echocardiogram, and these all came to the same conclusion: I have a thickened left ventricle in my heart, which throws off the ECGs but is just my normal anatomy. Phew. When I went for my pulmonary function test (PFT), though, the results were different. The pulmonologist came in with that same perplexed look, as he is expecting to see someone other than an early 40s, healthy weight individual sitting there. Our conversation went something like this: Pulmonologist: Do you, or did you ever, smoke? Me: No. Pulmonologist: Do you have carpets, rugs, or animals at your house? Me: No. Pulmonologist: Do you work in a factory or someplace where you're surrounded by potentially toxic chemicals? Me: No. Pulmonologist: Do you think you gave your best effort on the PFT? Me (slightly annoyed): Yes. Pulmonologist: I don't get it; you have the lungs of someone with chronic obstructive lung disease, but you don't fit into any of the risk factors. Me: I had bleomycin as part of my chemotherapy regiment for testicular cancer 20 years ago. Pulmonologist: Oh. Yeah. Oh. This is the crux of long-term survivorship: We look OK on the outside, but inside our body systems deteriorate faster than the noncancer population.2 For pediatric cancer and adolescents and young adult cancer survivors who could potentially have decades of life ahead of them, these late and long-term side effects are a perpetual consequence for surviving cancer. There is no light at the end of tunnel for us; the tunnel extends endlessly, and we grasp for any daylight we can to help us navigate the darkness moving forward. While there have been multiple studies addressing the long-term toxicity sequelae of cancer therapy, there is still inadequate understanding of optimal screening, risk reduction, and management and inadequate awareness of potential late effects among both medical professionals and survivors alike.3 Given the complexity of long-term toxicities for long-term survivors, a multidisciplinary team of health professionals can provide a comprehensive approach to patient care. For me, a key member of this team was the cardiac advanced practice nurse, who called me at 4:45 pm on a Friday afternoon to tell me that my cardiac evaluation was normal. Physical therapists do this by addressing fatigue, balance deficits, and functional decline through our multitude of rehabilitation tools. Cardiologists, pulmonologists, primary care physicians, dietitians, and mental health care workers can all meaningfully contribute to the well-being and long-term care of cancer survivors. The many health care providers in the lives of cancer survivors can also empower through education. However, the education pathway ends up being a two-way street, as so often it is the survivor who has to educate the nononcology provider about our internal physiological needs that belie our external appearance. As for me, I am trying out new inhalers to help with my breathing. I take a low-dose statin every morning with breakfast. I am now plugged into annual cardiac follow-ups. I do not run anymore, though, as the psychological toll of not being what I once was has affected me more than the physical toll. I march on, trying to be the best husband, father, physical therapist, and cancer survivorship advocate that I can be. While we may be living clinically with no evidence of disease, we live with the evidence of the history of our disease every day. Like petrified trees or fossilized shells, cancer treatments leave permanent physical and psychological reminders of our cancer experience. As greater attention is being focused on the optimized management of long-term toxicities in cancer survivorship, my sincere hope is that there will be effort to educate cancer and noncancer medical staff alike about the real physical and psychosocial adverse effects as well as advances in treatment that will both prevent development of long-term toxicity and yield better solutions for when they do occur. I hope better options will be available to all cancer survivors with all stages and all disease types in the not-so-distant future. I am OK, really, but I am not sure ‘otherwise healthy' really applies to me. Dr. Lidia Schapira: Hello and welcome to JCO's Cancer Stories: The Art of Oncology, which features essays and personal reflections from authors exploring their experience in the field of oncology. I'm your host, Dr. Lidia Schapira, Professor of Medicine at Stanford University. Today we're joined by Scott Capozza, Board Certified Oncology Physical Therapist at Smilow Cancer Hospital at the Yale Cancer Center. In this episode, we will be discussing his Art of Oncology article, “Patient is Otherwise Healthy.” At the time of this recording, our guest has no disclosures. Scott, welcome to our podcast and thank you for joining us. Scott Capozza: Thank you very much for having me. This is a great honor. Dr. Lidia Schapira: I look forward to chatting with you about this. First of all, what a great title. How did the title and the idea of sharing your experience with this audience, the readers of JCO OP and JCO publications, come to you? Tell us a little bit about the motivation and the inspiration. Scott Capozza: So the title actually came from my doctor's note, as I alluded to in the article, the Pandora's Box, so to speak, of patient access to medical records. I was reading his assessment of my regular wellness visit. And in that visit, I had discussed that I was having some breathing issues and some endurance issues with running, and I just didn't feel myself. And I knew that I hadn't had any significant cardio or pulmonary workups anytime recently. On top of that, we'd already discussed some of my other comorbidities, like my blood pressure, that sort of thing. So his intro line was “Patient is a 42-year-old otherwise healthy male.” Well, that's what caught my eye. I said, “Am I really otherwise healthy? I've got high cholesterol. I have this history of cancer. I am dealing with all kinds of late effects, and we're working those late effects up. And so am I truly otherwise healthy?” And I love my PCP, and he listens to me. And so I'm grateful for him and for him taking me seriously, because not everybody has that. Not every survivor has that person, that quarterback, so to speak. So that was really what