Podcasts about Infarction

Lancet 1993;342:821-28.Background The Survival After Ventricular Enlargement (SAVE) trial demonstrated that administration of the angiotensin converting enzyme inhibitor (ACEi) captopril, following MI complicated by LV dysfunction (EF ≤40%) but without clinical heart failure significantly improved morbidity and mortality over 3.5 years of follow-up. Yet many post-MI patients at the time had clinical heart failure and this represented a vulnerable population of patients with significantly increased morbidity and mortality compared to those without clinical heart failure. The Acute Infarction Ramipril Efficacy (AIRE) trial sought to test the hypothesis that administration of Ramipril to patients with AMI complicated by acute congestive heart failure would reduce morbidity and mortality vs a placebo. Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber.Patients Eligible patients were 18 years of age or older with a definite AMI occurring 2 to 9 days prior to randomization with clinical evidence of congestive heart failure at any time after the index MI. While clinical evidence of heart failure was mandatory for study entry, it could be transient and not necessarily present at the time of randomization. Patients were excluded with NYHA IV heart failure (these patients would receive ACEi therapy regardless), heart failure of primary valvular or congenital etiology, or patients with any recognized contraindications to ACEi therapy were excluded.Baseline characteristics The average age of patients was 65 years and 74% were men. Approximately one quarter of patients had had a prior MI, 12% had diabetes, 30% had hypertension and smoking status was not listed. The ejection fraction of study participants was not systematically assessed as part of the study protocol. 62% had a Q wave MI and the predominant location was anterior. The mean time to randomization was 5 days. Approximately 60% of patients received thrombolysis. The average blood pressure and heart rate were not provided. At the time of randomization 22% of patients were receiving a beta blocker and 12% digoxin.Many more patients (52,019) were reviewed than ultimately enrolled (1,986). The main reasons for exclusion were no definitive MI (21,302) and no definite heart failure (16,989). The authors estimate that among eligible patients with a definitive MI and heart failure that approximately half were enrolled. Information on those enrolled versus not enrolled was not provided.Procedures Patients were initiated on Ramipril 2.5 mg twice daily or matching placebo for 2 days after which the dose was increased to 5 mg twice daily. If patients could not tolerate the 5 mg twice daily dose they were discharged on 2.5 mg twice daily. For patients who could not tolerate the 2.5 mg dose they were given 1.25 mg twice daily for 2 days with attempts to up-titrate to 2.5 mg and 5 mg at discharge. For patients that could not tolerate at least 2.5 mg twice daily at discharge they were NOT discharged on the 1.25 mg dose. These patients were withdrawn from study treatment but followed up at the prespecified visit intervals and were included in the intention-to-treat analysis.Outpatient visits were scheduled at 1 month and 3 months following discharge from the index hospitalization and every 3 months thereafter until study close. Monitoring of renal function and electrolytes was done at the discretion of study investigators based on their normal practice. During follow up patients could be started on any medication with exception of an ACEi.Endpoints The primary study endpoint was all-cause mortality. The secondary endpoint was time to first event including (death, progression to NYHA class 4 heart failure, reinfarction or stroke).The investigators estimated they would need a sample size of 2,000 patients to detect a 25% relative reduction in the risk of death with 80% power and 2-sided alpha of 5%. This was based on an estimated death rate of 20% at 15 months in the placebo group and 15% in the Ramipril group.Results 2,006 patients were recruited from 144 centers in 14 countries. However, 20 patients from 1 center were excluded from the final analysis due to inconsistencies in the data. According to investigators the exclusion of these patients did not meaningfully change the final results. The final analysis included 1,986 patients; 1004 in the Ramipril group and 982 in the placebo group.90% of study participants were discharged from the hospital on study drug. In the Ramipril group, 77% were on the 5 mg dose, 14% were on the 2.5 mg dose and 9% were on no therapy. In the placebo group, 86% were on the 5 mg dose, 7% on the 2.5 mg dose and 7% on no therapy.Patients were followed for an average of 15 months and only 1 was lost to follow-up. Compared to placebo, Ramipril significantly reduced all cause death by 27% (17% vs 23%; p = 0.002). Ramipril also significantly reduced the secondary composite endpoint of time to first validated event (including death, progression to severe heart failure, reinfarction or stroke) by 19% (28% vs 34%; p = 0.008). Differences in this composite endpoint were mainly driven by death and progression to severe heart failure.Examination of subgroups showed no evidence of treatment effect heterogeneity but again, similar to the SAVE trial, the size of the trial limits subgroup testing.Premature withdrawals from study drug, not including death, occurred in 352 patients in the Ramipril group compared to 318 in the placebo group. Intolerance to the drug was cited as a factor in 126 of the Ramipril withdrawals and 68 of the placebo withdrawals whereas progression to severe heart failure was cited in 58 Ramipril withdrawals and 92 placebo. Syncope was more common in Ramipril treated patients compared to placebo (2.4% vs 1.7%) and so was hypotension (4.2% vs 2.3%) but not renal failure (1.5% vs 1.2%).Conclusions In patients with AMI complicated by clinical congestive heart failure, Ramipril significantly reduced death over 1.3 years of follow-up with a number needed to treat of approximately 17 patients. Ramipril also significantly reduced a composite of events, which were mainly driven by death and progression to severe heart failure. Unlike the SAVE trial, which did not estimate a particular sample size for hypothesis testing, AIRE was specifically designed to test whether Ramipril would reduce death by 25% over 15 months and indeed, it did! Thus, results from AIRE not only support but add legitimacy to findings from SAVE.One perceived limitation of AIRE, particularly when viewed through a contemporary lens, is its lack of ejection fraction estimation. There should be no doubt that these were sick patients in whom, significant LV dysfunction would have been present in most. We base this claim on the observation that the death rate in AIRE at 1.3 years in the placebo group was nearly equal to SAVE at 3.5 years (23% vs 25%). This highlights that development of clinical heart failure (regardless of LV function) confers a worse prognosis than LV dysfunction without heart failure.In our opinion, the external validity of AIRE is high for a trial performed 30 years ago. The average start date for treatment was 5 days post MI complicated by clinical heart failure. This is longer than we would anticipate in contemporary practice by 2 or 3 days but not unreasonable, especially for post-MI patients with tenuous hemodynamics requiring intravenous diuretic therapy. Furthermore, the dose titration parameters and follow up schedule in AIRE can be approximated in clinical practice. Also, no obvious treatment effect heterogeneity was noted across important subgroups (e.g., age > vs < 65 years) but these analyses are limited due to the overall sample size. Finally, no strict limits were placed on blood pressure and heart rate at study entry.Thank you for reading Cardiology Trial's Substack. This post is public so feel free to share it. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe

