Podcasts about htn

Viva StemYou meet a 60yo male for a laparoscopic cholecystectomy.PMx: IHD, T2DM, HTN. Neuropathic foot painMedications:MetoprololMetforminACEiStatinPregabalin---------Find us atInstagram: https://www.instagram.com/abcsofanaesthesia/Twitter: https://twitter.com/abcsofaWebsite: http://www.anaesthesiacollective.comPodcast: ABCs of AnaesthesiaPrimary Exam Podcast: Anaesthesia Coffee BreakFacebook Page: https://www.facebook.com/ABCsofAnaesthesiaFacebook Private Group: https://www.facebook.com/groups/2082807131964430---------Check out all of our online courses and zoom teaching sessions here!https://anaesthesia.thinkific.com/collectionshttps://www.anaesthesiacollective.com/courses/---------#Anesthesiology #Anesthesia #Anaesthetics #Anaesthetists #Residency #MedicalSchool #FOAMed #Nurse #Medical #Meded ---------Please support me at my patreonhttps://www.patreon.com/ABCsofA---------Any questions please email abcsofanaesthesia@gmail.com---------Disclaimer: The information contained in this video/audio/graphic is for medical practitioner education only. It is not and will not be relevant for the general public.Where applicable patients have given written informed consent to the use of their images in video/photography and aware that it will be published online and visible by medical practitioners and the general public.This contains general information about medical conditions and treatments. The information is not advice and should not be treated as such. The medical information is provided “as is” without any representations or warranties, express or implied. The presenter makes no representations or warranties in relation to the medical information on this video. You must not rely on the information as an alternative to assessing and managing your patient with your treating team and consultant. You should seek your own advice from your medical practitioner in relation to any of the topics discussed in this episode' Medical information can change rapidly, and the author/s make all reasonable attempts to provide accurate information at the time of filming. There is no guarantee that the information will be accurate at the time of viewingThe information provided is within the scope of a specialist anaesthetist (FANZCA) working in Australia.The information presented here does not represent the views of any hospital or ANZCA.These videos are solely for training and education of medical practitioners, and are not an advertisement. They were not sponsored and offer no discounts, gifts or other inducements. This disclaimer was created based on a Contractology template available at http://www.contractology.com.

PCOS and managing any health condition that calls for dietary changes can be really challenging when you're also trying to stay off diets and heal your relationship with food.   My guest today is a fellow non-diet dietitian. Julie Duffy Dillon is a Registered Dietitian and Host of Find Your Food Voice®, a popular long running nutrition podcast. Through speaking and writing, she helps people with a complicated relationship with food strategize how to remove the shame and blame dumped on them from the diet industry. Her work has been featured on TLC and in the New York Times, Outside Magazine, Shape and other outlets. She is the author of the book, Find Your Food Voice.   We cover a lot of ground in this conversation - including what it's like coming up as a dietitian in the medical field that very much subscribes to a weight-centric model of care, and we both spilled some tea about the inner reckonings we had that shook us and caused us to change the path we were on in our careers.    We also talked about emotional eating - Julie has a hot take on this that you don't want to miss.    Julie shares some great strategies for how to navigate health conditions like PCOS, HTN, diabetes, IBS, high chol, and things like that without getting sucked back into dieting.    Make sure you listen towards the end for the part where Julie talks about the concept of “finding your food voice” which is such a cool concept that is going to help you to silence diet culture and your inner critic as you are learning to trust yourself with food.    As you can tell, this is an incredible conversation, so pop in your ear buds, push play and get ready to be inspired!   Episode Highlights   -Why Julie bailed on the nutrition class she was teaching 5 minutes into it and almost got fired. -How chronic illnesses like PCOS, diabetes, high blood pressure, IBS, and high cholesterol impact our relationship with food. -PCOS and what mainstream medical culture gets wrong about it. -Finding your “food voice” and how this will help you make peace with food.   Resources Mentioned   - Connect with Julie Duffy Dillon on social media @FoodVoiceRD - Grab a copy of Julie's book Find Your Food Voice - Julie Duffy Dillon's website   Read the full episode show notes here.   Resources for Your Intuitive Eating Journey   Intuitive eating education on the blog Work with Katy Explore the self-paced mini-course Stepping Off The Dieting Rollercoaster     Connect with Katy Harvey   Website: KatyHarvey.net Instagram: @katyharvey.rd Facebook: KatyHarveyRD      Subscribe and Review   Rate, Review, & Follow on Apple Podcasts   I would be thrilled if you could rate and review my podcast! Your support helps me reach and encourage more people on their intuitive eating journeys. Click here, scroll to the bottom, tap to rate with five stars, and select “Write a Review.” Don't forget to share what you loved most about the episode!   Also, make sure to follow the podcast if you haven't already done so. Follow now!  

A 70 year old man with a history of BPH, HTN and dyslipidemia presents with a 3-day history of perineal pain, intermittent fever, dysuria, and difficulty initiating urine stream. He denies GI upset and is taking fluids without difficulty. He denies sexual activity with others for the past three years. He is alert, oriented and appears slightly uncomfortable while seated. Abdominal and scrotal exam are WNL, there is no penile discharge and digital rectal exam reveals a tender, enlarged prostate. UA reveals positive leukocyte esterase and > 10 WBCs per HPF. With a working diagnosis of acute bacterial prostatitis, which of the following is the most appropriate antimicrobial option in this clinical scenario?  A. Ciprofloxacin PO x 10 days B. IM Ceftriaxone as a one-time dose with doxycycline PO BID X 10 days C. IV piperacillin with tazobactam for 5 days D. Nitrofurantoin PO BID x 5 days.  Visit fhea.com to learn more!