kind of drove me to write the article. It was just an idea that it was in my head. I did not write the article right away. I'm now 48. So this was actually even a couple of years ago. But I think I wrote it because I really was writing it more for the non oncology provider, for the PCPs, and for the pulmonologists and the cardiologists who don't work in the oncology space like you and I do, to be cognizant of these late effects. And just because somebody is a year out from treatment, five years out from treatment, or in my case, 20 years out from treatment, that these late effects are real and they can play havoc with our quality of life. Dr. Lidia Schapira: So let me talk a little bit about nomenclature and the semantics. You know this field very well, and you know that not every person with a history of cancer identifies as a survivor. But the term is really helpful for us. And in the original article that Fitzhugh Mullan wrote in New England Journal called the “Seasons of Survival,” he reflected as a physician with cancer that you go through different periods in your survivorship, journey or life. Can you tell us a little bit about that and what it's been for you? When did you feel that you were a cancer survivor? Do you use the term and what have those seasons or those stages felt like for you? Scott Capozza: That's a great question. And for my old patients, I have this conversation with them as well. For me specifically, yes, I do identify as a cancer survivor. I will say, though, that when I was going through my treatments, I did not identify with that word. I also think that because I was young, I was 22, 23 at the time of my diagnosis, and I did not want any association with cancer, that I really did not want that label attached to me. At that time, I was a physical therapy student and a runner. Full disclosure, I'm a Boston Red Sox fan. You can hold that against me if you want. So I didn't want this extra label, so I didn't want it anyway in the first place. I do, I remember having a conversation with my nurses, and they said, “Oh, you should go to this walk or whatever that was happening for cancer survivors.” And I said, “But I'm in the middle of chemo. I've still got my port. And I don't think I should go because I'm not done with treatment.” And so that's why I think it's great that we have, the American Cancer Society and NCI have come out with very clear definitions that say that a person is a cancer survivor from the mode of diagnosis, and I use that for my own patients as well, because they have that same question. They ask me, “Am I really a survivor? Am I really done?” That sort of thing. And I say, no, I go by those definitions now. And so I always frame it as, you have to survive the words “You have cancer.” So that's me with the relationship with the term survivor. To your other point of the question, as far as the seasons of survivorship. Absolutely. And I think that we see this more prevalently with our younger population, with our pediatric survivors, and for me, as an adolescent, young adult survivor, an AYA. So I have gone through these seasons of survivorship. When I was diagnosed, I was young and I was single and I was finishing school. That's one thing. I was not dating anybody. So when I did just start to date somebody and move towards marriage and that sort of thing, and all of a sudden, now my fertility issues, because of my treatments, now that came to the forefront. So that became a new season, so to speak. How are we going to tackle that? And now as a father, that's a different season because I have three children, two boys, and it's on my mind that they have my genetic makeup. So are they at higher risk of developing testicular cancer because of me? So I'm in a different season now than I was when I was single and 25. Dr. Lidia Schapira: And so you also talk about having cisplatin induced ototoxicity. And now this latest problem, which is the bleomycin induced lung problem. That is what sort of unraveled this new season of trying to put these pieces together. How have you thought about this and perhaps shared it with your wife and your family? This idea that the exposures you had to toxic drugs which cured you and gave you this fortunate possibility of being a long term survivor keep on giving, that they keep on manifesting themselves. And fortunately, you have, it seems, a very receptive primary care doctor who listens but may not be particularly able to guide you through all this and may not know. So he's sort of taking his cues from you. How do you negotiate all this? The idea that there may still be something that's going to happen to you as a result of these exposures? Scott Capozza: Being vigilant, I think, is really important. And I think open lines of communication with my providers, open lines of communication with my wife. And also, again, my children are at this point now where I can have those conversations with them. I don't think that I could have done that when they were younger, but now I think they can start to understand why daddy wears hearing aids now is because daddy had to get a certain medicine to help get him healthy, to help get rid of the cancer. So to frame it in that context, I think it makes it easier for them to understand why I have this cytotoxicity from cisplatin. And they even know now with my pulmonary issues that daddy can't necessarily run with them. That was always going to be a goal. I was going to be able to run with my children, and I can't do that. I am still able to bike. It does not stress my pulmonary system as much as running does. So we are able to cycle as a family, and so we are able to do that. But as far as other late effects that might show up another five years or 10 years from now, those are things that I will continue to have those conversations with my PCP to say, do we need to continue to do cardiac screening every so often? Do we need to continue to do pulmonary screenings, blood work, that sort of thing? I also know that I am very fortunate that I work in the field, so I am surrounded by it, which sometimes is good and sometimes can be a little discerning, knowing what's out there also. So it is an interesting balance to be able to wear both of those hats at the same time. Dr. Lidia Schapira: I have a couple