POPULARITY
4 episodes with iabp
2 episodes with iabp
3 episodes with iabp
2 episodes with iabp
2 episodes with iabp
3 episodes with iabp
2 episodes with iabp
In this webinar, the CardioNerds collaborated with the Cardiogenic Shock Working Group (CSWG) to discuss LV unloading and the updated AMI guidelines, which upgraded transvalvular flow pumps to a Class 2A recommendation in AMI shock. Dr. Rachel Goodman and Dr. Gurleen Kaur from CardioNerds were joined by Dr. Navin Kapur (Tufts Medical Center), Dr. Shashank Sinha (INOVA Fairfax Hospital), and Dr. Rachna Kataria (Brown University) from the CSWG. Together, they explore a case of an older woman who presented with inferior STEMI and was found to have complete occlusion of an anomalous single coronary artery originating from the right coronary cusp and supplying the entire left ventricle. She was treated with DES to the anomalous RCA. Her course was complicated by AMI shock with re-occlusion of the DES, which was treated with thrombectomy and balloon angioplasty. An IABP was placed. After transfer to a tertiary care center, a pulmonary artery catheter revealed a CI of 0.96. With worsening shock, rising lactate, and end organ dysfunction, the team proceeded with VA-ECMO and Impella CP for LV unloading. Her lactate subsequently normalized. Produced by CardioNerds in collaboration with the Cardiogenic Shock Working Group. CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!
Hosts Mitsuaki Sawano, MD, and co-host Satoshi Shoji, MD, welcome regional associate editor Kentaro Ejiri, MD, for his debut appearance on the JACC: Baran Journal Club. Dr. Ejiri presents insights on the Altshock-2 trial, a pivotal randomized controlled trial evaluating early intra-aortic balloon pump (IABP) support in heart failure-related cardiogenic shock (HF-CS). The discussion covers the trial's clinical relevance, key challenges, and the implications of its findings within the Japanese healthcare context. The episode also delves into evolving definitions of cardiogenic shock, trial methodology, and the potential for Altshock-2 to inform more individualized treatment approaches in Japan.
What it is like to wake up intubated with an intra aortic balloon pump and then have Teia, your physical therapist, come in and get you walking? Bob shares with us how the ABCDEF Bundle helped him walk home from the ICU. www.DaytonICUConsulting.comNeed help making the business case for your hospital? Check out www.ABCDEFBundle.com !
Συζητάμε με τον κ. Γιαννακούλα για το καρδιογενές σοκ. Ποιος είναι ο ορισμός; Τι προτείνουν τα guidelines; Ποιες είναι οι θεραπείες για μηχανική υποστήριξη του κυκλοφορικού; IABP (https://www.nejm.org/doi/full/10.1056/NEJMoa1208410) VA-ECMO (https://www.nejm.org/doi/full/10.1056/NEJMoa2307227) Impella (https://www.nejm.org/doi/full/10.1056/NEJMoa2312572) Meta-analysis (https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01448-X) ECMELLA (https://doi.org/10.1093/eurheartjsupp/suad132)
PerfWeb 99 — Day 1, a webinar designed for perfusionists seeking to deepen their understanding and enhance their practice. This webinar is a part of our ongoing effort to provide valuable continuing education opportunities for perfusionists across the USA and Canada. By participating, attendees can earn CEUs towards their professional development and certification maintenance with the American Board of Cardiovascular Perfusion (ABCP). Our platform is renowned for hosting the largest knowledge resource for perfusionists worldwide, and we are committed to expanding this treasure trove of information with each event. The webinar is structured into two power-packed sessions, each an hour long, focusing on critical aspects of perfusion technology and its application. These sessions are meticulously designed to cater to both the seasoned practitioner and the emerging perfusion professional. Below is an overview of what to expect: The webinar is structured into two power-packed sessions, each an hour long, focusing on critical aspects of perfusion technology and its application. These sessions are meticulously designed to cater to both the seasoned practitioner and the emerging perfusion professional. Below is an overview of what to expect: IABP for Perfusion Faculty: J. Basha, CCP
Is it save to mobilize patients with trans-formal devices such as balloon pumps, impellas, and ECMO? Who was the first person to dare to ask, "Why can't we mobilize patients with trans-femoral balloon pumps?" Stephen Ramsey, PT, DPT, CCS shares with us his journey to developing the Ramsey protocol and revolutionizing mobility in the CVICU. Episode transcript and citations at: www.daytonicuconsulting.com --- Support this podcast: https://podcasters.spotify.com/pod/show/walkinghomefromtheicu/support
Welcome to Day 2 of our esteemed PerfWeb 97 series, a continuation of our commitment to providing top-tier educational content for perfusionists. Today's webinar focuses on a fundamental yet crucial topic in the field of perfusion: Intra-Aortic Balloon Pump (IABP) Basics. This session is specially designed to cater to both emerging and experienced perfusion professionals, aiming to enhance their understanding and skills in this critical area. Our distinguished faculty for this session is V. Carlyle, RN, BSN-CCRN, a renowned expert with extensive experience and knowledge in cardiac care and perfusion techniques. Carlyle's expertise in the field, coupled with a passion for teaching, makes this session an invaluable opportunity for attendees to learn from one of the best in the industry. This webinar is not just an educational journey; it's an investment in your professional growth. As a participant, you'll gain insights into the principles and practical aspects of IABP, understand its clinical applications, and learn about the latest advancements and best practices. The session will cover a range of topics, including the physiological principles behind IABP, patient selection criteria, management strategies, and troubleshooting common issues. Moreover, the interactive format of the webinar encourages participants to engage with the faculty, ask questions, and participate in discussions. This format ensures a comprehensive learning experience that goes beyond just theoretical knowledge, fostering a deeper understanding of IABP's role in patient care. Recognizing the importance of continuous education in the field of perfusion, this webinar has been approved for 1.2 Continuing Education Units (CEUs) by the American Board of Cardiovascular Perfusion (ABCP). This approval highlights the session's adherence to high educational standards and its relevance to the ongoing professional development of perfusionists. As you join us for this informative session, we remind you that our platform is more than just a webinar series. It's a community where knowledge meets passion, where professionals come together to learn, share, and grow. Our goal is to empower perfusionists across the USA and Canada with the knowledge and skills they need to excel in their field. With our extensive video library, we proudly stand as the largest knowledge resource for perfusionists worldwide. We look forward to having you with us for this enlightening session. Together, let's continue to elevate the standards of perfusion practice and patient care.
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 Keck School of Medicine USC medical student & former CardioNerds Intern Hirsh Elhence, answered first by Vanderbilt Cardiology Fellow and CardioNerds Academy Faculty Dr. Breana Hansen, and then by expert faculty Dr. Javed Butler. Dr. Butler is an advanced heart failure and transplant cardiologist, President of the Baylor Scott and White Research Institute, Senior Vice President for the Baylor Scott and White Health, and Distinguished Professor of Medicine at the University of Mississippi 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 #31 Mrs. Hart is a 70-year-old woman who was admitted to the CICU two days ago for signs and symptoms consistent with cardiogenic shock. Since her admission, she has been on maximal diuretics, requiring greater doses of intravenous dobutamine. Unfortunately, her liver and renal function continue to worsen, and urine output is decreasing. A right heart catheterization reveals elevated biventricular filling pressures with a cardiac index of 1.7 L/min/m2 by the Fick method. What is the next best step? A Continue current measures and monitor for improvement B Switch from dobutamine to norepinephrine C Place an intra-aortic balloon pump (IABP) D Resume guideline directed medical therapy Answer #31 Explanation The Correct answer is C – Place an intra-aortic balloon pump. This patient is between the SCAI Shock Stages C and D with elevated venous pressures, decreased urine output, and worsening signs of hypoperfusion. She has been started on appropriate therapies, including diuresis and inotropic support. The relevant Class 2a recommendation is that in patients with cardiogenic shock, temporary MCS is reasonable when end-organ function cannot be maintained by pharmacologic means to support cardiac function (LOE B-NR). Thus, the next best step is a form of temporary MCS. IABP is appropriate to help increase coronary perfusion and offload the left ventricle. In fact, for patients who are not rapidly responding to initial shock measures, triage to centers that can provide temporary MCS may be considered to optimize management (Class 2b, LOE C-LD). The guidelines further state that in patients presenting with cardiogenic shock, placement of a pulmonary arterial line may be considered to define hemodynamic subsets and appropriate management strategies (Class 2B, LOE B-NR). And so, if time allows escalation to MCS should be guided by invasively obtained hemodynamic data via PA catheterization. Several observational experiences have associated PA catheterization use with improved outcomes, particularly in conjunction with short-term MCS. Additionally, PA catheterization is useful when there is diagnostic uncertainty as to the cause of hypotension or end-organ dysfunction, particularly when the patient in shock is not responding to empiric initial measures, such as in this patient. There are additional appropriate measures at this time that are more institution-dependent. An institutional shock team would be very helpful here as they often comprise multidisciplinary teams of heart failure and critical care specialists,
I dive into the critical role of Intra-Aortic Balloon Pumps (IABP) in supporting patients with severe cardiac conditions. This episode unpacks the complexities of IABP therapy — from the underlying principles of operation to the nuances of patient management and monitoring. I discuss how the IABP works, its indications, hemodynamics, what to focus on, and complications. Instagram: https://www.instagram.com/cupofnurses/ Website: https://fanlink.to/CONsite Shop: https://fanlink.to/CONshop Free Travel Nursing Guide: https://fanlink.to/Travelnursingchecklist Nclex Guide: https://fanlink.to/NCLEXguide Interested in Travel Nursing? https://fanlink.to/TravelNurseNow YT: https://www.youtube.com/@CUPOFNURSES
Highlights: Choosing Registry Nursing: Discover the driving forces that led me to embrace registry nursing. Explore the advantages of increased pay and the freedom to craft my own schedule. Gain insights into how registry nursing has transformed my work-life balance. First-Week Orientation: A Remarkable Encounter: Join me as I narrate the exhilarating moments of my first week as a registry nurse. Listen to my experience dealing with a patient on CRRT, accompanied by an IABP, and managed with a Swan Ganz catheter. Understand how I navigated this complex medical scenario and collaborated with the healthcare team to deliver exceptional patient care. Instagram: https://www.instagram.com/cupofnurses/ Website: https://fanlink.to/CONsite Shop: https://fanlink.to/CONshop Free Travel Nursing Guide: https://fanlink.to/Travelnursingchecklist Nclex Guide: https://fanlink.to/NCLEXguide Interested in Travel Nursing? https://fanlink.to/TravelNurseNow Cup of Nurses FB Group: https://www.facebook.com/groups/cupofnurses YT: https://www.youtube.com/@CUPOFNURSES
Understanding the Physics of Intra-Aortic Balloon Pumps. Learn the 8 phases of the cardiac cycle and how to accurately time the IABP. IABP, Impella, and ECMO; when are they appropriate to use? "Mastering Intra-Aortic Balloon Pumps: Decoding the Physics and Timing for Optimal Cardiac Support" Welcome to our channel, where we delve into the fascinating world of cardiovascular physiology! In this comprehensive video, we invite you to embark on an enlightening journey to understand the physics of Intra-Aortic Balloon Pumps (IABP) and explore the critical role they play in supporting the cardiac cycle.
