Podcasts about j am coll cardiol

Walk, Don't Run to the Doctor with Miles Hassell, MD

Play Episode Listen Later Aug 27, 2024 12:00

Welcome to the latest episode of Medmastery's Cardiology Digest, where In less than 15 minutes we'll get you up to date on breakthrough studies and advancements in cardiology that can impact your clinical practice! STUDY #1: Brace yourself for insights into a study that evaluated rapid uptitration of evidence-based therapies for heart failure. Join us as we dissect the feasibility, resource demands, and patient implications? Biegus, J, Mebazaa, A, Davison, B, et al. 2024. Effects of rapid uptitration of neurohormonal blockade on effective, sustainable decongestion and outcomes in STRONG-HF. J Am Coll Cardiol. 4: 323–336. (https://doi.org/10.1016/j.jacc.2024.04.055) STUDY #2: Next, we examine a recent paper that challenges hospital-centric treatment paradigms for acute pulmonary embolism. Discover how some low-risk patients could benefit from home treatment, and what conditions are essential to ensure their safety and effective care. Luijten, D, Douillet, D, Luijken, K, et al. 2024. Safety of treating acute pulmonary embolism at home: An individual patient data meta-analysis. Eur Heart J. 32: 2933–2950. (https://doi.org/10.1093/eurheartj/ehae378) STUDY #3: Finally, we dive into a large cohort study looking at bariatric surgery in obese patients with obstructive sleep apnea, and see whether losing weight actually had a significant impact on cardiovascular outcomes. Aminian, A, Wang, L, Al Jabri, A, et al. 2024. Adverse cardiovascular outcomes in patients with obstructive sleep apnea and obesity: Metabolic surgery vs usual care. J Am Coll Cardiol. Published online. (https://doi.org/10.1016/j.jacc.2024.06.008) This episode promises to be packed with actionable insights on this thought-provoking cardiology research. Don't miss out—press play and enrich your practice today! Learn more with Medmastery's courses: Chest X-ray Essentials (7 CME) Chest X-ray Essentials Workshop (1 CME) Get a Basic or Pro account, or, get a Trial account. Show notes: Visit us at https://www.medmastery.com/podcasts/cardiology-podcast.

8. The Best Fats for the Best Health Part 1

Play Episode Listen Later Jul 19, 2024 24:37

Did you know that one simple change in your kitchen could transform your health? In today's episode, Miles Hassell, MD, explores the extensive health benefits of extra virgin olive oil (EVOO). Drawing on three lines of evidence, he makes a compelling case for making EVOO your primary kitchen fat. A few takeaways from Miles Hassell, MD: Studies have shown that EVOO supports gut health. A healthy gut can contribute to improved digestion, a stronger immune system, and even better mental health. Regular consumption of EVOO has been associated with a lower incidence of dementia. This connection underscores the importance of incorporating EVOO into your diet as part of a proactive approach to brain health. Research indicates that higher consumption of olive oil is linked to a lower incidence of certain cancers. The powerful antioxidant and anti-inflammatory properties of EVOO play a significant role in reducing cancer risk. One of the most well-documented benefits of EVOO is its ability to lower the risk of heart disease. Unlike other vegetable oils, EVOO has been consistently shown to promote cardiovascular health. Miles Hassell, MD emphasizes that EVOO is not just a cooking ingredient but a therapeutic tool. Its unique composition of monounsaturated fats, antioxidants, and anti-inflammatory compounds makes it a powerhouse for health promotion. While other vegetable oils lack the same level of evidence for health benefits, EVOO stands out for its protective effects. When compared to other oils, EVOO consistently comes out on top. Making the switch to EVOO can be a simple yet powerful change to improve your overall health. So next time you're cooking, reach for the EVOO and enjoy both its flavor and its multitude of health benefits. Join the cause! Support the podcast and be a champion of a future episode by donating here: https://greatmed.org/donate/ For more information and references head to: https://greatmed.org Purchase Good Food Great Medicine Twitter (X): https://x.com/greatmedorg Instagram: @mileshassellmd Facebook: https://www.facebook.com/people/GreatMedorg/61554645308577/ Substack: https://substack.com/@greatmed YouTube: https://www.youtube.com/@greatmedicine email: info@greatmed.org References for Today's Episode: Markellos C, Ourailidou ME, Gavriatopoulou M, Halvatsiotis P, Sergentanis TN, Psaltopoulou T. Olive oil intake and cancer risk: A systematic review and meta-analysis. PLoS One. 2022 Jan 11;17(1):e0261649. doi: 10.1371/journal.pone.0261649. PMID: 35015763; PMCID: PMC8751986. Millman JF, Okamoto S, Teruya T, Uema T, Ikematsu S, Shimabukuro M, Masuzaki H. Extra-virgin olive oil and the gut-brain axis: influence on gut microbiota, mucosal immunity, and cardiometabolic and cognitive health. Nutr Rev. 2021 Nov 10;79(12):1362-1374. doi: 10.1093/nutrit/nuaa148. PMID: 33576418; PMCID: PMC8581649. Guasch-Ferré M, Hruby A, Salas-Salvadó J, Martínez-González MA, Sun Q, Willett WC, Hu FB. Olive oil consumption and risk of type 2 diabetes in US women. Am J Clin Nutr. 2015 Aug;102(2):479-86. doi: 10.3945/ajcn.115.112029. Epub 2015 Jul 8. PMID: 26156740; PMCID: PMC4515873 Valls-Pedret C, Lamuela-Raventós RM, Medina-Remón A, Quintana M, Corella D, Pintó X, Martínez-González MÁ, Estruch R, Ros E. Polyphenol-rich foods in the Mediterranean diet are associated with better cognitive function in elderly subjects at high cardiovascular risk. J Alzheimers Dis. 2012;29(4):773-82. doi: 10.3233/JAD-2012-111799. PMID: 22349682. Moreno-Luna R, Muñoz-Hernandez R, Miranda ML, Costa AF, Jimenez-Jimenez L, Vallejo-Vaz AJ, Muriana FJ, Villar J, Stiefel P. Olive oil polyphenols decrease blood pressure and improve endothelial function in young women with mild hypertension. Am J Hypertens. 2012 Dec;25(12):1299-304. doi: 10.1038/ajh.2012.128. Epub 2012 Aug 23. PMID: 22914255. Cougnard-Grégoire A, Merle BM, Korobelnik JF, Rougier MB, Delyfer MN, Le Goff M, Samieri C, Dartigues JF, Delcourt C. Olive Oil Consumption and Age-Related Macular Degeneration: The Alienor Study. PLoS One. 2016 Jul 28;11(7):e0160240. doi: 10.1371/journal.pone.0160240. PMID: 27467382; PMCID: PMC4965131. Kien CL, Bunn JY, Tompkins CL, Dumas JA, Crain KI, Ebenstein DB, Koves TR, Muoio DM. Substituting dietary monounsaturated fat for saturated fat is associated with increased daily physical activity and resting energy expenditure and with changes in mood. Am J Clin Nutr. 2013 Apr;97(4):689-97. doi: 10.3945/ajcn.112.051730. Epub 2013 Feb 27. Erratum in: Am J Clin Nutr. 2013 Aug;98(2):511. PMID: 23446891; PMCID: PMC3607650. Guasch-Ferré M, Liu G, Li Y, Sampson L, Manson JE, Salas-Salvadó J, Martínez-González MA, Stampfer MJ, Willett WC, Sun Q, Hu FB. Olive Oil Consumption and Cardiovascular Risk in U.S. Adults. J Am Coll Cardiol. 2020 Apr 21;75(15):1729-1739. doi: 10.1016/j.jacc.2020.02.036. Epub 2020 Mar 5. PMID: 32147453; PMCID: PMC7233327. Ferrara LA, Raimondi AS, d'Episcopo L, Guida L, Dello Russo A, Marotta T. Olive oil and reduced need for antihypertensive medications. Arch Intern Med. 2000 Mar 27;160(6):837-42. doi: 10.1001/archinte.160.6.837. PMID: 10737284. Priore P, Cavallo A, Gnoni A, Damiano F, Gnoni GV, Siculella L. Modulation of hepatic lipid metabolism by olive oil and its phenols in nonalcoholic fatty liver disease. IUBMB Life. 2015 Jan;67(1):9-17. doi: 10.1002/iub.1340. Epub 2015 Jan 28. PMID: 25631376. Gutiérrez-Repiso C, Soriguer F, Rojo-Martínez G, García-Fuentes E, Valdés S, Goday A, Calle-Pascual A, López-Alba A, Castell C, Menéndez E, Bordiú E, Delgado E, Ortega E, Pascual-Manich G, Urrutia I, Mora-Peces I, Vendrell J, Vázquez JA, Franch J, Girbés J, Castaño L, Serrano-Ríos M, Martínez-Larrad MT, Catalá M, Carmena R, Gomis R, Casamitjana R, Gaztambide S. Variable patterns of obesity and cardiometabolic phenotypes and their association with lifestyle factors in the Di@bet.es study. Nutr Metab Cardiovasc Dis. 2014 Sep;24(9):947-55. doi: 10.1016/j.numecd.2014.04.019. Epub 2014 Jun 9. PMID: 24984822. Ramsden CE, Zamora D, Leelarthaepin B, Majchrzak-Hong SF, Faurot KR, Suchindran CM, Ringel A, Davis JM, Hibbeln JR. Use of dietary linoleic acid for secondary prevention of coronary heart disease and death: evaluation of recovered data from the Sydney Diet Heart Study and updated meta-analysis. BMJ. 2013 Feb 4;346:e8707. doi: 10.1136/bmj.e8707. Erratum in: BMJ. 2013;346:f903. PMID: 23386268; PMCID: Juul F, Vaidean G, Lin Y, Deierlein AL, Parekh N. Ultra-Processed Foods and Incident Cardiovascular Disease in the Framingham Offspring Study. J Am Coll Cardiol. 2021 Mar 30;77(12):1520-1531. doi: 10.1016/j.jacc.2021.01.047. PMID: 33766258. Schnabel L, Kesse-Guyot E, Allès B, Touvier M, Srour B, Hercberg S, Buscail C, Julia C. Association Between Ultraprocessed Food Consumption and Risk of Mortality Among Middle-aged Adults in France. JAMA Intern Med. 2019 Apr 1;179(4):490-498. doi: 10.1001/jamainternmed.2018.7289. PMID: 30742202; PMCID: PMC6450295. Lane MM, Gamage E, Du S, Ashtree DN, McGuinness AJ, Gauci S, Baker P, Lawrence M, Rebholz CM, Srour B, Touvier M, Jacka FN, O'Neil A, Segasby T, Marx W. Ultra-processed food exposure and adverse health outcomes: umbrella review of epidemiological meta-analyses. BMJ. 2024 Feb 28;384:e077310. doi: 10.1136/bmj-2023-077310. PMID: 38418082; PMCID: PMC10899807. Alonso-Pedrero L, Ojeda-Rodríguez A, Martínez-González MA, Zalba G, Bes-Rastrollo M, Marti A. Ultra-processed food consumption and the risk of short telomeres in an elderly population of the Seguimiento Universidad de Navarra (SUN) Project. Am J Clin Nutr. 2020 Jun 1;111(6):1259-1266. doi: 10.1093/ajcn/nqaa075. PMID: 32330232. Taneri PE, Wehrli F, Roa-Díaz ZM, Itodo OA, Salvador D, Raeisi-Dehkordi H, Bally L, Minder B, Kiefte-de Jong JC, Laine JE, Bano A, Glisic M, Muka T. Association Between Ultra-Processed Food Intake and All-Cause Mortality: A Systematic Review and Meta-Analysis. Am J Epidemiol. 2022 Jun 27;191(7):1323-1335. doi: 10.1093/aje/kwac039. PMID: 35231930.

#18: CHA2DS2-VASc scoring and anticoagulation for silent atrial fibrillation, race and renin-angiotensin system inhibition in HFrEF, V142I transthyretin gene variant and cardiovascular health

Play Episode Listen Later Jul 2, 2024 12:28

In less than 15 minutes, Medmastery's Cardiology Digest will give you the low-down on some of the most compelling studies in cardiology that clinicians with an interest in cardiovascular health need to know about. STUDY #1: We kick things off by exploring exactly where the CHA2DS2-VASc score fits into anticoagulation decisions in patients with silent atrial fibrillation. Building on the main findings from the ARTESiA and NOAH-AFNET 6 trials, this study sparks a thought-provoking discussion on the future of risk stratification. Tune in to hear insights that could shape your clinical practice. Lopes, RD, Granger, CB, Wojdyla, DM, et al. 2024. Apixaban versus aspirin according to CHA2DS2-VASc score in subclinical atrial fibrillation: Insights from ARTESiA. J Am Coll Cardiol. In Press, Journal Pre-proof. (https://doi.org/10.1016/j.jacc.2024.05.002) STUDY #2: Next, we break down misconceptions surrounding race and treatment efficacy in heart failure with reduced ejection fraction. This study shines a light on the impacts of renin-angiotensin system inhibition across different racial groups. See how these findings challenge the outdated genetic constructs of race, and what they mean for your approach to patient care. Shen, L, Lee, MM, Jhund, PS, et al. 2024. Revisiting race and the benefit of RAS blockade in heart failure: A meta-analysis of randomized clinical trials. JAMA. 24: 2094–2104. (https://doi.org/10.1001/jama.2024.6774) STUDY #3: Finally, we turn our focus to the V142I transthyretin gene variant, to evaluate its impacts on cardiovascular health within the U.S. Black population. This research not only highlights the need for targeted genetic screening but also raises important questions about the accessibility of costly treatments for transthyretin amyloidosis. Selvaraj, S, Claggett, B, Shah, SH, et al. 2024. Cardiovascular burden of the V142I transthyretin variant. JAMA. 21: 1824–1833. (https://doi.org/10.1001/jama.2024.4467) Maurer, MS, Miller, EJ, Ruberg, FL, et al. 2024. Addressing health disparities—The case for variant transthyretin cardiac amyloidosis grows stronger. JAMA. 21: 1809–1811. (https://doi.org/10.1001/jama.2024.2868) Yancy, CW. 2024. Heart failure in African American individuals, Version 2.0. JJAMA. 21: 1807–1808. (https://doi.org/10.1001/jama.2024.5217) Don't miss out on this rich discussion that promises to enhance your understanding and expertise! Learn more with these courses: Medical Treatment of Heart Failure (2 CME) Atrial Fibrillation Management Essentials (1 CME) Get a Basic or Pro account, or, get a Trial account. Show notes: Visit us at https://www.medmastery.com/podcasts/cardiology-podcast.

377. CardioOncology: Multi-modality Imaging in Cardio-Oncology with Dr. Nausheen Akhter

university chicago recommendations advances mri cardio imaging oncology modality mgh pfizer inc muga j am coll cardiol

Play Episode Listen Later Jun 24, 2024 15:19

CardioNerds Co-Founder Dr. Daniel Ambinder, Series Co-Chair Dr. Giselle Suero Abreu (FIT at MGH), and Episode Lead Dr. Iva Minga (FIT at the University of Chicago) discuss the use of multi-modality cardiovascular imaging in cardio-oncology with expert faculty Dr. Nausheen Akhter (Northwestern University). Show notes were drafted by Dr. Sukriti Banthiya and episode audio was edited by CardioNerds Intern and student Dr. Diane Masket. They use illustrative cases to discuss: Recommendations on the use of multimodality imaging, including advanced echocardiographic techniques and cardiac MRI, in patients receiving cardiotoxic therapies and long-term surveillance. Role of nuclear imaging (MUGA scan) in monitoring left ventricular ejection fraction. Use of computed tomography to identify and/or monitor coronary disease. Imaging diagnosis of cardiac amyloidosis. This episode is supported by a grant from Pfizer Inc. This CardioNerds Cardio-Oncology series is a multi-institutional collaboration made possible by contributions of stellar fellow leads and expert faculty from several programs, led by series co-chairs, Dr. Giselle Suero Abreu, Dr. Dinu Balanescu, and Dr. Teodora Donisan. CardioNerds Cardio-Oncology PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! References - Multi-modality Imaging in Cardio-Oncology Baldassarre L, Ganatra S, Lopez-Mattei J, et al. Advances in Multimodality Imaging in Cardio-Oncology. J Am Coll Cardiol. 2022 Oct, 80 (16) 1560–1578.

ADHD and the athlete: superpower or disadvantage? With Dr Dusty Narducci. EP#555

BJSM

Play Episode Listen Later Jun 21, 2024 30:43

In this podcast James Walsh speaks with Dr Dusty Narducci about ADHD in athletes. Dusty is one of the lead authors on the recent AMSSM ADHD position statement and is an expert in the treatment of ADHD in athletes. They discuss the different types of ADHD, how they can manifest in athletes, treatment and the implications of stimulant medication for cardiac health and competition. References and further reading: https://www.docdusty.com/post/adhd-add-a-superpower-in-athletes https://journals.lww.com/cjsportsmed/Fulltext/2023/05000/Athletes_With_Attention_Deficit_Hyperactivity.1.aspx https://bjsm.bmj.com/content/53/12/741 Lakshaajeni Thevapalan, Martyna Stasiak, Lauren Harris, Anand S Pandit, Smart drugs among surgeons: future cause for concern?, British Journal of Surgery, Volume 110, Issue 8, August 2023, Pages 1000–1002, https://doi.org/10.1093/bjs/znad139 Cage S, Warner L, Cook A, Swindall R, Wadle C, Warner BJ. Prevalence of Self-Reported ADHD Symptoms Among Collegiate Athletes. The Internet Journal of Allied Health Sciences and Practice. 2023 Mar 20;21(2), Article 18. Dikdan, S, Sun, M, Vyas, A. et al. MENTAL HEALTH AND THE YOUTH ATHLETE: AN ANALYSIS OF THE HEARTBYTES DATABASE. J Am Coll Cardiol. 2023 Mar, 81 (8_Supplement) 2173. Zhang L, Yao H, Li L, et al. Risk of Cardiovascular Diseases Associated With Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis. JAMA Netw Open. 2022;5(11):e2243597. doi:10.1001/jamanetworkopen.2022.43597

BrainWaves 2017 Update on PFO closure in stroke

MedLink Neurology Podcast

Play Episode Listen Later May 30, 2024 22:31

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. Episodes originally aired from 2016 to 2021. Originally released: September 14, 2017 In 2016, the management of patent foramen ovale was “open” for discussion. Now (2017), consider the case closed. Recent data indicate patent foramen ovales should be closed in certain patients with cryptogenic strokes. But some questions remain unanswered. This week's episode is a follow-up discussion on this frequent topic that troubles stroke units. Produced by James E Siegler and Chris Favilla. Music by Lee Rosevere and Marcos H. Bolanos. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education purposes only. Jim is not a cardiac surgeon. Just a guy who's trying to bring you all the latest updates on what smarter doctors are doing. REFERENCES Kent DM, Dahabreh IJ, Ruthazer R, et al. Device closure of patent foramen ovale after stroke: pooled analysis of completed randomized trials. J Am Coll Cardiol 2016;67(8):907-7. PMID 26916479Kent DM, Ruthazer R, Weimar C, et al. An index to identify stroke-related vs incidental patent foramen ovale in cryptogenic stroke. Neurology 2013;81(7):619-25. doi: 10.1212/WNL.0b013e3182a08d59. Epub 2013 Jul 17. PMID 23864310Meier B, Lock JE. Contemporary management of patent foramen ovale. Circulation 2003;107(1):5-9. PMID 12515733 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.

music stroke contemporary closure device neurology voiceover circulation epub brainwaves pmid lee rosevere wnl j am coll cardiol marcos h bolanos

#14: Semaglutide and cardiovascular disease in non-diabetic patients, comparing intravascular imaging, functional, and angiographically guided coronary intervention, anticoagulation in patients with subclinical atrial fibrillation

Play Episode Listen Later May 7, 2024 12:04

In this episode of Medmastery's Cardiology Digest, we delve into a trio of intriguing cardiology studies that raise as many questions as they answer. Whether you're a seasoned clinician or a medical student, these studies have implications that could influence your approach to patient care. STUDY #1: First, we turn our attention to the role of GLP-1 agonists in cardiovascular disease prevention among non-diabetic patients who are overweight or obese. With a focus on injectable semaglutide this study examines its cost-effectiveness and potential side effects. The findings might alter how we manage cardiovascular risk in these patients! Lincoff AM et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med 2023 Nov 11; [e-pub]. (https://doi.org/10.1056/NEJMoa2307563) STUDY #2: Next, we'll explore a compelling meta-analysis that could sway future guidelines and recommendations. They evaluated the outcomes of physiologic guidance and intravascular imaging in percutaneous coronary interventions (PCI), to see if these techniques improve patient outcomes beyond what's possible with angiographic guidance alone. Kuno T et al. Comparison of intravascular imaging, functional, or angiographically guided coronary intervention. J Am Coll Cardiol 2023 Dec 5; 82:2167. (https://doi.org/10.1016/j.jacc.2023.09.823) STUDY #3: Finally, we're going to examine the nuances of anticoagulation in patients with subclinical atrial fibrillation. The balance between preventing strokes and avoiding bleeding complications is a delicate one. With new data suggesting nuanced approaches, this segment will provide valuable insights for us when we're prescribing or considering anticoagulation therapies. Healey JS et al. Apixaban for stroke prevention in subclinical atrial fibrillation. N Engl J Med 2023 Nov 12; [e-pub]. (https://doi.org/10.1056/NEJMoa2310234) Svennberg E. What lies beneath the surface — Treatment of subclinical atrial fibrillation. N Engl J Med 2023 Nov 12; [e-pub]. (https://doi.org/10.1056/NEJMe2311558) Join us to explore the potential impacts of these studies, the ongoing debates they spark within the cardiology community, and to see how these findings could influence your clinical decisions. Learn more with these courses: Percutaneous Coronary Intervention Essentials (6 CME) Percutaneous Coronary Intervention Essentials Workshop (6 CME) Show notes: Visit us at https://www.medmastery.com/podcasts/cardiology-podcast.

#13: The best form of exercise to reduce blood pressure, the impact of peripartum cardiomyopathy (PPCM) on subsequent pregnancies, a possible link between rheumatoid arthritis and aortic stenosis

Play Episode Listen Later Apr 23, 2024 11:47

In this episode of Medmastery's Cardiology Digest, we bridge the gap between academic research and clinical practice, exploring three cardiology studies that provide important insights, some of which may even challenge what you think you know. STUDY #1: First, we explore a study from JAMA Internal Medicine that sheds light on the intricate relationship between chronic inflammation and cardiovascular health in patients with rheumatoid arthritis (RA). The big question is whether there's a link between RA and the development of aortic stenosis, and if so, what does it mean for the future of patient care? Johnson TM et al. Aortic stenosis risk in rheumatoid arthritis. JAMA Intern Med 2023 Jul 31; [e-pub]. (https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2807944) STUDY #2: Next, we tackle a meta-analysis from the British Journal of Sports Medicine that reveals practical insights about the best form of exercise to reduce blood pressure. The conclusion may surprise you, offering a fresh perspective on exercise regimens and their role in combating hypertension. But to grasp the full scope of these revelations, you'll have to tune in. Edwards JJ et al. Exercise training and resting blood pressure: A large-scale pairwise and network meta-analysis of randomized controlled trials. Br J Sports Med 2023 Jul 25; [e-pub]. (https://bjsm.bmj.com/content/57/20/1317) STUDY #3: Lastly, we discuss a study that assesses the risks associated with subsequent pregnancies in women who have experienced peripartum cardiomyopathy (PPCM). We find out the magnitude of the potential for adverse events, including death. Pachariyanon P et al. Long-term outcomes of women with peripartum cardiomyopathy having subsequent pregnancies. J Am Coll Cardiol 2023 Jul 4; 82:16. (https://www.jacc.org/doi/10.1016/j.jacc.2023.04.043) Each of these studies offers a piece of the larger puzzle of cardiovascular health, challenging us to rethink strategies for prevention, monitoring, and treatment. Don't miss this episode, where curiosity meets clinical expertise, unlocking new horizons in cardiology. For show notes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast. Learn more with these courses: Hypertension Mini: https://www.medmastery.com/courses/hypertension-mini Cardiac MRI Essentials: https://www.medmastery.com/courses/cardiac-mri-essentials Echo Masterclass—The Valves: https://www.medmastery.com/courses/echo-masterclass-valves Show notes: Visit us at https://www.medmastery.com/podcasts/cardiology-podcast.

Dr. med. Udo Beckenbauer: Prävention, Check-up Medizin & Gesunde Lebensführung

Der ERCM Medizin Podcast

Play Episode Listen Later Apr 19, 2024 28:14

In dieser Episode begrüßen wir Dr. Udo E. Beckenbauer, er ist Internist, Sportmediziner und Experte für "Healthy Living". Wir diskutieren wichtige medizinische Themen wie Prävention, die Rolle der Check-up Medizin und Strategien für eine gesunde Lebensführung. Dr. Beckenbauer erklärt, wie durch präventive Maßnahmen bis zu 50% der Krebserkrankungen und 70% der Herz-Kreislauf-Erkrankungen vermieden werden könnten. Er beleuchtet den Stellenwert regelmäßiger medizinischer Check-ups und wie moderne diagnostische Verfahren, wie z.B. das CardioCT, zur Krankheitsprävention beitragen können. Abschließend teilt er praktische Ratschläge für eine gesunde Ernährung und aktive Lebensgestaltung, die das allgemeine Wohlbefinden steigern und vor Krankheiten schützen. Fachartikel: Hörder H, Johansson L, Guo X, et al.: Midlife cardiovascular fitness and dementia: A 44-year longitudinal population study in women. Neurology 2018; 90: e1298-e1305: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5894933/ Ross R, Blair SN, Arena R, et al.: Importance of Assessing Cardiorespiratory Fitness in Clinical Practice: A Case for Fitness as a Clinical Vital Sign: A Scientific Statement From the American Heart Association. Circulation 2016; 134: e653–99: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.116.025646 Guthold R, Stevens GA, Riley LM, Bull FC: Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health 2018; 6: e1077–86: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(18)30357-7/fulltext Stamatakis E, Gale J, Bauman A, et al.: Sitting Time, Physical Activity, and Risk of Mortality in Adults. J Am Coll Cardiol 2019; 73: 2062–72: https://www.sciencedirect.com/science/article/pii/S0735109719337891?via%3Dihub Wen CP, Wai JP, Tsai MK, et al.: Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet 2011; 378: 1244–53: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60749-6/abstract Kenfield SA, Stampfer MJ, Giovannucci E, Chan JM: Physical activity and survival after prostate cancer diagnosis in the health professionals follow-up study. J Clin Oncol 2011; 29: 726–32: https://ascopubs.org/doi/10.1200/JCO.2010.31.5226

#10: Aspirin vs. P2Y12 inhibitors, bempedoic acid for statin-intolerant patients, intranasal treatment of supraventricular tachycardias

Play Episode Listen Later Mar 12, 2024 11:27

In our latest episode, we venture into the heart of cardiology innovation, exploring groundbreaking studies that are reshaping how we approach common cardiovascular conditions. STUDY #1: Our journey begins with a Lancet paper that looks at a potential alternative for treating supraventricular tachycardias (SVTs). Imagine a world where the distress of SVTs can be alleviated without ablation, a rush to the emergency department or the complexities of intravenous therapy. An intranasal medication might be the key, offering a beacon of hope for patients seeking simpler, yet effective solutions. But how effective is this approach, and what does it mean for the future of SVT management? Stambler, BS, Camm, AJ, Alings, M, et al. 2023. Self-administered intranasal etripamil using a symptom-prompted, repeat-dose regimen for atrioventricular-nodal-dependent supraventricular tachycardia (RAPID): A multicentre, randomized trial. Lancet. 10396: 118–128. (https://doi.org/10.1016/S0140-6736(23)00776-6) STUDY #2: Transitioning to the realm of antiplatelet therapy, we confront the longstanding question of P2Y12 inhibitors versus aspirin. Will these new findings tilt the balance and shift our approach to secondary coronary prevention? The nuances of this study prompt a deeper reflection on patient-centric care and the economics of new-generation medications. Gragnano, F, Cao, D, Pirondini, L, et al. 2023. P2Y12 inhibitor or aspirin monotherapy for secondary prevention of coronary events. J Am Coll Cardiol. 2: 89–105. (https://doi.org/10.1016/j.jacc.2023.04.051) STUDY #3: Lastly, we explore the potential of bempedoic acid in the landscape of cholesterol management, particularly for patients who are intolerant to statins. With cardiovascular diseases looming as a pervasive threat, the quest for alternative treatments is critical. We see if bempedoic acid could play a potential role in reducing major cardiovascular events, either alongside, or perhaps in lieu of, traditional statin therapy. Nissen, SE, Menon, V, Nicholls, SJ, et al. 2023. Bempedoic acid for primary prevention of cardiovascular events in statin-intolerant patients. JAMA. 2: 131–140. (https://doi.org/10.1001/jama.2023.9696) Kazi, DS. 2023. Bempedoic acid for high-risk primary prevention of cardiovascular disease: Not a statin substitute but a good plan B. JAMA. 2: 123–125. (https://doi.org/10.1001/jama.2023.9854) Each study we discuss brings its own set of questions, implications, and possibilities for the future of cardiology. From the practicalities of new drug administrations to the cost and effectiveness of established therapies, this episode will get you up to speed! For show notes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast.