questions that arose to me reading your essay. Now, I am an oncologist, so I know you know about these late effects. One of your lines is, this is the crux of long term survivorship that is appearing healthy, being labeled as otherwise healthy, but really having these exposures that predispose you to getting other illnesses and diagnoses. Do you think it would help if your PCP and pulmonologist wrote that you had an exposure to bleomycin in requesting the PFTs? Instead of just saying 42-year-old with such a symptom, 42-year-old with an exposure to bleomycin and dyspnea. Do you think that writing that in your chart, instead of just saying ‘otherwise healthy', just putting cancer survivor, testicular cancer survivor, and adding the exposures every time they require a test, could that in any way have made your life easier as you reflect back on the last few years? Scott Capozza: That's a really interesting question. I never thought of that before, and I think that could go one of two ways. A, it could be validating, but I could see the flip side of that where it's, you're constantly reminded of it. So I don't know that there's a perfect answer to that. I don't know what I would prefer, honestly. If we could hop back in time and change the documentation, then we make an addendum to the documentation. I don't know that I would really want that because obviously I know it. But do I want to continue to see that every time I open up my chart? I don't know. And I can see how it can be frustrating for my patients that when they get through my chart notifications or whatever it might be, that they're constantly reminded by it, and then that can lead to fear of occurrence, and that can lead to anxiety and depression. And all the things that you and I know, being providers in the oncology space, we know that these are all things also that our patients experience. So I don't know. I'll have to think about that a little more. Dr. Lidia Schapira: Maybe the next essay you send to us is about shared decision making, even, and how this is used, playing it forward a little bit in the cancer record, it's there and prominent. But in your primary care and other records, how important is that as a qualifier? All of these things are really interesting, and I wonder how you have used your personal experience in treating other patients and whether or not you disclose to your own patients that you are a cancer survivor. Scott Capozza: I don't lead with it because it's not my story. It's their story. It's their experience. So I never lead with it. I do think that patients are savvy. They do want to know who's on their care team. So I tell this story often that I was working with a young woman with breast cancer. She was still in the middle of treatment. She was very understandably upset. And I was about to say something along those lines of, “I can appreciate what you're going through, because I went through this, too.” And she said, “I know who you are. I looked you up.” Dr. Lidia Schapira: Wow. Scott Capozza: Yes. But she followed that up with saying, “And because I looked you up and because you're a survivor, that's why I want you working with me.” So again, it goes both ways. So in that instance, it did, it did work out. So, no, I never lead with it. I think patients a lot of times just figure it out on their own. If I'm working with a patient and we've been working together for a while, we might have that conversation, then it might come up. But again, it's about our patients. It's about making sure that they have the highest quality care. And so that's why they're at the center of everything that we do. So, no, I don't lead with it. Dr. Lidia Schapira: So as we wrap up, I have two questions. One is, did you share your essay with your primary care doctor? Scott Capozza: I have not yet. I have not actually seen him since it was published. My annual physical is coming up later in the summer. I was thinking that I would bring it to him to see what his reaction would be. Dr. Lidia Schapira: That sounds cool. Will you let me know what he says or she says? And the other question is, since you did decide to put your story in front of an audience of oncology professionals, what is your message to them? Scott Capozza: I think the message, again, is to listen to your patients. And again, you alluded to it a moment ago, the shared decision making, I think that's so critical. I think that's where we are now, and that's where we need to continue to move as a profession, not just in oncology, but I mean, across all health domains. And so I think that for oncology providers specifically, listen to our patients and to validate those concerns, to educate and then do something about it also, I think, is really critical. Dr. Lidia Schapira: And involving other members of the multidisciplinary team is key. I mean, we acknowledge we need that during treatment, but I think post-treatment, it's equally important to refer people to think about it, to think about referring for rehabilitation or prehabilitation in certain cases. To minimize the baggage that people carry into survivorship. Scott, thank you. Thank you for writing. I wish you good health, and I thank you very much for sending us your story. So until next time, thank you for listening to JCO's Cancer Stories: The Art of Oncology. Don't forget to give us a rating or review, and be sure to subscribe so you never miss an episode. You can find all of ASCO podcast shows asco.org/podcast. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Like, share and subscribe so you never miss an episode and leave a rating or review. Guest Bio: Dr. Scott Capozza is a Board Certified Oncology Physical Therapist at Smilow Cancer Hospital at the Yale Cancer Center.
All About Comparison ECGs for 12-Leads and Arrhythmias Guest: Ken Grauer, M.D. Host: Anthony H. Kashou, M.D. In this episode, we explore the importance of clinically correlated ECGs, including the optimal techniques for ECG comparison, the role of clinical history in this process, and the applications of comparison tracings for cardiac arrhythmias. Topics Discussed What can we learn from clinically correlated Comparison of ECGs? What is the optimal technique for comparing one tracing with another Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.
