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Howie and Harlan are joined by Yale School of Medicine neurologist Kevin Sheth to discuss how collaboration helps drive breakthroughs in brain health, including advances in detecting stroke and other neurological diseases earlier and more precisely. Harlan reflects on lessons from his family's recent experience navigating the healthcare system; Howie examines the expanding marketplace for GLP-1 weight-loss drugs and the challenges of ensuring safe and appropriate use. Show notes: The Family Perspective Cleveland Clinic: Percutaneous Coronary Intervention "What's the Difference Between a CCU and an ICU?" Kevin Sheth Alva Health Mayo Clinic: Stroke Video: Kevin Sheth at the Yale Innovation Summit Sandra Saldana, PhD, MBA "Buddy System" NIH: Multiple Principal Investigators "Assessing the Decade of the Brain" "Cerebrospinal fluid and plasma biomarkers in Alzheimer disease" Kevin Sheth: "Burden of Ischemic and Hemorrhagic Stroke Across the US From 1990 to 2019" Endovascular Thrombectomy (EVT) Ischemic vs Hemorrhagic Stroke "What is cognitive reserve?" Cheaper Obesity Drugs "Will Novo Nordisk's slashing of obesity drug prices save patients' money? It depends" "Novo Nordisk to halve US list price of Wegovy from 2027" "Walgreens Virtual Healthcare Adds Weight Management Services to Support Patients on Their Weight Loss Journey" In the Yale School of Management's MBA for Executives program, you'll get a full MBA education in 22 months while applying new skills to your organization in real time. Yale's Executive Master of Public Health offers a rigorous public health education for working professionals, with the flexibility of evening online classes alongside three on-campus trainings. Email Howie and Harlan comments or questions.
Howie and Harlan are joined by Yale School of Medicine neurologist Kevin Sheth to discuss how collaboration helps drive breakthroughs in brain health, including advances in detecting stroke and other neurological diseases earlier and more precisely. Harlan reflects on lessons from his family's recent experience navigating the healthcare system; Howie examines the expanding marketplace for GLP-1 weight-loss drugs and the challenges of ensuring safe and appropriate use. Show notes: The Family Perspective Cleveland Clinic: Percutaneous Coronary Intervention "What's the Difference Between a CCU and an ICU?" Kevin Sheth Alva Health Mayo Clinic: Stroke Video: Kevin Sheth at the Yale Innovation Summit Sandra Saldana, PhD, MBA "Buddy System" NIH: Multiple Principal Investigators "Assessing the Decade of the Brain" "Cerebrospinal fluid and plasma biomarkers in Alzheimer disease" Kevin Sheth: "Burden of Ischemic and Hemorrhagic Stroke Across the US From 1990 to 2019" Endovascular Thrombectomy (EVT) Ischemic vs Hemorrhagic Stroke "What is cognitive reserve?" Cheaper Obesity Drugs "Will Novo Nordisk's slashing of obesity drug prices save patients' money? It depends" "Novo Nordisk to halve US list price of Wegovy from 2027" "Walgreens Virtual Healthcare Adds Weight Management Services to Support Patients on Their Weight Loss Journey" In the Yale School of Management's MBA for Executives program, you'll get a full MBA education in 22 months while applying new skills to your organization in real time. Yale's Executive Master of Public Health offers a rigorous public health education for working professionals, with the flexibility of evening online classes alongside three on-campus trainings. Email Howie and Harlan comments or questions.
Neuro-ophthalmologist Amanda Redfern, MD, joins host Ogul Uner, MD, to review a case in which a 70-year-old woman experienced intermittent visual disturbances and headaches. Examination revealed a relative afferent pupillary defect and optic disc inflammation. Dr. Redfern explains her initial diagnosis of arteritic anterior ischemic optic neuropathy (AAION) and outlines the typical demographics of patients who present with AAION.
Dr. Emile Daoud, Deputy Editor of JACC Clinical Electrophysiology discusses Cerebrovascular Ischemic Lesions After Pulsed Field Ablation for Atrial Fibrillation Using Variable-Loop Ablation Catheter.
In the second episode of this two-part series, Drs. Justin Abbatemarco, Valérie Biousse, and Nancy J. Newman discuss the risk of non-arteritic ischemic optic neuropathy and how to counsel patients around GLP-1 medications. Show transcript: Dr. Justin Abbatemarco: Hello and welcome back. This is Justin Abbatemarco again with Valarie Biousse and Nancy Newman talking about non-arteritic ischemic optic neuropathy. I think the other major point that we had a discussion in the podcast was around the GLP-1 medications, which you mentioned have been truly life-changing for diabetes management and obesity. Can we talk about the risk of non-arteritic ischemic optic neuropathy and how you're counseling patients around this class of medications? Dr. Nancy J. Newman: Absolutely. This is probably one of the most difficult things we are dealing with because it is something that is in process and progress right now. We don't have all the information yet, but it would appear that there is likely a small association of about slightly less than two times risk in patients who are taking these medications of having NAION with a resultant still very, very small overall risk. And it is not necessarily causal. This has prompted the European Medicines Agency to say that these patients should have their GLP-1 RAs stopped if they have NAION. Our own FDA and certainly the American Academy of Ophthalmology and the North American Neuro-Ophthalmology Society have not taken that step, but have suggested that this be shared decision-making, not only with the person who makes this diagnosis of an NAION in the patient, but with their primary care doctor or the provider who has felt that a GLP-1 receptor agonist is important for this patient's treatment and health. Dr. Justin Abbatemarco: More to come. We're going to have you back to have discussions as we learn more and better understand the disease and how we help our patients with both their diagnosis and treatment. Thank you so much for your time.