CardioNerds co-founder Dr. Amit Goyal and episode leads Dr. Jaya Kanduri (FIT Ambassador from Cornell University) and Dr. Jenna Skowronski (FIT Ambassador from UPMC) discuss Complications of acute myocardial infarction with expert faculty Dr. Jeffrey Geske. They discuss various complications of acute MI such as cardiogenic shock, bradyarrythmias, left ventricular outflow tract obstruction, ruptures (papillary muscle rupture, VSD, free wall rupture), and more. Show notes were drafted by Dr. Jaya Kanduri. Audio editing by CardioNerds Academy Intern, student doctor Tina Reddy. The CardioNerds Beyond the Boards Series was inspired by the Mayo Clinic Cardiovascular Board Review Course and designed in collaboration with the course directors Dr. Amy Pollak, Dr. Jeffrey Geske, and Dr. Michael Cullen. CardioNerds Beyond the Boards SeriesCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls and Quotes - Complications of Acute Myocardial Infarction Sinus tachycardia is a “harbinger of doom”! The triad for RV infarction includes hypotension, elevated JVP, and clear lungs. These patients are preload dependent and may need fluid resuscitation despite having an elevated JVP. Bradyarrythmias in inferior MIs are frequently vagally mediated. The focus should be on medical management before committing to a temporary transvenous pacemaker, such as reperfusion, maintaining RV preload and inotropy, avoiding hypoxia, and considering RV-specific mechanical circulator support (MCS). Worsening hypotension with inotropic agents (e.g., dobutamine, epinephrine, dopamine, norepinephrine) after a large anterior-apical MI should raise suspicion for dynamic left ventricular outflow tract obstruction due to compensatory hyperdynamic basal segments. The myocardium after a late presentation MI is as “mushy as mashed potatoes”! Need to look out for papillary muscle rupture, VSD, and free wall rupture as potential complications. Papillary muscle rupture can occur with non-transmural infarcts, and often presents with flash pulmonary edema. VSDs will have a harsh systolic murmur and are less likely to present with pulmonary congestion. Free wall rupture can present as a PEA arrest. All of these complications require urgent confirmation on imaging and early involvement of surgical teams. Notes - Complications of Acute Myocardial Infarction How should we approach cardiogenic shock (CS) in acute myocardial infarction (AMI)? Only 10% of AMI patients present with CS, but CS accounts for up to 70-80% of mortality associated with AMI, usually due to extensive LV infarction with ensuing pump failure. Physical examSinus tachycardia is considered a “harbinger of doom”, when the body compensates for low cardiac output by ramping up the heart rateThe presence of sinus tachycardia and low pulse and/or blood pressure in a patient with a large anterior MI should raise suspicion for cardiogenic shockBe wary of giving IV beta blockers in this situation as negative inotropes can precipitate cardiogenic shock (Commit Trial) When interpreting a patient's blood pressure in the acute setting, it is helpful to know their baseline blood pressure and if they have a significant history of hypertension. Patients
The American Heart Association relayed that the 1960s saw the first rise of coronary care units (CCU) in response to heart attacks. Today, cardiac ICUs, both medical and surgical, provide intensive care to a breadth of fatalities, ranging from arrest to post-open heart surgeries. The CVICU is seen to be a home for a "special breed" of nurses with its required list of complex skillsets, such as the titration of vasopressors drips and management of life support and assistive devices (e.g., ventilators, chest tubes, LVAD, ECMO, IABP, CVVH). How true is the "toxic" environment of surgical ICUs? What is the main reason for extended patient stay in the ICUs? Why are CVICU nurses usually given a bad rep on social media?We are joined today by Dr. Danielle LeVeck, a dual board-certified Adult-Gerontology Acute Care Nurse Practitioner and Clinical Nurse Specialist. She received her BA in Communications from Purdue University in 2007, second degree of BS in Nursing from Indiana University in 2011, and DNP from the University of Maryland in 2018, with her doctoral research focusing on implementing palliative care for patients with end-stage heart failure. Working bedside in various cardiac ICUs for almost a decade, Dr. LeVeck is now a CVICU nurse practitioner and stands as one of the Healthcare Advisory Board of the medical apparel line FIGS. Beyond the hospital, she empowers all generations of nurses through her blog and online platform, Nurse Abnormalities, which she began in 2015 and has garnered over 170,000 subscribers. She has also contributed to several magazines, including The Strategist, Glamour, The Daily, and Board Vitals.Livestream Air Date: February 24, 2022Danielle LeVeck, DNP, ACNPC-AG, CCNS: IG @nurseabnormalitiesFriends of Franz: IG @friendsoffranzpod & FB @friendsoffranzpodChristian Franz (Host): IG @chrsfranz & YT Christian FranzThankful to the season's brand partners: Clove, BETR Remedies, Eko, Lumify, RescueMD, Medical School for Kids, Your Skincare Expert, Twrl Milk Tea
A big new HF and EP trial, doctors and probability, LV assist devices in cardiogenic shock, vitamin D, and exercise in PAD 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. Left vs Left RCT Taking Cardiac Pacing From Boring to Super-Cool https://www.medscape.com/viewarticle/973615 Conduction-System Pacing Shines vs BiV Pacing for CRT in Early Studies https://www.medscape.com/viewarticle/974173 • Baylor led research awarded $31 Million for Resynchronization Therapy in Patients with Heart Failure https://www.bcm.edu/news/baylor-led-research-awarded-31-million-for-resynchronization-therapy-in-patients-with-heart-failure II. Probability and Conjunction Fallacy Is What You Call Probable...Impossible? https://www.medscape.com/viewarticle/976451 • Analysis of Physicians' Probability Estimates of a Medical Outcome Based on a Sequence of Events https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2793624 III. LV Assist Devices Impella Pump for MI With Cardiogenic Shock Again Fares Poorly vs IABP in Study https://www.medscape.com/viewarticle/977994 • Clinical Outcomes and Cost Associated With an Intravascular Microaxial Left Ventricular Assist Device vs Intra-aortic Balloon Pump in Patients Presenting With Acute Myocardial Infarction Complicated by Cardiogenic Shock https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2794390 • Intravascular Microaxial Left Ventricular Assist Device for Acute Myocardial Infarction With Cardiogenic Shock—A Call for Evidence of Benefit https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2794394 • Intra-aortic Balloon Pump Therapy for Acute Myocardial InfarctionA Meta-analysis https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2210888 IV. Vitamin D Vitamin D Supplements Do Not Lower Risk of Fractures https://www.medscape.com/viewarticle/978108 Why Is Vitamin D Hype So Impervious to Evidence? https://www.medscape.com/viewarticle/968682 • Supplemental Vitamin D and Incident Fractures in Midlife and Older Adults https://www.nejm.org/doi/full/10.1056/NEJMoa2202106 V. Peripheral Artery Disease For Patients With Peripheral Artery Disease, Pain Can Be Gain https://www.medscape.com/viewarticle/978053 • Effects of Walking Exercise at a Pace With Versus Without Ischemic Leg Symptoms on Functional Performance Measures in People With Lower Extremity Peripheral Artery Disease: The LITE Randomized Clinical Trial https://www.ahajournals.org/doi/10.1161/JAHA.121.025063 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 mailto:news@medscape.net
As opposed to that unofficial bootleg IABP show you've probably been listening to, this is the real deal Daddy. Mike, Jon, and Sam return just as the MLB season does to give you their thoughts on a whole variety of things. Who wins it all, the road it looks like to get there, all the major awards, even a bunch of stuff Sam made up to pad the show. It's all here and it is a lot of baseball. Happy Opening Weekend! Follow the hosts on Twitter Mike-@mikegianella Jon-@jonhegglund Sam-@thesamuelhale For questions, comments, sponsorships, or anything else you might need: itsabaseballpodcast@gmail.com itsabaseballpodcast.com
In today's episode, we discuss almost everything you could want to know about intra-aortic balloon pumps with special guest, Dr Ivan Rapchuk. In part 2 of this series, we talk about which patients benefit most from balloon pumps, optimal and suboptimal balloon timing, and those things to be mindful of when anaesthetising a patient with a balloon pump in situ. Lastly, we have a brief chat about the similarities and differences between intra-aortic balloon pumps and the newer Impella devices. Feel free to email us at deepbreathspod@gmail.com if you have any questions, comments or suggestions. We love hearing from you!Thanks for listening, and happy studying.Resources for today's episode: Principles of intra-aortic balloon pump counterpulsation by M. Krishna and K. Zacharowski. https://academic.oup.com/bjaed/article/9/1/24/466259 The normal IABP waveform: https://derangedphysiology.com/main/required-reading/cardiothoracic-intensive-care/Chapter%206.3.4/normal-iabp-waveform The abnormal IABP waveform: https://derangedphysiology.com/main/required-reading/cardiothoracic-intensive-care/Chapter%206.3.4.2/pathophysiology-abnormal-iabp-arterial-waveforms The Impella Device: historical background, clinical applications and future directions by J. Glazier and A. Kaki. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679960/ Youtube video illustrating how an Impella works: https://www.youtube.com/watch?v=GhWB7T5QxMI
In today's episode, we discuss almost everything you could want to know about intra-aortic balloon pumps with special guest, Dr Ivan Rapchuk. In this episode, we focus on the physiology of how the pumps work to improve cardiac function. Feel free to email us at deepbreathspod@gmail.com if you have any questions, comments or suggestions. We love hearing from you!Thanks for listening, and happy studying.Resources for today's episode: Principles of intra-aortic balloon pump counterpulsation by M. Krishna and K. Zacharowski. https://academic.oup.com/bjaed/article/9/1/24/466259 The normal IABP waveform: https://derangedphysiology.com/main/required-reading/cardiothoracic-intensive-care/Chapter%206.3.4/normal-iabp-waveform The abnormal IABP waveform: https://derangedphysiology.com/main/required-reading/cardiothoracic-intensive-care/Chapter%206.3.4.2/pathophysiology-abnormal-iabp-arterial-waveforms The Impella Device: historical background, clinical applications and future directions by J. Glazier and A. Kaki. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6679960/ Youtube video illustrating how an Impella works: https://www.youtube.com/watch?v=GhWB7T5QxMI