Direct communication between patients and cardiologists through smartphone technology has revolutionized heart health monitoring. In this episode at ACC.24, Dr. David Albert, Chief Medical Officer and founder of AliveCor, shares the journey of his company revolutionizing cardiology with innovative technology reaching over 250 million ECGs from 5 million individuals across 40 countries in 15 years. AliveCor's devices empower consumers with FDA-cleared medical products, allowing them to personally monitor their heart health anytime, anywhere, fulfilling the need for direct patient-cardiologist communication through smartphone and wireless technology. He discusses the pivotal role of AI in healthcare when augmenting medical professionals' capabilities amidst a shortage of cardiologists, and enhancing patient engagement and compliance. Dr. Albert also urges listeners to prioritize their health, utilize tools like AliveCor's Kardia brand for proactive heart monitoring, and engage with healthcare professionals regularly. Join Dr. David Albert as he dives into AliveCor's journey, the future of AI in heart health, and the importance of proactive monitoring for everyone! Resources: Watch the entire interview here. Follow and connect with David Albert on LinkedIn. Learn more about AliveCor on their LinkedIn and website. Discover more about AliveCor's Kardia brand on their website.
Timestamp* 1:00 - Background and Sports Journey: Dr. Altini shares his academic journey in computer science, engineering, and data science, alongside his personal transition into endurance sports.* 3:31 - Defining HRV and How It Differs from Heart Rate: Understanding HRV as the variation in time between consecutive heartbeats, which reflects the autonomic nervous system's response to stress.* 8:10 - Clarifying Common HRV Myths: Dr. Altini dispels misconceptions such as the importance of absolute HRV values and the notion that higher HRV is always better.* 11:40 - Making the Case for HRV: Despite limitations, HRV provides unique insights into the body's stress response, which can inform training and lifestyle adjustments.* 14:10 - HRV in Free-Living Analysis: Large-scale research reveals that HRV is a more sensitive marker of stress than resting heart rate, and different stressors elicit varying physiological responses.* 18:45 - Validating Smartphone-Based HRV Measurement: Dr. Altini discusses how the HRV4Training app, using smartphone cameras, was proven to be as accurate as chest straps and ECGs.* 21:55 - Practical HRV Monitoring with HRV4Training: The app helps athletes accurately measure HRV, providing actionable insights based solely on physiological data while allowing users to add context manually.* 26:10 - Unique Features of HRV4Training: The app's focus on raw physiological data offers a clear distinction from competitors, who often combine behavioral data to produce composite scores.* 32:50 - HRV in Night vs. Morning Measurements: Dr. Altini elaborates on the differences between night and morning measurements and how HRV trends vary due to circadian rhythms and sleep stages.* 38:40 - HRV and Sleep Tracking Limitations: Despite advancements, wearable devices often lack accuracy in estimating sleep stages, emphasizing the importance of skepticism.* 43:30 - Spot Check vs. Continuous Monitoring: Dr. Altini warns against overinterpreting continuous HRV monitoring due to potential misinterpretation of data, recommending periodic spot checks instead.* 46:00 - HRV-Guided Training: Dr. Altini explains how to implement HRV-guided training by adjusting intensity based on daily HRV measurements relative to one's normal range.* 51:00 - HRV for Individual Athletes and Golfers: Coaches and individual athletes can use HRV trends over multiple tournaments and travel periods to identify patterns and refine performance strategies.* 55:20 - Advice for Golfers Considering HRV Monitoring: Golfers can use HRV to manage travel stress, tournament phases, and performance consistency by identifying patterns in their physiological responses.* 58:00 - Current Projects and Future Directions: Dr. Altini aims to improve communication around HRV while working on refining personalized feedback loops to optimize health and performance.* 1:03:00 - Book Recommendations and Influences: Dr. Altini recommends Suggestible You by Erik Vance, highlighting its insights into the placebo effect and psychological influences on performanceResourcesBook Recommendation #1: Suggestible You: The Curious Science of Your Brain's Ability to Deceive, Transform, and HealBook Chapter: How Data Can Capture Recovery: The Case for Heart Rate VariabilityPaper #1: What Is behind Changes in Resting Heart Rate and Heart Rate Variability? A Large-Scale Analysis of Longitudinal Measurements Acquired in Free-LivingPaper #2: Comparison of Heart-Rate-Variability Recording With Smartphone Photoplethysmography, Polar H7 Chest Strap, and ElectrocardiographyPaper #3: State of the science and recommendations for using wearable technology in sleep and circadian researchHRV4Training: https://www.hrv4training.com/Personal Substack: marcoaltini.substack.comHRV4Training Substack: hrv4training.substack.comTwitter/X: https://twitter.com/altini_marcoAbout Dr. Marco AltiniDr. Marco Altini is a scientist and developer specializing in health technology and performance, holding a Ph.D. cum laude in Data Science, an MSc cum laude in Computer Science Engineering, and an MSc cum laude in Human Movement Sciences with a focus on High-Performance Coaching. As the founder of HRV4Training, he created a pioneering mobile platform trusted by over 150,000 users, including Olympic medalists and professional teams, to monitor heart rate variability (HRV) and manage training stress. Dr. Altini also serves as a Data Science Advisor at Oura, Guest Lecturer at Vrije Universiteit Amsterdam, and Editor of the Wearable Department at IEEE Pervasive Computing Magazine. With over 10 years of experience modeling physiological data and more than 50 publications at the intersection of technology, health, and performance, he is passionate about empowering athletes and health enthusiasts to make data-informed decisions. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit noahsachs.substack.com