Join the Behind the Knife Bariatric Surgery Team as they kick off 2025 with a crucial discussion on pediatric and adolescent bariatric surgery. Drs. Matt Martin, Adrian Dan and Katherine Cironi delve into the latest ASMBS guidelines, comparing long-term outcomes of gastric bypass and sleeve gastrectomy in adolescents versus adults. They explore key comorbidities, including type 2 diabetes, hypertension, and orthopedic issues, and emphasize the importance of early intervention. This episode also tackles the complex ethical considerations surrounding surgery in this vulnerable population, including consent, multidisciplinary care, and the evolving role of medical therapies like GLP-1 agonists. Show Hosts: - Matthew Martin - Adrian Dan - Katherine Cironi Learning Objectives:  ·  Identify the current ASMBS guidelines for pediatric and adolescent bariatric surgery, including BMI thresholds and associated comorbidities.  ·  Describe common comorbidities seen in the pediatric population eligible for bariatric surgery, such as type 2 diabetes, hypertension, and orthopedic issues.  ·  Compare and contrast long-term outcomes of bariatric surgery (gastric bypass and sleeve gastrectomy) in adolescents and adults, including remission rates of comorbidities and reoperation rates.  ·  Discuss the importance of a multidisciplinary approach, including psychological and ethical considerations, when evaluating adolescent patients for bariatric surgery.  ·  Explain the ethical framework used in evaluating adolescents for bariatric surgery, including consent/assent, parental involvement, and addressing potential coercion.  ·  Recognize the evolving role of medical management (e.g., GLP-1 agonists) in conjunction with or as an alternative to bariatric surgery in adolescents. Article #1: Inge 2019 – Five-year outcomes of gastric bypass in adolescents as compared with adults https://pubmed.ncbi.nlm.nih.gov/31461610/ - The cumulative effect of sustained severe obesity (BMI >35) from adolescence into adulthood increases the likelihood of diabetes, hypertension, respiratory conditions, kidney dysfunction, walking limitations, and venous edema in legs/feet (when compared to adults that did not report severe obesity in adolescence) - American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines for adolescents who should be considered for bariatric surgery: BMI is ≥35 with a co-morbidity or if they have a BMI ≥40 (class 3 obesity, 140% of the 95th percentile) - This article utilizes the Teen-Longitudinal Assessment of Bariatric Surgery (TEENS LAB) and LABS (adults) databases to evaluate the outcomes of adolescents vs. adults who underwent bariatric surgery Roux-en-Y gastric bypass (2006-2009) - 161 adolescents (13-19 at the time of surgery) with severe obesity (BMI>35) vs 396 adults (25-50 years old at the time of surgery) who have remained obese (BMI>30) since adolescence  - Both groups had the gastric bypass procedure as their primary bariatric operation  - Both groups had unadjusted similar demographics, however, BMI was higher in adolescence (54) when compared to adults (51)  - Results were analyzed using linear mixed and Poisson mixed models to analyze weight and coexisting conditions - After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes and hypertension - Increased likelihood of remission of diabetes due to the shorter duration of diabetes, lower baseline glycated Hgb, less use of medications, and increased baseline C-peptide levels  - Increased vascular stiffness in adults along with a longer duration of hypertension make the cessation of hypertension less responsive with surgery in adults  - No significant difference in percent weight changes between adolescents and adults 5 years after surgery  - Both adults and adolescent groups had decreased rates of hypertriglyceridemia and low HDL levels, albeit not significantly different when comparing the two groups  - Of note, the rate of abdominal reoperations was significantly higher among adolescents (20%) than among adults (16%) with cholecystectomy representing nearly half the procedures in both groups - Limitations - At baseline, adults had a high prevalence of both diabetes and hypertension - only 14% of adolescents had diabetes vs 31% of adults  - Only 30% of adolescents had hypertension vs 61% of adults  Article #2: Ryder 2024 – Ten-year outcomes after bariatric surgery in adolescents  https://pubmed.ncbi.nlm.nih.gov/39476348/ - The goal is to discuss the long-term durability of weight loss and remission of coexisting conditions in adolescents after bariatric surgery  - This article utilizes the Teen-Longitudinal Assessment of Bariatric Surgery (TEENS LABS) database to evaluate the 10-year outcomes in adolescents who underwent gastric bypass or sleeve gastrectomy  - 260 adolescents with an average age of 17 years old at the time of surgery (ages ranged from 13-19 years old) - 161 adolescents underwent gastric bypass, 99 adolescents underwent sleeve gastrectomy  - Results were analyzed using propensity score-adjusted linear and generalized mixed models  - At 10 years, the average BMI had decreased significantly with both groups experiencing about a 20% change in BMI on average - To assess comorbidities, both groups were analyzed together -  55% of patients who had DM2 at baseline, were in remission at 10 years - 57% of patients who had HTN at baseline, were in remission at 10 years -  54% of patients who had dyslipidemia at baseline, were in remission at 10 years - Limitations  - Neither of these studies compare surgery to medical management. GLP-1s have shown promise for weight loss management but we need more data in terms of long-term outcomes in co-morbidities like diabetes, hypertension, dyslipidemia  - Highlighted Outcomes  - Metabolic bariatric surgery is quite effective in the adolescent population  - Adolescents tend to have weight loss that is similar to that of adults and improved resolution of comorbid conditions (DM2, HTN, dyslipidemia) Article #3: Moore 2020 – Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation https://pubmed.ncbi.nlm.nih.gov/33191162/ - The purpose of this paper is to describe the ethical framework that supports the use of metabolic & bariatric surgery (MBS) on the principle of justice, and how providers can conduct a thorough evaluation of patients presenting for these surgeries - Highlights adolescents with intellectual and developmental disabilities (IDD) and preadolescent children who pose more ethical questions before considering surgery  - This article utilizes the bariatric surgery center at one children's hospital and the institution's ethics consult service to develop an ethical framework to evaluate pediatric patients seeking bariatric surgery – using the national ASMBS guidelines  - This ethical framework utilized 4 central ethical questions 1.     Should any patients be automatically excluded from evaluation for MBS? 2.     How should it be determined that the benefits of MBS outweigh the risks? 3.     How do we ensure the patient fully understands and is capable of cooperating with the surgery and follow-up care? 4.     How do we make sure the decision to have surgery is truly voluntary, and not coerced by family or others? - Results: this ethical framework was discussed in depth in two case studies  - Overview of framework: an ethical question would arise from the bariatric team they would review & apply the ethical framework. The question is either resolved by the bariatric team OR ethics consult, continue pre-operative workup vs no surgery - Case 1: 17M (BMI 42) with a history of autism spectrum disorder, pre-DM, depression with behavior challenges, HTN, dyslipidemia. Testing at school demonstrates intellectual functioning at a fourth-grade level. Pt lives with mom and 11-year-old sister. Mom endorses food insecurity (on supplemental nutrition assistance benefits) and struggles with her son's large intake of food.  1.     Co-morbidities should not be exclusionary, but pt should undergo a comprehensive psychosocial evaluation with attention to family dynamics and support and the patient's decision-making capacity  2.     Discuss benefits vs risks. Benefits – decreased progression of DM2, HTN, hyperlipidemia, cardiometabolic dx. Risks – gastric leak, infection, bleeding, dumping syndrome, etc.  3.     Can assess decision-making capacity with the surgical team or if need be other teams. In this case, the pt had limited decision-making capacity  - His level of understanding remained stable during the pre-op visits, and he gave assent to surgery - The mom identified a second source of support (extended family) - The team talked to both the patient and mother alone and then, together, found that the patient developed an independent desire for surgery, and thus moved forward.  - Case 2: 8F (BMI 50) with a history of mod OSA, L slipped capital femoral epiphysis s/p surgical stabilization (6 mos prior). The patient is neurotypical & excels in school, and lives with mom & dad. Referred by mom & dad (mom with a recent history of sleeve gastrectomy).  1.     An 8-year-old should not be discriminated against based solely on age, but the patient should be offered more conservative/less invasive options before OR.  a.     In this case, the family had not yet been offered these nonsurgical approaches (structured weight management program, physical support, dietician) 2.     Discuss benefits vs risks. Benefits – preventing progression of hip disease, improvement of OSA, decreased risk of cardiometabolic dx. Risks – anatomic/infectious/nutrition risks  3.     Decision-making capacity was assessed. Found that the parents were more advocating for the surgery saying she has a poor quality of life physically and socially. When the patient was separated from her parents, she said she could lose weight if she had healthier foods at home and someone to exercise with. The patient had decision-making capacity & did not assent to surgery.  4.     When the ethics team interviewed the patient and parents, the parents had a strong preference toward surgery vs patient was scared of surgery and wanted to try other approaches first  a.      Decided that the child's dissent outweighed the medical necessity for surgery and that there were conservative treatment options still available to try  - Highlighted Outcomes  - ASMBS guidelines give us good direction on who qualifies for surgery and emphasize an interdisciplinary approach to decision-making. The decision to pursue surgery should always weigh the benefits and risks and should be made collaboratively with the patient, family, and care team ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

The NP sees a 74-year-old woman with a BMI=30 kg/m2 who has a 30-year history of type 2 diabetes, HTN, and dyslipidemia. Pertinent social history includes the following: a retired elementary school teacher who lives in a 1-story home with her spouse and adult child, nonsmoker, drinks approximately 2, 5 oz glasses of wine per month, and walks approximately 2 miles per day. Her current medications include telmisartan, HCTZ, rosuvastatin, metformin, semaglutide and canagliflozin at optimized doses, and current A1c=9.2%. Her current A1c= 9.2% and is at HTN and lipid goal. Prior mediations have included sitagliptin, with patient stating, “That medication did not help my sugar at all.” She states she is adherent to her medications and dietary advice. Her eGFR is within acceptable parameters and she is feeling well. Physical exams are unremarkable. Which of the following is the most appropriate next step? A. Advise that her A1c is at an age-acceptable level.  B. Add post-meal sliding scale rapid acting insulin C. Prescribe basal and pre meal insulin. D. Add oral glipizide.  Visit fhea.com to learn more!

This week we review a work from the department of cardiology and department of cardiac surgery at Boston Children's Hospital on late hypertension in patients following coarctation repair. Late hypertension has been associated previously with late transverse aortic arch Z score but can this be predicted by the immediate postoperative transverse aortic arch Z score also? What factors account for late hypertension in the coarctation patient? Should more patients have their aorta repaired from a sternotomy? Dr. Sanam Safi-Rasmussen, who is a PhD candidate at Copenhagen University, shares her insights from a work she performed while a research fellow at Boston Children's Hospital. DOI: 10.1016/j.jtcvs.2024.08.049

Mrs. Mahem is a 68-year-old patient with a 25-year history of type 2 diabetes mellitus. In the past year, her A1c remains at around 8.5% with the use of the following medications: metformin, sitagliptin, and canagliflozin, at optimized doses and with adherence.  She states, “ I haven't changed the way I eat and I walk about ½ h a day, just like I have for years”. Additional health issues include HTN and dyslipidemia, treated with medications and at therapeutic goal, and obesity with a BMI= 33. Her eGFR is 65. Which of the following is the most appropriate next step in the pharmacologic management of her diabetes?  A. Add glyburide to enhance glycemic control.B. Consider discontinuing metformin due to age and renal function.C. Advise that her glycemic control is adequate for an older adult. D. Prescribe semaglutide to help her achieve A1c goal.  Visit fhea.com to learn more!