Invasive arterial blood pressure (IABP) monitoring techniques have enjoyed a rich history of use throughout the mid-to-late 20th century in the peri-operative setting and are now a standard of care intensive care units. While there are a variety of IABP monitoring options, one of the most common techniques is percutaneous radial arterial catheterization. Although monitoring of radial arterial lines is a widely accepted skill in the critical care transport (CCT) world, placement by CCT providers is less common. Concerns over safety and logistical management have contributed to the perceived difficulty in arterial lines; however, this article aims to demonstrate that arterial lines can be placed safely and effectively in the pre-hospital setting. www.foamfrat.com
Episode 03 -- Show NotesIt doesn’t matter how far you are into your career, you can always further your education. The key thing is to stop waiting and just go for it.This insight comes from today’s conversation with nursing power couple Tanya and David Damron. A tale of opposites attracting, we talk about how Tanya and David first met before exploring their respective roles as Assistant Director of Nursing (Tanya) and Charge Nurse and IABP Life Flight Team Lead (David). We then dive into why Tanya and David pursued their Bachelor degrees while at a midpoint in their careers and how they managed their studies while working. After reflecting on how they landed their positions, we touch on the lessons that they’ve learned along the way. We discuss what they do to help their patients, with Tanya shedding light on the value of hospices and how they’re an often misunderstood niche of the medical industry. We ask Tanya and David for their top advice and their answers highlight the importance of teamwork, communication, and learning from your mistakes. Near the end of the episode, we explore the future of medicine and how learning about other healthcare fields can be as easy as picking up the phone. Tune in to hear more of Tanya and David’s incredible story. Key Points From This Episode: • How Tanya and David met, and their experience of working together.• Hear which superpowers today’s guests would choose. • Why Tanya and David pursued their Bachelor’s degrees in nursing.• How they managed to attain their degrees while working. • The benefit of getting your Bachelor's degree; “You can work anywhere.”• Exploring Tanya and David’s respective roles at their facilities. • David shares the top lessons that he’s picked up throughout his career. • Why Tanya chose to further her career within the hospice care field.• What a typical day looks like for Tanya and David.• Maintaining honest working relationships by communicating with management.• Dave and Tanya give listeners their best advice on teamwork and learning from mistakes.• Reflections on the future of nursing and the healthcare industry.• What you can do to learn more about hospice work. • We summarize our key takeaways from our conversation with David and Tanya.Links Mentioned in Today’s Episode:Intermountain Healthcare - https://intermountainhealthcare.org/Home Health and Hospice for Utah - https://hospice4utah.com/Life Flight Network - https://www.lifeflight.org/
CardioNerds (Amit Goyal & Daniel Ambinder) join University of Michigan cardiology fellows (Apu Chakrabarti, Jessica Guidi, and Amrish Deshmukh) for some craft brews in Ann Arbor! They discuss a challenging case of Ventricular Septal Rupture after acute MI. Dr. Kim Eagle, editor of ACC.org & host of Eagle's Eye View Podcast, and Dr. Devraj Sukul provide the E-CPR and message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident, Eunice Dugan, with mentorship from University of Maryland cardiology fellow Karan Desai. Jump to: Patient summary - Case media - Case teaching - References D The CardioNerds Cardiology Case Reports series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an “Expert CardioNerd Perspectives & Review” (E-CPR) for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus. We are teaming up with the ACC FIT Section to use the #CNCR episodes to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an E-CPR segment and a message from the program director. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza Patient Summary A male in his 60s with medical history of obesity and GERD presents with five days of progressive chest pressure radiating to bilateral arms and associated with dyspnea on exertion. Due to worsening chest pain with new lightheadedness, he decided to come to the ED. His presentation to the hospital was delayed due to fear of contracting COVID-19. In the ED, patient was afebrile, blood pressure 96/56, HR 137, RR 22, and oxygen saturation 94% on room air. On exam, he was ill appearing, acutely distressed, and altered. He had a 3/6 mid systolic murmur loudest at L sternal border, JVP to 10 cm H2O and had crackles up to mid-lung fields. His extremities were cool to touch. Labs notable for Cr 1.5, High-Sensitivity Troponin-T up to 5756, and lactate 3.9. EKG showed incomplete RBBB, PVCs, and ST elevations in the inferior leads with depressions in lateral and precordial leads. Coronary Angiography showed mid-RCA occlusion with faint L to right collaterals. He underwent PCI with restoration of TIMI 3 flow. After PCI, he continued to be hypotensive requiring IABP and norepinephrine. PA catheter demonstrated (in mmHg): RA 26, RV 63/29 (31), 55/36 (44), PCWP 29, and CO 5 L/min, CI 2.2, and SVR 467. Shunt run of mixed venous O2 saturation showed: SVC 71%, RA 72%, RV 62%, PA 85% with oxygen step up in the R-sided circuit. Left ventriculogram then confirmed septal rupture with contrast extravasation from LV into RV. Due to worsening shock, he was stabilized on VA ECMO which was complicated by hemolysis and acute renal failure requiring CVVHD. On day 7 after presentation, he underwent surgery which revealed a large 6x6 cm ventricular septal defect on the posterior aspect of the septum and repaired with a large bovine pericardial path. He was eventually discharged after a prolonged stay and repeat TTE on follow up showed biventricular dysfunction and residual 1cm VSD. Case Media ABCDClick to Enlarge A. ECG: Incomplete RBBB, PVCs, and ST elevations in the inferior leads with depressions in lateral and precordial leads. B. Coronary angiography: mid-RCA occlusion with faint L to right collaterals.C-D.
CardioNerds (Amit Goyal & Daniel Ambinder) join University of Connecticut (UCONN) cardiology fellows (Mansour Almnajam, Justice Oranefo, Yasir Adeel, and Srinivas Nadadur) as they enjoy the amazing view from the Heublein tower! They discuss a challenging case of left ventricular free wall rupture & pseudoaneurysm as a complication of a STEMI. Dr. Peter Robinson provides the E-CPR and program director Dr. Joyce Meng provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Bibin Varghese with mentorship from University of Maryland cardiology fellow Karan Desai. Jump to: Patient summary - Case media - Case teaching - References Episode graphic by Dr. Carine Hamo The CardioNerds Cardiology Case Reports series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an “Expert CardioNerd Perspectives & Review” (E-CPR) for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus. We are teaming up with the ACC FIT Section to use the #CNCR episodes to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an E-CPR segment and a message from the program director. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza Patient Summary A man in his mid 50s with no significant PMH presented with a 10-day history of chest pain that progressed to acute pleuritic pain and shortness of breath in the past 24 hours. On arrival, he was hypothermic, in rapid atrial fibrillation with HR in the 130-150s, and an initial BP was not able to be obtained. He was tachypneic with labored breathing, lethargic, and cyanotic. Exam revealed markedly elevated JVP, cool extremities, and diminished breath sounds with bibasilar rales. Labs demonstrated leukocytosis, significantly elevated liver enzymes, troponin-I at 10.91, elevated NT-proBNP, and lactate at 6. ECG demonstrated tall, broad R-waves in V1-V4 with downsloping STD and upright T-waves concerning for a posterior infarct. He was immediately intubated, cardioverted into NSR, and started on vasopressors. Bedside echocardiogram demonstrated diffuse LV hypokinesis with akinesis of the inferolateral wall, LVEF 25-30%, and pericardial fluid with hyperechoic material adherent to the inferior wall as well as tamponade physiology. Chest CTA was negative for aortic dissection and confirmed hemopericardium. He was taken to the OR where he underwent a subxiphoid pericardial window. They found significant clot burden (both old and new), but no frank rupture. Adherent clot was not removed to prevent further hemodynamic compromise. Intraoperative TEE additionally demonstrated severe eccentric MR with partial posteromedial papillary muscle rupture. An IABP was placed and inotropic and vasoactive support was continued to temporize pending definitive therapy and the patient improved hemodynamically. Repeat TTE prior to surgery demonstrated a large apical and inferolateral pseudoaneurysm. Coronary angiogram revealed proximal occlusion of the LCx and diffuse three vessel coronary disease otherwise. He ultimately underwent CABG, mechanical mitral valve replacement, and pericardial patch repair of the ventricular pseudoaneurysm. Final diagnosis: Free Wall Rupture & Pseudoaneurysm. Thankfully,
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Editor's Summary by Howard Bauchner, MD, Editor in Chief of JAMA, the Journal of the American Medical Association, for the February 25, 2020 issue
The use of IABP in cardiogenic shock remains controversial to date. In this podcast, Dr Chacko & I discuss the evidence available on this topic and make recommendations for the future.
