Podcasts about Eisenmenger

This episode covers questions on Eisenmenger syndrome.Written notes can be found at https://zerotofinals.com/paediatrics/cardiology/eisenmengersyndrome/Questions can be found at https://members.zerotofinals.com/Books can be found at https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.

This episode covers Eisenmenger syndrome.Written notes can be found at https://zerotofinals.com/paediatrics/cardiology/eisenmengersyndrome/Questions can be found at https://members.zerotofinals.com/Books can be found at https://zerotofinals.com/books/The audio in the episode was expertly edited by Harry Watchman.

Ben Eisenmenger by Gary Fogle

6 Hours and 57 MinutesPG-13This is the complete audio of Pete reading and commenting on Anna Eisenmenger's "Blockade."Pete and Thomas777 'At the Movies'Support Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

27 MinutesPG-13Pete concludes his reading and lite commentary on "Blockade: The Diary of an Austrian Middle-Class Woman 1914-1924."FoxnSons Coffee - Promo code "peter" for 18% off - https://www.foxnsons.com/VIP Summit 3-Truth To Freedom - Autonomy w/ Richard GroveSupport Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

31 MinutesPG-13Pete continues a reading and lite commentary on "Blockade: The Diary of an Austrian Middle-Class Woman 1914-1924."FoxnSons Coffee - Promo code "peter" for 18% off - https://www.foxnsons.com/VIP Summit 3-Truth To Freedom - Autonomy w/ Richard GroveSupport Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

36 MinutesPG-13Pete continues a reading and lite commentary on "Blockade: The Diary of an Austrian Middle-Class Woman 1914-1924."FoxnSons Coffee - Promo code "peter" for 18% off - https://www.foxnsons.com/VIP Summit 3-Truth To Freedom - Autonomy w/ Richard GroveSupport Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

36 MinutesPG-13Pete continues a reading and lite commentary on "Blockade: The Diary of an Austrian Middle-Class Woman 1914-1924."FoxnSons Coffee - Promo code "peter" for 18% off - https://www.foxnsons.com/VIP Summit 3-Truth To Freedom - Autonomy w/ Richard GroveSupport Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

32 MinutesPG-13Pete continues a reading and lite commentary on "Blockade: The Diary of an Austrian Middle-Class Woman 1914-1924."FoxnSons Coffee - Promo code "peter" for 18% off - https://www.foxnsons.com/VIP Summit 3-Truth To Freedom - Autonomy w/ Richard GroveSupport Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

54 MinutesPG-13Pete continues a reading and lite commentary on "Blockade: The Diary of an Austrian Middle-Class Woman 1914-1924."FoxnSons Coffee - Promo code "peter" for 18% off - https://www.foxnsons.com/VIP Summit 3-Truth To Freedom - Autonomy w/ Richard GroveSupport Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

46 MinutesPG-13Pete continues a reading and lite commentary on "Blockade: The Diary of an Austrian Middle-Class Woman 1914-1924."FoxnSons Coffee - Promo code "peter" for 18% off - https://www.foxnsons.com/VIP Summit 3-Truth To Freedom - Autonomy w/ Richard GroveSupport Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

56 MinutesPG-13Pete continues a reading and lite commentary on "Blockade: The Diary of an Austrian Middle-Class Woman 1914-1924."FoxnSons Coffee - Promo code "peter" for 18% off - https://www.foxnsons.com/VIP Summit 3-Truth To Freedom - Autonomy w/ Richard GroveSupport Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

55 MinutesPG-13Pete continues a reading and lite commentary on "Blockade: The Diary of an Austrian Middle-Class Woman 1914-1924."FoxnSons Coffee - Promo code "peter" for 18% off - https://www.foxnsons.com/VIP Summit 3-Truth To Freedom - Autonomy w/ Richard GroveSupport Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

43 MinutesPG-13Pete begins a reading and lite commentary on "Blockade: The Diary of an Austrian Middle-Class Woman 1914-1924."FoxnSons Coffee - Promo code "peter" for 18% off - https://www.foxnsons.com/VIP Summit 3-Truth To Freedom - Autonomy w/ Richard GroveSupport Pete on His WebsitePete's PatreonPete's Substack Pete's SubscribestarPete's GUMROADPete's VenmoPete's Buy Me a CoffeePete on FacebookPete on TwitterBecome a supporter of this podcast: https://www.spreaker.com/podcast/the-pete-quinones-show--6071361/support.

Today Dan and Ellen talk to Anne Eisenmenger, who is president of Beaver Dam Partners and publisher of several weekly newspapers in southeast Massachusetts, including Wareham Week and Sippican Week. Anne has a laser focus on developing and operating hyperlocal for-profit newspapers. Anne lives in Wareham, and she founded her community news company there in 2010 with the launch of Wareham Week. And, yes, it's an actual print newspaper, with a for-profit business model, and it's packed with ads.  Dan dives into one of the best newspaper stories in the country, which is right here in our backyard, or at least in the western sector of our backyard. It involves the Berkshire Eagle, a daily based in Pittsfield, Massachusetts, that was once regarded as one of the best small papers in the country. Then it fell into the hands of Alden Global Capital, so we all know what happened next. This story, though, has a happy ending, at least so far, and I'll talk about it in our Quick Takes. Ellen talked recently with Paul Hammel, a reporter doing a story on the loss of small-town newspapers across Nebraska. He focused on a couple who sold their paper, in a town of 1,000, but had to come back after retirement when the new owner quit in the middle of the night.

A look at the main forms of congenital heart disease including Left to Right Shunts (VSD,ASD, Patent Ductus Arteriosus, Anomalous Pulmonary Vein Connections) and Right to Left Shunts (Tetralogy of Fallot, Transposition of the Great Arteries, Ebsteins Anomaly). Heart Sounds by:Easy Auscultation https://www.easyauscultation.com/heart-soundsLicense https://drive.google.com/file/d/1alTtvcl4sXTwPLhTYIxRps-deCVbGQRz/view?usp=drive_linkVolumes altered - no other changes made. Consider subscribing on YouTube (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Patreon: https://www.patreon.com/rhesusmedicineBuy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Congenital Heart Disease?0:20 Types of Congenital Heart Disease Overview1:07 Normal Anatomy & Physiology 1:43 Left to Right Shunting Pathophysiology (Eisenmenger's Syndrome)3:04 Ventricular Septal Defect (VSD)5:25 Atrial Septal Defect (ASD)7:35 Patent Ductus Arteriosus (PDA)11:16 Anomalous Pulmonary Venous Connections (APVC)13:53 Tetralogy of Fallot (TOF)14:49 Transposition of the Great Arteries (TGA) 16:02 Ebstein's Anomaly17:45 Aortic Coarctation References:BMJ Best Practice (2023) Congenital Heart Disease. Available at https://bestpractice.bmj.com/topics/en-gb/1308/detailsArvanitaki, A (2020) Eisenmenger syndrome: diagnosis, prognosis and clinical management. Available at **https://heart.bmj.com/content/106/21/1638Remien, K & Majmunda, S.H (2023) Physiology, Fetal Circulation. Available at https://www.ncbi.nlm.nih.gov/books/NBK539710/MSD Manuals Pro. Congenital Cardiovascular Anomalies. Available at https://www.msdmanuals.com/en-gb/professional/pediatrics/congenital-cardiovascular-anomaliesPlease remember this podcast and all content from Rhesus Medicine is meant for educational purposes only and should not be used as a guide to diagnose or to treat. Please consult a healthcare professional for medical advice. 

