Podcasts about Heart failure

This week we are joined by Henry Abuto for part two of our discussion of surviving heart failure. Henry tells us about his journey to recovery, knowing the signs, and the importance of heart health. We discuss genetics and the impact they can have on your heart, and so much more! Find Henry AbutoIG: bywasonga https://www.instagram.com/bywasonga/FB: Henry Wasonga Abuto https://www.facebook.com/henry.abutoLinkedIn: Henry Abuto https://www.linkedin.com/in/henry-abuto-7141761b1/Websites:https://www.henryabuto.com/https://www.bywasonga.com/Check out our podcast, now on video, on my YouTube channel! https://www.youtube.com/channel/UCLzeA0jBX83j4wqpA2r9lpQTune in NOW and don't forget to subscribe, listen, rate, and review!To learn more about your host, Tiffany Blackmon…Check out my website,https://tiffanycblackmon.comSubscribe on YouTube, Tiffany Blackmonhttps://www.youtube.com/channel/UCLzeA0jBX83j4wqpA2r9lpQFollow me on Instagram, @tiffanycblackmonhttps://www.instagram.com/tiffanycblackmon/Follow me on Facebook, Tiffany Blackmonhttps://www.facebook.com/tiffanyslifestyleSubscribe to my newsletter HERE so you never miss anything!https://view.flodesk.com/pages/60e9bde415524dbe100c6f14

In the latest episode of Parallax, Dr. Ankur Kalra invites Dr. Vijay Rao, the Governor of the Indiana Chapter of the American College of Cardiology, to share his experience and insights with the audience. Dr. Rao, who also serves as the Director of Heart Failure, Cardio-oncology, and Co-Director of Anticoagulation at Franciscan St. Francis Health, discusses what initially drew him to the Indiana State Chapter of ACC. As Dr. Kalra asks Dr. Rao about the ways in which early career faculty members can get involved with the organization at a state level. Dr. Rao shares his insider tips and highlights key events where individuals can further their participation. Dr. Rao also sheds light on the governorship election process and shares his learnings from his new role. He emphasizes the importance of advocacy and describes the chapter's efforts to amplify the voice of cardiologists in relation to Roe v. Wade. Dr. Rao encourages healthcare professionals to reframe their perspectives and get involved with advocacy. Dr Rao shares his future plans as a governor and previews the upcoming annual event of the Indiana Chapter. Join Dr. Kalra and Dr. Rao in this engaging and thought-provoking episode of Parallax. How can you get involved with your local ACC chapter? How can you improve your leadership skills? What is Dr Rao's advice for our listeners?

 We begin this episode with a discussion about the Oscars and about the relevance of movies in general. We hear from a big-boned caller whose skeleton is apparently quite large, and then Christian updates us on his son, Zeke, who recently experienced heart failure. “Pastor Jack's Off” returns, followed by biebers involving bread and childish adults.  

ACC Recap No. 2: Pacing in HFpEF, Oral PCSK9 inhibitor, PAH, soft thinking on adherence, and so called metabolically healthy obese are discussed by John Mandrola, MD, 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. Pacing in HFpEF No Exercise Boost From Pacemaker in HFpEF With Impaired HR Response: RAPID-HF https://www.medscape.com/viewarticle/989681 - Rate-Adaptive Atrial Pacing for Heart Failure With Preserved Ejection FractionThe RAPID-HF Randomized Clinical Trial https://jamanetwork.com/journals/jama/article-abstract/2802147 - Accelerated Pacing a Possible Strategy for Preserved-EF Heart Failure? https://www.medscape.com/viewarticle/987815 - Could a Breakthrough in Heart Failure With Preserved Ejection Fraction Just Take a Change of Pace? - https://www.medscape.com/viewarticle/988088 - Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillation in Patients With Preclinical and Overt Heart Failure With Preserved Ejection Fraction: The myPACE Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2801001 - Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction https://doi.org/10.1016/j.jacc.2021.08.073 II Oral PCSK9i Oral PCSK9 Inhibitor Shows Encouraging LDL Lowering https://www.medscape.com/viewarticle/989655 - Efficacy and safety of the oral PCSK9 inhibitor MK-0616: a phase 2b randomized controlled trial https://www.jacc.org/doi/10.1016/j.jacc.2023.02.018 III PAH 'Unheard of' PAH Improvement With Novel Drug: STELLAR https://www.medscape.com/viewarticle/989612 - Phase 3 Trial of Sotatercept for Treatment of Pulmonary Arterial Hypertension https://www.nejm.org/doi/full/10.1056/NEJMoa2213558 IV Medical Adherence Waiving Co-Pays for CV Meds as Adherence Incentive Doesn't Cut Clinical Risk: ACCESS Trial https://www.medscape.com/viewarticle/989474 - Eliminating Medication Copayments for Low-income Older Adults at High Cardiovascular Risk: A Randomized Controlled Trial https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.123.064188 - Medicaid Expansion: Good First Step, but No Panacea for CV Care https://www.medscape.com/viewarticle/975141 - Health Care Access and Management of Cardiovascular Risk Factors Among Working-Age Adults With Low Income by State Medicaid Expansion Status https://jamanetwork.com/journals/jamacardiology/article-abstract/2793120 - Rand Link https://www.rand.org/pubs/reports/R3055.html - The Oregon Health Insurance Experiment https://www.healthaffairs.org/do/10.1377/hpb20150716.236899/full/ - Effect of Health Insurance in India: A Randomized Controlled Trial https://www.nber.org/papers/w29576 - Full Coverage for Preventive Medications after Myocardial Infarction https://www.nejm.org/doi/full/10.1056/nejmsa1107913 - Effect of Medication Co-payment Vouchers on P2Y12 Inhibitor Use and Major Adverse Cardiovascular Events Among Patients With Myocardial InfarctionThe ARTEMIS Randomized Clinical Trial https://jamanetwork.com/journals/jama/fullarticle/2720024 - Coronary CT Angiography and 5-Year Risk of Myocardial Infarction https://www.nejm.org/doi/full/10.1056/NEJMoa1805971 IV Metabolically Healthy Obese 'Metabolically Healthy Obesity' Rising, but Still Uncommon https://www.medscape.com/viewarticle/989398 - Trends in the Prevalence of Metabolically Healthy Obesity Among US Adults, 1999-2018 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2802164 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Heart Failure: Part II Special Guest: Cait Kulig, PharmD  https://cards.rxexplained.com/ 07:55 – Transitions of Care 17:35 – HFrEF GDMT 48:35 – HFpEF GDMT Reference List: https://pharmacytodose.files.wordpress.com/2023/03/heart-failure-part-ii-references.pdf PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

This episode covers chronic heart failure.Written notes can be found at https://zerotofinals.com/medicine/cardiology/heartfailure/ or in the cardiology section of the 2nd edition of the Zero to Finals medicine book.The audio in the episode was expertly edited by Harry Watchman.

Editor's Summary by Mary McGrae McDermott, MD, Deputy Editor of JAMA, the Journal of the American Medical Association, for the March 14, 2023 issue.

Approximately 3 million people in the US have heart failure with preserved ejection fraction (HFpEF). JAMA Executive Editor Gregory Curfman, MD, discusses diagnosis and treatment of HFpEF with authors Margaret Redfield, MD, and Barry Borlaug, MD, both from Mayo Foundation for Medical Education and Research Division of Cardiovascular Diseases. Related Content: Heart Failure With Preserved Ejection Fraction

This week, we welcome Henry Abuto back to My So-Called Fabulous for a two-part series! In 2021 Henry suffered from sudden and unexpected cardiac arrest. On today's episode we talk about his traumatic and unexpected heart failure. Henry shares the vague signs that preceded his heart failure, his experience of waking up from a coma, and his road to recovery. Henry is a one of a kind human, and it is a true miracle he is here to share his story with us today.Find Henry AbutoInstagram:@bywasonga https://www.instagram.com/bywasonga/@henryabuto https://www.instagram.com/henryabuto/FB: Henry Wasonga Abuto https://www.facebook.com/henry.abutoLinkedIn: Henry Abuto https://www.linkedin.com/in/henry-abuto-7141761b1/Websites:https://www.henryabuto.com/https://www.bywasonga.com/Check out our podcast, now on video, on my YouTube channel! https://www.youtube.com/channel/UCLzeA0jBX83j4wqpA2r9lpQTune in NOW and don't forget to subscribe, listen, rate, and review!To learn more about your host, Tiffany Blackmon…Check out my website,https://tiffanycblackmon.comSubscribe on YouTube, Tiffany Blackmonhttps://www.youtube.com/channel/UCLzeA0jBX83j4wqpA2r9lpQFollow me on Instagram, @tiffanycblackmonhttps://www.instagram.com/tiffanycblackmon/Follow me on Facebook, Tiffany Blackmonhttps://www.facebook.com/tiffanyslifestyleSubscribe to my newsletter HERE so you never miss anything!https://view.flodesk.com/pages/60e9bde415524dbe100c6f14