In the second episode of this two-part series, Dr. Justin Abbatemarco talks with Drs. Valérie Biousse and Nancy J. Newman about the management of non-arteritic ischemic optic neuropathy and its emerging relationship with GLP‑1 medications. Disclosures can be found at Neurology.org.
In part one of this two-part series, Drs. Justin Abbatemarco, Valérie Biousse, and Nancy J. Newman discuss common myths around non-arteritic ischemic optic neuropathy (NAION). Show transcript: Dr. Justin Abbatemarco: Hello and welcome. This is Justin Abbatemarco, and I just got done interviewing Valérie Biousse and Nancy Newman on all things around non-arteritic anterior ischemic optic neuropathy. I think one of my favorite takeaways from our interview were breaking some common myths around this disorder. Valérie and Nancy, could you maybe talk about one or two that you think are important that people should know are not true about this disease? Dr. Nancy J. Newman: So thing number one is that it's just another stroke of the eye. We know that it likely does have some vascular background to it, but the reality is it's not a stroke like neurologists know a stroke. You don't need to do an embolic workup. It has to do likely with the anatomy that a person is born with or that they acquire that crowds the front of their optic nerve. Secondly, thing number two, that it's a disease only of old people. I think that we know that you can be as young as age 11 and have this happen, mostly because you have a small, crowded optic nerve head. Thing number three, steroids really have not been proven to be helpful in this disorder and should likely not be used unless you are trying to decrease the optic nerve head edema, and the patient is insisting that they have some treatment. Dr. Justin Abbatemarco: So helpful. Please come back and check out the full podcast episodes where we dive into some of these elements in a little bit more detail.
In part one of this two-part series, Drs. Justin Abbatemarco, Valérie Biousse, and Nancy J. Newman discuss common myths around non-arteritic ischemic optic neuropathy (NAION). Show transcript: Dr. Justin Abbatemarco: Hello and welcome. This is Justin Abbatemarco, and I just got done interviewing Valérie Biousse and Nancy Newman on all things around non-arteritic anterior ischemic optic neuropathy. I think one of my favorite takeaways from our interview were breaking some common myths around this disorder. Valérie and Nancy, could you maybe talk about one or two that you think are important that people should know are not true about this disease? Dr. Nancy J. Newman: So thing number one is that it's just another stroke of the eye. We know that it likely does have some vascular background to it, but the reality is it's not a stroke like neurologists know a stroke. You don't need to do an embolic workup. It has to do likely with the anatomy that a person is born with or that they acquire that crowds the front of their optic nerve. Secondly, thing number two, that it's a disease only of old people. I think that we know that you can be as young as age 11 and have this happen, mostly because you have a small, crowded optic nerve head. Thing number three, steroids really have not been proven to be helpful in this disorder and should likely not be used unless you are trying to decrease the optic nerve head edema, and the patient is insisting that they have some treatment. Dr. Justin Abbatemarco: So helpful. Please come back and check out the full podcast episodes where we dive into some of these elements in a little bit more detail.
In part one of this two-part series, Dr. Justin Abbatemarco talks with Drs. Valérie Biousse and Nancy J. Newman about the clinical features and diagnostic tools utilized for non-arteritic ischemic optic neuropathy (NAION). Disclosures can be found at Neurology.org.
With Tim Balthazar, University Hospital of Brussels - Belgium and Luca Fazzini, Papa Giovanni XXIII Hospital, Bergamo - Italy. In this episode of HFA CardioTalk, Luca Fazzini interviews Tim Balthazar on the contemporary use of vasodilators and inotropic agents in heart failure. The conversation explores the gaps in current guidelines, the hemodynamic profile of patients suited for vasodilator therapy, and the rationale behind choosing specific inotropes in different clinical settings. Tim Balthazar further discusses the management of patients on chronic beta-blocker therapy presenting with signs of hypoperfusion and the challenges in designing randomized trials in this field. The discussion also touches on the role of inotropes in palliative care, as well as future perspectives and emerging pharmacological strategies. This 2025 HFA Cardio Talk podcast series is supported by Bayer AG in the form of an unrestricted financial support. The discussion has not been influenced in any way by its sponsor.