CardioNerds (Dr. Josh Saef and Dr. Sumeet Vaikunth) join Dr. Sheng Fu, Dr. Payton Kendsersky, and Dr. Aniqa Shahrier from the Medical University of South Carolina for some off-shore fishing. They discuss the following featuring a patient with D-TGA and Eisenmenger's syndrome treated with a Heartmate 3. Expert commentary was provided by Dr. Brian Houston. The episode audio was edited by student Dr. Adriana Mares. A 39-year-old woman with a history of D-transposition of the great arteries (D-TGA) with prior atrial switch repair (Mustard) was admitted from the clinic with cardiogenic shock. She underwent right heart catheterization which demonstrated elevated biventricular filling pressures and low cardiac index. An intra-aortic balloon pump was placed, and the patient was evaluated for advanced therapies. A liver biopsy showed grade 3 fibrosis, which, in combination with her shock state, made her a high-risk candidate for isolated heart or combined heart-liver transplantation. After a multi-disciplinary discussion, the patient underwent a Heartmate III left ventricular assist device (LVAD) implant in her systemic right ventricle. Although she did well post-operatively, she was admitted after a month with recurrent cardiogenic shock, with imaging showing her inflow cannula had become perpendicular to the septum.  The patient and family eventually decided to pursue comfort measures, and the patient passed. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - D-TGA and Eisenmenger's syndrome treated with a Heartmate 3 Pearls - D-TGA and Eisenmenger's syndrome treated with a Heartmate 3 Early diagnosis of cyanotic congenital heart disease is paramount for treatment and prevention of future complications. Adult congenital heart disease requires a multi-disciplinary team for management in consultation with an adult congenital cardiology specialist. Eisenmenger syndrome is related to multiple systemic complications and has a high rate of mortality. Advancement in PAH medical management can offer noninvasive treatment options for some patients. Transthoracic echocardiography is the cornerstone for diagnosis. Other modalities (e.g. cardiac CT, cardiac MRI, invasive catheterization) can aid in diagnosis and management. Pearls - D-TGA and Eisenmenger's syndrome treated with a Heartmate 3 While advances in pediatric surgery have allowed many patients born with congenital heart disease to survive into adulthood, adult congenital heart disease (ACHD) patients are complex and prone to numerous adverse sequalae including arrhythmias, heart failure, valvular disease, and non-cardiac organ dysfunction. Heart failure can be a challenging presentation in ACHD patients due to a longstanding history of clinical compensation. Their unique and complex anatomy, as well as highly variable clinical presentation, present unique challenges when it comes to advanced heart failure options such as durable left ventricular assist devices (LVAD) or transplantation. While durable LVAD implantation is possible in patients with systemic right ventricles, anatomic compatibility is paramount and poses ongoing challenges in their management. Goals of care discussions should be had early, as options for treatment may be limited. Show Notes - D-TGA and Eisenmenger's syndrome treated with a Heartmate 3 What are some common sequelae in ACHD patients? ACHD patients are a heterogeneous population, but atrial tachycardias are extremely frequent in this patient population, often due to re-entrant pathways around surgical suture lines. These can often be treated with radiofrequency ablation while paying clos...

CardioNerds (Dr. Josh Saef, Dr. Agnes Koczo) join Dr. Iva Minga, Dr. Kifah Hussain, and Dr. Kevin Lee from the University of Chicago - NorthShore to discuss a case of unrepaired congenital heart disease that involves D-TGA complicated by Eisenmenger syndrome. The ECPR was provided by Dr. Michael Earing. Audio editing by Dr. Akiva Rosenzveig. A 25-year-old woman with an unknown congenital heart disease that was diagnosed in infancy in Pakistan presents to the hospital for abdominal pain and weakness. She is found to be profoundly hypoxemic, and an echocardiogram revealed D-transposition of the great arteries (D-TGA) with a large VSD. As this was not repaired in childhood, she has unfortunately developed Eisenmenger syndrome with elevated pulmonary vascular resistance. She is stabilized and treated medically for her cyanotic heart disease. Unfortunately given the severity and late presentation of her disease, she has limited long-term options for care. CardioNerds discuss the diagnosis of D-TGA and Eisenmenger's syndrome, as well as long-term management and complications associated with this entity. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - Unrepaired Congenital Heart Disease Pearls - Unrepaired Congenital Heart Disease Early diagnosis of cyanotic congenital heart disease is paramount for treatment and prevention of future complications. Adult congenital heart disease requires a multi-disciplinary team for management in consultation with an adult congenital cardiology specialist. Eisenmenger syndrome is related to multiple systemic complications and has a high rate of mortality. Advancement in PAH medical management can offer noninvasive treatment options for some patients. Transthoracic echocardiography is the cornerstone for diagnosis. Other modalities (e.g. cardiac CT, cardiac MRI, invasive catheterization) can aid in diagnosis and management. Show Notes - Unrepaired Congenital Heart Disease Cyanotic congenital heart disease is often diagnosed in infancy and timely treatment is paramount. As these diseases progress over time, pulmonary over-circulation often pulmonary hypertension (PH), elevated pulmonary vascular resistance, and Eisenmenger syndrome will develop, which preclude definitive treatment. For D-TGA, before PH develops, there are surgical options such as the arterial switch procedure that can treat the disease. Unfortunately, once Eisenmenger syndrome develops, there are multiple systemic complications including hyperviscosity, thrombosis, bleeding, kidney disease, iron deficiency, arrhythmias, etc. that can occur. Management requires a multi-disciplinary team including an adult congenital cardiology specialist, but mortality rates remain high, with median survival reduced by 20 years, worse with complex cardiac defects. Bosentan is a first line treatment for patients with Eisenmenger syndrome, with PDE-5 inhibitors as a second line either by themselves or in combination with bosentan. Data are currently limited for latest-generation PH treatments in Eisenmenger syndrome and further study is still underway. References Ferencz C. Transposition of the great vessels. Pathophysiologic considerations based upon a study of the lungs. Circulation. 1966 Feb;33(2):232-41. Arvanitaki A, Gatzoulis MA, Opotowsky AR, Khairy P, Dimopoulos K, Diller GP, Giannakoulas G, Brida M, Griselli M, Grünig E, Montanaro C, Alexander PD, Ameduri R, Mulder BJM, D'Alto M. Eisenmenger Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022 Mar 29;79(12):1183-1198. Earing MG, Webb GD. Congenital heart disease and pregnancy: maternal and fetal risks. Clin Perinatol.

Eisenmenger syndrome is an end-stage complication of congenital heart disease that occurs when a left to right shunt causes pulmonary over-circulation, leading to vascular remodeling, increased vascular resistance, and ultimately even shunt reversal. Aside from cardiac complications, this pathology has unique complications secondary to chronic cyanosis. In this episode of CardioNerds co-founder Dr. Amit Goyal, ACHD series co-chair Dr. Josh Saef, and Dr. Khaled Tuwairqi (ACHD cardiologist at King Faisal / Elite Hospitals) join Dr. Alexander (Sasha) Optowsky (Director of the Adult Congenital Heart Disease Program at Cincinnati Childrens) to discuss diagnosis and management of Eisenmenger syndrome. Show notes were drafted by Dr. Anna Scandinaro and episode audio was edited by CardioNerds Academy Intern Dr. Akiva Rosenzveig. The CardioNerds Adult Congenital Heart Disease (ACHD) series provides a comprehensive curriculum to dive deep into the labyrinthine world of congenital heart disease with the aim of empowering every CardioNerd to help improve the lives of people living with congenital heart disease. This series is multi-institutional collaborative project made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Josh Saef, Dr. Agnes Koczo, and Dr. Dan Clark. The CardioNerds Adult Congenital Heart Disease Series is developed in collaboration with the Adult Congenital Heart Association, The CHiP Network, and Heart University. See more CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Eisenmenger Syndrome First described in 1897 by Victor Eisenmenger, Eisenmenger syndrome is a long-term complication of unrepaired left to right shunts, resulting from pulmonary vascular remodeling and pulmonary hypertension. This eventually leads to reversal of the shunt, with right to left flow causing cyanosis. Evaluation for Eisenmenger syndrome should include a comprehensive history, physical exam, ECG, echocardiogram, cardiac catheterization, and laboratory work to identify multi-system complications of cyanosis and secondary erythrocytosis. The most definitive means to diagnose Eisenmenger syndrome in a patient with a prior left-to-right shunt lesion is with a right heart cardiac catheterization showing right to left shunting (Qp:Qs < 1). Eisenmenger syndrome is a multi-organ disease and many manifestations occur due to secondary erythrocytosis. Prevention and treatment of these complications are the major goals of care in this population. Complications of Eisenmenger syndrome include gout, bilirubin gallstones, stroke, paraganglioma/pheochromocytoma, thrombophilia, retinal changes, hypertrophic osteoarthropathy, and kyphoscoliosis. Emergency non-cardiac complications of Eisenmenger syndrome include cerebral abscess and hemoptysis. Pregnancy is contraindicated in Eisenmenger syndrome due to high maternal and fetal mortality. Notes- Eisenmenger Syndrome 1. How does Eisenmenger syndrome develop? Does everyone with a left-to-right shunt develop it? Can it develop as an iatrogenic complication? The pulmonary vasculature is not used to seeing the increased flow it receives in the context of a left to right shunt. Over time this leads to an increase in pulmonary vascular resistance and pulmonary hypertension. When pulmonary pressures exceed systemic pressures, this causes shunt reversal with right to left shunting causing deoxygenated blood to cross from right side of the heart to the left side bypassing the lungs and causing cyanosis. The process of developing Eisenmenger syndrome is chronically progressive and so adaptive changes have time to occur. Not all persons with unrepaired shunts will develop Eisenmenger syndrome ...