Discover the inspiring journey of Bobbie-Anne Hutchinson, a mom who faced trauma, lost a child to a brain tumor, and battled cerebral infarctions. Her strength shines through. The post Multiple Cerebral Infarction Recovery – Bobbie-Anne Hutchinson appeared first on Recovery After Stroke.

VISIT US AT ⁠⁠⁠NCLEXHIGHYIELD.COM⁠⁠⁠ SUBSCRIBE TO OUR YOUTUBE CHANNEL: ⁠⁠⁠YOUTUBE.COM/NCLEXHIGHYIELD⁠⁠⁠ No matter where you are in the world, or what your schedule is like, access the entire course at ⁠⁠⁠⁠⁠www.NCLEXHighYieldCourse.com⁠⁠⁠⁠⁠  The NCLEX High Yield Podcast was featured on ⁠⁠⁠⁠⁠Top 15 NCLEX Podcasts⁠⁠⁠⁠⁠! Make sure you ⁠⁠⁠⁠⁠JOIN OUR NEW VIP FACEBOOK GROUP!⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠https://nclexhighyield.com/blogs/news/nclex-high-yield-quick-links⁠⁠⁠⁠⁠ A topic that confuses many, but listen to how Dr. Zeeshan breaks this bad boy down! Many people get overwhelmed with all the information that's out there, we keep it simple! Join us weekly for FREE Zoom Sessions and be one of the many REPEAT test takers that passed the exam by spending NO MONEY with NCLEX High Yield! NCLEX High Yield is a Prep Course and Tutoring Company started by Dr. Zeeshan in order to help people pass the NCLEX, whether it's the first time , or like the majority of our students, it's NOT their first time. We keep things simple, show you trends and tips that no one has discovered, and help you on all levels of the exam! Follow us on Instagram: ⁠⁠@NCLEXHighYield ⁠⁠or check out our website www.NCLEXHighYield.com Make sure you join us for our FREE Weekly Zoom Sessions! Every Wednesday 3PM PST / 6PM EST. Subscribe to our newsletter at ⁠⁠⁠⁠nclexhighyield.com⁠⁠⁠⁠ --- Support this podcast: https://podcasters.spotify.com/pod/show/nclexhighyield/support

Episode 852-Robots in Comics, December Beast Wars, Heart Attack Infarction, Thrawn Rebounds, Final Orders-JUSTICE LEAGUE VS GODZILLA VS KONG #1 & HACK SLASH BACK TO SCHOOL #1Sneak Peek at Next Week w/ Kyle & Drew-INVINCIBLE IRON MAN #10 & USAGI YOJIMBO ICE & SNOW #1Buy the revolutionary Magic Mind productivity drink, the ultimate solution to boost your focus, energy, and productivity. Made from all-natural ingredients, this drink is designed to enhance your cognitive function and provide you with sustained energy throughout the day, without the crash often associated with caffeine-based products. Go to https://www.magicmind.co/comicsfunprofit And get up to 56% off your subscription for the next 10 days with our code CFPThank you so much for listening and spreading the word about our little comic book podcast.   Patreon https://www.patreon.com/comicsfunprofit  Merch https://comicsfunprofit.threadless.comYour Support Keeps Our Show Going On Our Way to a Thousand EpisodesDonate Here https://bit.ly/36s7YeLAll the C4FaP links you could ever need  https://beacons.ai/comicsfunprofit Listen To the Episode Here: https://comcsforfunandprofit.podomatic.com/ 