DISCLAMER >>>>>> The Ditch Lab Coat podcast serves solely for general informational purposes and does not serve as a substitute for professional medical services such as medicine or nursing. It does not establish a doctor/patient relationship, and the use of information from the podcast or linked materials is at the user's own risk. The content does not aim to replace professional medical advice, diagnosis, or treatment, and users should promptly seek guidance from healthcare professionals for any medical conditions. >>>>>> The expressed opinions belong solely to the hosts and guests, and they do not necessarily reflect the views or opinions of the Hospitals, Clinics, Universities, or any other organization associated with the host or guests. Disclosures: Ditch The Lab Coat podcast is produced by (Podkind.co) and is independent of Dr. Bonta's teaching and research roles at McMaster University, Temerty Faculty of Medicine and Queens University. Welcome back to "Ditch the Labcoat," where today we're diving deep with the compelling insights of Dr. James East. From intense medical shifts that demand lightning-fast responsiveness to the emotionally charged transitions from ICU pressures to family presence, Dr. East offers a rare window into the life-saving ballet performed daily by our healthcare heroes.Together, they shed light on the emotional fortitude required in this profession, the camaraderie needed to weather the storm, and the ever-evolving tools at their disposal.As the worlds of healthcare and technology collide, we explore the role of AI and technological interfaces, challenging the traditional white coat with terms like Chat GPT and electronic health records. Dr. East, a critical care maestro, and tech startup visionary, debates the true utility of inference-based decisions and AI-assisted diagnostics, while Dr. Bonta lends his seasoned skepticism to the conversation on tools like ECGs and their digital interpretations.From the lab to the living room, the discussion navigates the emotional labor physicians carry and the importance of processing traumatic cases. And as if navigating the corridors of care wasn't enough, our guests tackle the digital transformation of healthcare head-on, weighing in on the potential integration of AI in patient care and the necessity of maintaining the human touch amidst digital disruption.Strap in for a journey through the pulse-pounding, data-driven, and deeply human field of modern medicine. You don't need a lab coat where we're going—this is "Ditch the Labcoat," featuring Dr. James East.Dr. James East, GIM/ICU physician at Mackenzie Health and Trillium Health Partners. Chief Product Officer and Head of Content Development at FirstHx / https://firsthx.com/about-us/Episode Timestamps :00:00 Doctor bridges clinical work with healthcare technology.10:16 Supportive partner helps balance demanding work schedule.13:33 Residency experience: few patients come home.18:43 Dealing with worst days, first responders' challenges.25:54 Advances in technology enhance clinical decision-making.27:13 Analyze electronic health records evolution from paper.36:55 AI engines lack meaningful benefits for clinicians.38:37 Need standardized, evidence-based, high-quality solutions for clinicians.48:06 AI can aid in efficient, thorough patient care.55:09 AI may struggle to replicate human empathy.59:16 Ethical concerns regarding AI in healthcare.01:05:11 Advocacy for seeking professional medical support online.01:09:04 AI aiding clinicians in diagnosing and treating.© 2024 ditchthelabcoat.com - All Rights Reserved
Computerized ECG Interpretations and AI in 2024 Guest: Dr. Ken Grauer Host: Anthony H. Kashou, M.D. In this episode, we explore the exciting and evolving world of computerized ECG interpretation, including its optimal use, its impact on medical practice, and the evolving role of AI in this field. Topics Discussed When did you first become interested in Computerized Interpretation of ECGs? Is the Computerized Interpretation of ECGs a "GOOD" or "BAD" thing? How are current developments in AI changing the way we use computer applications to assist in the interpretation of ECGs? Should the clinician ever look at the AI interpretation before they make their own initial impression? Will there ever be an AI application able to assess complex arrhythmias? Connect with Mayo Clinic's Cardiovascular Continuing Medical Education online at https://cveducation.mayo.edu or on Twitter @MayoClinicCV and @MayoCVservices. LinkedIn: Mayo Clinic Cardiovascular Services Cardiovascular Education App: The Mayo Clinic Cardiovascular CME App is an innovative educational platform that features cardiology-focused continuing medical education wherever and whenever you need it. Use this app to access other free content and browse upcoming courses. Download it for free in Apple or Google stores today! No CME credit offered for this episode. Podcast episode transcript found here.