Dr Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to the journal and its editors. I'm doctor Carolyn Lam, associate editor from the National Heart Center, and Duke National University of Singapore. Dr Greg Hundley: And I'm Greg Hundley, associate editor from the Pauley Heart Center at VCU Health in Richmond, Virginia. Dr Carolyn Lam: Have you heard of long non-coding RNAs? Well, they are definitely the hot topic and our feature paper today discusses the first demonstration of the importance of a linked RNA in atherosclerotic lesions not just in mice but also in humans. You have to listen on, it's coming up right after our copy chat. Greg, what are your picks upon the journal this week? Dr Greg Hundley: The first paper I wanted to discuss comes from France, and it's basically looking at ambulance density and outcomes after out of hospital cardiac arrest from Florence Dumas from Hôpital Cochin in Paris, France. This manuscript addresses the geographic disparities and survivorship of out of hospital cardiac arrest and the relevance of the patients characteristics versus whether ambulances are equipped with those trained in basic or advanced cardiac life support. So, what they did they had nineteen neighborhoods in Paris, and the number of BLS trained versus ALS ambulances was collected, and the authors assessed that respective associations of socio-economic characteristics of the patient population and the ambulance resources of these neighborhoods and compared those with successful return of spontaneous circulation or risk as the primary end point and then survival of out of hospital discharge as the second end-point. So, they had 80754 non-traumatic out of hospital cardiac arrests across the Paris area. 42% at ROSK 9% head survival at discharge, and after accounting for the patient's socio-economic status, greater than one and a half advanced cardiac life support ambulances per neighborhood and greater than 4 basic cardiac support basic life support units per neighborhood were associated with ROSK, but only the 1.5 ALS units per neighborhood were associated with survival. Dr Carolyn Lam: Oh, interesting Greg. So does this we need more advanced life support units? Dr Greg Hundley: So, Paul Dorian from St. Micheal's Hospital in Toronto, Canada wrote an excellent editorial, and one point he made related to these ALS units is that it was really a very small 1.3 adjusted odd ratio for survival to hospital discharge, and it's important to note that although the increase in survival was associated with more ALS units, there were many other variables that were likely important and not recorded in this study. For example, including the time to collapse, to calling for EMS, the time from the call to the deployment of that ALS unit to the scene, the time from collapse to the defibrillation, the total "no flow time" sort of in quotation, which is the total duration of collapse until CPR is started and so I think one of the points in this observational study is there could've been many differences that would've associated with the findings, interesting findings how about one of the papers that you liked? Dr Carolyn Lam: So, the paper that I selected here is a first time that a targeted anti-inflammatory therapy has been shown to reduce hospitalization for heart failure and at-risk patients. So, you know that some clinical inflammation associates with an increased risk of heart failure and associates with the worst prognosis in patients with heart failure, and yet, so far, treatments specifically directed at reducing inflammation in patients with heart failure have not been shown to improve clinical outcomes. That's why today's paper is so special and it's from Dr Everett and colleagues from Brigham and Women's Hospital Harvard Medical School in Boston, and basically, the authors looked at CANTOS and tested the hypothesis that the interleukin -1β inhibitor can canakinumab would prevent heart failure hospitalizations and the composite of heart failure hospitalizations on heart failure related mortality in the CANTOS trial. Now, remember the CANTOS trial randomized more than 10 000 patients with a prior myocardial infarction and with high sensitivity C-reactive proteins at least two or greater, and they were randomized to canakinumab 50, 150, and 300 mg or placebos. Now, before randomization, these participated were asked if they had a history of heart failure and 22% said yes so the current paper actually looks at this stratification of patients who said they had heart failure, and during a meeting follow-up of 3.7 years, 385 patients had a new heart failure hospitalization event. Now, here's the key: the authors found a dose dependent reduction in the risk of hospitalization for heart failure as well as the composite of hospitalization for heart failure or heart failure related mortality among those allocated to Canakinumab. Dr Greg Hundley: So, how does this differ from prior attempts targeting inflammation and heart failure? I mean is this ready for prime time thing? Dr Carolyn Lam: So, we have to bear a few things in mind here you know. CANTOS was different from a previously published randomized controlled trials, which were basically neutral and that was like of infliximab and etanercept so the drug in CANTOS targets interleukin-1 beta whereas the prior ones targeted the TNF-alpha, and also very importantly, CANTOS did not specifically enroll patients with an established heart failure only. CANTOS patients had to have a history of myocardial infarction and there was no data on their ejection fraction or natriuretic peptides at the time of randomization nor at the time of heart failure hospitalization. So, by the way, we don't know whether there's a differentially effect on hep pef versus hep-ref. So, again difference from the heart failure focused trial previously that used an anti-inflammatory agents. The other thing: although there was a dose dependent reduction in the risk of hospitalization for heart failure no single dose of Canakinumab compared to the placebo had a statistically significant reduction in the risk of heart failure hospitalization. Only the trend was statistically significant so all in all, this was a pre-specified aim of CANTOS to look at heart failure, the data presented here should really be considered hypothesis generally, but really quite promising. And what about you Greg? What's your other paper? Dr Greg Hundley: We're going to switch gears a little bit and shift over to the Jackson heart study. The large longitudinal cohort from Jackson, Mississippi that's recruited to follow for cardiovascular events, and it's an area of the United States where we have some of the highest cardiovascular disease event rates really across the nation so this study focuses on sleep apnea and is the Jackson's heart sleep study. It's a sub-study of this larger Jackson's heart study that involves 913 patients, and the investigators were looking at the association between sleep apnea and blood pressure control among those of a Black race. So, Dayna Johnson of Emerald University is the first author on the paper. What's nice about this sub-study, this sleep sub-study is that there are objective measures using an in-home type III sleep apnea study. They had clinical blood pressure measurements and then anthropometry as opposed to questionnaire derived data that may have been performed in the larger cohort. And the study determined these associations between moderate or severe obstructed sleep apnea with controlled, uncontrolled and resistant hypertension. So the analytic sample of the individuals with hypertension was 664, and they had an average age of about 64 years. They were predominately women 69%, obese 58%, College-educated at 51%. Among the sample, about a quarter had obstructive sleep apnea, which was untreated and unrecognized in 94% of the participants. That's an interesting point, just right there. Overall, 48% of the participants had uncontrolled hypertension and 14% had resistant hypertension. So, multiple medications, often four and still unable to control the blood pressure. So the findings participants with moderate or severe obstructive sleep apnea had 2 times higher odds' ratio of resistant hypertension. Dr Carolyn Lam: Whoa Greg, that's a huge risk and very important finding. I mean if sleep apnea could be modifiable risk factor perhaps for very important issue among African Americans resistant hypertension. What do you think about clinical implication? Dr Greg Hundley: One of the things to be considering now is what are we going to do about that cause as you know CPAP is really the preferred treatment for resistant hypertension, but it's efficacy hasn't been really that well studied in African Americans and CPAP tolerance is low so this study highlights for us potentially new mechanisms for resistant hypertension, but we still got to be thinking about what would be our next therapeutic intervention for this particular patient population. And what about your next study? Dr Carolyn Lam: The next study is about Impella support for acute myocardial infarction complicated by cardiogenic shock. Now, we use it all the time, but did you know that to date, there is no large randomized study actually comparing the use of Impella to other contemporary cardiac support devices and medical treatment in stem related cardiogenic shock. So, Dirk Westermann and colleagues from University Heart Center in Hamburg tried to address this knowledge gap by using a multi-national database of patients with acute myocardial infarction complicated by cardiogenic shock and treated with the Impella device and compared in a matched fashion their outcomes to patients from the IABP Shock II trial, which you would recall is a randomized trial which demonstrated similar outcomes between IABP and medical treatment in myocardial infarction in cardiogenic shock. So, they looked at 237 matched-pairs so remember this was pairs from this registry of acute myocardial infarction with shock and using an Impella matched with IABP shock patients and what they found was that there was no significant difference in 30-day all-cause mortality. Instead, severe or life-threatening bleeding and peripheral vascular complications occurred significantly more often in the Impella group when they limited the analysis to the IABP treated group as controlled versus Impella that was still the same results. Dr Greg Hundley: So, Carolyn, there are trying to match patient population from two different studies and they may have confounders in there that we can't account for so why we not able to produce large randomized trials of Impella devices in studies of patients with acute myocardial infarction? Dr Carolyn Lam: The rate of acute myocardial infarction complicated by cardiogenic shock has really declined in the past decade. Furthermore, clinical signs of shock really appear in half to three quarter of cases several hours after hospital admission so making randomization before primary PCI of the AMI really very difficult. And finally, many interventional cardiologists believe that there's equipoise that has already been reached on the use of these cardiac assistive devices in patients with cardiogenic shock and this was from registry data, and so if interventionists believe this then they also believe its unethical to randomize these patients in trials. Still, I think that current study to date really causes us to pause and to acknowledge that we really need to evaluate this better and prospective randomize trials of Impella treatment are warranted. Let's now go to our featured discussion, shall we? For our featured paper discussion today, we are talking about a basic science paper, and we have none other than the best of the best Dr Charles Lowenstein, our associate editor from University of Rochester Medical Center joining us as well as the first author of a really fantastic paper on long non-coding RNA in a specific