This week, please join author Milind Desai and Associate Editor Mark Link as they discuss the article "Dose-Blinded Myosin Inhibition in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Outcomes Through 32 Weeks." Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. We're your co-hosts. I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr Greg Hundley, Associate Editor, Director of the Poly Heart Center at VCU Health in Richmond, Virginia.  Dr. Carolyn Lam: Oh, Greg. Today's feature paper is just so, so important. It's the long-term follow up or the longer term follow up of the VALOR-HCM trial. And this, if I can remind you, examined the effect of mavacampten on the need for septal reduction therapy in patients with intractable symptoms from obstructive hypertrophic cardiomyopathy. So we're going to hear the results through 32 weeks, but not until we discuss the other papers in today's issue. And I'd like to go first. I'd like to tell you about a paper that really provides the foundation for deciphering chamber selective gene transcription. So in this study from Dr. William Pu of Boston Children's Hospital and colleagues, authors mapped the chromatin features of atrial and ventricular cardiomyocytes and nominated candidate chamber selective enhancers based on differential features. The candidate enhancers were tested in vivo using adeno associated virus delivered massively parallel reporter assay leading to identification of 229 chamber selective enhancers. They then characterized chromatin features of these chamber selective enhancers and used dense mutagenesis to identify their essential features. Altogether the study suggested that estrogen-related receptor promoted ventricular chamber selective enhancer activity. They validated this prediction by showing that estrogen-related receptor inactivation led to loss of ventricular cardiomyocyte identity. So in aggregate, the studies yielded a rich resource of chamber selective chromatin features and chamber selective enhancers, and began to unravel the molecular basis for chamber selective transcriptional programs. Dr. Greg Hundley: Wow. So Carolyn, estrogen-related receptor promotion and then inactivation and finding really very interested preclinical results. So tell us now what are the clinical implications of this very nice study.  Dr. Carolyn Lam: Wow. I mean, there are just so many implications. It can facilitate functional interpretation of genetic associations between variants and cardiac disease. Of course, it opens the doors to potential gene therapies and regenerative medicine and finally, identification of transcription regulators of the chamber identity really yield important mechanistic insights into the pathogenesis of important diseases like atrial fibrillation and cardiomyopathy. Dr. Greg Hundley: Wow, Carolyn, beautifully summarized. Well, my next paper pertains to COVID vaccines. So Carolyn, as we have seen SARS-CoV-2 targeted mRNA vaccines are a life-saving medical advancement developed to combat, of course, the COVID-19 pandemic. But in rare cases, some individuals can develop myocarditis following these mRNA vaccinations. Cases of adolescents and young adults developing post vaccine myocarditis have been reported globally, although the underlying immuno profiles of these individuals, they really haven't been described in detail. So these authors led by Dr. Lael Yonker from Massachusetts General Hospital, performed extensive system serology SARS-CoV-2 specific T-cell analysis and cytokine and SARS-CoV-2 antigen profiling on blood samples collected from adolescents and young adults either developed myocarditis or were asymptomatic following SARS-CoV-2 targeted mRNA vaccination.  Dr. Carolyn Lam: Wow. Wow. Important question. Everyone's interested in the results. So what did they find? Dr. Greg Hundley: Right, Carolyn. So 16 cases with post vaccine myocarditis and 45 asymptomatic vaccinated controls were enrolled with extensive antibodies profiling, including assessment for autoantibodies or antibodies against the human relevant virome. And Carolyn, they found that T-cell responses were essentially indistinguishable from controls despite a modest increase in cytokine production. Notably, markedly elevated levels of full length spike protein unbound by antibodies were detected in the plasma of individuals with post vaccine myocarditis, a finding that was absent. It was absent in the asymptomatic vaccinated controls. So Carolyn, in conclusion, immunoprofiling of vaccinated adolescents and young adults revealed that the mRNA vaccine-induced immune responses did not differ between individuals that developed myocarditis versus individuals that did not. However, free spike antigen was detected in the blood of adolescents and young adults who developed post mRNA vaccine myocarditis. Now while this finding does not alter the risk benefit ratio favoring vaccination against COVID-19 to prevent severe clinical outcomes, it may provide some insight into the potential underlying etiology associated with post mRNA vaccine-induced myocarditis. Carolyn, this is accompanied by a wonderful editorial by Dr. Biykem Bozkurt indicating that these results raise a question as to why the circulating spike protein levels remain elevated despite adequate levels and functionality of the anti-spike antibodies. Well, Carolyn, we do have some other articles in the issue and from the mailbag we have a research letter from Professor Cho entitled PERM1 Protects the Heart From Pressure Overload Induced Dysfunction by Promoting Oxidative Metabolism. Also, there's a new drugs and devices piece from Professor Kabatano entitled Pharmacology and Clinical Development of Factor XI inhibitors. And then Tracy Hansen has a wonderful cardiology news summary regarding articles entitled The Study Reveals Rapid Intestinal Adaptations after Switching to High Fat Diet From Cell Research. Another article entitled New Insights into Immunotherapy Related Myocarditis from Nature. And finally, an article entitled Scientist Identified Genetic Variants Linked to Longevity published in the Journal of Science.  Dr. Carolyn Lam: Wow. Interesting. There's also an exchange of letters between Drs. Monzo and Shah regarding the article, “Metabolomic Profiling of Effects of Dapagliflozin in Heart Failure with Reduced Ejection Fraction.” That is a Perspective piece by Dr. Davenport on contrast induced acute kidney injury and cardiovascular imaging, danger or distraction? Wow. What a beautiful issue. Thank you so much, Greg. Let's go to our feature discussion, shall we? Dr. Greg Hundley: Absolutely. Welcome, listeners, to this feature discussion on March 14th. And we have with us today Dr. Milind Desai from Cleveland Clinic in Cleveland, Ohio, and our own associate editor, Dr. Mark Link from University of Texas Southwestern Medical Center in Dallas, Texas. Welcome, gentlemen, Milind, we'll begin with you and bringing to us this study of mavacampten. Can you describe for us some of the background information that went into the preparation of this study, and what was the hypothesis that you wanted to address? Dr. Milind Desai: Thank you to the editorial staff, Dr. Hundley and the editorial staff at Circulation. So yes, mavacampten, as we know, is a novel first in class cardiac myocin inhibitor that was developed in the context of managing patients with hypertrophic obstructive cardiomyopathy. So the preliminary early stage studies have shown that it helped significantly in reducing outflow tract gradients as well as improved symptoms. But we wanted to take the conversation a bit further. In highly symptomatic patients, the current standard of care treatment is septal reduction therapy, which requires an experienced center and an experienced set of providers. So what we wanted to see was in such patients that are referred for septal reduction therapy, what does mavacampten do versus placebo? So does it reduce the need for septal reduction therapy? We divided the study into three parts. The first part was the placebo controlled 16 week study. The second part was we wanted to see what happens when the placebo arm crossed over to mavacampten and the mavacampten arm continued long-term. And that was the genesis of the study that we are discussing today. Dr. Greg Hundley: Very nice. So we've got a planned study, patients with hypertrophic cardiomyopathy, they ordinarily, because of guideline related therapeutic recommendations would undergo septal reduction therapy, but before that you're going to randomize patients to mavacampten versus a placebo. So we've sort of described a little bit the study design, and let's clarify specifically perhaps the study population and how many patients did you enroll? Dr. Milind Desai: Yes. In the original study, we enrolled 112 patients, 56 to mavacampten and 56 to placebo. After week 16, four patients, two of which underwent SRT and two withdrew consent. So essentially for the 32 week analysis, we had 108 patients, 56 in the mavacampten group and 52 in the placebo group that crossed over to mavacampten. So 108 patients. Dr. Greg Hundley: Very nice. So Milind, what were your study results? Dr. Milind Desai: Yes. What we found was at week 16, we have previously demonstrated that the group that got randomized mavacampten had a significant reduction in outflow tract radius, both resting and Valsalva, as well as biomarkers. And at week 16, what we found was 82% patients from the original group did not meet criteria for septal reduction therapy. So a hundred percent to begin with, 82%, that was at week 16. What we wanted to see, is the effect continued longer lasting and what happens to the placebo group that crossed over? So essentially what we found was at week 32, 89% of the total population no longer met criteria for septal reduction therapy. In addition to that, the mavacampten group continued to have reduced outflow tract gradients, continued improvement in Kansas City Score as well as biomarkers. But more importantly, the similar findings were demonstrated in the placebo arm that cross over to the mavacampten where, again, a significant proportion continued to show improvement in outflow tract gradient, Kansas City Score, as well as biomarker. The important point here in this study was at week 32, 95% patients chose to remain on medical therapy as opposed to going for SRT. Remember, a hundred percent patients were referred at the outset to undergo SRT. Dr. Greg Hundley: And Milind, did you notice any differences in your study results based on the age of the patients or based on their sex? Dr. Milind Desai: No, actually, we did not. This had a beneficial effect across gender, age, all the other variables. In fact, this is one of the strengths of the study because almost 50% patients that were randomized were women. So this was well represented across different genders. Dr. Greg Hundley: And then you mentioned a marked reduction in the gradient across the left ventricular outflow tract. What about the patient's symptomatology? Did you notice differences there? Dr. Milind Desai: There were significant improvement in patient symptomatology. More than 70% patients had a improvement in one NYHA class, 30% or thereabouts had a significant improvement in two NYHA class compared to placebo. So yes, there was a significant improvement in their functional capacity. Dr. Greg Hundley: And then last question, hypertrophic cardiomyopathy. Were most of these patients, was this concentric? Was this asymmetric septal hypertrophy? What was the breakdown, if you will, of the morphology of the left ventricles? Dr. Milind Desai: The vast majority of the patients had asymmetric septal hypertrophy, the characteristic with dynamic outflow tract gradient. There were some patients, but the vast majority of them were asymmetric septal hypertrophy. Dr. Greg Hundley: Very nice. Well, listeners, we're going to turn to our associate editor, Dr. Mark Link. Mark, this really sounds striking, randomized clinical trial, patients needing septal reduction therapy. They're randomized. The group randomized to mavacampten has marked reductions in left ventricular outflow tract gradient, symptomatology, and so much so that they no longer met the criteria for septal reduction therapy. I know you have a lot of papers come across your desk. Can you help us put what seemingly are exciting results into the context of other studies pertaining to mavacampten as well as treatment for patients with symptomatic hypertrophic cardiomyopathy? Dr. Mark Link: Yeah. There are very few randomized studies in patients with hypertrophic cardiomyopathy, probably only two that I know of. And mavacampten is a very exciting new drug that's a novel drug, a novel mechanism and has the potential to really improve life for our patients with hypertrophic cardiomyopathy. So this is a longer term study of mavacampten that's ever been published. So yeah, it was very exciting for us to look at this data to see how the patients did and we were very, very pleased to publish this paper. Dr. Greg Hundley: Very nice. So maybe, Milind, turn this back to you. What do you think are some of the next studies that'll be performed really in this arena of research? Dr. Milind Desai: Yes. Obviously, as Mark pointed out, this was one of the longest term studies, but we need to do a lot longer. So long term extension studies are ongoing. We should be evaluating one year outcomes in this specific population as well as longer, number one. Number two, I think in the grand scheme of things, this is a brand new class. So overall it is obviously now FDA approved and post-marketing survey and analysis should help us see a signal in terms of outcomes, mortality, et cetera. In your sister journal Circulation Imaging, we have simultaneously also published that mavacampten is causing a significant improvement in the structural changes like diastolic dysfunction, like LV mass, LA volume index. So we need to see how that plays out. Another important piece is about 30% patients have non-obstructive hypertrophic cardiomyopathy and there's no real treatment for this group and there's no outflow tract obstruction to cure in this. So we have just recently launched and started to randomize ODYSSEY HCM trial, which is checking the role of mavacampten versus placebo in non-obstructive HCM group. And I am fortunate. So it's a multi-centered trial that is being led out of Cleveland Clinic. So more data in that exciting field. But overall, this entire field of hypertrophic cardiomyopathies is exploding with multiple randomized controlled trials. There's another drug that is being tested in phase three trials, cardiac myocin inhibition. So that story also remains to see how that plays out. So a lot of stuff that is happening in this space. And then now there's gene therapy emerging. Dr. Greg Hundley: Right. And Milind, since you have quite extensive experience here, for our listeners, what side effect profiles have you observed in some of these patients? And if someone is considering working with placing a patient on this therapy, what are some of the considerations that they should be thinking about? Dr. Milind Desai: So that's a very important question. So the drug, as you are aware, was approved by the FDA under the REMS or Risk Evaluation Mitigation Strategy program. So the fundamental thing is both the patient and the physician have to sign up for the REMS program. The biggest issue that FDA wants us to be careful about is this is a cardiac myosin inhibitor. So it means we have to be very careful about over inhibition of the cardiac myosin and a drop in ejection fraction and its downstream ramifications including heart failure. The other aspect is drug-drug interaction because of its pathway of metabolism. So these are the two key things we have to be on the careful about. Now you asked my clinical experience. So we have been prescribing this for almost six, seven months, and we have dozens of patients on this using the REMS strategy, careful echocardiographic monitoring and clinical decision making. So far, we have been very successfully able to navigate these patients without any major adverse events. And the vast majority of the patients, true to form as we have shown in the clinical trial, are doing very, very well in terms of their symptoms, their need for SRT, as well as their markers, including outflow tract gradient. Dr. Greg Hundley: Very nice. And Mark, turning to you from the perspective of an electrophysiologist, what potential future studies do you see forming in this space? Dr. Mark Link: Yeah, very similar to Milind. And I think the long term efficacy and safety really has to be looked at. There's a signal for potential harm in that the EF can drop, and Milind mentioned that too, that we have to learn how to deal with that. The way to prescribe it now, you have to be in a special program. You have to be trained, you have to agree to get echoes every three months, I believe it is, essentially for the rest of their life. So we need to see what happens long term with these drugs and we need to know how to dose them and how to do it safely. Dr. Greg Hundley: Very nice. So for our listeners, really a class of drugs that is emerging and at this time only under really strictly supervise protocols. Well, from the perspective of our listeners, we want to thank Dr. Milind Desai and our own associate editor, Dr. Mark Link, for bringing us this informative new early randomized trial study results indicating that in severely symptomatic patients with obstructive hypertrophic cardiomyopathy, 32 weeks of mavacampten treatment showed sustained reduction in the proportion proceeding to septal reduction therapy. Well, on behalf of Petter, Carolyn and myself, we want to wish you a great week and we will catch you next week on The Run. This program is copyright of the American Heart Association, 2023. The opinions expressed by speakers in this podcast are their own and not necessarily those of the editors or of the American Heart Association. For more, please visit ahajournals.org.