Listen as Dr. London Smith (.com) and his producer Cameron discuss Anterior Spinal Artery Infarction with special guest Tony (Paul Heredia).  Sponsored by Caldera + Lab (use code "jockdoc" to get 20% off!). Not so boring! https://calderalab.com/pages/podcast-special-offer?show=Jock+Doc&utm_medium=podcast&utm_source=JocDoc https://www.patreon.com/join/jockdocpodcast Hosts: London Smith, Cameron Clark. Guest: Paul Heredia. Produced by: Dylan Walker Created by: London Smith

In this week's episode we review the important topic of troponin levels in children. What is an abnormal high sensitivity troponin level in children and do the levels vary based upon the assay? What are the differences between high sensitivity troponin I and T levels? Are there differences between boys and girls? Why would using the 97.5%ile upper reference limit result in a more reliable 'line in the sand' in comparison with the more traditional, high sensitivity troponin level cut off of 99th%ile. These are amongst the questions we review with this week's author, Dr. J. Bill McEvoy, Professor of Preventive Cardiology at University of Galway, Ireland. DOI: 10.1161/CIRCULATIONAHA.122.063281

When you are managing a patient in cardiac arrest, do you turn to bedside ultrasound? EMRA*Cast host Dustin Slagle, MD, talks to ultrasound guru Michael Gottlieb, MD, RDMS, about when you should, how it can be useful, and the best way to incorporate POCUS into the plan.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.04.24.538047v1?rss=1 Authors: Hood, R. J., Sanchez Bezanilla, S., Beard, D. J., Rust, R., Turner, R. J., Stuckey, S. M., Collins-Praino, L. E., Walker, F. R., Nilsson, M., Ong, L. K. Abstract: Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

ST-segment elevation myocardial infarction (STEMI) is a term that all emergency medicine residents learn and commit to memory early on. This term is far from perfect, however, and some physicians think it should be thrown out altogether. In this episode, host Masood Mohammed (@DocMooseEM) chats with Dr. Susy DeMeester (@SusyDemeester) about why ‘STEMI' misses the mark and what we can do to fix it.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2023.03.27.534410v1?rss=1 Authors: Shi, S. X., Li, Y.-J., Wendt, T. S., Shi, K., Jin, W., Liu, Q., Gonzales, R. J. Abstract: Sphingosine-1-phosphate receptor 1 (S1PR1) is highly expressed in endothelial cells and receptor activation plays an important role in mediating endothelial function and health, thus showing promise as a pharmacologic target for acute ischemic stroke (AIS) treatment. Here, we examined the effect of a selective S1PR1 ligand, RP101075, on infarct volume and neurological outcome in adult male mice subjected to transient middle cerebral artery occlusion (tMCAO). Concomitantly, we examined S1PR1 expression profile in the ischemic mouse brain, as well as S1PR1 expression and impact of receptor activation on human brain microvascular endothelial cell (HBMEC) proliferation and survival following hypoxia plus glucose deprivation (HGD). We observed that RP101075 administration at onset of reperfusion reduced infarct volume and lessened neurological deficits in tMCAO mice and these responses were S1PR1 dependent. Additionally, we observed that tMCAO increased brain S1PR1 protein levels and flow cytometry revealed increases in S1PR1 levels are greatest in brain endothelial cells compared to other brain cell types (astrocyte, neuron, microglia). In cultured HBMECs, RP101075 increased cell proliferation and ozanimod, parent compound of RP1010175, increased live cell count during HGD; this response was S1PR1 dependent. In conclusion, S1PR1 activation improves neuroprotection/outcome post-stroke and preserves brain endothelial cell survival following ischemia-like injury. Copy rights belong to original authors. Visit the link for more info Podcast created by Paper Player, LLC