For patients with ischemic priapism, time to treatment can mean the difference between recovery and long-term dysfunction. In this episode, Dr. Maia VanDyke (UT Southwestern Medical Center) joins host Dr. Juan Andino (UCLA Health) for a high-yield discussion on managing this urologic emergency, from early recognition to advanced surgical options.---SYNPOSISTogether, they cover diagnosis, patient demographics, and traditional versus advanced interventions, with special attention to the role of penoscrotal decompression in prolonged ischemic priapism. The conversation highlights surgical techniques, postoperative care strategies, and patient counseling, including the hard but essential discussions about long-term erectile dysfunction risk. Drs. Andino and VanDyke also emphasize the importance of collaboration, encouraging general urologists to adopt these approaches while leaning on colleagues and centers of excellence for complex cases.---TIMESTAMPS00:00 - Introduction02:18 - Understanding Priapism07:52 - Diagnosis and Initial Management16:51 - Advanced Management and Surgical Interventions28:21 - Patient Retention Challenges29:59 - Surgical Planning and Techniques37:29 - Post-Operative Care and Patient Rehabilitation44:13 - Future Directions in Research and Treatment51:28 - The Role of General Urology---RESOURCESDr. David Ralph article on use of MRI in management of priapismhttps://doi.org/10.1111/j.1464-410X.2010.09368.xDr. Tom Lue article on corporal aspirationhttps://doi.org/10.1038/nrurol.2009.50Arthur “Bud” Burnett article on corporal tunnelinghttps://doi.org/10.1016/j.juro.2012.08.245Allen “Al” Morey article on penoscrotal decompression erectile function outcomeshttps://doi.org/10.1111/bju.15127Survey on current management practices of ischemic priapismhttps://doi.org/10.1038/s41443-019-0120-4Risk factors, diagnosis, and long-term erectile dysfunction outcomes in priapismhttps://doi.org/10.1038/s41443-025-01076-9Video Journal of Sexual Medicine (VJSM) on Penoscrotal decompression: A better method for priapism managementhttps://www.vjsm.info/videos/all/penoscrotal-decompression-a-better-method-for-priapism-managementSurgical Management of Ischemic Priapism: what are the New Options? https://doi.org/10.1590/S1677-5538.IBJU.2024.0497The Impact of Immediate Salvage Surgery on Corporeal Length Preservationhttps://doi.org/10.1016/j.juro.2018.01.082
With Gregorio Tersalvi, Mayo Clinic, Rochester - USA, and Faiez Zannad, University of Lorraine, Nancy - France. In this episode of HFA CardioTalk, Gregorio Tersalvi interviews Faiez Zannad on the future of trials in heart failure. Together, they explore how the landscape of heart failure trials has evolved, the major challenges in trial design today, the relevance of current and emerging outcomes, and the vision for the next decades of heart failure research. The discussion also touches on lessons learned from landmark trials and advice for young clinicians and researchers who aspire to become trialists. Recommended readings: Zannad F, Pitt B. The Future of Clinical Trials. Circulation 2024 Jun 4;149(23):1783-85. doi: 10.1161/CIRCULATIONAHA.123.066982. This 2025 HFA Cardio Talk podcast series is supported by Bayer AG in the form of an unrestricted financial support. The discussion has not been influenced in any way by its sponsor.
Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Remote Ischemic Preconditioning Prevents Acute Kidney Injury Following Coronary Angiography: The BRICK Randomized Clinical Trial.
In this episode, we give a wrap-up of late-breaking clinical science presented at the ESC Congress 2025 in Madrid. First, David Berg presents the DAPA ACT HF-TIMI 68 trial, reporting on dapagliflozin in patients hospitalized for acute heart failure, along with a meta-analysis of SGLT2 inhibitors in this setting. Next, Javed Butler highlights results of the VICTOR trial, a large phase 3 study of vericiguat in chronic heart failure with reduced ejection fraction. Then, Andre Zimerman discusses the PhysioSync-HF trial, comparing conduction system pacing with biventricular resynchronization therapy in patients with HFrEF. Finally, Kieran Docherty shares insights from a community-based study on the benefits of early initiation of disease-modifying therapy in suspected heart failure. Additional information: Topic 1: With Gregorio Tersalvi, Mayo Clinic, Rochester, MN - USA, David Berg, Brigham and Women's Hospital, Boston - USA and Novi Yanti Sari, Siloam Hospitals Group, Jakarta - Indonesia Results paper: Dapagliflozin in Patients Hospitalized for Heart Failure: Primary Results of the DAPA ACT HF-TIMI 68 Randomized Clinical Trial and Meta-Analysis of Sodium-Glucose Cotransporter-2 Inhibitors in Patients Hospitalized for Heart Failure Replay ESC Congress Hot Line: https://esc365.escardio.org/presentation/312142 Circulation. 2025 Aug 29. doi: 10.1161/CIRCULATIONAHA.125.076575. Topic 2: With Javed Butler, Baylor Scott & White Health, Dallas - USA and Henrike Arfsten, Medical University of Vienna, Vienna - Austria Results papers: Vericiguat in patients with chronic heart failure and reduced ejection fraction (VICTOR): a double-blind, placebo-controlled, randomised, phase 3 trial Lancet. 2025 Replay ESC Congress hotline: https://esc365.escardio.org/presentation/312148 doi: 10.1016/S0140-6736(25)01665-4. Vericiguat for patients with heart failure and reduced ejection fraction across the risk spectrum: an individual participant data analysis of the VICTORIA and VICTOR trials Lancet. 2025 Aug 29:S0140-6736(25)01682-4. doi: 10.1016/S0140-6736(25)01682-4. Topic 3: With Andre Zimerman, Hospital Moinhos De Vento, Porto Alegre - Brazil and Floran Sahiti, University Hospital of Wurzburg, Wurzburg - Germany Methods paper: Conduction system pacing vs biventricular resynchronization in heart failure with reduced ejection fraction and left bundle branch block: Rationale and design of the PhysioSync-HF Trial Am Heart J. 2025 Dec:290:38-45. Replay ESC Congress: https://esc365.escardio.org/session/50327 doi: 10.1016/j.ahj.2025.06.002. Topic 3: With Kieran Docherty, University of Glasgow, Glasgow - UK and Jolie Bruno, Inserm UMR-S942, Paris - France Results paper: Benefit of early initiation of disease-modifying therapy in community-based patients with suspected heart failure Eur Heart J. 2025 Aug 29:ehaf675. doi: 10.1093/eurheartj/ehaf675. This 2025 HFA Cardio Talk podcast series is supported by Bayer AG in the form of an unrestricted financial support. The discussion has not been influenced in any way by its sponsor.