This episode covers acute left ventricular failure.Written notes can be found at https://zerotofinals.com/medicine/cardiology/acutelvf/ or in the cardiology section of the 2nd edition of the Zero to Finals medicine book.The audio in the episode was expertly edited by Harry Watchman.

It's another session of CardioNerds Rounds! In these rounds, Dr. Karan Desai (Formerly FIT at University of Maryland Medical Center and currently faculty at Johns Hopkins School of Medicine) joins Dr. Dan Burkhoff (Director of Heart Failure, Hemodynamics and MCS Research at the Cardiovascular Research Foundation) to discuss mechanical circulatory support options through the lens of pressure-volume loops! Dr. Burkhoff is the author of Harvi, an interactive simulation-based application for teaching and researching many aspects of ventricular hemodynamics. Don't miss this wonderfully nerdy episode with a world-renowned expert in hemodynamics and MCS! Audio editing by CardioNerds Academy Intern, student doctor Chelsea Amo Tweneboah. This episode is supported with unrestricted funding from Zoll LifeVest. A special thank you to Mitzy Applegate and Ivan Chevere for their production skills that help make CardioNerds Rounds such an amazing success. All CardioNerds content is planned, produced, and reviewed solely by CardioNerds. Case details are altered to protect patient health information. CardioNerds Rounds is co-chaired by Dr. Karan Desai and Dr. Natalie Stokes.  Challenging Cases - Atrial Fibrillation with Dr. Hugh Calkins CardioNerds Rounds PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Show notes - Hemodynamics and Mechanical Circulatory Support Case Synopsis: Case SynopsisWe focused on one case during these rounds. A man in his mid-50s presented to his local community hospital with 3 days of chest pain, nausea, and vomiting. He appeared ill in the emergency room with HR in the 150s, BP 90/70s and ECG demonstrating inferior ST elevations. He was taken emergently to the catheterization lab and received overlapping stents to his right coronary artery. Over the next 24 hours, he developed a new harsh systolic murmur heard throughout his precordium and progressed to cardiogenic shock. Echocardiogram demonstrated a large basal inferoseptum ventricular septal rupture. From this point, we discussed the hemodynamics of VSR and MCS options. Case Takeaways Dr. Burkhoff took us through the hemodynamics of VSR with pressure-volume loops to better understand the pathology and impact of various MCS options. Of note, there are no MCS devices specifically approved to treat acute ventricular septal rupture. In regards to the acute hemodynamic effects of a VSR (an abrupt left to right shunt), there are several aspects to note. First, the effective LV afterload is reduced; however, there is less “forward flow” as well and as a consequence, decreased left-sided cardiac output (“Qs”) and blood pressure. At the same time, flow through the pulmonary artery increases (the “Qp”). Additionally, due to the abrupt shunt flow, there is increased RV “loading” with increasing central venous pressure and pulmonary artery pressure. The hemodynamic priorities in treating patients with cardiogenic shock and VSR are to normalize blood pressure, cardiac output, and oxygen delivery, while attempting to minimize shunt flow to allow healing. However, medications and MCS are unlikely to completely normalize hemodynamics. For instance, if the patient was placed on peripheral VA ECMO, while total CO and BP may increase, flow across the VSR could also increase at high ECMO flows (e.g., by introducing more LV afterload). In patients with persistent cardiogenic shock and VSR, short-term MCS to divert flow away from the shunt can be an effective strategy. LV-to-aorta or LA-to-arterial MCS may provide the best single-device hemodynamic profiles by decreasing shunt flow, reducing pulmonary capillary wedge pressure, and improving blood pressure. Surgical and percutaneous VSD repair are the definitive treatment options. If able to stabilize patients and pursue delayed repair,

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I'm a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Australia, like the rest of the western world, has a heart problem. Over 9 million people around the world die from heart disease every year. Every 10 minutes, someone in Australia suffers a heart attack. And 21 lives are lost daily because of it. The devastating fact in all of this is…  Every one of those cases could have been prevented.

S1E9 A Novel Treatment for the Symptoms of Heart Failure with Paul Verrastro Host Carrie Young speaks with Paul Verrastro, Chief Marketing and Strategy Officer at CVRx. Paul explains the prevalence and various treatments for heart failure, and how their therapy, Barostim, outsmarts the heart by actively stimulating natural sensors in your body that tell your brain how to regulate your heart - relieving the symptoms of heart failure. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio.” Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

What's it like to be a person of color with heart failure? James Young will discuss how his community and lifestyle played into his condition -- and how he got his health back on track. Michelle M. Kittleson, MD, PhD, from the Smidt Heart Institute at Cedars-Sinai Medical Center will address the need for greater awareness among underserved communities to boost prevention and early detection.