Join CardioNerds EP Council Chair Dr. Naima Maqsood and Episode Lead Dr. Jeanne De Lavallaz as they discuss the results of the ARREST-AF Trial with expert faculty Dr. Prashanthan Sanders and Dr. Mehak Dhande. The ARREST-AF trial enrolled 122 patients with a BMI of 27 kg/m2 or greater and at least one cardiovascular risk factor with either paroxysmal or persistent AF and were scheduled to undergo de novo AF ablation. They were randomized to an intensive risk factor management (RFM) program versus usual care. The RFM program addressed obesity, sleep apnea, HTN, HLD, tobacco, and alcohol abuse, whereas the usual care arm had a discussion of risk factors but without an extensive risk factor modification or follow-up program. The study population had a mean age of 60 years, a mean BMI of 33 kg/m2, and 56-60% of patients with persistent AF. A third of the study population was female. The trial showed a significant improvement in the primary endpoint of the percentage of patients free from atrial fibrillation after ablation in those receiving the intensive lifestyle RFM program. At the end of the 12.3-month follow-up period, 66% percent of patients in the RFM group were free from AF compared to 42% in the usual care group (HR 0.53, p = 0.03). The RFM group also showed significant improvement in AF symptom severity, decline in body weight, systolic blood pressure, glycemic control, and exercise capacity. On average, patients in the RFM arm lost 9 kg of weight compared to 1 kg in the control group. Similarly, systolic blood pressure decreased by 13.1 mmHg in the RFM group but increased by four mmHg in the control group. This episode was planned in collaboration with Heart Rhythm TV with mentorship from Dr. Daniel Alyesh and Dr. Mehak Dhande. CardioNerds Journal Club PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! References - The SUMMIT Trial Pathak, Rajeev K., et al. "Aggressive Risk Factor Reduction Study for Atrial Fibrillation and Implications for the Outcome of Ablation: The ARREST-AF Cohort Study." Journal of the American College of Cardiology, vol. 64, no. 21, 2014, pp. 2222–2231.

Consey feat. Drew Saunders - the deepStatus The Marlboro Man feat. Greybeard - People Dislike MeRaggo Zulu Rebel x Ace Hits - Praying & CallingYoung Black and Gifted feat. Jae Hu$le - P.O.P.Perfect Pete x Spion Liape feat. Jabbathakut - Up To HereRiver Nelson - FlyingDNTE - Luxury DiningCrimi-Nal feat. Patrice Lee - How U FeelStay Tuned - Parts UnknownKing feat. PSDN - About YouNew Villain x Wyzrd x Zeus The Elevated - NenRazor - Switcha RiddimTali Rodriguez - The ProdigyACT-1 - SepsisFreestyle Session - InklineShowrocka feat. Jae Skeese & Afrado - Window PanePiff Penny feat. M Doc Diego, Decon Blu, Crotona P & Pa Pa Fresh - Kyng TalkBroGawd - Cigar JordanEyeshell - EverydayThe Silversmiths feat. K!ng L!ght - Supreme Secret SixLeo Davincci & Evaize feat. Sarah Jean - PiecesMRKBH - SamsaraCydney Poitier - The PerspectiveAdmiral Naughtz - PhilosophiesDa$h & HTN feat. Mike Shabb - No CouponScoob Rock & DW Underground - PostmanBlame One - Bounce Nod0161 Bowza - In My BagSupa Kaliente feat. Dtaylz The Profit & Mic Hoffa - Killagain IslandREKS x Myster DL - OutsideRufus Sims & Jae Haze feat. Kid Breeze, Ju Jilla & Panamera P - Bacon Egg N CheeseBoom Slapp & Dosage Hinojosa feat. Destruct - It Never RainsJay Royale feat. Tek - The Pookie Belt Buckle

Happy Holidays, Constructs! What a year 2024 has been for us all! We're so grateful for the TLT community and for all of you who tuned into the show this year and helped spread the word! In this episode we wrap up Act 2 of HtN covering chapters 20-22! We hope you have a safe and spectacular holiday! Let us know what you think of the episode and we'll catch you on the flipside of 2025! Art Mentioned: Harrow and Ortus with umbrella - morganida.tumblr.com Happy Holidays and stay wicked! The Bone Squad Find Us Here! ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ https://linktr.ee/theunlockedtomb⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ The Unlocked Tomb Podcast Artwork by: Marceline_Art - ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.instagram.com/marceline2174⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ - ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://linktr.ee/marceline2174⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Featuring Original Music by: Chelsea Lankes - Ghost© (Remix by Dance with the Dead (Permission for use granted by the artist) Ambient Music by UNIVERSFIELD© (Permission for use granted by the artist) Soularflair - Cue 3 - Dark-Brooding© (Permission for use granted by the artist) ROZKOL - Gather Your Remnants© (Permission for use granted by the artist) ROZKOL - SAMSARA© (Permission for use granted by the artist)

As we step away for a holiday break, we're excited to revisit some of the most popular episodes of the FNP Certification Q & A Podcast. These listener favorites have informed, inspired, and empowered aspiring NPs on their journey to certification success. Enjoy some of our favorites. We'll catch you in 2025 with fresh questions from Dr. Fitzgerald!Saundra is a 72-year-old with hypertension who is on an appropriate dose of an ACE inhibitor with adherence. Today's BP= 152/96 and is without HTN-related complaint.  Physical exam is unremarkable.She has a history of well-controlled asthma and is using ICS/LABA therapy.  Due to osteoarthritis, she reports, “I get up slowly. Sometimes I do not get the bathroom on time and I lose my urine control.” Which of the following represents the next best step in Saundra's HTN therapy? A.Advise that her BP is in an acceptable rangeB. Thiazide diuretic therapy should be initiatedC. Add a CCB to her current therapyD. A beta blocker represents the optimal additional therapy---YouTube: https://www.youtube.com/watch?v=JRjErXhuqpY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=99Visit fhea.com to learn more!

It can be difficult to determine whether you should treat undifferentiated hypertension or not. Many clinicians are distracted the number rather than focusing on the patient in front of them. Asymptomatic hypertension, in particular, is often benign. In fact, treating asymptomatic hypertension in a patient who a primary medical history of hypertension can harm them. In this podcast, we discuss these adverse effects related to blood pressure physiology, acute versus chronic hypertension, and how you can determine whether anti-hypertensives or other forms of therapy are indicated. Get CE hours for our podcast episodes HERE! -------------------------------------------- Twitter @heavyhelmet Facebook @heavyliesthehelmet Instagram @heavyliesthehelmet Website heavyliesthehelmet.com Email contact@heavyliesthehelmet.com Disclaimer: The views, information, or opinions expressed on the Heavy Lies the Helmet podcast are solely those of the individuals involved and do not necessarily represent those of their employers and their employees. Heavy Lies the Helmet, LLC is not responsible for the accuracy of any information available for listening on this platform. The primary purpose of this series is to educate and inform, but it is not a substitute for your local laws, medical direction, or sound judgment. --------------------------------------------  Crystals VIP by From The Dust | https://soundcloud.com/ftdmusic Music promoted by https://www.free-stock-music.com

29th ESC 2024: Noise and Air Pollution as RF for HTN

In the ACOG practice bulletin 203, the ACOG states that, “Traditionally, the diagnosis of hypertension (HTN) in pregnancy has been 140/90, on 2 occasions at least 4 hrs apart“. The keyword there is… “Traditionally”. In 2017, the ACC/AHA redefined hypertension with Stage I HTN being 130/80. Do some societies recommend the use of this lowered blood pressure criteria in pregnancy? It's a complicated answer. Does aspirin help prevent preeclampsia in women with Stage I (130/80) hypertension? The answer may surprise you! In this episode, we will do a deep dive into ACOG PB 203, the ACOG practice advisory from 2022 in response to the CHAP trial, and discuss the CLIP 2021 published data. This is a story of CHIP, CHAP, and CLIP… And we will give clear clinical implications of each in this episode!

Mrs. Martinez is a 64-year-old woman with 10 year-history of type 2 diabetes mellitus, HTN, and dyslipidemia. Her current medications include metformin, an SGLT-2 inhibitor, statin, ARB and thiazide diuretic. She is at EBP-advised goals including recent A1c=6.9%. Today, she reports she is feeling well. Her history and physical examination are unremarkable. She mentions that, for the past year, in addition to her prescribed medications, she drinks a special tea blend that her sister makes, taking this each day to help “draw out the sugar” in her blood. She states, “I feel much better when I take it.” Your most appropriate response is:A. “I don't believe the tea is helpful in controlling your blood sugar.”B. "Please stop using the tea until I can look into its contents."C. "Homemade teas might interact with your medicines”D. “Tell me more about how the tea draws out the sugar.”Visit fhea.com to learn more!

Hypertension (HTN) is a leading cause of death and disability in nearly half of all Americans. Alarmingly, almost 50% of individuals with HTN are unaware of their condition, and only about 20% have it under proper medical control. Nurse practitioners (NPs) play a crucial role in managing HTN, particularly in patient communication, shared decision-making and clinical expertise. On today's episode, Dr. Leslie Davis and Maria Bonanni explore how renal denervation (RDN) reduces hypertension, and discuss clinical trials, patient selection and recent regulatory approvals. They also highlight the NP's role in screening and educating patients about RDN through shared decision-making. A participation code will be given at the END of the podcast - make sure to write this code down. Once you've listened to the podcast and have the participation code, return to this activity in the CE Center. Click on the "Next Steps" button of the activity and Enter the participation code that was provided Complete the post-test Complete the activity evaluation. This will award your CE credit and certificate of completion.1.0 CE, through 09/30/25. This activity is supported by an independent medical educational grant from Medtronics

A 76-year-old woman with presbycusis presents for a follow-up visit on HTN and dyslipidemia, treated with an ARB, thiazide diuretic and a statin, and at treatment goal. Which of the following is she likely to report?A. Occasional difficulty with speech discriminationB. Need to use her prescription eyeglasses to readC. Altered sense of smellD. Diminished sense of touchVisit fhea.com to learn more!