This is a lot more interesting than it looks. Since I condensed two posts to 1100 words, your only risk of reading this is ten minutes of your time.Support the show
Commentary by Dr. Pilar Martin.
Drs. BJ Hicks, Birgitte Hede Ebbesen, and Boris Modrau discuss fatigue following transient ischemic attack and examine the characteristics of patients who experience pathologic fatigue. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000213605
Dr. BJ Hicks talks with Drs. Birgitte Hede Ebbesen and Boris Modrau about the study's methodology, findings, and implications for clinical practice, emphasizing the need for better awareness and support for TIA patients. Read the related article in Neurology®. Disclosures can be found at Neurology.org.
In this episode, we review the high-yield topic Transient Ischemic Attack from the Neurology section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
Join us on September 3rd for Baby Tribe Live! Tickets available now: https://smockalley.ticketsolve.com/ticketbooth/shows/873656691 Unlock the secrets of hypoxic ischemic encephalopathy (HIE) in newborns and understand the critical nuances of this life-altering condition. Join us as we navigate through the complexities of encephalopathy, explaining how it affects the brain function of infants and the symptoms that manifest as a result. Learn about the innovative treatment of therapeutic hypothermia, a revolutionary method that offers hope and healing for newborns. Meet Betsy Pilon, a mother whose compelling story and advocacy work sheds light on the personal side of HIE. Her journey with her son Max, who was born with this condition, highlights the importance of a strong support system and the challenges faced by families navigating the healthcare landscape. We discuss the emotional turbulence and communication hurdles often encountered within the NICU, emphasizing the need for improved support and understanding for parents. Explore the critical role of early intervention and diagnosis for infants at risk of conditions like cerebral palsy. We delve into the significance of early physiotherapy and the impact of organizations like Hope for HIE, which provide essential resources and community for affected families. As we discuss global collaboration efforts in HIE research, you'll gain insight into how international partnerships and technological advancements are paving the way for better outcomes. Hope for HIE: https://hopeforhie.org/ Proudly sponsored by: https://www.happytummy.ie/ Learn more about your ad choices. Visit megaphone.fm/adchoices
Wtih Robert Mentz, Duke University, North Carolina - USA, and Cornelia Margineanu University of Medicine and Pharmacy Carol Davila, Bucharest - Romania. A focused discussion and an update on the latest developments in iron deficiency — a journey from definition to outcomes through available therapeutic options. Not to be missed!
In this episode, we review the high-yield topic Ischemic Colitis from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
Vasculitis can be a tricky disease. It can be more straightforward with tissue loss at the pinnal tips, but it isn't always that easy! Lesions can vary from claw loss to paw pad lesions to hair loss.Curtis Plowgian, DVM, DACVD joins the podcast from Animal Dermatology Clinic in Indianapolis, Indiana for another episode! Dr. Plowgian wanted to discuss this topic after having a weird presentation in a cat... definitely strange to have vasculitis in a cat! Learn more about some of our weird vasculitis cases (and treatment options) on this week's episode of The Derm Vet podcast!00:00 Intro01:04 Basics of Vasculitis 10:00 Treatment Options for Vasculitis16:12 JAK-STAT Inhibitors and Steroids18:48 Future Vaccines23:36 Outro
Commentary by Dr. Shinya Goto.
Commentary by Dr. Jian'an Wang.
In this episode, we review the high-yield topic Ischemic Colitis from the Gastrointestinal section at Medbullets.comFollow Medbullets on social media:Facebook: www.facebook.com/medbulletsInstagram: www.instagram.com/medbulletsofficialTwitter: www.twitter.com/medbulletsLinkedin: https://www.linkedin.com/company/medbullets
Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Very Long-Term Outcomes of Cardiac Resynchronization Therapy in Patients With Ischemic and Nonischemic Cardiomyopathy.