The following question refers to Section 9.5 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.  The question is asked by Western Michigan University medical student & CardioNerds Intern Shivani Reddy, answered first by Brigham & Women's medicine resident and Director of CardioNerds Internship Dr. Gurleen Kaur, and then by expert faculty Dr. Shashank Sinha. Dr. Sinha is an Assistant Professor of Medical Education at the University of Virginia School of Medicine and an advanced heart failure, MCS, and transplant cardiologist at Inova Fairfax Medical Campus. He currently serves as both the Director of the Cardiac Intensive Care Unit and Cardiovascular Critical Care Research Program at Inova Fairfax. He is also a Steering Committee member for the multicenter Cardiogenic Shock Working Group and Critical Care Cardiology Trials Network and an Associate Editor for the Journal of Cardiac Failure, the official Journal of the Heart Failure Society of America. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #12 Mr. Shock is a 65-year-old man with a history of hypertension and non-ischemic cardiomyopathy (LVEF 25%) who is admitted with acute decompensated heart failure. He is currently being diuresed with a bumetanide drip, but is only making 20 cc/hour of urine. On exam, blood pressure is 85/68 mmHg and heart rate is 110 bpm. His JVP is at 12 cm and extremities are cool with thready pulses. Bloodwork is notable for a lactate of 3.5 mmol/L and creatinine of 2.5 mg/dL (baseline Cr 1.2 mg/dL). What is the most appropriate next step? A Augment diuresis with metolazone B Start sodium nitroprusside C Start dobutamine D Start oral metoprolol E None of the above Answer #12 Explanation The correct answer is C – start dobutamine.   In this scenario, the patient is in cardiogenic shock given hypotension and evidence of end-organ hypoperfusion on exam and labs. The patient's cool extremities, low urine output, elevated lactate, and elevated creatinine all point towards hypoperfusion.   In patients with cardiogenic shock, intravenous inotropic support should be used to maintain systemic perfusion and preserve end-organ function (Class 1, LOE B-NR). Further, in patients with cardiogenic shock whose end-organ function cannot be maintained by pharmacologic means, temporary MCS is reasonable to support cardiac function (Class 2a, LOE B-NR).   The SCAI Cardiogenic Shock Criteria can be used to divide patients into stages. Stage A is a patient at risk for cardiogenic shock but currently not with any signs or symptoms, for example, a patient presenting with a myocardial infarction without present evidence of shock. Stage B is “pre-shock” – this may be a patient who has volume overload, tachycardia, and hypotension but does not have hypoperfusion based on exam and lab evaluation. Stage C is classic cardiogenic shock – the cold and wet profile. Bedside findings for Stage C shock include cool extremities, weak pulses, altered mental status, decreased urine output, and/or respiratory distress. Lab findings include impaired renal function, increased lactate, increased hepatic enzymes, and/or acidosis. Stage D is deteriorating with worsening hypotension and hypoperfusion with escalating use of pressors or mechanical circulatory support.

Heart Failure: Part I Special Guest: Cait Kulig, PharmD  https://cards.rxexplained.com/ 06:15 – Definitions 13:48 – ADHF 29:50 – Diuresis and Diuretic Resistance 52:45 – IV Vasoactives Reference List: https://pharmacytodose.files.wordpress.com/2023/03/heart-failure-part-i-references.pdf PharmacyToDose.Com  @PharmacyToDose  PharmacyToDose@Gmail.com Learn more about your ad choices. Visit megaphone.fm/adchoices

Heart arrhythmias are an irregular heartbeat. It feels like a fluttering or a racing heart sometimes and can often be harmless. However, some heart arrhythmias may be indicative of serious underlying conditions. Listen to Dr. Rodrigo Bolanos, the electrophysiology lab director, director of Arrhythmia Services at Bostick Heart Center at Winter Haven Hospital, and the Co-chair of the Arrhythmia Committee for BayCare Health System discuss heart rhythm disorders and when you should see a specialist.

The following question refers to Section 8.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.  The question is asked by Western Michigan University medical student & CardioNerds Intern Shivani Reddy, answered first by Brigham & Women's medicine resident and Director of CardioNerds Internship Dr. Gurleen Kaur, and then by expert faculty Dr. Prateeti Khazanie. Dr. Khazanie is an Associate Professor and Advanced Heart Failure and Transplant Cardiologist at the University of Colorado. She was an undergraduate at Duke University as a B.N. Duke Scholar. She spent two years at the NIH in the lab of Dr. Anthony Fauci and completed a dual MD-MPH program at Duke Medical School. When she started residency, she thought she was going to be an ID doctor, but she fell in love with cardiology at Stanford where she was an intern, resident, and then chief resident. She went back to Duke for her general cardiology and advanced heart failure/transplant fellowships as well as research training at the DCRI. Dr. Khazanie joined the University of Colorado in 2015 as a health services clinician researcher with a focus on improving health equity and bioethics in advanced heart failure care. She mentors medical students, residents, and fellows and is a faculty mentor for the University of Colorado Cardiology Fellows “House of Cards” mentoring group. She has research funding from the NIH/NHLBI K23, NIH Ethics Grant, and Ludeman Center for Women's Health Research. Dr. Khazanie is an author on the 2022 ACC/AHA/HFSA HF Guidelines, the 2021 HFSA Universal Definition of Heart Failure, and multiple scientific statements. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #11 A 64-year-old woman with a history of chronic systolic heart failure secondary to NICM (LVEF 15-20%) s/p dual chamber ICD presents for routine follow-up. She reports several months of progressive fatigue, dyspnea, and peripheral edema. She has been hospitalized twice in the past year with acute decompensated heart failure. Efforts to optimize guideline directed medical therapy have been tempered by episodes of lightheadedness and hypotension. Her exam is notable for an elevated JVP, an S3 heart sound, and a III/VI holosystolic murmur best heard at the apex with radiation to the axilla. Labs show Na 130 mmol/L, Cr 1.8 mg/dL (from 1.1 mg/dL 6 months prior), and NT-proBNP 1,200 pg/mL. ECG in clinic shows sinus rhythm and a nonspecific IVCD with QRS 116 ms. Her most recent TTE shows biventricular dilation with LVEF 15-20%, moderate functional MR, moderate functional TR and estimated RVSP of 40mmHg. What is the most appropriate next step in management? A Refer to electrophysiology for upgrade to CRT-D B Increase sacubitril-valsartan dose C Refer for advanced therapies evaluation D Start treatment with milrinone infusion Answer #11 Explanation The correct answer is C – refer for advanced therapies evaluation. Our patient has multiple signs and symptoms of advanced heart failure including NYHA Class III-IV functional status, persistently elevated natriuretic peptides, severely reduced LVEF, evidence of end organ dysfunction, multiple hospitalizations for ADHF, edema despite escalating doses of diuretics, and progressive intolerance to GDMT. Importantly, the 2018 European Society of Cardiology revised definition of advanced HF focuses...

Welcome to my podcast. I am Doctor Warrick Bishop, and I want to help you to live as well as possible for as long as possible. I'm a practising cardiologist, best-selling author, keynote speaker, and the creator of The Healthy Heart Network. I have over 20 years as a specialist cardiologist and a private practice of over 10,000 patients. Australia, like the rest of the western world, has a heart problem. Over 9 million people around the world die from heart disease every year. Every 10 minutes, someone in Australia suffers a heart attack. And 21 lives are lost daily because of it. The devastating fact in all of this is…  Every one of those cases could have been prevented.

The following question refers to Section 7.7 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.  The question is asked by St. George's University medical student and CardioNerds Intern Chelsea Tweneboah, answered first by Baylor College of Medicine Cardiology Fellow and CardioNerds Ambassador Dr. Jamal Mahar, and then by expert faculty Dr. Michelle Kittleson. Dr. Kittleson is Director of Education in Heart Failure and Transplantation, Director of Heart Failure Research, and Professor of Medicine at the Smidt Heart Institute, Cedars-Sinai. She is Deputy Editor of the Journal of Heart and Lung Transplantation, on Guideline Writing Committees for the American College of Cardiology (ACC)/American Heart Association, is the Co Editor-in-Chief for the ACC Heart Failure Self-Assessment Program, and on the Board of Directors for the Heart Failure Society of America. Her Clinician's Guide to the 2022 Heart Failure guidelines, published in the Journal of Cardiac Failure, are a must-read for everyone! The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #10 Ms. Heffpefner is a 54-year-old woman who comes to your office for a routine visit. She does report increased fatigue and dyspnea on exertion without new orthopnea or extremity edema. She was previously diagnosed with type 2 diabetes, morbid obesity, obstructive sleep apnea, and TIA. She is currently prescribed metformin 1000mg twice daily, aspirin 81mg daily, rosuvastatin 40mg nightly, and furosemide 40mg daily. In clinic, her BP is 140/85 mmHg, HR is 110/min (rhythm irregularly irregular, found to be atrial fibrillation on ECG), and BMI is 43 kg/m2. Transthoracic echo shows an LVEF of 60%, moderate LV hypertrophy, moderate LA enlargement, and grade 2 diastolic dysfunction with no significant valvulopathy. What is the best next step? A Provide reassurance B Refer for gastric bypass C Refer for atrial fibrillation ablation D Start metoprolol and apixaban Answer #10 Explanation The correct answer is D – start metoprolol and apixaban. Ms. Hefpeffner has a new diagnosis of atrial fibrillation (AF) and has a significantly elevated risk for embolic stroke based on her CHA2DS2-VASc score of 6 (hypertension, diabetes, heart failure, prior TIA, and female sex). The relationship between AF and HF is complex and they the presence of either worsens the status of the other. Managing AF in patients with HFpEF can lead to symptom improvement (Class 2a, LOR C-EO). However, large, randomized trial data are unavailable to specifically guide therapy in patients with AF and HFpEF. Generally, management of AF involves stroke prevention, rate and/or rhythm control, and lifestyle / risk-factor modification. With regards to stroke prevention, patients with chronic HF with permanent-persistent-paroxysmal AF and a CHA2DS2-VASc score of ≥2 (for men) and ≥3 (for women) should receive chronic anticoagulant therapy (Class 1, LOE A). When anticoagulation is used in chronic HF patients with AF, DOAC is recommended over warfarin in eligible patients (Class 1, LOE A). The decision for rate versus rhythm control should be individualized and reflects both patient symptoms and the likelihood of better ventricular function with sinus rhythm. For patients with HF and symptoms caused by AF, AF ablation is reasonable to improve symptoms and QOL (Class 2a,