Contributor: Kiersten Williams MD, Travis Barlock MD, Jeffrey Olson MS2 Show Pearls Hypertensive disorders of pregnancy are one of the leading causes of maternal mortality worldwide. Hypertension (HTN) complicates 2-8% of pregnancies The definition of HTN in pregnancy is a systolic >140 or diastolic >90, measured 4 hours apart There is a range of HTN disorders Chronic HTN which could have superimposed preeclampsia (preE) on top Gestational HTN in which there are no lab abnormalities PreE w/o severe features Protein in urine Urine protein >300 mg in 24 hours Urine Protein to Creatinine ratio of .3 +2 Protein on urine dipstick PreE w/ severe features Systolics above 160 mmHg Diastolics above 110 mmHg Headache, especially not going away with meds, or different than previous headaches Visual changes, anything that lasts more than a few minutes RUQ pain, which could present as heartburn Pulmonary edema Low platelets, if

Episode 175: Alcohol Use Disorder Basics   Future Dr. Sangha explains the clinical presentation, diagnosis, and fundamentals of the treatment of alcohol use disorder (AUD). Dr. Arreaza offers insights about the human aspect of the treatment of AUD.    Written by Darshpreet Sangha, MS4, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.What is Alcohol Use Disorder?AUD is characterized as the inability to stop or control alcohol use despite adverse physical, social and occupational consequences. According to DSM-5, it is a pattern of alcohol use that, over 12 months, results in at least two of the following symptoms, indicating clinically substantial impairment or distress: Alcohol is frequently used in higher quantities or for longer periods than planned.There is a persistent desire or unsuccessful attempt to reduce or manage alcohol use.Activities that are required to get alcohol, consume alcohol, or recuperate from its effects take up a lot of time.A strong need or desire to consume alcohol—a craving.A pattern of drinking alcohol that prevents one from carrying out important responsibilities at work, school, or home.Sustained alcohol consumption despite ongoing or recurring interpersonal or social issues brought on by or made worse by alcohol's effects.Alcohol usage results in the reduction or cessation of important social, professional, or leisure activities.Frequent consumption of alcohol under risky physical circumstances.Continuing to drink even when one is aware of a chronic or recurrent health or psychological issue that may have been brought on by or made worse by alcoholTolerance: requiring significantly higher alcohol intake to produce the same intended effect. Withdrawal: Characterized by the typical withdrawal symptoms or a noticing relief after taking alcohol or a closely related substance, such as benzodiazepine.How can we determine the severity of AUD? Mild: 2–3 symptomsModerate: 4–5 symptomsSevere: >/= 6 symptomsWho is at risk for AUD?Note: Ancestry offers a DNA analysis to find out about your heritage. You can also send that DNA to a third party to learn about your risks for diseases and conditions (for example, Prometheus.) Anyone can find out about their risk for alcoholism by doing a DNA test. The risk factors for AUD are: Male genderAges 18-29Native American and White ethnicitiesHaving Significant disabilityHaving other substance use disorderMood disorder (MDD, Bipolar)Personality disorder (borderline, antisocial personality)What is heavy drinking?According to the National Institute of Alcohol Abuse and Alcoholism (NIAAA), heavy alcohol use is characterized as: Males who drink > 4 drinks daily or > 14 drinks per week Females who drink > 3 drinks on any given day or > 7 drinks per weekPathophysiology of AUD.The pathogenesis of AUD is not well understood, but factors that may play a role are genetics, environmental influences, personality traits, and cognitive functioning. Also, genetic factors may decrease the risk of AUD, i.e., the flushing reaction, seen in individuals who are homozygous for the gene that encodes for aldehyde dehydrogenase, which breaks down acetaldehyde. Who should be screened?A person with AUD may not be easy to diagnose in a simple office visit, but some clues may point you in that direction. First of all, patients with AUD may present to you during their sober state, that´s why ALL adults (including pregnant patients) must be screened for AUD in primary care )Grade B recommendation). The frequency has not been determined but as a general rule, at least in Clinica Sierra Vista, we screen once a year. The USPSTF has concluded that there is insufficient evidence to recommend screening adolescents between 12-17 years old. What are the clinical manifestations of AUD?Some symptoms may be subtle, including sleep disturbance, GERD, HTN, but some may be obvious, such as signs of advanced liver disease (ascites, jaundice, bleeding disorders, etc.)If you draw routine labs, you may find abnormal LFTs (AST:ALT ratio >2:1), macrocytic anemia (MCV >100 fL), and elevated Gamma-glutamyl transferase (GGT). All these findings are highly suggestive of AUD. Patients with AUD may present in either an intoxication or withdrawal state. Signs and symptoms of acute intoxication may include “slurred speech, nystagmus, disinhibited behavior, incoordination, unsteady gait, hypotension, tachycardia, memory impairment, stupor, or coma.” Signs and symptoms of withdrawal range from tremulousness to hallucinations, seizures, and death. They are seen between 4 and 72 hours after the last drink, peaking at 48 hours, and can last up to 5 days. Alcohol withdrawal is one of the few fatal withdrawal syndromes that we know in medicine, and the symptoms can be assessed using a CIWA assessment. Treatment of AUD.There are factors to consider before starting treatment: Evaluating the severity of AUD Establishing clear treatment goals is associated with better treatment outcomesAssessing readiness to change: It can be done by motivational interviewing and using the stages of change model, which are, Pre-contemplation, contemplation, preparation, action, maintenance, and relapse.Discussing treatment of withdrawal.Treatment may be done as outpatient or it may require hospitalization. Dr. Beare sent an email with this information: “The approach to treating patients with AUD can be broken into two parts - the first is withdrawal management and the second is the long-term maintenance part. You MUST have a good plan for withdrawal treatment as it can be fatal if it's not addressed properly.” “Patients with any history of seizures due to withdrawal or a history of delirium tremens need inpatient management. If their withdrawal symptoms are typically mild (agitation, tremors, sleeplessness, anxiety) then outpatient management may be appropriate, typically with a long-acting benzodiazepine such as Librium or Ativan.”According to Dr. Beare, “the human aspect isa key element in treating alcohol use disorder. These patients arrive with tremendous amounts of suffering, shame, guilt, and fear. The relationship between the patient and provider needs to be built with compassion and understanding that this disease is horrible from the patient's perspective and using an algorithmic and calculated approach can cause significant harm to the rapport-building process, leading to lower success rates.”Treatment requires a lot of motivation and willpower. Hopefully, we can use some tools to assist our patients to be successful.-For mild disorder, Psychosocial interventions like motivational interviewing and mutual help groups like AA meetings may be enough to help our patient quit drinking.-For moderate or severe disorder: 1st line treatment is Meditation and structured, evidence-based psychosocial interventions (CBT, 12-step facilitation); which leads to better outcomesFor patients who lack motivation, motivational interviewing can be a useful initial interventionFor motivated patients: medical management, combined behavioral intervention, or a combination of both can be utilizedFor patients with limited cognitive abilities, 12-step facilitation, or contingency management can be helpful For patients who have an involved partner: Behavioral couples therapy can be utilizedMedications for AUD.The first-line pharmacological treatment is Naltrexone. It is given as a daily single dose and can be started while the patient is still actively drinking. There is a monthly dose of long-acting injectable naltrexone as well. Naltrexone is contraindicated in individuals taking opioids, and patients with acute hepatitis or hepatic failure. Alternative 1st line treatment is Acamprosate which can be used in people with contraindications to Naltrexone.AUD is a chronic problem and requires a close follow-up to evaluate response to treatment and complications. Medications need to be used along with psychotherapy and support, and medications may need to be changed or adjusted depending on the patient. It is an individualized therapy that requires full engagement of the doctor, the patient, and their families or social support. In conclusion, I would just like to add that, be compassionate because AUD is not a choice. AUD is a chronic problem like diabetes and HTN and may require a long road to recovery. Treatment includes psychotherapy, medications, and regular follow-up.Thank you for listening!Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Risky drinking and alcohol use disorder: Epidemiology, clinical features, adverse consequences, screening, and assessment, https://www.uptodate.com/contents/risky-drinking-and-alcohol-use-disorder-epidemiology-clinical-features-adverse-consequences-screening-and-assessment, accessed on August 18, 2024.Hasin DS, Stinson FS, Ogburn E, Grant BF. Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry, Accessed on August 18, 2024.Alcohol use disorder: Treatment overview, https://www.uptodate.com/contents/alcohol-use-disorder-treatment-overview, assessed on August 18, 2024. Royalty-free music used for this episode, Grande Hip-Hop by Gushito, downloaded on Nov 06, 2023, from https://www.videvo.net

This is Vodcast 3 of a 4 part series on Unmet Needs in Hypertension. In this vodcast episode, we dissect evidence-based approaches to hypertension management, from lifestyle interventions to single-pill combination therapies. We explore implementation strategies to boost adherence to both lifestyle modifications and medication therapy, and review treatment algorithms for optimal medication use and the identification of secondary hypertension. Join us as we unravel the complexities of hypertension management, empowering healthcare professionals to optimize patient care and outcomes.