type involved in arthrosclerosis and plaque formation. This first author is Sebastian Creamer from Goethe University in Frankfurt. Charlie, could you start us off by telling us what is a long non-coding RNA? We've heard a lot about this in recent times. What's the big deal about them? Dr Charlie Lowenstein: So in the last decade, scientists have learned that your genome, your DNA inside you, every cell codes about 20,000 genes and those 20000 genes encode proteins, but there are another 20000 genes that encode RNA only, RNA that never turns into protein that leaves RNA are an amazing diversity of different kinds of RNA really short micro RNA, longer RNA that defends the host from viruses and long non-coding RNA that have a huge variety of effects regulating genes, turning genes on and off in proliferation and cell growth and inflammation so long non-coding RNAs are increasingly appreciated as an important part of the genome. Dr Carolyn Lam: What a perfect set up with that. Sebastian, could you tell us about your study please? Dr Sebastian Creamer: Our laboratory was interested in non-coding RNAs for some time and previously, we've found that this specific non-coding RNA MALAT1 regulates endothelial cell functions and because we were interested in analyzing this particular RNA in the disease setting it shows at a risk growth so it's because also we saw that when it's regulated by flow and end of previous cells and so we cross MALAT1 deficient mice to Apoe mice and set them on a high fat diet and analyzed and subtracted in both groups. And while we only saw a modest increase in plaque size in MALAT1 deficient mice, we could appreciate a higher amount of inflammatory cells in plaque of aortic roots in those mice, which let us hypothesize that inflammatory responses was appreciated and is a very important contributor to arthrosclerosis in MALAT1 deficient mice. And to test this, we decided to transplant MALAT1 deficient bone marrow in Apoe knockout mice with MALAT1 and interestingly, we saw that now plaques were significantly larger than compared to mice who received controlled MALAT1 white cell bone marrow, and also inflammatory cells were more prominent in those mice. Dr Greg Hundley: Sebastian, this is Greg Hundley. You also did some experiments in human subjects. Could you tell us a little bit about those too? Dr Sebastian Creamer: So, because we saw this interesting phenotype, we were very much interested if this also translates into the human setting. Luckily, we got a really nice collaboration receding in Stockholm access to high impact material from patients with arthrosclerosis and what we could see here that MALAT1 expression was down regulated in patients with arthrosclerosis and it also correlated with disease progression. Moreover, in another collaboration, we consolidated those findings with experiments, which showed that human cells have less MALAT1 compared to normal vasculature. Dr Carolyn Lam: It all sounds so sensible and logical and so on but let me just frame this for our audience. This is actually the first time that it's been demonstrated. The importance of long non-coding RNA in arthrosclerosis. Charlie, could you tell us a little bit about how significant these findings are? Dr Charlie Lowenstein: Sure. So, I'm really interested in the final figure in this paper because there are lots of interesting human data, showing that MALAT1 expressed more in normal than atherosclerotic arteries and also that MALAT1 expression is correlated with fewer major adverse cardiac events so the whole story is a very nice story saying that the expression of this anti-inflammatory link RNA not only has an effect in mice but it can be extended into the human field of arthrosclerosis and inflammation. It's particularly important because there's a lot of attention in the last decade that inflammation drives atherosclerosis, and in light of CANTO trial showing that anti-inflammatory therapy can actually decrease atherosclerosis and decrease cardiovascular events in humans. This is important cause it shows another pathway, which regulates inflammation. Not only in mice, but also in humans, and in the human atherosclerotic setting. Dr Carolyn Lam: Amazing. Sebastian, what are the next steps? How far are we away from clinical applications here? What are the next steps to get it in the clinic? Dr Sebastian Creamer: So, the very difficult thing is that MALAT1 is down-regulated in atherosclerosis and also therapeutic approaches is very difficult in such a complicated disease like atherosclerosis to actually increase the expression of such a long non-coding RNA. What we are currently working on is to decipher more than the clinical malade-1 is actually influencing atherosclerosis so we have lots of hints or some evidence that adhesion of inflammatory substances altered and the bone marrow activity, which is very important in atherosclerosis and also in other cardiovascular diseases like myocardial infarction is altered so we think that malade-1 might actually influence the resolution of inflammation and when it's lacking, inflammation can be resolved. So, we are now putting somewhat mechanistic studies and finally, we hope that we can find another downstream target like micron AB, we talked about in our paper, which we can directly target in the future. Dr Charlie Lowenstein: So, I agree with Sebastian. I think MALAT1 is going to turn out as one of those major link RNAs that controls inflammation possibly controlling the way in which the bone marrow reacts to systemic inflammation and produces cells and then have those cells home in on various inflammatory targets so I think this is an important observation that's going to have not only implications for atherosclerosis but also for other inflammatory diseases. Dr Carolyn Lam: Excellent. If you don't mind, I would love to switch tracks a little bit. We find it that very special and we can discuss basic papers with people who can explain it so well because we understand that there's so much work that goes in to these papers and so on. Charlie, could you take behind the scenes a little bit with the editors and tell us what is it that circulation looks for in basic science papers that makes us published? Dr Charlie Lowenstein: We get a lot of really good basic science papers, and it's a challenge for the associate editors, and the editors to figure out what's right for circulation and let me use this manuscript as a great example because this is a terrific paper. So, this paper is divided into four sections, and these sections are what we look for in any basic science paper that's going to reach an audience of clinicians who are interested in pathways and therapeutics so this paper has a section on mice. There's a gene in mice that's important then the paper delves into cells what's happening with cells and then a little bit of mechanisms and genes and proteins and then this paper takes the observation back into humans and shows that there's some human and clinical relevance so this is not only a great paper, but it is a classic example of what the associate editors are looking for in a basic science paper that's targeted towards clinicians. Dr Charlie Lowenstein: There's some in vivo work with mice, there's some mechanistic work then they take it back to the humans. Plus, of course like anything that comes into circulation, it's going to be novel, interesting and has some important relevance to human cardiovascular disease. This paper that we're discussing is a great example of a paper that we love to publish in a circulation and it's a real tribute to Dr Dimmeler and her team and to Sebastian that they put this paper together and submitted it to us. Dr Carolyn Lam: Thank you audience for joining Greg and I today. You've been listening to circulation on the run. Don't forget to tune in again next week.
Dr Carolyn Lam: Hello. We're here at the American Heart Association meeting in Chicago where circulation has 19 simultaneous publications this year. And that is a huge increase from six in the past to 19, all thanks to the man next to me. But first, let me introduce myself. I'm Dr Carolyn Lam. I'm associate editor from the National Heart Center and Duke National University of Singapore. I'm the voice you hear on 'Circulation On the Run'. I'm so pleased to be here in person today with Dr Dharam Kumbhani. He's associate editor from UT Southwestern and he also leads the simultaneous publications for this journal. So big applause for this amazing bonanza this year. Dr Dharam Kumbhani: Thank you. Dr Carolyn Lam: Next to him, we have Dr Sana Al-Khatib and she's from the Duke University. And finally, Dr Gabriel Steg from University of Paris. Wow! Okay, we've got 19 papers to chat about. No, I'm just kidding. We're going to talk and focus on the seven simultaneous publications that were late-breaking science. Why don't you start us off, Dharam. We will first start with the interventional trials, and there were three of them. I'd love you to chat about the first of them, but even before that, maybe, tell us what it's like to get a simultaneous publication. Because I think people underestimate the amount of work it takes to do that. Dr Dharam Kumbhani: Thanks a lot, Carolyn. I think under Joe's leadership the whole space of simultaneous publications in late paying clinical science has really been a big endeavor for him and for the journal. We just have an amazing team that's able to work on this in very quick order. So, for the viewers, I think it's a very involved process, but it's a very gratifying process. We work very closely among the associate editors, the senior editors, and then the circ staff, and we have very rapid turnaround time. So we owe a lot of gratitude to our reviewers who frequently will turn these reviews in within 48 hours. Our goal has been that we respond back with a decision usually within five to seven days. So it's been very gratifying. Then it moves onto the next set of revisions, et cetera. But even among the papers that we are unable to accept for circulation, it's just a quick turnaround time for the authors so they haven't lost as much time and can potentially look elsewhere. It's been a really gratifying process. It's been a great, great team effort. I appreciate everything you said, but really I don't deserve all that credit. It's been a great team effort. Dr Carolyn Lam: No, it's been rumored there's a lot of lost sleep on your end, so thank you, thank you Dharam for this. And maybe you could open with the ISAR-TEST 4, that's been [crosstalk 00:02:47]. Dr Dharam Kumbhani: Yeah, well thank you. I think we had some really interesting interventional trials and Dr Steg will discuss a couple of them as well. ISAR-TEST 4 was a very interesting trial. It is one of the first 10 trials that gets to the 10-year mark, so this is just the 10-year follow-up results of that. It was about a 2500 patient trial. It was done in Germany, multiple centers. Really they were trying to assess the space that they were trying to ... Or the knowledge gap that they were trying to fill was the durability of the bioabsorbable polymer stents. Specifically, they were looking at a bioabsorbable polymer sirolimus-eluting stent, the Yukon stent, and then they compared that with durable polymer stents including Xience or the everolimus-eluting stent and then Cypher, which is no longer available in the U.S., but that's a permanent polymer sirolimus-eluting stent. The primary results were published and presented a long time ago. There was really MACE events at one year and it showed non-inferiority for this bioabsorbable polymer stent back then. So, then they had, incredibly, 83% of the cohort that they were able to follow-up out of 10 years. And what they showed is that ... I don't want to necessarily get into the numbers and the details as much, but what they showed is that this bioabsorbable polymer sirolimus-eluting stent tended to have similar