#9: A primary mechanism behind decompression illness, cognitive repercussions of a myocardial infarction, and high-sensitivity cardiac troponin I (hs-cTnI) for risk-stratification of coronary artery disease

HelixTalk - Rosalind Franklin University's College of Pharmacy Podcast

Play Episode Listen Later Feb 27, 2024 10:30

Our latest episode dissects three groundbreaking studies that are reshaping our understanding of the heart and its intricate connections to the body and mind. STUDY #1: First, we explore the potential of high-sensitivity cardiac troponin I (hs-cTnI) in risk-stratifying patients with known coronary artery disease. While current guidelines don't yet recommend these tests, could there be untapped value in using troponin concentration as a preventive treatment guide? Join us as we explore the intriguing possibilities and implications presented in this study from the Journal of the American College of Cardiology. Wereski, R, Adamson, P, Daud, NSS, et al. 2023. High-sensitivity cardiac troponin for risk assessment in patients with chronic coronary artery disease. J Am Coll Cardiol. 6: 473–485. (https://doi.org/10.1016/j.jacc.2023.05.046) STUDY #2: Next, we shift our focus to the brain-heart connection. Ever wondered about the cognitive repercussions of a myocardial infarction (MI)? This study from JAMA Neurology sheds light on the potential cognitive consequences of an MI. Johansen, MC, Ye, W, Gross, A, et al. 2023. Association between acute myocardial infarction and cognition. JAMA Neurol. 7: 723–731. (https://doi.org/10.1001/jamaneurol.2023.1331) STUDY #3: Third, we dive deep (pun intended!) into decompression illness. Certain divers might want to reconsider their next dive because a recent Annals of Internal Medicine study suggests a primary mechanism behind decompression illness that could change the way we perceive diving risks. What are the implications for those passionate about the deep blue? Lee, H-J, Lim, DS, Lee, J, et al. 2023. Decompression illness in divers with or without patent foramen ovale: A cohort study. Ann Intern Med. 7: 934–939. (https://doi.org/10.7326/M23-0260) Don't miss out on these captivating discussions. Listen in to stay at the forefront of cardiology insights and to satiate your curiosity about these studies' findings. We promise, it's a heartbeat away from being your favorite episode yet! For show notes, visit us at https://www.medmastery.com/podcasts/cardiology-podcast.

Review of the DIGAMI trial

Cardiology Trials

Play Episode Listen Later Feb 20, 2024 8:42

J Am Coll Cardiol 1995;26:57-65.Background Patients with diabetes have higher short- and long-term rates of mortality following acute myocardial infarction (AMI). Possible explanations for this include increased fatty acid metabolism, compromising glycolysis in ischemic and nonischemic areas as well as impairment of platelet and fibrinolytic function. This led to the theory that both processes could be improved with insulin infusion. Small studies at the time provided conflicting results. The Diabetes Mellitus Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) trial sought to test the hypothesis that rapid improvement of metabolic control in diabetic patients with AMI by means of insulin-glucose infusion would decrease early mortality and that continued good metabolic control would improve subsequent prognosis.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 Patients admitted to the CCUs of 19 Swedish hospitals with suspected AMI within the preceding 24 hours with a blood glucose level >11 mmol/l (198 mg/dl) with or without a previous history of diabetes mellitus. Exclusion criteria included inability to participate for reasons of health, refusal to give consent, residence outside the catchment area or enrollment in other studies.Baseline characteristics There were 1,240 patients who met inclusion criteria and 50% were excluded, mainly due to inability or unwillingness to participate. Compared to those enrolled, excluded patients were older (72 years of age) and more were women. The majority of those enrolled were men (62%) at an average age of 68 years. Nearly 40% had a history of previous MI and 22% had congestive heart failure. The mean time from the onset of symptoms to randomization was 13 hours. More than 80% of patients were non-insulin dependent. The average HbA1c at randomization was 8% and the blood glucose was 279 mg/dl.Procedures Patients randomized to insulin therapy were started on an insulin-glucose infusion at 30 ml/h and blood glucose was checked after 1 hour. The infusion rate was adjusted according to protocol. The infusion was continued until stable normoglycemia was attained for ≥24 hours. Subcutaneous administration of insulin was given immediately after cessation of the infusion, according to a multidose regimen, with the aim of maintaining normoglycemia. Serum potassium was measured immediately before the infusion and then after 6, 12, and 24 hr and was checked immediately in patients who developed any kind of clinically significant arrhythmia. Control patients were treated according to standard coronary care unit practice and did not receive insulin unless it was deemed clinically indicated.Endpoints The primary endpoint was all-cause mortality at 3 months. The investigators hypothesized that the insulin-glucose infusion followed by multidose subcutaneous insulin for 3 months would reduce the mortality rate by 30%, from a 35% mortality rate in the control group (35/100 to 24.5/100). Based on that assumption, a sample size of 600 was needed to demonstrate the expected mortality reduction with a 5% significance level and power of 80%.Results 620 patients were randomized, 306 to the intervention group and 314 to the control group. The blood glucose level was significantly lower in the insulin group 24 hours after randomization (173 mg/dl vs 211 mg/dl; p

trial swedish results substack exclusion baseline serum hba1c ccus subcutaneous j am coll cardiol background patients

TdC 221: Reposição de Potássio

Ta de Clinicagem

Play Episode Listen Later Jan 31, 2024 27:45

Kaue, Ingrid e Luísa conversam sobre os riscos da hipocalemia e como fazer reposição de potássio: classificação da hipocalemia, quais os riscos, reposição enteral, reposição venosa e quando usar diuréticos poupadores de potássio, tudo neste episódio. Referências: Ferreira JP, Butler J, Rossignol P, et al. Abnormalities of Potassium in Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(22):2836-2850. doi:10.1016/j.jacc.2020.04.021 Kim GH, Han JS. Therapeutic approach to hypokalemia. Nephron. 2002;92 Suppl 1:28-32. doi:10.1159/000065374 Cohn JN, Kowey PR, Whelton PK, Prisant LM. New guidelines for potassium replacement in clinical practice: a contemporary review by the National Council on Potassium in Clinical Practice. Arch Intern Med. 2000;160(16):2429-2436. doi:10.1001/archinte.160.16.2429 Kim MJ, Valerio C, Knobloch GK. Potassium Disorders: Hypokalemia and Hyperkalemia. Am Fam Physician. 2023;107(1):59-70. Asmar A, Mohandas R, Wingo CS. A physiologic-based approach to the treatment of a patient with hypokalemia. Am J Kidney Dis. 2012;60(3):492-497. doi:10.1053/j.ajkd.2012.01.031 Grobbee DE, Hoes AW. Non-potassium-sparing diuretics and risk of sudden cardiac death. J Hypertens. 1995;13(12 Pt 2):1539-1545. Ferreira JP, Butler J, Rossignol P, et al. Abnormalities of Potassium in Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 2020;75(22):2836-2850. doi:10.1016/j.jacc.2020.04.021 Goyal A, Spertus JA, Gosch K, et al. Serum Potassium Levels and Mortality in Acute Myocardial Infarction. JAMA. 2012;307(2):157–164. doi:10.1001/jama.2011.1967 Macdonald JE, Struthers AD. What is the optimal serum potassium level in cardiovascular patients?. J Am Coll Cardiol. 2004;43(2):155-161. doi:10.1016/j.jacc.2003.06.021

mortality refer therapeutic national council jama clinical practice potassium suppl abnormalities hyperkalemia reposi art review j am coll cardiol nephron kaue am fam physician arch intern med

177 - The Antidote Arsenal: Exploring the Emergency Toolbox for Anticoagulant Reversals

Play Episode Listen Later Jan 23, 2024 38:36

In this episode, we review evidence-based guidelines for the emergency reversal of warfarin, dabigatran, and the oral Xa inhibitors (apixaban, edoxaban, and rivaroxaban). Key Concepts Reversal of anticoagulation is indicated in patients with major hemorrhage or when emergency surgery is necessary. Reversal of warfarin (Coumadin®) involves a fast-acting, short-term solution (usually prothrombin complex concentrates [PCC]) and a slower-acting, long-term solution (intravenous vitamin K). Idarucizumab (Praxbind®) is the preferred reversal strategy for dabigatran (Pradaxa®). Idarucizumab is a monoclonal antibody fragment specific that binds and inactivates dabigatran. If idarucizumab is unavailable, PCCs are recommended. Andexanet alfa (Andexxa®) is the preferred reversal strategy for oral Xa inhibitors and has FDA approval specific to apixaban and rivaroxaban. Andexanet alfa is a decoy factor Xa protein with higher binding affinity than human clotting factor Xa. There are several barriers to use with andexanet alfa that has led to low utilization in hospitals. If andexanet alfa is unavailable, PCCs are recommended. References Baugh CW, et al. Anticoagulant Reversal Strategies in the Emergency Department Setting: Recommendations of a Multidisciplinary Expert Panel. Ann Emerg Med. 2020;76(4):470-485. Cuker A, Burnett A, Triller D, et al. Reversal of direct oral anticoagulants: Guidance from the Anticoagulation Forum. Am J Hematol. 2019;94(6):697-709. doi:10.1002/ajh.25475 Tomaselli GF, et al. 2020 ACC Expert Consensus Decision Pathway on Management of Bleeding in Patients on Oral Anticoagulants: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2020;76(5):594-622.

management patients emergency fda guidance arsenal antidote american colleges reversal bleeding toolbox pcc reversals xa anticoagulant ann emerg med pccs j am coll cardiol coumadin pradaxa idarucizumab

BrainWaves #77 Bridging the gap

MedLink Neurology Podcast

Play Episode Listen Later Jan 2, 2024 17:11

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: September 21, 2017 Atrial fibrillation increases your risk of clotting. Anticoagulation increases your risk of bleeding. Surgery increases your risk of both. Dr. Mike Rubenstein speaks with Dr. Jim Siegler this week about how providers weigh the risks and benefits of anticoagulant bridging in the perioperative setting. Produced by Michael Rubenstein and James E Siegler. Music by Chris Zabriskie, Lee Rosevere, and Jason Shaw. Voiceover by Erika Mejia. BrainWaves' podcasts and online content are intended for medical education only and should not be used for clinical decision-making. REFERENCES Garcia DA, Regan S, Henault LE, et al. Risk of thromboembolism with short-term interruption of warfarin therapy. Arch Intern Med 2008;168(1):63-9. PMID 18195197Raval AN, Cigarroa JE, Chung MK, et al. Management of patients on non-vitamin K antagonist oral anticoagulants in the acute care and periprocedural setting: a scientific statement from the American Heart Association. Circulation 2017;135(10):e604-33. Erratum in: Circulation 2017;135(10 ):e647. Erratum in: Circulation 2017;135(24):e1144. PMID 28167634Rechenmacher SJ, Fang JC. Bridging anticoagulation: primum non nocere. J Am Coll Cardiol 2015;66(12):1392-403. PMID 26383727Schulman S, Carrier M, Lee AY, et al. Perioperative management of dabigatran: a prospective cohort study. Circulation 2015;132(3):167-73. PMID 25966905Steinberg BA, Peterson ED, Kim S, et al. Use and outcomes associated with bridging during anticoagulation interruptions in patients with atrial fibrillation: findings from the Outcomes Registry for Better Informed Treatment of Atrial Fibrillation (ORBIT-AF). Circulation 2015;131(5):488-94. PMID 25499873Stroke Prevention in Atrial Fibrillation Study. Final results. Circulation 1991;84(2):527-39. PMID 1860198 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.

music management risk surgery bridging bridging the gap voiceover american heart association circulation brainwaves pmid kims lee rosevere chris zabriskie jason shaw perioperative erratum anticoagulation j am coll cardiol arch intern med outcomes registry better informed treatment

Atrial Fibrillation Guideline Update: Part II

management patients develop diagnosis guidelines monitoring american colleges epub pharmd pmid ceu atrial fibrillation bcps atrial clinical practice guidelines fccp pharmacy practice matt boyd j am coll cardiol

Play Episode Listen Later Jan 1, 2024 37:23 Transcription Available

Atrial fibrillation is the most common clinical arrhythmia. The newest guidelines have significant changes in diagnosis, assessment, and treatment. Join host, Geoff Wall, with guest Matt Boyd, as they evaluate the pharmacotherapy changes in the new guidelines in this two-part episode.The GameChangerRate and rhythm control medications largely have the same clinical outcomes. Patients with heart failure with reduced ejection fraction should try rhythm control first. Monitoring is key for atrial fibrillation pharmacotherapy. HostGeoff Wall, PharmD, BCPS, FCCP, BCGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint HealthGuest Mathew Boyd, PharmD Clinical Pharmacist, Unity PointReferenceJoglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2023 Nov 23:S0735-1097(23)06465-3. doi: 10.1016/j.jacc.2023.08.017. Epub ahead of print. PMID: 38043043.https://www.jacc.org/doi/10.1016/j.jacc.2023.08.017Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Discuss rate versus rhythm control in patients with atrial fibrillation 2. Develop a monitoring plan and selection of medications in rhythm control0.05 CEU/0.5 HrUAN: 0107-0000-24-XXX-H01-PInitial release date: 1/1/2023Expiration date: 1/1/2025Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

Atrial Fibrillation Guideline Update: Part I

management diagnosis guidelines american colleges epub pharmd pmid ceu atrial fibrillation bcps atrial clinical practice guidelines fccp pharmacy practice j am coll cardiol

Play Episode Listen Later Dec 28, 2023 30:34 Transcription Available

Atrial fibrillation is the most common clinical arrhythmia. The newest guidelines have significant changes in diagnosis, assessment, and treatment. Join host, Geoff Wall, as he evaluates the first half of the guidelines in this two-part episode.The GameChangerDifferent stratifying types of atrial fibrillation no longer exist. Additionally, left atrial occlusive devices are now recommended as first-line therapy for the prevention of stroke, though anticoagulants are the treatment of choice. HostGeoff Wall, PharmD, BCPS, FCCP, BCGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint Health ReferenceJoglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2023 Nov 23:S0735-1097(23)06465-3. doi: 10.1016/j.jacc.2023.08.017. Epub ahead of print. PMID: 38043043.https://www.jacc.org/doi/10.1016/j.jacc.2023.08.017 Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CPE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Describe new definitions of atrial fibrillation and risk factors for stroke 2. Discuss mechanical prevention of stroke in high risk patients 0.05 CEU/0.5 HrUAN: 0107-0000-23-401-H01-PInitial release date: 12/25/2023Expiration date: 12/25/2024Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagram

Microvasculair Lijden en Coronairspasme, met Peter Damman

Hart op de Tong

Play Episode Listen Later Dec 12, 2023 67:38

Angina pectoris is niet alleen voorbehouden aan mensen met epicardiaal obstructief coronairlijden. Tegenwoordig worden niet-obstructieve oorzaken als microvasculaire vaatdysfunctie en coronairspasme erkend. In de derde aflevering van "hart op de tong" spreken we hierover dr. Peter Damman. Hij is een autoriteit op het gebied van niet-obstructief coronairlijden. Onderwerpen zoals bij welke patiënt je hieraan moet denken, hoe een coronaire functietest in zijn werk gaat, wat de risico's zijn en hoe je een patiënt met niet-obstructief coronairlijden behandelt, passeren onder andere de revue. Tot slot horen we of dr. Damman liever een bon pakt of de Bieber van de kroeg is. (00:00) - Introductie Peter Damman (10:29) - Microvasculaire dysfunctie (28:26) - Coronaire functiesten (54:10) - Behandeling en toekomst (01:03:00) - Duivelse dillema's en take home messages Jansen TPJ, Damman P et al. Assessing Microvascular Dysfunction in Angina With Unobstructed Coronary Arteries: JACC Review Topic of the Week. J Am Coll Cardiol. 2021 Oct 5;78(14):1471-1479. doi: 10.1016/j.jacc.2021.08.028. PMID: 34593129.

hij tot bieber pmid tegenwoordig onderwerpen angina j am coll cardiol

The Role of Circulating Biomarkers in Heart Failure

HFA Cardio Talk

Play Episode Listen Later Nov 30, 2023 17:27

With Henrike Arfsten,Medical University of Vienna - Austria & Antoni Bayes-Genis, Heart Institute, University Hospital Germans Trias and Pujol de Badalona - Spain In this episode of HFA CardioTalk, Henrike Arfsten interviews Antoni Bayes-Genis on circulating biomarkers in heart failure. They focus in particular on natriuretic peptides and discuss the benefits of biomarkers assessment and their fundamental role in heart failure diagnosis and disease progression. NEW! If you want to know more on this topic, access some recommended readings from the speakers: - Bayes-Genis A, et al.; Eur J Heart Fail. 2023 Sep 15 - Mueller C, et al.; Eur J Heart Fail. 2019 Jun;21(6):715-731. - Bayes-Genis A, et al.; Eur J Heart Fail. 2021:23,1432–1436. - Huelsmann M, et al.; J Am Coll Cardiol. 2013 Oct 8;62(15):1365-72 - Tsutsui H, et al; Eur J Heart Fail. 2023 May;25(5):616-631.

heart failure biomarkers medical university pujol circulating heart institute j am coll cardiol

345. Case Report: A Case of Unrepaired Congenital Heart Disease – University of Chicago – Northshore University

2 View: Emergency Medicine PAs & NPs

Play Episode Listen Later Nov 22, 2023 60:26

CardioNerds (Dr. Josh Saef, Dr. Agnes Koczo) join Dr. Iva Minga, Dr. Kifah Hussain, and Dr. Kevin Lee from the University of Chicago - NorthShore to discuss a case of unrepaired congenital heart disease that involves D-TGA complicated by Eisenmenger syndrome. The ECPR was provided by Dr. Michael Earing. Audio editing by Dr. Akiva Rosenzveig. A 25-year-old woman with an unknown congenital heart disease that was diagnosed in infancy in Pakistan presents to the hospital for abdominal pain and weakness. She is found to be profoundly hypoxemic, and an echocardiogram revealed D-transposition of the great arteries (D-TGA) with a large VSD. As this was not repaired in childhood, she has unfortunately developed Eisenmenger syndrome with elevated pulmonary vascular resistance. She is stabilized and treated medically for her cyanotic heart disease. Unfortunately given the severity and late presentation of her disease, she has limited long-term options for care. CardioNerds discuss the diagnosis of D-TGA and Eisenmenger's syndrome, as well as long-term management and complications associated with this entity. US Cardiology Review is now the official journal of CardioNerds! Submit your manuscript here. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Case Media - Unrepaired Congenital Heart Disease Pearls - Unrepaired Congenital Heart Disease Early diagnosis of cyanotic congenital heart disease is paramount for treatment and prevention of future complications. Adult congenital heart disease requires a multi-disciplinary team for management in consultation with an adult congenital cardiology specialist. Eisenmenger syndrome is related to multiple systemic complications and has a high rate of mortality. Advancement in PAH medical management can offer noninvasive treatment options for some patients. Transthoracic echocardiography is the cornerstone for diagnosis. Other modalities (e.g. cardiac CT, cardiac MRI, invasive catheterization) can aid in diagnosis and management. Show Notes - Unrepaired Congenital Heart Disease Cyanotic congenital heart disease is often diagnosed in infancy and timely treatment is paramount. As these diseases progress over time, pulmonary over-circulation often pulmonary hypertension (PH), elevated pulmonary vascular resistance, and Eisenmenger syndrome will develop, which preclude definitive treatment. For D-TGA, before PH develops, there are surgical options such as the arterial switch procedure that can treat the disease. Unfortunately, once Eisenmenger syndrome develops, there are multiple systemic complications including hyperviscosity, thrombosis, bleeding, kidney disease, iron deficiency, arrhythmias, etc. that can occur. Management requires a multi-disciplinary team including an adult congenital cardiology specialist, but mortality rates remain high, with median survival reduced by 20 years, worse with complex cardiac defects. Bosentan is a first line treatment for patients with Eisenmenger syndrome, with PDE-5 inhibitors as a second line either by themselves or in combination with bosentan. Data are currently limited for latest-generation PH treatments in Eisenmenger syndrome and further study is still underway. References Ferencz C. Transposition of the great vessels. Pathophysiologic considerations based upon a study of the lungs. Circulation. 1966 Feb;33(2):232-41. Arvanitaki A, Gatzoulis MA, Opotowsky AR, Khairy P, Dimopoulos K, Diller GP, Giannakoulas G, Brida M, Griselli M, Grünig E, Montanaro C, Alexander PD, Ameduri R, Mulder BJM, D'Alto M. Eisenmenger Syndrome: JACC State-of-the-Art Review. J Am Coll Cardiol. 2022 Mar 29;79(12):1183-1198. Earing MG, Webb GD. Congenital heart disease and pregnancy: maternal and fetal risks. Clin Perinatol.

29 - Toxoplasmosis, the OPAL trial, medical marijuana, appendicitis, and colchicine.

Play Episode Listen Later Oct 13, 2023 49:33

Show Notes for Episode 29 of “The 2 View” – Toxoplasmosis, the OPAL trial, medical marijuana, appendicitis, and colchicine. CDC - Toxoplasmosis CDC – Parasites – Toxoplasmosis (Toxoplasma infection). Cdc.gov. Published June 9, 2023. Accessed September 26, 2023. https://www.cdc.gov/parasites/toxoplasmosis/index.html OPAL RCT for Opioids in Back Pain Jones C, O'Day R, Koes B, et. al. Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial. The Lancet. Thelancet.com. Published July 22, 2023. Accessed September 26, 2023. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00404-X/fulltext Sikina M, Kiel J. Re-evaluating Red Flags for Back Pain. Acep.org. Sports Med. Published August 17, 2022. Accessed September 26, 2023. https://www.acep.org/sportsmedicine/newsroom/newsroom-articles/august2022/re-evaluating-red-flags-for-back-pain Medical Marijuana Brooks M. Is Medical Cannabis the Answer to the Opioid Crisis? Medscape Emergency Medicine. Published October 3, 2022. Accessed September 26, 2023. https://www.medscape.com/viewarticle/981767?ecd=wnlinfocu4broadbroadpersoexpansion-editorial_20230603&uac=106964SV&impID=5490911 Novak S. Physicians Aren't Asking Enough Questions About Cannabis Use. Medscape Emergency Medicine. Published August 29, 2023. Accessed September 26, 2023. https://www.medscape.com/viewarticle/995954?ecd=WNLtrdalrtpos1230904etid5820671&uac=106964SV&impID=5820671 Appendicitis Appendicitis. Acep.org. Accessed September 26, 2023. https://www.acep.org/patient-care/clinical-policies/appendicitis Dora-Laskey A. Acute pain control. EM. Accessed September 26, 2023. https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m3-curriculum/group-acute-pain-control/acute-pain-control Hidayat AI, Purnawan I, Mulyaningrat W, et al. Effect of Combining Dhikr and Prayer Therapy on Pain and Vital Signs in Appendectomy Patients: A Quasi-Experimental Study. NIH: National Library of Medicine. J Holist Nurs. Accessed September 26, 2023. https://pubmed.ncbi.nlm.nih.gov/37277995/ Smink D, Soybel D. Management of acute appendicitis in adults. UpToDate. Uptodate.com. Updated February 15, 2023. Accessed September 26, 2023. https://www.uptodate.com/contents/management-of-acute-appendicitis-in-adults Colchicine Chiabrando JG, Bonaventura A, Vecchié A, et al. Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review. J Am Coll Cardiol. ScienceDirect. Published January 2020. Accessed September 26, 2023. https://www.sciencedirect.com/science/article/pii/S0735109719384840?via%3Dihub Gout clinical practice guidelines. American College of Rheumatology. Rheumatology.org. Accessed September 26, 2023. https://rheumatology.org/gout-guideline Telmesani A, Moss E, Chetrit M. The Use of Colchicine in Pericardial Diseases. American College of Cardiology. Published December 5, 2019. Accessed September 26, 2023. https://www.acc.org/Latest-in-Cardiology/Articles/2019/12/04/08/22/The-Use-of-Colchicine-in-Pericardial-Diseases Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

Chapter 23 - A mother's love -Peripartum Cardiomyopathy

Always On EM - Mayo Clinic Emergency Medicine

Play Episode Listen Later Oct 1, 2023 85:13

Dr. Katie Young, co-director of the cardioobstetrics clinic here at Mayo Clinic sits down to talk about peripartum cardiomyopathy. This is something we will likely consider many times in our careers for patients with shortness of breath in and around late pregnancy. Find out what interventions are key, what patients are most likely to suffer a bad outcome and more. CONTACTS X - @AlwaysOnEM; @VenkBellamkonda YouTube - @AlwaysOnEM; @VenkBellamkonda Instagram – @AlwaysOnEM; @Venk_like_vancomycin; @ASFinch Email - AlwaysOnEM@gmail.com REFERENCES & LINKS Gierula J, et al. Prospective evaluation and long-term follow up of patients referred to secondary care based upon natriuretic peptide levels in primary care. European Heart Journal – Quality of Care and Clinical Outcomes. 2019. 5, 218-224 Bay M, et al. NT-proBNP: A new diagnostic screening tool to differentiate between patients with normal and reduced left ventricular systolic function. Heart. 2003. 89,150-154 Dockree S, et al. Pregnancy reference intervals for BNP and NT-pro BNP – changes in natriuretic peptides related to pregnancy. Journal of Endocrine society. 2021. 5(7)1-9 Mueller C, et al. Heart failure association of the European society of cardiology practical guidance on the use of natriuretic peptide concentrations. European Journal of Heart Failure. 2019. 21, 715-731 Ravichandran J, et al. High-sensitivity cardiac troponin I levels in normal and hypertensive pregnany. American J of Medicine. 2019. 132,362-366 High sensitivity troponin T and I among pregnant women in the US – the National Health and Nutrition Examination Survey. JAMA Cardiology. 2023. 8(4)406-408 Tweet MS, et al. Spontenaoues Cardic Artey Dissection associated with pregnancy. Journal of the American College of Cardiology. 2017. 70,426-435 Baggish AL, et al. The differential diagnosis of an elevated amino-terminal Pro-B-Type Natriuretic Peptide level. Am J Cardiol. 2008. 101,43A-48A Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute Respiratory Failure – the Blue Protocol. Chest. 2008. 134,117-125 Smit MR, et al. Comparison of linear and sector array probe for handheld lung ultrasound in invasively ventilated ICU patients. Ultrasound in Med & Biol. 2020. 46(12)3249-3256 Haller EP, Nestler DM, Campbell RL, Bellamkond VA. Point-of-care ultrasound findings of acute pulmonary embolism: McConnell sign in the emergency medicine. JEM. 2014. 47(1)e19-e24 Halpern DG, et al. Use of medication for cardiovascular disease during pregnancy:JACC State of the Art Review. J Am Coll Cardiol. 2019. Feb, 73(4)457-476 Loyanga-Rendon RY, et al. Outcomes of patients with peripartum cardiomyopathy who received mechanical circulatory support. 2014. Circ Heart Failure. 7,300-309 Adedinsewo DA, et al. Detecting cardiomyopathies in pregnancy and the postpartum period with an electrocardiogram-based deep learning model. European Heart Journal – Digital Health. 2021. 2,586-596 Zieleskiewicz L., et al. Lung ultrasound-guided management of acute breathlessness during pregnancy. Anesthesia. 2013. 68,97-101 Balaceanu A. B-type natriuretic peptides in pregnant women with normal heart or cardiac disorders. Medical Hypotheses. 2018. 121,149-151

Episódio 203: Pericardite Aguda - 4 clinicagens

Ta de Clinicagem

Play Episode Listen Later Sep 13, 2023 20:40

Iago e Gabriel conversam sobre os principais aspectos do diagnóstico de uma pericardite aguda! Referências: Chiabrando JG, Bonaventura A, Vecchié A, et al. Management of Acute and Recurrent Pericarditis: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:76. Spodick DH. Differential characteristics of the electrocardiogram in early repolarization and acute pericarditis. N Engl J Med 1976; 295:523 Ginzton LE, Laks MM. The differential diagnosis of acute pericarditis from the normal variant: new electrocardiographic criteria. Circulation 1982; 65:1004. Yehuda Adler, Philippe Charron, Massimo Imazio, Luigi Badano, Gonzalo Barón-Esquivias, Jan Bogaert, Antonio Brucato, Pascal Gueret, Karin Klingel, Christos Lionis, Bernhard Maisch, Bongani Mayosi, Alain Pavie, Arsen D Ristić, Manel Sabaté Tenas, Petar Seferovic, Karl Swedberg, Witold Tomkowski, ESC Scientific Document Group , 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: The Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC) https://doi.org/10.1093/eurheartj/ehv318

management diagnosis epis task force refer acute circulation differential iago european society new england journal of medicine aguda art review j am coll cardiol cardiology esc

Guidelines for Heart Failure with Preserved Ejection Fraction

management guidelines american colleges cardiology epub pharmd preserved heart failure pmid ejection fraction ceu bcps fccp pharmacy practice hfpef j am coll cardiol

Play Episode Listen Later Jun 19, 2023 24:17

Half of patients with heart failure have Heart Failure with Preserved Ejection Fraction (HFpEF). Join host, Geoff Wall, as he talks about the new guidelines from the American College of Cardiology for diagnosis, treatment, and challenges in therapy for persons with HFpEF.The GameChangerHFpEF is the fastest growing cause of heart failure and is often difficult to diagnose. New therapies are shown to improve symptoms and decrease hospitalizations. Management of comorbid conditions, like obesity and diabetes, is critical to optimizing care. HostGeoff Wall, PharmD, BCPS, FCCP, BCGPProfessor of Pharmacy Practice, Drake UniversityInternal Medicine/Critical Care, UnityPoint HealthReferenceKittleson MM, Panjrath GS, Amancherla K, et al. 2023 ACC Expert Consensus Decision Pathway on Management of Heart Failure With Preserved Ejection Fraction: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. 2023 May 9;81(18):1835-1878. doi: 10.1016/j.jacc.2023.03.393. Epub 2023 Apr 19. PMID: 37137593. Pharmacist Members, REDEEM YOUR CPE HERE! Not a member? Get a Pharmacist Membership & earn CE for GameChangers Podcast episodes! (30 mins/episode)CE Information Learning ObjectivesUpon successful completion of this knowledge-based activity, participants should be able to:1. Discuss the H2FPEF scoring system for HFpEF diagnosis2. Apply the new practice guidelines to HFpEF patient pharmacotherapy 0.05 CEU/0.5 HrUAN: 0107-0000-23-228-H01-PInitial release date: 6/19/2023Expiration date: 6/19/2024Additional CPE details can be found here.Follow CEimpact on Social Media:LinkedInInstagramDownload the CEimpact App for Free Continuing Education + so much more!