Episode 2 in the Unmet Needs in Hypertension Vodcast Series Discussing the strategies of lifestyle management of blood pressure. In this vodcast, watch experts detail the importance of diet, exercise, and other behavioral modifications in lowering and maintaining blood pressure. 

Episode 1 of the Unmet Needs in HTN Vodcast Serries. This vodcast delves into the essentials of home blood pressure monitoring (HBPM). Experts discuss why HBPM is crucial for managing hypertension effectively and discover the various benefits it offers to patients. Join us on discussion of educating patients on selecting the right monitoring device, preparing for accurate readings, and integrating HBPM data seamlessly into their hypertension management plans, ensuring comprehensive care and improved health outcomes.

DCS 1403: HTN

A 48-year-old woman presents for follow up on T2DM and HTN. As part of today's visit, routine labs are ordered. Which of the following is an appropriate form of electronic communication for sharing these  results  with the patient?A. Private message through Facebook® or similar social media website with patient permissionB. Electronic fax or scan uploaded to the patient's personal account for a third-party file sharing service (e.g., DropBox®) C. Using encrypted email  or other messaging service that is part of the patient's electronic medical record (EMR) system  D. Text message using the patient's personal mobile phone number---YouTube: https://www.youtube.com/watch?v=MH2-1Wi0NWQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=76Visit fhea.com to learn more!

A 49-year-old woman with type 2 diabetes mellitus was started on a standard dose of an ARB daily 6 weeks ago for the management of hypertension. Today her blood pressure is 128/78 mm Hg, stating she is taking the medication without difficulty and is feeling well. The appropriate action at this time would be to:A. Order a white blood cell count to assess for neutropenia.B. Continue her current medication regimen.  C. Add HCTZ to enhance HTN control.D. Obtain a 12-lead ECGVisit fhea.com to learn more!

We have an alcohol problem in the U.S. and very few people are talking about it. We need to change the narrative and understand that alcohol is a toxin. Treat it as such. Frequency + dose defines the poison.  Alcohol consumption is often the hidden cause of your health issues (obesity, HTN, CV disease) and limiting our intake should be one of your first priorities in your path towards wellness. Additionally alcohol impacts your kidneys, bladder, and prostate. Join Dr. Joe Pazona, board-certified urology on today's candid discussion on alcohol consumption and your health.

CardioNerds Co-Founder Dr. Daniel Ambinder, Episode Chair Dr. Dinu Balanescu, and FIT Lead Dr. Natalie Tapaskar discuss advanced heart failure in CardioOncology with expert Dr. Richard Cheng. Audio editing by CardioNerds Academy Intern, Dr. Akiva Rosenzveig. In this episode, we discuss the spectrum of advanced heart failure in patients with a history of cancer. We dissect cancer therapy-related cardiac dysfunction (CTRCD) cases and the imaging and biomarker tools available for risk stratification and disease monitoring. We delve into the data on the use of guideline-directed medical therapy (GDMT) and cardiac resynchronization therapy (CRT) in these patients. We discuss the risk of prior radiation and chemotherapy during cardiac surgery. Finally, we learn about the post-transplant risk of rejection, recurrent malignancy, and de-novo malignancies, as well as treatment strategies we can employ for these patients. This episode is supported by a grant from Pfizer Inc. This CardioNerds Cardio-Oncology series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Giselle Suero Abreu, Dr. Dinu Balanescu, and Dr. Teodora Donisan.  CardioNerds Cardio-Oncology PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Advanced Heart Failure in CardioOncology Use the HFA-ICOS risk tool to understand the baseline risk of developing cancer therapy-related cardiac dysfunction (CTRCD). Key factors are type of cancer therapy, baseline CV risk factors, and age. A relative change in global longitudinal strain of more than 15% from baseline is a marker of early cardiac dysfunction and predicts the subsequent risk for systolic dysfunction in patients undergoing cardiotoxic chemotherapy. Statins may be useful in prevention of cardiovascular dysfunction in patients receiving anthracycline chemotherapy. There is limited data on the 4 pillars of GDMT in prevention of CTRCD, but should be started early once CRTCD is suspected or diagnosed! Mediastinal radiation causes adhesions and scarring which increase the risk of bleeding during cardiac surgery, lead to longer operative times, and can lead to RV failure and poor wound healing. Patients with a pre-transplant history of malignancy have a higher risk of mortality due to post-transplant malignancy. And patients with active cancer should not be considered for heart transplant. Post-transplant malignancy risk can be mitigated by utilizing an mTOR based, CNI free immunosuppression regimen. Show notes - Advanced Heart Failure in CardioOncology How do cardio-oncology and advanced heart failure intersect? There are 3 basic populations of patients to consider:Patients with advanced heart failure who develop cancer.Patients with pre-existing chemotherapy and radiation exposure for cancer treatment who later develop advanced heart failureHeart transplant recipients who, in the long term are at very high risk of developing cancer Cardio-oncologists must consider risk assessment and mitigation, long-term prognosis, and treatment strategies for each of these unique populations. How can we assess the risk of developing cardiovascular disease during cancer treatment (CTRCD)? There are many proposed risk tools. However, the majority are not well-validated. One of the most used tools is the HFA-ICOS risk tool.1You can select the planned cancer therapy for the patient (anthracyclines, HER-2, VEGF, RAF/MEK inhibitors, Kinase inhibitors, multiple myeloma therapies) and then calculate their risk of developing CV disease during cancer treatment based on baseline variables:1) previous history of CV disease,2) biomarkers – troponin and NT-proBNP3)age,4) CV risk factors -HTN, DM,

Does renal denervation (RDN) provide durable blood pressure (BP) control? Expert hypertension (HTN) faculty discuss. Credit available for this activity expires: 5/8/25 Earn Credit / Learning Objectives & Disclosures: https://www.medscape.org/viewarticle/1000752?ecd=bdc_podcast_libsyn_mscpedu

It's only been a year and Maddie's addicted to mobile games. Has it been a while? It's been a long time. 53yo M w PMH of HTN, HLD, DM2 p/w NSTEMI w CP. Check out Binging with Bbirchtats on YouTube: https://www.youtube.com/watch?v=i6djKQIviwk Ride on the magic council! I went to the school to get the D. Dimothy? Doug Dimmidome? Drubder? YOU DON'T HAVE PARENTS! This anime is trash and I'm Oscar THE FUCKING GROUCH. This dying thing is sick... Triggering all chemists. Say hello to GUMBO, THE DESTROYER OF WORLDS. Has Jim been uploading to YouTube for us?? We know our FBI guy is at least named ..... Eddd.... Wurddd? He knows at least 3 of the 5 guys! The milkman, the paper boy, THE EVENING TV. Gariel and Angelo, the cats who love you.   If you'd like to request us to cover YOUR favorite anime on My Favorite Anime, then donate on Ko-fi or Patreon https://ko-fi.com/myfavoriteanime https://www.patreon.com/mfanime Merch is back up (with some exclusive patreon merch soon): https://animate-station.creator-spring.com/listing/tanks-are-for-girls-my-favor Links to the podcast: https://open.spotify.com/show/0AV1raD6J16xjX5sVTuqNR?si=s1174woBQMSAlEAdZZqKgQ https://pca.st/BA5s https://podcasts.apple.com/us/podcast/my-favorite-anime/id1448147787

Which of the following is consistent with the clinical presentation of placental abruption? a. A 38 year-old with primary HTN, who is now 28 weeks pregnant with her 6th child, presents with a 1-h history of sudden onset abdominal pain as well as dark red vaginal bleeding,dizziness,  tachycardia and BP= 88/ 55b. A 32 year old who's pregnant with her eighth child, now 32 weeks pregnant presenting with A2 hour history of bright red vaginal bleeding stating she does not have abdominal pain.c. 28 year old who states she had a positive home pregnancy test three days ago with last menstrual period six weeks ago. Normal timing and flow with an 8 hour history of intermittent bright red vaginal spot spotting with mild cramping.d. A 26 year old with a past medical history of pelvic inflammatory disease who's now 8 weeks pregnant by LMP with A2 hour History of sudden onset. Severe left sided abdominal pain radiating to the shoulder, Small amount of bright red bleeding per vagina. Feeling lightheaded. Vital signs reveal tachycardia in ABP of 80 / 45.---YouTube: https://www.youtube.com/watch?v=WlRlHSKphHQ&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=60Visit fhea.com to learn more!