To pass ACLS, you will need to be able to identify common rhythms on a monitor during your mega code and ECG strips on your written exam. If you don't normally monitor patients as part of your job, I suggest two things: Find a system for ECG interpretation that works well for you; and Practice reading ECGs every day for a few weeks before your class.Review of normal ECG morphology of P wave, QRS complex, and T wave in lead II. Characteristics of first degree heart block. Characteristics of third degree (complete) AV block. Treatment of unstable patients in third degree block following the ACLS Bradycardia algorithm. Special considerations for use of Atropine when patients are in a third degree heart block. The use of TCP, Dopamine, & Epinephrine drip for unstable bradycardic patients refractory to Atropine.Connect with me:Website: https://passacls.com@PassACLS on X (formally known as Twitter)@Pass-ACLS-Podcast on LinkedInGive back - buy Paul a bubble tea hereGood luck with your ACLS class!
The JournalFeed podcast for the week of Feb 19-24, 2024.These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Monday Spoon Feed:This single-center prospective study found that in 2,275 ECGs with a computerized interpretation of “normal” and “otherwise normal,” there was a negative predictive value (NPV) of 100% for STEMI, with no final diagnoses of ACS or STEMI, and none required cardiac catheterization that visit.Source:Validity of Computer-interpreted "Normal" and "Otherwise Normal" ECG in Emergency Department Triage Patients. West J Emerg Med. 2024;25(1):3-8. doi:10.5811/westjem.58464Tuesday Spoon Feed:An artificial intelligence (AI) ECG model outperformed standard STEMI criteria in identifying occlusion myocardial infarction (OMI) confirmed by coronary angiography.Source:International evaluation of an artificial intelligence–powered electrocardiogram model detecting acute coronary occlusion myocardial infarction, European Heart Journal - Digital Health, 2023. https://doi.org/10.1093/ehjdh/ztad074
BIO: Chuck Hazzard is an entrepreneur and wearable expert. Chuck is currently working with Heads Up Health, the leading connected health platform being used for remote patient monitoring, precision medicine, and individuals seeking to achieve peak performance. Chuck is also an advisor to CardioMood, a Swiss-made, and clinically validated wearable device.In the past, Chuck has designed and built computer networks, developed software applications for large corporations, helped build a successful telecommunications business from the ground up, helped a large telecommunications company develop and bring to market products and services yielding an additional $500M in annual revenue, and most recently worked with Oura Ring during their early growth years.Chuck earned his BA in Computer Science and Mathematics from the University of Maine, where he also earned his JD at their School of Law. Chuck is also a graduate of the FDN program and is a licensed Heartmath Provider.SHOWNOTES:
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Deepthy Varghese, MSN, ACNP, FNP, of Northside Hospital is joined by Dr. Matthew Kalscheur, MD, of the University of Wisconsin and Dr. Hawkins Gay, MD, MPH, of Northwestern University Feinberg School of Medicine discuss the study aimed to validate the use of artificial intelligence (AI) in identifying paroxysmal atrial fibrillation (AF) from 12-lead electrocardiograms (ECGs) in sinus rhythm (SR). The AI algorithm was trained on ECG data from a single center, including patients with and without AF. The dataset comprised 494,042 ECGs from 142,310 patients. Testing the model on the first ECG of each patient showed an accuracy of 78.1%, an area under the receiver-operating characteristic curve of 0.87, and an area under the precision-recall curve of 0.48. Performance varied with AF prevalence, demonstrating higher precision in high-risk groups (30% AF prevalence) and lower precision in low-risk groups (3% AF prevalence). The approach was robust when externally validated in another hospital. In conclusion, the AI-enabled ECG algorithm effectively identified paroxysmal AF in patients in sinus rhythm, showcasing potential clinical utility, particularly in high-risk populations. https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2023.04.008 Host Disclosure(s): D. Varghese: No relevant financial relationships with ineligible companies to disclose. Contributor Disclosure(s): M. Kalscheur: No relevant financial relationships with ineligible companies to disclose. H. Gay: No relevant financial relationships with ineligible companies to disclose. “This episode has .25 ACE credits associated with it. If you want credit for listening to this episode, please visit the episode page on HRS365 https://www.heartrhythm365.org/URL/TheLeadEpisode46.