Lancet 1999;353:2001-07Background: Beta-blockers directly reduce cardiac contractility and myocardial oxygen demand. For decades, they were avoided in patients with acute and chronic heart failure over concerns they would facilitate decompensation of the condition. The therapeutic cornerstones of treatment, prior to the modern era of clinical trials, focused on managing symptoms and quality of life with diuretics and inotropic agents like digoxin; however, new paradigms were arising that focused on addressing neurohormonal mechanisms of chronic disease that were over-activated in the failing heart. The first major success came with inhibition of the renin angiotensin aldosterone system with angiotensin converting enzyme inhibitors whose effect on mortality for patients with mild and severe forms of chronic heart failure were demonstrated in the V-HEFT II, CONSENSUS, and SOLVD trials. Additional benefits were demonstrated with the mineralocorticoid receptor antagonist spironolactone in the RALES trial. These drug classes primarily work by reducing afterload and volume retention. Appreciating why they work for improving cardiac performance and managing symptoms in heart failure patients is straightforward when we consider the major factors that effect cardiac stroke volume - preload, afterload and contractility; however, it is also noteworthy the effects these agents have on sudden death. How beta-blockade benefits the failing heart is less obvious (outside prevention of sudden death). Mechanistic studies in patients with chronic heart failure have consistently shown that when beta blockers are used for more than 1 month, left ventricular function improves. Beta blocker therapy appears to restore the density of beta-adrenergic receptors after they have been downregulated by the chronic overactivity of the sympathetic nervous system. The first major placebo-controlled RCT to demonstrate a mortality benefit used the non-selective beta blocker carvedilol. The trial was small and not originally designed to test mortality and was stopped early without clearly predefined stopping rules. Furthermore, 8% of total patients selected for participation in the trial were excluded prior to randomization after a 2 week, open-label run-in phase with the study drug, which saw 2% of all patients experience worsening heart failure or death representing 24 patients (the difference in total deaths between groups was 9 when the trial was stopped). The Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF) was the first large scale trial designed to test the hypothesis that beta-blockade with metoprolol controlled/extended release (CR/XL) added to optimum medical therapy reduces mortality in patients with chronic systolic heart failure.Patients: Patients were recruited from 313 sites in 13 European countries and the United States. Eligible patients were men and women between the age of 40 to 80 years with symptomatic heart failure (NYHA class II-IV) for >/= 3 months before randomization. They had to be on a diuretic and ACE inhibitor for at least 2 weeks. Other drugs, including digoxin, could also be used. Patients also had to have an EF of /=68 beats per minute.Patients were excluded if: they had an MI or unstable angina within 28 days; had an indication or contraindication for treatment with beta-blocker; beta blockade within 6 weeks; heart failure due to systemic disease (i.e., amyloidosis) or alcohol abuse; scheduled or performed cardiac transplant; an ICD; procedures such as CABG or PCI planned or performed in the past 4 months; 2nd or 3rd degree AV block unless a pacemaker was present; unstable or decompensated heart failure defined by pulmonary edema or hypoperfusion or supine systolic BP 25% deviation of the number of observed versus expected consumed placebo tablets during the run-in period.Baseline characteristics: The mean age of patients was 64 years and approximately 78% were male. Slightly more than 30% of patients were above the age of 70. The average EF was 28%. The average SBP was 130 mmHg and heart rate was 82 bpm. Most patients had mild to moderate heart failure, with 41% in NYHA Class II, 56% in Class III, and only 3% in Class IV. Ischemic cardiomyopathy accounted for 65% of cases and nonischemic causes accounted for 35%. Most patients were on an ACE inhibitor or ARB (95%) and diuretic (90%). Digoxin was used in 63%. Trial procedures: Prior to randomization, the study was preceded by a single-blind, 2-week placebo run-in period. Patients meeting eligibility were then randomized to placebo or metoprolol CR/XL. The starting dose of placebo or metoprolol CR/XL was 12.5 mg daily for patients in NYHA class III or IV and 25 mg daily for patients in NYHA class II. The dose was doubled every 2 weeks until the target dose of 200 mg daily was reached. Patients were followed every 3 months.Endpoints: The primary outcome was all-cause mortality. It was estimated that 3,200 patients would need to be followed for 2.4 years to detect a 30% relative reduction in mortality based on annual mortality rate of 9.4% in the placebo group. This would achieve at least 80% power with a 2-sided alpha of 0.04. Patients were recruited faster then planned and so the final sample size of 3,991 patients increased the power of the study.The study was monitored by an independent safety committee and predefined stopping rules for efficacy were based on all-cause mortality, done when 25%, 50%, and 75% of expected deaths had occurred. Results: The trial was stopped early after the 2nd preplanned interim analysis when 50% of expected deaths had occurred. The mean duration of follow-up at the time of stopping was 1 year. The mean daily dose of metoprolol CR/XL was 159 mg once daily, with 87% receiving 100 mg or more and 64% receiving the target dose of 200 mg daily. In the placebo group, the corresponding values were 179 mg daily, 91% and 82%. The study drug was discontinued permanently in 14% of patients in the metoprolol