Episode 138: SGLT-2 Inhibitors in heart failure

Rio Bravo qWeek

Play Episode Listen Later May 12, 2023 19:09

Episode 138: SGLT-2 Inhibitors in heart failureFuture doctor Enuka explains the use of sodium-glucose-linked cotransporter-2 inhibitors (SGLT-2 inhibitors) in heart failure. Dr. Arreaza adds his experience with these medications and emphasizes their role as an effective treatment for type 2 diabetes. Written by Princess Enuka, MSIV, Ross University School of Medicine. Editing by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Intro:Heart failure is a major medical condition that affects millions of people worldwide. It is one of the leading causes of hospitalization and death in developed countries. Recently, SGLT2 inhibitors have emerged as a promising treatment option for heart failure. Today, we will discuss their benefits, their effectiveness, and their adverse effects.SGLT2 inhibitors, also known as sodium-glucose-linked cotransporter-2 inhibitors, are a relatively novel class of drugs that have shown promise in heart failure treatment. This transporter reabsorbs glucose from the glomerular filtrate back into the bloodstream. Under normal circumstances, SGLT-2 reabsorbs 100% of the filtered glucose unless it is saturated (as in hyperglycemia) or blocked by medications. SGLT2 inhibitors increase the amount of glucose excreted in the urine, which leads to blood glucose reduction. Examples include empagliflozin, dapagliflozin, and canagliflozin.SGLT-2 inhibitors have become a first-line therapy for diabetes mellitus. I heard before that it was used in Europe for T1DM, but it seems like they are no longer used, according to my most recent review of articles. SGLT2 inhibitors are not approved by the FDA for use in type 1 diabetes due to the risk of DKA. Princess, besides the benefits in diabetes, what else did you find in your review?Benefits/Efficacy:SGLT2 inhibitors have additional benefits beyond their glucose-lowering effects. One of the benefits of SGLT2 inhibitors is their ability to increase myocardial energy production, alleviate systemic microvascular dysfunction, and improve systemic endothelial function. Natriuresis and glucosuria mediated by SGLT2 inhibitors have been shown to lower cardiac pre-load and reduce pulmonary congestion and systemic edema, which is beneficial for heart failure management.Studies have shown that these drugs can also improve cardiovascular outcomes in patients with heart failure with a reduced ejection fraction. Some studies:The EMPEROR-Reduced trial demonstrated that empagliflozin, brand name Jardiance®, reduced the risk of cardiovascular death and hospitalization for heart failure in patients with reduced ejection fraction by 25% compared to placebo. Several clinical trials have also shown that this result is significant whether patients have type 2 diabetes or not. Also, in a multicenter, double-blind, randomized, placebo-controlled trial in patients with heart failure, treatment with dapagliflozin, brand name Farxiga®, improved heart failure-related symptoms and physical limitations after only 12 weeks of treatment. Patients treated with dapagliflozin had a significant, clinically meaningful improvement in the 6-minute walking test distance. The magnitude of these benefits was statistically and clinically significant, spanning all subgroups categorized. This included patients with and without type 2 diabetes and those with an ejection fraction above or below 60%.Anecdote:During a previous clinical rotation, I had a patient taking Jardiance for heart failure. He also had a history of chronic kidney disease and managed his condition well with medications and regular follow-ups. Interestingly, he was prescribed Jardiance®, which I initially believed was solely for diabetes management. When I asked him about it, he explained that his cardiologist prescribed Jardiance specifically for his heart. At the time, I did not understand the rationale behind prescribing Jardiance®, especially since the patient did not have type 2 diabetes. But after researching the medication, I figured that his cardiologist had chosen Jardiance® due to its demonstrated benefits in reducing the risk of cardiovascular death and hospitalization for heart failure. Although initially considered to be only glucose-lowering agents, the effects of SGLT2 inhibitors have expanded far beyond that. Their use has expanded to include heart failure and chronic kidney disease, even in patients without diabetes. It is, therefore, essential that cardiologists, diabetologists, nephrologists, and primary care physicians are familiar with this drug class.Adverse effects:It is worthwhile to note that SGLT2 inhibitors are not typically used as first-line treatment for heart failure, and not all patients with heart failure are appropriate candidates for these medications. SGLT2 inhibitors are generally well-tolerated, but they can cause adverse effects. Genital and urinary tract infections and euglycemic diabetic ketoacidosis are the most common side effects experienced by patients. The incidence of these adverse effects is generally low and can be managed with appropriate monitoring and treatment. In addition, SGLT2 inhibitors can also cause dehydration, electrolyte imbalances, hypotension, and acute kidney injury (AKI). These imbalances are more common in elderly patients or those with renal impairment, like the patient I discussed earlier. Genital yeast infections: Diabetes is also a risk factor for genital yeast infections because glucose in the urine is used as a substrate by microorganisms to grow in the GU tract. UTI and genital yeast infections are prevented by staying well hydrated while taking these meds. Increased intake of water will dilute the urine and decrease the concentration of glucose in urine. UTI/genital yeast infections are treated as usual, and the SGLT-2 can be resumed after infections are treated. In case of recurrence, the clinician may consider discontinuation of medication based on a case-by-case assessment. Patients using SGLT2 inhibitors for treatment should have regular follow-ups with their physicians for the early detection of adverse effects. Bladder cancer: It is not clear if chronic glucosuria is tumorigenic since there are no long-term data. In clinical trials, 10 cases of bladder cancer were diagnosed among dapagliflozin users, five of which occurred only in the first six months of treatment. The FDA has recommended postmarketing surveillance studies. Dapagliflozin is not recommended in patients with active bladder cancer. Bone fractures and limb amputation: One trial (CANVAS) demonstrated an increased incidence of bone fractures and limb amputations among users of canagliflozin, but another trial (CREDENCE) did not demonstrate such an increased incidence of bone fractures or limb amputations. This increased risk has not been proven with empagliflozin. Summary: SGLT2 inhibitors have shown promise in heart failure treatment, particularly in patients with a reduced ejection fraction. Even though the specific mechanism of action through which they work on the cardiovascular system is currently unknown, they have been shown to reduce the risk of hospitalization for heart failure and cardiovascular death in several clinical trials. These medications lower blood glucose levels and have other beneficial effects on the cardiovascular system that make them good options for the management of heart failure.____________________Conclusion: Now we conclude episode number 138, “SGLT-2 inhibitors in heart failure.” Princess explained that SGLT-2 inhibitors have many benefits that go beyond their glucose-lowering properties. Recently, the use of SGLT-2 inhibitors has been extended to include heart failure with reduced ejection fraction and chronic kidney disease, even in patients without diabetes. Dr. Arreaza also explained that FDA has not approved the use of SGLT-2 inhibitors for the treatment of type 1 diabetes because of the reported increased risk of diabetic ketoacidosis or DKA. There is ongoing research about additional uses of SGLT-2 inhibitors, and we are looking forward to hearing more about these medications in the future.This week we thank Hector Arreaza and Princess Enuka. Audio editing by Adrianne Silva.Even without trying, every night, you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you. Send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _________________Links:Packer M, Anker SD, Butler J, et al. Cardiovascular and renal outcomes with empagliflozin in heart failure. N Engl J Med. 2020;383(15):1413-1424. https://pubmed.ncbi.nlm.nih.gov/32865377/Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41(2):255-323. https://pubmed.ncbi.nlm.nih.gov/31497854/Heerspink HJL, Perkins BA, Fitchett DH, et al. Sodium glucose cotransporter 2 inhibitors in the treatment of diabetes mellitus: cardiovascular and kidney effects, potential mechanisms, and clinical applications. Circulation. 2016;134(10):752-772. https://pubmed.ncbi.nlm.nih.gov/27470878/Zelniker TA, Braunwald E. Mechanisms of cardiorenal effects of sodium-glucose cotransporter 2 inhibitors: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(4):422-434. https://pubmed.ncbi.nlm.nih.gov/32000955/Nassif, M. E., et al. (2020). The SGLT2 inhibitor dapagliflozin in heart failure with preserved ejection fraction: A multicenter randomized trial. Nature Medicine, 27(11), 1954-1960. https://doi.org/10.1038/s41591-021-01536-xRoyalty-free music used for this episode: "Tempting Tango." Downloaded on October 13, 2022, from https://www.videvo.net/

079 - Viabilidade Miocárdica: qual o seu papel na prática clínica?

2 View: Emergency Medicine PAs & NPs

Play Episode Listen Later Apr 13, 2023 28:58

⁠DozeNews PRIME⁠⁠: as melhores e mais didáticas revisões de cardiologia direto na sua caixa de entrada! Assine agora e tenha acesso à todo material já produzido! - ⁠⁠https://dozeporoito.substack.com/ Nesse episódio, Maju, Manu e Batah discutem sobre a viabilidade miocárdica. Nele, definem o conceito de miocárdio hibernado, os principais exames para investigar territórios viáveis, e as prinicpais indicações nas diretrizes. Por fim, debatem os últimos estudos sobre o tema, as recentes polêmicas e em que contexto a solicitação de viabilidade miocárdica se encaixa na prática clínica atual. - Minutagem: (00:00) Apresentação (02:30) Oque é viabilidade miocárdica? (06:30) Como avaliar viabilidade? (16:25) Evidências científicas sobre viabilidade (22:00) Como interpretar a viabilidade na prática clínica (27:00) Considerações finais

state qual nesse manu papel apresenta refer nele american heart association considera napr assine evid maju minutagem j am coll cardiol mioc

25 - Pediatric Nurse Practitioners Are Not Okay, DEA Updates, and Hyperacute T-Waves

Play Episode Listen Later Apr 10, 2023 55:36

Welcome to Episode 25 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 25 of “The 2 View” Pediatric Nurse Practitioners Are Not Okay Della Volpe K. We Are Not Ok, Say Pediatric NPs. Clinical Advisor. Published March 17, 2023. Accessed March 27, 2023. https://www.clinicaladvisor.com/home/meeting-coverage/napnap-2023/pediatric-nps-not-ok/?utmsource=newsletter&utmmedium=email&utmcampaign=NWLTRCADCONFNAPNAPMODERNA032023RM&hmEmail=1f%2FJfEV7hN5vJr6vg%2FQRqK0NA6IXtyO3&sha256email=092493d8223fdfa40d9e995176d13e5fc5b5211674db9deb440c025fd462c80c&hmSubId=&NID=1639413404&elqTrackId=31abe541d69a4ca587368d18c07e2aeb&elq=24134fa5abd64addafddd14ad54e8f8d&elqaid=13088&elqat=1&elqCampaignId=10964&fbclid=IwAR2YZErTgA9ET7Yzib3bPYuhD68VDtGAayIfQ2bu398LBTX6xEmLjZX3EY Sarjoo A. Pediatricians: We Can't Bear the Burden of Teen Angst. Medscape. Published March 13, 2023. Accessed March 27, 2023. https://www.medscape.com/viewarticle/989552 New TASER Bleetman A, Hepper AE, Sheridan RD. The use of TASER devices in UK policing: an update for clinicians following the recent introduction of the TASER 7. BMJ Journals. Emerg Med J. Published 2023. Accessed March 27, 2023. https://emj.bmj.com/content/40/2/147.long Taser Injuries. Emergency Central. Unboundmedicine.com. Accessed March 27, 2023. https://emergency.unboundmedicine.com/emergency/view/5-MinuteEmergencyConsult/307682/all/Taser_Injuries Vilke G, Chan T, Bozeman WP, Childers R. Emergency Department Evaluation After Conducted Energy Weapon Use: Review of the Literature for the Clinician. NIH National Library of Medicine: National Center for Biotechnology Information. PubMed. J Emerg Med. Published September 26, 2019. Accessed March 27, 2023. https://pubmed.ncbi.nlm.nih.gov/31500994/ Hyperacute T-Waves Dr. Smith's ECG blog. Blogspot.com. Published March 2023. Accessed March 27, 2023. http://hqmeded-ecg.blogspot.com/search/label/hyperacute%20T-waves Koechlin L, Strebel I, Zimmermann T, et al. Hyperacute T Wave in the Early Diagnosis of Acute Myocardial Infarction. Ann Emerg Med. PubMed. NIH: National Library of Medicine. National Center for Biotechnology Information. Published online February 9, 2023. Accessed March 27, 2023. https://pubmed.ncbi.nlm.nih.gov/36774205/ Writing Committee, Kontos MC, de Lemos JA, et al. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Published November 2022. Accessed March 27, 2023. https://www.jacc.org/doi/10.1016/j.jacc.2022.08.750 DEA Updates – Segment with Dr. Rick Bukata Criteria for Furnishing Number Utilization by Nurse Practitioners. State of California, DCA (Department of Consumer Affairs). Board of Registered Nursing. Rn.ca.gov. Accessed March 27, 2023. https://www.rn.ca.gov/pdfs/regulations/npr-i-16.pdf DEA Announces Proposed Rules for Permanent Telemedicine Flexibilities. Drug Enforcement Administration (DEA). Published February 24, 2023. Accessed March 27, 2023. https://www.dea.gov/press-releases/2023/02/24/dea-announces-proposed-rules-permanent-telemedicine-flexibilities Mid-Level Practitioners Authorization by State. US Department of Justice. Drug Enforcement Administration. Diversion Control Division. Usdoj.gov. Accessed March 27, 2023. https://www.deadiversion.usdoj.gov/drugreg/practioners/ Removal of DATA Waiver (X-Waiver) Requirement. SAMHSA. Substance Abuse and Mental Health Services Administration. Samhsa.gov. Last Updated January 25, 2023. Accessed March 27, 2023. https://www.samhsa.gov/medications-substance-use-disorders/removal-data-waiver-requirement Statutory Changes in Pharmacy Law. Pharmacy.ca.gov. Published December 9, 2022. Accessed March 27, 2023. https://www.pharmacy.ca.gov/lawsregs/newlaws.pdf Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in and see what we have to share!

075 - Betabloqueadores na IC aguda: Manter, reduzir ou suspender?

Play Episode Listen Later Mar 16, 2023 39:16

DozeNews PRIME⁠: as melhores e mais didáticas revisões de cardiologia direto na sua caixa de entrada! Assine agora e tenha acesso à todo material já produzido! - ⁠https://dozeporoito.substack.com/

069- Origem Anômala de Coronárias

refer cta origem considera investiga finais defini anomalous coron epidemiologia achados valsalva j am coll cardiol

Play Episode Listen Later Feb 2, 2023 30:09

Podcast 846: Early Repolarization vs. Anterior STEMI

md qt anterior ekg summarized stemi qrs ama pra category ann emerg med j am coll cardiol

Play Episode Listen Later Jan 30, 2023 2:35

Contributor: Travis Barlock, MD Educational Pearls: Early repolarization a benign EKG pattern that can mimic an anterior STEMI Can be seen in the anterior leads typically in young male patients Can differentiate Early Repolarization vs Anterior STEMI by looking at four variables: Corrected QT interval QRS amplitude in V2 R wave amplitude in V4 ST elevation 60 ms after J point in V3 These four variables can be plugged into a formula (available on MDCalc) Note that a longer QT is more corelated with STEMI References Macfarlane PW, Antzelevitch C, Haissaguerre M, et al. The Early Repolarization Pattern: A Consensus Paper. J Am Coll Cardiol. Jul 28 2015;66(4):470-7. doi:10.1016/j.jacc.2015.05.033 Smith SW, Khalil A, Henry TD, et al. Electrocardiographic differentiation of early repolarization from subtle anterior ST-segment elevation myocardial infarction. Ann Emerg Med. Jul 2012;60(1):45-56.e2. doi:10.1016/j.annemergmed.2012.02.015 Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account.

Flat sheets, a CHD study + how it pertains to dietetics, and holiday plans

The Dietitian Group Chat

Play Episode Listen Later Dec 8, 2022 36:02

Hey Besties! Holiday season is upon us and we planned on taking a Peloton class together, so we decided to record a pod too! Naturally we are all over the place: tucking or untucked flat sheets, reviewing a journal article Cara sent us earlier in the week, and some holiday plans, and much more. Enjoy! Study mentioned: Zakai N, Minnier J, Safford M, et al. Race-Dependent Association of High-Density Lipoprotein Cholesterol Levels With Incident Coronary Artery Disease. J Am Coll Cardiol. 2022 Nov, 80 (22) 2104–2115

holiday study naturally flat peloton sheets dietetics holiday plans pertains hey besties j am coll cardiol

12: The 12 Medical Conditions of Concern…and a Partridge in a Pear Tree

Floss & Flip-Flops

Play Episode Listen Later Dec 1, 2022 58:03

Join the Sanders Sisters as they welcome the holidays and the last episode of their first season of Floss & FlipFlops! In this episode, the sisters discuss the 12 medical conditions on Santa's list that can indicate a bigger systemic complication, and how you can integrate your knowledge of these conditions in helping your patients achieve lifelong health! Floss and Flip-Flops with the Sanders sisters features hosts dental hygienist and speaker Katrina M. Sanders, RDH, and podiatrist Dr Elizabeth Sanders, DPM. Together, the sisters discuss the oral-systemic link and its impact—from your teeth down to your toes. The podcast is produced monthly by Dental Products Report® and Modern Hygienist®, in partnership with The Sanders sisters. For additional content for dental professionals visit DPR and MH at dentalproductsreport.com. Katrina Sanders, RDH, can be reached at: Website: katrinasanders.com Facebook Instagram LinkedIn EPISODE 12 REFERENCES: Tattersall, M. C., et. al. (2015). Asthma Predicts Cardiovascular Disease Events: The Multi-Ethnic Study of Atherosclerosis. Arteriosclerosis, Thrombosis, and Vascular Biology, 35(6), 1520-1525. Yeh, E. T. H., & Bickford, C. L. (2009). Cardiovascular Complications of Cancer Therapy: Incidence, Pathogenesis, Diagnosis, and Management. J Am Coll Cardiol, 53(24), 2231-2247. Chaikriangkrai, K., et. a l. (2015). Additive prognostic value of coronary artery calcium score and renal function in patients with acute chest pain without known coronary artery disease: up to 5-year follow-up. Int J Cardiovasc Imaging. 31(8), 1619-1626. Liu, Y., et. al. (2014). Kidney Stones and Cardiovascular Risk: A Metaanalysis of Cohort Studies. Am J Kidney Dis, 64(3), 402-410. Uddin, S. M. I., et. al. (2018). Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis. Circulation. doi:10.1161/circulationaha.118.033990 Clarson, L. E., et. al. (2015). Increased risk of vascular disease associated with gout: a retrospective, matched cohort study in the UK Clinical Practice Research Datalink. Annals of the Rheumatic Diseases, 74(4), 642-647 Beckman, J., Duncan, M., et al. HIV and PAD. March 12, 2018. Circulation; 10.1161.117.032647 van Nimwegen, F. A., et. al. (2015). Cardiovascular disease after Hodgkin lymphoma treatment: 40-year disease risk. JAMA Intern Med. doi: 10.1001/jamainternmed.2015.1180 Rodondi, N., et al. (2010). Subclinical hypothyroidism and the risk of coronary heart disease and mortality. JAMA, 304(12), 1365-1374. Larsson Susanna, C., et. al. (2019) Thyroid Function and Dysfunction in Relation to 16 Cardiovascular Diseases: A Mendelian Randomization Study. Circulation: Genomic and Precision Medicine, 0(0). doi:10.1161/CIRCGEN.118.002468 Adelborg, K., et. al. (2018). Migraine and risk of cardiovascular diseases: Danish population based matched cohort study. Bmj, 360. doi:10.1136/bmj.k 96 Chapple ILC, Potential mechanisms underpinning the nutritional modulation of periodontal inflammation. J Am Dent Assoc. 2009; 140 (2): 178-184. Hujoel P. Dietary carbohydrates and dental-systemic diseases. J Dental Res. 2009; 88 (6): 490-502. Lee M, et al "Current Helicobacter pylori infection is significantly associated with subclinical coronary atherosclerosis in healthy subjects: A cross-sectional study" PloS One 2018; 13(3): e0193646. Shah NH, LePendu P., Bauer-Mehren A., et al. (June 10, 2015). Proton Pump Inhibitor Usage and the risk of MI in the general population. LLoS ONE 10(6). Mercado FB, Marshall RI, Bartold PM. Inter-relationships between rheumatoid arthritis and periodontal disease. A Review. J Clin Periodontol 2003; 30: 761-772.

Impacts of Poor Sleep (Ep. 98)

Taylored Talks

Play Episode Listen Later Nov 28, 2022 23:09

Taking a minor break from ruffling the f*cking cages and feathers of what we call modern society these days and I wanted to talk about something a bit more conventional but important nevertheless and that is sleep. I have a multitude of studies for you to do your own research as I want to present this topic as clear cut as possible. Time Stamps: (0:28) Are You Enjoying the Podcast? (2:30) Going On a Journey With Sleep (6:40) Adverse Effects From Poor Sleep (16:30) Stress and the Blood-Brain Barrier (18:50) Naps ---------------------------- Resources: [i] Pilcher JJ, Walters AS. How sleep deprivation affects psychological variables related to college students' cognitive performance. J Am Coll Health. 1997 Nov;46(3):121-6. View Abstract [ii] Walker MP, et al. Practice with sleep makes perfect: sleep-dependent motor skill learning. Neuron. 2002 Jul 3;35(1):205-11. View Abstract [iii] Rosen IM, et al. Evolution of sleep quantity, sleep deprivation, mood disturbances, empathy, and burnout among interns. Acad Med. 2006 Jan;81(1):82-5. View Abstract [iv] Cohen S, et al. Sleep habits and susceptibility to the common cold. Arch Intern Med. 2009 Jan 12;169(1):62-7. View Full Paper [v] Patel SR, et al. Association between reduced sleep and weight gain in women. Am J Epidemiol. 2006 Nov 15;164(10):947-54. View Full Paper [vi] Donga E, et al. A single night of partial sleep deprivation induces insulin resistance in multiple metabolic pathways in healthy subjects. J Clin Endocrinol Metab. 2010 Jun;95(6):2963-8. View Abstract [vii] Williamson AM, Feyer AM. Moderate sleep deprivation produces impairments in cognitive and motor performance equivalent to legally prescribed levels of alcohol intoxication. Occup Environ Med. 2000 Oct;57(10):649-55. View Full Paper [viii] Kim TW, Jeong JH, Hong SC. The impact of sleep and circadian disturbance on hormones and metabolism. Int J Endocrinol. 2015;2015:591729. View Full Paper [ix] Vgontzas AN, et al. IL-6 and its circadian secretion in humans. Neuroimmunomodulation. 2005;12(3):131-40. View Abstract [x] Meier-Ewert HK, et al. Absence of diurnal variation of C-reactive protein concentrations in healthy human subjects. Clin Chem. 2001 Mar;47(3):426-30. View Full Paper [xi] Meier-Ewert HK, et al. Effect of sleep loss on C-reactive protein, an inflammatory marker of cardiovascular risk. J Am Coll Cardiol. 2004 Feb 18;43(4):678-83. View Abstract [xii] van Leeuwen WM, et al. Sleep restriction increases the risk of developing cardiovascular diseases by augmenting proinflammatory responses through IL-17 and CRP. PLoS One. 2009;4(2):e4589. View Full Paper [xiii] Chennaoui M, et al. Effect of one night of sleep loss on changes in tumor necrosis factor alpha (TNF-α) levels in healthy men. Cytokine. 2011 Nov;56(2):318-24. View Abstract [xiv] Vgontzas AN, et al. Chronic insomnia is associated with a shift of interleukin-6 and tumor necrosis factor secretion from nighttime to daytime. Metabolism. 2002 Jul;51(7):887-92. View Abstract [xv] He J, et al. Sleep restriction impairs blood-brain barrier function. J Neurosci. 2014 Oct 29;34(44):14697-706. View Full Paper [xvi] Zlokovic BV. The blood-brain barrier in health and chronic neurodegenerative disorders. Neuron. 2008 Jan 24;57(2):178-201. View Abstract [xvii] Hurtado-Alvarado G, et al. Blood-Brain Barrier Disruption Induced by Chronic Sleep Loss: Low-Grade Inflammation May Be the Link. J Immunol Res. 2016;2016:4576012. View Full Paper [xviii] Esposito P, et al. Corticotropin-releasing hormone and brain mast cells regulate blood-brain-barrier permeability induced by acute stress. J Pharmacol Exp Ther. 2002 Dec;303(3):1061-6. View Full Paper [xix] Steiger A. Sleep and the hypothalamo-pituitary-adrenocortical system. Sleep Med Rev. 2002 Apr;6(2):125-38. View Abstract [xx] Vgontzas AN, et al. Daytime napping after a night of sleep loss decreases sleepiness, improves performance, and causes beneficial changes in cortisol and interleukin-6 secretion. Am J Physiol Endocrinol Metab. 2007 Jan;292(1):E253-61. View Full Paper ---------------------------- Follow Me on Instagram! @tayloredwellbeing ---------------------------- Click Here to Apply to Work with Me or visit taylorsappington.com/application

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ATS Reading List Podcast: Episode 4 - Submassive Pulmonary Embolism

Breathe Easy

Play Episode Listen Later Nov 8, 2022 43:27

GuestParth Rali, MD Temple University HostJennifer D. Duke, MD Mayo ClinicP.J. Gary, MD Mayo ClinicShow Notes If you enjoyed this content, please follow or subscribe and leave us a review! Access the ATS Reading List. Recommended Reading Konstantinides S, Geibel A, Heusel G, et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002; 347:1143-50. Meyer G, Vicaut E, Danays T, et al. PEITHO investigators. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014; 370:1402-11. Supplement to: Meyer G, Vicaut E, Danays T, et al. Fibrinolysis for patients with intermediate-risk pulmonary embolism. N Engl J Med 2014;370:1402-11. DOI: 10.1056/NEJMoa1302097 Rali P, Criner GJ. Submassive Pulmonary Embolism. Am J Respir Crit Care Med 2018; 198(5):588-98. Chaudhury P, Gadre SK, Schneider E, et al. Impact of multidisciplinary pulmonary embolism response team availability on management and outcomes. Am J Cardiol 2019; 124:1465-69. Konstantinides S, Vicaut E, Danays T, et al. Impact of Thrombolytic Therapy on the Long-Term Outcome of Intermediate-Risk Pulmonary Embolism. J Am Coll Cardiol. 2017 Mar, 69 (12) 1536–1544.