Lancet 1988;349-360Background The introduction to the ISIS-2 manuscript opens with a remarkable statement from the authors:Reductions in mortality that are realistically moderate (eg, “only” 20-25%) are important, especially if produced by widely practicable treatments for common causes of death.At the time of this posting, January 2024, it's amazing to think, how in 1988, a 20-25% reduction in mortality was considered moderate for a “widely practicable treatment for a common cause of death” and now the profession seems to grasp at almost anything, at nearly any cost, that reduces some composite of hard, soft and, in some cases, completely meaningless endpoints by the same amount. Regardless, ISIS-2 sought to test the hypothesis that streptokinase and aspirin, either alone or together, would reduce vascular mortality in patients with MI.Patients Patients with suspected myocardial infarction, who the responsible physician thought were within 24 hours of symptom onset and had no clear indication for, or contraindication to, streptokinase or aspirin. Absolute contraindications included: any history of stroke or of gastrointestinal ulcer. Possible contraindications included: recent arterial puncture, recent severe trauma, severe persistent hypertension, allergy to streptokinase or aspirin, low risk of cardiac death, or some other life-threatening disease. ECG changes at entry were not required.The design was meant to be pragmatic to facilitate patient enrollment; however, exclusion criteria was more extensive for ISIS-2 compared to ISIS-1, which reflects concern about hemorrhagic side effects associated with use of these agents. Like ISIS-1, there were no special procedures dictating patient follow-up after the hospitalization ended.Baseline characteristics Basic demographic information is not provided in the main manuscript but we can infer from the subgroup Forest plots that more than two thirds of patients were men, the overwhelming majority were less than 70 years of age, and nearly half were less than 60. Less than 20% had a previous MI and only around 7% had diabetes. Patients with inferior and anterior STEMI's composed more than half of the cohort. About 43% of patients presented within 4 hours of symptom onset, another 42% presented between 5 and 12 hours, and the remaining 15% presented between 13 and 24 hours.Procedures A 2x2 factorial study design was used. All patients were randomly assigned to receive either streptokinase or a matching placebo. All patients were also randomly assigned to receive either aspirin or a matching placebo. This led to 4 distinct treatment groups: 1) streptokinase + aspirin placebo, 2) aspirin + streptokinase placebo, 3) streptokinase + aspirin, or 4) placebo onlyPatients allocated to receive streptokinase were immediately given 1.5 MU of ‘Streptase' over 1 hour. Patients allocated to receive aspirin were immediately given 162.5 mg of an enteric coated tablet that was crushed, sucked, or chewed for a rapid anti-platelet effect. Thereafter, they took a 162.5 mg tablet daily for 1 month.Endpoints Vascular mortality over 5 weeks was the primary endpoint. Follow-up after discharge involved only mortality, through government records wherever possible.Results 17,187 participants were randomized from 417 hospitals in 16 countries. Compliance with the assigned treatments was estimated to be between 90-95%.The results of ISIS-2 are not reported in a standard results table, making vascular mortality as well as all-cause mortality impossible to infer over the duration of the trial. The number of non-vascular deaths are presented in a table but vascular deaths beyond 5 weeks are not formally provided in the original publication. The only evidence of vascular deaths beyond 5 weeks is presented in survival curves.Over 5 weeks, Streptokinase alone reduced vascular mortality compared to placebo by approximately 25% (9.2% vs 12.0%) and these results were highly significant. The difference remained highly significant over the course of the trial. Non-vascular deaths accounted for a tiny fraction of all deaths (3.5%) and were unchanged between groups. Subgroup analysis of streptokinase efficacy based on time from pain onset showed it was more effective if given within 4 hours (8.2% vs 12.3%) vs between 5-24 hours (10.0% vs 11.8%).Streptokinase use was associated with higher rates of hypotension and bradycardia (10% vs 2.0%), allergic reactions (4.4% vs 0.9%), minor bleeding (3.5% vs 1.0%) and major bleeding (0.5% vs 0.2%). The bleeding excess appeared similar whether streptokinase was used with aspirin or not. Streptokinase was also associated with a small but significant risk of cerebral hemorrhage (7 vs 0 events) all of which were followed by death or severe disability. However, overall, streptokinase was not associated with an increase in stroke (0.7% vs 0.8%) or in the risk of disabling/fatal stroke (0.5% vs 0.6%).Aspirin alone reduced vascular mortality compared to placebo by 23%, approximately the same amount as streptokinase alone over 5 weeks (9.4% vs 11.8%), and these results were highly significant and remained so over the course of the trial. There were fewer non-vascular deaths among aspirin allocated patients, so all-cause deaths were also significantly reduced but like with streptokinase, non-vascular death accounted for a tiny fraction of all deaths. Unlike Streptokinase alone, the treatment effect of aspirin was unchanged regardless of when it was started relative to the onset of pain.Aspirin significantly increased minor bleeds (2.5% vs 1.9%) but there were no major differences in any other side effects.Streptokinase and aspirin compared to double placebo reduced vascular mortality nearly twice as much as either agent alone (8.0% vs 13.2%) and these results were highly significant and remained so over the course of the trial. Non-vascular deaths were the same between groups and so all-cause mortality was also significantly reduced by streptokinase and aspirin. Subgroup analysis based on time from pain onset demonstrated greater efficacy for those receiving treatment in under 4 hours (6.4% vs 13.1%) compared to those receiving treatment between 5-24 hours (9.2% vs 13.3%).Streptokinase and aspirin together were associated with increases in major and minor bleeding as well as cerebral hemorrhage that were similar to streptokinase alone both in terms of their relative and absolute differences.Additional subgroup analyses suggest that patients presenting with anterior STEMI's derived the greatest benefit from streptokinase alone and in combination with aspirin. The risk of death was about twice as high for patients presenting with an anterior vs inferior STEMI (15% vs 8%). Patient's presenting with ST depression on their ECGs experienced a similar overall risk of death compared to patients with anterior STEMI's but did not appear to derive a significant benefit from any combination of treatment.Conclusions Streptokinase alone and aspirin alone reduced death over 5 weeks compared to placebo. 