CardioNerds (Amit and Dan) join Dr. Maria Pabon (cardiology fellow), Dr. Kevin Bersell (cardiology fellow), Dr. Saad Sultan Ghumman (interventional cardiology fellow), and Dr. Rhanderson Cardoso (cardiovascular imaging fellow) from Brigham and Women's Hospital. Together, they explore a complex case of STEMI that was further complicated by ventricular free wall rupture. Additionally, Dr. Ajar Kochar, Program Director for Interventional Cardiology at Brigham and Women's Hospital, provides an insightful "ECPR" segment, adding a unique perspective to the case. Audio editing by CardioNerds Academy Intern, student doctor Chelsea Amo Tweneboah. This is the case of a patient who presented with STEMI and was found to have a moderate pericardial effusion with echogenic material within the pericardial space concerning for thrombus. Urgent CTA/CT surgery was engaged due to concern for dissection, but no evidence of dissection, rupture or intramural hematoma was found. The patient underwent an urgent pericardiocentesis which yielded 350cc of hemorrhagic fluid, leading to an improvement in hemodynamic status. A coronary angiogram was performed which showed a 100% thrombotic occlusion of OM 1, the culprit lesion for the STEMI. Due to the possibility of a delayed STEMI and high suspicion for mechanical complication of MI, aspirin and IV cangrelor were chosen as the preferred antiplatelet strategy. However, cangrelor was held and cardiac surgery was consulted, as LV free wall rupture was suspected. The patient underwent urgent repair of the LV free wall rupture, with an uneventful post-op recovery and discharge on day 8 to cardiac rehab. CardioNerds is collaborating with Radcliffe Cardiology and US Cardiology Review journal (USC) for a ‘call for cases', with the intention to co-publish high impact cardiovascular case reports, subject to double-blind peer review. Case Reports that are accepted in USC journal and published as the version of record (VOR), will also be indexed in Scopus and the Directory of Open Access Journals (DOAJ). CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media Pearls - When Infarction Brings the Walls Down - Brigham and Women's Hospital In the era of primary PCI, mechanical complications of MI are relatively rare. Timely recognition using multi-modality imaging and prompt surgical intervention can result in favorable outcomes. An approach that involves a Heart Team can be advantageous in optimizing outcomes in such complex cases. Show Notes - When Infarction Brings the Walls Down - Brigham and Women's Hospital Incidence of post AMI LV free wall rupture: 0.1-1% Risk factors for LV Free wall Rupture: Older age Female sex Prior HTN 1st lateral or Anterior Wall MI Protective factors towards free wall rupture: LV hypertrophy CHF Hx of prior infarcts Chronic ischemic heart disease Early use of beta blockers post MI Timely intervention Incidence of Mortality associated with mechanical rupture related to AMI: 8-10% When to suspect a mechanical complication of AMI: AMI with shock/hypotension New murmur New pericardial effusion > 10mm on bedside echo Other etiologies that can cause free wall rupture: Trauma Cardiac infection Aortic dissection Cardiac tumors Infiltrative diseases Iatrogenic from PCI or surgical procedures References - When Infarction Brings the Walls Down - Brigham and Women's Hospital Varghese S, Ohlow MA. Left ventricular free wall rupture in myocardial infarction: A retrospective analysis from a single tertiary center. JRSM Cardiovasc Dis. 2019 Jan-Dec;8:2048004019896692. doi: 10.1177/2048004019896692. PMID: 31970072. Pineda-De Paz, D.O.,

MedLink Neurology Podcast is delighted to feature selected episodes from BrainWaves, courtesy of James E Siegler MD, its originator and host. BrainWaves is an academic audio podcast whose mission is to educate medical providers through clinical cases and topical reviews in neurology, medicine, and the humanities, and episodes originally aired from 2016 to 2021. Originally released: May 31, 2018 Unfortunately, stroke is all too common. Nearly 1 million new strokes are diagnosed in the United States each year. And this means that complications of stroke--even if rare--may also be common. One such complication is hemorrhagic transformation. This week, Dr. Ava Liberman reviews a clinical case of hemorrhage following ischemic stroke. Produced by James E Siegler. Music by Ghost, Kevin McLeod, and Scott Holmes. Voiceover by David Manly. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Benjamin EJ, Virani SS, Callaway CW, et al. Heart Disease and Stroke Statistics-2018 Update: A Report From the American Heart Association. Circulation 2018;137(12):e67-492. Erratum in: Circulation 2018;137(12 ):e493. PMID 29386200 Frontera JA, Lewin JJ 3rd, Rabinstein AA, et al. Guideline for Reversal of Antithrombotics in Intracranial Hemorrhage: A Statement for Healthcare Professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocrit Care 2016;24(1):6-46. PMID 26714677 Prabhakaran S, Gupta R, Ouyang B, et al. Acute brain infarcts after spontaneous intracerebral hemorrhage: a diffusion-weighted imaging study. Stroke 2010;41(1):89-94. PMID 19892994  We believe that the principles expressed or implied in the podcast remain valid, but certain details may be superseded by evolving knowledge since the episode's original release date.