outcomes to Xience, which we accept as state of the art current generation stent, permanent polymer. And it did better than the Cypher stent, both in terms of MACE events and stent thrombosis. So suggesting that, the big advance in the field for this is ... This is a long-term follow-up of the stent. It suggests that outcomes may be similar in this patient population. Although only 12% were really enrolled with an MI in this patient population. Most of them were stable or less sick ACS patients. And they show fairly good outcomes out of 10 years, comparable to Xience and better than Cypher. I think it was interesting. Gabriel, what is your take [crosstalk 00:04:57]. Dr Gabriel Steg: I think it's important. There's been a tremendous interest in international community on trying to tease out which are the best types of stents and beyond brands, try to understand the type of stent, the coating, the drug that you put on it, whether the polymer is durable or not durable. I think these types of fairly well done, large randomized trials with long term flow are critical. A lot of the focus in the interventional community originally was on lumen size, late loss, angiographic parameters short term. And now the field has matured, and we've moved to clinical outcomes, patient-oriented outcomes, long term follow-up. And it's important because we've learned from long term trials such as PROTECT that the result at one year may not predict what happens at five years, and sometimes you have surprises. So, it's really important. We owe it to our patients because these are irretrievable devices. Once you've implanted them, they are there. We talked about Cypher being out of the market, but there are more than a million patients who walk every day on this plant with a Cypher in their coronary artery, so we better know what the long-term follow-up is. Dr Dharam Kumbhani: Yeah, that's a great point. Dr Carolyn Lam: Wow. And then thanks also for the discussion that allows me, as a noninterventionist, to realize ... It's hard to keep track of what's happening with all the different types of stents and polymers and so on. But could you then summarize for the field, does that mean that these biodegradable ones are now ... Do I sound ignorant when I say that? That they are now really in the game. Is that what it does? Dr Dharam Kumbhani: This whole bioabsorbable field, there are nuances. So this really is testing a bioabsorbable polymer where - Dr Carolyn Lam: Oh! Dr Dharam Kumbhani: So, with every stent you have a stent, you have the polymer, and then you have the drug. Dr Carolyn Lam: Thank you. Dr Dharam Kumbhani: And so, the polymer and the drug go away, and then you're left behind with a bare metal stent. And that's this Yukon stent. Dr Carolyn Lam: Got it. Dr Dharam Kumbhani: The one that has been in the press a lot more is the bioabsorbable scaffold where the stent and the polymer and the drug, everything in theory should be gone at a certain period of time. So this is ... It's an important distinction though. Because I know that it's very confusion when you just say bioabsorbable and it's unclear if you're talking about the polymer or you're talking about the stent, itself. But this really was a bioabsorbable polymer issue, so you're left behind with a bare metal stent at the end of it. Dr Carolyn Lam: Got it, crystal clear, and thank you. That's cool. That's super. Dr Sana Al-Khatib: I agree, for an electrophysiologist too. Dr Carolyn Lam: But now, let's go into the AMI field. There were two trials that really spoke to acute management patients coming in with an AMI and with cardiogenic shock, for example. Gabriel, could you tell us a little bit about the IABP-SHOCK II trial, as well as the really talked about a door-to-unload IMPELLA Trial. Dr Gabriel Steg: The IABP II trial is a randomized trial looking at the benefit, or lack thereof, of intraaortic balloon pump in patients with cardiogenic shock and acute MI. It's been standard practice since the '60s to offer IABP pumping to patients with cardiogenic shocks and AMI. So, literally more than a million patients have been implanted with IABP, but the reality is when we look at the randomized trial evidence of benefit there was none. They were very small trials, inconclusive, underpowered. Professor Thiele from Germany and his colleagues deserve enormous credit for having had the courage to really do what needed to be done. A proper randomized controlled trial, of course open label. And what they found in IABP II, which they already reported a few years ago, was that there was no acute benefit of IABP on survival short term, or for that matter on many of the secondary clinical outcomes looked at in this trial. They subsequently reported one year mortality. What they did here is they gathered follow-up on almost all of the cohort at more than six years. And they found that the long term survival is identical for patients who received an IABP and those who did not. So I think this nails the issue. But there's another thing we learn. The mortality at six years is staggering, it's close to 60%. And although a large fraction of the patients die in the first 30 days, you still have an additional 10% of patients who die between the first year and six years. So there still remains a very sick patient population for whom we need to investigate new strategies. I don't think it's going to be necessarily mechanical. We have to think of all of the strategies we do to prevent and mitigate cardiogenic shock to build up. And that's gets us to the second trial that I'll talk to you about in a minute. Dr Sana Al-Khatib: I have a quick question about this. Did they provide any information about modes of death in these patients? Dr Gabriel Steg: Yes. They did capture information about that. Off the top of my head, I'm unable to provide information, but yes they did capture that. The German system allowed them to retrieve information about causes of death and it's a closed system. It's a national trial, so they were able to get enormous follow-up. Dr Sana Al-Khatib: Because this information can help us inform what interventions are needed next. Dr Gabriel Steg: Yes. That's really important. Dr Dharam Kumbhani: To your point about ... You use a very interesting word, the last nail. That's actually how Dr Hochman addressed her editorial. She wrote a really nice editorial- Dr Gabriel Steg: The leading expert in the field. Dr Dharam Kumbhani: And so, I'm interested in your thoughts. The use of balloon pumps for shock, there's a discrepancy between the American guidelines and the European guidelines. Last year the European guidelines were updated. It is really such a practice changing guideline in that it now lists routine use of balloon pumps in cardiogenic shock- Dr Gabriel Steg: Class III. Dr Dharam Kumbhani: -as a class III indication. Going through training, that was all you had when someone came in with shock, you would throw in a balloon pump. So that's really quite a practice changing event. Dr Gabriel Steg: Yeah. These investigators are embarking on new studies with ECMO and I think it's going to be fascinating to see whether ECMO, which also gets increasingly used worldwide, whether there is evidence to acutely support or not whether this is useful. I think they are doing the proper thing. They are doing the right thing, randomized trials. And we could commend them because these are really difficult trials. Dr Carolyn Lam: Absolutely. Dr Gabriel Steg: In the acute MI setting, shock patients, ECMO, IABP, that's really difficult. They are brave investigators, they are good investigators, and I think they provided the community with a clear answer. Dr Carolyn Lam: And exactly the kind of papers that we like publishing at circulation, isn't it? Now what about the door-to-unload? Dr Gabriel Steg: That is actually a good segue with door-to-unload because if we can't properly treat shock once it's there, can we do something to prevent shock? Can we do something to preserve myocardium? One of the experimental findings that is very clear is that if you unload experimental myocardial infarction, if you unload the left ventricle you reduce infarct size. Dr Gabriel Steg: So, investigators have been trying to translate this experimental finding into the clinical arena using the Impella device. There's enormous interest, particularly in North America for Impella use in acute MI patients with larger infarcts with the idea that if you can unload the left ventricle, you might be able to mitigate the extent of the myocardial infarction, and therefore avoid cardiogenic shock and probably improve prognosis. Although this is a very attractive theoretical concept, it still deserves to be tested. And so, if you want to test it you have to unload the ventricle as soon as possible, ideally before reperfusion, which means that you're going to have to delay reperfusion for the time of implanting the device and unloading the ventricle. And so what the investigators did in this trial is to study whether delaying proposedly by 30 minutes reperfusion, to unload the ventricle for 30 minutes prior to reperfusion, was feasible and reasonably safe. It's a small trial. It's really a pilot trial. By no means does it test the proof of concept of the device or the theoretical issue, but it shows that it's feasible. There doesn't seem to be a massive increase in total time to reperfusion because just by change the group that was not delayed had a longer time to PCI, so eventually things are sort of evening out. They looked at MRI size of infarcts at follow-up. There was no obvious difference, but of course it could still be tied to errors. We're not totally sure about this, but it certainly paves the way for doing a proper proof of concept randomized trial, testing unloading versus no unloading with a true control group. And I think that's what investigators are looking forward, but I understand there's immense interest for this concept in international community, particularly in the United States and I'm quite curious to see what this future trial will look like and what the results will be. Dr Carolyn Lam: Yeah, indeed. Gabriel, I noticed you were very careful to frame it, to say what the trial was trying to address and what it wasn't. And there's been quite a bit of buzz after that. Do you agree with everything Gabriel has said and what have you heard? Dr Dharam Kumbhani: I think he was incredibly eloquent in outlining the premise of the trial and what it really showed. I think the one thing that ... And this was brought up in the very nice editorial by Dr Patel from Duke as well, is it would've been really nice to have a control arm which didn't have any unloading. Because these are not patients with shock, that just directly had primary PCI. And then comparing infarct size. So, I think that was one of the pieces of information that would've been helpful to then put this in perspective. When you have an infarct size of 8% or 10%, how does that compare in the same patient population in their testing? You're absolutely right about the need to do difficult trials like this, where a lot of times it's just assumed to be true and is embraced in clinical practice. As I gave the example about the balloon pump earlier, where as a Fellow you saw someone in shock and your reflex was to put in a balloon pump. And so, I think testing these very difficult patient scenarios, as well as just in terms of trial execution, it's amazing to have two trials on that. Dr Gabriel Steg: If I may come back to this? Dr Carolyn Lam: Yes. Dr Gabriel Steg: It's funny because we've been using the IABP for years, thinking this is what we should do in shock. Now our German colleagues have proven that IABP doesn't work. So a lot of investigators have reverted, saying "Well, we should use Impella." But where is the evidence showing that Impella is beneficial? Dr Dharam Kumbhani: That's right. Dr Carolyn Lam: That's right. Dr