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Podcast 826: STEMI Equivalents

Play Episode Listen Later Nov 1, 2022 4:00

Contributor: Travis Barlock, MD Educational Pearls: The presence of a STEMI has traditionally been used to determine if a patient with acute chest pain requires urgent cath lab management STEMI indicates an occluded coronary artery, and urgent intervention is needed to restore perfusion to ischemic tissue Patients with occluded coronary arteries can present with EKG findings other than STEMI 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department was recently published in the Journal of the American College of Cardiology Recognizes STEMI equivalents that necessitate cath lab management ST depression in precordial leads Indicates a posterior infarct/possible RCA occlusion LBBB c ST elevation meeting modified Sgarbossa criteria Hyperacute and/or De Winter T wave First indication of coronary artery occlusion Most beneficial time to initiate cath lab because more tissue is salvageable These recommendations will likely alter clinical practice for ED management of acute chest pain References Kontos MC, de Lemos JA, Deitelzweig SB, et al. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Oct 6 2022;doi:10.1016/j.jacc.2022.08.750 Meyers HP, Bracey A, Lee D, et al. Comparison of the ST-Elevation Myocardial Infarction (STEMI) vs. NSTEMI and Occlusion MI (OMI) vs. NOMI Paradigms of Acute MI. J Emerg Med. Mar 2021;60(3):273-284. doi:10.1016/j.jemermed.2020.10.026 Tziakas D, Chalikias G, Al-Lamee R, Kaski JC. Total coronary occlusion in non ST elevation myocardial infarction: Time to change our practice? Int J Cardiol. Apr 15 2021;329:1-8. doi:10.1016/j.ijcard.2020.12.082 Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MD, & Erik Verzemnieks, MD In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/ Donate to EMM today!

"The Big Ask" - Hypertension (Part II)

Primary Care Pearls

Play Episode Listen Later Oct 17, 2022 46:43 Transcription Available

In the second episode of our hypertension series, Taylor and Dr. Gallagher discuss lifestyle modifications and medications used in the treatment of high blood pressure.Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!=== Outline ===1. Introduction2. Chapter 1: Setting goals3. Chapter 2: Lifestyle modifications4. Chapter 3: Initiating Pharmacotherapy5. Chapter 4: Adherence to Medications6. Conclusion=== Learning Points ===Most patients with hypertension would benefit from having a low blood pressure, regardless of the degree of lowering.Recognize that asking patients to start medications can be a large ask for a patient, especially if they are otherwise healthy and have several other conditions to manage. Lifestyle modifications—such as reducing salt intake and drinking water—may lower blood pressure to some degree. However, finding such “low-hanging fruit” in lifestyle modifications is difficult, and providers should not shy away from pharmacotherapies. Firstline therapies for lowering blood pressure include long-acting calcium channel blockers, ACE inhibitors/ARBs, and diuretics. Optimizing a patient's regimen may require a combination of therapies, and combination pills may be effective in improving adherence.=== Our Expert(s) ===Benjamin Gallagher, MD, FACP is an Assistant Professor of Clinical Medicine (General Medicine) at Yale School of Medicine.=== References ===2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71:e127-e248.Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data Brief, no 364. Hyattsville, MD: National Center for Health Statistics. 2020.SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373(22):2103–16. 2015.Thomopoulos C, Parati G, Zanchetti A. Effects of blood pressure-lowering treatment on cardiovascular outcomes and mortality: 14 – Effects of different classes of antihypertensive drugs in older and younger patients: Overview and meta-analysis. J Hypertens 36(8):1637–47. 2018.=== Recommended Reading ===Appel LJ, Brands MW, Daniels SR, Karanja N, Elmer PJ, Sacks FM; American Heart Association. Dietary approaches to prevent and treat hypertension: a scientific statement from the American Heart Association. Hypertension. 2006 Feb;47(2):296-308. doi: 10.1161/01.HYP.0000202568.01167.B6. PMID: 16434724.=== About Us ===The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts about core primary care topics centered around real patient stories.Hosts: Josh Onyango, Maisie OrsilloProducers: Helen Cai, Kevin Wheelock, Danish ZaidiLogo and name: Eva ZimmermanTheme music and Editing: Josh OnyangoOther background music: Dan Lebowitz, penguinmusic, future mono, Jesse Gallagher, VYEN, madriFan, Instagram: @pcpearlsTwitter: @PCarePearlsListen on most podcast platforms: linktr.ee/pcpearls

Episode 113: Statins in Primary Care

Rio Bravo qWeek

Play Episode Listen Later Oct 7, 2022 17:42

Episode 112: Statins in Primary CareDr. Tiwana explains the use of statins for the primary prevention of cardiovascular disease.Written by Ripandeep Tiwana, MD (Post-Doctoral Research Fellow at Cedar Sinai Medical Center – Heart Institute). Edition of text and comments by Hector Arreaza, MD.____________________________________________You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Definition.Statins commonly referred to as lipid-lowering medications, are important in primary care as they serve multiple long-term benefits than just lipid lowering alone. They are HMG-CoA reductase inhibitors. As a refresher, this is the rate-controlling enzyme of the metabolic pathway that produces cholesterol. This enzyme is more active at night, so statins are recommended to be taken at bedtime instead of during the day. Statins are most effective at lowering LDL cholesterol. However, they also help lower triglycerides and raise HDL cholesterol.Statins are not limited to just patients with hyperlipidemia. They reduce illness and mortality in those who have diabetes, have a history of cardiovascular disease (including heart attack, stroke, peripheral arterial disease), or are simply at high risk for cardiovascular disease. Statins are used for primary and secondary prevention.Types of statins.How do we determine which statin our patients need?First, we need to know that not all statins are created equal. They vary by intensity and potency thus, and they are categorized as either low, moderate, or high intensity.Several statins are available for use in the United States. They include Atorvastatin (Lipitor), Fluvastatin (Lescol XL), Lovastatin (Altoprev), Pitavastatin (Livalo, Zypitamag), Pravastatin (Pravachol), Rosuvastatin (Crestor, Ezallor), Simvastatin (Zocor)Commonly used in clinics: Simvastatin, Atorvastatin, and Rosuvastatin.Statin Dosing and ACC/AHA Classification of Intensity Low-intensity Moderate-intensity High-intensityAtorvastatin NA 1 10 to 20 mg 40 to 80 mgFluvastatin 20 to 40 mg 40 mg 2×/day; XL 80 mg NALovastatin 20 mg 40 mg NAPitavastatin 1 mg 2 to 4 mg NARosuvastatin NA 5 to 10 mg 20 to 40 mgSimvastatin 10 mg 20 to 40 mg NAOf note, atorvastatin and rosuvastatin are only for moderate or high-intensity use, and do not use simvastatin 80 mg.Identifying patients at risk.How do we determine who needs statin therapy?Once we become familiar with the different statins, we must figure out which intensity is advised for our patient. Recommendations for statin therapy are based on guidelines from The U.S. Preventive Services Task Force (USPSTF), American Diabetes Association (ADA), and the American College of Cardiology/American Heart Association (ACC/AHA) which recommend utilizing the ASCVD risk calculator in those patients who do not already have established cardiovascular disease.ASCVD stands for atherosclerotic cardiovascular disease, defined as coronary heart disease, cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin. ASCVD remains a leading cause of morbidity and mortality in the United States, especially in individuals with diabetes.The ASCVD risk score determines a patient's 10-year risk of cardiovascular complications, such as a myocardial infarction or stroke. This risk estimate considers age, sex, race, cholesterol levels, use of blood pressure medication, diabetic status, and smoking status. Regarding age, this calculator only applies to the age range of 40-79 as there is insufficient data to predict risk outside this age group.There are several online and mobile applications available to calculate this score. Once calculated it gives a recommendation for which intensity statin to use. However, as this is a recommendation, it is essential to use your own clinical judgment to decide what is best for your individual patient. Please refer to the above table as a reference for which statin and dose you may consider using.Keeping the above calculator in mind, additional statin guidelines are recommended by the ACC:Patients ages 20-75 years and LDL-C ≥190 mg/dl use high-intensity statin without risk assessment. (You do not need the calculator.)People with type 2 diabetes and aged 40-75 years use moderate-intensity statins, and risk estimate to consider high-intensity statins. (It means moderate for all diabetics older than 40, high for some.)Age >75 years, clinical assessment, and risk discussion. Age 40-75 years and LDL-C ≥70 mg/dl and 10%. Grade B recommendation: prescribe a statin for the primary prevention of CVD.Grade C – 40-75 years with >= 1 cardiovascular risk factor AND estimated 10-year ASCVD risk 7.5-10%. Grade C recommendation: selectively offer a statin for the primary prevention of CVD. The likelihood of benefit is smaller in this group than in persons with a 10-year risk of 10% or greater.Grade I - The USPSTF found insufficient evidence to recommend for or against initiating a statin for the primary prevention of CVD events and mortality in adults 76 years or older.The USPSTF is also very clear regarding the intensity of statin therapy. They explained that there is limited data directly comparing the effects of different statin intensities on health outcomes. Most of the trials they reviewed used moderate-intensity statin therapy. They conclude that moderate-intensity statin therapy seems reasonable for most persons' primary prevention of CVD.The USPSTF has a broader recommendation, whereas the ACC guidelines are more detailed and individualized and provide guidance on the recommended intensity of statin therapy.Labs needed.Establish baseline labs for serum creatinine, LFTs, and CK only if there is a myopathy risk. Routine monitoring of LFTs, serum creatinine, and CK is unnecessary; only check if clinically indicated.A lipid panel should be checked in 6-8 weeks, and the patient should monitor themselves for any side effects, including myalgias. If LDL-C reduction is adequate (≥30% reduction with intermediate statins and 50% with high-intensity statins), regular interval monitoring of risk factors and compliance with statin therapy is necessary to sustain long-term benefit.Side effects and contraindications.Some common side effects include URI-like symptoms, headache, UTI, and diarrhea. Some patients are very hesitant to take any medications. Warning about side effects may decrease compliance. Major contraindications for statin therapy include active liver disease, muscle disorders, pregnancy, and breastfeeding.Special considerations.Chronic kidney disease: The preferred statins for CKD with severe renal impairment are atorvastatin and fluvastatin because they do not require dose adjustment. Pravastatin would be a second choice.Chronic liver disease: Statins are contraindicated in patients with decompensated cirrhosis or acute liver failure. Abstinence from alcohol is critical in patients with chronic liver disease who are taking statins. Pravastatin and rosuvastatin are the preferred agents. Check lipid levels to determine if LDL-C reduction is accomplished with no changes in aminotransferases. You may consider stopping, increasing dose, or changing statin as you discuss the risks vs. benefits with your patient.Conclusion: Simply put, if a patient has an LDL of greater than 190, is a diabetic, has an established history of cardiovascular disease, or is at risk for it, then the patient should ideally be taking a statin unless there is a contraindication, allergy, or other special circumstance that limits him/her from doing so. If you have patients that apply to any of the above scenarios and are not already on a statin, determine their risk, and consider starting them on a statin “stat” to reduce morbidity and mortality. On the other hand, be mindful of overprescribing. Do not prescribe statins to patients who do not meet the above criteria.________________________________________Now we conclude our episode number 113, “Statins in Primary Care.” Statins are powerful medications for the prevention of cardiovascular disease. Do not forget to recommend non-pharmacologic measures such as healthy eating and physical activity, but let's also consider adding a statin to patients who are at moderate to high risk for cardiovascular disease.This week we thank Hector Arreaza and Ripandeep Tiwana. Audio by Adrianne Silva.Even without trying, every night, you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you; send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week!______________________________________References:1. Statins, U.S. Food & Drug Administration, 2014, December 16, fda.gov, https://www.fda.gov/drugs/information-drug-class/statins, accessed September 14, 2022.2. Chou R, Cantor A, Dana T, et al. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: A Systematic Review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Aug. (Evidence Synthesis, No. 219.) Available from: https://www.ncbi.nlm.nih.gov/books/NBK583661/3. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; March 17. https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2019/03/07/16/00/2019-acc-aha-guideline-on-primary-prevention-gl-prevention. 4. ASCVD Risk Estimator Plus, published by the American College of Cardiology, https://tools.acc.org/ascvd-risk-estimator-plus/#!/calculate/estimate/, accessed September 14, 2022.5. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication, U.S. Preventive Services Task Force, Final Recommendation Statement, 2022, August 23. https://uspreventiveservicestaskforce.org/uspstf/recommendation/statin-use-in-adults-preventive-medication6. Videvo. “Distinction.” Https://Www.videvo.net/Royalty-Free-Music-Track/Distinction/227882/, Https://Www.videvo.net/, https://www.videvo.net/royalty-free-music-track/distinction/227882/. Accessed 26 Sept. 2022.

"This Seems Crazy... Nothing's Wrong with Me." - Hypertension (Part 1)

Primary Care Pearls

Play Episode Listen Later Oct 3, 2022 39:33 Transcription Available

In the first episode of our hypertension series, our patient Taylor joins us for a discussion on receiving and coming to terms with a diagnosis of high blood pressure.Share your reactions and questions with us at Speak Pipe . We might feature you on a future episode!=== Outline ===1. Introduction2. Chapter 1: Taylor's Story/Hypertensive Urgency3. Chapter 2: Defining Hypertension4. Chapter 3: Measuring Blood Pressure5. Chapter 4: White Coat Hypertension6. Conclusion=== Learning Points ===The ideal target for a patient's blood pressure is based on their risk score for cardiovascular events and mortality in the long term. Measurement of blood pressure in an office setting is often performed in nonideal conditions.Out-of-office monitoring of blood pressure monitoring should be used whenever possible. The “white coat effect” refers to high blood pressure that is above a patient's treatment goal in the office, but below their treatment goal at home. This effect is still clinically significant.=== Our Expert(s) ===Benjamin Gallagher, MD, FACP is an Assistant Professor of Clinical Medicine (General Medicine) at Yale School of Medicine.=== References ===2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2018;71:e127-e248.Ostchega Y, Fryar CD, Nwankwo T, Nguyen DT. Hypertension prevalence among adults aged 18 and over: United States, 2017–2018. NCHS Data Brief, no 364. Hyattsville, MD: National Center for Health Statistics. 2020.SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK, Sink KM, et al. A randomized trial of intensive versus standard blood-pressure control. N Engl J Med 373(22):2103–16. 2015.Powers BJ, Olsen MK, Smith VA, Woolson RF, Bosworth HB, Oddone EZ. Measuring blood pressure for decision making and quality reporting: where and how many measures? Ann Intern Med. 2011 Jun 21;154(12):781-8, W-289-90. doi: 10.7326/0003-4819-154-12-201106210-00005. PMID: 21690592.de la Sierra A, Segura J, Banegas JR, Gorostidi M, de la Cruz JJ, Armario P, Oliveras A, Ruilope LM. Clinical features of 8295 patients with resistant hypertension classified on the basis of ambulatory blood pressure monitoring. Hypertension. 2011 May;57(5):898-902. doi: 10.1161/HYPERTENSIONAHA.110.168948. Epub 2011 Mar 28. PMID: 21444835.=== About Us ===The Primary Care Pearls (PCP) Podcast is created in collaboration with faculty, residents, and students from the Department of Internal Medicine at the Yale School of Medicine. The project aims to create accessible and informative podcasts for furthering the medical education of residents and clinicians in early stages of their careers. Building on the work of other medical education podcasts, Primary Care Pearls includes contributions from patients themselves, who have the autonomy to share their own experiences of how their primary care physician directly impacted the quality of their care.Hosts: Josh Onyango, Maisie OrsilloProducers: Helen Cai, Kevin Wheelock, Danish ZaidiLogo and name: Eva ZimmermanTheme music and Editing: Josh OnyangoOther background music: The Mini Vandals, Asher Fuller, Astron, Joel Cummins, penguinmusic, Unicorn heads, Dan Bodan, Instagram: @pcpearlsTwitter: @PCarePearlsListen on most podcast platforms: linktr.ee/pcpearls

#8 - Cocaine & Beta-Blockers: Unopposed Alpha-Adrenergic Stimulation

Pyrlcasts

Play Episode Listen Later Sep 8, 2022 15:37

Pyrlcasts, brought to you by Pyrls.com! We take a closer look at interesting and relevant clinical topics related to pharmacotherapy. Want to learn more clinical pearls? Boost your clinical confidence? Visit and sign-up for an account at pyrls.com to get over 10 high-quality charts absolutely FREE! Episode References: Center for Behavioral Health Statistics and Quality. (2021). Results from the 2020 National Survey on Drug Use and Health: Detailed tables. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/ COCAINE HYDROCHLORIDE NASAL solution. Lannett Company, Inc. Accessed via DailyMed. Updated August 27, 2020. Zimmerman JL. Cocaine intoxication. Crit Care Clin. 2012;28(4):517-526. doi:10.1016/j.ccc.2012.07.003 Richards JR, Hollander JE, Ramoska EA, et al. β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon. J Cardiovasc Pharmacol Ther. 2017;22(3):239-249. doi:10.1177/1074248416681644 Anderson JL, Adams CD, Antman EM, et al. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines [published correction appears in J Am Coll Cardiol. 2013 Sep 10;62(11):1040-1]. J Am Coll Cardiol. 2013;61(23):e179-e347. doi:10.1016/j.jacc.2013.01.014 Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines [published correction appears in Circulation. 2014 Dec 23;130(25):e433-4. Dosage error in article text]. Circulation. 2014;130(25):e344-e426. Smith SC Jr, Benjamin EJ, Bonow RO, et al. AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation [published correction appears in Circulation. 2015 Apr 14;131(15):e408]. Circulation. 2011;124(22):2458-2473. doi:10.1161/CIR.0b013e318235eb4d Richards JR, Laurin EG. Cocaine. [Updated 2022 May 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430769/ Lo KB, Virk HUH, Lakhter V, et al. Clinical Outcomes After Treatment of Cocaine-Induced Chest Pain with Beta-Blockers: A Systematic Review and Meta-Analysis. Am J Med. 2019;132(4):505-509. doi:10.1016/j.amjmed.2018.11.041

049 - Miocárdio não compactado e hipertrabeculação: O manejo prático!

Dr. Baliga's Internal Medicine Podcasts

Play Episode Listen Later Sep 1, 2022 25:22

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Play Episode Listen Later Aug 18, 2022 12:47

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047 - TILT TEST: quando, como e porquê? - Ft. Dr. Guilherme Dagostin e Dr. Ricardo Neif

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Play Episode Listen Later Aug 18, 2022 38:28

N215 - ISGLT2 no IAM - Paulo Rizzo Genestreti

SBD

Play Episode Listen Later Aug 16, 2022 4:47

Autor: Paulo Rizzo Genestreti Ref: Sodium Glucose Cotransporter-2 Inhibition for Acute Myocardial Infarction: JACC Review Topic of the Week. J Am Coll Cardiol. 2022 May 24;79(20):2058-2068. doi: 10.1016/j.jacc.2022.03.353.

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Inflation Reduction Act, Intradermal Jynneos, and more!

Pharm5

Play Episode Listen Later Aug 12, 2022 4:42

This week on Pharm5: Inflation Reduction Act's impact on Medicare Part D Monkeypox and Jynneos vaccine updates Tennessee sues Walgreens for opioid over-distribution FDA declines Nuplazid's indication for Alzheimer's psychosis Two BP readings better predicts ASCVD risk References: Statement by president Biden on Senate Passage of the inflation reduction act. The White House. https://bit.ly/3dcWRfs. Published August 7, 2022. Accessed August 11, 2022. Part D Senior Savings Model (insulin savings) common questions & answers. https://go.cms.gov/3SGrKcx. Accessed August 11, 2022. JYNNEOS vaccine. Centers for Disease Control and Prevention. https://bit.ly/3STVq6e. Published August 10, 2022. Accessed August 11, 2022. FDA authorizes intradermal use of Jynneos vaccine for Monkeypox. Medscape. https://wb.md/3C2K9ua. Published August 9, 2022. Accessed August 11, 2022. Assistant Secretary for Public Affairs (ASPA). Biden-Harris Administration Bolsters Monkeypox Response; HHS secretary Becerra declares public health emergency. HHS.gov. https://bit.ly/3pabFhK. Published August 5, 2022. Accessed August 11, 2022. Williams J. Judge says Walgreens contributed to San Francisco's opioid crisis. PBS. https://to.pbs.org/3zMFH04. Published August 10, 2022. Accessed August 11, 2022. Gorman S. Tennessee sues Walgreens Pharmacy chain over Opioid Distribution. Medscape. https://wb.md/3Qk2VkW. Published August 5, 2022. Accessed August 11, 2022. Staff R. FDA declines to approve expanded use of antipsychotic drug. Medscape. https://wb.md/3bIlSz2. Published August 5, 2022. Accessed August 11, 2022. Clark CE, Warren FC, Boddy K, et al. Higher arm versus lower arm systolic blood pressure and cardiovascular outcomes: A meta-analysis of individual participant data from the Interpress-IPD Collaboration. Hypertension. August 2022. doi:10.1161/hypertensionaha.121.18921. Whelton P, Carey R, Aronow W, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults. J Am Coll Cardiol. 2018 May, 71 (19) e127–e248. https://doi.org/10.1016/j.jacc.2017.11.006.

046 - Digoxina: remédio ou veneno?

Play Episode Listen Later Aug 11, 2022 24:19

Qual a relação de uma planta com o James Bond? Digoxina é remédio ou veneno? Ainda tem espaço para essa medicação na cardiologia? Como prescrever? Quais os cuidados? Como é e como tratar a intoxicação? Cada vez menos prescrevemos essa droga e seu uso está ficando escasso e, por isso, as dúvidas e angústias surgem. Nesse episódio, Rapha Rossi e Mateus Prata debatem todos esses tópicos sobre a digoxina, de maneira bem descontraída.

043 - Trombo no VE

PEBMED - Notícias médicas

Play Episode Listen Later Jul 21, 2022 24:24

left toda tem refer bom deixe diagn considera egito tratamento fatores epidemiologia art review j am coll cardiol

PEBMED e Pfizer: PAF - Polineuropatia Amiloidótica Familiar e sinais de alerta

Play Episode Listen Later Jul 13, 2022 14:59

Neste episódio especial da PEBMED em parceria com a Pfizer, Marcelo Gobbo, médico de comunidade e família e editor médico do Portal recebe a neurologista Viviane Carvalho para falar sobre PAF, a Polineuropatia Amiloidótica Familiar, uma condição rara que pode ter sua trajetória modificada quando identificada precocemente e adequadamente tratada. Referências Bibliográficas: 1- Picken MM. The Pathology of Amyloidosis in Classification: A Review. Acta Haematol. 2020;143(4):322-334. doi: 10.1159/000506696. Epub 2020 May 11. PMID: 32392555. 2- Adams D, Koike H, Slama M, Coelho T. Hereditary transthyretin amyloidosis: a model of medical progress for a fatal disease. Nat Rev Neurol. 2019 Jul;15(7):387-404. doi: 10.1038/s41582-019-0210-4. Epub 2019 Jun 17. PMID: 31209302. 3- Guevara C, Barrientos N, Flores A, Idiáquez J. Polineuropatia amiloidótica familiar tipo I. Rev Méd Chile. 2003;131:1179-82. 4- Centenário do nascimento de Corino de Andrade. Sinapse, publicação da Sociedade Portuguesa de Neurologia, Suplemento 1, Volume 6, Nº1, Maio de 2006. 5- Andrade, C. A peculiar form of peripheral neuropathy; familiar atypical generalized amyloidosis with special involvement of the peripheral nerves. Brain. 1952 Sep;75(3):408-27. doi: 10.1093/brain/75.3.408. PMID: 12978172.) 6- Saporta, M. A. C., C Zaros, M W Cruz, C André, M Misrahi, et al. "Penetrance estimation of TTR familial amyloid polyneuropathy (type I) in Brazilian families." European journal of neurology 16.3 (2009): 337-341. 7- Vieira M, Saraiva MJ. Transthyretin: a multifaceted protein. Biomol Concepts. 2014 Mar;5(1):45-54. doi: 10.1515/bmc-2013-0038. PMID: 25372741. 8- Galant NJ, Westermark P, Higaki JN, Chakrabartty Al. Transthyretin amyloidosis: an under-recognized neuropathy and cardiomyopathy. Clin Sci. 2017 ;131(5):395-409 9-Simões M. V., Fernandes F, Marcondes-Braga F, Scheinberg P, Correia E, et al. Posicionamento sobre Diagnóstico e Tratamento da Amiloidose Cardíaca (2021). Arquivos Brasileiros de Cardiologia, 117, 561-598. 10- Bonaiti B, Olson M, Hellman U, Surh O, Bonaiti-Pellie C, et al. TTR familial amyloid polyneuropathy: does a mitochondrial polymorphism entirely explain the parent-of-origin difference in penetrance? Eur J Hum Genet. 2010;18(8):948- 52 11- Ando Y, Coelho T, Berk J, Cruz M, Ericzon B-G, et al. Guideline of transthyretin- related hereditary amyloidosis for clinicians. Orphanet J Rare Dis. 2013;8:31 12- Salvi F, Pastorelli F, Plasmati R, Bartolomei I, Dall'Osso D, et al. Genotypic and phenotypic correlation in an Italian population of hereditary amyloidosis TTR-related (HA-TTR): clinical and neurophysiological aids to diagnosis and some reflections on misdiagnosis. Amyloid. 2012;19 Suppl 1:58-60. 13-Gertz MA, Benson M, Dyck PJ, Grogan M, et al. Diagnosis, Prognosis, and Therapy of Transthyretin Amyloidosis. J Am Coll Cardiol. 2015 Dec 1;66(21):2451-2466. doi: 10.1016/j.jacc.2015.09.075. PMID: 26610878 14- Luiz F. Pinto, MD; and Marcus V. Pinto, MD, MS. The most common amyloidosis are both treatable; accurate diagnosis is paramount. Practical Neurology, July, 2021.

ms european brain italian therapy md chile neste brazilian portal pfizer diagnosis sim guidelines andrade hereditary refer alerta pinto maio pathologies diagn epub sinais tratamento pmid prognosis suppl posicionamento centen paf neurologia amyloid cardiologia suplemento idi amyloidosis ttr bibliogr sociedade portuguesa j am coll cardiol transthyretin corino sinapse pebmed practical neurology eur j hum genet

N211 - ISGLT2 no IAM - Paulo Rizzo Genestreti

SBD

Play Episode Listen Later Jul 5, 2022 4:47

Autor: Paulo Rizzo Genestreti Revista: J Am Coll Cardiol Ref: Sodium Glucose Cotransporter-2 Inhibition for Acute Myocardial Infarction: JACC Review Topic of the Week. J Am Coll Cardiol. 2022 May 24;79(20):2058-2068. doi: 10.1016/j.jacc.2022.03.353.

i am rizzo inhibition j am coll cardiol

037 - Controle da Fibrilação Atrial: ritmo ou frequência?