Full article: https://www.ajronline.org/doi/abs/10.2214/AJR.22.28852  Eymen Ucisik, MD discusses a recently published AJR article aiming to explore the potential of the insular ribbon involvement on the initial MRI as a marker of tissue fate by analyzing serial follow up MRI findings and the affected patients' clinical outcomes. It is relevant for the general radiologists and neurologists since it may help identify patients who could benefit from late-window reperfusion treatments or neuromodulation treatments.

In this episode, we review the high-yield topic of Renal Infarction from the Renal section. Follow Medbullets on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbullets --- Send in a voice message: https://anchor.fm/medbulletsstep1/message

Why Combination Lipid-Lowering Therapy Should be Considered Early in the Treatment of Elevated LDL-C For CV Risk Reduction Mini G Varughese, MD; Matthew Deshotels, MD; Christie M. Ballantyne, MD, FACC    

The Journal RETINA is devoted exclusively to diseases of the retina and vitreous. These podcasts are intended to bring to its listeners summaries of selected articles published in the current issue of this internationally acclaimed journal.

Mark DeVol from You Can Bet on That joins Tim Lawson to go over a group of episodes from Rick and Morty, Community and Scrubs, culminating with "My Ocardial Infarction from Scrubs. After their discussion, Tim previews a couple of new endeavors coming from The Bettor Life.Co-host: @YouCanBetOnThatShow: @TheBettorLife

In this radiology lecture, we discuss the chest x-ray and CT appearance of pulmonary infarction in the setting of acute The post Radiology Case of the Week: X-ray & CT of Pulmonary Infarction appeared first on Radiologist Headquarters.

On this episode Dave is joined by Dr. Jerry W. Jones, MD FACEP FAAEM, to discuss why ST elevation is not always an infarction. Dr. Jones will highlight why we need to think about morphology and shape when interpreting ECGs and why reciprocal changes are just as important as the primary changes and more!    Dr. Jones is the CEO and Founder of Medicus of Houston. Medicus of Houston is a continuing medical education company that specializes in advanced ECG interpretation and instruction.  He is a Board-certified emergency physician, author, speaker, instructor and and internationally-recognized expert in electrocardiography. Dr. Jones is a diplomate of the American Board of Emergency Medicine who has practiced internal medicine and emergency medicine for over 40 years. Also In This Episode How to diagnose real infarctions How ischemia damages the cell Cells creating electrical current How electrical current creates is responsible for ST depression and elevation Systolic and Diastolic currents of injury How not to confuse subendocardial ischemia with reciprocal change    Subscribe to the video version of this podcast to have access to the visuals that accompany the audio as well as additional tools and resources to help improve your understanding.  Subscribe now at CurrentECG.com  And Stay Current!  

MINOCA=Myocardial Infarction with Non-Obstructive Coronary Arteries

Radiology 202107 9.50 infarction pattern

2019509 nejm Extended infarction treating window

People Get admitted and discharged from the hospital every day- What we don't want is to come back within 30 days of that last admission. Face it No one wants to be in the hospital and NO ONE wants to be back within 30 days of being discharged or at all! There's no place like home ! Lets keep you there by talking about which conditions are the ones that can cause the most readmissions and how to prevent that. And yes I do say Myocardial Infection not Infarction. Told you it's all me in all my glory ready or not I do not edit- I just upload. You get a very raw Joyce. Text or call 847-809-1214 for questions or comments. #advocate #privateadvocate

On this week's episode, JD must deal with the fact that Elliot has become a better doctor than him. In the real world, Zach's sound pad is finally operational! Joelle's co-hosting the Snyder Cut Red Carpet, and the guys discuss the 2000's thong craze. Apply to date Joelle @ datejoellemonique@gmail.com. Buy tickets to the live show here: https://onlocationlive.com/product/fake-doctors-real-friends Learn more about your ad-choices at https://www.iheartpodcastnetwork.com

Mark DeVol from You Can Bet on That joins Tim Lawson to go over a group of episodes from Rick and Morty, Community and Scrubs, culminating with "My Ocardial Infarction from Scrubs. After their discussion, Tim previews a couple of new endeavors coming from The Bettor Life. Guest co-host: @YouCanBetOnThat Show: @TheBettorLife Use promo code "YOELEVEN" for 11% off at The Bettor Life online shop: TheBettorLife.us/merch Support the show with a monthly pledge at Patreon.com/TheBettorLife Please, take a moment to leave us a rating and review in your podcast app of choice like iTunes, Stitcher, or Spotify.