group and 15% in the placebo group. Six months after randomization, heart rate decreased by 14 bpm in the metoprolol group compared to only 3 bpm in the placebo group. Systolic blood pressure decreased less in the metoprolol group (-2.1 vs 3.5 mmHg).Compared to placebo, metoprolol significantly reduced all-cause mortality (7.3% vs 10.8%; RR 0.66; 95% CI 0.53—0.81). Cardiovascular mortality accounted for 91% of all deaths; with sudden death accounting for 58% and death from worsening heart failure accounting for 24% of all deaths. All 3 of these causes of death were significantly reduced by metoprolol. The relative and absolute effects on death were greatest for patients with NYHA class III heart failure.Conclusions: In this trial of stable patients with mild to moderate chronic systolic heart failure, who were optimized on an ACEi or ARB and diuretic, metoprolol CR/XL significantly reduced all-cause mortality. Approximately 30 patients would need to be treated with metoprolol compared to placebo for 1 year to prevent 1 death. This trial represents a significant win for beta blockade in patients with chronic systolic heart failure. While the NNT in this trial is slightly higher than in SOLVD, it is important to appreciate that follow-up time in SOLVD was more than 3x longer. Limitations to external validity in this trial include the run-in period and stringent inclusion and exclusion criteria. Our enthusiasm is also tempered by early stopping, which has been found to be associated with false positive or exaggerated results but this concern is mitigated to some extent in this trial because the rules for early stopping were clearly defined in the protocol.Cardiology Trial's Substack is a reader-supported publication. To receive new posts and support our work, consider becoming a free or paid subscriber. Get full access to Cardiology Trial's Substack at cardiologytrials.substack.com/subscribe
Clopidogrel Versus Aspirin for Long-term Maintenance Monotherapy in Patients with High Ischemic Risk After Percutaneous Coronary Intervention
In this powerful episode honoring HIE Awareness Month, Neonatal Nurse Practitioner Jessica Fulton shares the raw and emotional story of her son Bo's birth — a delivery marked by unexpected complications that led to a diagnosis of Hypoxic-Ischemic Encephalopathy (HIE). Jessica opens up about what it was like to watch her own son become a critical patient in the very NICU where she had worked for years — as her personal and professional worlds suddenly collided. She speaks candidly about the shocking helplessness she felt as a parent, despite her medical background, and the lifelong challenges that continue to follow: a cerebral palsy diagnosis, fierce advocacy, intensive therapies, emotional isolation, and the realities of parenting a child with complex needs. This episode is a must-listen for NICU parents, healthcare providers, and anyone supporting a family navigating the lifelong impact of HIE. Dr. Brown's Medical: https://www.drbrownsmedical.com Our NICU Roadmap: A Comprehensive NICU Journal: https://empoweringnicuparents.com/nicujournal/ NICU Mama Hats: https://empoweringnicuparents.com/hats/ NICU Milestone Cards: https://empoweringnicuparents.com/nicuproducts/ Newborn Holiday Cards: https://empoweringnicuparents.com/shop/ Empowering NICU Parents Show Notes: https://empoweringnicuparents.com/shownotes/ Episode 68 Show Notes: https://empoweringnicuparents.com/episode68 Empowering NICU Parents Instagram: https://www.instagram.com/empoweringnicuparents/ Empowering NICU Parents FB Group: https://www.facebook.com/groups/empoweringnicuparents Pinterest Page: https://pin.it/36MJjmH
Story at-a-glance Ischemic strokes block blood flow to brain cells, causing damage through three distinct cell death mechanisms, with iron overload playing a key role Excess iron accumulation during strokes accelerates cell death, functioning like "gasoline on a fire" and worsening brain damage significantly New research shows targeting iron-related cell death could lead to better stroke treatments that protect more brain cells from damage A simple blood test called serum ferritin measures your iron stores. Keeping levels below 100 ng/mL, ideally between 20 and 40 ng/mL, helps protect your brain Regular blood donation (two to four times yearly) is an effective strategy to manage iron levels and reduce stroke risk and severity
With Justyna Sokolska, Institute of Heart Diseases, Wroclaw Medical University, Wroclaw - Poland, and Maja Cikes, University of Zagreb School of Medicine, Head at the Unit for Heart Failure and Mechanical Circulatory Support, Department of Cardiovascular Diseases, University Hospital Center, Zagreb - Croatia. In this episode of HFA CardioTalk, Justyna Sokolska interviews Maja Cikes on the challenges in management of long-term left ventricular assist device in patients with advanced heart failure. The discussion emphasizes the importance of selecting appropriate patients at the optimal time, examines the adverse events and highlights major ongoing clinical trials. Recommended readings: Aspirin and Hemocompatibility Events With a Left Ventricular Assist Device in Advanced Heart Failure: The ARIES-HM3 Randomized Clinical Trial, Mehra MR, et al. JAMA. 2023 Dec 12;330(22):2171-81 Trends and Outcomes of Left Ventricular Assist Device Therapy: JACC Focus Seminar, Varshney AS, et al. J Am Coll Cardiol 2022 Mar 22;79(11):1092-1107 Cardiac implantable electronic devices with a defibrillator component and all-cause mortality in left ventricular assist device carriers: results from the PCHF-VAD registry, Cikes M, et al. Eur J Heart Fail 2019 Sep;21(9):1129-41 A Fully Magnetically Levitated Left Ventricular Assist Device — Final Report, Mehra MR, et al. N Engl J Med 2019 Apr 25;380(17):1618-27 This 2025 HFA Cardio Talk podcast series is supported by Bayer AG in the form of an unrestricted financial support. The discussion has not been influenced in any way by its sponsor.