In this episode, we review the high-yield topic of ⁠Eisenmenger Syndrome⁠⁠ ⁠⁠from the Cardiovascular section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets

Vereinbare jetzt dein kostenloses Strategiegespräch: https://termin.sales-by-women.de/podcast In der heutigen Episode von Sales by Women treffen wir Kathlen Eisenmenger, eine herausragende Expertin für gesunde Darmernährung und eine wahre Inspiration für Menschen mit chronisch-entzündlichen Darmerkrankungen. In dem Video berichtet sie von ihrem eigenen Kampf mit der Krankheit und wie sie es geschafft hat ihre Beschwerden selbstbestimmt zu lindern. Kathlen erzählt von den zahlreichen Herausforderungen, die sie bewältigen musste, und den vielen alternativen Ansätzen, die sie ausprobiert hat, um endlich Linderung zu finden. Durch ihren persönlichen Leidensweg hat sie ihre Berufung als selbstständige Darmexpertin gefunden und ist nun fest entschlossen, anderen Menschen in ähnlichen Situationen zu helfen. Viel Spaß!

In this episode, we review the high-yield topic of ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Eisenmenger Syndrome ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Cardiovascular section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.07.28.550928v1?rss=1 Authors: Guan, L., Eisenmenger, A., Crasta, K., Sandalova, E., Maier, A. B. Abstract: Cellular senescence is a permanent state of cell arrest, regarded as a therapeutic target for ageing and age-related diseases. Natural products hold the translational potential to promote healthy ageing. This systematic review examined dietary interventions and association with senescence in animals and humans to identify senotherapeutic potential. The databases PubMed and Embase were systematically searched. 82 articles consisting of 78 animal studies and 4 human studies aimed to reduce cellular senescence load using dietary interventions. In animal studies, the most-frequently used senescence model was normal ageing (26 studies), followed by D-galactose-induced models (17 studies). Resveratrol (8 studies), vitamin E (4 studies) and soy protein isolate (3 studies) showed positive effects on reducing the level of senescence markers such as p53, p21, p16 and senescence-associated beta-galactosidase in various tissues of physiological systems. Ginsenoside Rg1 had no positive effect on reducing senescence in human muscle tissues after exercise. Resveratrol, vitamin E and soy protein isolate are promising senotherapeutics studied in animals. Studies testing dietary interventions with senotherapeutic potential in humans are limited and translation is highly warranted. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

SwineCast 1234 Show Notes: Dr. Tyler Te Grotenhuis (Christensen Farms) and Dr. Mike Eisenmenger (recently retired from the Swine Vet Center) discuss with the At The Meeting team how to implement biosecurity on nursery-grow-finish sites. On ‘At the Meeting’, Honoring Dr. Bob Morrison are Dr. Montserrat Torremorell (College of Veterinary Medicine, University of Minnesota), Dr. …

SwineCast 1234 Show Notes: Dr. Tyler Te Grotenhuis (Christensen Farms) and Dr. Mike Eisenmenger (recently retired from the Swine Vet Center) discuss with the At The Meeting team how to implement biosecurity on nursery-grow-finish sites. On ‘At the Meeting’, Honoring Dr. Bob Morrison are Dr. Montserrat Torremorell (College of Veterinary Medicine, University of Minnesota), Dr. …

Learn about the bonkers life of Johannes Eisenmenger, a man who spent 19 years under false pretenses within the Jewish community. Over those 19 years, he meticulously studied the Talmud, and eventually wrote a wild 2000-page text about the evils of the Talmud. In this episode, Yael and Schwab explore the personal motives, societal implications, and long-lasting effects of his actions. Join us as we dissect this tale of deception and bigotry in the light of history, faith, and human behavior. This episode was hosted by Jonathan Schwab and Yael Steiner. Our education lead is Dr. Henry Abramson. Audio was edited by Rob Pera, and we're produced by Rivky Stern. For more on Johannes Eisenmenger, and this episode: https://docs.google.com/document/d/1KeADzNKcvU0A5UjvwAwnA0SONmunnrGxFCjaD8Kpr3o/edit?usp=sharing Tell us what you think about the podcast here: https://jewishunpacked.com/nerdsurvey

Belen Blanton was born with tricuspid atresia in Caracas, Venezuela back in 1965. When she was born, many doctors told her mom that she was not going to make it. Fortunately, her mother took her to a cardiologist that had contact with Houston Children's hospital in Texas, where she had surgery, a Potts Shunt procedure performed by Dr. Denton Cooley. From age 15 she began to experience complications including arrhythmia. When she was 21 she moved to the US and from age 30 experienced atrial fibrillation, endocarditis, Eisenmenger Syndrome, and pulmonary hypertension. She is married with two sons and has recently started a charity to help those living in her home country of Venezuela. She believes her life has been a gift and she has felt a need to give back to others in her country by creating a nonprofit organization called ‘Estrellita de Belen Foundation.'Belen's foundation can be found at https://fundacionestrellitadebelen.orgOr email her at belenblanton@fundacionestrellitadebelen.orghttps://www.linkedin.com/in/belenblantonaltuve/https://www.instagram.com/estrellitadbelen/Website: The Heart Chamber (theheartchamberpodcast.com)Transcript: Joyful Beat | The Heart Chamber (theheartchamberpodcast.com)The Heart Chamber (@theheartchamberpodcast)Thanks to Michael Moeri for being my right hand man. Michael Moeri - Audio Editor, Podcast Producer and Marketing Director

Imagine a patient with a SPO2 in the 80's, not in distress, and acting normal. Their echocardiogram shows an atrial septal defect and a pulmonary artery pressure of 95!!! What can we do for this patient? What could cause such a high PA pressure?Today's guest Nick McGowan MSN, RN, CCRN, had this experience and is sharing his patient's story with Sarah. Nick revisits how this case evolved, from getting test results to discovering his shockingly high PA pressure and transferring the patient to the ICU.Many nurses haven't heard of this condition before, but you'll understand the pathophysiology of Eisenmenger syndrome and its prognosis by the end of this episode. We also go over the importance of establishing goals of care with patients, and the role of nurses in the ICU.Nick is also a nursing educator, so tune in to learn his helpful tips on treating elevated PA pressures!Topics discussed in this episode:Nick finding his passion in intensive care nursingHow he became a Nursing EducatorInitial assessment of his Eisenmenger syndrome patientThe pathophysiology of Eisenmenger syndromeTreatment optionsWhat to remember when treating elevated PA pressuresLearn more from Nick here:Website: https://www.ccrnacademy.comLinkedIn: https://www.linkedin.com/in/ccrnacademy/Instagram: https://www.instagram.com/critical_care_academy/Youtube: https://www.youtube.com/@criticalcareacademy8312Facebook: https://www.facebook.com/CCRNacademy/Use the code "RAPID10" to get 10% off his e-learning course just for being a podcast listener! https://www.ccrnacademy.comANDIf you would like to check out Sarah's 1hr, 1 CE course, go to: http://www.rapidresponseandrescue.comTo get the FREE Rapid Response RN Assessment Guide and the coupon code for $10 off the cost of the course, message Sarah on Instagram @TheRapidResponseRN and type the word PODCAST!This episode was produced by Podcast Boutique http://www.podcastboutique.com

Join CardioNerds to learn about patent ducts arteriosus and Eisenmenger syndrome! Dr. Dan Ambinder (CardioNerds co-founder), ACHD series co-chair Dr. Dan Clark,  Dr. Tony Pastor (ACHD fellow, Harvard Medical School), and Dr. Kate Wilcox, Medicine/Pediatrics Resident, Medical College of Wisconsin join Dr. Candice Silversides (Editor-in-chief #JACCAdvances) for this terrific discussion. Notes were drafted by Dr. Kate Wilcox. .Audio editing by CardioNerds Academy Intern, Dr. Maryam Barkhordarian. The CardioNerds Adult Congenital Heart Disease (ACHD) series provides a comprehensive curriculum to dive deep into the labyrinthine world of congenital heart disease with the aim of empowering every CardioNerd to help improve the lives of people living with congenital heart disease. This series is multi-institutional collaborative project made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Josh Saef, Dr. Agnes Koczo, and Dr. Dan Clark. The CardioNerds Adult Congenital Heart Disease Series is developed in collaboration with the Adult Congenital Heart Association, The CHiP Network, and Heart University. See more Disclosures: None CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Patent Ductus Arteriosus & Eisenmenger Syndrome The ductus arteriosus, which is formed from the distal portion of the left sixth arch, is key to fetal circulation because it allows blood to bypass the high resistance pulmonary circuit present in utero. After birth there is a significant drop in pulmonary vascular resistance (PVR) which generally leads to functional ductal closure within 48 hours (permanent seal takes 2-3 weeks to form). Risk factors for having a PDA include birth before 37 weeks of gestation, trisomy 21, and congenital rubella. A PDA results in a left to right shunt (qP:qS >1) which over time overloads the left side of the heart and causes pulmonary vascular remodeling. The extra workload on the left side of the heart causes left atrial (can cause atrial arrhythmias) and left ventricular dilation. If left untreated you can eventually have shunt reversal due to very high PVR (Eisenmenger physiology). There are some treatment options at this point (pulmonary vasodilators, etc) but it's definitely better to close the PDA before this point. One interesting physical exam finding that can stem from shunt reversal in a hemodynamically significant PDA is differential cyanosis (upper body or pre-ductal saturations will be higher than lower body/post-ductal saturations). You can also see clubbing in the toes but not the hands for the same reason. Meet Our Collaborators! Adult Congenital Heart AssociationFounded in 1998, the Adult Congenital Heart Association is an organization begun by and dedicated to supporting individuals and families living with congenital heart disease and advancing the care and treatment available to our community. Our mission is to empower the congenital heart disease community by advancing access to resources and specialized care that improve patient-centered outcomes. Visit their website (https://www.achaheart.org/) for information on their patient advocacy efforts, educational material, and membership for patients and providers CHiP Network The CHiP network is a non-profit organization aiming to connect congenital heart professionals around the world. Visit their website (thechipnetwork.org) and become a member to access free high-quality educational material, upcoming news and events, and the fantastic monthly Journal Watch, keeping you up to date with congenital scientific releases. Visit their website (https://thechipnetwork.org/) for more information.