As defined by the International Classification of Headache Disorders-3, persistent migraine aura without infarction is a rare but well documented condition. There should be persistence of a migraine aura for more than one week without radiographic evidence of infarction. Please stay on Podbean and listen to my other podcasts to learn about migraine.This is a podcast by Britt Talley Daniel MD, member of the American Academy of Neurology,  migraine textbook author, podcaster, and blogger.Check out my books on Migraine on Amazon.Follow my webpage at www.doctormigraine.com.Titles: Migraine-400 page textbook, and Volume 1 of the Mini Neurology Series, Migraine-40 page book.  Both books are offered as print or eBooks.All the best.Follow me at:  www.doctormigraine.com, Pinterest, Amazon books, Podcasts, and YouTube.Britt Talley Daniel MD 

Why is it important to have clear diagnostic criteria to use when assessing cardiac rupture in the mouse model of permanent occlusion myocardial infarction? Listen as Deputy Editor Merry L. Lindsey (University of Nebraska Medical Center) interviews lead author Nikolaos Frangogiannis (Albert Einstein College of Medicine) and expert Kristine DeLeon-Pennell (Medical University of South Carolina) about the new study by Hanna et al which compared results from their in-depth histopathological examination with visual inspection of cardiac rupture. Frangogiannis and co-authors found that identifying the rupture site had high specificity but low sensitivity, with a low rate of false positives. Conversely, identifying hemothorax had high sensitivity yet low specificity. Hanna et al. observed key sex differences in their non-reperfusion mouse model of MI. In addition, differences in macrophages and fibroblasts in mice of both sexes which died of cardiac rupture indicated that a perturbed balance of inflammatory mediators may be a factor in the pathogenesis of cardiac rupture. What is the key take-away? When evaluating the cause of death in infarcted mice, look for the rupture site. Listen now.   Anis Hanna, Arti V Shinde, and Nikolaos G. Frangogiannis Validation of diagnostic criteria and histopathological characterization of cardiac rupture in the mouse model of non-reperfused myocardial infarction Am J Physiol Heart Circ Physiol, published October 15, 2020. DOI: doi.org/10.1152/ ajpheart.00318.2020

CardioNerds (Amit Goyal & Daniel Ambinder) join Houston Methodist cardiology fellows (Isaac Tea, Stephanie Fuentes, Peter Rothstein) for a trip to Hermann Park! They discuss a challenging case of right ventricular (RV) infarction leading to acute RV failure treated with right ventricular assist device (RVAD) support. Dr. Mahwash Kassi provides the E-CPR and program director Dr. Stephen Little provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Tommy Das 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 early 70s with ASCVD risk factors and known CAD (PCI to proximal LAD 4 years prior) presented with typical angina refractory to maximal medical therapy. A nuclear stress test showed a reversible perfusion defect in the RCA territory, and he was referred for PCI. Coronary angiogram showed severe stenosis of the proximal RCA and a DES was successfully deployed with TIMI 3 flow, though several large acute marginal branches were jailed.   The night following PCI, the patient developed bradycardia, hypotension, and tachypnea. Physical exam showed newly elevated JVP, lower extremity edema, and bibasilar crackles without a new cardiac murmur. ECG showed ST elevation in V1-V4, and bedside echocardiogram showed a severely dilated RV with decreased systolic function. With concern for acute RV failure, the patient was fluid resuscitated, started on dopamine for chronotropy, and was admitted to the CCU. A Swan-Ganz catheter was placed, showing a CVP 12, RV 41/15, PA 36/20 (25), PCWP 18, CI 1.6 (by Fick method). The calculated PAPi was 0.84.   The patient was transitioned to dobutamine to improve RV inotropy, epinephrine in the setting of hypotension, and inhaled nitric oxide in an attempt to decrease RV afterload. Despite these interventions, the patient had worsening shock, anuric renal failure requiring CVVH, and respiratory failure requiring intubation. A centrifugal RA to PA pump was placed (Protek Duo) for right-sided mechanical circulatory support, with improvement in RV hemodynamics and cardiogenic shock. Notably, a repeat angiogram was done, which showed a patent left coronary circulation as well as a right coronary artery without flow in the acute marginal branches. After 6 days of mechanical circulatory support, the patient was ultimately able to be weaned from vasoactive agents, and the Protek Duo was removed. He continued to have junctional bradycardia, and a permanent pacemaker was placed. After a nearly month-long admission, the patient was discharged to rehab; at 4 months follow-up,

Go online to PeerView.com/NDJ860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, a stroke and vascular neurologist shares a patient case to provide clinical relevance and a practical exploration of the latest advances in the diagnosis and treatment of patients with a large hemispheric infarction (LHI). Upon completion of this activity, participants should be better able to: Apply current evidence-based guidelines to diagnose and treat patients with an LHI, Identify clinical characteristics associated with increased risk of cerebral edema in patients following an LHI, Summarize the benefits and limitations of current and emerging therapeutic strategies to prevent cerebral edema in patients following an LHI.

Go online to PeerView.com/NDJ860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, a stroke and vascular neurologist shares a patient case to provide clinical relevance and a practical exploration of the latest advances in the diagnosis and treatment of patients with a large hemispheric infarction (LHI). Upon completion of this activity, participants should be better able to: Apply current evidence-based guidelines to diagnose and treat patients with an LHI, Identify clinical characteristics associated with increased risk of cerebral edema in patients following an LHI, Summarize the benefits and limitations of current and emerging therapeutic strategies to prevent cerebral edema in patients following an LHI.