Commentary by Dr. Valentin Fuster

The latest news you need to know about XBB.1.5, norovirus, and avian influenza. AMA's Vice President of Science, Medicine and Public Health, Andrea Garcia, JD, MPH, shares new data from the CDC detailing COVID-19 mortality rates for vaccinated and unvaccinated people, preliminary findings on coronavirus infection and heart complications from a small study at Columbia University in NYC, as well as the latest research on lasting heart problems related to COVID infection published in the Journal of the American College of Cardiology. American Medical Association CXO Todd Unger hosts.

The following question refers to Section 7.6 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.  The question is asked by premedical student and CardioNerds Intern Pacey Wetstein, answered first by Baylor College of Medicine Cardiology Fellow and CardioNerds Ambassador Dr. Jamal Mahar, and then by expert faculty Dr. Nancy Sweitzer. Dr. Sweitzer is Professor of Medicine, Vice Chair of Clinical Research for the Department of Medicine, and Director of Clinical Research for the Division of Cardiology at Washington University School of Medicine. She is the editor-in-chief of Circulation: Heart Failure. Dr. Sweitzer is a faculty mentor for this Decipher the HF Guidelines series. The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #9 Mr. Flo Zin is a 64-year-old man who comes to discuss persistent lower extremity edema and dyspnea with mild exertion. He takes amlodipine for hypertension but has no other known comorbidities. In the clinic, his heart rate is 52 bpm and blood pressure is 120/70 mmHg. Physical exam reveals mildly elevated jugular venous pulsations and 1+ bilateral lower extremity edema. Labs show an unremarkable CBC, normal renal function and electrolytes, a Hb A1c of 6.1%, and an NT-proBNP of 750 (no prior baseline available). On echocardiogram, his LVEF is 44% and nuclear stress testing was negative for inducible ischemia. What is the best next step in management? A Add furosemide BID and daily metolazone B Start empagliflozin and furosemide as needed C Start metoprolol succinate D No change to medical therapy Answer #9 Explanation The correct answer is B – start empagliflozin and furosemide as needed. The patient described here has heart failure with mildly reduced EF (HFmrEF), given LVEF in the range of 41-49%. In patients with HF who have fluid retention, diuretics are recommended to relieve congestion, improve symptoms, and prevent worsening HF (Class 1, LOE B-NR). For patients with HF and congestive symptoms, addition of a thiazide (eg, metolazone) to treatment with a loop diuretic should be reserved for patients who do not respond to moderate or high-dose loop diuretics to minimize electrolyte abnormalities (Class 1, LOE B-NR). Therefore, option A is not correct as he is only mildly congested on examination, and likely would not require such aggressive decongestive therapy, particularly with normal renal function. Adding a thiazide diuretic without first optimizing loop diuretic dosing would be premature. The EMPEROR-Preserved trial showed a significant benefit of the SGLT2i, empagliflozin, in patients with symptomatic HF, with LVEF >40% and elevated natriuretic peptides. The 21% reduction in the primary composite endpoint of time to HF hospitalization or cardiovascular death was driven mostly by a significant 29% reduction in time to HF hospitalization, with no benefit on all-cause mortality. Empagliflozin also resulted in a significant reduction in total HF hospitalizations, decrease in the slope of the eGFR decline, and a modest improvement in QOL at 52 weeks. Of note, the benefit was similar irrespective of the presence or absence of diabetes at baseline. In a subgroup of 1983 patients with LVEF 41% to 49% in EMPEROR-Preserved, empagliflozin, an SGLT2i, reduced the risk of the primary composite endpoint of cardiovascular death or hospitalization f...

Focus Issue on Heart Failure and Cardiomyopathies

After several misdiagnoses, Jen Singer was diagnosed with stage 3 non-Hodgkin lymphoma. During her treatment, she was blogging about parenthood for Good Housekeeping and began writing about her cancer experience. That inspired her to become a full-time medical writer. Listen in to learn more about Jen's journey with cancer, COVID, and heart failure. You'll also hear in detail how she's used empathy to become an award-winning medical writer.   What You'll Learn: Jen Singer is introduced. (2:35) There were several misdiagnoses before Jen got diagnosed with stage 3 non-Hodgkin lymphoma. (4:05) After being rushed to the hospital, Jen got a second opinion. (9:45) When she finally got the correct diagnosis, Jen's first thoughts were her daughters. (11:00) Having an honest doctor was everything for Jen. (13:48) After recovering from COVID, Jen went into heart failure. (16:45) Jen laughs about learning the difference between the oncology floor and cardiology floor. (18:50) The term heart failure is terrifying for many people. (22:10) Anger is a common feeling when patients have multiple big diagnoses in their life. (23:00) Asking smart, specific questions about your treatment is important. (26:45) Seeing terrified patients, Jen was inspired to create "The Just Diagnosed Guides" (27:40) "How is it for you today?" is a great question to ask patients. (30:26) Healthcare providers need to be careful about what they say. (33:25)   Ideas worth sharing: "I wrote a script to call different pulmonologist offices." - Jen Singer "When you see something concerning, doctors should say, "That's odd we should investigate." - Dr. Rosalyn Morrell "The whole thing was how can I get the right treatment as fast as possible, and how can I protect my family from people saying things that aren't always helpful." - Jen Singer "Googling your symptoms is never a good idea when you don't know what you're looking for." - Jen Singer "The more dangerous the diagnosis, the more opinions you should seek." - Jen Singer "We're taught how to be healthy, not how to be sick." - Jen Singer   Resources: Rosalyn Morrell, MD: Website Jen Singer: Website

The following question refers to Section 7.3 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by Palisades Medical Center medicine resident & CardioNerds Intern Dr. Maryam Barkhordarian, answered first by MedStar Washington Hospital Center cardiology hospitalist & CardioNerds Academy Graduate Dr. Luis Calderon, and then by expert faculty Dr. Gregg Fonarow.Dr. Fonarow is the Professor of Medicine and Interim Chief of UCLA's Division of Cardiology, Director of the Ahmanson-UCLA Cardiomyopathy Center, and Co-director of UCLA's Preventative Cardiology Program.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #8 Ms. Flo Zinn is a 60-year-old woman seen in cardiology clinic for follow up of her chronic HFrEF management. She has a history of stable coronary artery disease, hypertension, hypothyroidism, and recurrent urinary tract infections. She does not have a history of diabetes and recent hemoglobin A1c is 5.0%. Her current medications include carvedilol, sacubitril-valsartan, eplerenone, and atorvastatin. Her friend was recently placed on an SGLT2 inhibitor and asks if she should be considered for one as well. Which of the following is the most important consideration when deciding to start this patient on an SGLT2 inhibitor? A The patient does not have a history of type 2 diabetes and so does not qualify for SGLT2 inhibitor therapy B While SGLT2 inhibitors improve hospitalization rates for HFrEF, there is no evidence that they improve cardiovascular mortality C Patients taking SGLT2 inhibitors tend to suffer a more rapid decline in renal function than patients not taking SGLT2 inhibitor therapy D Patients may be at a higher risk for genitourinary infections if an SGLT2 inhibitor is started Answer #8 Explanation   The correct answer is D – SGLT2 inhibitors have been associated with increased risk of genitourinary infections. Sodium-glucose co-transporter protein 2 (SGLT2) inhibitors have gathered a lot of press recently as the new kid on the block with respect to heart failure management. While they were initially developed as antihyperglycemic medications for treating diabetes, early cardiovascular outcomes trials showed reduced rates of heart failure hospitalization amongst study participants independent of glucose-lowering effects and irrespective of baseline heart failure status – only 10-14% of patients carried a heart failure diagnosis at baseline. This prompted trials to study the effects of SGLT2 inhibitors in patients with symptomatic chronic HFrEF who were already on guideline directed medical therapy irrespective of the presence of type 2 diabetes mellitus. The DAPA-HF and EMPEROR-Reduced trials showed that dapagliflozin and empagliflozin, respectively, both conferred statistically significant improvements in a composite of heart failure hospitalizations and cardiovascular death (Option B). Most interestingly, these effects were seen irrespective of diabetes history. In light of these findings, the 2022 HF guidelines recommend SGLT2 inhibitors in patients with chronic, symptomatic HFrEF with or without diabetes to reduce hospitalization for HF and cardiovascular mortality (Class I, LOE A). The benefits of SGLT2 inhibitors extend beyond cardiovascular health.