1.17 Eisenmenger Syndrome   Cardiovascular system review for the USMLE Step 1 exam.  

Congenital heart disease is the most common birth defect, affecting 1 in 100 babies. Amongst these ventricular septal defects are very common with the majority of patients living into adulthood. In this episode we will be reviewing key features of VSDs including embryologic origin, anatomy, physiology, hemodynamic consequences, clinical presentation and management of VSDs. Dr. Tommy Das (CardioNerds Academy Program Director and FIT at Cleveland Clinic), Dr. Agnes Koczo (CardioNerds ACHD Series Co-Chair and FIT at UPMC), and Dr. Anu Dodeja (Associate Director for ACHD at Connecticut Children's) discuss VSDs with expert faculty Dr. Keri Shafer. Dr. Shafer is an adult congenital heart disease specialist at Boston Children's Hospital, and an assistant professor of pediatrics within Harvard Medical School. She is a medical educator and was an invited speaker for the inaugural CardioNerds Sanjay V Desai Lecture, on the topic of growth mindset. Script and notes were developed by Dr. Anu Dodeja. Audio editing by CardioNerds Academy Intern, Shivani Reddy. The CardioNerds Adult Congenital Heart Disease (ACHD) series provides a comprehensive curriculum to dive deep into the labyrinthine world of congenital heart disease with the aim of empowering every CardioNerd to help improve the lives of people living with congenital heart disease. This series is multi-institutional collaborative project made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Josh Saef, Dr. Agnes Koczo, and Dr. Dan Clark. The CardioNerds Adult Congenital Heart Disease Series is developed in collaboration with the Adult Congenital Heart Association, The CHiP Network, and Heart University. See more Disclosures: None Pearls • Notes • References • Guest Profiles • Production Team CardioNerds Adult Congenital Heart Disease PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls - Ventricular Septal Defects Most common VSDs: Perimembranous VSD The shunt volume in a VSD is determined largely by the size of the defect and the pulmonary vascular resistance. VSDs cause left to right shunt. The long-term effects are left sided chamber dilation, as is the case with PDAs (post-tricuspid shunts) VSDs can be associated with acquired RVOTO, double chamber right ventricle, LVOTO/sub aortic membrane formation, and aortic regurgitation from aortic valve prolapse. Eisenmenger syndrome results from long-term left-to-right shunt, usually at higher shunt volumes. The resulting elevated pulmonary artery pressure is irreversible and leads to a reversal in the ventricular level shunt, desaturation, cyanosis, and secondary erythrocytosis. Endocarditis prophylaxis is not indicated for simple VSD. It is required for 6 months post VSD closure, in patients post VSD closure with a residual shunt and in Eisenmenger patients with R—>L shunt and cyanosis. Show notes - Ventricular Septal Defects Notes (developed by Dr. Anu Dodeja): What are types OF VSD? (Please note that there are several nomenclatures) Perimembranous VSDMost common type of VSD - 80% of VSDsOccurs in the membranous septum and can be associated with inlet or outlet extensionLocated near the tricuspid and aortic valves, often time can be closed off by tissue from the septal leaflet of the tricuspid valve and associated with abnormalities in the septal leaflet of the tricuspid valve secondary to damage from the left to right shuntCan be associated with acquired RVOTO, double chamber right ventricle, LVOTO/sub aortic membrane formation On TTE, the parasternal short axis view at the base demonstrates this type of VSD at the 10-12 o'clock position. Muscular VSDSecond most common VSD - 15-20% of VSDsCompletely surrounded by muscle,

No Cardiocast de hoje o Dr. Halsted Gomes continua a revisão do importante tema publicado na revista JACC no seu estado da Arte: A síndrome de Eisenmenger.

No Cardiocast de hoje o Dr. Halsted Gomes revisa um importante tema publicado na revista JACC no seu estado da Arte com uma excelente revisão, a síndrome de Eisenmenger.

$5 Q-BANK: https://www.patreon.com/highyieldfamilymedicine Intro 0:30, Fetal circulatory system 2:00, Persistent fetal circulation 6:38,  Patent ductus arteriosus 8:02, Differential cyanosis 8:40, CCHD screening 9:24, Common themes 10:39, Non-cyanotic heart defects 13:26,  Ventricular septal defects 14:08, Atrial septal defects 15:35, Eisenmenger syndrome 16:28, Aortic and pulmonary stenosis 17:42, Coarctation of the aorta 18:42, Double aortic arch 19:53, Interrupted aortic arch 21:07, Cyanotic heart defects 21:34,  Tetralogy of Fallot 23:39, Transposition of the great arteries 28:03, Hypoplastic left heart syndrome 29:47, Persistent truncus arteriosus 31:09, Partial and total anomalous pulmonary venous connection 33:01, Scimitar syndrome 35:04, Tricuspid and pulmonary atresia 36:03, Prostaglandin E1 indications 36:31, DiGeorge syndrome 38:08, CHARGE syndrome 38:42, Dextrocardia 39:06, Situs inversus and total situs inversus 39:16, Ebstein anamoly 40:04, Noonan syndrome 40:34, Turner syndrome 41:11, Down syndrome 41:28, Marfan syndrome 40:52, Congenital heart blocks 43:03, Practice questions 43:27

Doctor Normalize brings on his childhood best friend, Ben Eisenmenger, to talk about the importance of walking for our overall mental and physical health. Ben Eisenmenger is a competitive strongman, personal trainer, and owner of Be Strong Gym in Northern Kentucky. He has worked full time in health and fitness for over a decade and has helped hundreds of people move better, get stronger, and feel more confident in their bodies. Ben is a husband and father of 3, but still finds ways to regularly stay active and continues to compete in top tier competitions. He is a two-time Kentucky Strongest Man and National Champion as a middleweight strongman. He enjoys learning about the mind, body, and history of humans and believes the best way to continue success is to remain curious and find joy in learning new ideas and constructs. Music: Independent Music Licensing Collective - One Man Book/Existence Strategy --- Support this podcast: https://anchor.fm/normalizethisshit/support

Mit navn er Benjamin og jeg er 23 år Jeg lider af en special hjerte og lunge sygdom som gør jeg venter på nyt hjerte. Jeg har prøvet lidt af hvert og skulle håndtere flere ting på en I disse 2 afsnit går jeg meget i dybden med hvem er jeg enlig og i kan få en større indblik på hvem jeg er som person hvordan jeg tænker forhold til mit sygdoms forløb. Tager jer med ind det psykiske når man skal lave forberedelserne til transplantation men man står med det hele selv.