30 to 40 patients would need to be treated with either agent alone to prevent 1 person from dying, which was very similar to the effect noted in the GISSI trial that tested Streptokinase alone. In ISIS-2, the combination of the 2 agents (Streptokinase and Aspirin) reduced death even further (nearly twice the effect of either agent alone) compared to double placebo controls and this was associated with an NNT of 20 or less. Streptokinase, whether alone or in combination with aspirin, exerted the greatest effect when given to patients presenting within 4 hours from pain onset but was still effective when given outside this window (subgroup stratification was not the same as GISSI, which showed that the benefit waned and possibly reversed after 6-9 hours). In ISIS-2 there was no evidence to suggest that sicker patients or those with larger MI's did worse (i.e, lower SBP, higher HR, or anterior STEMI) but again, not all subgroups presented were the same as in the GISSI trial, which did show less benefit for some higher risk groups. Like GISSI, ISIS-2 provided evidence that patients presenting with NSTEMI's did not benefit from streptokinase.In summation, ISIS-2, like the GISSI trial that preceded it, demonstrated the significant impact of early revascularization via thrombolysis on mortality in patients presenting with STEMI. It also demonstrated the significant benefit of aspirin and the additive effect of both agents together. To this day, the pillars of STEMI management involve aspirin and prompt revascularization, whether done via thrombolysis or PCI.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe
Welcome to AI Meets Life Sci, the newest video podcast from DeviceTalks and Drug Discovery & Development. Co-hosted by Kayleen Brown, managing editor at DeviceTalks, and Brian Buntz, pharma and biotech editor, the series offers a comprehensive look into the intersection of AI and life sciences from two unique perspectives. In the first segment, Paul Friedman, MD, Chair of the Department of Cardiovascular Medicine at Mayo Clinic, and Dave McMullin, Chief Business Officer of Anumana, discuss the groundbreaking collaboration between Mayo Clinic and Anumana in applying AI to enhance cardiovascular diagnostics, particularly through ECGs. They explore how AI can detect cardiac conditions early, with a focus on the EAGLE study's findings on AI-enhanced ECGs, and discuss Anumana's role in transforming these AI innovations into accessible medical devices. In the second segment, Jeff Elton, PhD, CEO of ConcertAI, speaks to the transformative role of AI in clinical trials. He sheds light on AI's capabilities in improving patient selection for clinical trials and streamlining processes within life sciences. Dr. Elton emphasizes the broader implications of AI, from enhancing patient care to accelerating the development of new treatments, and discusses the ethical considerations of AI integration in healthcare.These interviews provide insights into the evolving roles of AI in various sectors like medtech, pharma, and biotech, showcasing its potential in transforming healthcare and research methodologies. But that's not all! Join us for the next episode of AI Meets Life Sci, which features an interview with the Global Business Leader for Health and Life Sciences at Microsoft. Catch the full episode on major podcast platforms and YouTube to dive deeper into the exciting convergence of AI and healthcare. Thank you to our contributors, some of who include Catalyze Healthcare and SmartTRAK Business Intelligence, for providing vital support. To learn more about our contributors, visit: www.catalyzehealthcare.com and www.smarttrak.com. Thank you for watching and listening to AI Meets Life Sci.
Jared and Mike walk through a tough peri-intubation collapse case sent in by a listener. We hope you enjoy the insights and are very appreciative of the listener that sent very in depth case details. Don't miss the blog for this one as it has the complete case with ECGs. CLICK HERE to go to the blog. Get your questions in for the next episode CLICK HERE to submit CLICK HERE to watch the episode on YouTube
America Out Loud PULSE with Dr. Peter McCullough and Malcolm – In regards to these turbo cancers we've seen people having, do you have an idea of how close the onset is in regards to the time a person gets the jab and then cancer? How can I find out if I have Spike Protein or mRNA in my blood? Do you recommend ECGs for young teens and adults getting sports physicals?
A nurse who is Britain's worst child serial killer has been given a rare Whole Life Order which means she'll spend the rest of her life in jail. Lucy Letby was convicted on Friday of murdering seven babies and attempting to kill six other infants at the Countess of Chester Hospital. Letby deliberately injected babies with air, force fed others milk and poisoned two of the infants with insulin. Also in the programme: scientists have trained Artificial Intelligence on MRI scans and ECGs to calculate the effective age of a human heart - often different to the age of the patient. We hear from the lead researcher. And after Tropical Storm Hilary ravages Southern California, how are residents coping? (Photo: Court artist drawing by Elizabeth Cook of Judge Mr Justice Goss addressing the dock containing two dock offices beside empty seats during the sentencing of nurse Lucy Letby at Manchester Crown Court. Credit: Elizabeth Cook/PA Wire)
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