Play Episode Listen Later Jun 9, 2022 32:46

estamos toda tem dessa refer controle ritmo deixe resumo frequ atrial art review j am coll cardiol

Podcast 787: TAVR and Stroke

md surgery stroke isolated cardiology summarized emm tavr savr transcatheter high risk patients ama pra category j am coll cardiol year outcomes

Play Episode Listen Later Jun 6, 2022 4:46

Contributor: Nick Hatch, MD Educational Pearls: Transcatheter aortic valve replacement (TAVR) is an increasingly common endovascular procedure to treat aortic stenosis TAVR is an alternative to the open approach surgical aortic valve replacement (SAVR) for patients who are inoperable or are high risk surgical candidates Following TAVR, there is increased risk of stroke, particularly in the first 30 days TAVR-related strokes are due to embolic debris left on the valve root, which is generally cleaned out during SAVR Further, following the procedure many patients are anticoagulated which increases the risk for conversion to hemorrhagic stroke Isolated, unexplained nausea and vomiting in elderly patients should prompt concern for a neurologic workup with imaging - even more so if they have recently undergone TAVR References Davlouros PA, Mplani VC, Koniari I, Tsigkas G, Hahalis G. Transcatheter aortic valve replacement and stroke: a comprehensive review. J Geriatr Cardiol. 2018;15(1):95-104. doi:10.11909/j.issn.1671-5411.2018.01.008 Gleason TG, Reardon MJ, Popma JJ, et al. 5-Year Outcomes of Self-Expanding Transcatheter Versus Surgical Aortic Valve Replacement in High-Risk Patients. J Am Coll Cardiol. 2018;72(22):2687-2696. doi:10.1016/j.jacc.2018.08.2146 Siontis GCM, Overtchouk P, Cahill TJ, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. Eur Heart J. 2019;40(38):3143-3153. doi:10.1093/eurheartj/ehz275 Summarized by Kirsten Hughes, MS4 | Edited by John Spartz MS4 & Erik Verzemnieks, MD The Emergency Medical Minute is excited to announce that we are now offering AMA PRA Category 1 credits™ via online course modules. To access these and for more information, visit our website at https://emergencymedicalminute.org/cme-courses/ and create an account. Donate to EMM today!

031 - Insuficiência Mitral em perspectiva

patients voc med tem perspectiva deixe heart failure medical treatment carpentier mitral minutagem j am coll cardiol aha acc

Play Episode Listen Later Apr 28, 2022 41:36

13 - Nystagmus, SCAD, Sotrovimab, Paxlovid, Molnupiravir, and more.

2 View: Emergency Medicine PAs & NPs

Play Episode Listen Later Jan 27, 2022 80:22

Welcome to Episode 13 of “The 2 View,” the podcast for EM and urgent care nurse practitioners and physician assistants! Show Notes for Episode 13 of “The 2 View” – Nystagmus, SCAD, Sotromivab, Paxlovid, Molnupivarvir, and more. Nystagmus Mehar A. CanadiEM Frontline Primer - Vertigo workup. CanadiEM. Published April 25, 2020. Accessed January 11, 2022. https://canadiem.org/canadiem-frontline-primer-vertigo/ Nystagmus. NeurologyNeeds.com. Accessed January 11, 2022. https://www.neurologyneeds.com/neurological-examination-tips-tricks/nystagmus/ Nystagmus. The Proceduralist. Published January 10, 2022. Accessed January 11, 2022. https://www.youtube.com/watch?v=fW3sVsNgJ2k Talmud JD, Coffey R, Edemekong PF. Dix Hallpike Maneuver. NCBI. StatPearls Publishing. Last Update December 19, 2021. Accessed January 11, 2022. https://www.ncbi.nlm.nih.gov/books/NBK459307/ SCAD Beardsell L. Preventing mid-life spontaneity becoming a crisis - SCAD as a serious cause of chest pain. St Emlyn's. St.Emlyn's Emergency Medicine. Published May 29, 2021. Accessed January 11, 2022. https://www.stemlynsblog.org/scad/ Durrani M. Spontaneous Coronary Artery Dissection (SCAD). REBEL EM - Emergency Medicine Blog. Published October 19, 2020. Accessed January 11, 2022. https://rebelem.com/spontaneous-coronary-artery-dissection-scad/ Hayes SN, Tweet MS, Adlam D, et al. Spontaneous Coronary Artery Dissection: JACC State-of-the-Art Review. J Am Coll Cardiol. Published August 2020. Accessed January 11, 2022. https://www.jacc.org/doi/abs/10.1016/j.jacc.2020.05.084 Johnson AK, Tweet MS, Rouleau SG, Sadosty AT, Raukar NP. 243 Spontaneous Coronary Artery Dissection in the Emergency Department: The Elusive Dissection. Ann Emerg Med. Published October 1, 2020. Accesseed January 11, 2022. https://www.annemergmed.com/article/S0196-0644(20)31003-9/fulltext#relatedArticles Kim ESH. Spontaneous Coronary-Artery Dissection. N Engl J Med. Published December 10, 2020. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/NEJMra2001524 Sotromivab, Paxlovid and Molnupivarvir Beigel JH, Tomashek KM, Dodd LE, et al. Remdesivir for the Treatment of Covid-19 - Final Report. N Engl J Med. Published November 5, 2020. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/nejmoa2007764 Jayk Bernal A, Gomes da Silva MM, Musungaie DB, et al. Molnupiravir for Oral Treatment of Covid-19 in Nonhospitalized Patients. N Engl J Med. Published online December 16, 2021. Accessed January 11, 2022. https://www.nejm.org/doi/full/10.1056/NEJMoa2116044 PAXLOVIDTM (nirmatrelvir tablets; ritonavir tablets): Now Authorized for Emergency Use. For Patients. Pfizer. Covid19oralrx-patient.com. Accessed January 11, 2022. https://www.covid19oralrx-patient.com/ Sotrovimab. Sotrovimab.com. GSK. Accessed January 11, 2022. https://www.sotrovimab.com/ Guest Interview: JIM ROBERTS - IVERMECTIN Bryant A, Lawrie T, Dowswell T, et al. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. American Journal of Therapeutics. Lww.com. Published July/August 2021. Accessed January 11, 2022. https://journals.lww.com/americantherapeutics/fulltext/2021/08000/ivermectinforpreventionandtreatment_of.7.aspx Em-news.com. Accessed January 11, 2022. http://www.em-news.com Kory P MD, Meduri GU MD, Iglesias J, et al. Review of the Emerging Evidence Demonstrating the Efficacy of Ivermectin in the Prophylaxis and Treatment of COVID-19. Published online 2020. Updated January 16, 2021. Accessed January 11, 2022. https://covid19criticalcare.com/wp-content/uploads/2020/11/FLCCC-Ivermectin-in-the-prophylaxis-and-treatment-of-COVID-19.pdf Mike & Martha's Something Sweet: Safest Countries in the World in 2021 Safest Countries in the World 2021. Worldpopulationreview.com. Accessed January 11, 2022. https://worldpopulationreview.com/country-rankings/safest-countries-in-the-world Recurring Sources Center for Medical Education. Ccme.org. http://ccme.org The Proceduralist. Theproceduralist.org. http://www.theproceduralist.org The Procedural Pause. Emergency Medicine News. Lww.com. https://journals.lww.com/em-news/blog/theproceduralpause/pages/default.aspx The Skeptics Guide to Emergency Medicine. Thesgem.com. http://www.thesgem.com Trivia Question: Send answers to 2viewcast@gmail.com Be sure to keep tuning in for more great prizes and fun trivia questions! Once you hear the question, please email us your guesses at 2viewcast@gmail.com and tell us who you want to give a shout-out to. Be sure to listen in – this month we are giving away 20% off of our July Bootcamp Course and lunch with the faculty! Win and join us in Vegas this summer – come and share your ER experiences with us over a good meal.

covid-19 world las vegas er treatments prevention pac pfizer preventing published msn gomes emergency medicine efficacy american journal ivermectin therapeutics medical education gsk paxlovid final report scad new england journal of medicine prophylaxis molnupiravir art review ncbi published may published october nystagmus published august ann emerg med published november j am coll cardiol sotrovimab statpearls publishing st emlyn canadiem emerging evidence demonstrating

ACCEL Lite: The Serious (and Not So Serious) Side of Faints and Falls: Is My Syncope Patient at Increased Risk?

ACCEL Lite: Featured ACCEL Interviews on Exciting CV Research

Play Episode Listen Later Jan 11, 2022 10:41

Syncope occurs commonly in the general population and apart from risks of injury due to physical collapse, they can cause patients considerable anxiety and diminished quality-of-life. Better understanding of the syncope 'landscape' can help practitioners provide more effective prevention strategies while permitting patients to cope more effectively with fears of recurrences. In this interview, David G Benditt, MD, FACC, FHRS, FESC, FRCPC, CCDS and Thomas F. Deering MD, FACC discuss The Serious (and Not So Serious) Side of Faints and Falls: Is My Syncope Patient at Increased Risk? Related References: ACC/AHA/HRS Versus ESC Guidelines for the Diagnosis and Management of Syncope: JACC Guideline Comparison. J Am Coll Cardiol 2019;74:2410–2423. Benditt DG, van Dijk JG, Krishnappa D, Adkisson WO, Sakaguchi S. Neurohormones in the Pathophysiology of Vasovagal Syncope in Adults. Front Cardiovasc Med 2020;7:76.

management patients md falls adults diagnosis lite pathophysiology accel increased risk syncope frcpc j am coll cardiol ccds

The End of ACE Inhibitors? - Frankly Speaking Ep 253

Pri-Med Podcasts

Play Episode Listen Later Dec 6, 2021 8:01

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-253 Overview: ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are both recommended as first-line treatments for hypertension. ACE inhibitors have known side effects, such as cough, that are frustrating for many patients, while ARBs appear to have less annoying side effects. This podcast will review a recently published retrospective, comparative cohort study comparing the effectiveness and safety of ACE inhibitors vs ARBs in the first-line treatment of hypertension. Episode resource links: Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248. doi: 10.1016/j.jacc.2017.11.006 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato

education medical credit american colleges credits blood pressure hypertension doi clinical practice guidelines faafp arbs frankly speaking ama pra category ace inhibitors j am coll cardiol claim credit robert a baldor

The End of ACE Inhibitors? - Frankly Speaking Ep 253

Frankly Speaking About Family Medicine

Play Episode Listen Later Dec 6, 2021 8:01

Credits: 0.25 AMA PRA Category 1 Credit™ CME/CE Information and Claim Credit: https://www.pri-med.com/online-education/podcast/frankly-speaking-cme-253 Overview: ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers) are both recommended as first-line treatments for hypertension. ACE inhibitors have known side effects, such as cough, that are frustrating for many patients, while ARBs appear to have less annoying side effects. This podcast will review a recently published retrospective, comparative cohort study comparing the effectiveness and safety of ACE inhibitors vs ARBs in the first-line treatment of hypertension. Episode resource links: Hypertension. 2021;78:591–603. DOI: 10.1161/HYPERTENSIONAHA.120.16667 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/ NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2018;71:e127–e248. doi: 10.1016/j.jacc.2017.11.006 Guest: Robert A. Baldor MD, FAAFP Music Credit: Richard Onorato

education medical credit american colleges credits blood pressure hypertension doi clinical practice guidelines faafp arbs frankly speaking ama pra category ace inhibitors j am coll cardiol claim credit robert a baldor

Episódio 116: Manejo de Taquiarritmias

Ta de Clinicagem

Play Episode Listen Later Nov 24, 2021 55:36

Gui, Joanne e Kaue debatem sobre o manejo de taquiarritmias. Abordamos alguns conceitos de eletrocardiograma, conversamos sobre o passo a passo da avaliação de taquiarritmias com QRS estreito e largo, além de cardioversão elétrica e as drogas possíveis. Esse episódio foi em parceria com o Whitebook A medfriday vai começar em breve! Acesso o site pra ficar informado! https://medfriday.pebmed.com.br/?utm_source=podcast&utm_medium=cpc&utm_campaign=medfriday-comercial-2021-tdc&utm_content=tdc Referências: Brugada J, Katritsis DG, Arbelo E, et al. 2019 ESC Guidelines for the management of patients with supraventricular tachycardiaThe Task Force for the management of patients with supraventricular tachycardia of the European Society of Cardiology (ESC). Eur Heart J 2020; 41:655. Kalbfleisch SJ, el-Atassi R, Calkins H, et al. Differentiation of paroxysmal narrow QRS complex tachycardias using the 12-lead electrocardiogram. J Am Coll Cardiol 1993; 21:85. Brugada P, Brugada J, Mont L, et al. A new approach to the differential diagnosis of a regular tachycardia with a wide QRS complex. Circulation 1991; 83:1649. Vereckei A, Duray G, Szénási G, et al. Application of a new algorithm in the differential diagnosis of wide QRS complex tachycardia. Eur Heart J 2007; 28:589. Kaiser E, Darrieux FC, Barbosa SA, et al. Differential diagnosis of wide QRS tachycardias: comparison of two electrocardiographic algorithms. Europace 2015; 17:1422. Ganz LI, Friedman PL. Supraventricular tachycardia. N Engl J Med 1995; 332:162. Katritsis DG, Josephson ME. Differential diagnosis of regular, narrow-QRS tachycardias. Heart Rhythm 2015; 12:1667. Link MS. Clinical practice. Evaluation and initial treatment of supraventricular tachycardia. N Engl J Med 2012; 367:1438. Smith GD, Dyson K, Taylor D, et al. Effectiveness of the Valsalva Manoeuvre for reversion of supraventricular tachycardia. Cochrane Database Syst Rev 2013; :CD009502. Appelboam A et al. Postural Modification to the Standard Valsalva Manoeuvre for Emergency Treatment of Supraventricular Tachycardias (REVERT): A Randomised Controlled Trial. Lancet 2015.

Episode 185: 185. USPSTF, Lupus, Diabetes Risk Factor, C. Diff

Questioning Medicine

Play Episode Listen Later Sep 3, 2021 21:40

Davidson KW et al. Screening for prediabetes and type 2 diabetes: US Preventive Services Task Force recommendation statement. JAMA 2021 Aug 24; 326:736. (https://doi.org/10.1001/jama.2021.12531) The Task Force found moderate-certainty evidence that screening is beneficial for nonpregnant adults (age range, 35–70) who are overweight (i.e., body-mass index [BMI], ≥25 kg/m2) or obese (BMI, ≥30 kg/m2) and have no symptoms of diabetes. Referring patients for, or directly providing, effective preventive interventions is recommended (B recommendation). The main change from the 2015 recommendation is the lower age threshold for screening — 35 rather than 40. The decision was made because of the increasingly younger age of onset for diabetes and the known benefits of intervention at a wide range of ages. Notably, the USPSTF found little direct evidence that screening improves clinical outcomes; Lifestyle modifications and metformin are considered appropriate interventions for preventing or delaying onset of diabetes; however, metformin is not approved for this specific use by the U.S. FDA. ---- NO NO NO NO NO NO NO you cant do that.. Aringer M et al. European League Against Rheumatism (EULAR)/American College of Rheumatology (ACR) SLE classification criteria item performance. Ann Rheum Dis 2021 Feb 10; 80:775. (https://doi.org/10.1136/annrheumdis-2020-219373) Diagnosising SLE—its always lupus till its not lupus but new diagnosis criteria In 2019, the European League Against Rheumatism and the American College of Rheumatology published the following classification criteria for systemic lupus erythematosus (SLE; Ann Rheum Dis 2019; 78:1151):· Positive antinuclear antibody (ANA) test with titer ≥1:80 is a required “entry criterion.”· If the ANA criterion is met, points are assigned from seven clinical categories and three immunologic test categories; a criterion is not counted if another cause is more likely than SLE. A score ≥10 is considered to be consistent with SLE. When these criteria were validated, sensitivity for SLE was 96%, and specificity was 93%. But ANA what about ANA Sensitivity and specificity of ANA were 99.5% and 19.4%, respectively. NEXT Gómez-Outes A et al. Meta-analysis of reversal agents for severe bleeding associated with direct oral anticoagulants. J Am Coll Cardiol 2021 Jun 22; 77:2987. (https://doi.org/10.1016/j.jacc.2021.04.061)Use of direct oral anticoagulants (DOACs) is associated with about a 3% annual risk for major bleeding, though that varies by age, comorbidity profile, and concomitant therapies. investigators examined clinical outcomes associated with the use of 4-factor prothrombin complex concentrate (4PCC), idarucizumab, or andexanet for severe DOAC-associated bleeding.These drugs are greatBut if you do bleed then about 20% of the time we cant get hemostasis with mortality around 18% DESPITE getting reversal agents.. This is good to talk to your patients about— The risk of bleeding in 1 and 33 per year..Out of every 3300 people treated about 20 people will have a bleed that isn't controlled and 18 of those people will die.It sounds like a lot but remember without these drugs the risk of stroke is much much higher, of course depending on your comorbid conditions. NEXT Cardiovascular risk prediction in type 2 diabetes before and after widespread screening: a derivation and validation study - ClinicalKeyLancet, The, 2021-06-12, Volume 397, Issue 10291, Pages 2264-2274, Copyright © 2021 Elsevier Ltd Formulas for cardiovascular (CV) risk calculations are based on population studies and generally include diabetes as a major risk factor. Do formulas that were derived when diabetes usually was diagnosed at later stages overestimate CV risk for people in whom diabetes is diagnosed early?? Basically long ago we diagnosed in DM at a1c of 12 not we diagnosis it at a1c of 6-6.5-7—even prediabetes at a1c of 5.5……Those are not the same population so now are we over diagnosing CV risk??? The answer for this new zeeland study was yes--In this modern diabetic population, the median 5-year risk for an adverse CV event, as estimated by the new formula, was 4.0% in women and 7.1% in men. The older formula overestimated median risk in women (14.7%) and in men (17.1%).This is has to do with new Zealand not the the more recent and commonly used American pooled cohort equation but even that I would love to see put through the ringer as many of the studies were done back in the 90s, over thirty years ago, when we were quite as sharp about diagnosing diabetes yet…either way you have to remember the ascvd risk score is for discussion it is not evidence based gold it is a conversation starter Next DVT – I am always confused when people say airline travel is a risk factor. I have sat on my couch for 6 hours without moving and I never got a dvt so why would being on a plane for 3 hours. Well maybe it is something I don't understand about air travel because as this paper Munger JA et al. Television viewing, physical activity and venous thromboembolism risk: The REasons for Geographic and Racial Differences in Stroke (REGARDS) study. J Thromb Haemost 2021 Jun 2; [e-pub]. They looked to see if tv watching was associated with DVT and it was not – it didn't matter if you just watched a little bit of tv per day or over 4 hours of tv per day, there was no association with increase DVT and TV hours per day once accounting for total activity.. yes those that are watching TV move less and are more obese but is it he TV watching or just all the risk factors…. This article says it is the risk factors. Last articleKelly CR et al. Prevention, diagnosis, and treatment of Clostridioides difficile infections. Am J Gastroenterol 2021 Jun; 116:1124. (https://doi.org/10.14309/ajg.0000000000001278) Oral vancomycin or fidaxomicin generally is favored for treating patients with nonsevere CDI, but metronidazole is acceptable for low-risk patients — especially when cost is a factor. Patients with severe CDI should be treated with either oral vancomycin or fidaxomicin (but not metronidazole). Severe disease is defined as having a leukocytosis >15,000 white blood cells/mm3 or a creatinine level of >1.5 mg/dL. Fecal microbiota transplantation (FMT) should be considered for refractory or severe CDI. *******A first recurrence should be treated with tapering/pulsed-dose vancomycin or fidaxomicin if it was not the initial therapy. ********A patient experiencing a second or further recurrence of CDI should be treated with FMT, delivered via a colonoscope or capsules, with enemas used when colonoscopy or capsules are not available. Repeat FMT can be used to treat a recurrence within 8 weeks of initial FMT. *****Patients with recurrent CDI who are not FMT candidates or have relapsed after FMT can be given long-term oral vancomycin prophylaxis to prevent recurrences. Oral vancomycin prophylaxis also can be considered when patients with recurrent CDI are given systemic antibiotics.

Episode 184: 184. Question and Answer From the Last Two Podcast

Questioning Medicine

Play Episode Listen Later Jul 25, 2021 24:36

I've found that I can often increase compliance with statins by having pt take them 3x/week or QOD. I try this often especially in my secondary prevention group. I understand "any statin is better than none", but do data support this approach? -- any is better than none! No rct with this but yes data supports every other day but that is observational..what about vascepa in reducing CAD risk both primary and secondary risk? Vascepa is now the first and only drug approved by the FDA as an adjunct to maximally tolerated statin therapy to reduce the risk of myocardial infarction, stroke, coronary revascularization, and unstable angina requiring hospitalization in adult patients with elevated triglyceride (TG) levels (≥150 mg/dL) and established cardiovascular disease or diabetes mellitus and two or more additional risk factors for cardiovascular diseaseReduce it trial---The big trial which showed all the promise used mineral oil as a placeboAND then we have evaporate trial—which showed steady plaqueThe groups didn't start off the same!When you do an RCT- everything is random and therefor EVERYTHING IS EQUAL—but that idnt happen. And yes the people were blinded but they don't say that the people reading the CT was blindedThe placebo group had higher CRP and dramatically worse cholesterol panels after taking mineral oilThen most recently we have the strength it trial- which showed no difference and should have had high bioavailability! Like LDL that went up 50 points in the placebo group!! That shouldn't happen!What about fibrates for triglycerides > 400 or 500 to prevent complications like pancreatitis? No – no- no- no evidence for fibrates, period, throw them away. DRUGECTOMY for everyoneGiven evidence is only for patient to age 79, what do you recommend for patients over 79 with high lipids or on who are on a statin if concern for risk of negative cognitive effects of statins in this group? Remember 5 years or less to live. stop the statin. And the cognitive declinePlease comment on lipophilic vs hydrophilic statins and possible detrimental effects on cognition.If cognitive risk is so small, why is there a black-box warning? It makes it difficult to convince the patient to take a statin when they read this warning.ano M, Bell KL, Galasko D, et al. A randomized, double-blind, placebo-controlled trial of simvastatin to treat Alzheimer disease. Neurology 2011;77(6):556-563.In this multicenter trial, the authors gave simvastatin or placebo to 406 patients with mild to moderate Alzheimer disease, aged at least 50 years, with a Mini-Mental State Examination score between 12 and 26, who otherwise would not have been taking a statin. Simvastatin was no better than placebo in slowing cognitive deterioration in patients with mild to moderate Alzheimer disease. (LOE = 1b)Steenland K, Zhao L, Goldstein FC, Levey AI. Statins and cognitive decline in older adults with normal cognition or mild cognitive impairment. J Am Geriatr Soc 2013;61(9):1449-55.These researchers serially assessed approximately 3500 elderly patients for 3.4 years. The elders did not have dementia at baseline and approximately one third were using a statin. After 3.4 years of follow-up, the rate of cognitive decline among statin users was comparable with that of nonusers. https://www.ahajournals.org/doi/10.1161/circ.128.suppl_22.A10589Results: Significantly higher proportional reporting ratios (PRRs) were observed for lipophilic statins, which more readily cross the blood-brain barrier, (range: 1.48-3.50) compared to hydrophilic statins (range: 0.68-1.60). However, fluvastatin, lovastatin, and pitavastatin (lipophilic) had relatively few adverse reports in the AERS database. The signal of higher risk of cognitive dysfunction was observed for the lipophilic statin atorvastatin (PRR = 2.68, 95% confidence interval: 2.52-2.85) followed by simvastatin (PRR = 2.20, 95% confidence interval: 2.02-2.40).Conclusions: Inconsistent with the FDA class warning, highly lipophilic statins with specific pharmacokinetic properties (atorvastatin and simvastatin) appear to confer a significantly greater risk of adverse cognitive effects compared to other lipophilic statins and those with hydrophilic solubility properties.“Keep in mind that cohort studies are unable to account for 2 important phenomena: the healthy-user effect and reverse causality. The healthy-user effect, the primary explanation for older theories of the "benefits" of hormone replacement, refers to the observation that healthy people are more likely to use preventive measures and that the outcomes are due to good health, not the intervention. In reverse causality, we find that patients in declining health stop using treatments because they no longer perceive a potential benefit. It takes a randomized trial to overcome these phenomena.”Last but not leastZhou Z et al. Effect of statin therapy on cognitive decline and incident dementia in older adults. J Am Coll Cardiol 2021 Jun 29; 77:3145. (https://doi.org/10.1016/j.jacc.2021.04.075)They followed 18,846 study participants for a median of 4.7 years. Participants' median age was 74 years, and 56% were women. With 85,557 person-years of follow-up, the investigators identified 566 incident cases of dementia. Statin use was associated with nonsignificant increases in all-cause dementia (hazard ratio, 1.16) and probable Alzheimer disease (HR, 1.33; 95% CI 1.00 to 1.77). Statin use was not associated with mild cognitive impairment, but there was a nonsignificant increase in association with Alzheimer disease (HR, 1.44).Any thoughts on coronary CTA (rather than calcium score) or carotid intimal medial thickness as a tool for risk assessment? No—no prospective RCT—all retrospective. And the people are baseline high risk to begin with. if you would choose one single best statin for primary and secondary prevention, which one would you pick? The one the pt will takeshould take a statin if it increases LFT?? YES remember we are decreasing heart attacks and strokes!! We have no evidence on was a smell increase in your LFT does long term but we have evidence that long term these drugs have a 30% RR reduction in heart attacks and strokes!Some patients like to take Co Q10 with their statin. What is your experience with this? Taking it for muscle aches and remember there is no real difference in muscle aches compared to placebo. If you don't check cholesterol but every 10 years, how do you know that further risk reduction is needed for secondary prevention or additional medication to statin is needed -- you do it based on their risk reduction! There are 3 criteria – 1. 1 event in last 12 months. 2. 2 eents in their life. 3. An event with 3 or more risk factors. what are the real risks of statins increasing risks of DM? depends where you read—cocochane has the HR at 1.18 but that is a 2 yr study. For our calculation of the risk of diabetes the answer likely lies between 0.4% and 4%, and we have chosen what we believe to be a conservative estimate of 2% as a midway point in this credible interval.The raw numbers of 270 and 216 new onset diabetes cases from 24 months of exposure to a statin and a placebo (respectively) can be extrapolated, assuming that increased diabetes risk is likely to continue linearly with exposure. This yields 675 and 540 cases at 5 years. How long do you do washout between statin? No hard science to this they have not randomized different months of wash out as far as I am aware of so 3-6 months and you will be fine. Anything to say about Nexletol?Is there any benefit in obtaining lipoprotein profiles? NO—not for the events we care about. There is evidence that you can get this panels and then you could add a drug or increase a dose and decrease a lab value but we treat patients not lab values and there is no evidence It improves patient orientated outcomes. WHATPCSK9 DO YOU USE? Whatever insurance will pay for and remember they are still really really really expensive and IV only so this should be dead last line and only in the highest of the highest of the highest risk.

dm alzheimer's disease fda iv neurology dl cad rr cta tg crp statins rct coq10 statin loe two podcast prr lft prrs j am coll cardiol qod j am geriatr soc

Cardiovascular laboratory: Biomarkers, testing, & clinical implications

Lab Medicine Rounds

Play Episode Listen Later May 21, 2021 18:42

Timestamps:00:00 Intro01:00 How does the cardiovascular laboratory support patient care?01:47 Can you tell us a bit about ceramides? What are they?04:14 When should ceramides be tested? 06:04 Can you modify someone’s ceramides such that the test can be repeated and monitored, or is it once in a lifetime because ceramides or more static?08:05 What is the controversary around ceramides? 09:52 Could you give our listeners an introduction to Lipoprotein(a)?11:45 Who should be tested for Lipoprotein(a)?13:59 How do we treat elevated Lipoprotein(a)? 17:20 How did your interests in laboratory medicine develop? How has this brought meaning for you in your career professionally? 19:23 Outro Resources:1. Ceramides and Ceramide Scores: Clinical Applications for Cardiometabolic Risk Stratification. Hilvo M, Vasile VC, Donato LJ, Hurme R, Laaksonen R. Front Endocrinol (Lausanne). 2020 Sep 29;11:570628. doi: 10.3389/fendo.2020.570628. eCollection 2020. PMID: 33133018 Free PMC article. Review. 2. Measuring the contribution of Lp(a) cholesterol towards LDL-C interpretation. Fatica EM, Meeusen JW, Vasile VC, Jaffe AS, Donato LJ. Clin Biochem. 2020 Dec;86:45-51. doi: 10.1016/j.clinbiochem.2020.09.007. Epub 2020 Sep 28. PMID: 32997972 3. Ceramides improve atherosclerotic cardiovascular disease risk assessment beyond standard risk factors. Meeusen JW, Donato LJ, Kopecky SL, Vasile VC, Jaffe AS, Laaksonen R. Clin Chim Acta. 2020 Dec;511:138-142. doi: 10.1016/j.cca.2020.10.005. Epub 2020 Oct 12. PMID: 33058843 4. Ceramide Scores Predict Cardiovascular Risk in the Community. Vasile VC, Meeusen JW, Medina Inojosa JR, Donato LJ, Scott CG, Hyun MS, Vinciguerra M, Rodeheffer RR, Lopez-Jimenez F, Jaffe AS. Arterioscler Thromb Vasc Biol. 2021 Apr;41(4):1558-1569. doi: 10.1161/ATVBAHA.120.315530. Epub 2021 Feb 18. PMID: 33596665 5. High-Sensitivity Cardiac Troponin for the Diagnosis of Patients with Acute Coronary Syndromes. Vasile VC, Jaffe AS. Curr Cardiol Rep. 2017 Aug 24;19(10):92. doi: 10.1007/s11886-017-0904-4. PMID: 28840515 Review. 6. Natriuretic Peptides and Analytical Barriers. Vasile VC, Jaffe AS. Clin Chem. 2017 Jan;63(1):50-58. doi: 10.1373/clinchem.2016.254714. Epub 2016 Oct 10. PMID: 28062611 Review. 7. Diseased skeletal muscle: a noncardiac source of increased circulating concentrations of cardiac troponin T. Jaffe AS, Vasile VC, Milone M, Saenger AK, Olson KN, Apple FS. J Am Coll Cardiol. 2011 Oct 18;58(17):1819-24. doi: 10.1016/j.jacc.2011.08.026. Epub 2011 Sep 29. PMID: 21962825 8. Elevated cardiac troponin T levels in critically ill patients with sepsis. Vasile VC, Chai HS, Abdeldayem D, Afessa B, Jaffe AS. Am J Med. 2013 Dec;126(12):1114-21. doi: 10.1016/j.amjmed.2013.06.029. Epub 2013 Sep 28. PMID: 24083646

Cardiac Power Output (CPO) in Cardiogenic Shock

Saving Lives: Critical Care w/eddyjoemd

Play Episode Listen Later May 10, 2021 14:49

Cardiac power output is a calculation one should do when caring for patients with cardiogenic shock. Data has shown it to be the strongest hemodynamic correlate of mortality in cardiogenic shock. We should be using it in our practice to determine whether a patient will benefit from mechanical circulatory support (MCS). Show Notes: https://eddyjoemd.com/cardiogenic-shock-mcs/ Receive a FREE audiobook (TWO for Amazon Prime members) with your FREE 30-day trial by using my link for Audible: CLICK HERE! You will be reminded when your trial is ending, by the way.