Trailer for the upcoming episode of Normalize This Sh!t where Doctor Normalize is joined by his childhood best friend, Ben Eisenmenger, who is a competitive strongman, personal trainer, and owner of Be Strong Gym in Northern Kentucky. He is a two-time Kentucky Strongest Man and National Champion as a middleweight strongman. He enjoys learning about the mind, body, and history of humans and believes the best way to continue success is to remain curious and find joy in learning new ideas and constructs. Airing 09/02/2022 at 9am PST, Ben normalizes something we all take for granted: walking. And the incredible benefits it gives our bodies. Tune in. --- Support this podcast: https://anchor.fm/normalizethisshit/support

Das Buen Camino Projekt - 1000 Kilometer für die Tiere Afrikas. Mit diesem tollen Projekt unterstützt die 26 jährige Nora nicht nur den Verein Affenstark e.V. zum Schutz von Primaten und Wildtieren in Afrika, sondern versucht auch ihren Verstärker des Herzens etwas lauter zu stellen. Und ihre Pilgerreise auf dem Camino dem Norte unter genau dieses Thema zu stellen. In dieser sehr ehrlichen Folge erfährst du…

In this episode, Shavini Fernando discusses her severe pulmonary hypertension diagnosis due to Eisenmenger's Syndrome. After facing multiple cardiac arrests and strokes due to the low oxygen levels in her body, she developed OxiWear, the first ever wearable for continuous blood oxygen monitoring device that alerts patients who are prone to hypoxia to live life independent without having to worry about their oxygen levels. Use Coupon Code "PHA2022" to receive 20% off if you purchase a OxiWear device by 6/30/22. Learn more about pulmonary hypertension trials at www.phaware.global/clinicaltrials. Never miss an episode with the phaware® podcast app. Follow us @phaware on Facebook, Twitter, Instagram, YouTube & Linkedin Engage for a cure: www.phaware.global/donate #phaware #ClinicalTrials 

Commentary by Dr. Valentin Fuster

Diese etwas andere Folge von Games Insider widmen wir Richard Eisenmenger, Anfang der 90er-Jahre Redakteur der legendären Spielezeitschrift Power Play. Leider ist "Richie", wie ihn seine Redaktionskollegen seinerzeit nannten, im Frühjahr 2021 nach schwerer Krankheit verstorben. Richard ist Benedikt aus seiner Jugendzeit nicht nur als kompetenter Amiga-Enthusiast in Erinnerung geblieben, er hatte wenige Wochen vor seinem Tod auch persönlichen Kontakt zu ihm. Benedikt erzählt in dieser Episode von Richards Power-Play-Zeit, schmökert ein wenig in alten Testberichten, berichtet vom weiteren Werdegang des Journalisten und Autors und erklärt, wie und warum es überhaupt zur Kontaktaufnahme kam. Zudem ist Richard Eisenmenger selbst in einem Einspieler zur hören, genauso wie der frühere Power-Play-Chefredakteur Anatol Locker. In diesem Sinne: Mach's gut, Richard Eisenmenger! Benedikt Unterstützt unsere Arbeit und erhaltet exklusive Bonus-Podcasts: https://www.patreon.com/gamesinsider oder https://steadyhq.com/gamesinsider

Do you want to level up your training? On the show this week, I'm really excited to have Ben Eisenmenger, an incredibly well-rounded strength athlete, good friend, fellow coach, and on and off client of Rebel Performance. Ben is 230 pounds and just won Kentucky's Strongest Man where he pulled a 700+ lb deadlift. Not to mention he's pushing a sub-6-minute mile while maintaining those numbers. I wanted to have him on the show to talk about some key strategies and tactics he uses in his training to help him become the well-rounded, robust athlete he is. Ben and I hit on a ton of actionable tips and takeaways you can implement in your own training: the role conditioning plays, utilizing kettlebells and medicine balls, and, of course ways to improve your deadlift so you can hit record numbers. We also unpack the importance of sticking to the basics and filling up your training buckets. Listen in to hear how you can level up your attribute bars across the board so you can become the total package athlete. What You'll Learn in This Episode:  [04:35] Intro to Ben Eisenmenger [06:15] Strongman weight classes [07:50] Types of loads being moved at a bodyweight of 230 lbs [13:44] Benefits to building a slow aerobic base [14:40] The importance of implementing and prioritizing your conditioning [16:13] Contributions to Ben's success as a strength athlete [18:02] Sticking to the basics [19:22] The brick-by-brick analogy [21:44] How to use kettlebells in your training [25:16] Kettlebell routine for off season work [26:34] Building a better squat pattern [29:17] Powerful contributors to building Ben's deadlift [31:38] Utilizing the high trap bar [34:22] The importance of filling your training buckets [37:31] Where to find Ben Eisenmenger Links: Explore our free training samples here: https://www.rebel-performance.com/training-templates/ Follow James Cerbie on IG here: https://www.instagram.com/jamescerbie/ Follow Ben Eisenmenger on IG here: https://www.instagram.com/bestrongky/ Follow Be Strong KY on IG here: https://www.instagram.com/bestrongky_gym/ Check out Be Strong KY here: https://www.bestrongky.com/ Want to learn more about the Rebel Performance Training Team? Click here to chat with our team: http://m.me/rebelperf PLUS: Whenever you're ready... here are 3 ways we can help you unlock total package strength, physique, and athleticism (without being in pain or getting beaten down by injuries). 1. Listen to the podcast.  We release a new episode every Sunday evening where we break down what to do in and outside the gym to help you become the total package (and perform pain-free) - http://radio.rebel-performance.com/listen (Click here to listen.) 2. Buy a pre-made program.  Looking for an expertly crafted training program minus the coaching and camaraderie? Then https://shop.rebel-performance.com/ (go here). 3. Claim your 90-day risk-free trial. Want to work directly with me and my team to find your peak performance, train pain-free, and become a total package athlete in 90 days? Then reply "trial" to this email and I'll send you all the details. Oh, and https://www.rebel-performance.com/reviews (here's a bunch of reviews) if you want to know what real humans think of working with us. 

Ashley Eisenmenger is considered the first NCAA triathlete with a disability that required some sport specific adaptation. As a blind triathlete, Ashley raced varsity women's triathlon her junior and senior year at North Central College. She continues to compete at the highest level at various triathlons, including the Chicago Tri which is in her back yard. Ashley was recently able to get certified as a USAT coach and is connected to Dare2Tri, a Move United member organization, where she helps out at some of their camps. Outside of sports, she works for a nonprofit in Chicago called Access Living where she consults and trains on diversity, equity, and inclusion.

This episode covers eisenmenger's syndrome!

Grow-finish farms are the last segment of hog production to enact strict biosecurity protocols. That needs to change, reports Mike Eisenmenger, DVM, Swine Vet Center, St. Peter, Minnesota. The post Eisenmenger: Time to invest in market-transport biosecurity appeared first on Pig Health Today.

This episode covers the Eisenmenger syndrome.Written can be found at https://zerotofinals.com/paediatrics/cardiology/eisenmengersyndrome/ or in the cardiology section in the Zero to Finals paediatrics.The audio in the episode was expertly edited by Harry Watchman.

Carsten Eisenmenger, the Goalkeeping Coach for Germany's U20 Youth National Team, discusses the academy systems of Central Europe, the pressures of modern goalkeeping and developing mental strength.