European Heart Journal, Volume 26, Issue 7, 2005, 650–661Background  Patients with diabetes have a higher risk of death after myocardial infarction than those without diabetes. There are many possible reasons for this difference. One may be that diabetic patients have detrimental responses during the acute phase of MI. In the DIGAMI 1 trial, patients with diabetes and AMI were randomized to intensive glucose control via IV insulin or standard care. Although the primary endpoint of all-cause mortality at 3 months was not statistically significant, the 1-year mortality was reduced by 30% in the IV-insulin group.  The DIGAMI 1 trial had lower than expected mortality which led to wide confidence intervals.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.The hypothesis of the DIGAMI 2 trial was early and continued insulin-based metabolic control is a key to mortality reduction in patients with diabetes and AMI.Patients Eligible patients with type 2 diabetes or an admission blood glucose > 198 mg/dl who were admitted to participating CCU were eligible if they had suspected AMI due to symptoms (chest pain >15 min during the preceding 24 h) and/or recent ECG signs (new Q-waves and/or ST-segment deviations in two or more leads). Exclusion criteria were inability to cope with insulin treatment or to receive information on the study; residence outside the hospital catchment area; participation in other studies.Baseline Characteristics The trial recruited 1253 patients (mean age 68 years; 67% males) with type 2 diabetes and suspected acute myocardial infarction. At hospital discharge, approximately 85% of patients fulfilled the diagnosis of MI. Nearly half of these were STEMI. The remaining patients had unstable angina. The mean duration of diabetes was 8 years but about 20% of patients had diabetes of less than one year duration. Almost a third of patients had had a previous MI. Thirty percent of patients were on some form of insulin treatment before randomization. At randomization, HbA1c was 7.2, 7.3, and 7.3% in groups 1, 2, and 3, respectively.  The three groups were well matched in most respects, however, there were significantly fewer previous Mis and trend towards fewer patients with HTN, DM and HF in group 3.Evidence-based treatments for MI was extensive in all groups. Nearly all eligible patients had acute revascularization.Trial procedures DIGAMI 2 was carried out in 44 centers in Sweden, Finland, Norway, and Denmark. It had three treatment arms: a 24 h insulin–glucose infusion followed by a subcutaneous insulin-based long-term glucose control (group 1); a 24 h insulin–glucose infusion followed by standard glucose control (group 2), and, routine metabolic management according to local practice (group 3).The authors attempted to balance randomization and simulate the DIGAMI 1 trial by communicating baseline variables before randomization—which was based on an algorithm that included prognostic markers from the first DIGAMI trial. The goal was to improve the ability to compare the two DIGAMI trials. During the first 24 h, blood glucose was followed according to the infusion protocol in groups 1 and 2 and at the discretion of the attending physician in charge in group 3 (standard care).In groups 1 and 2, glucose-lowering treatment was initiated with a glucose–insulin infusion with the objective to decrease blood glucose as fast as possible and keep it between 126 and 180 mg/dl.  The infusion lasted until stable normoglycemia and at least for 24 h. In group 1, subcutaneous insulin was initiated at the cessation of the infusion. The treatment goal for patients in group 1 was a fasting blood glucose level of 90–126 mg/dl and a non-fasting level of

A 56-year-old man with a 10-year history of hypertension (HTN) presents for a primary care visit, stating he has not taken his HTN medications, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the past 3 months due to “running out of the medication and not getting to the pharmacy.” Today, his blood pressure (BP) is 192/120, and he is without complaint, denying shortness of  breath, chest pain or visual changes.  He states, “ I just came in today for a visit since I ran out of high blood pressure refills. I need to get back to work in a ½ hour.”  His physical examination shows no acute distress, grade 1 HTN retinopathy, and S4 heart sound, neck veins WNL, chest is clear, no peripheral edema with resting HR= 73, RR=16. 12-lead ECG is WNL. BMI= 33. Which of the following is the next best step in this patient's care?A.  Administer in-office oral clonidine and reassess blood pressure in 1 hour. B.  Activate EMS with prompt transfer to emergency departmentC.  Restart prior blood pressure medications with follow-up within the next monthD.  Advise restricting dietary sodium and weight loss to help with BP control. ---YouTube: https://www.youtube.com/watch?v=QCT8CPoBb7w&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=58Visit fhea.com to learn more!

A 56-year-old man with a 10-year history of hypertension (HTN) presents for a primary care visit, stating he has not taken his HTN medications, a calcium channel blocker, angiotensin-converting enzyme inhibitor, and thiazide diuretic for the past 3 months due to “running out of the medication and not getting to the pharmacy.” Today, his blood pressure (BP) is 192/120, and he is without complaint, denying shortness of  breath, chest pain or visual changes.  He states, “ I just came in today for a visit since I ran out of high blood pressure refills. I need to get back to work in a ½ hour.”  His physical examination is normal with the exception of which of the following? A. S4 heart soundB. Grade 3 HTN retinopathyC. Neck vein distensionD. Murmur of aortic regurgitation---Youtube: https://www.youtube.com/watch?v=tkfqvPOo8Cg&t=69sVisit fhea.com to learn more!

Kentucky REC advisor Lacy Shumway provides a comprehensive overview of the 3-year Coverdell Grant, focusing on its mission to enhance stroke care in collaboration with the CDC. She shares details behind the numbers in Kentucky's application for the grant: addressing high stroke mortality rates and risk factors. Explore the seven strategies implemented by the Coverdell Grant, formally known as the Paul Coverdell National Acute Stroke Program, including: HTN control; quality improvement; education; and EMS collaboration. Lacy discusses data collection challenges and the critical role of ZIP CODES in the Social Deprivation Index (SDI). Uncover the system-wide impact of the grant, addressing challenges and bridging geographical gaps in stroke care across Kentucky. Get ready for an engaging discussion that unveils the transformative impact of the Coverdell Grant on the future of stroke care in the Bluegrass State!Lacy Shumway is the Program Manager for the Paul Coverdell National Acute Stroke Program at the Kentucky Regional Extension Center, University of Kentucky. With 13 years in healthcare, Lacy's expertise includes 7 years as Coordinator for Stroke Program Outreach at Norton Healthcare. She successfully marketed the stroke program and developed a pre-hospital stroke education training offered across Kentucky and Southern Indiana. Lacy serves as Vice-Chair of the Cardiac and Stroke Subcommittee at the Kentucky Board of EMS, and is the Chair of the EMS and Education Committee with the Stroke Encounter Quality Improvement Program (SEQIP). A graduate of Indiana University, Lacy brings a wealth of knowledge to our discussion. Tune in for an informative exploration of stroke care advancements in Kentucky!

Most clinical settings now use oscillometric BP devices to measure patients' BP, and over half of people with hypertension (HTN) use a home BP monitor.   Can we trust these BP readings if an inappropriate cuff size was used? How will this impact the way we assess BP control? Guest Authors:  Vincent Lam, PharmD and Kathleen Pincus, PharmD, BCPS, BCACP, CDCES Music by Good Talk

A 68 year-old woman presents for follow-up at her primary care provider with a chief complaint of “another urine infection”, stating she was seen 4 days ago at urgent care with new onset dysuria and urinary frequency. Review of her clinical record reveals that she has had 3 symptomatic, culture- confirmed UTIs in the past 8 months.  She is currently on day 4 of 5 of the antimicrobial prescribed and is without symptoms. Her concomitant health issues include HTN and dyslipidemia, both at treatment goals with lifestyle modification and medication.  When discussing with the patient efforts to prevent future UTIs, the NP considers that which of the following will be appropriate? A. Adding cranberry juice supplements to her diet daily. B. Avoiding tub baths. C. Initiating long-term antimicrobial prophylaxisD. Regular use of a vaginal estrogen. YouTube: https://youtu.be/jwYcSXCfHn4Visit fhea.com to learn more!

CardioNerds nerd out with Drs. Karishma Rahman (Mount Siani Vascular Medicine fellow), Shu Min Lao (Mount Sinai Rheumatology fellow), and Constantine Troupes (Mount Sinai Vascular Surgery fellow). They discuss the following case: A 20-year-old woman with a history of hypertension (HTN), initially thought to be secondary to a mid-aortic syndrome that resolved after aortic stenting, presents with a re-occurrence of HTN. The case will go through the differential diagnosis of early onset HTN focusing on structural etiologies of HTN, including mid-aortic syndrome and aortitis. We will also discuss the multi-modality imaging used for diagnosis and surveillance, indications and types of procedural intervention, and how to diagnose and treat an underlying inflammatory disorder leading to aortitis. The expert commentary was provided by Dr. Daniella Kadian-Dodov, Associate Professor of Medicine and Vascular Medicine specialist at the Icahn School of Medicine at Mount Sinai. Audo editing was performed by Dr. Chelsea Amo-Tweneboah, CardioNerds Academy Intern and medicine resident at Stony Brook University Hospital. 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 - Hypertension With a Twist Pearls - Hypertension With a Twist Early onset hypertension (HTN) and lower extremity claudication should raise suspicion for aortic stenosis (including mid-aortic syndrome). Initial evaluation should include arterial duplex ultrasound and cross-sectional imaging such as CT or MR angiogram of the chest, abdomen, and pelvis to assess for arterial stenosis involving the aorta and/or branching vessels. Mid-aortic syndrome can have multiple underlying etiologies. Concentric aortic wall thickening should raise suspicion for an underlying inflammatory disorder. Initial evaluation should include inflammatory markers such as ESR, CRP, and IL-6, but normal values do not exclude underlying aortitis.  While Takayasu arteritis is the most common inflammatory disorder associated with mid-aortic syndrome, IgG4-RD should also be a part of the differential diagnosis. IgG subclass panel can detect IgG4-RD with elevated serum IgG4 levels, but some cases can require pathology for diagnosis. Catheter based intervention is a safe and effective treatment of aortic stenosis for both primary aortic stenosis and post-procedural re-stenosis. Multi-modality imaging, including cross-sectional imaging and duplex ultrasound, plays a central role for the diagnosis, management, and post-procedural surveillance of aortic disease. A multi-disciplinary team (as exemplified by the participants of this podcast!) is essential for the management of complex aortopathy cases to optimize clinical outcomes. Show Notes - Hypertension With a Twist 1.  Early onset HTN can have multiple etiologies – aortic stenosis (including but not limited to secondary to congenital aortic coarctation and mid–aortic syndrome, as well as in stent re-stenosis if there is a history of aortic stenting), thrombosis, infection, inflammatory/autoimmune disorders, renovascular disease, polycystic kidney disease, and endocrine disorders. 2. Mid-aortic syndrome is characterized by segmental or diffuse narrowing of the abdominal and/or distal descending aorta with involvement of the branches of the proximal abdominal aorta (renal artery, celiac artery, superior mesenteric artery) and represents approximately 0.5 to 2% of all cases of aortic narrowing. Underlying etiologies include genetic syndromes, inflammatory, non-inflammatory, and idiopathic. It is important to have a high suspicion of underlying inflammatory disorders if cross-sectional i...