Go online to PeerView.com/NDJ860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, a stroke and vascular neurologist shares a patient case to provide clinical relevance and a practical exploration of the latest advances in the diagnosis and treatment of patients with a large hemispheric infarction (LHI). Upon completion of this activity, participants should be better able to: Apply current evidence-based guidelines to diagnose and treat patients with an LHI, Identify clinical characteristics associated with increased risk of cerebral edema in patients following an LHI, Summarize the benefits and limitations of current and emerging therapeutic strategies to prevent cerebral edema in patients following an LHI.

Go online to PeerView.com/NDJ860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, a stroke and vascular neurologist shares a patient case to provide clinical relevance and a practical exploration of the latest advances in the diagnosis and treatment of patients with a large hemispheric infarction (LHI). Upon completion of this activity, participants should be better able to: Apply current evidence-based guidelines to diagnose and treat patients with an LHI, Identify clinical characteristics associated with increased risk of cerebral edema in patients following an LHI, Summarize the benefits and limitations of current and emerging therapeutic strategies to prevent cerebral edema in patients following an LHI.

Go online to PeerView.com/NDJ860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, a stroke and vascular neurologist shares a patient case to provide clinical relevance and a practical exploration of the latest advances in the diagnosis and treatment of patients with a large hemispheric infarction (LHI). Upon completion of this activity, participants should be better able to: Apply current evidence-based guidelines to diagnose and treat patients with an LHI, Identify clinical characteristics associated with increased risk of cerebral edema in patients following an LHI, Summarize the benefits and limitations of current and emerging therapeutic strategies to prevent cerebral edema in patients following an LHI.

Go online to PeerView.com/NDJ860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, a stroke and vascular neurologist shares a patient case to provide clinical relevance and a practical exploration of the latest advances in the diagnosis and treatment of patients with a large hemispheric infarction (LHI). Upon completion of this activity, participants should be better able to: Apply current evidence-based guidelines to diagnose and treat patients with an LHI, Identify clinical characteristics associated with increased risk of cerebral edema in patients following an LHI, Summarize the benefits and limitations of current and emerging therapeutic strategies to prevent cerebral edema in patients following an LHI.

Go online to PeerView.com/NDJ860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, a stroke and vascular neurologist shares a patient case to provide clinical relevance and a practical exploration of the latest advances in the diagnosis and treatment of patients with a large hemispheric infarction (LHI). Upon completion of this activity, participants should be better able to: Apply current evidence-based guidelines to diagnose and treat patients with an LHI, Identify clinical characteristics associated with increased risk of cerebral edema in patients following an LHI, Summarize the benefits and limitations of current and emerging therapeutic strategies to prevent cerebral edema in patients following an LHI.

Go online to PeerView.com/NDJ860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, a stroke and vascular neurologist shares a patient case to provide clinical relevance and a practical exploration of the latest advances in the diagnosis and treatment of patients with a large hemispheric infarction (LHI). Upon completion of this activity, participants should be better able to: Apply current evidence-based guidelines to diagnose and treat patients with an LHI, Identify clinical characteristics associated with increased risk of cerebral edema in patients following an LHI, Summarize the benefits and limitations of current and emerging therapeutic strategies to prevent cerebral edema in patients following an LHI.

Go online to PeerView.com/NDJ860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, a stroke and vascular neurologist shares a patient case to provide clinical relevance and a practical exploration of the latest advances in the diagnosis and treatment of patients with a large hemispheric infarction (LHI). Upon completion of this activity, participants should be better able to: Apply current evidence-based guidelines to diagnose and treat patients with an LHI, Identify clinical characteristics associated with increased risk of cerebral edema in patients following an LHI, Summarize the benefits and limitations of current and emerging therapeutic strategies to prevent cerebral edema in patients following an LHI.

Go online to PeerView.com/NDJ860 to view the activity, download slides and practice aids, and complete the post-test to earn credit. In this activity, a stroke and vascular neurologist shares a patient case to provide clinical relevance and a practical exploration of the latest advances in the diagnosis and treatment of patients with a large hemispheric infarction (LHI). Upon completion of this activity, participants should be better able to: Apply current evidence-based guidelines to diagnose and treat patients with an LHI, Identify clinical characteristics associated with increased risk of cerebral edema in patients following an LHI, Summarize the benefits and limitations of current and emerging therapeutic strategies to prevent cerebral edema in patients following an LHI.