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#73 ¿Correr en exceso puede ser malo para el corazón? con el Dr. Joaquín Barjau

Hijos de la Resistencia

Play Episode Listen Later Feb 25, 2021 83:11

👉🏽 https://www.adidas.es/running ---------------------------------------------------------------------- En los últimos años ha aumentado el número de accidentes cardiacos entre corredores. La prensa se ha echo eco de ello y la alarma social es evidente. En este episodio, el Dr. Joaquín Barjau nos presenta la evidencia científica que hay sobre este tema y nos cuenta cómo funciona el corazón cuando corremos, qué es lo que puede fallar e intentamos posibles soluciones a este problema que ya es una realidad. RRSS del Dr. Barjau: @dr.barjau Estudios a los que se refiere el doctor en este episodio: 1. Training for Longevity: The Reverse J-Curve for Exercise. Mo Med. Jul-Aug 2020;117(4):355-361 2. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. 2015 Feb 10;65(5):411-9. 3. Various Leisure-Time Physical Activities Associated With Widely Divergent Life Expectancies: The Copenhagen City Heart Study. Mayo Clin Proc. 2018 Dec;93(12):1775-1785. 4. Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective–An Update: A Scientific Statement From the American Heart Association. Circulation. 2020;141:e705–e736 5. Charla TED de James Okeefe https://youtu.be/Y6U728AZnV0 6. Charla de Iñigo San Millán https://youtu.be/DZfOvYiQtow

training exercise puede dose joaqu malo el coraz american heart association correr circulation rrss exceso jul aug san mill j am coll cardiol charla ted mayo clin proc copenhagen city heart study

Closer to the Heart | GameChangers

Pharmacy Podcast Network

Play Episode Listen Later Jan 26, 2021 28:53

In December 2020, the American College of Cardiology published an Expert Consensus Decision Pathway for Antithrombotic Therapy in Patients undergoing Percutaneous Coronary Intervention. This guideline addresses a timely problem of patients on anticoagulation and antiplatelet therapy. This episode is accredited for CPE. Subscribe at CEimpact ( https://www.ceimpact.com/pharmacist ) and claim your CE today! Reference: 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Dec 18, 2020. Epublished DOI: 10.1016/j.jacc.2020.09.011. Accessed at https://www.jacc.org/doi/10.1016/j.jacc.2020.09.011 CPE details for GameChangers Podcast January 2021 Learning Objective: Recommend an appropriate antithrombotic/anticoagulant regimen in a patient who has received percutaneous coronary intervention with stenting 0107-0000-21-079-H01-P 0.2 CEU/2.0 Hrs (Knowledge) Initial Release Date: 01/25/21 Expiration Date: 01/26/24 Additional CPE information is located at https://www.ceimpact.com/podcast See omnystudio.com/listener for privacy information. Learn more about your ad choices. Visit megaphone.fm/adchoices

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Closer to the Heart | GameChangers

Play Episode Listen Later Jan 26, 2021 27:38

In December 2020, the American College of Cardiology published an Expert Consensus Decision Pathway for Antithrombotic Therapy in Patients undergoing Percutaneous Coronary Intervention. This guideline addresses a timely problem of patients on anticoagulation and antiplatelet therapy.This episode is accredited for CPE. Subscribe at CEimpact ( https://www.ceimpact.com/pharmacist ) and claim your CE today!Reference: 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Dec 18, 2020. Epublished DOI: 10.1016/j.jacc.2020.09.011. Accessed at https://www.jacc.org/doi/10.1016/j.jacc.2020.09.011CPE details for GameChangers Podcast January 2021Learning Objective: Recommend an appropriate antithrombotic/anticoagulant regimen in a patient who has received percutaneous coronary intervention with stenting0107-0000-21-079-H01-P0.2 CEU/2.0 Hrs (Knowledge)Initial Release Date: 01/25/21Expiration Date: 01/26/24Additional CPE information is located at https://www.ceimpact.com/podcastSee omnystudio.com/listener for privacy information.

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Closer to the Heart | GameChangers

GameChangers | CEimpact

Play Episode Listen Later Jan 26, 2021 27:38

In December 2020, the American College of Cardiology published an Expert Consensus Decision Pathway for Antithrombotic Therapy in Patients undergoing Percutaneous Coronary Intervention. This guideline addresses a timely problem of patients on anticoagulation and antiplatelet therapy. This episode is accredited for CPE. Subscribe at CEimpact ( https://www.ceimpact.com/pharmacist ) and claim your CE today! Reference: 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Dec 18, 2020. Epublished DOI: 10.1016/j.jacc.2020.09.011. Accessed at https://www.jacc.org/doi/10.1016/j.jacc.2020.09.011 CPE details for GameChangers Podcast January 2021 Learning Objective: Recommend an appropriate antithrombotic/anticoagulant regimen in a patient who has received percutaneous coronary intervention with stenting 0107-0000-21-079-H01-P 0.2 CEU/2.0 Hrs (Knowledge) Initial Release Date: 01/25/21 Expiration Date: 01/26/24 Additional CPE information is located at https://www.ceimpact.com/podcast See omnystudio.com/listener for privacy information.

patients closer game changers american colleges cardiology ceu cpe anticoagulant pharmacy podcast network j am coll cardiol pharmacy podcast antithrombotic therapy ceimpact

Closer to the Heart | GameChangers

Pharmacy Podcast Network

Play Episode Listen Later Jan 26, 2021 27:38

In December 2020, the American College of Cardiology published an Expert Consensus Decision Pathway for Antithrombotic Therapy in Patients undergoing Percutaneous Coronary Intervention. This guideline addresses a timely problem of patients on anticoagulation and antiplatelet therapy. This episode is accredited for CPE. Subscribe at CEimpact ( https://www.ceimpact.com/pharmacist ) and claim your CE today! Reference: 2020 ACC Expert Consensus Decision Pathway for Anticoagulant and Antiplatelet Therapy in Patients With Atrial Fibrillation or Venous Thromboembolism Undergoing Percutaneous Coronary Intervention or With Atherosclerotic Cardiovascular Disease: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol. Dec 18, 2020. Epublished DOI: 10.1016/j.jacc.2020.09.011. Accessed at https://www.jacc.org/doi/10.1016/j.jacc.2020.09.011 CPE details for GameChangers Podcast January 2021 Learning Objective: Recommend an appropriate antithrombotic/anticoagulant regimen in a patient who has received percutaneous coronary intervention with stenting 0107-0000-21-079-H01-P 0.2 CEU/2.0 Hrs (Knowledge) Initial Release Date: 01/25/21 Expiration Date: 01/26/24 Additional CPE information is located at https://www.ceimpact.com/podcast See omnystudio.com/listener for privacy information.

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Journal Club 神内脑外星期四 Episode 44

Play Episode Listen Later Dec 31, 2020 30:36

FDA 批准降钙素基因相关肽单抗用于预防偏头痛和丛集性头痛的发作JAMA Neurology 妊娠与临床孤立综合征发病的关系J Am Coll Cardiol 复杂的颈动脉斑块是引起隐源性卒中的一个原因Nature子刊颅内恶性肿瘤的无创检测Nature子刊合成纳米颗粒治疗胶质母细胞瘤加那珠单抗（galcanezumab）降钙素基因相关肽（CGRP）受体位于疼痛信号通路、颅内动脉和肥大细胞中，其活化被认为在偏头痛的病理生理学中起着因果作用。加那珠单抗（galcanezumab）是一种CGRP单克隆抗体。和此前在《神经科星期四 Episode 4》中介绍的治疗急性偏头痛的CGRP受体拮抗剂包括：瑞美吉泮（rimegepant）和乌布吉泮（ubrogepant）；以及《神经科星期四 Episode 14》中介绍的预防偏头痛发作的依替尼单抗（eptinezumab）属于一类药物。2018年9月，FDA批准加那珠单抗用于预防偏头痛发作；2019年6月，FDA批准加那珠单抗用于预防丛集性头痛发作。《CONQUER研究：加那珠单抗预防偏头痛的安全性和有效性的3b期临床研究》Lancet Neurology，2020年10月 (1)这项多中心、随机、双盲、安慰剂对照的3b期研究，纳入2到4类偏头痛预防药物无效的患者655例，患者年龄在18-75岁之间，有发作性或慢性偏头痛，在50岁之前发生偏头痛，入组后随机接受安慰剂或加那珠单抗（120mg q1m * 3m）。在1-3个月期间，加那珠单抗治疗的患者偏头痛发作天数比安慰剂显著减少。与基线相比，加那珠单抗组每月平均少4·1天，而安慰剂组每月平均少1·0天（p < 0·0001）。加那珠单抗和安慰剂之间治疗紧急不良事件的类型和数量相似。结论：加那珠单抗在偏头痛的预防治疗方面优于安慰剂，并且在以前的多个标准预防治疗失败的患者中有良好的耐受性。《加那珠单抗预防发作性丛集性头痛的临床研究》New England Journal of Medicine，2019年7月(2)阵发性丛集性头痛是一种神经功能障碍，其特征是每天头痛发作，持续数周或数月。共招募患者106人，随机分配接受加那珠单抗（300mg）或安慰剂组。基线期每周丛集性头痛的平均发作次数，加那珠单抗组为17.8，安慰剂组为17.3。在第1至3周中，加那珠单抗组每周平均减少为8.7次，而安慰剂组为5.2次（P =0.04）。在第3周，头痛频率降低≥50%的患者，加那珠单抗组为71%，安慰剂组为53%。除了加那珠单抗组8%的患者有注射部位疼痛外，不良事件发生率在组间没有实质性差异。结论：与安慰剂相比，在首次注射后的1-3周内，加那珠单抗300mg ip降低了偶发性丛集性头痛的发作频率。多发性硬化多发性硬化（multiple sclerosis，MS）是以中枢神经系统白质炎性脱髓鞘病变为主要特点的自身免疫病。本病最常累及的部位为脑室周围白质、视神经、脊髓、脑干和小脑，主要临床特点为中枢神经系统白质散在分布的多病灶与病程中呈现的缓解复发，症状和体征的空间多发性和病程的时间多发性。多发性硬化症主要的模式和病程可以分为以下几种临床亚型：临床孤立综合征（CIS）、复发缓解型（RR）、继发进展型（SP）、和原发进展型（PP）。《前瞻性队列研究：妊娠与临床孤立综合征发病的关系》JAMA Neurology，2020年12月 (3)多发性硬化症常诊断于育龄妇女，但妊娠是否能延迟脱髓鞘或临床孤立综合征（CIS）的首次发作尚无共识。研究的目的是探讨妊娠与CIS发病时间的关系。这个国际、多中心、前瞻性研究纳入2557名女性，CIS发病的平均年龄为31岁，发病前46%至少有1次怀孕，43%至少有1次分娩。首次怀孕的平均年龄为23.3岁，首次分娩的平均年龄为23.8岁。与从未怀孕过的女性相比，有过怀孕和分娩经历的女性发生CIS的时间较晚，延迟3.3年（P < 0.001）。与从未分娩过的女性相比，分娩过的女性发病年龄也较晚，延迟3.4年（P < 0.001）。孕产次数与发病延迟无关。结论：发病前怀孕和分娩与CIS发病时间之间存在关联，但与次数无关。需要进一步的研究来帮助解释怀孕和多发性硬化症发病之间关联的机制。《前瞻性观察性队列研究：持续免疫治疗与活动性继发进展性多发性硬化症患者残疾结果的相关性》JAMA Neurology，2020年11月 (4)研究旨在评价继发进展性多发性硬化的患者中残疾累计发生率，及是否能够通过治疗延缓残疾累积的进展。这项观察性队列研究中，招募53680例多发性硬化的患者，其中4997例继发进展型，在1621例符合纳入条件的患者中，女性患者68.0%，发病时的平均年龄为33.9岁。共有661例（40.8%）患者在继发进展性多发性硬化期间经历了叠加性复发。早期治疗方案和残疾累计发生无关。继发进展期的高复发率与轮椅依赖的残疾风险增加有关（P = 0.009）。在继发进展性多发性硬化期间经历反复复发的患者中，抑制疾病进展的治疗与残疾进展率的降低和轮椅依赖风险的降低显著相关。结论：继发进展型多发性硬化症患者中，残疾进展率与早期病程和治疗方案无关，但是与疾病复发相关。多发性硬化的治疗多发性硬化治疗的主要目的是抑制炎性脱髓鞘病变进展，防止急性期病变恶化及缓解期复发，晚期采取对症和支持疗法，减轻神经功能障碍带来的痛苦。疾病修正治疗（disease-modifying therapy，DMT）主要包括：抗整合素α-4单抗（那他珠单抗 natalizumab），抗CD20单抗（奥瑞珠单抗 ocrelizumab、奥法木单抗 ofatumumab、利妥昔单抗 rituximab），抗CD52单抗（阿伦单抗 alemtuzumab）、干扰素（干扰素β-1a、干扰素β1-b）、富马酸类（富马酸二甲酯 dimethyl fumarate、富马酸单甲酯 monomethyl fumarate）、鞘氨醇调节剂（芬戈莫德 fingolimod、西尼莫德 siponimod、奥扎莫德 ozanimod）、免疫抑制剂（克拉屈滨 cladribine），还可使用其他免疫抑制剂如特立氟胺（teriflunomide）、硫唑嘌呤、环磷酰胺、米托蒽醌等。《OPERA I和OPERA II研究：复发相关的恶化与复发无关的进展对典型复发性多发性硬化症总体确认残疾积累的贡献》JAMA Neurology，2020年9月 (5)奥瑞珠单抗（ocrelizumab）是一种靶向CD20+B细胞的单克隆抗体，于2017年被批准用于多发性硬化的治疗。研究旨在评价复发相关的恶化（relapse-associated worsening，RAW）和复发无关的进展（progression independent of relapse，PIRA）对证实的残疾累积（confirmed disability accumulation，CDA）的影响，并评估两种治疗方法对预后的影响。这2个相同的、3期、多中心、双盲随机临床试验中，1656人纳入分析，两组平均年龄37.2-37.1岁，随机奥瑞珠单抗组（奥瑞珠单抗 600mg ivgtt q24w）或干扰素组（干扰素 ip q3w）共96周。12周后，干扰素组和奥瑞珠单抗组的残疾累积事件发生率分别为29.6%和21.1%；24周发生率分别为22.7%和16.2%。复发无关的进展事件是12周和24周复合残疾累积事件的主要影响因素，分别占干扰素组的78.0%和80.6%，占奥瑞珠单抗组的88.0%和89.1%。结论：大部分的残疾积累事件与明显的疾病复发无关，这挑战了目前多发性硬化复发和进展形式的临床区别。《ORATORIO研究的事后分析：奥瑞珠单抗治疗原发性进行性多发性硬化症的长期随访》Lancet Neurology，2020年12月 (6)ORATORIO研究是一项国际、多中心、双盲、随机对照的3期试验，招募年龄18-55岁的、原发性进行性多发性硬化症患者，随机分配奥瑞珠单抗（600mg ivgtt q24w）或安慰剂，至少120周，之后可以选择进入开放标签阶段。共451人进入完成6.5年的随访。在早期使用奥瑞珠单抗的患者，残疾进展比例较低（51.7% vs 64.8%，P=0.0018），复合进展率较低（73.2% vs 83.3%；p = 0.0023）；需要轮椅的比例较低（11.5% vs 18.9%；p = 0.0274）。在研究结束时，奥瑞珠单抗组患者T2病变体积更小（0.45% vs 13.00%， p

dna medicine risk safety trial prevention fda raw conquer stroke american colleges contribution systemic dmt detection cardiology prevalence cis t2 new england journal onset cda t1 pira journal club new england journal of medicine nature medicine quantification oratorio idh cgrp cd20 nat commun comparative effectiveness j am coll cardiol jama neurology randomized clinical trials lancet neurol dna cfdna

Journal Club 神内脑外星期四 Episode 44

Play Episode Listen Later Dec 31, 2020 30:36

FDA 批准降钙素基因相关肽单抗用于预防偏头痛和丛集性头痛的发作JAMA Neurology 妊娠与临床孤立综合征发病的关系J Am Coll Cardiol 复杂的颈动脉斑块是引起隐源性卒中的一个原因Nature子刊颅内恶性肿瘤的无创检测Nature子刊合成纳米颗粒治疗胶质母细胞瘤加那珠单抗（galcanezumab）降钙素基因相关肽（CGRP）受体位于疼痛信号通路、颅内动脉和肥大细胞中，其活化被认为在偏头痛的病理生理学中起着因果作用。加那珠单抗（galcanezumab）是一种CGRP单克隆抗体。和此前在《神经科星期四 Episode 4》中介绍的治疗急性偏头痛的CGRP受体拮抗剂包括：瑞美吉泮（rimegepant）和乌布吉泮（ubrogepant）；以及《神经科星期四 Episode 14》中介绍的预防偏头痛发作的依替尼单抗（eptinezumab）属于一类药物。2018年9月，FDA批准加那珠单抗用于预防偏头痛发作；2019年6月，FDA批准加那珠单抗用于预防丛集性头痛发作。《CONQUER研究：加那珠单抗预防偏头痛的安全性和有效性的3b期临床研究》Lancet Neurology，2020年10月 (1)这项多中心、随机、双盲、安慰剂对照的3b期研究，纳入2到4类偏头痛预防药物无效的患者655例，患者年龄在18-75岁之间，有发作性或慢性偏头痛，在50岁之前发生偏头痛，入组后随机接受安慰剂或加那珠单抗（120mg q1m * 3m）。在1-3个月期间，加那珠单抗治疗的患者偏头痛发作天数比安慰剂显著减少。与基线相比，加那珠单抗组每月平均少4·1天，而安慰剂组每月平均少1·0天（p < 0·0001）。加那珠单抗和安慰剂之间治疗紧急不良事件的类型和数量相似。结论：加那珠单抗在偏头痛的预防治疗方面优于安慰剂，并且在以前的多个标准预防治疗失败的患者中有良好的耐受性。《加那珠单抗预防发作性丛集性头痛的临床研究》New England Journal of Medicine，2019年7月(2)阵发性丛集性头痛是一种神经功能障碍，其特征是每天头痛发作，持续数周或数月。共招募患者106人，随机分配接受加那珠单抗（300mg）或安慰剂组。基线期每周丛集性头痛的平均发作次数，加那珠单抗组为17.8，安慰剂组为17.3。在第1至3周中，加那珠单抗组每周平均减少为8.7次，而安慰剂组为5.2次（P =0.04）。在第3周，头痛频率降低≥50%的患者，加那珠单抗组为71%，安慰剂组为53%。除了加那珠单抗组8%的患者有注射部位疼痛外，不良事件发生率在组间没有实质性差异。结论：与安慰剂相比，在首次注射后的1-3周内，加那珠单抗300mg ip降低了偶发性丛集性头痛的发作频率。多发性硬化多发性硬化（multiple sclerosis，MS）是以中枢神经系统白质炎性脱髓鞘病变为主要特点的自身免疫病。本病最常累及的部位为脑室周围白质、视神经、脊髓、脑干和小脑，主要临床特点为中枢神经系统白质散在分布的多病灶与病程中呈现的缓解复发，症状和体征的空间多发性和病程的时间多发性。多发性硬化症主要的模式和病程可以分为以下几种临床亚型：临床孤立综合征（CIS）、复发缓解型（RR）、继发进展型（SP）、和原发进展型（PP）。《前瞻性队列研究：妊娠与临床孤立综合征发病的关系》JAMA Neurology，2020年12月 (3)多发性硬化症常诊断于育龄妇女，但妊娠是否能延迟脱髓鞘或临床孤立综合征（CIS）的首次发作尚无共识。研究的目的是探讨妊娠与CIS发病时间的关系。这个国际、多中心、前瞻性研究纳入2557名女性，CIS发病的平均年龄为31岁，发病前46%至少有1次怀孕，43%至少有1次分娩。首次怀孕的平均年龄为23.3岁，首次分娩的平均年龄为23.8岁。与从未怀孕过的女性相比，有过怀孕和分娩经历的女性发生CIS的时间较晚，延迟3.3年（P < 0.001）。与从未分娩过的女性相比，分娩过的女性发病年龄也较晚，延迟3.4年（P < 0.001）。孕产次数与发病延迟无关。结论：发病前怀孕和分娩与CIS发病时间之间存在关联，但与次数无关。需要进一步的研究来帮助解释怀孕和多发性硬化症发病之间关联的机制。《前瞻性观察性队列研究：持续免疫治疗与活动性继发进展性多发性硬化症患者残疾结果的相关性》JAMA Neurology，2020年11月 (4)研究旨在评价继发进展性多发性硬化的患者中残疾累计发生率，及是否能够通过治疗延缓残疾累积的进展。这项观察性队列研究中，招募53680例多发性硬化的患者，其中4997例继发进展型，在1621例符合纳入条件的患者中，女性患者68.0%，发病时的平均年龄为33.9岁。共有661例（40.8%）患者在继发进展性多发性硬化期间经历了叠加性复发。早期治疗方案和残疾累计发生无关。继发进展期的高复发率与轮椅依赖的残疾风险增加有关（P = 0.009）。在继发进展性多发性硬化期间经历反复复发的患者中，抑制疾病进展的治疗与残疾进展率的降低和轮椅依赖风险的降低显著相关。结论：继发进展型多发性硬化症患者中，残疾进展率与早期病程和治疗方案无关，但是与疾病复发相关。多发性硬化的治疗多发性硬化治疗的主要目的是抑制炎性脱髓鞘病变进展，防止急性期病变恶化及缓解期复发，晚期采取对症和支持疗法，减轻神经功能障碍带来的痛苦。疾病修正治疗（disease-modifying therapy，DMT）主要包括：抗整合素α-4单抗（那他珠单抗 natalizumab），抗CD20单抗（奥瑞珠单抗 ocrelizumab、奥法木单抗 ofatumumab、利妥昔单抗 rituximab），抗CD52单抗（阿伦单抗 alemtuzumab）、干扰素（干扰素β-1a、干扰素β1-b）、富马酸类（富马酸二甲酯 dimethyl fumarate、富马酸单甲酯 monomethyl fumarate）、鞘氨醇调节剂（芬戈莫德 fingolimod、西尼莫德 siponimod、奥扎莫德 ozanimod）、免疫抑制剂（克拉屈滨 cladribine），还可使用其他免疫抑制剂如特立氟胺（teriflunomide）、硫唑嘌呤、环磷酰胺、米托蒽醌等。《OPERA I和OPERA II研究：复发相关的恶化与复发无关的进展对典型复发性多发性硬化症总体确认残疾积累的贡献》JAMA Neurology，2020年9月 (5)奥瑞珠单抗（ocrelizumab）是一种靶向CD20+B细胞的单克隆抗体，于2017年被批准用于多发性硬化的治疗。研究旨在评价复发相关的恶化（relapse-associated worsening，RAW）和复发无关的进展（progression independent of relapse，PIRA）对证实的残疾累积（confirmed disability accumulation，CDA）的影响，并评估两种治疗方法对预后的影响。这2个相同的、3期、多中心、双盲随机临床试验中，1656人纳入分析，两组平均年龄37.2-37.1岁，随机奥瑞珠单抗组（奥瑞珠单抗 600mg ivgtt q24w）或干扰素组（干扰素 ip q3w）共96周。12周后，干扰素组和奥瑞珠单抗组的残疾累积事件发生率分别为29.6%和21.1%；24周发生率分别为22.7%和16.2%。复发无关的进展事件是12周和24周复合残疾累积事件的主要影响因素，分别占干扰素组的78.0%和80.6%，占奥瑞珠单抗组的88.0%和89.1%。结论：大部分的残疾积累事件与明显的疾病复发无关，这挑战了目前多发性硬化复发和进展形式的临床区别。《ORATORIO研究的事后分析：奥瑞珠单抗治疗原发性进行性多发性硬化症的长期随访》Lancet Neurology，2020年12月 (6)ORATORIO研究是一项国际、多中心、双盲、随机对照的3期试验，招募年龄18-55岁的、原发性进行性多发性硬化症患者，随机分配奥瑞珠单抗（600mg ivgtt q24w）或安慰剂，至少120周，之后可以选择进入开放标签阶段。共451人进入完成6.5年的随访。在早期使用奥瑞珠单抗的患者，残疾进展比例较低（51.7% vs 64.8%，P=0.0018），复合进展率较低（73.2% vs 83.3%；p = 0.0023）；需要轮椅的比例较低（11.5% vs 18.9%；p = 0.0274）。在研究结束时，奥瑞珠单抗组患者T2病变体积更小（0.45% vs 13.00%， p

nature ms dna medicine risk safety trial journal prevention fda raw conquer stroke american colleges contribution systemic bbb tia dmt detection cardiology prevalence cis t2 new england journal onset cda t1 pira journal club new england journal of medicine nature medicine gbm quantification oratorio idh 7t cgrp cd20 nat commun comparative effectiveness j am coll cardiol jama neurology randomized clinical trials cfdna lancet neurol dna cfdna