Dr. Carolyn Lam:               Hello from the American Heart Association meeting in Anaheim. I'm Dr. Carolyn Lam, associate editor from Circulation at National Heart Centre in Duke National University of Singapore and I'm so pleased to be here with the Circulation team led by editor in chief Dr. Joe Hill, as well as with Dr. Laura Mauri, senior editor from Brigham and Women's Hospital, and Dr. Dharam Kumbhani, associate editor from UT Southwestern. Boy, we've got lots to discuss. I mean, I want to just first start with congratulating you, Joe. We have got quite a number of simultaneous publications here at the AHA. Dr. Joseph Hill:                  I appreciate that, Carolyn. Don't congratulate me. We have a team that is a privilege to work with. One of the initiatives that we launched right from the start was a desire to foster and shine a bright light on emerging science at the major meetings around the world. Often, that involves simultaneous publication.                                                 I'm proud to say that we have 11 simultaneous publications, a record for us here at AHA. Most of them are clinical trials. A few are clinical science, and two of them are young investigators who are competing in the various different competitions. We reached out to them a few weeks ago and offered them the opportunity to submit to us, of course with no guarantees, and our standard remains the same, but we promised that we would provide them with an external peer review. Two of them made it through the process and they will be simultaneously published with their presentations here in Anaheim. Dr. Carolyn Lam:               Wow, well you heard it. A record 11 simultaneous publications. We've got a lot to talk about. Let me just maybe group the topics a little bit. Let's start with talking about peripheral artery disease. I think there are at least three papers around that area, and then we'll talk about coronary artery disease, and almost focusing more on implementation science, papers, there are two there, and then of course we have to talk about heart failure. Dharam, could you start? Tell us about the FOURIER PAD trial. Dr. Dharam Kumbhani:  Yeah. It's very exciting to have clinical trials in the PAD realm. FOURIER PAD is certainly really well done sub-study of the FOURIER trial. As you remember, this was a landmark trial, which compared a PCSK9 inhibitor Evolocumab in two doses, two placebo. The overall trial was done in about 27,000 patients who were followed for a median of 2.2 years. In this trial, Marc Bonaca and investigators, they looked at the PAD subset, which were about 13% of the total cohort. Now, they specifically set out to look at how patients with PAD, during this trial and very gratifyingly, they also specifically assessed how patients with PAD did as far as limb events, not just cardiovascular events.                                                 At the outset, not surprisingly, patients with PAD had a higher risk of cardiovascular events by, I think it was about 60% higher for the primary end point compared with patients who did not have PAD. There was really no, in fact, modification by PAD in that the benefit of Evolocumab that we saw in the overall trial was preserved among the patients with PAD as well as those without PAD. However, because patients with PAD had higher event rates, the absolute risk reductions were higher in patients with PAD.                                                 Then, these investigators looked specifically at the incidents of major adverse limb events, which is a composite of acute limb ischemia, urgent revasc, and major amputations. What they show is that in the overall cohort, there is a 42% reduction in the risk of these major adverse limb events with Evolocumab compared with placebo. Obviously, the effect is significantly higher in patients with PAD. Although the benefit wasn't noted in the PAD subset specifically, the overall p-value for interaction was negative.                                                 One of the really exciting things about this paper is that just like investigators have shown a monotonic reduction in cardiovascular event rates with LDL reduction, similarly, the investigators show a reduction in limb events, which is dose related and the same way in a monotonic fashion with Evolocumab. I think this is really exciting and I think this will be a very important paper for the field. Dr. Carolyn Lam:               Yeah. Dharam, that was beautifully summarized but once you start talking about the peripheral artery disease and this lack of interaction on effects and so on, I think of the CANVAS trial results that were reported at this meeting too. If I could maybe briefly summarize what the authors did in this circumstance, they looked at the more than 10,000 patients in the CANVAS trial who were randomized into Canagliflozin versus placebo in diabetic patients but this time they looked at whether or not there was a difference in effect with the primary prevention cohort versus the secondary prevention.                                                 Primary prevention meaning those adults who had diabetes and risk factors but no established cardiovascular disease and the secondary prevention were those with peripheral artery disease, for example, and other established cardiovascular disease. The same thing, a lack of interaction, which I think is really important because it was the same sort of idea that the overall risk of cardiovascular events was lower in the primary prevention group. Looking at them as a subgroup alone, you didn't get the p-value that crossed the limit because the power was less in a lower risk group, but the lack of statistical interaction really gives us additional information, I think, that Canagliflozin and maybe the SGLT2s in general may be effective for primary prevention in diabetic patients. What do you think? Dr. Dharam Kumbhani:  Yeah. I mean, I think certainly, very interesting findings along those lines. As you pointed out, the event rates are much lower in the primary prevention cohort. All the confidence intervals overlap one, but because all the p-values for interaction for the three-point maze, the four-point maze, et cetera, one would say that there really isn't a difference between the primary and the secondary prevention subgroups. You would potentially have the same benefit in that subgroup as well. Dr. Carolyn Lam:               Fortunately or unfortunately, in that same study, they looked at the risk of amputations and there was a lack of interaction too for that meaning there was a higher risk of amputations with Canagliflozin versus placebo. That of course is a really hot topic now, isn't it? I just wanted to point out though, when you look at it in the primary prevention group, there are only 33 events. What do you think? It spells caution but further look needs to be done? Yeah. Contrast that with the EMPA-REG outcome PAD analysis. You want to tell us about it? Dr. Dharam Kumbhani:  Yeah. Once the Canagliflozin CANVAS findings came out showing a high rate of amputations with Canagliflozin, the Empagliflozin, the EMPA-REG outcome's investigators went back and looked at the PAD subset in EMPA-REG outcomes. This was about 20% of the total cohort. I will say that unlike FOURIER, which we just discussed, the ascertainment of amputations was not prospectively defined for this trial and it was really obtained from the CRF forms.                                                 However, having said that, it did not appear that amputation rates were higher with Empagliflozin. They did not break it down by the different doses but one assumes that the benefit is consistent between the two doses that they study. One would imagine the PAD patients would have a higher rate overall, which it was, but even in that group, it was about 6% over three years and there was really no difference between the patients who received Empagliflozin versus those who got placebo. Dr. Carolyn Lam:               That EMPA-REG outcome paper, I mean, interestingly, it was a research letter. Joe, you've been watching this whole field unfold right now and our journal has published so many good papers, including CVD REAL, all in this space. Could you comment on that a little bit and the research letter concept and the fact that we're publishing so many of these interesting papers in this topic? Dr. Joseph Hill:                  Well, Carolyn, as you inferred, this field is evolving very rapidly. Now, the interface between metabolic disease and diabetes and heart disease is blurring. Some of these diabetic drugs are really emerging as heart failure drugs, it looks like and so there's a great deal of interest in exploring that and trying to find underlying mechanisms. It's an incredibly exciting time. In parallel with that, we are publishing research letters now for papers where, again, our bar starts with validity. Our bar doesn't change but if it's a story that can be communicated with really one multi-paneled figure and an 800word text, then that is a nice bite-size piece of information that we can get out to our readership. We're publishing one or two a week now. Overall, it appears to be well received and I think it's an effective vehicle for conveying certain types of our content. Dr. Carolyn Lam:               Frankly, it's such a delight to read, isn't it? It's hard to write. I think the shorter, the harder to write but this just goes to show how equally important they are. Dr. Joseph Hill:                  Absolutely. Dr. Carolyn Lam:               That we're discussing it here. Well, let's go on to the next topic then, coronary artery disease. Regionalization of the care. I'll say that again, regionalization of the care. Would you like to comment on the two papers that are simultaneously being published? One would be the ACCELERATOR-2 trial. That's in the U.S. Then, a second from New Zealand, the ICare-ACS trial. Slightly different but- Dr. Joseph Hill:                  Well, that's exactly right. Often, we know what to do but we don't do what we know we need to do in medicine. The implementation of what we already know is an area of hot research and is an area that's evolving rapidly. These two studies, ACCELERATOR-2 here in the United States, focused on regionalization of the interface between EMS systems and EDs, how to get patients identified in the hospital to their device, whether it's a stent or a balloon pump or whatever it is. The first medical contact to device was the metric and by implementing what we already know, the AHA mission lifeline principles, these investigators were able to optimize this regionalization, so there wasn't so much variability across these 12 metropolitan regions. As a consequence, the time to first medical contact to device was shortened, and there was in fact a striking, maybe even surprising, mortality benefit. Dr. Carolyn Lam:               Exactly. That was striking to me too. Dr. Joseph Hill:                  From the street to the lab, another paper from New Zealand that you referred to called ICare-ACS focused on doing a better job in the emergency department with serial ECGs and serial high sensitivity troponins, risk stratification algorithms and they found that, again, by developing these clinical pathways within the ED, they were able to shorten the length of stay in the ED and the length of stay in the hospital. Dr. Carolyn Lam:               Yeah. I thought those were amazing and then also from different parts of the world, really strong public health messages as well. Laura, you take care of these ACS patients right on there. What did you think of these papers? Dr. Laura Mauri:                No, I agree. I think that we've, in the past, focused on science and focused on clinical trials but ultimately, none of that matters if we don't deliver the healthcare to the patient. I think this is just a growing field and I'm glad that we're emphasizing it in circulation. Dr. Carolyn Lam:               Absolutely. If we would now go to another area that is really increasing in prevalence throughout the world. Heart failure, and of course, heart failure with preserved ejection fraction. Dr. Joseph Hill:                  Your favorite topic. Dr. Carolyn Lam:               Congratulations, Laura on the paper that you're presenting, that is being presented at this meeting, the REDUCE LAP trial. Could you tell us a little bit more about that? Dr. Laura Mauri:                Sure. Yes, as you know, it's a really challenging field, heart failure with preserved ejection fraction. There aren't a lot of therapies that we have. We really don't have great medical therapy. This study actually looks at a medical device to treat patients. It really is a feasibility study, so it's a relatively small trial, just over 90 patients but it's randomized. We know in the device arena, as in all trials, how important randomization is but also blinding. This was actually a sham-controlled blinded trial really designed to look at this interatrial shunt device in patients who have an elevated wedge pressure.                                                 The REDUCE LAP stands for reduce left atrial pressure. That was the primary endpoint, was pulmonary capillary wedge pressure. This was not only looked at the safety, which showed that the device placement was very safe, but at the same time also looked at the proof of concept that by placing the shunt device, there was actually a reduction in wedge pressure over a period of exercise. It needs to be followed on. It's certainly just the first phase of trials but a pretty good standard with the sham control. Dr. Carolyn Lam:               Yeah, well, congratulations again. I mean, this follows … There was a previous publication of the single arm trial and now, this is the first randomized sham-controlled, and the results are consistent. It's a very difficult trial to carry out. HFpEF patients are notoriously difficult to recruit. Could you tell us a little bit about what it was like successfully completing this trial? Dr. Laura Mauri:                Yeah. Well, we had very enthusiastic centers and principal investigators, Ted Feldman and Sanjiv Shah. I think what it really required in this early phase was sites that were committed to characterizing the exercise physiology. The next stage of rolling this out to a broader number of sites and a larger number of patients to see if there's a clinical effect will really be more focused on the clinical endpoints and quality of life because ultimately that's the goal, is to improve symptoms in these patients. Dr. Carolyn Lam:               What I love about the design and the whole concept, it's so simple and elegant. We almost sometimes forget that HFpEF is heart failure, which means that by definition, there's raised filling pressures. It's hemodynamic at the end and this is just a simple concept of offloading the left atrium. That's so beautiful but it does come with some questions. Every time you mention this to someone, they go, “What about, I don't know, Eisenmenger's syndrome developing later?” The right side, volume overload, pulmonary hypertension, what about atrial fibrillation down the line? How about the safety parts of it? Dr. Laura Mauri:                Right, so the procedural safety was excellent but then I think you raise really important questions and these patients are still in follow-up but looking at the report here at this meeting, there was no pulmonary hypertension in excess in the shunt treated arm. The patient selection was towards patients who had higher wedge compared with right atrial pressure and among those patients, there was no evidence of RV overload. At least at this stage things look good to go on to the next step. Dr. Carolyn Lam:               That's wonderful and exciting. We definitely need a therapy for HFpEF. Joe, would you like to highlight any other trial? We have 11. We've discussed six. Dr. Joseph Hill:                  Tonight at the editorial board meeting, we will be saluting these two young investigators who are presenting their work in this competition and simultaneously publishing their work. We've invited these young investigators and their mentor and they will present a short talk to the editorial board dinner. It's an effort to salute and recognize these early career investigators, to congratulate them on outstanding work. We're pleased and privileged to publish it, so I'm particularly excited about that. Dr. Carolyn Lam:               Wow, Joe. That is great. Thank you. I didn't know that was happening either. That's fabulous. Dharam or Laura, any other highlights that you may want to mention in this meeting? Dr. Laura Mauri:                I think that it's just been a wonderful kickoff to the meeting. We've covered, I think, many of the really important trials so it's really exciting to be able to see the work in print. Dr. Carolyn Lam:               That's great, and to discuss it as well. Dr. Dharam Kumbhani:  Yeah, I agree. This is really exciting and hopefully, we can keep growing from strength to strength every year. Dr. Carolyn Lam:               Yep. You heard it right here everyone. We are going to grow from strength to strength under your leadership and with this great team, so thank you very much for joining us today.  