See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog I am not sure if you play THE “WHAT'S THE DISEASE THAT I DON'T WANT TO HAVE GAME with yourself, but since I am a doctor I have spent a lot of time thinking about what diseases I do not want! I started my list in medical school when I witnessed what certain diseases can do to your life. Medicine has many cures and treatments, yet some diseases that are treated still can negatively change your life forever. Even though losing a limb and amputation were at the top of my list there is one disease that tops my list. Of course, I also have under stroke the usual scary situations like paralysis, or having an incapacitating heart attack that prevents an individual from taking care of himself or herself. However, my most feared diagnosis is having a STROKE! You may not fully comprehend how a stroke can change your life, but it can affect your speech, your ability to move, to think, to go places, to have a sense of humor, to write and communicate, even to have a sexual relationship with your loved one. A stroke essentially can take away your ability to be the person you have always been, AND it requires that someone must become your caretaker. That helplessness is something I am most afraid of….We all have our personal fears, but whether you fear having a stroke or not, you should try your hardest to avoid having one! DEFINITION: a stoke is a medical emergency that occurs when blood flow to the brain is blocked or a blood vessel bursts. This can damage or kill parts of the brain, which can lead to long-term disability, brain damage, or even death. This can cause s a loss of function, physical, mental, and emotional, and loss of one or more of the senses like sensation, speech, sight, hearing and taste and smell! In my practice at BioBalance Health we always work with our patients to prevent them having a stroke and or heart attack. These two conditions are the biggest villains that steal the joy of our “golden years” from us. From the start of my BioBalance Health practice, I have incorporated healthy diet training, exercise options and encouragement, how and what to take to supplement my patients' diet and how to outsmart their genetic makeup so they can be healthier than their parents. All of these lifestyle changes can decrease the risk of stroke and heart attack in a person. So what is it like to have a stroke? First let's go over what symptoms are typical of someone having a stroke. The symptoms of a stroke are multiple, and a person might not have all of them. Weakness on one side of the body Facial drooping on one side of the face Dizziness Numbness Loss of balance Sudden loss of vision. Trouble making sense when speaking Trouble talking, reading or understanding Sudden nausea and vomiting Brief loss of consciousness such as fainting, seizures, confusion, or coma. When someone has one or more of these symptoms it is an emergency, and you should call 911, then start asking the patient to open their eyes, smile, raise both arms and hold them up. Ask them to talk to see if their speech is impaired. Your findings will be helpful to the EMTs who come to the scene. An event is called a stroke, when there is a deficit in physical or mental function and that deficit continues and doesn't go away. If it the symptoms completely resolve, it is called a TIA- a transient Ischemic attack. It is a warning to see a doctor and make sure you don't have a stroke in the future and it is a wakeup call to stop all poor lifestyle choices. PREVENTING A STROKE: This last month, the American Heart and Stroke prevention Association released new Guidelines on how to prevent a stroke. I think talking about the risk factors for stroke and discussing how to prevent having one, is worthy of discussion. Recently the medical guidelines for stroke prevention have been revised, and even though I think a few more things should have been included, the fact that they made the first change in the guidelines in 10 years is a first step. Here is what they advise all people who are aging should do. #1 See your internal medicine or Family physician regularly, at least yearly #2. Stop sedentary behavior—walk/exercise/ do Yoga, just get out of the chair for the majority of your day! #3. If you are diabetic, they advocate going on Ozempic/Mounjaro to lose weight—that will lower your risk of a stroke, and heart attack.. #4 If you are hypertensive, take your BP medicine every day #5 Follow these lifestyle changes called Life's Essential 8: Your behavior and lifestyle put you at risk for having a stroke: Healthy diet, low carb Mediterranean diet, no junk food! Physical activity every day Achieve a healthy weight, Make sure your sleep is restful Stop use of tobacco products, No smoking or vaping Achieve healthy levels of blood glucose, and blood pressure. Don't drink more than one 4 oz glass of wine a day I add these recommendations to theirs for the care of my patients: Drink ½ your weight in water every day Wat at least half your weight in grams of protein a day Get a Cardiac calcium scan to see if you have arterial plaque. If you do have plaque (arteriosclerosis) then you are at risk for stroke as well. See a cardiologist to be treated preventatively and tested. Option other than a cardiac calcium scan, get a carotid ultrasound to make sure you don't have plaque in the neck vessels that lead to your brain.. Make sure your Homocysteine level is normal (
Dr. Drew Carey speaks with Dr. Tongalp H. Tezel on his study comparing patients with nonarteritic ischemic optic neuropathy (NAION) with healthy non-NAION patients with crowded discs and noncrowded optic discs. From his Ophthalmology article, “Vitreopapillary Findings in Nonarteritic Ischemic Optic Neuropathy versus Healthy Eyes.” Vitreopapillary Findings in Nonarteritic Ischemic Optic Neuropathy versus Healthy Eyes. Hondur, Ahmet M. et al. Ophthalmology, Volume 132, Issue 3, 327 – 334 CALL FOR ABSTRACTS! Now accepting paper, poster, and video submissions through April 8. Imagine presenting at AAO 2025; learn more and submit yours at aao.org/pod25
Darshan H. Brahmbhatt, Podcast Editor of JACC: Advances, discusses a recently published original research paper on Significance of Coronary Artery Calcifications and Ischemic Electrocardiographic Changes Among Patients Undergoing Myocardial Perfusion Imaging
With Robert M.A. van der Boon, Erasmus Medical Center, Rotterdam - The Netherlands, and Anuradha Lala, Mount Sinai Fuster Heart Hospital, New York City - USA. In this episode of HFA Cardio talk, we dive into how factors like sex, socio-economics status and ethnicity shape the way heart failure presents and progresses in different populations. We'll discuss why recognizing these differences is critical for accurate diagnosis and effective treatment and highlight practical steps clinicians can take to close the gaps in prevention and care. Papers: https://onlinelibrary.wiley.com/doi/10.1002/ejhf.2534 https://academic.oup.com/eurheartj/article/40/47/3859/5652224?login=true https://www.sciencedirect.com/science/article/pii/S1071916421004322?via%3Dihub https://www.sciencedirect.com/science/article/pii/S0002914922010074?via%3Dihub https://www.sciencedirect.com/science/article/pii/S2468266719301082?via%3Dihub https://journals.lww.com/co-cardiology/fulltext/2021/05000/racial_and_ethnic_disparities_in_heart_failure_.12.aspx https://onlinelibrary.wiley.com/doi/10.1002/ehf2.14986 This 2025 HFA Cardio Talk podcast series is supported by Bayer AG in the form of an unrestricted financial support. The discussion has not been influenced in any way by its sponsor.