The birth of a child is a joyous occasion for an entire family.  But for the families of American babies born each year with congenital heart disease (CHD), it can also bring fear and uncertainty. Dr. Matthew O'Connor, attending cardiologist and the Medical Director of the Heart Failure and Transplant Program at Children's Hospital of Philadelphia (CHOP)has information about innovations in cardiac care that can save and improve the lives of children with heart disease worldwide.  

Cardiac rehab is often needed after a heart event or surgery. Learn more about why cardiac rehab is needed and how it can help you recover. Learn more about UnityPoint Health - St. Luke's Hospital in Cedar Rapids, Iowa at unitypoint.org.Do you have a question about a trending medical topic? Ask Dr. Arnold! Submit your question and it may be answered by Dr. Arnold on the podcast! Submit your questions at: https://www.unitypoint.org/cedarrapids/submit-a-question-for-the-mailbag.aspx If you have a topic you'd like Dr. Arnold to discuss with a guest on the podcast, shoot us an email at stlukescr@unitypoint.org.

Where is God in the midst of the trials and suffering we face in life? Jesus told us that in this world we will have trouble, and the entire Bible from Genesis to Revelation is filled not only with testimony to this fact, but with a theology of suffering that we must know, embrace, and pass on as an inheritance to our kids. If you're like me, you often wonder how God works in the lives of those who face unimaginable suffering. When all seems hopeless is there any hope? Today, I chat with some young youth worker friends who have been and are in the midst of the unimaginable. Stick with us for a compelling conversation about real life suffering, real life hope, and a challenge to teach this to our kids, on this episode of Youth Culture Matters.

The following question refers to Section 7.3.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.  The question is asked by Palisades Medical Center medicine resident & CardioNerds Intern Dr. Maryam Barkhordarian, answered first by MedStar Washington Hospital Center cardiology hospitalist & CardioNerds Academy Graduate Dr. Luis Calderon, and then by expert faculty Dr. Robert Mentz.  Dr. Mentz is associate professor of medicine and section chief for Heart Failure at Duke University, a clinical researcher at the Duke Clinical Research Institute, and editor-in-chief of the Journal of Cardiac Failure. Dr. Mentz is a mentor for the CardioNerds Clinical Trials Network as lead principal investigator for PARAGLIDE-HF and is a series mentor for this very 2022 heart failure Decipher the Guidelines Series. For these reasons and many more, he was awarded the Master CardioNerd Award during ACC22. Welcome Dr. Mentz!  The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #7 Ms. Valarie Sartan is a 55-year-old woman with a history of HFrEF (EF 35%) and well controlled, non-insulin dependent diabetes mellitus who presents to heart failure clinic for routine follow up. She is currently being treated with metoprolol succinate 200mg daily, lisinopril 10mg daily, empagliflozin 10mg daily, and spironolactone 50mg daily. She notes stable dyspnea with moderate exertion, making it difficult to do her yardwork. On exam she is well appearing, and blood pressure is 115/70 mmHg with normal jugular venous pulsations and trace bilateral lower extremity edema. On labs, her potassium is 4.0 mmol/L and creatinine is 0.7 mg/dL with an eGFR > 60 mL/min/1.73m2. Which of the following options would be the most appropriate next step in heart failure therapy?  A  Increase lisinopril to 40mg daily  B  Increase spironolactone to 100mg daily  C  Add sacubitril-valsartan to her regimen  D  Discontinue lisinopril and start sacubitril-valsartan in 36 hours  E  No change  Answer #7 Explanation   The correct answer is D – transitioning from an ACEi to an ARNi is the most appropriate next step in management.   The renin-angiotensin aldosterone system (RAAS) is upregulated in patients with chronic heart failure with reduced ejection fraction (HFrEF). Blockade of the RAAS system with ACE inhibitors (ACEi), angiotensin receptor blockers (ARB), or angiotensin receptor neprilysin inhibitors (ARNi) have proven mortality benefit in these patients.   The PARADIGM-HF trial compared sacubitril-valsartan (an ARNi) with enalapril in symptomatic patients with HFrEF. Patients receiving ARNi incurred a 20% relative risk reduction in the composite primary endpoint of cardiovascular death or heart failure hospitalization. Based on these results, the 2022 heart failure guidelines recommend replacing an ACEi or ARB for an ARNi in patients with chronic symptomatic HFrEF with NYHA class II or III symptoms to further reduce morbidity and mortality (Option D). This is a class I recommendation with level of evidence of B-R and is also of high economic value. Making no changes at this time would be inappropriate (Option E).  While it would be reasonable to increase the dose of lisinopril to 40mg (Option A), this should be pursued only if ARNi therapy is not tolerated.   Mineralocorticoid receptor antagonists (MRAs) have a class I (LOE A...

What you need to know about wine, chocolate, vitamins and your heart on Valentine's Day and every day.  Guest:Ellina Feiner, MD, cardiologist with Lehigh Valley Heart and Vascular Institute, discusses women's heart health with Mike and Steph from B104. Chapters:     · 00:01 - Intro     · 1:23 - Milk vs. dark chocolate     · 1:49 - What is the healthiest dark chocolate?     · 2:15 - Antioxidants in chocolate     · 2:54 - Can dark chocolate lower your risk of heart failure?     · 3:51 - Dark chocolate recipe     · 4:17 - Are there minerals in dark chocolate that are good for me?     · 4:51 - Dark chocolate and your health     · 5:58 - The dark side of chocolate     · 6:25 - Top two minerals your heart needs     · 6:35 - How low magnesium can affect your heart     · 7:00 - What to do if you think you may be magnesium deficient      · 7:22 - Wine health benefits     · 8:09 - What is the healthiest wine?     · 8:22 - How much wine can I have?      · 9:01 - Vitamins and supplements for a woman's heart      · 9:31 - CoQ10 health benefits      · 9:58 - Fish oil and your heart     · 10:50 - Concerns about inflammation      · 11:28 - How to reduce inflammation      · 12:20 - Turmeric health benefits      · 12:52 - Is garlic good for your heart?      · 13:42 - Garlic supplements     · 13:53 - The “silent killer” in women     · 14:21 - Symptoms you shouldn't ignore     · 15:21 - Who is most at risk for developing heart disease?     · 15:31 - How heart disease affects your life     · 16:01 - Ways to prevent heart disease     · 17:22 - Broken Heart Syndrome      · 18:04 - Treatment for Broken Heart Syndrome     · 18:40 - How to take care of your heart     · 19:06 - American Heart Month     · 19:34 - Valentine's Day Plans

Drug and non-drug therapies for HFpEF, the search for AF, and exercise as medicine 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. SGLT2 Inhibitors in HFpEF Dapagliflozin Gets Expanded Heart Failure Indication in Europe https://www.medscape.com/viewarticle/988034 Dapagliflozin in Heart Failure with Mildly Reduced or Preserved Ejection Fraction https://www.nejm.org/doi/full/10.1056/NEJMoa2206286 II. HFpEF and Heart Rate Accelerated Pacing a Possible Strategy for Preserved-EF Heart Failure? https://www.medscape.com/viewarticle/987815 III. Stroke and AF STROKE AF at 3 Years: High AF Rate After Atherosclerotic Stroke https://www.medscape.com/viewarticle/988076 Effect of Long-term Continuous Cardiac Monitoring vs Usual Care on Detection of Atrial Fibrillation in Patients With Stroke Attributed to Large- or Small-Vessel Disease https://jamanetwork.com/journals/jama/fullarticle/2780490 Cryptogenic Stroke and Underlying Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/nejmoa1313600 Duration of device-detected subclinical atrial fibrillation and occurrence of stroke in ASSERT https://pubmed.ncbi.nlm.nih.gov/28329139/ Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke https://www.nejm.org/doi/full/10.1056/NEJMoa2101897 IV. Exercise as Medicine Trending Clinical Topic: Exercise Prescription https://reference.medscape.com/viewarticle/985373 Effect of Moderate and Vigorous Aerobic Exercise on Incident Diabetes in Adults With Obesityhttps://pubmed.ncbi.nlm.nih.gov/36716009/ Features Could a Breakthrough in Heart Failure With Preserved Ejection Fraction Just Take a Change of Pace? https://www.medscape.com/viewarticle/988088 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Wanting to provide the best treatment available, help people live their healthiest lives, and alleviate the health care burden on providers, Intermountain Healthcare, a Utah-based not-for-profit system of 33 hospitals in 7 states, and Story Health, a California-based health technology and services company, have partnered to disseminate specialty care for patients living with heart failure in rural areas. Goals of this new partnership include ensuring patients get the care they need in a sustainable manner, increasing health system efficiency by preventing unnecessary hospitalizations, and getting high-quality care from urban population centers to rural patients while saving costs to the health care system and saving patients and their families time and convenience. On this episode of Managed Care Cast, we speak with Tom Stanis, CEO and co-founder of Story Health, and Phillip Wood, Intermountain Ventures program director on how their partnership came about, how it is going so far, and the future of their collaboration.