In Episode 12, Dr. William Cushman, co-investigator of the 2015 SPRINT (Systolic Blood Pressure Intervention) Trial, joins us for a discussion all about hypertension trials, their long history, and what's ahead for research in this space. Too young to remember SPRINT or looking for a "CliffsNotes" of HTN trials? This episode's for you!Here's a Renal Fellow Network post from 2017 with a link to a cheat sheet of hypertension clinical trial.Nephrons: Matthew Sparks, Samira FaroukGuests: William Cushman, Medical Director & Professor, Department of Preventive Medicine, University of TennesseeLinks from the Show:00:41: Systolic Blood Pressure Intervention Trial (2015)02:17: VA Cooperative Study (1967)05:13: ACCORD Study (2010)06:30: SPRINT MIND (2019)08:40: Framingham Heart Study (Started 1948)11:27: Attended vs. unattended blood pressure – learnings beyond SPRINT (2021)14:03: Systolic Hypertension in the Elderly Program Study (1989)14:05: Hypertension Detection & Follow Up Program (1979)15:32: JNC 8 Guidelines (2014)16:01 AHA/ACC Guidelines (2017)17:54: Syst-Eur (Treatment of HTN in Patients > 60 y, 1998)17:54: HYVET (Treatment of HTN in Patients > 80 y, 2008)18:01: Syst-China (2000)22:18: AAFP HTN Guidelines (2022)22:40: KDIGO HTN Guidelines (2021)25:37: ALLHAT Study (2002)32:22: Secondary Prevention of Small Subcortical Strokes Trial (SPS3, 2013)

Mrs. Parr, an 82-year-old woman with a 30-year history HTN and dyslipidemia, treated and at EBP goals, presents with a 3-day history of weakness and urinary incontinence. She was seen in urgent care yesterday, diagnosed with a UTI, and appropriately treated.  She resides with her adult daughter who states, “The last two days, Mom kept saying she needed to get to work. She retired 15 years ago. She's never been confused like this.”  The NP understands that, with delirium, the changes in mental status usually:A.   Occur rapidly and are associated with an acute illness.B.   Are noted over a number of weeks and typically progressive.C.   Irreversible and usually slowly advancing.D.   Without a predictable pattern and often noted in the absence of an acute illness.---YouTube: https://www.youtube.com/watch?v=nQ6JtFvWZeg&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=43Visit fhea.com to learn more!

Stage 1 HTN treatment

A 76 year-old man with a 20-year history of HTN presents for a sick visit in the primary care clinic, stating, “I do not think that new medicine agrees with me.”  Until recently, his BP was at goal with an ARB, but about 1 week ago, due to continued elevated readings, a second BP med, a thiazide diuretic, was added.  Which of the following is most likely to be reported by this patient? A. “Since I started on the medicine, I passed out and woke up on the floor 4 times.”B. “About 2 days after I started the new medicine, I started feeling lightheaded when I stand up quickly.”C.” After starting the new medication, I feel like the room is spinning around me.”D. “I've had chest pain and sweating off and on since I started the new medication.”---YouTube: https://www.youtube.com/watch?v=Tt0iVD7ohAM&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=40Visit fhea.com to learn more!

A 60 year-old man who has a 10 year history of Parkinson disease presents with a chief complaint of “flaking skin that just does not go away, sometimes worse, sometimes better”, stating this problem has been present for > 6 years. Concurrent health issues include HTN, dyslipidemia and generalized anxiety disorder. The affected areas are occasionally itchy and will ache when particularly severe. He has used OTC hydrocortisone cream and skin moisturizers without seeing improvement. Physical exam reveals inflamed patches on the scalp, accompanied by greasy yellow scales. Similar lesions are noted in the nasolabial folds and behind the ears and into the ear canals. Which of the following is the most likely diagnosis?A. DandruffB. Seborrheic dermatitisC. PsoriasisD. Atopic dermatitis---YouTube: https://www.youtube.com/watch?v=VgCO_kpY208&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=39Visit fhea.com to learn more!

Coated vs uncoated ASA, a new trial in CAD, conflicts of interest, first AF in the hospital, and changing HTN scoring and CHADSVASC 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. ASA No Benefit of Enteric-Coated Aspirin vs Uncoated in CVD https://www.medscape.com/viewarticle/997119 -  JAMA Cardiology: Coated vs Uncoated ASA https://jamanetwork.com/journals/jamacardiology/fullarticle/2809795 -  ADAPTABLE https://www.nejm.org/doi/10.1056/NEJMoa2102137 II. RECHARGE -  Revascularization Choices Among Under-Represented Groups Evaluation (The RECHARGE Program) https://www.pcori.org/research-results/2023/revascularization-choices-among-under-represented-groups-evaluation-recharge-program -  Gaudino/Stone: Reconsidering Coronary Revascularization Trials III. Conflicts of Interest -  Financial Conflicts of Interest in Public Comments on Medicare National Coverage Determinations of Medical Devices  https://jamanetwork.com/journals/jama/fullarticle/2808721 IV. First AF in the Hospital Decoding AFib Recurrence: PCPs' Role in Personalized Care https://www.medscape.com/viewarticle/997011 -  Annals of Internal Medicine: AF Recurrence https://doi.org/10.7326/M23-1411 V. Changing CHADSVASC Score -  JAMA Network Open: HTN Guidelines and CHADSVASC Up-Scoring  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2809933 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

Chief Medical Officer at Northwestern Medicine Central DuPage Hospital Dr. Kevin Most joins the Steve Cochran Show to discuss a groundbreaking cancer treatment aimed at curbing peanut allergies, an innovative Alzheimer's drug rolling out in July, and he debunks common misconceptions surrounding blood pressure.  Dr. Kevin Most's Steve Cochran Show Notes: Cancer Drug that curbs peanut allergies?  More? A new drug to treat cancer may also block peanut allergy- Acalabrutinib- “A CAL A Brut In IB” Study published last month shows that a drug used to treat lymphoma, by inhibiting an enzyme in our body known as BKT, also reduced skin test responses to peanut allergies. BTK is an enzyme that is necessary for severe allergic reactions, and blocking it appears to stop on minimize the allergic reaction Baseline testing before the drug was given, showed a reaction to 29 milligrams of peanut protein ( a single peanut has 200 milligrams of peanut protein After being treated with this medication  for 2 days, some patients tolerated over 4,000 milligrams of peanut protein without having a reaction (highest dose for testing ) Seven out of ten patients went thru a peanut ingestion test without any problems and the other 3 had a much higher threshold Larger trials need to be completed, and testing as to see if this drug will block other allergies is being reviewed This may lead to allowing a patient to take a drug they are allergic to, when no other alternative is available. The patient would be pre treated with this drug and then receive the treatment they need This is the first drug to prevent allergic reactions to foods in a rapid onset Leqembi- Alzheimer's Drug approved in July rolling out soon. Five major health systems are working on administration and payment for this drug and will be offering it soon, including Northwestern, here in Chicago CMS reported that Medicare will cover 80% of the cost of the drug, without having to be enrolled in a trial. Current cost is quoted at $26,500 per year This will change how Alzheimer's is treated here in the US dramatically. 6.5 million individuals have been diagnosed with Alzheimer's the vast majority of which are on Medicare. Doctors are now looking to see which patients in their practice qualify for the medication, as it is approved for individuals who are early in the illness In order to qualify, you must have cognitive testing, genetic testing to look for a specific genetic change that would disqualify some individuals and a spinal tape or imaging that shows amyloid Leqembi removes amyloid Health systems are now screening patients to see who qualifies and then presenting the risks to the patient and family and explaining the monitoring that will occur. Blood Pressure Myths I can't have High blood pressure, I feel fine and have no headaches- in US 75 million people have HTN of those 11 million do not know it. I take blood pressure pills so I am fine- It is estimated that 45% of those with HTN are poorly controlled mainly due to compliance and lifestyle changes HTN is only seen in old people- 7.5% of those between 18-39yo 33% of those between 40-59 and 63% of those over the age of 60 have Hypertension After taking BP meds for a while I can stop- individuals who take BP meds and do behavior modifications with diet and exercise may see the need for BP meds to drop, for most however it is a lifelong issue Only Men get HTN-  Men do have a higher risk of HTN until the age of 45 , between 45-64  the risk becomes equal for men and women and over 65 women have a higher risk of HTN Blood pressure is the pressure in the heart- No blood pressure taken in arm is actually the pressure measured as blood is pushing against the walls of the arteries. Doctors pump up the cuff until it hurts- No the cuff is pumped up to a pressure that stops blood flow thru the artery, the systolic number is the pressure noted when we hear movement as we decrease the pressure. The diastolic number is when we no longer hear any sounds. My family has High Blood Pressure so I will also end up with it- False- if an individual knows they have a family history of HTN, they should be following a healthy lifestyle – diet- exercise- weight control- low sodium intake- limited alcohol intake- may prevent HTN Apple Cider vinegar lowers blood pressure- There is no validated research that shows Apple Cider vinegar lowers Blood Pressure, you should see a doctor for treatment options Blood pressure machines for the home are not accurate – There are websites that verify the accuracy of machines as well as bringing the home machine with you to the doctor to compare results  See omnystudio.com/listener for privacy information.