Journal Club 心脏血管星期一 Episode31

Play Episode Listen Later Dec 13, 2020 34:12

FDA 批准颈动脉窦压力反射刺激疗法治疗心衰Lancet 血ACE2水平与心血管疾病及死亡的关系Science子刊一种具有几何适应性的人工心脏瓣膜BAROSTIM NEO系统BAROSTIM NEO系统包括一个植入式脉冲发生器（IPG）、一个颈动脉窦含铅套件和一个程序。医生将BAROSTIM NEO脉冲发生器植入晚期心力衰竭患者的左或右锁骨下方，并在患者的左或右颈动脉窦处放置颈动脉窦导线，然后将脉冲发生器连接到颈动脉窦导线上。医生根据病人的个人需求制定脉冲发生器程序，然后向颈动脉的压力感受器传递电脉冲。压力反射激活（BAT）疗法的目的是激活颈动脉壁的压力感受器，刺激自主神经系统的传入和传出神经，大脑接收到神经信号作出相应反应：松弛血管、降低心率、并通过改善肾功能来减少液体储留。2019年8月，FDA批准BAROSTIM NEO系统用于药物治疗无效的、不符合心脏再同步化治疗适应症的、难治性心力衰竭患者。《BeAT-HF研究：这项研究证明了压力反射刺激疗法（BAT）对射血分数降低的心力衰竭患者的安全性和有效性》Journal of American College of Cardiology，2020年7月 (1) BeAT-HF研究是一项多中心、前瞻性、随机对照研究，纳入408名射血分数降低的心力衰竭（HFrEF）患者中，入组要求：纽约心功能分级II-III级、射血分数≤35%、药物治疗方案稳定≥4周、不符合心脏再同步化治疗的I类指征。这篇报告重点汇报了D队列中、NT-proBNP

Journal Club 心脏血管星期一 Episode31

Play Episode Listen Later Dec 13, 2020 34:12

FDA 批准颈动脉窦压力反射刺激疗法治疗心衰Lancet 血ACE2水平与心血管疾病及死亡的关系Science子刊一种具有几何适应性的人工心脏瓣膜BAROSTIM NEO系统BAROSTIM NEO系统包括一个植入式脉冲发生器（IPG）、一个颈动脉窦含铅套件和一个程序。医生将BAROSTIM NEO脉冲发生器植入晚期心力衰竭患者的左或右锁骨下方，并在患者的左或右颈动脉窦处放置颈动脉窦导线，然后将脉冲发生器连接到颈动脉窦导线上。医生根据病人的个人需求制定脉冲发生器程序，然后向颈动脉的压力感受器传递电脉冲。压力反射激活（BAT）疗法的目的是激活颈动脉壁的压力感受器，刺激自主神经系统的传入和传出神经，大脑接收到神经信号作出相应反应：松弛血管、降低心率、并通过改善肾功能来减少液体储留。2019年8月，FDA批准BAROSTIM NEO系统用于药物治疗无效的、不符合心脏再同步化治疗适应症的、难治性心力衰竭患者。《BeAT-HF研究：这项研究证明了压力反射刺激疗法（BAT）对射血分数降低的心力衰竭患者的安全性和有效性》Journal of American College of Cardiology，2020年7月 (1) BeAT-HF研究是一项多中心、前瞻性、随机对照研究，纳入408名射血分数降低的心力衰竭（HFrEF）患者中，入组要求：纽约心功能分级II-III级、射血分数≤35%、药物治疗方案稳定≥4周、不符合心脏再同步化治疗的I类指征。这篇报告重点汇报了D队列中、NT-proBNP

Journal Club 心脏科星期一 Episode 11

Play Episode Listen Later Nov 15, 2020 22:42

FDA 批准血管紧张素II用于休克病人低血压的治疗NEJM 秋水仙碱在慢性冠心病患者中的疗效Circulation 心脏内源性干细胞和心肌细胞增殖的争论、谬误和进展血管紧张素II（angiotensin II）2017年12月，FDA批准合成人血管紧张素II用于治疗分布性休克患者。《ATHOS-3研究：血管紧张素II治疗血管舒张性休克的3期临床研究》New England Journal of Medicine，2017年8月 (1)血管舒张性休克的患者对高剂量的血管收缩剂反应差，而且会增加死亡率。此研究的目的是评价这类患者使用血管紧张素II的疗效。研究纳入需要大剂量血管收缩药物维持血压的、血管舒张性休克的患者344人（去甲肾上腺素用量>0.2μg/kg/min或等剂量的血管收缩药），随机分入血管紧张素II治疗组和安慰剂组。用药3小时后，血压升高10mmHg或平均血压升高至75mmHg的患者，干预组达到69.9%，安慰剂组只有23.4%（P0.2）或高血压显著升高的情况（P>0.2）。结论：卡那单抗虽然可降低主要心血管事件发生率，但这些获益与血压变化无关。《COLCOT研究：小剂量秋水仙碱治疗心肌梗死的疗效和安全性》New England Journal of Medicine，2019年11月 (6)秋水仙碱是一种口服的，有效的抗炎药物，是用于治疗痛风和心包炎。研究的目的是评价秋水仙碱抗炎治疗近期心肌梗死患者对缺血性心血管事件的影响。研究招募了急性心肌梗死30天内的患者共4745人，随机分到秋水仙碱 0.5mg qd组或安慰剂。平均随访22.6个月后，秋水仙碱组和安慰剂组分别有5.5%和7.1%的患者出现主要终点事件（心血管原因死亡、心脏骤停复苏、心肌梗死、卒中或因心绞痛紧急住院导致冠状动脉血运重建）（P = 0.02）。与安慰剂相比，秋水仙碱心血管原因死亡的风险比0.84，心脏骤停风险比0.83，心肌梗死风险比为0.91；能显著降低卒中的风险达74%，同时能显著降低心绞痛住院再次血运重建的风险达50%。两组最常见的不良事件是腹泻，发生率没有差异，最严重的不良事件是肺炎，发生率分别为0.9%和0.4%（P = 0.03）。结论：在近期心肌梗死患者中，每天0.5 mg的秋水仙碱比安慰剂显著降低缺血性心血管事件的风险。《COLCOT研究：秋水仙碱治疗起始时间与心肌梗死后心血管预后的关系》European Heart Journal，2020年8月 (7)这项COLCOT研究的分析，纳入了4661例患者，按照启动秋水仙碱治疗距离急性心肌梗死的时间可分为三个亚组，8天组。平均随访22.7个月后，8天组没有统计学意义（风险比 0.96和0.82）。不仅如此，3天内启动秋水仙碱治疗的患者，心绞痛住院血运重建术的风险显著降低（风险比 0.35）、再次血运重建风险显著降低（风险比 0.63），而且所有的复合心血管死亡、心脏骤停、心肌梗死或卒中的风险均显著降低（风险比 0.55，P < 0.05)。结论：心肌梗死后，患者应尽早在医院内给予秋水仙碱治疗。《LoDoCo2研究：秋水仙碱在慢性冠心病患者中的疗效》New England Journal of Medicine，2020年8月(8)秋水仙碱的抗炎作用可降低近期心肌梗死患者发生心血管事件的风险，但对慢性冠心病患者的证据有限。这项随机、对照、双盲试验中，招募5522名慢性冠心病患者，随机分配至秋水仙碱0.5mg qd组或安慰剂组，平均随访时间为28.6个月。主要终点事件（心血管死亡、自发心肌梗死、缺血性卒中或缺血驱动的冠状动脉血运重建）在秋水仙碱组和安慰剂组的发生率分别为6.8%和9.6%（P < 0.001)。次要终点事件（心血管死亡、自发心肌梗死、缺血性卒中）在秋水仙碱组和安慰剂组的发生率分别为4.2%和5.7%（P = 0.007）。秋水仙碱组的自发性心肌梗死或缺血驱动的冠脉血运重建的复合终点、心血管死亡或自发性心肌梗死的复合终点、缺血驱动的冠脉血运重建和自发性心肌梗死的发生率也显著降低。秋水仙碱组的非心血管疾病死亡发生率高于安慰剂组（风险比 1.51）。结论：秋水仙碱可以显著降低慢性冠心病患者发生心血管事件的风险。小羽点评：冠心病发病机制复杂，不仅限于胆固醇内膜浸润，也是免疫系统的全身和局部激活驱动的血管壁的慢性炎症的结果，最终导致斑块破裂或侵蚀、血栓形成、心肌梗死。在广泛使用他汀类药物后，仍有大量患者出现复发，反映了残留炎症并没有被充分控制。现在抗炎药物治疗成为热点，但是否能上升到一线治疗的地位，我们拭目以待。心脏干细胞修复技术《综述：心脏内源性干细胞和心肌细胞增殖的争论、谬误和进展》Circulation，2020年7月 (9)在过去的十年里，许多类型的心脏干细胞（CSCs）从实验室到临床研究，但并有什么确切的治疗效果。有关干细胞示踪的基础研究开始质疑心脏干细胞的基础生物学和作用机制，挑战心脏干细胞的起源和存在。除了心脏干细胞在心脏再生中的潜在作用外，现有心肌细胞的增殖得到了更多的关注。中国科学院研究人员发表的这篇综述评估了过去和现在关于心脏干细胞和心肌细胞增殖的研究的方法和技术方面，也讨论了潜在局限性。作者认为未来的研究方向：（1）由于缺乏常驻CSC存在的证据，内源性心肌细胞增殖频率又非常低，如何促进心肌细胞增殖可能是未来一个重要的研究领域；（2）除了诱导心肌细胞增殖外，还可以考虑其他替代方法，比如通过过表达特定转录因子、或小分子诱导的方式，使成纤维细胞原位重新编程成为心肌细胞，如此使心肌细胞再生同时减少瘢痕形成；（3）人胚胎干细胞或诱导多潜能细胞来源的心脏祖细胞和心肌细胞已成功移植到大型动物模型中，并已证实了移植细胞在宿主心肌内的存活和心脏功能的改善；（4）即使没有直接的心肌细胞再生，促进新血管形成的方法，如通过移植能够分泌血管生长因子的间充质干细胞，或减轻心肌梗死后炎症损伤等方法，来改善心肌存活率、减少疤痕形成；（5）双重干细胞疗法协同改善心肌损伤后心脏功能和血管新生，如人类诱导性多潜能干细胞来源的心肌细胞和间充质干细胞，或人类胚胎干细胞来源的心外膜细胞和心肌细胞；（6）含有生长因子或多种心脏细胞类型的心外膜贴片，也被证明可以改善心肌梗死后的心脏功能和新生血管；（7）通过RNA修饰心外膜祖细胞后产生的血管内皮生长因子A可以使血管再生增强；最后，作者认为，由于内源性假定心脏干细胞的错误，因此，为达到心脏修复和再生的最终目标，应该将更多的精力和资源投入到更有前途的方向上是很重要的。《综述：对胚胎干细胞在心脏修复中的作用的评价》European Heart Journal，2020年7月 (10)尽管胚胎干细胞（ESCs）具有分化为心肌细胞的能力，胚胎干细胞或胚胎干细胞来源的细胞的移植仍面临着一些非常棘手的问题：（1）移植物排斥反应，通过药物诱导免疫抑制本身就是一种疾病；（2）心律失常，研究发现在灵长类动物中移植人类胚胎干细胞来源的细胞会导致危及生命的心律失常，而这种心律失常的发生与剂量无关；（3）恶性肿瘤，在当代临床研究中，对恶性肿瘤等灾难性影响的耐受限度为零。尽管胚胎干细胞分化成肿瘤的可能性非常低，但不是完全没有可能，特别是移植细胞的数量级在十亿的时候；（4）长期再生能力，虽然胚胎干细胞和胚胎干细胞来源的细胞被吹捧为具有长期再生能力，但干细胞示踪技术显示这些细胞在移植后迅速消失，没有长期移植或再生的证据；（5）越来越多的证据表明胚胎干细胞的作用是通过旁分泌机制来发挥的，尚没有开展或启动胚胎干细胞来源细胞在心血管疾病中的临床对照试验；作者最后对未来发展的方向做了预估：（1）成年细胞已用于数千名心脏病患者，没有显著的副作用，其结果令人鼓舞，值得进行II期和III期试验。（2）人诱导的多潜能干细胞提供类似胚胎干细胞的多能性，而不需要终身免疫抑制。《COVID-19患者中使用秋水仙碱治疗对心脏、炎症指标及临床预后的影响》JAMA Network Open，2020年6月 (11)研究旨在比较秋水仙碱和标准化治疗对心脏、炎症指标及临床预后的影响。在105例随机临床试验中，秋水仙碱干预组在常规治疗的基础上，首剂1.5mg，如果没有观察到胃肠道不良反应则60分钟后再给0.5mg，维持剂量为0.5mg qd（体重60kg）直至出院或满21天。对照组的主要临床终点、临床恶化率高于秋水仙碱组，而且对照组患者出现恶化比较快。两组高敏肌钙蛋白浓度无差异，但秋水仙碱组患者D-二聚体的增幅较小。结论：秋水仙碱对COVID-19由一定的治疗作用。参考文献1.Khanna A, Ostermann M, Bellomo R. 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Eur Heart J. 2020;41(25):2397-404.11.Deftereos SG, Giannopoulos G, Vrachatis DA, Siasos GD, Giotaki SG, Gargalianos P, et al. Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial. JAMA Network Open. 2020;3(6):e2013136-e.

Journal Club 心脏科星期一 Episode 11

Plant Prescription Podcast

Play Episode Listen Later Nov 15, 2020 22:42

FDA 批准血管紧张素II用于休克病人低血压的治疗NEJM 秋水仙碱在慢性冠心病患者中的疗效Circulation 心脏内源性干细胞和心肌细胞增殖的争论、谬误和进展血管紧张素II（angiotensin II）2017年12月，FDA批准合成人血管紧张素II用于治疗分布性休克患者。《ATHOS-3研究：血管紧张素II治疗血管舒张性休克的3期临床研究》New England Journal of Medicine，2017年8月 (1)血管舒张性休克的患者对高剂量的血管收缩剂反应差，而且会增加死亡率。此研究的目的是评价这类患者使用血管紧张素II的疗效。研究纳入需要大剂量血管收缩药物维持血压的、血管舒张性休克的患者344人（去甲肾上腺素用量>0.2μg/kg/min或等剂量的血管收缩药），随机分入血管紧张素II治疗组和安慰剂组。用药3小时后，血压升高10mmHg或平均血压升高至75mmHg的患者，干预组达到69.9%，安慰剂组只有23.4%（P0.2）或高血压显著升高的情况（P>0.2）。结论：卡那单抗虽然可降低主要心血管事件发生率，但这些获益与血压变化无关。《COLCOT研究：小剂量秋水仙碱治疗心肌梗死的疗效和安全性》New England Journal of Medicine，2019年11月 (6)秋水仙碱是一种口服的，有效的抗炎药物，是用于治疗痛风和心包炎。研究的目的是评价秋水仙碱抗炎治疗近期心肌梗死患者对缺血性心血管事件的影响。研究招募了急性心肌梗死30天内的患者共4745人，随机分到秋水仙碱 0.5mg qd组或安慰剂。平均随访22.6个月后，秋水仙碱组和安慰剂组分别有5.5%和7.1%的患者出现主要终点事件（心血管原因死亡、心脏骤停复苏、心肌梗死、卒中或因心绞痛紧急住院导致冠状动脉血运重建）（P = 0.02）。与安慰剂相比，秋水仙碱心血管原因死亡的风险比0.84，心脏骤停风险比0.83，心肌梗死风险比为0.91；能显著降低卒中的风险达74%，同时能显著降低心绞痛住院再次血运重建的风险达50%。两组最常见的不良事件是腹泻，发生率没有差异，最严重的不良事件是肺炎，发生率分别为0.9%和0.4%（P = 0.03）。结论：在近期心肌梗死患者中，每天0.5 mg的秋水仙碱比安慰剂显著降低缺血性心血管事件的风险。《COLCOT研究：秋水仙碱治疗起始时间与心肌梗死后心血管预后的关系》European Heart Journal，2020年8月 (7)这项COLCOT研究的分析，纳入了4661例患者，按照启动秋水仙碱治疗距离急性心肌梗死的时间可分为三个亚组，8天组。平均随访22.7个月后，8天组没有统计学意义（风险比 0.96和0.82）。不仅如此，3天内启动秋水仙碱治疗的患者，心绞痛住院血运重建术的风险显著降低（风险比 0.35）、再次血运重建风险显著降低（风险比 0.63），而且所有的复合心血管死亡、心脏骤停、心肌梗死或卒中的风险均显著降低（风险比 0.55，P < 0.05)。结论：心肌梗死后，患者应尽早在医院内给予秋水仙碱治疗。《LoDoCo2研究：秋水仙碱在慢性冠心病患者中的疗效》New England Journal of Medicine，2020年8月(8)秋水仙碱的抗炎作用可降低近期心肌梗死患者发生心血管事件的风险，但对慢性冠心病患者的证据有限。这项随机、对照、双盲试验中，招募5522名慢性冠心病患者，随机分配至秋水仙碱0.5mg qd组或安慰剂组，平均随访时间为28.6个月。主要终点事件（心血管死亡、自发心肌梗死、缺血性卒中或缺血驱动的冠状动脉血运重建）在秋水仙碱组和安慰剂组的发生率分别为6.8%和9.6%（P < 0.001)。次要终点事件（心血管死亡、自发心肌梗死、缺血性卒中）在秋水仙碱组和安慰剂组的发生率分别为4.2%和5.7%（P = 0.007）。秋水仙碱组的自发性心肌梗死或缺血驱动的冠脉血运重建的复合终点、心血管死亡或自发性心肌梗死的复合终点、缺血驱动的冠脉血运重建和自发性心肌梗死的发生率也显著降低。秋水仙碱组的非心血管疾病死亡发生率高于安慰剂组（风险比 1.51）。结论：秋水仙碱可以显著降低慢性冠心病患者发生心血管事件的风险。小羽点评：冠心病发病机制复杂，不仅限于胆固醇内膜浸润，也是免疫系统的全身和局部激活驱动的血管壁的慢性炎症的结果，最终导致斑块破裂或侵蚀、血栓形成、心肌梗死。在广泛使用他汀类药物后，仍有大量患者出现复发，反映了残留炎症并没有被充分控制。现在抗炎药物治疗成为热点，但是否能上升到一线治疗的地位，我们拭目以待。心脏干细胞修复技术《综述：心脏内源性干细胞和心肌细胞增殖的争论、谬误和进展》Circulation，2020年7月 (9)在过去的十年里，许多类型的心脏干细胞（CSCs）从实验室到临床研究，但并有什么确切的治疗效果。有关干细胞示踪的基础研究开始质疑心脏干细胞的基础生物学和作用机制，挑战心脏干细胞的起源和存在。除了心脏干细胞在心脏再生中的潜在作用外，现有心肌细胞的增殖得到了更多的关注。中国科学院研究人员发表的这篇综述评估了过去和现在关于心脏干细胞和心肌细胞增殖的研究的方法和技术方面，也讨论了潜在局限性。作者认为未来的研究方向：（1）由于缺乏常驻CSC存在的证据，内源性心肌细胞增殖频率又非常低，如何促进心肌细胞增殖可能是未来一个重要的研究领域；（2）除了诱导心肌细胞增殖外，还可以考虑其他替代方法，比如通过过表达特定转录因子、或小分子诱导的方式，使成纤维细胞原位重新编程成为心肌细胞，如此使心肌细胞再生同时减少瘢痕形成；（3）人胚胎干细胞或诱导多潜能细胞来源的心脏祖细胞和心肌细胞已成功移植到大型动物模型中，并已证实了移植细胞在宿主心肌内的存活和心脏功能的改善；（4）即使没有直接的心肌细胞再生，促进新血管形成的方法，如通过移植能够分泌血管生长因子的间充质干细胞，或减轻心肌梗死后炎症损伤等方法，来改善心肌存活率、减少疤痕形成；（5）双重干细胞疗法协同改善心肌损伤后心脏功能和血管新生，如人类诱导性多潜能干细胞来源的心肌细胞和间充质干细胞，或人类胚胎干细胞来源的心外膜细胞和心肌细胞；（6）含有生长因子或多种心脏细胞类型的心外膜贴片，也被证明可以改善心肌梗死后的心脏功能和新生血管；（7）通过RNA修饰心外膜祖细胞后产生的血管内皮生长因子A可以使血管再生增强；最后，作者认为，由于内源性假定心脏干细胞的错误，因此，为达到心脏修复和再生的最终目标，应该将更多的精力和资源投入到更有前途的方向上是很重要的。《综述：对胚胎干细胞在心脏修复中的作用的评价》European Heart Journal，2020年7月 (10)尽管胚胎干细胞（ESCs）具有分化为心肌细胞的能力，胚胎干细胞或胚胎干细胞来源的细胞的移植仍面临着一些非常棘手的问题：（1）移植物排斥反应，通过药物诱导免疫抑制本身就是一种疾病；（2）心律失常，研究发现在灵长类动物中移植人类胚胎干细胞来源的细胞会导致危及生命的心律失常，而这种心律失常的发生与剂量无关；（3）恶性肿瘤，在当代临床研究中，对恶性肿瘤等灾难性影响的耐受限度为零。尽管胚胎干细胞分化成肿瘤的可能性非常低，但不是完全没有可能，特别是移植细胞的数量级在十亿的时候；（4）长期再生能力，虽然胚胎干细胞和胚胎干细胞来源的细胞被吹捧为具有长期再生能力，但干细胞示踪技术显示这些细胞在移植后迅速消失，没有长期移植或再生的证据；（5）越来越多的证据表明胚胎干细胞的作用是通过旁分泌机制来发挥的，尚没有开展或启动胚胎干细胞来源细胞在心血管疾病中的临床对照试验；作者最后对未来发展的方向做了预估：（1）成年细胞已用于数千名心脏病患者，没有显著的副作用，其结果令人鼓舞，值得进行II期和III期试验。（2）人诱导的多潜能干细胞提供类似胚胎干细胞的多能性，而不需要终身免疫抑制。《COVID-19患者中使用秋水仙碱治疗对心脏、炎症指标及临床预后的影响》JAMA Network Open，2020年6月 (11)研究旨在比较秋水仙碱和标准化治疗对心脏、炎症指标及临床预后的影响。在105例随机临床试验中，秋水仙碱干预组在常规治疗的基础上，首剂1.5mg，如果没有观察到胃肠道不良反应则60分钟后再给0.5mg，维持剂量为0.5mg qd（体重60kg）直至出院或满21天。对照组的主要临床终点、临床恶化率高于秋水仙碱组，而且对照组患者出现恶化比较快。两组高敏肌钙蛋白浓度无差异，但秋水仙碱组患者D-二聚体的增幅较小。结论：秋水仙碱对COVID-19由一定的治疗作用。参考文献1.Khanna A, Ostermann M, Bellomo R. Angiotensin II for the Treatment of Vasodilatory Shock. N Engl J Med. 2017;377(26):2604.2.Bellomo R, Forni LG, Busse LW, McCurdy MT, Ham KR, Boldt DW, et al. Renin and Survival in Patients Given Angiotensin II for Catecholamine-Resistant Vasodilatory Shock. A Clinical Trial. Am J Respir Crit Care Med. 2020;202(9):1253-61.3.Silvain J, Kerneis M, Zeitouni M, Lattuca B, Galier S, Brugier D, et al. Interleukin-1beta and Risk of Premature Death in Patients With Myocardial Infarction. J Am Coll Cardiol. 2020;76(15):1763-73.4.Everett BM, MacFadyen JG, Thuren T, Libby P, Glynn RJ, Ridker PM. Inhibition of Interleukin-1beta and Reduction in Atherothrombotic Cardiovascular Events in the CANTOS Trial. J Am Coll Cardiol. 2020;76(14):1660-70.5.Rothman AM, MacFadyen J, Thuren T, Webb A, Harrison DG, Guzik TJ, et al. Effects of Interleukin-1beta Inhibition on Blood Pressure, Incident Hypertension, and Residual Inflammatory Risk: A Secondary Analysis of CANTOS. Hypertension. 2020;75(2):477-82.6.Tardif JC, Kouz S, Waters DD, Bertrand OF, Diaz R, Maggioni AP, et al. Efficacy and Safety of Low-Dose Colchicine after Myocardial Infarction. N Engl J Med. 2019;381(26):2497-505.7.Bouabdallaoui N, Tardif JC, Waters DD, Pinto FJ, Maggioni AP, Diaz R, et al. Time-to-treatment initiation of colchicine and cardiovascular outcomes after myocardial infarction in the Colchicine Cardiovascular Outcomes Trial (COLCOT). Eur Heart J. 2020.8.Nidorf SM, Fiolet ATL, Mosterd A, Eikelboom JW, Schut A, Opstal TSJ, et al. Colchicine in Patients with Chronic Coronary Disease. New England Journal of Medicine. 2020.9.He L, Nguyen NB, Ardehali R, Zhou B. Heart Regeneration by Endogenous Stem Cells and Cardiomyocyte Proliferation. Circulation. 2020;142(3):275-91.10.Wysoczynski M, Bolli R. A realistic appraisal of the use of embryonic stem cell-based therapies for cardiac repair. Eur Heart J. 2020;41(25):2397-404.11.Deftereos SG, Giannopoulos G, Vrachatis DA, Siasos GD, Giotaki SG, Gargalianos P, et al. Effect of Colchicine vs Standard Care on Cardiac and Inflammatory Biomarkers and Clinical Outcomes in Patients Hospitalized With Coronavirus Disease 2019: The GRECCO-19 Randomized Clinical Trial. JAMA Network Open. 2020;3(6):e2013136-e.