Dr Carolyn Lam:                Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to The Journal and its editors. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore.                                                 Today's issue features two exciting papers regarding heart failure in patients with breast cancer. We will be discussing this right after these summaries.                                                 Are we any closer to improving survival in Eisenmenger syndrome? Well, today's first original paper looks at contemporary trends and presents a multivariable mortality risk stratification model based on five simple noninvasive predictors of death in this population. Dr. Kempny and colleagues from Royal Brompton Hospital in London in the United Kingdom preform a large multicenter study in 1098 patients with Eisenmenger syndrome followed up between years 2000 and 2015.                                                 At the end of the study almost two-thirds of patients were on advance therapy for pulmonary arterial hypertension, while only six patients underwent lung or heart and lung transplantation. The study showed that despite advances in management, there was significant mortality amongst contemporary adults with Eisenmenger syndrome and 25.3% of patients died over a median follow up period of 3.1 years. Mortality was higher in older patients, those with a pre-tricuspid shunt, lower oxygen saturation, absence of sinus rhythm, or with a pericardial effusion.                                                 This important study is accompanied by an editorial by Drs. Lange, from Texas Tech University Health Sciences Center El Paso and Dr. Brickner from UT Southwest Medical Center in Dallas, Texas. The editorialists call for a prospective randomized control trials of the effect of current, or future pulmonary vasoactive disease targeting therapies on mortality in Eisenmenger syndrome patients, and say it's time to direct our efforts from improving risk-stratification towards improving survival.                                                 The next study provides experimental evidence of tolerogenic dendritic cell therapy as a novel anti-remodeling therapy in myocardial infarction. Tolerogenic dendritic cells are promising, potent, beneficial regulators of the post-infarct healing process via their control of T-regulatory cells and M1 M2 macrophages. Plus they have the advantage of the ease of administration and feasibility of a heart specific tolero-dendritic cell production.                                                 In the current paper by co-first authors, Drs. Choo and Lee, and co-corresponding authors, Drs. Chang and Lim, from Catholic University Korea and Chai University in Korea, authors generated tolerogenic dendritic cells by treating bone marrow-derived dendritic cells with TNF-alpha and cardiac lysate from mice with myocardial infarction. They then injected myocardial infarction mice twice with tolerogenic dendritic cells within 24 hours and at 7 days after LAD ligation. In treated animals, in vivo cardiac magnetic resonance imaging and ex vivo histology confirm the beneficial effects on post-infarct LV remodeling. Furthermore, subcutaneously administered tolerogenic dendritic cells near the inguinal lymph node migrated to the regional lymph nodes and induced infarct tissue specific T-regulatory T-cell populations in the inguinal and mediastinal lymph nodes, spleen, and infarcted myocardium, all of which elicited an inflammatory to reparative macrophage shift. The altered immune environment in the infarcted heart resulted in better wound remodeling, preserved left ventricular systolic function, and an improved survival following myocardial infarction. Thus, this study shows that tolerogenic dendritic cell therapy in a preclinical model of myocardial infarction may be potentially translatable into an anti-remodeling therapy for ischemic repair.                                                 The final paper reports results of cell therapy on exercise performance and limb perfusion in peripheral artery disease from the PACE trial, which is an NHLBI-sponsored randomized double-blind placebo-controlled phase two clinical trial, designed to assess the safety and efficacy of autologous bone marrow-derived aldehyde dehydrogenase bright cells in peripheral artery disease, and to explore associated claudication physiological mechanisms. In this paper from corresponding author Dr. Moye from UT School of Public Health in Houston, Texas and colleagues of the Cardiovascular Cell Therapy Research Network, a total of 82 patients with claudication and infrainguinal peripheral artery disease were randomized at nine sites to receive alcohol dehydrogenase bright cells or placebo. All patients underwent bone marrow aspiration and isolation of aldehyde dehydrogenase bright cells followed by 10 injections into the thigh and calf of the index leg. Results showed that there were no significant differences in the change over six months between study groups for the co-primary endpoint of peak walking time, collateral count, peak hyperemic popliteal flow, and capillary profusion measured by magnetic resonance imaging.                                                 Additionally, there were no significant differences for the secondary endpoints including quality of life measures. There were no adverse safety outcomes. Interestingly, a post-hoc exploratory analysis suggested that aldehyde dehydrogenase bright cell administration might be associated with an increase in the number of collateral arteries in participants with completely occluded femoral arteries.                                                 In summary, cell therapy did not improve peak walk time or magnetic resonance outcomes, and the changes in peak walk time were not associated with the anatomic or physiologic MRI endpoints. However, future peripheral artery disease cell therapy trial design may be informed by new anatomic and perfusion insights. These and other issues are discussed in an accompanying editorial by Drs. Breton-Romero and Hamburg from Boston University School of Medicine. Well, that wraps it up for our summaries, now for our feature discussion.                                                 We are really in the grove here in Washington, D.C. and I am borrowing the words of my very special, star associate editor, guest, Dr. Gregory Hundley, and he's from Wakefield University School of Medicine. We're discussing two very important papers and they deal with the risk of heart failure following breast cancer. Why they're so important? Well, first of all, it's about time we looked at this problem in detail, and secondly, they actually represent papers in a new section of the journal called "Bridging Disciplines," and in this case cardio-oncology. Very, very important topics.                                                 We're here with the corresponding authors of both papers, Bonnie Ky from University of Pennsylvania School of Medicine and Dr. Margaret Redfield from Mayo Clinic. Dr Gregory Hundley:      Thank you, Carolyn. I really appreciate that wonderful introduction and also the chance to talk with Bonnie about this exciting topic.                                                 So, Bonnie, you've got a paper here, now, where you did a study in patients with breast cancer, and it sounds like you acquired echocardiograms over a period of time. Can you tell us a little bit about that? Dr Bonnie Ky:                     Correct. So this is longitudinal prospective cohort study, it's an NIH-funded R01, whereby we are enrolling patients from the breast cancer clinic who are receiving doxorubicin or trastuzumab or a combination of the two therapies. And we're performing very careful cardiovascular phenotyping, from the time at which they initiate chemotherapy through their chemotherapy and then annually once a year we have them come back, for a total follow up time of 10 years.                                                 We took a subcohort, 277 patients, and from their echocardiograms, we analyze them very carefully for various measures of left ventricular size, function, not only systolic function but also diastolic function. We also looked at measures of contractility such as strain in multiple dimensions, and then also measures of ventricular arterial coupling, as well as arterial loads, so how the ventricle interacts with the arterial system. And what we found was that over a 3.2 period time period, on population average, these modest declines in left ventricular ejection fraction, and even across all three treatment groups, and even at three years there were persistent LVF declines. Dr Gregory Hundley:      So, I understand, Bonnie, that you also collected some information as to whether or not these patients were experiencing symptoms associated with heart failure. How did the imaging markers relate to the symptomatology associated with heart failure? Dr Bonnie Ky:                     What we found was that early changes in arterial stiffness or total arterial load, as well as early changes in EF were associated with worse heart failure symptoms at one year. A lot of our other analysis was focused on defining what echo parameters of remodeling, size, function are driving or associated most strongly with LVF decline, as well as LVF recovery. Dr Gregory Hundley:      And then at two years, what happened? Did the echo parameters, were they still associated with heart failure or was there a little discrepancy there? Dr Bonnie Ky:                     Interestingly, at two years ... no, there was no significant association with changes in arterial load and heart failure symptoms at two years. Dr Gregory Hundley:      So there might be something transient that's occurring that is associated with heart failure early, and then the patients still had heart failure late, so maybe something else is operative. What do you think we need to do next? What's the next step in your research and then other investigators around the world; what do we need to do to design studies to look at these issues further? Dr Bonnie Ky:                     Yeah. What