Dr RR Baliga's Internal Medicine Podkasts for Physicians: GOT KNOWLEDGE DOC Podkasts about Long-Term Risk of HF with Chemotherapy with Trastuzumab   Long-Term Risk of Heart Failure in Breast Cancer Patients After Adjuvant Chemotherapy With or Without Trastuzumab. JACC Heart Fail 2019;7:217-224.   Not Medical Advice or Opinion

Dr. Derek Stitt teaches us about spinal cord infarct and TIA.  Show references: https://neurology.libsyn.com/website/march-13-2018-issue https://cp.neurology.org/content/early/2019/12/04/CPJ.0000000000000778    

Cardiac Biomarkers (BNP and Prognosis)-5 + MCQ Dr RR Baliga's MUST KNOW FACTS PODCASTS  for PHYSICIANS from Baliga's Textbook of Internal Medicine with 1480 MCQs available at www.MasterMedFacts.com authored by Devin W Kehl, MD Attending Cardiologist, Palo Alto Foundation Kevin S Shah, MD Assistant Professor and Heart Failure Faculty University of Utah, Salt Lake City, UT Alan Maisel, MD Emeritus Professor University of California, San Diego (UCSD) Not Medical Advice or Opinion

Cardiac Biomarkers (Clinical Utility of BNP)-4 + MCQ Dr RR Baliga's MUST KNOW FACTS PODCASTS  for PHYSICIANS from Baliga's Textbook of Internal Medicine with 1480 MCQs available at www.MasterMedFacts.com authored by Devin W Kehl, MD Attending Cardiologist, Palo Alto Foundation Kevin S Shah, MD Assistant Professor and Heart Failure Faculty University of Utah, Salt Lake City, UT Alan Maisel, MD Emeritus Professor University of California, San Diego (UCSD) Not Medical Advice or Opinion

Cardiac Biomarkers (Troponin in Acute MI)-1 + MCQ Dr RR Baliga's MUST KNOW FACTS PODCASTS  for PHYSICIANS from Baliga's Textbook of Internal Medicine with 1480 MCQs available at www.MasterMedFacts.com authored by Devin W Kehl, MD Attending Cardiologist, Palo Alto Foundation Kevin S Shah, MD Assistant Professor and Heart Failure Faculty University of Utah, Salt Lake City, UT Alan Maisel, MD Emeritus Professor University of California, San Diego (UCSD) Not Medical Advice or Opinion

Cardiac Biomarkers (Non MI causes of Troponin Elevation)-2 + MCQ Dr RR Baliga's MUST KNOW FACTS PODCASTS  for PHYSICIANS from Baliga's Textbook of Internal Medicine with 1480 MCQs available at www.MasterMedFacts.com authored by Devin W Kehl, MD Attending Cardiologist, Palo Alto Foundation Kevin S Shah, MD Assistant Professor and Heart Failure Faculty University of Utah, Salt Lake City, UT Alan Maisel, MD Emeritus Professor University of California, San Diego (UCSD) Not Medical Advice or Opinion

Cardiac Biomarkers (Analytics of Troponin & Troponin in Prognosis)-3 + MCQ Dr RR Baliga's MUST KNOW FACTS PODCASTS  for PHYSICIANS from Baliga's Textbook of Internal Medicine with 1480 MCQs available at www.MasterMedFacts.com authored by Devin W Kehl, MD Attending Cardiologist, Palo Alto Foundation Kevin S Shah, MD Assistant Professor and Heart Failure Faculty University of Utah, Salt Lake City, UT Alan Maisel, MD Emeritus Professor University of California, San Diego (UCSD) Not Medical Advice or Opinion

The anti-inflammatory colchicine is powerful and cheap. It’s thought that, because cardiovascular problems often stem from inflammation, colchicine could help prevent secondary events after MI. That’s what Jean-Claude Tardif and an international group of colleagues set out to investigate. The group reports in the NEJM that daily low-dose colchicine was associated with a lower rate of […]

With Borja Ibanez, Spanish National Centre for Cardiovascular Research - Spain & Allan Davies, Hunter New England Health - Australia.

Chipping away at the problems of cardiac stem cell therapy Though stem cells transplanted into heart attack patients can develop into cardiomyocytes and integrate with undamaged host tissue, preclinical studies and clinical trials have only shown limited improvements in cardiac function. Using a simplified, in vitro, "muscle on-a-chip" system, Aratyn-Schaus et al. reveal that mechanical forces aren't transmitted efficiently between weaker, stem cell–derived cardiomyocytes and stronger, more mature host cells. This biosights episode presents the paper by Aratyn-Schaus et al. from the February 15th, 2016, issue of The Journal of Cell Biology and includes an interview with one of the paper's co-first authors, Francesco Pasqualini (Harvard University, Cambridge, MA). Produced by Caitlin Sedwick and Ben Short. See the associated paper in JCB for details on the funding provided to support this original research. Subscribe to biosights via iTunes or RSS View biosights archive The Rockefeller University Press biosights@rockefeller.edu