Nutrition and Heart Disease with a cardiologist and former president of American College of Cardiology, Dr. Kim Williams

Play Episode Listen Later Oct 12, 2020 99:30

We are joined by the former president of the American College of Cardiology, Dr. Kim Williams. Vegan since 2003, he has been a prominent figure in advocating for the role of a plant-based diet in the cardiology field. Dr. Williams is quite well known for his famous quote: “There are two kinds of cardiologists: vegans and those who haven’t read the data.” We cover: His prowess as a tennis player & why he became vegan Modifiable risk factors for COVID-19 Protecting children early The role of sugar, sat fat & cholesterol How heme iron (found in meat) oxidizes cholesterol His thoughts on coconut oil, fish oil, & dairy Reversal of heart disease The role of statins High HDL & mortality You can connect with Dr. Williams on Twitter: @cardio10s and through his RUSH Website Episode Resources: J Am Coll Cardiol 70(4) (healthy PDD) J Am Coll Cardiol 60(25):2631-9 (LDL Mendelian) Am J Epidemiology 173(3):319-329 (NHS mortality risk) JAMA Intern Med 174(4):516-24 (sugar and CVD) NEJM 378:e34 (Med diet w oil/nuts) J Am Coll Cardiol 70(4):411-422 (healthy vs unhealthy PBD) Am J Lifestyle Med 2019 (industry & cholesterol) IJDRP 2(1) (egg on your face) Am J Clin Nutr 100(1):320S-328S (PREDIMED) Am J Clin Nutr 110(1):24-33 (red vs white meat) JAMA 317(9):912-924 (diet & mortality) Circulation 141:803-814 (coconut oil) JAMA 176(10):1453-1463 (animal vs plant protein) Lancet 336(8708):129-33 (Ornish 1) JAMA 280(23):2001-7 (Ornish 2) J Family Prac 63(7):356-364 (Esselstyn) JAMA 316(22):2373-2384 (GLAGOV) Eur Heart J 38(32):2478-2486 (HDL & mortality) IJDRP 2(1) (amino acid def) Dr. Belardo: Green/yellow/red light nutrition Thank you for tuning in! Make sure to subscribe to the Plant Prescription Podcast so you get notified when new episodes are published. IG: Muzammil: @dr.plantbased, Cass: @plant_fuel

Episode 4- The Rise of Lethal Loperamide

The Poison Lab

Play Episode Listen Later Aug 26, 2020 58:43

Buying as much loperamide as you possibly can Loperamide history1969- Synthesized (1)1976 FDA Approved as schedule V (2)Jaffe trial of "abuse potential"- https://pubmed.ncbi.nlm.nih.gov/7438696/1982- Descheduled (3)2010-Annually Increasing in # of poison center calls, cases of arrhythmia and hospitalization (4,5,6)2016- Submission to DEA for rescheduling of loperamide denied (7)2019- FDA works with manufactures to reduce package size to 48 tablets (8)Pharmacist knowledge of abuse remains low https://pubmed.ncbi.nlm.nih.gov/32641253/Toxic MechanismFun theories about co evolution of PGP and CYP https://pubmed.ncbi.nlm.nih.gov/10837556/Inhibition of sodium channels, and to a higher affinity, Human Ether a Go-Go Related (HERG) channel leads to prolonged repolarization (9)IC50 for HERG Ikr ~ 40 nm/l (1908 ng/dl), inhibits as low as 10 nm/l (10)Case reports of conduction disturbance with level of 22 ng/ml (14)Levels in fatalities vary but reported as high as 270 ng/ml in some studies (15)Prolonged re polarization leads to torsadesEarly after depolarizations may trigger, which are then propagated torsades via re entrant rhythms (11)TreatmentACMT loperamide guidelines (12)Supportive careArrhythmia managementTorsades (13)Electrical cardioversion (terminates re entrant rhythm)Magnesium (prevents early after depolarization)Target Mg >2 and K >4Lidocaine-> Recommended in 2006 Sudden cardiac death guidlines, not mentioned in 2017, however one of the only VT recommended antiarryhtmics that do not prolong QTc (others, sotalol, amiodarone, and procainamide, do)If preceded by bradycardia, Overdrive pacing with isoproterenol to target HR~ 100Beta blockers are recommended in patients with LQTSSodium channel blockade induced wide QRS complex tachycardia (12)Hypertonic sodium to over whelm sodium channel blockade (1-2 amps of 8.4% Sodium Bicarbonate given IV)Where do we go in the future?More research will help us understand the true incidence of how often this occurs and what impact the FDA decisions will haveAny concerned citizen can submit for rescheduling of loperamide. Interested? Reach out at toxtalk1@gmail.comDrug Enforcement Agency. The Controlled Substances Act. Available at: https://www.dea.gov/controlled-substances-act.Florey, Klaus (1991). Profiles of Drug Substances, Excipients and Related Methodology, Volume 19. Academic Press. p. 342. ISBN9780080861142."IMODIUM FDA Application No.(NDA) 017694". U.S. Food and Drug Administration (FDA). 1976.https://www.deadiversion.usdoj.gov/schedules/orangebook/orangebook.pdf.Miller H, Panahi L, Tapia D, Tran A, Bowman JD. Loperamide misuse and abuse. J Am Pharm Assoc (2003). 2017;57(2S):S45eS50.Feldman R, Everton E. National assessment of pharmacist awareness of loperamide abuse and ability to restrict sale if abuse is suspected [published online ahead of print, 2020 Jul 5]. J Am Pharm Assoc (2003). 2020;S1544-3191(20)30264-8. doi:10.1016/j.japh.2020.05.021Eggleston W, Marraffa JM, Stork CM, et al. Notes from the Field: Cardiac Dysrhythmias After Loperamide Abuse — New York, 2008–2016. MMWR Morb Mortal Wkly Rep 2016;65:1276–1277. DOI: http://dx.doi.org/10.15585/mmwr.mm6545a7https://www.chpa.org/PDF/09_05_17_CommentsCitizenPetitionLoperamide.aspxhttps://www.fda.gov/drugs/drug-safety-and-availability/fda-limits-packaging-anti-diarrhea-medicine-loperamide-imodium-encourage-safe-useKang J, Compton DR, Vaz RJ, Rampe D. Proarrhythmic mechanisms of the common anti-diarrheal medication loperamide: revelations from the opioid abuse epidemic. Naunyn Schmiedebergs Arch Pharmacol. 2016;389(10):1133-1137. doi:10.1007/s00210-016-1286-7Klein MG, Haigney MCP, Mehler PS, Fatima N, Flagg TP, Krantz MJ. Potent Inhibition of hERG Channels by the Over-the-Counter Antidiarrheal Agent Loperamide. JACC Clin Electrophysiol. 2016;2(7):784-789. doi:10.1016/j.jacep.2016.07.008https://www.sciencedirect.com/science/article/pii/S1880427611800050Eggleston W, Palmer R, Dubé PA, et al. Loperamide toxicity: recommendations for patient monitoring and management. Clin Toxicol (Phila). 2020;58(5):355-359. doi:10.1080/15563650.2019.1681443Al-Khatib SM, Stevenson WG, Ackerman MJ, et al. 2017 AHA/ACC/HRS Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society [published correction appears in J Am Coll Cardiol. 2018 Oct 2;72(14):1760]. J Am Coll Cardiol. 2018;72(14):e91-e220. doi:10.1016/j.jacc.2017.10.054Marraffa JM, Holland MG, Sullivan RW, et al. Cardiac conduction disturbance after loperamide abuse. Clin Toxicol (Phila). 2014;52(9):952-957. doi:10.3109/15563650.2014.969371Miller H, Panahi L, Tapia D, Tran A, Bowman JD. Loperamide misuse and abuse. J Am Pharm Assoc (2003). 2017;57(2S):S45-S50. doi:10.1016/j.japh.2016.12.079

46. Introducing CardioNerds Case Reports: Recruitment Edition Series – with Dr. Nosheen Reza

Play Episode Listen Later Aug 17, 2020 32:27

CardioNerds Amit and Dan are joined by Dr. Nosheen Reza, chair of the ACC FIT section, to announce the launch of the CardioNerds Case Reports: Recruitment Edition Series! In this exciting project, the CardioNerds collaborated with the ACC FIT section to invite every fellowship program to co-produce a case-based episode. Fellows from the program present and discuss a fascinating case and an expert provides the E-CPR editorial, followed by a message to applicants from the program director. We've asked every program to help us promote diversity in their fellow ambassadors to the CardioNerds show. We also discuss the value of podcasts and innovations in medical education, Dr. Reza's perspectives and advice for the upcoming virtual recruitment, getting involved with the ACC as fellows-in-training (#FIT!), promoting diversity and inclusion within cardiology, and Dr. Reza's advice for thriving during fellowship. We also introduce the brand new CardioNerds Academy! We will be growing the platform by offering a uniquely tailored and mentored experience to several future CardioNerds Fellows. Our goal is to teach our CardioNerds Fellows the ropes of med-ed podcasting through a comprehensive curriculum with dedicated mentorship. We are honored to have recruited Dr. Justin Berk as program director and Dr. Heather Kagan as associate program director. Episode graphic by Dr. Carine Hamo 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 Key Reference: Reza N, Krishnan S, Adusumalli S. A Model for the Career Advancement of Women Fellows and Cardiologists. J Am Coll Cardiol. 2020;76(8):996 LP - 1000. Nosheen Reza, MD Dr. Nosheen Reza is a cardiologist and translational researcher at the University of Pennsylvania focusing on advanced heart failure and transplant cardiology and cardiovascular genetics, genomics, and phenomics. She obtained her medical degree from the University of Virginia School of Medicine in 2012 and completed her internal medicine residency training at the Massachusetts General Hospital in 2015. She then completed her Cardiovascular Disease fellowship at the University of Pennsylvania in 2018 and served as 2017-2018 Chief Fellow. At Penn, Dr. Reza pursued additional scholarship in genomic medicine as an NIH T32-funded postdoctoral fellow and in healthcare quality as a Penn Benjamin & Mary Siddons Measey Fellow in Quality Improvement and Patient Safety. She completed her final year of clinical training at Penn in Advanced Heart Failure and Transplant Cardiology and joined the faculty at the University of Pennsylvania in July 2020. Dr. Reza is passionate about medical education and has won many distinctions in the field throughout her training. She serves as an editorial board member for JACC: Case Reports, JACC: CardioOncology, and Current Cardiovascular Risk Reports. Dr. Reza is an active leader in the Heart Failure Society of America, American Heart Association, and American College of Cardiology at the local and national levels and volunteers on multiple leadership councils and steering committees within these organizations. CardioNerds Case Reports: Recruitment Edition Series Production Team Daniel Ambinder, MDAmit Goyal, MDHeather Kagan, MDJustin Berk, MD MPH MBA

43. Introducing CardioNerds Case Reports – with Dr. Julia Grapsa

Plant Prescription Podcast

Play Episode Listen Later Aug 6, 2020 40:46

JACC: Case Reports Editor-in-Chief, Dr. Julia Grapsa joins Cardionerds, Amit and Dan, to introduce a new episode series: CardioNerds Case Reports (#CNCR)! We discuss the value of learning through cases, podcasts and other innovations in education, importance of promoting wellness in medicine, the editorial review process for case reports, and being an editor-in-chief as a woman in medicine. The CardioNerds Case Reports series will shine 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. Take me to the Cardionerds Case Report (CNCR) Series PageTake me to the Cardionerds Episode Topics Page Episode graphic created by Dr. Carine Hamo References Grapsa J (2019) Voices in Cardiology. JACC Case Reports. Grapsa J, Fuster V (2019) JACC: Case Reports: New Era of Clinical Cases, Bridging Patients With Guidelines. J Am Coll Cardiol. Grapsa J, Fuster V (2020) JACC: Case Reports: Moving to a Multimedia Educational Vehicle. J Am Coll Cardiol. (2006) Mindset: the new psychology of success. Choice Rev Online. Balasubramanian S, Saberi S, Yu S, Duvernoy CS, Day SM, Agarwal PP (2020) Women representation among cardiology journal editorial boards. Circulation. Dr. Julia Grapsa serves as the Editor-in-Chief of JACC: Case Reports. Dr. Grapsa worked for Cleveland Clinic Abu Dhabi and then she moved to UK as a a consultant cardiologist for Barts Heart Center. In March 2020, Dr. Grapsa started working as consultant cardiologist at Guys and St Thomas NHS Trust. Within the UK’s leading structural valve disease group, Dr. Grapsa is responsible for the valvular heart disease network and echocardiography, a position previously held by Professor John Chambers. Dr. Grapsa has served as chair of the young community for multimodality imaging for the European Association of Cardiovascular Imaging and as a member of the European Society of Cardiology (ESC) education committee, leading the ESC clinical case gallery. She was responsible for ESC social media, since its birth and she has been a member of imaging and online education committees of Heart Failure Association. Prior to her role as JACC: Case Reports editor-in-chief, Dr. Grapsa served as an editorial consultant for JACC: Cardiovascular Imaging. She is a fellow of the ACC, the American Heart Association, the American Society of Echocardiography and the European Society of Cardiology. Julia Grapsa, MD, PhD, FACCAmit Goyal, MDDaniel Ambinder, MD

Cholesterol and saturated fat, keeping healthy eating inexpensive, and practicing Lifestyle Medicine with Dr. Michelle McMacken

Play Episode Listen Later Aug 4, 2020 65:08

Dr. Michelle McMacken is an internal medicine physician and assistant professor of medicine at NYU School of Medicine. After attending a lifestyle medicine conference in 2013, she was inspired to integrate lifestyle changes and a whole food, plant-based diet into her clinical practice. She works tirelessly to educate patients and health care professionals alike, is the author of multiple research articles, and speaks regularly at medical conferences. Dr. McMacken is also the director of the NYC Health and Hospitals/Bellevue Plant-Based Lifestyle Medicine Program. In this episode we cover: How she transitioned into medicine from being an English major Discovering lifestyle medicine and integrating it into her practice Why physicians should not assume patients are not willing to change How she discusses food and diet with her patients All about The Plant-Based Lifestyle Medicine Program at NYC Health + Hospitals/Bellevue Common nutrition myths Optimal protein sources and why protein combining isn't necessary How a plant-based diet can be cost effective Talking nutrition with patients below the poverty line The relationship between dietary cholesterol, saturated fat, and LDL cholesterol Why it's ok if your HDL drops when you go plant-based Remission of type 2 diabetes in patients who adopt a whole food, plant-based diet You can connect with Dr. McMacken on Instagram: @veg_md and Twitter: @Veg_MD Information about the Plant-Based Lifestyle Medicine Program is here: https://www.nychealthandhospitals.org/bellevue/health-care-services/plant-based-lifestyle-medicine-program/ Episode resources: Front Nutr. 2019: An economic gap between recommended healthy food patterns and existing diets of minority groups in the US National Health and Nutrition Examination Survey 2013-14 ACC Expert Analysis: Quality Over Quantity: The Role of HDL Cholesterol Efflux Capacity in Atherosclerotic Cardiovascular Disease Drugs Context. 2018: High-density lipoprotein (HDL) functionality and its relevance to atherosclerotic cardiovascular disease J Am Coll Cardiol. 2006: Consumption of Saturated Fat Impairs the Anti-Inflammatory Properties of High-Density Lipoproteins and Endothelial Function EAT Lancet Summary Report Canada’s Food Guide Thank you for tuning in! Make sure to subscribe to The Plant Prescription Podcast so you get notified when new episodes are published. If you enjoy our material and are listening on Apple Podcasts, please leave us a review as this will help more people discover this podcast. We would love to hear from you guys on what you thought of the episode and what you'd like to hear in the future so please connect with us on Instagram. IG: Muzammil: @dr.plantbased, Cass: @plant_fueled. Facebook: @theplantprescription. Music credit: Scott Holmes.

41. Women’s Cardiovascular Prevention with Dr. Leslie Cho

Dr. Baliga's Internal Medicine Podcasts

Play Episode Listen Later Jul 26, 2020 44:16

The CardioNerds discuss Women's Cardiovascular Prevention with Dr. Leslie Cho, Interventional Cardiologist and Director of the Cleveland Clinic’s Women’s Cardiovascular Center. She is also Section Head of Preventive Cardiology and Rehabilitation in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic. Amit, Dan and Carine take a deep dive into women's cardiovascular prevention and discuss the epidemiology, unique risk factors, different manifestations of CVD and treatment strategies to lower cardiovascular risk in women. Tune in as we discuss cases from the CardioNerds Women's Clinic to learn more! Take me to the Cardionerds Cardiovascular Prevention PageTake me to episode topics page Cardiac Consult PodcastTall Rounds Lectures Key Reference: Cho L, Davis M, Elgendy I, et al (2020) Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review. J Am Coll Cardiol 75:2602–2618 We are truly honored to be producing the Cardionerds CVD Prevention Series in collaboration with the American Society for Preventive Cardiology! The ASPC is an incredible resource for learning, networking, and promoting the ideals of cardiovascular prevention! This series is kicked off by a message from Dr. Amit Khera, President of the American Society for Preventive Cardiology and President of the SouthWest Affiliate of the American Heart Association. Cardionerds Cardiovascular Prevention Series Dr. Leslie Cho is a professor of Medicine at Cleveland Clinic Lerner School of Medicine Case Western Reserve Medical School and serves as Director of the Cleveland Clinic’s Women’s Cardiovascular Center. She is also Section Head, Preventive Cardiology and Rehabilitation in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic. Dr. Cho received her undergraduate degree in interdisciplinary studies from the University of California, Los Angeles, graduating cum laude. She received her medical degree from the University of Chicago Pritzker School of Medicine, and took her residency in internal medicine at the University of Washington Medical Center where she received the John Humphrey Award as Most Outstanding Internal Medicine Resident. Her clinical training continued when she accepted a fellowship in cardiology, followed by a fellowship in interventional cardiology and peripheral disease, both from Cleveland Clinic. Leslie Cho, MDAmit Goyal, MDCarine Hamo, MDDaniel Ambinder, MD

women director university california president los angeles medicine md clinic american society rehabilitation amit american heart association cho cleveland clinic cardiovascular diseases cvd cardiovascular medicine primary prevention preventive cardiology art review interventional cardiologist section head chicago pritzker school washington medical center cardiovascular prevention j am coll cardiol cardiovascular center amit khera cardionerds suzanne tomsich department

VTE rate, "COVID toes," and Virchow's triad: What you need to know about COVID and coagulation

Blood & Cancer

Play Episode Listen Later May 21, 2020 32:48

Adam C. Cuker, MD, joins host David H. Henry, MD, to discuss recent findings regarding coagulation in COVID-19 patients. Both Dr. Cuker and Dr. Henry both practice at the Hospital of the University of Pennsylvania in Philadelphia. Dr. Cuker cited data suggesting at least 25%-30% of patients with COVID-19 develop venous thromboembolism (VTE), despite receiving prophylactic anticoagulation. Furthermore, COVID-19 patients have presented with “lots of different thrombotic manifestations,” he said. This includes stroke and “COVID toes syndrome,” a condition in which patients present with ischemic toes, which appears to have a thromboembolic etiology. Dr. Cuker suggested that all three aspects of Virchow’s triad may be at play in patients with COVID-19 who have thrombotic manifestations, including: Circulatory stasis (in patients who are immobilized/sedated/prone/paralyzed). Hypercoagulability (inflammation, high levels of factor VIII and fibrinogen, neutrophil extracellular traps). Endothelial injury (SARS-CoV-2 may infect endothelial cells via ACE2). Dr. Cuker notes that high D-dimer correlates with disease severity and prognosis in COVID-19 patients. He also compares COVID-19 to heparin-induced thrombocytopenia (HIT), noting that both are associated with venous and arterial thromboses. And, like HIT patients, those with COVID-19 may require therapeutic-intensity anticoagulation to prevent clots. Dr. Cuker says his hospital’s recommendations for anticoagulation in COVID-19 patients are as follows: Stable hospitalized patients should receive standard-intensity prophylaxis. ICU patients should receive intermediate- or therapeutic-intensity anticoagulation (at the discretion of the provider). On discharge, patients should receive low-dose rivaroxaban (Xarelto) at 10 mg daily for 30 days as prophylaxis. A nonhospitalized patient who has no risk factors for thrombotic events should not receive thromboprophylaxis. Dr. Cuker also discusses two recent publications on thrombosis and anticoagulation in COVID-19 patients. In one study, thrombotic events occurred in 31% of COVID-19 patients admitted to the ICU at three Dutch hospitals (Thromb Res. 2020 Apr 10. pii: S0049-3848(20)30120-1). Another study suggested that systemic anticoagulation may improve outcomes of patients hospitalized with COVID-19 (J Am Coll Cardiol. 2020 May 5. pii: S0735-1097(20)35218-9). Show notes by Emily Bryer, DO, resident in the department of internal medicine, University of Pennsylvania, Philadelphia. Disclosures: Dr. Henry has no financial disclosures relevant to this episode. Dr. Cuker has served as a consultant for Synergy CRO. His institution has received research support on his behalf from Alexion, Bayer, Pfizer, Novo Nordisk, Sanofi, Spark, and Takeda. * * * For more MDedge Podcasts, go to mdedge.com/podcasts Email the show: podcasts@mdedge.com Interact with us on Twitter: @MDedgehemonc David Henry on Twitter: @davidhenrymd

? Tocilizumab for Severe COVID-19 infections

Play Episode Listen Later Mar 16, 2020 11:55

? Tocilizumab for Severe COVID-19 infections with Cytokine Release Syndrome Dr RR Baliga's 'Got Knowledge Doc' Podcasts for Physicians Gantara et al J Am Coll Cardiol 2019;74:3153–63 Neilan et al J Am Coll Cardiol 2019;74:3099–108 Siddharth Mukherjee: The Promise and Price of Cellular Therapies | The New Yorker Jul 22, 2019 Not Medical Advice or Opinion

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Podcast 546: Complete Heart Block

Play Episode Listen Later Mar 3, 2020 3:57

Author: Jared Scott, MD Educational Pearls: Differentiating symptomatic bradycardia from asymptomatic may be essential in determining workup and treatment Airway, breath, circulation always hold true Symptoms may include dizziness, syncope, or weakness An EKG is essential in the majority of cases Complete heart block can be a cause of symptomatic bradycardia and requires immediate attention Complete heart block can be caused by drugs (beta-blockers, calcium channel blockers), Lyme disease, infiltrative disease, or degeneration of the conduction system References: Kusumoto FM, Schoenfeld MH, Barrett C, Edgerton JR, Ellenbogen KA, Gold MR, Goldschlager NF, Hamilton RM, Joglar JA, Kim RJ, Lee R, Marine JE, McLeod CJ, Oken KR, Patton KK, Pellegrini CN, Selzman KA, Thompson A, Varosy PD. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(7):e51. Epub 2018 Nov 6. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

management md symptoms evaluation american colleges lyme epub ekg airway summarized clinical practice guidelines j am coll cardiol heart rhythm society heart block

Podcast 524: Bacterial Endocarditis

united states patients md classic lancet epub bacterial janeway summarized osler infective j am coll cardiol

Play Episode Listen Later Dec 20, 2019 3:33

Contributor: Sue Chilton, MD Educational Pearls: More intracardiac devices and injection drug abuse are thought to be increasing incidence of endocarditis Classic signs of endocarditis have included: Osler nodes (painful hemorrhagic lesions on hands and feet), Janeway lesions (painless hemorrhagic lesions on the hands and feet), and splinter hemorrhages in the nail beds Other classic findings like fever and murmur are variable More non-specific symptoms can include flu-like symptoms Patients who inject drugs are at higher risk for this diagnosis References Pant S, Patel NJ, Deshmukh A, Golwala H, Patel N, Badheka A, Hirsch GA, Mehta JL Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011. J Am Coll Cardiol. 2015;65(19):2070. Infective endocarditis. Cahill TJ, Prendergast BD Lancet. 2016;387(10021):882. Epub 2015 Sep 1. Summarized by Will Dewispelaere, MS4 | Edited by Erik Verzemnieks, MD

040 Does Activity Counteract Sitting?

Pain Science and Sensibility

Play Episode Listen Later May 13, 2019 41:54

In this month's episode we are examining more of a general health question. But it is one that is very relevant to people in pain. Much has been made of "Sitting is the new smoking" with some indications that the negative effects of sitting may not be able to be undone with exercise and activity. This study looked at that concept in particular. Join us for Episode 40. Sitting Time, Physical Activity, and Risk of Mortality in Adults. Stamatakis E, Gale J, Bauman A, Ekelund U, Hamer M, Ding D. J Am Coll Cardiol. 2019 Apr 30;73(16):2062-2072. doi: 10.1016/j.jacc.2019.02.031. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music by Kevin MacLeod - incompetech.com: Intro - Brandenburg No4 and Meatball Parade Close - Meatball Parade

music risk sitting adults activity kevin macleod mortality physical activity counteract j am coll cardiol

43 - The Cursed

Bedside Rounds

Play Episode Listen Later Feb 17, 2019 43:05

What killed Charles II of Spain, the inbred monarch whose autopsy famously showed a heart the size of a peppercorn, a head full of water, and a bloodless body? This episode addresses that medical mystery by not only delving deep into Charles’ unfortunate past, but by exploring some of the fundamental assumptions physicians have made about the nature of disease. Along the way we’ll walk about inbreeding coefficients, postmodern philosophy, and two thousand years of anatomy and autopsy. Plus a new #AdamAnswers about whether Vincent van Gogh’s love of the color yellow was caused by digitalis poisoning! Sources: Alvarez G, Ceballos FC, Quinteiro C (2009) The Role of Inbreeding in the Extinction of a European Royal Dynasty. PLoS ONE 4(4): e5174. https://doi.org/10.1371/journal.pone.0005174 Burchell HB, Digitalis poisoning: historical and forensic aspects. J Am Coll Cardiol. 1983 Feb;1(2 Pt 1):506-16. Burton JL, A Bite Into the History of the Autopsy: From Ancient Roots to Modern Decay. Forensic Sci. Med. Pathol. 1:4:277. Cerda JL. Charles II of Spain, «the bewitched». Rev. méd. Chile [Internet]. 2008 Feb [cited 2019 Feb 11] ; 136( 2 ): 267-270.Cullen W, Nosology. Retrieved online at: https://books.google.com/books?id=3IgUAAAAQAAJ&printsec=frontcover&source=gbs_ge_summary_r&cad=0#v=onepage&q&f=false Foucault, Michel. The Birth of the Clinic: An Archaeology of Medical Perception. New York: Vintage Books, 1975. Gargantilla Madera P. Enfermedades de los reyes de España, los Austrias : de la locura de Juana a la impotencia de Carlos II el Hechizado. Madrid 2005.Ghosh SK, “Giovanni Battista Morgagni (1682-1771): father of pathologic anatomy and pioneer of Modern Medicine, Anat Sci Int, 6 Sep 2016. Gruener A. Vincent van Gogh's yellow vision. Br J Gen Pract. 2013;63(612):370-1.Hodge GP. A Medical History of the Spanish Habsburgs: As Traced in Portraits. JAMA. 1977;238(11):1169–1174. Lagay F, The Legacy of Humoral Medicine, Virtual Mentor. 2002;4(7): Lee TC. Van Gogh's Vision: Digitalis Intoxication? JAMA. 1981;245(7):727–729. Lesney MS, Flowers for the heart, ACS, March 2002, Vol. 5, No. 3, pp 46, 48 López AG et al, Charles II: From Spell to Genitourinary Pathology. Arch. Esp. Urol. 2009; 62 (3): 179-185. Somberg J et al, Digitalis: Historical Development in Clinical Medicine, The Journal of Clinical Pharmacology, Volume 25, Issue 7 Starkstein, S., & Berrios, G. (2015). The “Preliminary Discourse” to Methodical Nosology, by François Boissier de Sauvages (1772). History of Psychiatry, 26(4), 477–491. Viale G, The rete mirabile of the cranial base: a millenary legend. Neurosurgery. 2006 Jun;58(6):1198-208.

Fluoroquinolones and Aortic Pathology

FOAMcast - Emergency Medicine Core Content

Play Episode Listen Later Jan 31, 2019 25:40

The US Food and Drug Administration (FDA) recently released another warning for fluoroquinolones, this time regarding aortic dissection and aneurysm. We review the evidence behind this warning, including the following studies: Lee CC Risk of Aortic Dissection and Aortic Aneurysm in Patients Taking Oral Fluoroquinolone. JAMA Intern Med. 2015;175(11):1839-47. Lee CC Oral Fluoroquinolone and the Risk of Aortic Dissection. J Am Coll Cardiol. 2018;72(12):1369-1378. Pasternak B Fluoroquinolone use and risk of aortic aneurysm and dissection: nationwide cohort study. BMJ. 2018;360:k678. We then review the ACEP clinical policy on aortic dissection covering risk scores, d-dimers, and management of aortic dissection Thanks for listening! Jeremy Faust and Lauren Westafer

risk pathologies bmj drug administration fda us food aortic acep aortic dissection jama intern med fluoroquinolones aortic aneurysm j am coll cardiol jeremy faust lauren westafer

Podcast # 419: Etripamil

md mond svt summarized j am coll cardiol pubmed pmid

Play Episode Listen Later Dec 20, 2018 3:55

Author: Don Stader, MD Educational Pearls: Etripamil is an intranasal calcium channel blocker in development for use in SVT A recent study showed that etripamil has an SVT conversion rate of around 80% Etripamil does not have the same feeling of “impending doom” that can occur with adenosine Editor's note: Etripamil is still in development and these results are from a phase II clinical trial. References: Stambler BS, Dorian P, Sager PT, Wight D, Douville P, Potvin D, Shamszad P, Haberman RJ, Kuk RS, Lakkireddy DR, Teixeira JM, Bilchick KC, Damle RS, Bernstein RC, Lam WW, O'Neill G, Noseworthy PA, Venkatachalam KL, Coutu B, Mondésert B, Plat F. Etripamil Nasal Spray for Rapid Conversion of Supraventricular Tachycardia to Sinus Rhythm. J Am Coll Cardiol. 2018 Jul 31;72(5):489-497. doi: 10.1016/j.jacc.2018.04.082. PubMed PMID: 30049309. Summarized by Travis Barlock, MS4 | Edited by Erik Verzemnieks, MD

Podcast #387: Fluoroquinolones are Perfectly Safe?