In this episode of Autism for Badass Moms, we sit down with Allysa Parker, a dedicated Certified Dental Assistant and fierce advocate for her 6-year-old son, Julian. Julian was diagnosed with Hypoxic Ischemic Encephalopathy (H.I.E.) just two days after birth and later received an Autism diagnosis at 4.5 years old. Navigating these diagnoses has been an emotional rollercoaster for Allysa, bringing moments of helplessness and anxiety. But through it all, she has remained committed to ensuring Julian experiences the world to the fullest. Now, Allysa is using her journey to empower other moms, sharing her insights on H.I.E. and Autism while building a community of support and encouragement. Tune in to hear Allysa's incredible journey. Follow her journey on Instagram: https://www.instagram.com/lovely.loveable.leo/ Don't forget to subscribe and stay tuned for more empowering stories like Allysa's. Follow Us: Instagram: https://www.instagram.com/theabmpodcast/ Facebook: https://www.facebook.com/profile.php?id=100095054651586
Sandra Narayanan, MD, Vascular Neurologist and Neurointerventional Surgeon at the Pacific Stroke and Neurovascular Center at Pacific Neuroscience Institute, explains the difference between hemorrhagic and ischemic stroke.The main difference between the two types of stroke is the underlying cause of the brain damage. In ischemic stroke, the damage is caused by a lack of blood supply, while in hemorrhagic stroke, it is caused by bleeding into the brain tissue. Both types of stroke are medical emergencies and require immediate medical attention to prevent further damage and improve outcomes.
In this episode, Dr. Valentin Fuster reviews an exploratory analysis from the 80s2 trial, which examined CSL 112's impact on ischemic events after acute myocardial infarction. While CSL 112 didn't significantly reduce cardiovascular death or stroke in the short term, the study found promising long-term benefits, suggesting that enhancing cholesterol efflux could be a valuable approach for reducing recurrent ischemic events in high-risk patients.
Dr. Jodie Roberts and Dr. Amra Sakusic discusses the relationship between reversal therapy and ischemic stroke, between duration off anticoagulation and risk of ischemic strokes or systemic embolism. Learn more about the Neurology Practice Current section and fill out the survey now. Show reference: https://survey.alchemer.com/s3/7969148/Practice-Current-When-do-you-start-anticoagulation-therapy-for-patients-with-both-ICH-and-AF https://www.neurology.org/doi/10.1212/WNL.0000000000209664
In this episode, Dr. Valentin Fuster discusses a groundbreaking study that evaluates the role of myocardial fibrosis in predicting sudden cardiac death and ventricular arrhythmias in patients with non-ischemic cardiomyopathy. The findings suggest that assessing fibrosis through advanced imaging techniques offers a more accurate risk stratification than the traditional reliance on left ventricular ejection fraction, ultimately refining treatment approaches for at-risk patients.
VISIT US AT NCLEXHIGHYIELD.COM 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
In part two of this two-part series, Dr. Dan Ackerman and Dr. Gaspard Gerschenfeld discuss the differences in treatment between American Stroke Centers and those in France. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209398
This week we delve into the world of heart failure and transplantation when we review a recent PHTS study assessing the impact of ischemic time on outcomes of pediatric heart transplantation. What is considered to be a long ischemic time and what is the impact on outcomes in the pediatric patient undergoing transplant? Why does it appear as the impact of a longer ischemic time is less associated with graft failure in the present era in comparison to the past? What might be the impact of newer heart perfusion devices used to transport organs for transplant? These are amongst the questions reviewed with Professor of Pediatrics at U. Colorado, Dr. Scott R. Auerbach. DOI: 10.1016/j.healun.2024.03.002
Dr. Dan Ackerman and Dr. Gaspard Gerschenfeld discuss the efficacy and safety of both thrombolytics in patients with large ischemic core. Show reference: https://www.neurology.org/doi/10.1212/WNL.0000000000209398
Dr. Dan Ackerman talks with Dr. Gaspard Gerschenfeld about the efficacy and safety of both thrombolytics in patients with large ischemic core. Read the related article in Neurology. Disclosures can be found at Neurology.org.
In this episode, we discuss treatment of acute ischemic priapism, including some updates from the American Urological Association. Show notes and references: FOAMcast.org
We will continue our discussion on ischemic episodes with a focus on ischemic colitis. We will examine what disrupts blood flow to the colon, leading to symptoms such as cramping abdominal pain, bloody diarrhea, and urgency to defecate. We will delve into risk factors, including underlying vascular disease, extreme exercise, and in some cases, colonoscopies. A thorough medical history and physical examination, along with an x-ray to check for any free air, are essential. We will also discuss various treatments depending on the severity of the condition. Join Dr. Niket Sonpal for this gut checkup. June 24, 2024 — Do you work in primary care medicine? Primary Care Medicine Essentials is our brand new program specifically designed for primary care providers to increase their core medical knowledge & improve patient flow optimization. Learn more here: Primary Care Essentials —