Drs. Shannon Holden and David Bragin-Sanchez share new developments in heart failure pharmacotherapy and guidelines, while stressing the importance of the role of the clinical pharmacist as part of a collaborative team.   Guest speakers: Shannon Holden, PharmD, BCACP, CACP Senior Clinical Director of Ambulatory Pharmacy Vizient   David Bragin-Sanchez, MD, FACC, FESC, FISC Cardiologist  MultiCare Pulse Heart Institute   Moderator: Gretchen Brummel, PharmD, BCPS Pharmacy Executive Director Vizient Center for Pharmacy Practice Excellence   Show Notes: [02:27-04:07] The increased focus on cardiology lately [04:08-06:47] Recent updates to the guidelines [06:48-09:05] What clinicians need to know about guidelines moving forward [09:06-10:47] How guideline changes impact patients and workflow [10:48-13:42] Other ways pharmacy staff can contribute and what is their role in your clinic [13:43-16:37] Additional thoughts on role of a pharmacist in this type of clinic [16:38-19:31] Initiating SGLT2 inhibitors prior to discharge in some heart failure patients [19:32-23:07] Future roles for pharmacists in this kind of setting [23:08-25:09] Advice for pharmacists getting involved with this type of clinic setting and these types of patients   Links | Resources: Vizient Pharmacy Market Outlook Member link: Click Here Vizient Pharmacy Market Outlook highlights public version: Click Here AHA/ACC/HFSA 2022 Guidelines CHARM trial   Subscribe Today! Apple Podcasts Amazon Podcasts Google Podcasts Spotify Stitcher Android RSS Feed  

What role do genetics, diet, exercise and cholesterol play in preventing and treating diseases of the heart? Learn about advances in the prevention and treatment of heart disease, coronary artery disease and heart attacks, abnormal rhythms such as atrial fibrillation, cardiac arrest, the failing heart, and diseases of the heart valves. In this program, Dr. Krishan Soni discusses interventions such as angioplasties and stents to treat heart attacks. Series: "Mini Medical School for the Public" [Health and Medicine] [Show ID: 38484]

A possible major breakthrough in thinking about diastolic dysfunction and HFpEF, MRI scanning and cardiac devices, and AF and dementia are the topics John Mandrola, MD, covers 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. New Thinking in HFpEF Accelerated Pacing a Possible Strategy for Preserved-EF Heart Failure? https://www.medscape.com/viewarticle/987815 - Effect of Personalized Accelerated Pacing on Quality of Life, Physical Activity, and Atrial Fibrillation in Patients With Preclinical and Overt Heart Failure With Preserved Ejection Fraction: The myPACE Randomized Clinical Trial https://jamanetwork.com/journals/jamacardiology/fullarticle/2801001 - Effect of β-Blocker Withdrawal on Functional Capacity in Heart Failure and Preserved Ejection Fraction https://doi.org/10.1016/j.jacc.2021.08.073 - A Targeted Treatment Opportunity for HFpEF: Taking Advantage of Diastolic Tone https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.056412 - Lenient versus Strict Rate Control in Patients with Atrial Fibrillation https://www.nejm.org/doi/full/10.1056/nejmoa1001337 II. MRI and ICD Function Legacy ICDs Exposed to MRI Still Shock, Pace as Needed https://www.medscape.com/viewarticle/987729 - Implantable Defibrillator System Shock Function, Mortality, and Cause of Death After Magnetic Resonance Imaging https://doi.org/10.7326/M22-2653 - 2017 HRS expert consensus statement on magnetic resonance imaging and radiation exposure in patients with cardiovascular implantable electronic devices https://pubmed.ncbi.nlm.nih.gov/28502708/ III. AF and Dementia Atrial Fibrillation and Dementia: What Do We Know? https://www.medscape.com/viewarticle/985900 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Dr. Arpit Sothwal explains who is most at risk to develop heart failure. He talks about what symptoms someone with heart failure might experience and what treatments are available to someone who has heart failure. Learn more about our hospital and our experienced cardiologists at St. Luke's Heart Care Clinic in Cedar Rapids, Iowa.https://www.unitypoint.org/cedarrapids/heart.aspxor call (319) 364-7101.Do you have a question about a trending medical topic? Ask Dr. Arnold! Submit your question and it may be answered by Dr. Arnold on the podcast! Submit your questions at: https://www.unitypoint.org/cedarrapids/submit-a-question-for-the-mailbag.aspx If you have a topic you'd like Dr. Arnold to discuss with a guest on the podcast, shoot us an email at stlukescr@unitypoint.org.

Heart failure affects 86 million Americans and by the time many people living  with heart failure realize they're in trouble, it's often too late— their symptoms are at a dangerous severe level for hospitalization. But thankfully, nurses are working with engineers to develop the technology to change this narrative; providing tools that enable those affected or their loved ones to recognize red flags before things become critical. Get ready to put your best foot forward! Today on This Is Getting Old: Moving Towards an Age-Friendly World, we're taking our knowledge up a notch with Pamela Cacchione, PhD, RN, FAAN – an expert in nurse innovation.  She's here to make sure you don't miss out on an emerging technology that can  help manage heart failure - Heart Failure Socks. Key points covered in this episode: ✔️ What Are Heart Failure Socks? Heart failure monitoring socks are a revolutionary technology for heart failure patients. By tracking swelling of the feet and fatigue, these innovative socks can detect any changes in heart failure symptoms before they become dangerous--empowering patients to take greater control of their health and seek out medical advice as soon as possible.  In addition to providing patient-tailored data crucial for better treatment decisions by clinicians, the thought of having a ‘high-tech' solution for something so mundane can be incredibly encouraging for those coping with a chronic illness. Heart failure monitoring socks significantly reduce the risk of worsening symptoms due to the timely warnings they provide, ultimately making life considerably more manageable and less stressful. ✔️ How The Heart Failure Socks Came to Be Pamela's brother was 40 years old when he underwent open heart surgery, during which the doctor performed a mitral valve replacement. Unfortunately, this resulted in the development of heart failure. Since his brother resided in Maryland at the time and Pamela was located in Pennsylvania, she had to assist with managing her brother's condition remotely. Her brother refused to weigh himself despite his condition, leaving Pamela exasperated.  As an alternative way of assessing his weight gain due to fluid accumulation, Pamela suggested observing how deep the indentations were on his socks caused by their compression; they deduced that as they became more deeply impressed into his skin, it would indicate that he had accumulated more fluid than usual. To do so, they utilized FaceTime video chat to observe these indents and better understand how much fluid he had retained.  The lingering idea of developing heart failure monitoring socks for other people like her brother, Peter, who did not want to weigh themselves, was very percolated before Pam  finally started investigating and working on them. ✔️ Socking Away Heart Failure: Progress in a Pair of Socks  Pamela Cacchione, PhD, RN, FAAN and Heart Failure Socks has gone through an impressive journey to get to where it is now as a finalist in the J&J Quick Fire and ANA Awards.  Her unwavering persistence and endurance throughout the application process set her apart from other applicants.  She started her own company, Aging Sense, LLC, and went through an extensive process with her university's Penn Center for Innovation to make it happen. The school-owned center assists in furthering the dreams of those with innovative ideas, which helped Pamela meet all the criteria needed for her to be considered for such a prestigious Innovation Award and internal funding. ✔️ Next Steps For The Heart Failure Monitoring Socks When asked about her plans for the Heart Failure Monitoring Socks, Pam answered, “After extensive research, I have decided that my next step is to pilot test a small project involving participants in a nursing home.” “After collecting data from this test, I plan to submit an STTR - a business-style grant. This would be organized to obtain funding and resources for the project to increase its reach and expand any benefits it might bring about.”  “By taking these steps, I hope to ensure the success of this project and allow it to have an even greater impact than originally expected.”    ---------------------------- How To Connect With Pam: Connecting with Pam is easier than ever! For those in the nursing profession, the University of Pennsylvania Penn Nursing website is a valuable resource to view her work and learn more about her expertise in aging.  Additionally, you can reach out to Pam via email at pamelaca@nursing.upenn.edu or follow her on Twitter @agingsense1 for valuable insights not available elsewhere. With so many options available to make contact and stay connected, introducing yourself to Pam is just one click away! If you have questions or comments or need help, please feel free to drop a one-minute audio or video clip and email it to me at melissabphd@gmail.com, and I will get back to you by recording an answer to your question.  ---------------------------- About Melissa Batchelor, PhD, RN, FNP, FGSA, FAAN: I earned my Bachelor of Science in Nursing ('96) and Master of Science in Nursing ('00) as a Family Nurse Practitioner (FNP) from the University of North Carolina Wilmington (UNCW) School of Nursing (SON). I genuinely enjoy working with the complex medical needs of older adults. I worked full-time for five years as FNP in geriatric primary care across many long-term care settings (skilled nursing homes, assisted living, home, and office visits), then transitioned into academic nursing in 2005, joining the faculty at UNCW SON as a lecturer. I obtained my PhD in Nursing and a post-master's Certificate in Nursing Education from the Medical University of South Carolina College of Nursing ('11). I then joined the faculty at Duke University School of Nursing as an Assistant Professor. My family moved to northern Virginia in 2015 which led to me joining the George Washington University (GW) School of Nursing faculty in 2018 as a (tenured) Associate Professor. I am also the Director of the GW Center for Aging, Health, and Humanities. Please find out more about her work at https://melissabphd.com/.