Gabriel Steg: We have none, so I think that's a trial that deserves to be done. Dr Dharam Kumbhani: And ECMO. Yeah, exactly. Dr Carolyn Lam: Yeah, ECMO. Exactly. And, you know, going back to door-to-unload, it's important to prove safety in order to go to the next step, which is exactly how you frame- Dr Gabriel Steg: I think it shouldn't be over interpreted. Dr Carolyn Lam: That's how it should be, exactly, received by the community. So that's great. Now let's switch gears a bit. Sana, in EP world, the EP guided noninvasive radio ablation of VT. Fascinating stuff. What are your thoughts? Dr Sana Al-Khatib: I absolutely agree, definitely. This was a phase two study that the authors did. They enrolled 19 patients, so it was a small study, but it was really helpful. Remember, there's a major clinical need there. These are patients who have an ICD, who have recurring ventricular tachycardia, that have been treated with at least one antiarrhythmic medication, at least one catheter ablation procedure, and then what do you do with those patients? This is actually a clinical scenario that comes up frequently and we absolutely need to be looking for more therapies for those patients. So that's what that study was about, trying to explore new ways to treat these patients. To be able to do it noninvasively, I think is fascinating. That's what ... They enrolled these patients. Patients had to have failed these treatments, antiarrhythmic medications, prior catheter ablation, and they underwent noninvasive imaging to really localize the source of the ventricular tachycardia, where it's coming from, and then they subjected them to stereotactic body radiotherapy to ablate those sources of ventricular tachycardia. And, of course, the results were fascinating because they showed on the effectiveness side that this seemed to be very effective because if you look at the reduction in the burden of ventricular tachycardia, and a couple of their patients actually had significant PVCs and PVC induced cardiomyopathy, there was a significant reduction in the rates of these arrhythmias in these patients with this intervention, which was great to see. In fact, to be specific, about 94% of these patients, so 18 out of the 19, had significant benefit. And in about 89% of the patients there was more than 75% reduction in the arrhythmia. So these are actually really interesting findings, especially in a patient population where we really don't have other options. Now of course you're going to ask me about the safety. What are the safety concerns? Of course, this was a primary endpoint for the authors. They did look at safety up to 90 days and they found that there were two significant adverse events that occurred in those 90 days. One was heart failure and one was pericarditis. The concern, of course, with radiation is what else can we expect especially if you follow the patients longer? So certainly we need more data. The authors acknowledged that beautifully and I think their intent is to launch a multi-center randomized clinical trial. I don't know if it will be randomized, but at least a multi-center clinical trial to see if they can replicate those findings. So that was very interesting to see. Dr Carolyn Lam: Yeah it was. Thanks, that was really exciting. So, some exciting trials in my world of cardiometabolic disease too, and I want to highlight two. The CARMELINA trial and the CAMELLIA-TIMI 61. First the CARMELINA trial. This was a secondary analysis of CARMELINA and this was ... CARMELINA, if I can remind everyone, is a cardiovascular outcomes trial, randomizing about 7000 patients with type 2 diabetes and atherosclerotic cardiovascular disease, and/or chronic kidney disease. Randomizing them to the DPP-4 inhibitor linagliptin 5 mg a day versus placebo, following up for a median of about two years. We know that type 2 diabetic patients are at risk of heart failure and there's always been a bit of a question mark when it comes to DPP-4 inhibitors and their risk for heart failure. And so this secondary analysis looks specifically at the hospitalization for heart failure and related events in CARMELINA. The important thing is that all these were prospectively centrally adjudicated events, and this was a pre-specified post hoc analysis. And the summary of it all is that linagliptin was not associated with an increased risk of hospitalization for heart failure or the composite of cardiovascular death in hospitalization or the related outcomes. Importantly, the authors did also sensitivity analyses and interaction analyses to show that the results were consistent whether or not patients had a history of heart failure, which was in 27% of patients, regardless of the baseline ejection fraction that was measured within a year of starting the drug, and also regardless of renal function. So EGFR or urinary albumin to creatinine ratio. This is really important because this trial adds to the growing perhaps understanding of DPP-4 inhibitor heart failure risk. The whole question mark actually came with SAVOR TIMI and that was saxagliptin. But since then there's been three other trials that have showed no heart failure risk. EXAMINE, TECOS, and now CARMELINA. So, an important addition and I think it should reassure us. And then from diabetes and heart failure risk, which is always very hot, but now obesity. The CAMELLIA-TIMI 61 trial looked at renal outcomes in this trial. Now what was this trial? It was actually testing lorcaserin, and that is a selective serotonin 2C receptor agonist, in about 12,000 obese or overweight patients. Basically, the primary results showed that it did not increase any ... It met it's CV safety outcomes with weight loss and so on. But this time they looked at renal outcomes. Because obesity has been known to be associated with hyperfiltration of the kidneys, you get albuminuria and it's apparently worsening of kidney disease. So what we need to know is pharmacological weight loss going to be associated with improved renal outcomes? And basically, that is what CAMELLIA-TIMIA 61 showed. Their renal outcomes were new or persistent albuminuria and then the standard doubling of EGFR or end-stage renal failure, renal transplant or renal death. And that was improved by lorcaserin. Along with that, there was the anticipated reduction in weight, HbA1c, and BP. It does look like, from these late breaking results that we have another tool in our toolbox. Dr Sana Al-Khatib: And for the clinicians out there, which patients should they be thinking to use this medication in? What kind of obesity are we talking about? At what point do you introduce that? Dr Carolyn Lam: This is common garden, just defined by BMI that was above 27. And I don't think they're saying to use it in patients with renal dysfunction, but to sort of say to look and see whether weight loss also associates with renal function improvement, and it does. It's reassuring. Dr Sana Al-Khatib: Yeah, okay. Dr Carolyn Lam: And then ... Okay, let's round up with that last trial. A very interesting one because it's pragmatic mobile health and wellness. Tell us. Dr Dharam Kumbhani: It's really a monumental effort. This is ... I'll be brief, but it's really a phenomenal trial from an epi standpoint and implementation standpoint. This is from India. It was coordinated by the Center for Chronic Disease Control and the Public Health Foundation of India where, as everyone knows, India is now the diabetes capital of the world and chronic diseases have very quickly overtaken other infectious causes as the number one cause of mortality and morbidity. This was a big undertaking, really collaboration from three continents, but it was a community based plus a randomized trial. They had 40 community health centers and what they were trying to see is primarily for hypertension and diabetes. That if you implemented a structure and typically using this mWELLCARE tool, which is basically an electronic medical records storage facility and then it also has inbuilt clinical decision support. And really for hypertension and diabetes management, but also, they had tobacco and alcohol screening, abuse screening, and also for depression. So what they really wanted to do ... A very ingenious endeavor and they try to see if doing this systematically on a clustered randomized fashion if that would actually influence patient outcome. They had a little over 3000 patients and they followed them for 12 months. Unfortunately, the trial, itself, as far as the primary endpoint, which was change in systolic blood pressure and hemoglobin A1c, they had pretty significant reductions in both arms, about 12 to 13 millimeters, which is amazing from a population health standpoint, in both arms not statistically significant, and in hemoglobin A1c also by 0.5% in both arms. Just suggesting that having this more frequent interactions with the medical health system, itself, was driving a lot of this benefit. So although the trial, itself, was negative for the primary endpoint, I think it's a huge step forward for the management of chronic disease epidemiology and burden in developing countries. Dr Gabriel Steg: Neutral. Dr Carolyn Lam: Ah, true. Dr Dharam Kumbhani: Fair point. Dr Carolyn Lam: We've discussed this whole array of seven trials and they are difficult trials. I mean, talk about another difficult type of trial to do, cluster randomized pragmatic trial. It's amazing the breadth of simultaneous publications we've had this year. Thanks again to everyone for introducing this and thank you for joining us today.
Survival in patients with advanced heart failure (AHF) has improved over the last 2 decades. An increasing number of patients however, are dying with progressive heart failure over the same duration. Optimal utilization of medical therapies and devices like implantable defibrillators and biventricular pacemakers are the likely reasons patients are surviving longer albeit with progressive HF. Evolution in mechanical circulatory support (MCS) devices has occurred over the same period, such that they can now be rapidly instituted providing support for pump failure, often percutaneously, with timely restitution of physiologic and metabolic derangements with fewer complications. MCS devices can be classified as Short term and Long term. Short term devices such as Intraaortic balloon pumps (IABP), Impella ®, TandemHeart® or Venoarterial extracorporeal membrane oxygenation (VA – ECMO) using a Cardiohelp® device, are usually employed as ‘Bridge to Recovery’(BTR) or Bridge to Decision’(BTD), usually in acute settings. Long term devices such as implantable left ventricular assist devices (LVADs) e.g. Heartmate II® & 3®, Heart ware HVAD® are implanted as ‘Bridge to transplant’ (BTT) or ‘Destination therapy’ (DT) usually in patients ‘sliding’ on inotropes when they are transplant eligible (BTT) or ineligible (DT) respectively. Ventricular assist devices have traditionally been developed for left ventricular support in case of severe left heart or biventricular dysfunction. Historically, right ventricular (RV) dysfunction following LVAD implantation or as a component of biventricular dysfunction was managed with either medical therapy, temporary VADs (i.e. ECMO configuration with continuous flow centrifugal pumps like CentriMag®, Rotaflow ®) or occasionally with LVADs placed on the right side. Recently the Impella RP® and ProtekDuo®, percutaneously placed pumps with inflow in the inferior vena cava & right atrium respectively and outflow in pulmonary artery, have become available as less invasive options, for short term RV support. The Syncardia® is the only approved total artificial heart system currently in use; however various biventricular, total heart systems (e.g. BiVACOR®) in development show promise. Mechanical circulatory devices provide attractive, viable, physiologically plausible ventricular support options that can be used effectively in carefully selected patients.