New Technology Supports Behavior Change in Hypertension Management Hypertension, or high blood pressure, is the most common modifiable cause of death in the world and affects 1.3 – 1.4 billion people worldwide including almost 50% of people over the age of 65. Consistently controlling blood pressure over time is the most crucial element in minimizing the risks of blood pressure driven diseases such as stroke, heart disease, heart failure, kidney disease, cognitive decline, vision loss, reproductive diseases and more. Consequently, episodic monitoring of blood pressure is antiquated as it does not assess blood pressure values consistently over time. New technology offers “continuous” blood pressure monitoring and personalized feedback on how specific lifestyle changes are impacting blood pressure levels. While only 50% of people with HTN are “salt sensitive” there are some dietary modifications that can reduce the intake of sodium while keeping flavor in mind. Tune into this episode with cardiologist Dr. Jay Shah and dietitian Angel Planells to learn about: ·       Hypertension (HTN) facts – definition, prevalence, diagnosis and management ·       Typical diet and lifestyle recommendations for HTN ·       Why episodic monitoring of blood pressure (BP) is antiquated ·       Average intake of and dietary recommendations for sodium ·       How only 50% of people with HTN are salt sensitive ·       How technological advances can help improve BP monitoring and management ·       The Hawthorne effect ·       How to seek out a registered dietitian nutritionist for guidance and support ·       Resources for health professionals and the public Full shownotes and resources at: https://soundbitesrd.com/245         

A 67-year-old man has been recently diagnosed with HTN, dyslipidemia and T2DM. As part of his medication treatment plan, he agrees to start statin therapy. The NP appreciates that which of the following laboratory tests should be conducted about 4-12 weeks after starting statin therapy?A. AST and ALTB. CK and potassiumC. Lipid profileD. CBC with WBC differential and platelet count---YouTube: https://www.youtube.com/watch?v=EwQBD3z6rQs&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=28Visit fhea.com to learn more!

In Feb 2023, the USPSTF recommended that clinicians “screen for hypertensive disorders of pregnancy”. Specifically, they stated that “measuring blood pressure at each prenatal visit is the best approach”. Mind blowing I know.

The world of "Hypertension (HTN) in Pregnancy" is an ever-evolving environment! Many clinicians have adopted patients' home monitoring of blood pressure (BP) in their management of hypertensive disorders in pregnancy. Do you recommend home BP monitoring in your OB patients? On May 4, 2022 we summarized the results of 2 RCTs examining whether home BP monitoring during antepartum care prevents HTN morbidity and mortality. These were BUMP1 and BUMP2 (JAMA). We will again summarize the key findings from those 2 RCTs in this episode. PLUS, we will highlight a brand new publication from Obstet Gynecology (the Green Journal) which was just released on June 13, 2023 (Steele et al) which examines the effectiveness of POSTPARTUM home BP monitoring in patients with hypertensive disorders of pregnancy. Does that reduce postpartum HTN morbidity? Its completely acceptable to be "medically conservative" and have patients self-monitor their BPs at home...but is that also data-driven? And which antihypertensive seems to work the best in the immediate postpartum interval: labetalol, nifedipine, or is it furosemide? Listen in and find out!

The following question refers to Section 4.7 and Table 18 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern Student Dr. Shivani Reddy, answered first by Fellow at Johns Hopkins Dr. Rick Ferraro, and then by expert faculty Dr. Roger Blumenthal.Dr. Roger Blumenthal is professor of medicine at Johns Hopkins where he is Director of the Ciccarone Center for the Prevention of Cardiovascular Disease. He was instrumental in developing the 2018 ACC/AHA CV Prevention Guidelines. Dr. Blumenthal has also been an incredible mentor to CardioNerds from our earliest days.The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association.Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #28 Mr. A. C. is a 78-year-old gentleman with a long-standing history of HTN receiving antihypertensive medications & dietary management for blood pressure control. What is the target diastolic blood pressure recommendation for all treated patients such as Mr. A.C.?A< 80 mmHgB< 90 mmHgC< 70 mmHgD< 95 mmHgE< 100 mmHg Answer #28 Explanation The correct answer is A: DBP < 80 mmHg Blood pressure treatment targets: when drug treatment is used, the aim is to control BP to target within 3 months. Blood pressure treatment targets in the 2021 ESC Prevention guidelines are more aggressive than previously recommended, as evidence now suggests the previously recommended targets were too conservative, especially for older patients. The magnitude of BP lowering is the most important driver of benefit. ·       It is recommended that the first objective of treatment is to lower BP to

The following question refers to Section 9.1 of the 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure.  The question is asked by Keck School of Medicine USC medical student & CardioNerds Intern Hirsh Elhence, answered first by Duke University cardiology fellow and CardioNerds FIT Ambassador Dr. Aman Kansal, and then by expert faculty Dr. Anu Lala. Dr. Lala is an advanced heart failure and transplant cardiologist, associate professor of medicine and population health science and policy, Director of Heart Failure Research, and Program Director for the Advanced Heart Failure and Transplant fellowship training program at Mount Sinai. Dr. Lala is deputy editor for the Journal of Cardiac Failure. Dr. Lala has been a champion and role model for CardioNerds. She has been a PI mentor for the CardioNerds Clinical Trials Network and continues to serve in the program's leadership. She is also a faculty mentor for this very 2022 heart failure decipher the 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 #13 Mrs. Hart is a 63-year-old woman with a history of non-ischemic cardiomyopathy and heart failure with reduced ejection fraction (LVEF 20-25%) presenting with 5 days of worsening dyspnea and orthopnea. She takes carvedilol 12.5mg BID, sacubitril-valsartan 24-46mg BID, empagliflozin 10mg daily, and furosemide 40mg daily and reports that she has been able to take all her medications. What is the initial management for Mrs. H? A Assess her degree of congestion and hypoperfusion B Search for precipitating factors C Evaluate her overall trajectory D All of the above E None of the above Answer #13 Explanation The correct answer is D – all of the above.   Choice A is correct because in patients hospitalized with heart failure, the severity of congestion and adequacy of perfusion should be assessed to guide triage and initial therapy (Class 1, LOE C-LD). Congestion can be assessed by using the clinical exam to gauge right and left-sided filling pressures (e.g., elevated JVP, S3, edema) which are usually proportional in decompensation of chronic HF with low EF; however, up to 1 in 4 patients have a mismatch between right- and left-sided filling pressures. Hypoperfusion can be suspected from narrow pulse pressure and cool extremities, intolerance to neurohormonal antagonists, worsening renal function, altered mental status, and/or an elevated serum lactate. For more on the bedside evaluation of heart failure, enjoy Episode #142 – The Role of the Clinical Examination in Patients With Heart Failure – with Dr. Mark Drazner. Choice B, searching for precipitating factors is also correct. In patients hospitalized with HF, the common precipitating factors and the overall patient trajectory should be assessed to guide appropriate therapy (Class 1, LOE C-LD). Common precipitating factors include ischemic and nonischemic causes, such as acute coronary syndromes, atrial fibrillation and other arrhythmias, uncontrolled HTN, other cardiac disease (e.g., endocarditis), acute infections, anemia, thyroid dysfunction, non-adherence to medications or new medications. When initial clinical assessment does not suggest congestion or hypoperfusion, symptoms of HF may be a result of transient ischemia, arrhythmias, or noncardiac disease such as chronic pulmonary disease or pneumonia,