does the field need, the field of cardio-oncology that's really growing and developing at rapid paces. Some of the major findings from the study was that changes in total arterial load were very strongly associated with both LVF decline and LVF recovery. So total arterial load is the measure of blood pressure or total arterial stiffness, it's derived from blood pressure. And to me, that begs the question, or begs the next step is that changes in blood pressure are associated with decline as well as recovery. I think, oh, as cardiologists we've also always recognized the importance of afterload reduction. And to me, this study suggests that we need a study, a randomized clinical trial, looking at blood pressure lowering in this population to help mitigate LVF declines. Dr Carolyn Lam:                I'd actually like to turn it back to you. You are world-renowned for your work in cardio-oncology. Where do you think this fits in, and where do you think we need to address most urgently? Dr Gregory Hundley:      I think where this fits in wonderfully is a lot of individuals around the world are collecting echocardiographic measures, and all different types. And what Bonnie has helped do is clarify what we would expect to see in this particular patient population. How those measures change over time and that feeds into another block of data, when the measurements head south, do we change therapy, do we add protective agents, and things of that nature. So I think Bonnie's work really contributes on that front. What she has also pointed out is that more research needs to be performed, not necessarily because the patients had heart failure symptomatology at two years, but not necessarily associated with the decline in EF; are there other systems in the cardiovascular realm that are being affected? The vascular system- Dr Carolyn Lam:                Yeah. Dr Gregory Hundley:      Skeletal muscle, many other areas. So as cardiologists start to work more with oncologists in this space, and we're all working together to make sure that not only patients survive their cancer, but they have an excellent quality of life, I think we'll see, as we have in other heart failure syndromes, a look toward other aspects of the cardiovascular system, body in general, to reduce the overall morbidity associated with the disease.                                                 I think what we need to recognize as cardiovascular medicine specialists is that now for many forms of cancer, cardiovascular events, and certainly morbidity are becoming the primary issue that folks have to deal with with survivors. It's not necessarily the cancer recurrence, it's not necessarily a new cancer, it's cardiovascular. So we've got to integrate cardiology earlier in working with oncologists to improve overall survival and create an excellent quality of life from our different perspectives. Dr Carolyn Lam:                So, Maggie, let's move on to your paper now. You looked at radiotherapy's effect, whereas Bonnie looked at chemotherapy's effect. Could you tell us what you did and what you found? Dr Margaret Redfield:    The rationale for doing this study was, of course, seeing a lot of patients with HFpEF who had had radiation therapy for breast cancer, and I always just sort of assumed that that was because 12% of women over the age of 40 get breast cancer and 20% of women over the age of 40 get heart failure, but it seemed to be somehow more common than that. The other rationale was that radiation therapy does not actually affect the cardiomyocytes; they are very radiation resistant. And what radiation does is cause microvascular endothelial cells damage and inflammation, and that is felt to be fundamental in the pathophysiology for HFpEF.                                                 So we thought we should look at this. I collaborated with a radiation oncologist and oncologists, and they were interested in looking at this because there's a lot of techniques now to reduce cardiac radiation exposure during radiation therapy, including proton beam therapy, and they're trying to prioritize who they use this new technology on. So what we did was start with a population-based study, all women who lived in Olmsted county who received radiation therapy for breast cancer in the contemporary era, where they're already using these dose reducing techniques. So we wanted to make it relevant to what's going on today. And so we started with a base cohort of all women. We matched patients' cases, it was a case-control study, so we matched cases and controls according to their age at the time of breast cancer, whether they had heart failure risk factors, like hypertension or diabetes, whether they got adjuvant chemotherapy, and tumor size, because we felt it was important that radiation could affect different parts of the heart, depending on whether it was right- or left-sided tumor.                                                 And what we found is that the risk of heart failure increased with the mean cardiac radiation dose. We measured the mean cardiac radiation dose in every case and every control from their CT scans and their radiation plants. And as the radiation dose went up, the risk of heart failure went up, even matching or controlling for chemotherapy, which wasn't used that often in this group, or heart failure risk factors. And the vast majority of these cases were indeed HFpEF.                                                 So we then looked at factors that happened in-between the radiotherapy and the onset of heart failure, making sure that this all wasn't just coronary artery disease, 'cause we know radiation can increase the risk of coronary artery disease. And indeed there were, only in about 18% of cases was there a new episode of coronary disease in the interim between the radiotherapy and the breast cancer. So, basically found that the mean cardiac radiation dose, even in today's era, does increase the risk of heart failure with preserved ejection fractions. Dr Carolyn Lam:                The things that stuck out to me ... it's population based. You did such a comprehensive study to really answer very key questions: dose of radiation, is it really just mediated by age and age-related risk factors, is it just about MI or could it be more microvascular disease? Congratulations, I really appreciated this paper. Some of the take-home messages are directly related to the treatment of breast cancer, isn't it? And about the importance of minimizing radiation dose if possible. I suppose one of the take-homes is, as well, for screening and watching out for heart failure. One thing though: how were these woman diagnosed with HEpEF? I mean, this is always the questions I get. How do you get diagnosed with HEpEF? Dr Margaret Redfield:    Right, well, first we started with looking to see if they had a ICD code for heart failure, and then we looked at each case of heart failure and determined if they either met Framingham criteria at the time of the diagnosis and the majority of them did. If they didn't actually meet the Framingham criteria, we looked to be sure there was a physician diagnosis of heart failure in the record and that they had supportive evidence of heart failure: echocardiographic findings, natriuretic peptide findings, and other clinical characteristics of heart failure.                                                 And importantly, in the large control group from where we, you know, got our controls, people, a very large group of patients who did not get heart failure, we'd use natural language processing to look at all those records to make sure we weren't missing anybody who didn't have an ICD diagnosis or code for heart failure to make sure we weren't missing any cases of heart failure. So, we really tried to use very stringent methods to make sure we had true cases and control groups. Dr Carolyn Lam:                Indeed, and it actually goes back to Bonnie's paper as well, where we have to remind everyone that the diagnosis of HEpEF really starts with the symptomatology of heart failure in particular, that you so rigorously determined. I think just one last thing, Maggie: what do you think this implies now, for HEpEF? What do we do in general so the non-radiation-associated, do we believe more the Walter Paulus-Carsten Tschope hypothesis, and if so, what do we do? Dr Margaret Redfield:    Yes, well I think it really does support that hypothesis. We know that radiation therapy, again, we know what it does to the coronary microvascular endothelial cells and that's been elegantly worked out both in patients and in animal models. I think this really supports the Paulus hypothesis because this microvascular damage was able to produce heart failure, so I think that really supports that hypothesis. And there's been some studies showing decreased coronary flow reserve in HEpEF patients; it's very common. So I think indeed it does support that hypothesis and that the coronary microvasculature is key in the pathophysiology of HEpEF.                                                 However it's a little scary to me because that sort of damage, once it's established, may be very hard to treat. You know, proangiogenic strategies in peripheral vascular disease have not yet yielded the benefits that we hoped for, so I think it's a tough therapeutic challenge that'll be very important to try to address in pre-clinical studies to try and figure out once the microvasculature is so damaged how do we treat that? How do we reverse that process? Dr Carolyn Lam:                Yeah. Words of wisdom. Maggie, thanks so much for inspiring, just all of us in this field. I just had to say that. You know, you are the reason that I am totally in love with HEpEF. (laughter) Dr Margaret Redfield:    (laughter) Dr Carolyn Lam:                So thank you so much for joining me today on the show. In fact, thank you to all my three guests.                                                 You've been listening to Circulation on the Run. You must tell everyone about this episode, it is full of gems.                                                 Thank you, and tune in next week.