La cardiomiopatía de takotsubo es un fallo cardiaco usualmente transitorio que puede imitar un síndrome coronario agudo y ocurre luego de un estresor físico o emocional significativo. Signos y síntomas típicos de un síndrome coronario agudo Dolor de pecho luego de un disturbio emocional Cambios en el electrocardiograma que sugieren un infarto Dificultad para respirar Anomalías en movimiento de ventrículo izquierdo (hipocinesis o acinesis) La cardiomiopatía de takotsubo ocurre casi exclusivamente en mujeres. El término "tako-tsubo" significa en japonés "olla de pulpo". La hipocinesia o acinesia del ventrículo izquierdo hace que el corazón tenga cierto parecido a esta olla cuando se observa por ecocardiografía. El siguiente video muestra el ultrasonido cardiaco durante y después de la resolución del síndrome: https://youtu.be/wgBPdD0v-1o Takotsubo es un imitador de STEMI La cardiomiopatía de takotsubo se manifiesta exactamente igual que cualquier otro síndrome coronario agudo. De hecho, ¡puede inclusive tener elevación en el segmento ST en el EKG! A pesar de que se ve igual que un infarto al miocardio con elevación de segmento ST (STEMI), la cardiomiopatía de takotsubo no es un STEMI. Es difícil, y hasta a veces imposile, hacer un diagnóstico prehospitalario de takotsubo. El manejo inicial sigue siendo exactamente igual al de un infarto agudo al miocardio con elevación del segmento ST, según enseñado en el curso de Soporte Vital Cardiovascular Avanzado (ACLS). No es un STEMI pero puede ser fatal El hecho de que la cardiomiopatía de takotsubo no sea realmente un STEMI no significa que no sea importante. La hipocinesia o acinesia del ventrículo izquierdo en los pacientes con takotsubo hace que puedan desarrollar fallo cardiaco que puede resultar en shock cardiogénico. En este caso, la resucitación del paciente en shock cardiogénico ocurre de forma tradicional. De igual manera, el paciente puede desarrollar arritmias súbitas tales como taquicardia ventricular o fibrilación ventricular. También pueden desarrollar bloqueos de conducción atrioventricular. El fallo cardiaco puede durar varias semanas y puede tardar 2 meses en recuperarse totalmente. En algunos casos se ha reportado el uso del balón de contrapulsación aórtica para mantener perfusión coronaria. Pero también hay reportes recientes (2018) de deterioro hemodinámico luego del uso del IABP cuando hay obstrucción en el tracto de salida (LVOTO). Criterios de diagnóstico de takotsubo El diagnóstico de la cardiomiopatía de takotsubo requiere tener cuatro criterios: Hipocinesis de un segmento del ventrículo izquierdo que se extiende más allá del territorio de una arteria coronaria, usualmente luego de un evento estresor Ausencia de enfermedad coronaria obstructiva o evidencia angiográfica de ruptura de placa Anomalías nuevas en ECG (elevación de segmento ST o inversión de onda T) Ausencia de feocromocitoma o miocarditis Por qué ocurre La enfermedad fue reportada por primera vez relativamente recientemente en el 1990 por Sato et al, pero aún está bajo investigación. Aunque hay varias teorías, una de las más importantes sugiere que las catecolaminas que libera el cuerpo cuando está bajo estrés sobrecargan el corazón. El segmento del ventrículo izquierdo que se afecta y deja de funcionar coincidentalmente es la parte del corazón que tiene más sensores para las catecolaminas. https://youtu.be/nBuvk59I480 Referencias https://emedicine.medscape.com/article/1513631-overview https://www.health.harvard.edu/heart-health/takotsubo-cardiomyopathy-broken-heart-syndrome http://circ.ahajournals.org/content/124/18/e460 https://www.bhf.org.uk/heart-health/conditions/cardiomyopathy/takotsubo-cardiomyopathy http://www.revespcardiol.org/es/discinesia-medioventricular-izquierda-transitoria-aspectos/articulo/13116662/
Intra-aortic Balloon Pump Counterpulsation therapy is a miracle of modern science that has roots going to the 1960's. We have come a long way since those days and now, although not a high volume request, flight crews are regularly transporting patients with these lifesaving devices in place. Because this service is not a high volume request, it's very important to ensure you understand how an IABP works, what the numbers mean, and how you can help and hinder the mechanical function through the use of medications. Did you know that by giving a medication you believe could help stabilize your patient's blood pressure, you may actually be potentiating the deficit the patient's weak, and fragile heart is already experiencing? Download and join us as Eric Bauer takes us through the IABP Pearls. If you love what you are hearing from us, please take a moment and review our show in iTunes, Stitcher, Google Play Music, or wherever you get your podcasts. Your review could mean the difference in others like you hearing this information, or not. Be a part of building the future of pre-hospital, critical care, and emergency medicine!See omnystudio.com/listener for privacy information.
Intra-aortic Balloon Pump Counterpulsation therapy is a miracle of modern science that has roots going to the 1960’s. We have come a long way since those days and now, although not a high volume request, flight crews are regularly transporting patients with these lifesaving devices in place. Because this service is not a high volume request, it’s very important to ensure you understand how an IABP works, what the numbers mean, and how you can help and hinder the mechanical function through the use of medications. Did you know that by giving a medication you believe could help stabilize your patient’s blood pressure, you may actually be potentiating the deficit the patient’s weak, and fragile heart is already experiencing? Download and join us as Eric Bauer takes us through the IABP Pearls. If you love what you are hearing from us, please take a moment and review our show in iTunes, Stitcher, Google Play Music, or wherever you get your podcasts. Your review could mean the difference in others like you hearing this information, or not. Be a part of building the future of pre-hospital, critical care, and emergency medicine!
In this fascinating podcast, I have the great opportunity to chat to Dr Ed Litton from the Fiona Stanley Hospital in Perth, Western Australia Ed is a well known critical care researcher who is leading the PINBALL program of clinical research into the role of the Intra-Aortic Balloon Pump in high risk cardiothoracic surgery.
Commentary by Dr. Valentin Fuster
Louisville Lectures Internal Medicine Lecture Series Podcast
In this lecture, Dr. Lorrel Brown takes time to discuss the indications, mechanics, and physiology of mechanical circulatory support. She provides a great introduction for internists to some of the most advanced ICU therapies. Dr. Lorrel Brown covers evidence and indications for various modalities like IABP (intra-aortic balloon pump), ECMO (extracorporeal membrane oxygenation), and percutaneous VAD (ventricular assist device). Some items in this lecture may have come from the lecturer’s personal academic files or have been cited in-line or at the end of the lecture. For more information, see our citation page. Disclaimers©2016 LouisvilleLectures.org
In this episode of The FlightBridgeED Podcast Eric is joined by Kelly Miller, Regional Clinical Manager for Air Methods, Inc., to demystify the technical and physiologic application of the intra-aortic balloon pump (IABP). These devices have come a long way over the course of their lives, and in the wake of their continued development lives have been saved and outcomes have been improved. It’s important that we as providers constantly refresh on the operation and application of the IABP since they are a low volume niche of our transport population. Join us as we unpack the ballon pump, and get the industry professional tips and tricks you need to succeed.
In this episode of The FlightBridgeED Podcast Eric is joined by Kelly Miller, Regional Clinical Manager for Air Methods, Inc., to demystify the technical and physiologic application of the intra-aortic balloon pump (IABP). These devices have come a long way over the course of their lives, and in the wake of their continued development lives have been saved and outcomes have been improved. It's important that we as providers constantly refresh on the operation and application of the IABP since they are a low volume niche of our transport population. Join us as we unpack the ballon pump, and get the industry professional tips and tricks you need to succeed.See omnystudio.com/listener for privacy information.
In this episode of The FlightBridgeED Podcast, a perfect storm is rising over a terribly complicated case. Juggling a multitude of therapies and way behind, the flight team must fight to keep their heads above water. Find out what happens as the flight team and patient struggle for survival!
In this episode of The FlightBridgeED Podcast, a perfect storm is rising over a terribly complicated case. Juggling a multitude of therapies and way behind, the flight team must fight to keep their heads above water. Find out what happens as the flight team and patient struggle for survival!See omnystudio.com/listener for privacy information.
Litton investigates the use of the intra-aortic balloon pump in high risk patients.
Background: The number of patients presenting with acute myocardial infarction (AMI) and being untreatable by interventional cardiologists increased during the last years. Previous experience in emergency coronary artery bypass grafting (CABG) in these patients spurred us towards a more liberal acceptance for surgery. Following a prospective protocol, patients were operated on and further analysed. Methods: Within a two year interval, 127 patients (38 female, age 68 +/- 12 years, EuroScore (ES) II 6.7 +/- 7.2%) presenting with AMI (86 non-ST-elevated myocardial infarction (NSTEMI), 41 STEMI) were immediately accepted for emergency CABG and operated on within six hours after cardiac catheterisation (77% three-vessel-disease, 47% left main stem stenosis, 11% cardiogenic shock, 21% preoperative intraaortic balloon pump (IABP), left ventricular ejection fraction 48 +/- 15%). Results: 30-day-mortality was 6% (8 patients, 2 NSTEMI (2%) 6 STEMI (15%), p=0.014). Complete revascularisation could be achieved in 80% of the patients using 2 +/- 1 grafts and 3 +/- 1 distal anastomoses. In total, 66% were supported by IABP, extracorporal life support (ECLS) systems were implanted in two patients. Logistic regression analysis revealed the ES II as an independent risk factor for mortality (p
Ms. Davis was trained as an Auditory Integration Training (AIT) practitioner by Dr. Berard (the founder of AIT) in 1992, was certified as a Berard Instructor of AIT by Dr. Berard, was one of the original 50 members of the International Association of Berard Practitioners (IABP), and was asked by Dr. Berard to take on the administration of the IABP, prior to its disbandment. Dr. Berard gave Ms. Davis special credentials to work with children under the age of 3 who can benefit from AIT because of her audiological area of expertise. Ms. Davis’ research has also identified that AIT retrains the acoustic reflex muscle in the middle ear, allowing better transmission of ‘clearer’ sound to the cochlea and subsequently to the brain for comprehension. She was voted to be one of the founding 12 members of the AIT-Pro Steering Committee to establish a foundation for AIT professionals world wide. She is also a member of the current Berard AIT Practitioners group and holds the Certification Mark distinguishing her as a Certified Berard AIT Practitioner
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