Focus Issue on Heart Failure and Cardiomyopathies

Dr. Faraz Ahmad discusses the importance of the research and clinical AI (Artifial Intelligence) program and the exciting new developments with AI and healthcare. AI is being used to detect at risk patients, giving doctors advanced notice on heart failure!

We're back with Season 4! Sorry for the unplanned hiatus. Today we talk about the CLOVERS trial, which tested the hypothesis that early vasopressors and restrictive fluid would be superior to liberal fluids plus rescue vasopressors. We also looked at the TRANSFORM-HF study, which compared torsemide and furosemide in congestive heart failure, the PREVENT CLOT study, which compared aspirin to enoxaparin for VTE prophylaxis after a traumatic fracture, and the AID-ICU study, which compared haloperidol to placebo in the treatment of ICU delirium. CLOVERS trialTorsemide vs Furosemide in CHFAspirin vs Enoxaparin for VTE ppx after FractureIV Haloperidol in ICU DeliriumWe also quickly review some papers we missed in 2022:Apixaban for VTE in ESRD Acetazolamide for Congestive Heart FailureModerate or Aggressive IV Fluids for PancreatitisPerioperative Management of AnticoagulationCRISTAL study (aspirin vs enoxaparin after TKA/THA)Music from Uppbeat (free for Creators!):https://uppbeat.io/t/soundroll/dopeLicense code: NP8HLP5WKGKXFW2R

As a nurse practitioner in primary care, there are SO many things I've wanted to ask a cardiology nurse practitioner. This week, I had the lovely pleasure of interviewing Scott Pasquale, FNP and cardiology nurse practitioner, with questions from the RWNP community. In this episode, we covered:What cardiologists wish primary care providers knewA breakdown of common cardiovascular tests, how to explain them to patients, and how to choose between each one!Review of how to order holter monitors the right way!Common cardiovascular topics like atrial fibrillation, anticoagulation, and heart failureResources for nurse practitioners interested into going into cardiovascular medicineIf you liked this post, also check out:Heart Failure in Primary CareApproach to Resistant Hypertension Part 1Approach to Resistant Hypertension Part 2Read the full blog post hereTimestamps:00:00 - Introduction03:13 - How Scott Pasquale choose Cardiology04:14 - What NP Cardiologist Wish That Primary Care Providers Knew06:51 - Ordering a Stress Test11:57 - Other Names for Nuclear Scans12:54 - Example Situation18:57 - Type of Monitor to Use 24:45 - EKG Learning Resources29:14 - A-Fibrillation31:14 - Anticoagulation33:56 - Cold Calling35:20 - Coronary Calcium Score/Scan36:54 - Hypertension Management and Their Side Effects39:55 - Resources/Recommendations for New Nurse Practitioners Getting into Cardiology41:32 - Heart Failure44:24 - Diuresis Management48:20 - Time in Specialty Practice vs Primary Care© 2022 Real World NP. For educational and informational purposes only, see realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

“Medical school cannot, and should not, feel easy—but it should feel worthwhile” – these are the opening words of Dr Kittleson's book, Mastering the Art of Patient Care. Dr Kittleson's book is not only a great resource for patient care, but a heartful companion to early career faculty as well. Dr Kalra's guest on Parallax this week is Dr Michelle Kittleson, Professor of Medicine at Cedars-Sinai, Director of Education in Heart Failure and Transplantation and Director of Heart Failure Research at the Smidt Heart Institute. Coming from generations of doctors, Dr Kittleson describes herself first and foremost a dedicated clinician. With her new book, Dr Kittleson offers her mentorship and shares her advice on how to make patient care fulfilling for both clinicians and patients. In this rich and insightful discussion, Dr Kittleson talks about the origins of famous #kittlesonrules, a collection of tips for doctors shared on Twitter, and her thoughts on mentorship. We learn more about Mastering the Art of Patient Care. Dr Kalra and Dr Kittleson discuss strategies for managing difficult situations in patient care. You can find out more about Mastering the Art of Patient Care here: https://t.co/zdJT2MWl6J How do you pick a medical programme? How can you define your medical style? What can you learn from Mastering the Art of Patient Care? Questions and comments can be sent to “podcast@radcliffe-group.com” and may be answered by Ankur in the next episode. Guest: @MKIttlesonMD, host: @AnkurKalraMD and produced by: @RadcliffeCARDIO.

The loop diuretic duels, adverse events during hospital admissions, BP accuracy, and, again, left main revascularization strategies (again) are the topics John Mandrola 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. TRANSFORM HF Clarity on Torsemide vs Furosemide in HF: TRANSFORM-HF Published https://www.medscape.com/viewarticle/987128 • Effect of Torsemide vs Furosemide After Discharge on All-Cause Mortality in Patients Hospitalized With Heart Failure https://jamanetwork.com/journals/jama/fullarticle/2800428 • RANSFORM-HF—Can We Close the Loop on Diuretics in Heart Failure? https://jamanetwork.com/journals/jama/fullarticle/2800445 II. Adverse Events in the Hospital Adverse Events Reported in One Quarter of Inpatient Admissions https://www.medscape.com/viewarticle/987091 • The Safety of Inpatient Health Care https://www.nejm.org/doi/full/10.1056/NEJMsa2206117 III. BP Accuracy Experts Demand Validation of Automatic Blood Pressure Devices https://www.medscape.com/viewarticle/987032 IV. Left Main Coronary Artery Disease Real-World Examination of Revascularization Strategies for Left Main Coronary Disease in Ontario, Canada https://doi.org/10.1016/j.jcin.2022.10.016 Management of Left Main Coronary Artery Disease in Nonemergent Settings: The Heart of Multidisciplinary Teamwork https://doi.org/10.1016/j.jcin.2022.11.024 You may also like: Medscape editor-in-chief Eric Topol, MD, and master storyteller and clinician Abraham Verghese, MD, on Medicine and the Machine https://www.medscape.com/features/public/machine The Bob Harrington Show with Stanford University Chair of Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

This episode covers the 2022 American College of Emergency Physicians (ACEP) clinical policy on acute heart failure syndromes with a special focus on high dose nitrates References and Show Notes: FOAMcast.org Thanks for listening! Lauren Westafer

The following question refers to Section 7.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure. The question is asked by New York Medical College medical student and CardioNerds Intern Akiva Rosenzveig, answered first by Cornell cardiology fellow and CardioNerds Ambassador Dr. Jaya Kanduri, and then by expert faculty Dr. Clyde Yancy.Dr. Yancy is Professor of Medicine and Medical Social Sciences, Chief of Cardiology, and Vice Dean for Diversity and Inclusion at Northwestern University, and a member of the AHA/ACC/HFSA Heart Failure Guideline Writing Committee.The Decipher the Guidelines: 2022 AHA / ACC / HFSA Guideline for The Management of Heart Failure series was developed by the CardioNerds and created in collaboration with the American Heart Association and the Heart Failure Society of America. It was created by 30 trainees spanning college through advanced fellowship under the leadership of CardioNerds Cofounders Dr. Amit Goyal and Dr. Dan Ambinder, with mentorship from Dr. Anu Lala, Dr. Robert Mentz, and Dr. Nancy Sweitzer. We thank Dr. Judy Bezanson and Dr. Elliott Antman for tremendous guidance.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #5 Ms. L is a 65-year-old woman with nonischemic cardiomyopathy with a left ventricular ejection fraction (LVEF) of 35%, hypertension, and type 2 diabetes mellitus. She has been admitted to the hospital with decompensated heart failure (HF) twice in the last six months and admits that she struggles to understand how to take her medications and adjust her sodium intake to prevent this.  Which of the following interventions has the potential to decrease the risk of rehospitalization and/or improve mortality? A Access to a multidisciplinary team (physicians, nurses, pharmacists, social workers, care managers, etc) to assist with management of her HF   B Engaging in a mobile app aimed at improving HF self-care   C Vaccination against respiratory illnesses   D A & C   Answer #5   The correct answer is D – both A (access to a multidisciplinary team) and C (vaccination against respiratory illness).   Choice A is correct. Multidisciplinary teams involving physicians, nurses, pharmacists, social workers, care managers, dieticians, and others, have been shown in multiple RCTs, metanalyses, and Cochrane reviews to both reduce hospital admissions and all-cause mortality. As such, it is a class I recommendation (LOE A) that patients with HF should receive care from multidisciplinary teams to facilitate the implementation of GDMT, address potential barriers to self-care, reduce the risk of subsequent rehospitalization for HF, and improve survival. Choice B is incorrect.  Self-care in HF comprises treatment adherence and health maintenance behaviors. Patients with HF should learn to take medications as prescribed, restrict sodium intake, stay physically active, and get vaccinations. They also should understand how to monitor for signs and symptoms of worsening HF, and what to do in response to symptoms when they occur. Interventions focused on improving the self-care of HF patients significantly reduce hospitalizations and all-cause mortality as well as improve quality of life. Therefore, patients with HF should receive specific education and support to facilitate HF self-care in a multidisciplinary manner (Class I, LOE B-R). However, the method of delivery and education matters. Reinforcement with structured telephone support has been shown to be effective. In contrast the efficacy of mobile health-delivered educational interventions in improve self-care in patients with HF remains uncertain. Choice C is correct. In patients with HF, vaccinating against respiratory illnesses is reasonable to reduce mortality (Class 2a, LOE B-NR). For example, administration of the influenza vaccine in HF patients has been shown to reduce...